0105-072 (SFD)y
LICENSED CONTRACTOR DECLARATION
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1 herefby affirm under penalty of perjury that I am licensed under provisions of,
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and lmy License is in full,force and effect. !
License # Lic. Class Exp. Date
760335 13 l ,, - r!� 3�AW,2.
Date Signature of Contractor_
OWNER -BUILDER bECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
() I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
() I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work fir which this permit is issued.
�,,) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No. .
4 A36 -p A-0€1371
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensat on prov�es ofis of Section 3700of the Labor
Code, I shall forthwith comply wi h'those ffroVeisior's. ��
Date: Applicant/"
Warning: Failure to secure Wok ers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is, performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees:
2. Any permit issued as a result of this application becomes null and void.if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned prope y for,inspe tion purposes,,..-
f . Signature (Owner/Agent " W ' -y' " ✓ � Date
BUILDING PERMIT PERMT#
DATE s /I VALUATION LOT TRACT
JOB SITE, APN
ADDRESS
Z�JTOLX DRIVE
OWNER Y
CONTRACTOR/DESIGNER/ENGINEER
514C1AVM43DAT.,WiTT,
.5 14 0 AYMMA~T(WX'9
WaaSB D CA 92008
CAZ3,1;SBAD CA 92008
(760)8046868 3376
USE OF PERMIT
aftilm-6 FAbaly'
sn') o Lot 41 1';iAw 2&3 - py- tl4t r 'L azz mar I'AIm'um? E1..Ctm'iPYA"
PCI()L O}? DIUVLrW11Y .s's.PPRO.ACN, 73% PIM C ]i.E' .vK PFLE._c PP4,1'ED reOR
'MULTIPLZ 1387UA14C E OF SAME P1.,.A.14 71fiPK
Cusp om CONSTRUCTION 2,616.00 OF
Pt!W.WP.A.i:IO 523.00 Sly'
QA_gA0 V 0RT W) IOA66.40
39�'.�7T `.1: COST OF CORRSTRUCT'ION
221.157.40
c' 01407 RUC.`7'ION FEE 101 000-4164100 AWISO
PLAN CHECK lsFLO 101.000.43.9-318 $193.7
NECi5ANIM, FU 101-000.421-000 135.50
RUC' RICAL FEE lot -000-420-000 $121.71
Y
F11MADIVI 4 M 101-000-419-000 $16+2.5
S TfL )NO NOTION FEE . MISID 101 -WO -41-000 $19.80
OVIRCAO11NG IRE 101 -000423,,QW $20,00
Ol✓� ,IDP s ' 114PJ3,CT FERY, $1;90'7.00
"AtCa
CEMWEICX)✓L!10, 9C
$�,d�3,9I•wtA-�TAL
L=3 P.R&PAIDREM
$0.00
Yus 00 Ele HOW
1 i i
JUN - 5 2X001 +
- ys`
CITY OF I A 01 11A,
E�ECEIPT FINAN g P '' %r BY
DATE FIN ED
INSPECTOR/
r�.,�
INSPECTION (RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade ���j/��� �[ !�%�1�//
Ducts
it
Steel
Roof Deckz
_
Combustion Air
Exhaust Fans
O.K. to Wrap ,/ 9�
�/ Q
F.A.U.
Framing *1k, G�
/
Compressor
Insulation
`7/�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywa1- Int. L th
Final
Final
�rlzll ...POOLS
-SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines
�p/is%d/ �G��Q�/�
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
// ��(
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
/
/�i,�s �X 6�/2p( 6N
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
/
Utility Notice (Perm)
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BUILDING PERMIT PERMIT#
LICENSED CONTRACTOR DECLARATION
N
I hereby affirm under penalty of perjury that I am licensed under provisions of
APN
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
CN W
Professionals Code, and my License is In full force and effect.
p
License Jt Lic. Class Exp. Date
d
C LLJ
760335 B - 03/31/2(
d ZO
Date Signature of Contractor
CARLSBA.D CA 92008
J U
OWNER -BUILDER DECLARATION
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I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following
SFD - LOT 41 PLAN 2B - PERMIT DOES NOT INCLUDE BLOCKWALL,
reason:
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( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not Intended or offered for
sale (Sec. 7044, Business & Professionals Code),
( ) I, as owner of the property, am exclusively contracting with licensed
`
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section , B&P.C. for this reason
ODate
Signature of Owner
CD
ELECTRICAL FEE 101-000-420-000. $121.71
a Q
WORKER'S COMPENSATION DECLARATION
U)< CC
I hereby affirm under penalty of perjury one of the following declarations:
O
( ) I have and will maintain.a certificate of consent to self -insure for workers'
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compensation, as provided for by Section 3700 of the Labor Code, for the
O J Qperformance
C CD
of the work for which this permit is issued.
Q ()
( ) I have and will maintain workers' compensation insurance, as required by
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d
Section 3700 of the Labor'Code, for the performance of the work for which this
is issued. My
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permit workers' compensation insurance carrier & policy no. are:
Z
Carrier Policy No.
ao
035-10.0001279
►� a
g
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
M r i
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: Applicant
U) '
z'.
F'
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
m.
addition to the cost of compensation, damages as provided for in Sectiori 3706
I
of the Labor Code, interest and attorney's fees.
F
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IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
I( •
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
I
the above-mentioned property for inspection purposes.
.
@C¢d
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0105-072 TRACT
$221,157.40 41 29147-2
JOB SITE
APN
ADDRESS 57-555 SEA4INOLE DRIVE
761-1-40-015
OWNER
CONTRACTOR/DESIGNER/EN INEER
ASHBROOK DEVELOPMENT COMPANY
ASHBROOK DEVELOPMENT C:OMPAN
5140 AVENIUAENCIlJA3
5140 AVENMAENCINAS
0AR.LSBAD CA 92008
CARLSBA.D CA 92008
(760)804-6868 CBLI 337E
USE OF PERMIT
SINGLE FAZvf[L.Y DWELLING
SFD - LOT 41 PLAN 2B - PERMIT DOES NOT INCLUDE BLOCKWALL,
POOL OR DRIVEWAY APPROACH. 75% PLAN CHECK FEE APPLIED FOR
MULTIPLE ISSUANCE OF SAME PLAN TYPE.
CUSTOM CONSTRUCTION 2,615,00 SF
PORCH/PATIO 525.00 SF
CIARAGEICARPORT (SF) 10,466.40
ESTIMATED COST OF CONSTRUCTION
221,157.E
PERIVII"I' f'EE SUMMARY
CONSTRUCTION FEE 101-000.418-000 $954:50
PLAN CHECK FEE 101-000-439-318 $193.73
MECHKN ICAL FEE 101-000-4 21-000 $85.50
ELECTRICAL FEE 101-000-420-000. $121.71
PL,UMBINO FEE 101-000-419.000 $162.50
STRO140 MOT1014 FEE - RESID 101-000-241-000 $19.00
GRADINCI .FEE 101.000-423-000 $20.00
DEVELOPER IMPACT FES $1,907.00
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$3,463.94
LE -33 PRE -PAID FEES
$0.00
TOTAL PEIUVgf FEES T)TTE NOW
4+3;463:94
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification: SINGLE FAMILY DWELLING
57-555 SEMINOLE DRIVE
Occupancy Group: R-3 Type of Construction:
Owner of Building: ASHBROOK DEVELOPMENT
Building Official
vN
Bldg. Permit No.: 0105-072
.Land Use Zone: RL
Address:
5140 AVENIDA ENCINAS
City:
CARLSBAD, CA., 92008
By:-
DANIEL P. CRAWFORD JR.
Date:
10/11/02
POST IN A CONSPICUOUS PLACE