0105-074 (SFD)i r LICENSED CONTRACTOR DECLARATION
.0 hereby 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 my License is in full forcR and effect.
License # -Lic. Class Exp. Date
Date "'� Signature of Contracto �'r �=' -'••-�` ,",
-low_�"" �•
..,....•.----''-01NNER-BUILDER DE ARATION
""'Thereby 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).
( ) 1, 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 for 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.
(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' compensation• p'rovisigns of Section 3700 of the Labor
Code, I shall forthwith comply wi 4hose p,6visio
Date:-/-, 1 'Applicant
Warning: -Failure to secure Work rs' 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 property for'inspectIon purpo�ssees.—
Signature (Owner/Agent)/ Date
BUILDING PERMIT.' PERMIT#
DATE �2i� r� .TRACT
VALUATION LOT !X�
/
$214,107,30 4D 29147-2
JOB SITE / --
ADDRESS
APN
.157495 SE
OWNER
CONTRACTOR/DESIGNER/ENGINEER
RAW312,OC;K Dk"V"M*al?MM* OSS ''ANY
AfMR OK D9V"ktiC)PAtlDn COMPANY
5140AV WMA.W.4QWS
114 0 AVEN, IDAM4aul i
C1ARl'.,OS.d D CA. 492008
CARIMAD C,'A 920(A
(760)804.6868 CRIJI 3376
USE OF PERMIT
Sf
E11XXKWfi,L4 POOH.. t,1k D1?TV A.Y A&°PROACI•T, 75% PLAN CRECK WE-
APPLIED YOK .%1UVf1•P1,Z 1 UA11CZ OF x%MZ PLAN !HYPE,
CUSTOM tIONSTRUCTIOW Z50LOO Ski
'90110WATIO W.06 S.W
>
OARAOwt ~arover (if) l j,e oo
WMAIND C `T 0.1r, C0H9. 11TC'n0H
214,107.M
CONSTRUCTION Fr iy 101-000-416-000' lsl,wa ao
PLA.! C"'ECK'om . 201-000,499'•338 $311,n
MUC>r1A3M1ICAL FEE 101-000.421-000 9111140
F31,ECT"RICALk'Ea 101-00042�42 O V$3.14
-
PLLtMOT3dO FEB 150 4-000-41 00-41 S) -M $197, 9 '
STR0,14 11d2,()VOW .MP, •X16D 101-000-241-000 $31.41
ORAD114(1 JW- 101 -000-423-OW. $20.00
'01V:G'ZL0PLqIMPACT PEZ sipo D
ART N P1J13W PLA M, kk= 701.000-2.55.000 slli `I
Vit•
.+
COITG"''f�6aM AND k�'LOOT Cli�t,1'°
,e LR1.4�
JZ1S 3 •$'1Er.PAM Fu's .
koo
, P1 LR DUE NOW
JUN - 5 2001
CITY OF LA OUIN TA
_ FINANCE DEPT
RECEIPT
DATE
BY
DATE F ASE
INSPECTOg
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs_
Forms& Footings Z3 o/
Slab Grade
`/ /f
Underground Ducts
Ducts
Return Air
Steel
Roof Deck
Combustion Air.
Exhaust Fans
O.K. to Wrap
Framing
�2� (c/
F.A.U.
Compressor
Insulation
��,pi (�(/
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. l th !/(y(,�((�
Final /6�d��%
BLOCKWALL APPROVALS
Final
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I I
Gas Piping
PLUMBING APPROVALS
Waste Lines// ��
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_
�r/�/a
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
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)
-LICENSED CONTRACTOR DECLARATION
I he 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 my License is Lin full c. Class force and effect. Exp. Date
License #
760335 B 03,131/2(
Date Signature of Contractor
OWNER -BUILDER DECLARATION
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). g&p,C, for this reason
( ) I am exempt under Section
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 for 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. 035-10-0001279
BUILDING PERMIT
VALUATION LOT
DATE $214,107.30
JOB SITE
ADDRESS 57-595 SFM.NOLE DRIVE
(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' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: -- Applicant
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
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,
empll void it
2. Any permit issued as a result of this application becomes null
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 property for inspection purposes.
Date
AS11BROOK DEVELOPMENT COMPANY
5140 AVEN DAENCINAZ
CARLSBAD CA 92008
USE OF PERMIT
SINGLE FAMILY DWELLING
0105-074 TRACT
43 29147-2
APN
761-140-01.5
ASHBROOK DEVELOPMENT COMPANY
514 0 AVENIDA E14 CINAS
CARLSBAD CA 92008
(760)804-6868 CBL4 3376
SFD - LOT 43 PLAN IA W/CASITA - PERMIT DOES NOT INCLUDE
BLOCKWALL, POOL OR DRIVEWAY APPROACH. '75% PLAN CHECK FEE
APPLIED FOR MULTIPLE ISSUANCE OF SAME PLAN TYPE.
CUSTC)M CONSTRUCTION 2,501.00 SF
PORCH/PATIO 558.00 SF
CIARAUFJCARPORT (5F) 11,858,00
ES•I7.MATED COST OF CONSTRUCTION
PERwr'FEE SUMMARY$1,042.00
101.000-418-000
CCiNSTRUCTION FEE
lUl-UUU-439-318
� $213.88
PLAN CHECK FEE
101-000-421-000
$111.00
MECHANICAL FEE
1 U 1-000-420-000
$133.14
ELECTRICAL FEE
10] •000-4] 9-000
$197.75
P1.IIMBING FEE
STRONG MOTION FEE • RESID
10 1-000-241-000
.41
X20,00
C1IADI�N0 FEE
101-000-423.000
$1,9[17.00
DEVELOPER IMPACT FEE.
PLACES- - RE�IL 701-000-255-000
$35.27
ART IN PUBLIC
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
LE So PRE -PAID FEES
TOTAL PERMIT FEES DLTE NOW
DATE FINALED
RECEIPT
DATE BY I
214,107.30
$3,681.45
$0.00
$3,681,45
INSPECTOR
i .'
Certificate of Occupancy
City of La Quinta
BuildingSafety and 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: 57-595 SEMINOLE DRIVE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0105-074
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
OwnerofBuilding: ASHBROOK DEVELOPMENT CO. Address: 5-140,AVENIDA ENCINAS
Building Official
City: CARLSBAD, CA., 92008
By: STEVE TRAXEL
Date: 10/22/02
POST IN A CONSPICUOUS PLACE