0207-108 (SFD)LICENSED CONTRACTOR DECLARATION
I 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 Licenseis in.full:,force and effect.
License #.' Lic. Class Exp. Date
Signature of Contractor Tfd a.
OWNER -BUILDER DECLARATION .
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) -1, 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
V0
rmance of the work for which this permit is issued.
) 1 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 S7 ATZ VI ND Policy No. 1609301-00
(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, 1 sh II!forthwith comply with HZ elprovisions.
,Date:` AlWt! ' Applicant ` t'T •,T7�°ir-/.,mt:-_._
Warning: Failure to secure Workers' Compensat onscoverage 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 personat
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 purposes. `
Daff,Signature (Owner/Agent)
•ss;� .'
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT 29147-1
JOB SITE I
ADDRESS $`J -.67+j7 N'
APN
x fi•6 7
OWNER
CONTRACTOR /DESIGNER / EN INEER
.`W WLFI?Z,LP.
fi.RhMCT%IMJPWP-%MRAA Y
5140,AWYWA+1111VM\ND
5140 AMAl ayAS
CA 92008
C'.a`�q:�i.Q.>'I".B�gr�3��y C'•.r"s��5W8
y�g2cy
USE OFF�PERMIT
y�yp��yr
' ►71.1 •i�,TJ...S:..C.~,t'AI1t1:J.tA Zl trV+li,J.wl.stRV l7
.
SPD - LCiT411 1'L:N 7B P91WIT i)OES NOT NCLUDE BLOCK
WALL% P0014 5.PA, s^• R DRUMAY APPRl3.daC:H.- .' M PLAN!' Gid ear. mr,
RMUC 1'EON YOR, MULTIVII:E MISU NCZ OF SAM PLAN TYP .
CUIVI'M CONSTRUCTION 21095,00 OF
€ ORC:A.flk, TIO 5215.00 SF'
0ARAMMARPOR.T S3a.01r- OF
FFITU :M C"0sr OF C ONS MUCTION
2.21.,13'1.10
Pkl=r Yff. WY
CONSTRUCTION Fri Ell 101.000-41 ffi4. 00 s1,wso
PIIAN C<OECK`' IEEE 101_00";39_318 $211,42
P ECHA1.N1Cd!,1.FRE 101-000.4,21.000 $111.00
EIZCTIUC°.AL, PZZ 101-400420-000 0420-000 $1.15.71
PL41Ih13I1;IC 1' RIF, 101-000-419.060 S181,1,1111
ST'kOND f1 OT1®la FEL? - RESID 101-000" 241-000 $22.12
t3iLAMNO F' "h i til eiltli! f tP iCt $101_40
DWELZPJM IMPACT I'M X7.)09,00
ART IN PUBLIC PLACE9 - W.iT d70-000-445.000 $52,8¢
a
�.1'B-1XYJ"Px, C`:t31 Y Cat �i'1ON M Pr Am f.-mC3:G
$4,212.39
IX I:'RYt-PATO 1 EMS
�t3.00
/M prammm's InTE Now
fir- rr,,
CITY OF LA QUINTA
FI�APICE DEPT.
RECEIPT
DATE .± �
r"
. BY �
DATA A;E9�
l,� 7JV
INSP OR
�
1;c1
U
A
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
a �_
Ducts
Slab Grade
p
Return Air
Steel
A el
Combustion Air
Roof Deck
i
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drpall - In Lath
Final 3
Final T
BLOCKWALL APPROVALS
POOLS - SPAS
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
i
Gas Test
Electric Final
Waste Lines
Heater Final -
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral�/
Pool Cover
Sewer Connection
vs�
Encapsulation
Gas Piping
Gas Test
-3
Appliances
Final
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 d1141k 3
Final
Utility Notice (Perm)
COMMENTS:
LIGCIV.7CY GVM MAG 1 VM UtGr.A�1AIIVIV
1. hereby, affirm under penalty of perjury that 1 am licensed under provisions of
`. H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my. License.is in full force and effect.
C M..M h Celine* Uc. Class Exp. Date
1-C31;LID x`760335 B .3131103
1t3 ;e�DSignature of Contractor
co 0. ais
J:V - OWNER -BUILDER. DECLARATION
FW- aW I Hereby aifrm under penalty of perjury that I am exempt from the Contractors
Udensd; Law for the following reason:
Z (').;..I, as owner of the property, or my employees with wages as their sole
coitl 6,f sation; will do the work, and the structure is not intended or offered for
safe,($$$. 7044, Business & Professionals Code).
( ) , f, ;as owner of the property, am exclusively' contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O i am exempt Under Section , B&RC. for this reason
NDate Signature of Owner
0 cm,!
Q - WORKER'S•COMPENSATION DECLARATION -.. ----- -
p Q
M • L hereby affirm under penalty of perjury one of the following declarations:
, t— 0 ( ) f'have and will maintain a certificate of consent to self insure for workers'
X LU LL ` mpensation, as provided. for by Section 3700 of the Labor Code, for the
0 _j _Jrformance of the work for which this permit is issued.
m Q U (.) 1 have and Will maintain workers' compensation insurance, as required by
U
Q Section 3700 of the .Labor Code, for the_perfomiance of the work for which this
L IQ— ''permit is issued. My workers', Compensation insurance carrier &-policy no. are:
�
_? Gamer STATE FUND Policy No. „ 1608301=0I3
" J (This -section need not be completed if the permit valuation- is for -$100:00 -orless):
(.) 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' 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 resultof 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 sucti
permit, or cessation of work for 180 days will subject.permit to•cancellation.
1 certify that I have read this application and state that the above information is
• correct. 1 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.
Signature (Owner/Agent) Date
BUILDING PERMIT
DATE VALUATION LOT TRACT
`S221,157A0 . 48 ' ` 292474
JOB SITE
ADDRESS • 57-675 SEIIttTOLE DRIVE
APN
762-380-Q07
,
OWNER
CONTRACTOR/DESIGNER/EN (NEER
CRV GOLF WEST, L.P.
A.SIMROOK DEVELOPMENT COMPANY
.5-140-AVMMAERCIANs _ _ -
- -5:140 AVEIMAENC114A9
CAR" BAD CA MIXIS
CARLSBAD CA 3120(38 .
(760)804.6868 CBL# 3376 '
USE OF PERMIT
SIl GLE FAMII Y DWELL NG
:SFD - LOT49 PLAN 211 . PERMIT DOES NOT INCLUDE BLOCK
WALLS,'POOL, SPA OR DRIVEWAY APPROACH. 73% PLAN CHECK FEE
-REDUCTION FOR'MULTIPLE ISSUANCE OF SAME PLAN TYPE.
.CUSTOM 'CONSTRUCTION 2615.00 SF
PORCHIPATIO . .525.00. SF .
�r
0ARAORMARPORT' 534.00 SF
ES7=AMM COST OF CONSTRUCTION221,157AO
,
:
-PER3MFM.SUXhMRY .
11STRUCTION W- E " - "1 U1=o00-418=000 f1,Q66.S0
PLAN CHECK FEE 101,000-439-31:8 � $217.42
'-MECHANICAL FEE 101-000-421-000 5111.00 _
"i
ELECTRICA ;FEE 101-M-420-000
PLUMBINO PEE 101-000-419-000 5181.73
STRONQ MOTION FEE - RESID 101-000441-000 822.12
t3RADIN(3 FEE 101.-000-423-000 530.00
"
DEVELOPER IMPACT FEE $2,405.00
IN PUBLIC PLACES - RESIE 270.000-445-000 53T,89
SUB. -TOTAL CONBTRUCITONAND, PLAN -CH=
$4,212.39_1'._L
LESS PRE -PAID FEES
TOTAL PERMff FEES DUE NOW
$4,212,39
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
rcCertificate of Oqcupanc
y ,
City of La-,Quintc!
�
_
Suildingand SafetyDepartmentOF,
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:- 57-675 SEMINOLE DRIVE
Use Classification: SINGLE FAMILY DWELLING e -.Bldg. Permit,No.: 0207-108
Occupancy Group: R-3' Type of Construction: VN Land Use Zone:, RL
Owner of Building: CRV GOLF WEST, L.P., . Address:. 5140 AVENIDA ENCIANS
City: CARLSBAD, CA 92008 -
By: DANIEL P. CRAWFORD JR.
Date: ' 5/30/03
Building Official _
s POST IN A CONSPICUOUS PLACE
..l