HomeMy WebLinkAbout0402-022 (SFD)LICENSED CONTRACTOR DECLARATION
I herebyaffirm 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 force and effect.
License # Lic. Class Exp. Date
7E$ aU P.1 C:1tiY1C
ate � - t o "�' Signature of Contractor—
OWNER-BUILDER
ontractor 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).- .'
() 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' compensationIinsurance carrier & policy no. are:
Carrier Policy No.
EntmPT
(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 provisionsof Secti • n 700 of the Labor
Code, I shall forthwith comply with those -provisions.
Date:6'�!Applicant?�
vim..
Warning: Failure to secure Workers)'Compens'ation coverage is unlawful and
shall subject an employer to criminalrpenalties 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 aind'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 purposes.
ignature (Owner/Agent) � Date
-=:BU_ILDIERMIT PERMIT# ;
DATE ' ~VALUATION LOT 0402-02-2 TRACT ~'
�..:. 29147.1
JOB SITE
APN
ADDRESS S2-0704191 IM. XC(X11X1WXS
7161-820-W7
OWNER
CONTRACTOR / DESIGNER / EN INEER'
W kOPT, i?.P+at iI-WF10 1, LLC
XMLM ;A C09VrRU1';110N DTC � r =
BI- 07 0 CH19.1�'.lAi LFER
7€I.070 CAMI,
L& C TMUA C„ A 927,,53
LA Q:u .A CA. 92253
(769.)56,4.4832 CB.V 3237
USE OF PERMIT
antG e Pxh4.IY.,'.f Dldr`.C,i.:4,•]]cTC1
STT) • 1,0T7, PLAN 6. PERMIT DORS NO t' 113C:I, UDZ BLOC I(WA,LLA
P001,5 $PA. ORDRIVEWAYWPPROACH. 75% MUC a ION TO P.L& CHRcy.
FKF VJ1,r ". 0 MUL'i1;PI. E ISSUA14C E, LIP S.AMM, PL&14 TY'PB
CUSTOM CONSTRUCTION 30I2100 V
PORC,'FI/PNT10 9113.00 SF
C11ii.1�G33�1tvPiP't�3t`C 996.00 `P
X`sru"TLID CON'r or r0NIVI TICrIDN
30fb W?AO
C.'ONSTRUCTIOX . E 101-030.418-000 a),364.40
PL&N CHECK F12, 1.01-000-439-:31.8 STA.95
MECHANICAL FER 101-000.421-400 $162.50
ELECTRICAL 101-00042"00 0210.:14
FL'UMBINCI FYIE 101.040-419b000 W111.73
ST,RONO MOTION PEE • RI{:3:D 101440-24.1 -000 $30.0
ORADING FEE 101.000.423„4130 $15.00
D V Y,1D V_h1, IMPACT I $2,40100
PidWISE.PIAN - 101"000441-M $100.00
ART TIS PUBLIC'. PLACES - RESIL 270-000-445-000 3266.02
STMI -'AOTAL COA1'S'ERUCITIOW AND PURI C.WWK.3,019.OS
e =93 PRE-11,AM TrEW
$0.00
D
0rTAL',P10M3PrFM. DUE NOW
",Q] 9M
FEB 10 2004 ' '
CITY OF LA QUINTA
FINANCE`DEPT
RECEIPT
DATE,.
4. 1
F
BY �f,�/
DATE F N ED
l
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR,
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs _
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck d
Exhaust Fans
_
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation a o
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
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
Gas Test
Electric Final
Waste Lines
Water Piping
Heater Final
Plumbing Final
Plumbing Top Out 61
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test l c
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) C
COMMENT,A�� � y3j/y
��
�oachella Valley Uniilen nicnoo Listrict
'.O. Box 847, Thermal, CA 9_ �4
760) 398-5909 — Fax (760) 398-1224
This Box For District Use Only
DEVELOPER FEES PAID
AREA
AMOUNT
LEVEL ONE AMOUNT.
LEVEL TWO AMOUNT
MITIGATION AMOUNT
COMWIND AMOUNT-
DATE
RECEIPT
CHECK M
INITIALS
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name: The Summit @ PGA West Date.
Owner's Name: Weiskoph Partners 1 LLC __ Phone N .
Project Address: Shinnecock H111s La Winta CA 92253 --
Project Description: 7 SFD
APN:761-820-001 thru 007
Type of Development: Residential
Tract #• ?91 47 1 Lot #'s:
ffi Commercial
Total Square Feet of Building Area: 24,944 sq . f t .
Industrial
Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement
under penalty of perjury and further represents that he/she is authorized to sign obehalf of he owner/developer.
Dated: 2 ^ I o — G 9 Signature:
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *(* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABO ROJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code Gov. Code Project Agreement Existing Not Subject to Fee
17620 65995 Approval Prior to 1/1/87 Requirement
Note:
Number of Sq.Ft. 24,944
Amount per Sq.Ft. $ 2.19
Amount Collected $ 54, 627.36
Building Permit Application Completed: Yes/No
By: Carey M. Carlson
Asst. Supt., Business Serv.
Certificate issued by: El vi ra Mattson Signature:
Office Technician
NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES
Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a written notice to
the project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90-day period to protest the imposition of
these Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall
serve to advise you that the 90-day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of
any other requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether
payable at this time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This
Certificate of Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School
District, and up to three (3) such extensions may be granted. At such time as this Certificate expires, if a building permit has not been issued for the project
that is the subject of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance.
M V c/mydocs/devfees/certificate of compliance 09/30/02
1�1.
J
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Date: February 4, 2004
Owner: Weiskopf Partners 1,LLC
81-070 Chanticleer
La Quinta, Ca 92253
I
PERMIT FEE SUMMARY
(760) 7 7 7 - 7 0 0 0
FAX (760) 777-7101
Builder: Kahuilla Construction
78-070 Calle Cadiz
La Quinta, Ca 92253
7 qPn Tha Qtimmit (al Pr,a \A/Azt Tract 99147-1 1 otc 1-7
Lot
Plan
Sq. Ft.
Address
APN
Permit #
Fees
1
6
3,512
81-010 SHINNECOCK HILLS
761-820-001
0402-016
#*55,105.62
2
7
3,632
81-020 SHINNECOCK HILLS
761-820-002
0402-017
#*55,140.91
3
6
3,512
81-030 SHINNECOCK HILLS
761-820-003
0402-018
$5,019.06
4
7
j 3,632
81-040 SHINNECOCK HILLS
761-820-004
0402-019
$5,045.66
5
6
1 3,512
81-050 SHINNECOCK HILLS
761-820-005
0402-020
$5,019.06
6
7
3,632
81-060 SHINNECOCK HILLS
761-820-006
0402-021
$5,045.66
7
6
3,512
81-070 SHINNECOCK HILLS
761-820-007
0402-022
$5,019.06
Total Area:
24,944
01 Q Q q >e
Total Permit Fees:
$35,395.03
* Denotes full fee permit. Remaining permits reflect 75% reduction to plan check fee due to multiple issuance of same plan
type.
# $1,500 plan check fee spread over the 2 plan types.