9809-020 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapier 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
7,10745F§ ?sl 199
vDate , cfG Signature of Contractor t
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 clothe 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' compensation insurance carrier & policy no. are:
Carrier Policy No.
CIGNA ' CAID41.3534
(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 prove ipns.
'/ate: 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,7Safety ri
for a permit subject to the conditions and restrictions set forth on his
application. R
1. Each person upon whose behalf this application is made & each person ata,
whose request and for whose benefit work is performed under or p'ur'suant 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 I
the above-mentioned property for inspection purposes.
ignature (Owner/Agent) AA . a- Y "'!_. __ Date.
BUILDING PERMIT PERMIT�� CONTROL#
t
nAT6 VAI I IATVVJ $27.9,9, ,1 17 I -T 35 TRAr.T
.1.6
OI-
JOB Slik i
791-905
ADDRESS sANIG
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CAPrI`,:.hL 1°r^C,*'JC t f43LDINGS., INC,
C=APMAI.,FACIT[C .1 OI IES INIC:
4100 x►ACARTHUR BLVD #200
4100 MAC ARTHUR BLVD 9200
NEWP4J1t1 BEACH CA •92660
NEW'POl't'1'1313ACH CA 926E+0
(94W,22-84.00. C8L# 1503
USE OF PERMIT
SINGLE FA1diTL Y 1 WELI.,ING
&'i1 -PLAN 3AP, LOQ`# 35.1''1SitibtiT DOLS NOT INC<LUDII BLOCK WALL
(iRt :4` OOC L. FLAN CHECK FFF fiE DUC•FA) BY 75°ro FOR M-ULTI:P LE 1.4, 3UANCE
OF SAME, PLAN TYP
CUSIR 110ivf CONS -1 RU-CTION 3,400.00 SC'
PORCHIPA.TiO 268.00 ST:.
OARAWCA:RPORT 539.00 SF
1+ TIMATIED COST OF COMSTRU "TI:€: N
279,963.30
PERMIT F.Ek 81AC&URY
CONSTRUCTION RE 101-000-419-000 1269.50
PLAN C&IE/C 1:.1; U, ! 01-0001-439- 3! 9 5256.13
IMCCH ANICiAL IF LE 14140-421•-0001 $93.50
'EL:ECTRICAL FEIN 101 -006 -420 -ON $188,28
PLUMBING Ff_; 3 141:1-000-41:9.2300 o ISO 50
STRONG MO'1'T.ON'0W, -1t 111' 101-000-241-N)1) e28.00
GRADING ME 10I-•100421000 $20100
1N1*"'E2A.`5':t°1 UC°Tl fRE 17-1 - tdL"10-461 3=1 1600A
ART Ii>i PUBLIC PLACES - RESID 701.Oil{3-255-(i00 54�19.�12
p p
cKM1'X11.C:t2141SIMUCTI ON.A:,�r..i' �P1.A1� CfIE-CCK
�13e4�i.R�
LESS €'1'R -'-PATI) E,E'ES
PA
°n(1.T10
SEP 2 91998 T(YCNL PIKWrr . ECS DUE NOW
$8,490.93
RECEIPT .,
't:.
DATE
SBY
DAT FIN E
INSP T
.�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs �Q��"�(/
Underground Ducts
Forms & Footings
Ducts
_
Slab Grade -
ReturnAir ..
Steel
Combustion Air
Roof Deck
.
��
Exhaust Fans
0. K. to Wrap
_ _
� c�
F.A.U.
Framing != _C
Compressor
Insulation - Q
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
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
Electric Final
Waste Lines/Q ����/
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
. r
Gas Test
Appliances
Final
COMMENTS:
Final
/ .r� 1 �F ��/ 2-6A
Utility Notice (Gas)
/
ELECTRICAL APPROVAL.
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)
_
Desert Sands Unified School District
47-950 Dune Palms Road 6
Notice: La Quinta, CA 92253 tp
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 9/17/98 APN # 769-560-035
No. 17753 Jurisdiction La Quinta -
Owner NameCapital Pacific Holdings, Inc. Permit #
No. 79-905 Street Tangelo .
City La Quinta zip 92253
Log #
Study Area
Tract # 24890-3 Lot,# 35 Square Footage 1 -
Type of Development Single Family Residence No. of Units 1
Comments
Under grandfather agreement - 3,400 sq. ft. (The Citrus Course)
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered
patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes.
It has been determined the above-named owner is exempt from paying school fees at this time 'due to the following
reason:
Under Mitigation Agreement
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Mitigation Agreement in the amount of
628.00 X 1 or $ 628.00 the property listed above and that;building
permits and/or Certificates of Occupancy for this square footage in this proposed projectmay,n.ow be issuzd
1;11 " 7 ;
Fees Paid By CC/Wells Fargo& Co./Manuel ." Telephone ^564-4475:
Name on the check
By Dr. Doris Wilson
Superintendent{
Fee collected /exempted by Juanita Green Payment Received $628.00
1____) A Check No. 0643036924
Signature
NOTICE: Pursuant of Assebp bly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or, to another public entity authorized to
collect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.;
.Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
"Certifica-te of Qccq'pancy
City of La. Quinta
Building and Safety. Department OF.��
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: 79-905 TANGELO
Use Classification: SFD Bldg. Permit No.: 9809-020
Occupancy Group: R3 Type of Construction: VN Land Use Zone: LR
Owner of Building: CAPITAL PACIFIC HOMES INC Address: 4100 MAC ARTHUR BLVD #200
City: NEWPORT BEACH
By: KIRK KIRKLAND
Date: 6-11-99
Building Official
POST IN A CONSPICUOUS PLACE