0302-129 (SFD)LICENSED CONTRACTOR DECLARATION
I_ hereb"-affirm under penalty of perjury that I am licensed under provisions of
Chapter 9,�#*mmencing 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
% 529-976 B FfCf: /�/31 Et?4
/„Date_ " il.,' 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). -
() 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 + TATE AME7 Policy No. 046-02-0009050
(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
su t5ject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisionsr �y
Date: 0` ?— oX Applicant Alw,*•'C..,=
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, 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.
Signature (Owner/Agent) - C ... " Date" o `/
BUILDING PERMIT PERMIT#
DATE, VALUATION LOT TRACT
5 XJ
JOB SITE
APN
ADDRESS 9r 481 1'0 FA7J0 LANE NE 80TrM-
7&15-01 w ••012.
OWNER = _ -
CONTRACTOR / DESIGNER / ENGINEER
ROJaMrS CIE113` ES
DEWiWIIARRI'
i ZIO I. SO,
7.ir•�� 161y+�+,�U�-L�T���E1NY, SUI_! I,-3
q79-25pI�/'�,e�OM
q(
CA 92211
(76LjS68-x'335 C -M R 6851
USE OF PERMIT
IGL;er-Aww y
5542 ,&IR SYD PEWIT DOM IdO I' 114CLUDE 8WICK VWLS, POOL OR
D111V•ZWAY A.PPIZ.OA.CH
CuS,TOrA 0Ci1`1l" T LIi,TIC3W 60M100 :1;F
PORC:1.11PAT10 2,292.00 SF
0i#FtAWCA'RPORT 1,130.00 OF
RTAMNaT Is'101? SUMMARY
CONSTI UCTION IEEE 301.-000.418.000 WXSO
PLAN C14FIc v FEE 1 Q I -4010 !4,33-3113 �1y 191.2Y
riPE DZP0SIt 101.000-439-328 •$1,000,60
a
MECKANI+::A1. FEIP 101-000-11.21-000
RL .CTRICAL FEE 101.000.420.000 3323,61,
PL,Y1NIF fNG FEE, 101-000-414-000 $238,119
S s 1i0NO MCA101.4 PEE. • I MID 101.000-241.000. 9 ",?A
OI2AT)PHC3 FEE 101-000-4-23-000 81s,0�
VEVE PER IMPACT FH, 440S,0141
I3RP.C".ISE F'i.AIN 1.01-000-441-345 $100.00
ART IN PUBLIC: PLAC - RES -11270-000-445-000 a93f1.�5
11i1"L'-TMAL CI?2.3'I'R.UC:i10,VI SiM PLAN C".fflWK
$8,2,63.54
Lt W PRE,11AIDIBJ
U
-S1,000.00
TOTAL 1?� :kR'I�d s DUE, �OW
�7' �•l
41
,.. 0 $ 2004 .
JAS
`a 4
CIV OP LD` `aU�7TA
O
s�tA�LC.E =
r
REC
DATE J
B< /
DATE FI ALED
INSP C O
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
- 2 -o
Ducts
Slab Grade
3 - i 'O - /
Return Air
Steel
Combustion Air
Roof Deck
_
e
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Z p
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 I
I
Gas Piping
PLUMBING APPROVAL
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
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
�,.s� ,p�,r�-/ ii✓ d���'�°�F �'�'.�y /zem.. `S/��
��-
P� �Naa/ 4171,
Ga Z: as 6/Z&/0ee4—"7
Final
Utility Notice (Gas)
ELECTRICAL APPROVA S
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) ( Q
I 't
M
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District �o� �o
47950 Dune Palms Road Q BERMUDA DUNES r
1/8/04 La Quinta, CA 92253 RAN LCf
{� AN WELLS E
Date INDIAN
No. 25345 (760) 771-8515 �� PALM DESERT
I.Ay
�NDIO
QIDIO
0
Owner Robert Geddes
APN #
766-041-011
Address 79251 Tom Fazio Lane So
Jurisdiction
La Quinta
City La Quinta Zip 92253
Permit #
0302-129
Tract # 27728
Study Area
Type Single Family Residence
No. of Units
1
Lot # No. Street S.F.
Lot # No.
Street S.F.
Unit 1 5 79281 Tom Fazio Lane South 5542
Unit 6
Unit 2
Unit 7
Unit 3
Unit 8
Unit 4
Unit 9
Unit 5
Unit 10
Comments
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 (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14 X 5,542 S.F. or $11,859.88 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By CC/Provident - Mark Coyle Check No. 110511
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by
Signature
Payment Recd
$11,859.88 Over/Under
NOTICE: Pursuant to Government Code Section 66020(d)(1), his Will 94rve 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 oh,W the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALIE? if Duplicated
Embossed Original - Building Department/Applicant Copy - AppBcant/Receipt Copy - Accounting
Monday, December 29, 2003
Mr. Greg Butler, Manager
Building and Safety Department
City of La Quinta
78-495 Calle Tampico
La Quinta CA 92253
Dear Mr. Butler:
RAM Development has been contracted by Mr.. Bob Geddes to build a custom home at
79-281 Tom Fazio Lane, The Quarry. We are hereby requesting a one-time extension
for plan check.
Please acknowledge by phone to 760/568-9335 or FAX to'760/346-8833.
We thank you for your time and consideration.
Sincerely,
RAM DEVELOPMENT
Michael M. Robinson, Owner
By: Sue Codekas, Contracts Administrator
MMR:lw
cc: Mr. Bob Geddes
Marc Coyle, Jobsite Superintendent
1.
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPR9VED
FOP-' FoSqr4S%
IDAM a30 DL BY Z: �
A�l,�c�,�ur� ti��s►rni Geo►alcr7i .
AQQucpgto� A mFiTi.cAul EK?%t 11v5
Ur.I�g ywµq 15 ISSUED a� of- P& fV%a
75-161 Sego Lane, Suite F-3, Palm Desert, California 92211, (760) 568-9335, Fax (760) 346-8833
Michael M. Robinson, President License No. 529976
AA
0
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
78-194 Elenbrook Ct.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETES RUCT. STEEL ASSEMBLY O
❑ POST TENSIONED CONCRETE O ASPHALT �DTHER
O REINFORCED MASONRY O FIRE PROOFING
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REPORT SEQUENCE NO.
TYPE._Og6CTUiW
•MATERtAI
PERMIT NO.
OA
DAY OF WEEK
DEESCR(IP`T'IJOYNyv� � � � _ �.7 ✓
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8
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CONTINUED ON NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MJ
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
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SIGN TURE OF REGIS EO INSPECTOR
v 6 -75-
ATE F REP RT REGISTER NUMBER
RF[:lCTFRFD INSPECTOR'S WEEKLY REPORT
JON TANDY
78-194 Elenbrook Ct.
Palm Desert, CA 92211
Office (760) 772-7192 F.
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING
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DAV OF WEEK
MATERIAL DESCRIPTION ,�b/
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ASSISTANTS
MRS. CHARGED
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DATE
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COPY SENT TO CLIENT ❑
CONTINUED ON NEXT PAGE ❑
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF M`!
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
G ATU E OF RE RED INSPECTOR
r� �j D
DATE F R POR REGISTER NUMBER
clrl'od JON TANDY
,�.�. 37630 Medjool Ave.
j®r
�M %qY m Palm Desert, CA 92211
� RFD
Office (760) 772-7192
SPECIAL Fax (760) 772-7193
'`Pager (760) 776-3338
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE'OF
.INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY ❑
❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCATIO
--('D o L-iA 4 ^ �/vC) u `� TA
REPORT SEOUENCE NO.
TYP �RUCTURE
iiDESCRIPTION
PERMIT NO. S
DAT
DAV OF WEEK
MATERIAL
ARCHITECT
INSPE TOR
MRS. CHARGED
ENGINEER
ASSISTANTS
NRS. CHARGED
INSPECTION
GATE
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CONTRACTOR lei
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COPY SENT TO CLIENT ❑
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PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
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SIGN TUBE OF REGISTERED INS P C OR
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DATE O REPORT REGISTER NUMBER
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Materials and weldments conform to plans and specifications and AISC, and AWS 01.1
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CITY OF LA'01 IIN-'AJON TANDY
MAY 12 RECD 37630 Medjool Ave.
Palm Desert, CA 92211
BUILDING f�Ivv
Office (760) 772-7192
SPECIAL' • Fax (760) 772-7193
REGISTERED INSPECTOR'S WEEKLY REPORT Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
D REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
)Z -POST TENSIONED CONCRETE ❑ ASPHALT
D REINFORCED MASONRY ❑ FIRE PROOFING
❑
D OTHER
JOB LOCATIONa�^^
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REPORT SEQUENCE N0.
TYPE OF STRUCTURE
S F -b &E -AC Es Fey DLULNg".
PERMIT NO.
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DATE
575 `t`I
DAY OF WEEK
MATERIAL DESCRIPTION
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COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE O
PAGE / OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
NATURE OF RE STERED IN
- Z99
Ssc ip -?Au-42o i P43
DAIFE OF REPORT REGISTER NUMBER
��- Certificate'of Occupancy
�w4
G�of Building � Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 79-281 TOM FAZIO LANE SOUTH
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0302-129
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: ROBERT GEDDES. Address: 79-251 TOM FAZIO LANE SOUTH
City, ST, ZIP: LA QUINTA, CA 92253
By: GARY HARTMAN
Date: FEBRUARY 2, 2005
Building Official
POST IN A CONSPICUOUS PLACE