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0304-069 (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 License is in full force and effect. . License # Lic. Class Exp. Date 05M I PA 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). - () I am exempt under Section B&RC. 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 F°.1�3 } :t?IL, 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 provisions of Section 3700 of the Labor Code,- I shall forthwith comply with those rovisions. Date` R.✓" - `)Applicant �. &_ ",f /1' Warning! Failure to secure Workers' Compensation coverage is unlawful'and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on. his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant tori` any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit• issued as a result of this application becomes null and void if Work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I. have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize -representatives of this City to enter upon the above-mentionedpro erty for inspection purposes. ,Signature (Owner/Agent);' Date BUILDING, PERMIT ; PERMIT# tea,• _ x•. DATE < VALUATION LOT TRACT JOB SITE J�A�i� cy+ry� APN Y ADDRESS L.!•✓^ +� �� �iri6.vt•1i, i fqC, Falx.:•` - . y_' Y .i-1��,''i.-;- � r,� • OWNER CONTRACTOR/DESIGNER/ENGINEER FRIA1v1;.&,aAMY'TO r iC T)+!t �c6h�I: NXIQ 1Wi LC010R.f M. -IM,11 496"X •77^^C:Clf' CHEL%AIaR .", ,?y',y �(. 74}-y99'.y',. �6 DRWI `.�C.; �'1.1. p �(� i..r fh 7 fi�'�}I.J:� d'1{.t .l 6w"`' o'ART 11'S. £!J .1, �ll/(76C )566-6070 CMP 2'2j -A USE �OFF_PERMIT + STD.f"KCLUDES' l .AJ LS'/FC,0UORA if.IiVAY`APP.R.Q iCH. CCIKPY„}IAWC-Fe V :43H .Flb-rL+?$f�i:.P�rr c�4►.�'i,li.'T.�: i.a`?;�'/�, t�;i;'..i�:l�JC�Tii `,.�f;'at�F£..i�C��rn.�1�7' �Pti�GT�`s� . ,ACT Or VY5 IF'.APPL.1L;AVIX,15 C:fl,STOIa1 C't 3r'9E' ;fit"`f')'a) 41,767,00 SF PORCI-YP,ATIO 1,,03.R,QO yfe 0MLAO&VARIPORX WIN 3F UTIMKi:StM CCAIT 0V t'.CWS1rY1T(2110Tq d ifs ,f 6➢,3�� 1'''YCRU,T 1 LVE R6IM'aa'. U'!i Ct7R;;'"1 LIC T1101I FFJ° 101,r500.,41 S -KOs 5i,t5�6,�G PLAW CHECK MME 101 $i,399 . -M MsEDawFOSIIT -$1,060,09 ' 11I:B 11A,141CA1, 02"00 $19.3.60 KLEC"I`RICA1,Wli• 1Oil -(Kx0420-e0o $d!50.2p PLUMS NO FeR.. •101-00-419-. 00 $255.23 STRONG Ata- TH."rfF21-itlUID 101-00-2414wo $dfi,P OPI ALAI -10 FEE 3 01 $ 0.00 DEVKLOPE11. ImF,/ cT I'LF: $ ,90g.i1G Y ART Ptd PIUA1 1C P1,AC ES • P,9WI: 270-000-d45.- ' o SLAB-V,iTAL ('.E. 470;"!;t'i7Ci`Iis4,Y Ad7■) Pyy'y,l,n.AIT C RE;�C�Ly'.. 14 NO �7 S PRE -1 [ 'JUL 18 803 CITY OF LA (11HAITA RECEIPT FINANCE DI DATE By,- DATE FI ALED INSPECT Vij 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 — Exhaust Fans O.K to Wrap F.A.U. Framing o Compressor Insulation s Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate LinesAa Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final 3 BLOCKWALL A PROVALS 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 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 2 Appliances " Final _Final'' /f Utility Notice (Gas)NL 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) 60 COMMENTS: tot, C� r Q !' CERTIFICATE OF COMPLIANCE vsc Desert Sands Unified School District 47950 Dune Palms Road Q BERMUDA DUNES r La Quinta CA 92253 Cn RANCHO MIRAGE CJ Date 7/18/03 I INDIAN WELLS ALM DESERT No. 24723 (760) 771-8515 ��^P LA QUINTA :V INDIO y^ YYY Q J Owner Frank & Sandy Rossi APN # 766-031-005 Address 49830 Coachella Drive Jurisdiction La Quinta City La Quinta Zip 92253 Permit # 0304-069 Tract # 28189 Study Area Type Single Family Residence No. of Units 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 kA 600 Tom°Fazio"Lane North`'°'4767 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9. Unit 5 Unit 10 Comments Overpayment of $238.35 to be refunded as a direct payment & mailed to :Ludington Link General Contracting, Inc. at 45120 San Pablo, Suite 2-i, Palm Desert, CA 92260 At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, 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 4,767 S.F. or $10,201.38 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/Califomia Bank 8r Trust -Brian Ludington Check No. 01941 Name on the check Telephone 760/275.6709 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by S Signature ilvrey Payment Recd $10,439.73 238.35 OverlUnder NOTICE: Pursuant to Government Code Section 66020(d)(1), this willserve 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 iisued, 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 Districtrs) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting Li 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 Pam TYPE OF INSPECTION PERFORMED O REINFORCED CONCRETE TRUCT. STEEL ASSEMBLY O O POST TENSIONED CONCRETE ASPHALT THERrt�e. O REINFORCED MASONRY O FIRE PROOFINGW� JOB LOCATION _ ` Co (,A `PERMIT Q v t �� REPORT SEQUENCE NO. TYPE OF STRUCTURE 4Q�1 J t I1F'w. ! NO. D 0 191 DAY OF WEEK MATERIAL DESCRIPTION ARCHITHT NS o rel I SPC l - HRS. CHARGED 7 G CCA('-) ENGINEER Vo() ASSISTANTS HRS. CHARGED INSPECTION DATE GENERAL `` ii / �/ _CONTRACTOR �� ��%l Or ..(�.,\Q��1�,, I SUB jn , � �' U)e- -10't ii �C/1ONTRAC70R. a D&-SaQ F� s��. ss w «► Lo 1.6 3 I C.i,s z _ y- ,� ;, (A S '� ka fQ Lk' L -:u in Co w(, iplow a 0j9s�-� ©` —S -P-L u LL'la t N Cz) vk 1a/ eClb2 poe.o1'- dl8 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. SIWA URE OF REGISTERED PECTOR Ick 01 0� �64q)) =— ATE 0 REPORT REGISTER NUMBER imp" NMI mm mulmmmlimmmams mm Illammummmiml, mm MmEmmmol SERM111111 mm momomm M -EER NMI Elm MEMEMMIMI Elm mallEMMEMERE1110111 m mammmmmmmims mm 1111211EMEMBERERIERN Elm mvmmmmmmmlml�mm mummmmammawl mm mommmmmmmams Elm lmmmmmmmlml�m ammummmmam�m 03/26/2004 12:27 7605684439 LUDINGTON LINK PAGE 01 •-0/2612004 09:44 7603605719 YOUNG ENGINEERING SE PAGE 02 YOUNG ENGVW 'a UNG SE,RWES 77804 Wildcat Drive Nim Delett, Co 92211 Phone: (760) 360.5770 Fax; (760) 360-5714 March 26, 2004 Tom Hartung Building & Safety City of 1A Quulta ' Re si a 4-72190 'TbM F- ' _ e North La A anc'nta. Dear Tota, We have reviewed the framing £cr the above referenced projei;t and find it to be in general confdrmarnce with the approved structural plans. Please note that this IeMer docs not relieve the City or. the Spe.ial Inspectors from determining compliance with, the approved plans. If you have atay questions please call. S.E. 0 y