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9807-008 (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 6/a le Signature of Contractor` d-12 o 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 riot 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. 7=11171 INSURA34CE Z042-062.503 (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 shall fo hwith comply with tho a pr isions. VDate: 2 Applicant— ,_ pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines upAto $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 !y, 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 thebuilding construction, and hereby authorize representatives of this City to enter upon, t he"above-mentioned propertyJJor inspection purposes. VSSignature (Owner/Agent)r/Date d / i T PERMIT # CONTROL # BUILDING PERMIT "07-008 DATE to#'f" VALUATION $551.282,60 LOT 40 TRACT - 28654 JOB SITE ADDRESS 7$-705 70741 F"',10 LANEi`IOIC111 APN OWNER CONTRACTOR / DESIGNER / ENGINEER IIPIRAMI NI JOHNSON' `S".I.R??:t I CrOWN 17RI U 'i' ON1 CO. LA QUINTA C.A. 02253 (76(1}777-7691 t;t3L# 3751 USE OF PERMIT S-1-0 - Prat N -iii DOES NOT iNC'LUD8 ULCI(K WALLS OR Pool, CUSTOXI C+a:NSMU'C; NOIN 5,374.0 SF 11GR(,f''kPiU IU 733000 MZ ileAft�ltblNJt:Eiki'(�12'1' 1. 131.4A) 31: .~n:Y N.11%1 1116T D COST,01? CONSTRUCTION 1 7:id.G-t�t�.rt'ril' Pit+G3iMIT FEE St31i'3MARV CONS'1'RU(7110N FFAz 101-4}(1(1-418-000 SLU71.59 P).AN C:iilA C K Flat; 10!-000-439-31R A+1,517,&5 t?E DripOS1"r tol_000_439113 �$a,c1fur, Nit, MANIC At. FM; 1_4}.100ff-'421-(?w $156.00 M1•:i:," -I.CAL Ff-E 101-(H.3 -420-000 531,7.21 VIT11W%00FT:F'„ =: 0()1-001.410-000 `!'.IOIN FEE _ RE TI) 1.01 -000 -241 -OW 1-45.13 GRAW NO VJW 101-1Jii A23-tvi 1NFRA,Tt'KUM'(M PEE 225-i1iH)443-342 $6,(Nlli.ilil ART T! PVRIJC PLACES - TWS!V, 101.-000-255-000 V7921 s r 1' AL ('_C)A1�''1`R.t fMION AND PLAN C(.1kTC !�1.14ft5t1.3_s LESS PRE -PAID FLIES -$1,000.4:0 OCT 01 1998 'S MAI, PERMIT 1F MX;'33 OVE NOW S tE#•11511.73 %11Y ® QUINTA RECEIPT DATE BY DATE FINALED INSPECTOR OPERATION DATE I INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms 8 Footings �1:5' Slab Grade Ducts Return Air Steel Combustion Air Roof Deck • 2 2 _ 99 Exhaust Fans O.K to Wrap -1747 F.A.U. Framing _ C 411 4--' Compressor Insulation -- .2- - 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 (/- / - ,t2 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection za- lGj_ -f e Encapsulation Gas Piping Gas Test IK 11/11, Appliances Final Final ,sblfiQ Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G. F.1. Smoke Detectors Temp. Use of Power t i Final Utility Notice (Perm) COMMENTS: 11 160-7-006 TwT 4 QuiRm P.O. BOX 1504 APPLICATION ONLY 78-495 CALLE TAMPICO Building7�7l%S rC+yAZ�y NG2rh LA QUINTA, CALIFORNIA 92253 ,,V.2Ar.2 Owner A• 41, IG IIAJ;rOAJ I City Zip Tel. Contractor Address CAYL,. 00"."1=� ZipTel. 777— dol State Lic.Ljc. # & Classif. , � U%i W o Arch., Engr., Designer /%u 4 E l Jaz &tk4.S Gv Address 1 54k. fry .35 l',\r✓� ale City Zip State j !. r r�+ 1t) I•�'EL� j CA a 22 t 4 Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affjrm that I am licensed under provisions of Chapter 9 (commencing with Sectlon 7000) of DIylsion 0 of the B�usiness �and Professions Code, and my license is in full force and effect.f'f%i!(ld`h�a�''►fLh*O %—� �� d DATE �GNATURE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law: for the following reason: (Sec. 7031.5,BusihOss and Professions Code: Any city or county. which requires a permit to construct, alter, improve, demolish, or repair any structure, prior lo'Its Issuance also requires the applic$nl for such permit to lila a Signed statement that he is licensed pursuant to (commencing with' Section 7000) o! the provisions of the Contractor's License Law, Chapter 9 Division 30 f the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation o/ Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). (; I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the struW.+re is not intended or offered for sale. (Sec. 7044, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) I 1 1, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law.) 7 1 am exempt under Sec. B. t: P.C. for this reason Date Owner -! WORKERS' COMPENSATION DECLARATION I hereby a:firm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company (7 Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM 4 WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation 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. BUILDING: TYPE'C761- O7NST. ;52--o23 OCC.GRP. A.P. Number / 61 Legal Description LCT TNC' G�ca ►cfl� Y Description Sq. Ft. No.t No. Dw. ' Size S46D Stories Units New IY Add ❑ Alter ❑ Repair ❑ Demolition ❑ PERMIT AMOUNT Plan Chk. Dep. /./i�/r1. r7✓ Plan Chk. Bal. -- Rear Setback IrA Rear Prop. Line Const. Side Street SetbaA from Center Line Mech. -.c Side Setback from Property Line Electrical Plumbing FINAL DATE a�1d INSPECTOR S.M.I. _?� r;� i Permit Grading .*Issued by' Date Driveway Enc. Infrastructure Valid/ated b'� p't �qQQ �s .., y I v r Signature of a0plicant Date Validation: -. ••'�"^ Mailing Address City, Stale, Zip \I"• r TOTAL �/ ��• //r% REMARKS Date Owner NOTICE TO APPLICANT: If, aher making this Certificate of'Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith ZONE: BY: Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. 1�_7 Front Setback from Center Line + -- Rear Setback IrA Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street SetbaA from Center Line I hereby affirm that there is a construction lending agency for the performance of the -.c Side Setback from Property Line work for which this permit is issued. (Sec. 3097, Civil Code.) 4 Lender's Name Lender's Address FINAL DATE a�1d INSPECTOR This is a building permit when properly filled out, signed and validated, and is subject to if work thereunder is suspended for 180 days. _?� r;� i Permit expiration I certify that I have read this application and state that the above information is correct. .*Issued by' Date 1 agree to comply with all city and county ordinances and state l ws relating to building -of this cit to enter the above= construction, and hereby authorize representatives mentioned property for inspection purposes. Valid/ated b'� p't �qQQ �s .., y I v r Signature of a0plicant Date Validation: -. ••'�"^ Mailing Address City, Stale, Zip \I"• r WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 10/1/98 No. 17823 Owner NameHarmon Johnson No. 79-705 Street Tom Fazio North City La Quinta Tract # Lot # Type of Development _ Single Family Residence Comments APN # 761-552-023 Jurisdiction La Quinta Permit # Log # Zip 92253 Study Area Square Footage 5,374 No. of Units 1' 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: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of ,f�h 't 1.93 X 5,374 or $ 10,311.82 the property listed above and �thatt!.`'-building_, permits and/or Certificates of Occupancy for this square footage in this proposed project may npW b.e,issued Of Fees Paid By CC/1st Community Bank/Ed Wright F ' 4 fTtle hone By Dr. Doris Wilson ..y Superintendent 4 Fee collected /exempted by Juanita Green Payment Received $10,371.82 Check No. 081750 Signature NOTICE: Pursuant of A s mbly 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 f19fn the dale 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 Dist ct('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 Dear Builder: Tu4t 4 4 0" Prior to issuance of a building permit, you will be required to obtain Public Works Department approval for one of the following: 1. Verification of pad elevation by a licensed surveyor or engineer. PO 4014OLI., 2. Engineered grading plan for project requiring on -lot retention. 9 9 9 Tract #26524 (Estancias) Tract #26769 (Mountain View Estates) 3. Verification that the building pad has been graded and compacted in accordance with the soils reports, and tract grading plan. Tract #28034 (South Valley Estates) W, , IN Public Works Authorization ��- -7 o5 To,., L,�. IJos�� c:PWauthAtr/da •cls OF LA QUll;v-rA , JON • TANDY i.�• '='� JAN'2 6 RECD '137630 Medjool Ave. Palm Desert, CA 92211 w pIa-0114G r ND SAFE YOffice (760) 772=7192 Fax (760) 772-7193 REC IAL INSPECTION SE RVIC ' Pager (760). 776-3338 REGISTERED INSPECTOR'S WEEKLY REPORT TYPE OF INSPECTION PERFORMED -< '❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY ❑ POST TENSIONED CONCRETE ' _ ❑ ASPHALT '' ❑`REINFORCED MASONRY �O'FIRE PROOFING X E p"'r O OTHER (( JOBLOCATION / 7 — 7Q5 om .F g Oa �� ul REPORT SEQUENCE N0. TYPE OF STRUCTURE-�ihv� S'� l .lo "�,��-•, - PERMIT 0."'"`_--�""+��-._— - "" - DO g GATE - 1 a1 DAV Of WEEK MATERIAL DESCRIPTION Wg7`�vy S �ARCHITECT J INSPE TOR HRS. CHARGED. f,2 icy ENGINEER ASSISTANTS HRS. CHARGED INSPECTION DATE -GENERAL CONTRACTOR / �` _ SUB CONTRACTOR . �Q ��1 j ".`•. .• •`' .. P -obs k f 'LoLAsE r � 1 ' COPY SENT TO CLIENT ❑ 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. / _. _D . SI NATURE OF'R GISTERED INSPECTOR _ Scoo M 13-24- gy .,. DATE OF REPORT REGISTER NUMBER JON TANDY �y OF I.A OI'INTA37630 Medjool Ave. � f U 2 3 RECD Palm Desert, CA 92211 Office (760) 772-7192 • Fax (760) 772-7193 '� 6AFEVager (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 LOCATION v7 �" 9 .-1.0_ 6wv FA'LVo 0 - LA G?ut I REPORT SEQUENCE N0. TYPE 0 .S U TOREPERMIT N0. Dp� 66 'f / 10 7 DAV OF WEEK MATERIAL DESCRIPTION At /- ARCHITECT 1 \ �/ I N LRI SY HAS. CHARGED ^ •_ ENGINEER ASSISTANTS I HRS. CHARGED INSPECTION DATE GENERAL SUB` CONTRACTOR � �� CONTRACTOR nA � r1^ 1J 1f - J A G K a G bpes w� 0; COPY SENT TO CLIENT ❑ CONTINUED OPWXT PAGE ❑ 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. S G URE OF EGIS E SPECTOR f 1 I� .1z 6;-� -) .� DATE OF REPORT REGISTER NUMBER 0� LA QUIN A'' JON= TANDY'.` T . SEC 15 RECD 37630 Medjool Ave. `\t Palm Desert, CA 92211 �A� Office (760) 772-7192 . • • • 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 LOCATION z o / L e ^I , t 'PT��.—,[�-V REPORT SEQUENCE N0. ' TYPE F STR TORE PERMIT,NO._ D�j.�( DAY OF WEEK MATERIAL DESCRIPTION fl -3(o C!�M ARCHITECT I S CTOR HRS. CHARGED E`er 1 T= N ENGINEER ASSISTANTS J HRS. CHARGED INSPECTION DATE GENERAL CONTRACTOR �� (N SUB CONTRACTOR s ,,4 o J � ltJ lelik" ` o1-4 l e— r• • COPV SENT TO CLIENT 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. 4r SIGNATURE OF REGISTERED SPECTOR s . 64�i� DA E OF REPORT REGISTER NUMBER CI ail O"F 0,_A9, INTA MAR m 1 RECD JON . TANDY 37630 Medjool Ave. BUILE)IN SfPalmr Desert, CA 92211 Office (760) 772-7192 SPECIAL 0 Fax (760) 772-7193 REGISTERED INSPECTOR'S WEEKLY REPORT _ Pager; (760) 77.6-3338 TYPE OF INSPECTION PERFORMED _ _ _ _ _- _. [3, REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY ❑ ❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER - ❑-REINFORCED MASONRY._- ❑ FIRE PROOFING JOB LOCATION i7q �('� 0 Zt 0 Lo r q 'T / REPORT SEOUENCE NO. T OF STRUCTURE ^--� b �; . I � -. �.. _. PERMIT.NO. 7 _ .6 � p q,j DAV OF WEEK MATERIAL DE RIPjjQNSS � , J ARCHITECT INSPECTOR, d`TAN�► HRS. CHARGED ENGINE 6 ASSISTANTS HRS. CHARGED INSPECTION GENERAL �y+ SUB DATE CONTRACTOR TU CONTRACTOR L cr X ST Li u4 -e-�. —� e C�.l U'j_ ML, C'!, vv pp T ' &ZS o(A F COPY SENT TO CLIENT ❑ CMED ON NEXT PAGE ❑ 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. ..A I s, 2-f URf 1OF 7 REGISTE INSPECTOR DATE OF REPORT R GISTER NUMBER REGISTERED INSPECTOR'S WEEKLY REPORT JON TANDY 37630 Medjool Ave. Palm Desert, CA 92211 Office (760) 772-7192 Fax (760) 772-7193 Pager (760) 776-3338 TYPE OF INSPECTION PERFORMED ❑ REINFORCED CONCRETE ❑ POST TENSIONED CONCRETE ❑ REINFORCED MASONRY ❑ STRUCT. STEEL ASSEMBLY ❑ ASPHALT ❑ FIRE PROOFING ❑ ❑ OTHER JOB LOCATION �^ / 'fiLA 1o2`I LO, �Ie4-2i REPORT SEQUENCE NO. T RUCTUR •o I�So�► c2�s PERMIT N0. g 7 -o DAT DAY OF WEEK MATERIAL DESCRIPTION ARCHITECT INSP TOR •: HRS. CHARGED ENGINEER ASSISTANTS HRS. CHARGED INSPECTION DATE GENERAL Q CONTRACTOR L) ��rl SUB CONTRACTOR c- as A �l c2irvt. u L A 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. SIGNATURE Of REGIS RED INSPECTOg 1 q--? DA E OF AEPORT REGISTER NUMBER