0210-202 (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
'7064-10 13
i�Date -Signature of Contract�� ��� E1/�� 'th_ p Aa
OWNER -BUILDER DECLARATION 1
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 UR CF, Policy No. 20420 S07
(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 prodions.
,D'ate: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and, Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit';issued as a result of this applicaton agrees to, & shall, indemnity
& hold harmless'the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this :application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to -comply with all City, and State laws relating to the building
construction, and hereby autho,iie representatives of this City to enter upon,
the above-mentioned pro�erty or insrpectlon�ptrposes.
��
/Signature (Owner/Age'nt) '�`1 "" r► Date / X8 Q?
R1
'..BUILDING PERMIT PERMIT # .
DATE i ' VALUATION LOT '$ ¢' TRACT
TSJW� 35
JOB SITE
ADDRESS : 78,4,W2 'rA1,MC. G.RiOC 71YRN
APN
170-3004)1_7
OWNER --. --_ _.- -_- -
CONTRACTOR/DESIGNER/EN (NEER=-
PAUL•. )(ADIR
T'i.!'€tP` li ct?Yd.mCimok+ -co.
4373 GOLF COURSE DR
1 201 CAIL- :-93moo 0141,06
waim VILLAGE, AGE, CA. 9136
LA, Cad. 92233°'
(76OY777-7611 GB11A 1751
`
USE OF PERMIT
Slll3tJ1t}rX�CppL�gStIpplC F—S i�J'.p�itcl.,ryd•:�5�i74�C4)�{l�yl(li7�,RT�ig54►L��MgYAwf'['yt.,��'+y1pa9127t��t,Apf�;HIC�yPyJ�E��99y1�'T•..1AtINCe�}��p�'yW7YTH
!'�aSiJ6.x' M, &Si.�"A,c E, i,AW,� INCI,UD111W' THE l� I.rvi.�.�.f�3t7dS:`N�l+•) 9l".2n1vI S •
,D�df�!Lr c
ACT OF W3 IYAPPLI ARLAIS REQUIRV.D. f i+
CUSTOM CONSTRUCTION 6.422.0 SP
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. 2,451.00 3F
.PORCs�iPAT10 Ys �+
�JC/u{aaa*a7`A4.sa.RO Jr�iS'�6 "':' 8i �f• }. (� S
,
CONSTRUCTION AW 101-006.4.18,000
PLAN CHECX FU 101-l7t 439-318 S1,804.1g
FEE DEPOSIT 101-000-439.318-$1,66uo
Y!11FCf A-1410ALPEE 101-000-421-000 $145.50
ELEC` WCAL ME $354.66
PLUMBING FM
STRONG MOT10H FEV • M911) 101.000.7.41.000 $46.45
Ctp"13`1t31t'S:E 101 -000 -423 -OLIO $15.00
DWELOPM IMPACT FEE S ?,405100
i
ART IN PUBLIC P1.,is:GrES •• WME "0-000-445-000 $9.13.19
W&TOTAL CO i1a UOfii N AM) MAN S tg1WX
$9,213.24
PRE-FAW MRS
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P11MM MEN DIM,
VFIMS
N 2 8 1633
OF: L4 c� fi�rA
Afdcc F3
RECEIPT
DATE BY
DATEFINALED �/
INSPE R
I
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
(J
Return Air
Steel
Combustion Air
Roof Deck
v
Exhaust Fans
"O.K.to Wrap
_ _
�j�
F.A.U.
_ _
Framing
Compressor
Insulation�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
% 03
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 -/
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:
Levi- Zl�r•-iS 3- ^ , a
J
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`QLG (>
L f��/licl �" �� ;Z O 3 SGL
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-2-f cg
(,L yk- 7 Q3
Final
Utility Notice (Gas) t
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 Q
Utility Notice (Perm) - ,3
CERTIFICATE OF COMPLIANCE'.J�tFsc
Desert Sands. Unified School District
w 47950 Dune Palms Road
C BERMUDA DUNES r
Date' 1/23/03 La Quinta, CA 92253 rn RANCHO MIRAGE (�
INDIAN WELLS
No. 24056 (760) 771-8515 dPLAQUINTAT y
- ti�j�INDIO.���
V O
Owner Paul Ladin APN # 7.69-262-001
Address 4373 Golf Course Dr. Jurisdiction La Quinta
City Westlake Zip 9136. Permit # 0210-202 _
Tract_ # 28470-2 Study Area
Type Single Family Residence No. of Units 1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 35 78542'Talkmg RockTurn 6428 Unit 6 "
Unit 2 _ Unit 7
Unit 3 ' Unit 8k
Unit 4 Unit 9
Unit 5 Unit 10 -
d s s
Comments '
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patioshmalkways, 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. a
in the amount of $2.14 X 6,428 S.F. or $13,755.92 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/Pacific Western Bank -Bill Turpin a Check No.. 209077 "
Name on the check Telephone 760-777-7611 ,
' r Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by -Monica Guillen " $131'755.92".4$o:oo r
Payment Recd Over/Under
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 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 VALID if Duplicated
Embossed Original - Building Department/Applicant . Copy - Applicant/Receipt Copy - Accounting
J a �•c
Certificate'of Occupancy.
I gn
c
9�5
OF B u (ding . & Safety Department
'"T
rThis Certificate is issued pursuant to the requirements of Section 109 of the California Building
k
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
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i,
r�
construction and/or use.
BUILDING ADDRESS: 78-542 TALKING ROCK TURN
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Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0210-202
Occupancy Group: R-3 Type of Construction: VNLand Use Zone: RL
i v
Owner of Building: PAUL LADIN Address: 4373 GOLF COURSE DRIVE
4 'u
City, ST, ZIP: WESTLAKE VILLAGE, CA
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By: KIRK KIRKLAND
`
Date: January 7, 2004
i ;
Building Official
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POST IN A CONSPICUOUS PLACE
f
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. RUCT. STEEL ASSEMBLY O
O POST TENSIONED CONCRETE O ASPHALT O OTHER
❑ REINFORCED MASONRY O FIRE PROOFING
JOB LOC I , Sg- 01" I < / A- IGLv ` i%-rA-
REPORT SEQUENCE NO.
TYPE RE / A 0 I0 e r •
/Y�`
PEi I� .4) ` 3L �
DAZ& O�
DAY OF WEEK
MATERIAL DESCRIPTION A r +
S �
ARCCHJITE3CT
INS .TOR
HRS. CHARGED
IT- qg ol , u)-
G
w
ASSISTANTS
HRS. CHARGED
INSPECTION GENERAL •
� (�
DATE ._ CONTRACTOR -, U.�. �� CONTRACTOR SACS61 ja %C -V' -
V 2. KOATMW
�...•A, �� C- a
COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE ❑
PAGE Of
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV
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.
SI ATURE OF REGISTERED IN CTOR
dg - y
ATE &F REPORT REGISTER NUMRFR
•
ECIAL INSPECTION SERVIC E);
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
D REINFORCED CONCRETE UCT. STEEL ASSEMBLY ❑O
0 ST TENSIONED "HER ` ��L ,i6
❑ REO NFORCED MASONgyRETE D FIREHPROOFING
JOB LOC I_I �� �� ���� y� 1�� ���h
REPORT SEQUENCE NO.
TV OF ST_gUCTURE 9• ��
L'oMATERIAL
PERMIT NO.
DATE
DAV OF WEEK
DESCRIPTION ^
ARCHITECT
$P, TORS
HRS. CHARGED
K
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPL SUB
DATE ECTION GENECONTRACTOR jAl ftkUd1'4 "4e�S CONTRACTOR -S, %' oq (I.,
LSOP- wan Is
-�
- TM"GD8 ` C -7A _&e ► CA TIL
a42So is 0 0 A l e ---Q
. F .
COPY SENT TO CLIENT O
CONTIN ED 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.
NAT RE OF REGISTERE NSPECTOR
a 0 7S'
DA E OF REPORT REGISTER NUMRFR