0111-129 (SFD)ocf)
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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with "Secfion 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
i '744091 , B 124 112(
Date Signature of Contractor
Y 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).
O I am exempt under Section B&P. for this reason f
Date r 4 Signature of Owner N.)e �._- �r � i;. .�
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.
STATE FUND 220.02-0020714
(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 shlall f6rthwith comply with, those provisioS.
Date: Applicant /! ✓ ). / / = f (,1 C "� `7
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 orr 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 employ
2. Any permit issued as a result of this application becomes null and vo
work is not commenced within 180 days from date of issuance of
permit, or cessation of work for 180 days will subject permit to cancell
I certify that I have read this application and state that the above informat' is
correct. I agree to comply with all City, and State laws relating to the bu din
construction, and hereby authorize representatives of this City to enter .port
the above-mentioned properly_ or-in�spectiori purposes.. /^
° Signature (Owner/Agent) `r fih�1 -� .'76ate
BUILG"DINPERMIT '. PERM T//
DATE j` VALUATION LOT H.^ �.`�� TRACT
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
�
�3�1ME1..V�J
T'�.3�11 5�'12
11 CA, 91612
LA Q'Urft4TA CA,. 92253
f
f,M0)772^2625 MW 5393
USE OF PERMIT
SfV/ DO`+ll;.IN'T NC off.A.%G fPOlrl.dt'1i2i%rLPVVAY AIPPROACtW,'0 t1P1,LAXC15�
i. .TH ALL FLDERA.t, NClrU€ii'NO THF MDA -1409M
$PZC1ES A T 0? 1M. JF ArPLICJWLFJ8 REQUIRED.
CUSTOM CONSTRUCTION 3,rxoo S
POR.GFdWATIO V.60 SV
GAR AOi ICAlYEORT 1,296,00 SP
ZMAKMD CGET OF CO.T:IQ,'MUCTI N
4Q,N0420
CONSTRUCTION PPM. 101-000416-1000 $At9; Sf1
PLA! CHSCK FEE 101-000-439-218 =1,554.1
N3?Z DEPOSIT 101.000u44.39!-318 4111000.041
'
MlrG:H 1!aIC,AIIME 101-000421 - SM50
ELECTRICAL 1FZ 101"000-420-000 12x.34
PI;i2Y4g13ING FEE 101-000-419-000 3123.3.73
STRONG MOT104 YU - W441D 101.0{10.241.000 W.".
OR.AI ING FEE 101-000.42.3-000
DEVELOPER IMPACT VEY, SkA.l3il
Airr al P1.i-BLtC B'i�mEs = t2 1L 'tJ-000^445-11410 675. 1
raiLl�^d XL'Jm.r ��6I.Ci OG ..F1�.11 �.�E..£'1J: D PLAN'M=
$6,82al'i
LWIS '.PFX-Pd W MARS
41,(J00.00
W)rALPEMM MEI DUE NOW
MAP(
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DATE fi
///j� ,I(,('
BY.„ ; ^�
,._ _.rte":,, ^o"'
DATE FINALED
INSP TOR
�/���y(��/�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
- MECHANICAL APPROVALS
Set Backs
T
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans -
O.K.to Wrap
Framing
Compressor
Insulation
- d
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall- Int. Lath
_0��= a.Z_
Final
Final
_ c:
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
V���,(p•� %.d-�
Plumbing Final
Plumbing Top Out
%%��
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral _
Pool Cover
Sewer Connection �'f0 L
��
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
RDUr- /,is J/,9. 7,-a 02-
ZUtility
Final
UtilityNotice (Gas)-
_ , p o%L
_ G/ _
W vJ 2— G/.r,1--
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
- — 3
Utility Notice (Perm)
;/ 7_
Desert Sands'Unified,Schoot.District �y
47-950 Dune Palms Road
Notice:' La Quinta, CA 92253'
Document Cannot Be Duplicated 760-1771-8515,.
CERTIFICATE ,OF'COMPLIANCE r
Date 3/1/02 r APN# 770-300-013
No. 23003 Jurisdiction La Quinta
owner NameDecinces Properties b - " . permit # '
No. 78462 Street Talking Rock Turn Log #
r •
City La Quinta , Zip . 92253 .' .Study Area
Tract # Lot # Square Footage` "5576.
Type of Development Single Family Residence J No. of Units ,
Comments
TRADITION: Single Family D.wellirig iwth'Attached Guest House of 5576 sq. ft
4
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 thie following reason:
EXEMPTION NOT. APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 `in the amount of ,
2.14 X 5,576 or $ 11,932.64 - the property listed above and that building
permits and/or Certificates of Occupancy.for this square footage in this proposed project may no%v be issued
Fees Paid By CC Wells Fargo Bank/Doug DeCinces Telephone 760-771-4794
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Crystal Scott Payment Received $1.1,932.64
` Check No0737703393
Signature '
OTICE: Pursuant to Assembly 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
bove 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
Alect 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
C4
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Certificate of:Olccup
ancy
City of La Quinta.
Building and Safet
V DepartmentoFti°
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: 78-462 TALKING ROCK TRN
Use Classification: SFD Bldg. Permit No.: 0 111- 129
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: DECINCES PROPERTIES
Address: 12 STRAWBERRY FARM RD
City: IRVINE CA 92612
By: KIRK KIRKLAND
a'z-t Date: 2-7-03
Building Official
POST IN A CONSPICUOUS PLACE
SPEC IAL INSPECTION SERVICE
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 ❑ STRUCT. STEEL ASSEMBLY ❑
❑POST TENSIONED CONCRETE O ASPHALT ❑OTHER `
❑ REINFORCED MASONRY ❑ FIRE PROOFING _ E'0 Cf
JOB LOCATION ���
� ��
9
REPORT SEQUENCE NO,
TVP F R CTURE
T
P RMIT NO.
DA� AY OF WEEK
MATERIAL DESCRIPTION_
3 �_
ARCHITECT
INSPE HRS. CHARGED
L
ENGINEER
ASSISTANTS HRS. CHARGED
INSPECTION
DATE
GENERAL_
CONTRACTOR SV CA
0 LSTA
CONTRACTOR
, - 1
3'0
4
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(A TOSS I b 0
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(Jeu.S I ve —(e.s r a � �sOc7
COPY SENT TO CLIENT O
CONTINUED
EXT PAGE O
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.
SI URE OF REGIST I SPECT
6 0 v Z a 4q7�
ATE OF REPORT REGISTER NUMRFR