9908-167 (SFD). Y
LICENSED CONTRACTOR DECLARATION
Hiereby 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
13C20l.36 09%30/.201
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 off eied for
sale (Sec. 7044, Business & Professionals Code).
( ) 1, 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' i
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.
S'i'A.: 1'Ulv`U "I'VI-L"0-4J°:0350
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 -provisions.
Date: % 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, 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 purpose/s."
Signature (Owner/Agent) f'' • '` "��'� Date b-
#
BUILDING PERMIT PERMIT99044-167
DATE �7 / i VALUATION 'S91,19S,10 LOT 20 TACTBLK152jJ16
ADDRESSOB SITE 52-580 A���,NIDA V.M.L JO
APN `�%.�-f�3-Ufitri
OWNER
CONTRACTOR/DESIGNER/ENGINEER t ,
DAVID HEUS.l,NI ;GELD
DDH DE ;TT,01I&IENT CORP
110 BOX 2982
78-921 RLfNAW AI tBAY
PALM DESEk7V CA IY2261
BERMUDA DUNU S CA. 92261
t
(760)3W8706 CBL.# 157..6
USE OF PERMIT
SINGLE FAAffiLY DWELLING
�
Oil D 1�i RMI T 1"iOES -illi. TN _3_'IJ_D 1:�t.in- K WALL Off. K � +
T1'v�C'fi C °u"t3a"s"ilii{ iiiJt�i 1,496.0
P0_11 fPAT'1v 33.00 SF
UA.f .K01 CAF.A)ICr 433..00 SF
3 FT. WOOD 3± E'Nty'F. 2W.00 LF
F4
&AMIMA7i.ED COS €31' COMM 1i3UC I€3h'
a:i.a`ii9,3f1
Pk;12AO T F g+ E SiLMSCMV
CON S 11RUC:'17i)hl F03 101-000-4 ).8-000 $603,50
PT .A N (71-W.CK FFF J01 -MO -439-318 Son), SA
X.11r,11IAN A -AL I`1..6 101-000-121-000 S�It.CU
�JZ4 T i%CAL FEE 101-000420-000
1'l.,i MBINGr.rHE 30140-419.000 $i2L!i0
S'iROWC,NtU)TTOINF1"FFSir) 101-000_241440 $`►•1R
GRAD FE'S 101-004-12'3-CCi,,
DEVEs".0E-E-k .iM" PA.<:T 1F3s 5i1,•9it7.ut)
1'3tEt; ISE PLAIN 1.01-000-441-345 SICK►.w
'river; I01-0011-434-119-g�5ft.(tn
ST M -f CYVA. L C ONK MUCTI(0INANniyl,AtNrHECK
T-3,46116
LESS PRE -RAID EES
42`0.04
TOTAL iPC' HMrJ' F KS B111r3; NOW
�S3,2i t.3.fi
RECEIPT DATE BY /)f( ` DAT FI E /)G, INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
_
Ducts
Slab Grade
d
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
�� pp 4�z'> r.,
Compressor
Insulation-4�
aT
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Srd
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
Water Piping
_ 7
Heater Final
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:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole - 3,7 -�v Z
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)
Building
Mailing
Address U
City
Contractor ,.�
-.Address
City
r
r _ ... . z� a � s^ - .. -. �„--..� _r _. wr .. a F.Y � -..yF. ` ,r'-� .... �,,,•....-^ y. , T. : �.
• A on
"r� Of 64F (49WAV
P.O. BOX 1504 4
��
78-495 CALLE TAMPICO APPLICA Y
ly V 16 6 e J Q LA QUINTA, CALIFORNIA 92253
1� BUILDING: TYPE'CONST.C r L� OCC. GRP.
(t �► A.P. Number % % -3 " a 9
Tel. 4"A
Legal Description !/ A 4 4 &i?,
Project Description r.. T A o L- 14 S` U 1 to
Q
Tel.
r, s k In L 1<6 AA r- 64 A,,_
State Lic. City
& Classif. _ l r Lic. # Sq. Ft.
Size 4 L)
Arch., Engr.,
j 5
Designer �r ` F, 5' New Add ❑
el.
7 3- &'-/v IIl.t w ,f t 1 1
-/l?
Cityj
Lan
State
A. !
r 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 1/3/00
No. 19863
Owner NameDavid Heusinkveld
No. 52-580 Street Avenida Vallejo
City La Quinta
Tract #
Lot #
')type of Development . Single Family Residence
Comments
APN # 773-293-004
Jurisdiction La Quinta
zip 92253
Square Footage
Permit #
Log #
Study Area
1496
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
1.93 X 1,496 or $ 2,887.28
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/Palm Desert National Bank/Felipe
Fre oso
g Teieptione 71,0-5:64-5227'
Name on the check
�.:
By Dr. Doris Wilson
Superintendent
;
tib° F1'�_:�
Fee collected /exempted by Olivia Aguirre
Payment Received $2,887.28
Check No. 73782
Signature
NOTICE: Pursuant t Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 9D -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 sssued or on which they are paid to the District(s) or to another public entity authorized to
collect 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
�1%y op �A X111
NTq
RC District -Planning Review Form BUIL9 RECD
D�,tiG AND
This form is to be used by CDD staff for review of single family dwellings in the RC (Co''veFETy
Residential) District, in order to determine the applicabitity of compatibility issues or need
to require the filing of Master Design Guidelines by the applicant. It shall be transmitted to .
Building & Safety as your correction list. Please attach additional explanations as necessary.
APPLICANT: DGH Development Corp.
PROJECT r 52-580 Avenida Vallejo
ADDRESS:
APN: 773-293-
LEGAL: LOT 20 , BLOCK152 , UNIT 16. S.C. @ V.L.Q.
CK'D BY: Greg Trousdell
BIN NO: .
CASE NO99-100 CHECK -DA . .TE: 7,g�� /
.
Inform- the assigned Building plan checker upon your assignment to this case. The CDD
Executive Secretary maintains a log book to track applications and assign case numbers.
REQUIRED ITEM I Y � 'N COMMENT/CORRECTION
Case logged and number assigned V 1 v'"
verify legal and APN information OPj�
Consistent with MDG on file (as applicable) tri I
MDG filing required (5+ filings since 9/3/98)
with-street/surrounding area:.
Consistency � ' _
Colors
Materials 2� d
.Architecture
REQUIREMENTS:'
C� ems• •'S " �- .. `� I ICO � I � I I� I .
The Toning code, architectural and landscaping manuals, and/or assigned inspector should
be consulted where uncertainties arise. The completed checklist shall be maintained in the
Building & Safety address 1He. lL �� �6
O�s
..��� f
< .. i. .. 1 IS _— •I'� '..� .:�. -.—�.sM1..4�r � ft—.� - ll%� t? c�'i`i�T
Certificate of Occupancy
City of La Quinta
Building and Safety Department
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: 52-580 AVENIDA VALLEJO
Use Classification: SFD Bldg. Permit No.: 9908-167
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC
Owner of Building: DAVID HEUSINKVELD
Building Official
Address: P.O. BOX 2982
City: PALM DESERT, CA 92261
By: STEVE TRAXEL
Date: 06-02-00
POST IN A CONSPICUOUS PLACE