9702-048 (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 # 2ptS f Q 1Lic. Class 3 j C / Exp. Date y� Q
� � V
A e .
Date Signature of C
Date
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&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.
( r) 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 SI -ATG !FoaP. Policy No. 2.2.`1-17 coi 5i�,45
(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
object to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forth ith comply with those provisions
Date: S '%'' y Applicant—
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on- his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of Such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
t e above-mentioned property for inspection `purposes.
Signature (Owner/Agent) Date
N
BUILDING PERMIT PERMIT# CONTROL#
I 9702-00 5023
DATE VALUATION LOT TRACT 4122197��9�3��i�.4�fN3 7732fiF5x
JOB SITE
ADDRESS 47-495 VIA MONTAM
APN (PL3420-04.55
OWNER
CONTRACTOR/DESIGNER/ENGINEER
wy it. f4itC+ n' Ii '��+F.;f rJi6:
�U.A SCS^d COMPANYINC
dig 'k;ANIEk DR
7_1ti7:x3 Gfri )1�'1".ld`ar CLUB DR
CYPRESS CA 00630
8H"R.NIIJDA. E) UNFS CA 92204
06(045.3M C'Uff
USE OF PERMIT
\i=C►
Si )-.t iift 'i!$ f.Ni`LtJi3 4=t f,.l'.„ S` C'1>kti� ahi vtitiI,"":. J+S SHOWN ON
I,ANCD.V'„AP1? PLAN. POOL'IT) INK UNDER SEPAt2A'1:iy
"!"RfiC'r CUDI4;i9'.fdUC"a' ON 3,200.00 Sir
t'K:aIt.0 iLk'A"6`ttu z �;.u�+ sk
I V1', WALL "kr./)Ct Lf.
GAR A:.0043'ARPORT 7544A) SF
EST .SJA'3 E'1 1:0. ' OF C"altrSTiol CTION
193,614-f*
PE..RMIT F.AE'. SUl'1`i:Mf1Ag' ,ea
01F 0E_P0%1f 42Y).01)"
- ..
� A14 CHEM :
�.
CONS't`I7UCIN.014 k1MR 101400418-00D
ift.(::t1ANti AL f j .: 101-000.421-0M SW5.0
1.3,ECT.RIC,Af, FFF 1.01440420 -ft) sm.m
P11TA0,11NO FF 101400419-000
,7'ONO M0TIt:3I'!'I*"L-2 R#;: SIT) 101-000-241-000 $19.36
o
4: RAD Nt) FElf. 101-00.423-000 vo.to
Q 1�
f NIKRAS1A1 r(a'fTrIZ : FIJY,; 225-00*40-342 11,'21, 12. 1 J
M
w.
hl:l(1-'f C sr� 1, (a `nfS"i'r;T rf:; i'Tr)N E1Ni'l I'f,,A itii rli#;C f.' ,"
%t'i,RT1.32
1,.PS1 PRE -.1'2 .1'1.) Ff. L` `r
N"fl;;;S 011NOW
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
"AS
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 J I
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL P ROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
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:
Final
Utility Notice (Gas) iTV
ELECTRICAL hPgROVALS
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)
'. `,4,/ �•� �� Jn3�'4 LaT 773 ••P:O. BOX 1504
Building _ 78-105 CALLE ESTADO APPLICATION ONLY
Address VIA A10 k1 -;o /�-4 LA QUINTA, CALIFORNIA 92253
Owner
Mailing � 733 oRivT
Address up!//�`%2 `� �Lcl�v
City Zip Tel.
.2v�✓0A/,v�r g22oi 345= 322
Contractor
V14 ; SO ee tW,--4A, y Iti
Address -
Qt j�ip�ZzO/ j4S:•
�22�rinv0N Z
State Lic. City
&Class if. 29g810 /3, tG 2J - 0_?6 Lic. # .
Arch., Engr.,
Designer ��_ ��✓'�S�
Ad Tel.
iJ City Zip State
'. Lic.�0
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I an� licensed under provision of Chapter 9 (commencing with Section
7000) of Division 3 o thg Busipe�s and Professio C $e, ay�of license is in full force and
effect. /��1//i �isG�
SIGNATURE. ��i�,I :/,L� / DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions 01 the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
L' 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, 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 I, 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 contractor(s) licensed pursuant to the Contractor's License Law.)
i } 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm 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
rJ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
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 thg 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.
Date Owner
+NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
Vobject to the Workers' Compensation provisions or the Labor Code, you must forthwith
mply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that -I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING DIVISION
BUILDING: TYPE CONST:_OCC.
^ /OCC. GRP.
A.P. Number L / I O �
Legal Description '772A L"f 2l� S 2 9 7 273.
Project Description s ' f ��� L /°
c> c- C3W,4,e 0A-- _X24? O tib re
Sq. Ft.No. NoDw. /
Size 5-200 Stories , Units
New 91' Add ❑
Alter ❑ . Repair ❑ Demolition ❑
REMARKS
MAtf�-P_ IA*�_b �aY � MAIle e C aseal,E �
46-2- R410f e -n.. Pp_
CYPRESS, C,4 !Z0636
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
r S e Street Setback!from Center Line
E tde Setback from Property Line
FINAL DATE,. - -1 010'7 INSPECTOR
Issued by: Date Permit
Valida't by'li� LgNTA
Validation:
lislez_UDE5 W'A'l1.S fns
5µ87.,5A) oa,I L S_ pL" P �
A,'e.M )T TA 9C M@Z�+.,.
t G _b5_C_?A-,eAZEZ4
stimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
ZSV O Q
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
ZSU. !!O
REMARKS
MAtf�-P_ IA*�_b �aY � MAIle e C aseal,E �
46-2- R410f e -n.. Pp_
CYPRESS, C,4 !Z0636
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
r S e Street Setback!from Center Line
E tde Setback from Property Line
FINAL DATE,. - -1 010'7 INSPECTOR
Issued by: Date Permit
Valida't by'li� LgNTA
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING E1
7ST FL.'— SO. FT. @ $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
f
2ND FL. SO. FT, @
FORMS
YARD SPKLR SYSTEM
POR. SO. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. S0. FT. 0
OTHER APPJEOUIP.
DRAINAGE PIPING
WALL ' SO. FT. @
TEMP. POLE
DRINKING FOUNTAIN
S0. FT. @
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
_$
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ IA c
SEWAGE DISPOSAL
LATHING
SO.FT.GAR @ 3/4c
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
INSULATION/SOUND
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
1 1!
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING R AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
GARDEN WALL FINAL
N5PEG7 VH'S 51GNA1 URt5/1N1 i IAL5
P Desert Sands Unified School District
Notice:.82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201
,s
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 4/10/97 - APN'# 643-120-045
No. 15419 Jurisdiction La Quinta
Owner Name Roy & Mary Tweedie Permit #
No. 47-495 Street Via Montana Log #
City La Quinta Zip 92253 Study Area 1.23
Tract # 26152 Lot # 273 Square Footage 3200
Type of Development Single Family Residence` '
t No. of Units 1
Comments
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
1.84 X 3,200 or $ 59888.00 the property listed above and that building
'
permits and/or Certificates of Occupancy, for this square footage in:this proposed'projec>t may now be. issued
Fees Paid By cc/Wells Fargo Bank\� `
y - Telephone x:345-3222
Name on the check
By Dr. Carol McGrew
Administrator in Charger.
Fee collected /exempted by Pauline Pearson '. " ` Payment Received $5,888.00
Check No.. 0389001499
Signature P1 Ai
a
IOTICE: Pursuant of 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
above will begin to run from the date on which the building or installation permit for this project is sssued orbn which they are paid to the District(s) or to another public entity authorized to
ollect 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-"Applicaht/Receipt Copy - Accounting
CITY 0
LA 01jINTA
/(01'111A R
BUILDING AND y
78-495 CALLE TAMPICO LA OUINTA, CALIFORNIA 92253 ' (619) 777-7000
r; f Tvk ' FAX (619) 777-7101
March 6, 1997
Mr. Bill Watson
Watson Company, Inc.
79-733 Country Club Drive, Suite 5.
Bermuda Dunes, Ca. 92201
SUBJECT: Planning Commission action on Site Development Permit 97-601
Dear Mr. Watson,
The Planning Commission at its meeting of February 25, 1997, approved your architectural
plans for a single family residence on Via Montana in take La Quinta, subject to conditions: .
Attached is a copy of the conditions of approval for your use. The final construction plans,
including landscaping must be submitted to our department to verify compliance with the
conditions prior to issuance of a building permit.
Should you have any questions, feel free to contact me at (619) 777-7064.
Very truly yours,
JERRY HERMAN..
COMMUNITY DEVELOPMENT DIRECTOR
STAN B. SAWA
Principal Planner
sbs
' C Mark Hold, building and Safety
Ltrsdp97601
"A=
MAILING ADDRESS P.O. BOX 1504 LA OUINTA, CALIFORNIA 92253 ®�
Y'
1r ate'`
PLANNING COMMISSION RESOLUTI.O.N 97-014`
CONDITIONS OF APPROVAL - ADOPTED
SITE DEVELOPMENT PERMIT 97-601
MR. & 'MRS. ROY TWEEDIE
FEBRUARY 25, 1997
GENERAL:
n
1. Approval of this Site Development Permit is for architectural plan approval of
a 3,200± *Square foot single family resident"e on lot 273, Tract 26152, as
noted on plans in the Community Development Department, unless amended
herein.
2. All requirements. of Tentative Tract 26152 and the RL Zone District shall be
met during plan check process.
3. Lawn areas for front yards shall be either Hybrid'Bermuda (Summer) orr Hybrid
Bermuda/Rye- (Winter) depending upon the season when it is installed. All
trees shall be double staked to prevent wind damage. All shrubs and trees
shall be watered with bubblers or emitters. Landscape improvements shall be .
installed before final occupancy of the house. All trees shall be a minimum 24-
inch box size with 2-1/2". caliper, 18" above base of tree.
4. Ground mounted equipment (air-conditioning condensers, pool equipment, etc.)
shall be located inside and rear yard areas behind screen walls or landscaping.
All equipment shall be a minimum distance of -five -feet from the property line.
}
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