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9904-047 (SFD)LICENSED CONTRACTOR DECLARATION -I hereby affirm under penalty of perjury that'l am licensed under provisions of rjChapter 9 (commencing with Section 7000) of Division 3 of We Business and Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date i 5ui "13 , 3!31100 ate Signature:of Contractor s o OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that lam 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).,;, r ( ) 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.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. .( ?['have and will maintain, workers' compensation insurance, as required, by Se&tion 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 i Policy No. • t r{{ ' qy. r r C� w ... ( :P v V ori s � •th _ UI'V.4ly i'!R� a'{,tl.:l �J� �a.t�,.yi` ..3:•�1�.b 61:e�• (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 provislons'of Section 3,700 of the Labor Code, I sh I forthwith comply with those p4rovlsibns. Date: Applicant Wyarning: 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, r 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 It+ 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 totKe. building 1. construction, and hereby authorize, representatives of this City to enter. upon the above-mentioned property for inspect� ,purposes. r .�I Signature (Owner/Agent) �=.- Y. Date'80 -BUI,LDING PERMIT PERMIT# r "044)47' DATE VALUATION X18.1, l.13 61) LOT 270 � TRACT '� � 26152 .' CCI t JOB SITE ADDRESS 47� 85 VIA NIONTAKA APN "34204)49 OWNER CONTRACTOR / DESIGNER / ENGINEER , ' t q�yy p6 ry�1T �a�y L tia��t ,4..a�'i. QiJ.OI TI1?�. ��,`,ry.OAiBfO 1' 4�[./::+, LLLC � �^•,�C .t 1 F t•+�.A �T � �y �P ��� COMPANY ti.+d'>NI TI'i.F,E.t,...i, f�,• 4, ili"�'1�'.i9,NY Irf4BROOOKHO1:.I:t 'U4/' Dk-IVE, SUVrE 208 1570 BROOUTfv31.[.OW:t RI'vtt, 5UITF4-408 ANTA..ANA CA _V2,705 SA:N I A. t NA C.A. 92'105 Q -,L# 43.5 USE OF PERMIT 'LOC 276, F'1 AN',{l:?(t0 - :SC•U: PO?,: ( OOSS :NOT 173t,t' %JOU 3LOCK '+riiAF. (.S olt. 3•"OG7.- J 5't'rV s t i ra g,t).,aoo - t't`?:int~ I!!I'A 7Cir 330.0 S.V C,A]d:Pift1�1't.1ti'+',�Ft.'f." hAi.f30;Stj , '4 'd�9i P',f•1K7ti �4"'.a^+0'F'tltiJ'4'�pi ,LL• S.At t•�•A Akl# '+,.•'ll-> 6. a./,e� �.,VtA e.D x.lSeJ •.6 xw�1'\ .LLtitl;,e`?u. .¢v�.t t�?,:'d�t�`�'i< I�.�ll ,•�'sJ.i�'���E�.t��ti' CeNa'i ltCtL '1°l�t�I l tG !!i! -f ltl-�d1 S-0(3(3 S926-50 ' t I��.�G)a'G�i':f ,. tllw()f}0.33{3-318 _- .S2�U.txt► lof t "u. 1c"ad 101-000-421-000 r..$G'S.`!<lLtSl:�.i t.;tr , tUl.••UCiU-/l243••Cft3F3 :$:?t.t3.1'l w!`r7,riti 1�i ttgfFs973ii7 RFs if1! (1t►Fl-4.1�a 01(!01 '.FE E J01,000-42'3-000 RA RAS : RUC URE FET", r1R`i,"1N;f�aJl3[,Tr°F�?,_� a-Rt„.ti `Iflq-i1tNi.h551}(1(1 $204.08 af4'-r"'i1TAGOON.;'"� UC'TIONAW-)fl,�A-'N t{r:£rk`� 4, ,a r•oz LESS >R.1-TACD7 FEES 42$0-0 • + r ' ' �e .tt� \E {{CE` T S�f� t j, ,i tW1 BATE BY I�C j11i DA E .Q INSPECTOR ` . JU i \ INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade s / Q i Return Air Steel Combustion Air Roof Deck - - Exhaust Fans O.K to Wrap 7.8 F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath 'Z 3— 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 o • Z / Appliances Final COMMENTS: �. :. . Final Utility Notice (Gas) 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 Utility Notice (Perm) ... .- x,�s.�n-v-r•'�� :"S .4 . .. r .... .. yi+ f .1i .r""T7.�Arr-•'^"�"r - ♦ -' a<r°^�>---r+`.."a r,ry^ .r" _"✓. >.e�.-,.�.�1. tee, vq.+.:w4r�l�..•71..r'i: ..�wy+-�n-Ar,+tir'.. y'.'`. . T4ht 4 4 " . P.O.' BOX 1504 Building / ( p Mtf f�� +L, 7 76-495 CALLE TAMPICO APPLICATION ONLY Address '"1 595 V ( CA 0 LA QUINTA, CALIFORNIA 92253 Owner Mailing Address (S-70rov Contractor Address A `7_- a nS Zip State Lic.�, City & Classif. 5 tf' S6 1 11� I Lic. # Designer Address Tel. City (Zip State I Lic. # LICENSED CONTRACTOR'S DECLARATION I Thereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. rS SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm'that I am exempt from the Contractors License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter, 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 of 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: 1, 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.) 1-1 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 contractor(s) licensed pursuant to the Contractor's License Law.) 17 I 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 (7 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 (E100) 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. Date Owner NOTICE TO APPLICANT: H. after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply 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 ttiis 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 Mailing Add City, State, BUILDING: TYP/E'CONST. OCC. GRP. A.P. Number 1,43 - i 20 - o''`/I 8 (_ Legal Description Lot, # A -74-2 ';LW Sa Project Description +SS �t( 4 Y1 1l Yl0' e " 2 -�— C— - S CS28at,p[ Sq. Ft. �b No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ PERMIT i AMOUNT Plan Chk. Dep. I -¢,,. n Plan Chk. Bal. i Const. Mech. Electrical Plumbing S.M.I. . Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION z 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 4/15/99 APN # 643-120-048 No. 18578 y Jurisdiction '+ La Quinta Owner NameLake La Quinta Comm., LLC ' "} Permit # .No. 47-585 Street Via Montana Log # City La Quinta zip 92253'' - StudyArea Tract # Lot # Square Footage 3018 Type of Development Single Family'Residence ' • 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 1.93 X 3,018 or $ 5,824.74 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 • sit 't}aF� _ Fees Paid By CC/Life` Bank - Robert Walker ; J . Telephtonei , 771-9636 A i. Name on the check. By ; Dr. Doris Wilson r • 7 Y' ~� ��� -' 'wi „ Y C 1 W Superintendent Fee collected /exempted by Ellen Patino °` Payment Received -Check No. 4400313 Signature DTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve -to notify you that the'90ifay approval period in which you may protest the fees or other payment identified love 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 3Ilect them on the District('s)(s') behalf, whichever is earlier. _A. 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 + PUBLIC WORKS CLEARANCELETTER FOR CUSTOM HOME LOTS Dear Builder: - Prior to issuance of a building permit, you will be required to obtain clearance from the Public Works Department for one, or more, of the following: 1. Verification that rough grading is complete, and the'pad elevation certifications prepared by 'a licensed surveyor, or engineer, are on file in the Public Works Department. 2. Verification that infrastructure improvements and other required tract improvements' are complete, & sufficiently.advanced to warrant building permit issuance. 3. Prepare an engineered grading plan that.provides for on -lot storm water retention, and have it checked and approved by the Public Works Department. • Tract 26524 (Estancias) • • Tract 26769 (Mountain View Estates) 4. Prepare an engineered grading plan that .provides. for building pad grading in accordance with the existing soils report and- tract grading plan, and have it checked and approved by the Public Works Department. • Tract 28034 (South Valley Estates) FOR INTERNAL USE BY PUBLIC WORKS DEPARTMENT TRACT: LOT: V, PUBLIC WO KS AU HORIZATION DATE FAPWDEPTIDOCS\FORMSIPW CLEARANCE LETTER.ss COMMENTS: ESI/FME, Inc. Structural Engineers . Date: .2-26-99—, By : R. R.W. 1921 East Carnegie Ave., 1 St. 3 J — Santa Ana, California 92705 Company: CANADAY AND CO. Project Name: " South Shore On Address : 1570 Brookhollow Drive, St. 208 Lake La Quinta " Santa Ana; CA. 92705 E S .I / F M E Job No.: 298-8436 Contact": Steve Sarite. Project Eng.: R.R.W. Phone (714) 751' -9151 -.'.FAX'::' -(7:14) 751-9152.'.: PH.: (71a)261-1811 Fax 261-8506 x Phone Conversation... Ffd Meet'g Meet'g @ Client's _�IIn-House Meeting City of La Quints..'.. Department of Building and Safety.' 78495 Calle Tampico La Quinta, CA. 92253:: ;• ..,.. ; RE: South Shore On"'Cake`"La Quinta Plan .3DR G/ LOT 276 Phase III 47-585 Via Florence .. To Whom It May Concern We have reviewed the truss •drawings and calculations by for the above reference project Wand. find them in. substantial; conformance with the structural framing plans prepared for submittal to the City .Of La Quinta . Inland Truss, Inc`--.'**: 15457 Foothill,Blvd Fontana, CA, .92335 Ph. ( 909).355-87 1 87 . Fax ( 909) 355'-821 ESSfpN�! oQapf Ram' R. W ng; II,' S..E.2345 x No $2345 1 fxo 12.3101 c.c.: Steve Sante 78-995 Via Trieste La Quinta; .- CA..922.53; r .. f OF CAtii4�` . ESI FME He .