HomeMy WebLinkAbout0309-166 (SFD)U)
(V U)
04W
W r
o Z
0.O
J
IW- a
N
Z
CY)
u�
N
ON
U °)
Q
0
,FZO-
X w —
m � U
O
SMF
,• Z
ob
0
J
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
Date l/t r {Signature of Contractor`
M
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.
( 1); I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for wl bh'this
permit is issued. My workers' compensation insurance carrier & policy no"ore:
Carrier Policy No.
VA'TZ Pi.fW'D irs.)0- 1,64 9013-0.2
(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: 1 r, > y Applicant /w. ' .2 . ' . -
''Warning: Failure to secure Workers' Compensation sation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT., Application is hereby made to the Director of Building and Safety
for•'a permit subjectfto the conditions and restrictions set forth on his
application."
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to "
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such.
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is: .
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon"
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) YDate Z
,y
PERMIT #
BUILDING
"PERMIT
DATE VALUATION LOT • pT�l< {;� TRACT
..x.
JOB SITE "
APN
ADDRESS"
9—ID42 �'X.�.Gi?�.� I�M.A.:.iiIT DRY V.1'�. Y r..
�{ ✓$ p �}7 �.j
{ y
•U f. �.:`:� �
OWNER gas x.
CONTRACTOR / DESIGNER / ENGINEER
P14, Rk?y�(i�.r'�MA a 'Me.,.Iry.-�y10-Z
C
^+'�1'Lfi�j4
C'�
J1:•i �d.i ti^.L::!'•r..i aY ,.p A��m 0-Z
(i>}AFti/rq:[
i!e�-F?G7 [�Yffix:Fi.�1� Z_11 ME 02,
9 A i Mxw'G0 CA 421"31
:?A41 " I.XTR .1 � CA -02131
Oa MW9 4972I
USE OF PERMIT
D - LSyyJT�I, KilUX :G�ip�'.��1p'TA',?�A'Ly1Y7�' l'�O'TSNN01 ;G.@iCLUDE •3L..CIC-Z 1w,"Ci ,LU3,
Pool,zJF
Oli ��dT.a!' .6.VPRi, 7 APPROACH,
TRACT d:ONSTlti.tlCUO.N ;:001W 3F
Cf !;ATIO 3155.0ii INIF
CW�AOY :I'AAPi" RT 05.00 SIP
F'i TEMATM) COW a. F teC}NbMUC`110N
N`=v�r�si'7r�t:°�,"lf��� �'�i1 ����^t?ilc.�q,`��•mc�c��3 ��$s�.�n
iaLr',V C;itfl?C C Flab t_75LIA
•VoiS/4T:i81.i.UCM LF 1.439.•CStXf?:1 .1-r o �2 .t�3
.
Vt,3 T1UCA'i, t tt� 101-0004-20-OUO $361.5
ON)
IPI:uSk 1; t J° 10.000-419.00) WON)
ceTPt?,NO MOTIC1"4 '1"VZ, i . ID 1 to) -000-241-t0^,
iieiAl�3iJ� �?L� 10.1.000.423.709
- (`i s'l�fSf.# �� 1^ j. tyLJST ► , ill *iq.A' ARE) PIU41 s Sf.7'1.r4..L,��W
i :74
'OCT
Ci r' LA fJL
C := C3 ehL'"
:mb
RECEIPT
DATE
BY
DAT FINALED F„ ',
INSP�EcpR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs A7
Underground Ducts
Forms & Footings /Q --TO -Q3
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck . / b -
Exhaust Fans
O.K. to Wrap - _
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 .-
- 2 3 -
Drywall - Int. Lath2- 44n
Final
-
Final —
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines //- -
Heater Final
Water Piping �-J jj
Plumbing Top Out Oma- �/
Plumbing. Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
_
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
FinaF.
Final
Utility Notice (Gas) C�
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring .. V
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:.
Date 10/10/03
No. 25065
Owner PM Renaissance, LLC
Address 9968 Hibert St., Ste. 102
City La Quinta Zip 92253
Tract # 29053-1
Type Single Family Residence
Lot #
Unit 1 1
Unit 2
Unit 3
Unit 4
Unit 5
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
No. Street
79926 Derek Alan Drive
4a5
APN #
Jurisdiction
Permit #
Study Area
No. of Units
S.F. Lot # No
2650 Unit 6
Unit 7
Unit 8
Unit 9
Unit 10
OJ09- /��
Q` BERMUDA DUNES
r/� RANCHO MIRAGE
�J INDIAN WELLS
hr PALM DESERT
LA T
INDIO
649-630-027
La Quinta
1
Street
Comments Certs #25065 through 25084 used for CC#220712 in the amount of $119,801.48.
S.F.
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 (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.
in the amount of $2.14 X 2,650 S.F. or $5,671.00 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 - Bob Turpin Check No. 220712
Name on the check Telephone 760/801.3623
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted
Signature
ilvrey
11
Payment Recd
$5,671.00
$o.00
Over/Under
NOTICE: Pursuant to Government Code SeZtion 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
Certificate of Occupancy
�
� RA7M
G OF9w Building & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
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
construction and/or use.
BUILDING ADDRESS: 79-925 DEREK ALAN DRIVE
Use classification: S.F.D. Building Permit No.: 0309-166
Occupancy Group: R-3 Type of Construction: N-V Land Use Zone: R-L
Owner of Building: PM RENAISSANCE LLC Address 9968 HIBERT ST, STE 102
City, ST, ZIP: SAN DIEGO CA 92131
By: G. SHOWALTER
Date: 06/01/04
Building Offici I
POST IN A CONSPICUOUS PLACE
....