0307-088 (SFD)U
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LICENSED CONTRACTOR DECLARATION J,
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
44041 B C20 C 09/3
Date(1!6/J'� Signature of Contractor 11!::'11'^_'x✓ ,
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.
( ) 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 STATE FUD Policy No. 164069-03
(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 tha`if I should become
subject to the workers' compensation provisions of Section 3700, of the Labor
Code, I s, all fKrthwith comply with th se provisions.,,/
Dat e'S� /rs•� Applicantr�� t2+�I'
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 t
any permit issued as a result of this applicaton agrees to, & shall, indemni
& 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
work is not commenced within 180 days from date,,of issuance of suc
permit, or cessation of work for 180 days will subject permit to cancellatio .
I certify that I have read this application and state that the above information i
correct. I agree to comply with all City, and State laws relating to the buildin
!construction, and hereby authorize representatives of this City to enter upon
0 the above-mentioned propeerty�f inspection purp'osses.
Signature (Owner/Aggrit);'� r"�" Date
BUILDING PERMIT PERMIT#
0307- �
DATE .VALUATION LOTTRACT
71' BLK, 18 4
JOB SITEy�a
APN
i
ADDRESS - � LiS +N�
774-0724M.
OWNER
CONTRACTOR / DESIGNER / ENGINEER
DON DRMUPMEW CORP
1,7F.:V0,0P1.%WT.C(XRr_
784121RUNAWAY BAY
7t-921 1:'.3NAWA,i, HAY
.131.PAZML7DA DLW..Z Chi 92261
ElFk 5 (JD..1k1XnTES CA 912061
(70)360.V06 CM1.191 M6
USE OF PERMIT
I�INGLESIMIALY .ILWIM.:UNC+
1621 S.K VD,'PERMIT DOES NOT 'nIC1 O]DE-BLOCK WALL,, P001JSP'A
OR DRIVEWAY APPROACH
TRACT C003TRUC° ION 11021!,00 NF
PORCHPATTO 67.00 sp
O.AUKIEUCAI1PORT 4100 OF
i S',,1C.C?it1AM COST OF CONYMUC TON
S*.,123.40
CON STRKTION FIG 101.000.418.000 $635,100
PLAN CHECK FZrf 101 -OW -439-318 $526,94
FEE DEPOSIT 101-000.433-315 650,00
MFXRANICA L PEE 101-000.421-000
EI.Pi+ TR1t:.i 1, FEE 101-0140.420.000 S11a,&d
PLUNISINO XVIE 101-000-419-000 $I1&.IiO
t
ST.RO110 MOTION FEE - X&OR 3 101-.00i -241-000 S5.81
QRAJD11%IC1 ",E 101-000-423-000 $15.00
DEV'EbOPE.R. IMPACT FEE - $2,443.00
PR,CISIP PLAN 101-000-441-345 $10i5.fi4'
I i13 f,C MMIR I'CTI013 NL91x1.:MT Oki 4K
r :
$4,48-1.39
LESS Pi x -P H'F �
$0,100
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6 2 03LA
:FINANCE
QUINTA
DEPT
RECEIPTDATIJr�'�
.�ti
BY ��''
DATE IN LED. dL
INSPEC
'�I
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— Q
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
�J
Vents
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
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
_
—T
Appliances
`
Final
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)
COMMENTS:
O
Date ' 9/3/03
No. 24909
Owner
DGH Development Corp
Address
78921 Runaway Bay
City
Bermuda Dnes Zip 92261
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
APN #
Q BERMUDA DUNES r
RANCHO MIRAGE t�
INDIAN WELLS
(Si PALM DESERT ,y
tj> LA QUINTA
4 1 N0O ��
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774-071-003
Jurisdiction La Quinta
Permit # 0307-088
Tract # BLK 184 Study Area
Type Single Family Residence No. of Units 1
Lot # No. Street
Unit 1 21 53320 Avenida Diaz
Unit 2
Unit 3
Unit 4
Unit 5
S.F. Lot # No.
1621 Unit 6
Unit 7
Unit 8
Unit 9
Unit 10
Comments Overpayment of $619.25 to be issued as a direct pay mailed to address shown above.
Street 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 1,621 S.F. or $3,468.94 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/Palm Desert National Bank - Art Lambrose Check No. 086961
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by S cGllvrey Payment Recd $619.25
$4,088.19 Over/Under
Signature
NOTICE: Pursuant to Government Code Section 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 DepartmenUApplicant Copy - Applicant/Receipt Copy - Accounting
Certificate of Occupancy
T-vf 4 4v 4"
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.
Use classification: SFD
Occupancy GroupR3
BUILDING ADDRESS 53-320 AVENIDA DIAZ
Type of Construction: VN
Owner of Building: DGH DEVELOPMENT CORP
Building Official
Building Permit No.: 0307-088
Land Use Zone: RC
Address: 78-921 RUNAWAY BAY
City, ST, ZIP: BERMUDA DUNES CA 92261
By: KIRK KIRKLAND
Date: 4-22-04
T IN A CONSPICUOUS PLACE
„9,
2 February 2004
The City of La Quinta
Department of Building and Safety
78.495 Calle Tampico
La Quinta, CA 92253
Project: Single Family Residence for:
D. G. H. Development Corporation at:
53-320 Avenida D� iaz
La Quinta, CA
Regarding: Project Observation and Field Revisions
To Whom it May Concern,
CHARLES D. RAR
Architecture, Interiors, Space and Land Planning
Structural Calculations
On 30 January 2004 1 visited the noted project site to perform code required structural
observations. At the time I noted only minor blocking, nailing and strapping issues that were
resolved at the time of my visit.
Therefore, I hereby state that the project's structure is in substantial conformance with the
structural design intent as represented in the construction documents.
If you have any further questions regarding this project please do not hesitate in contacting me.
Sincerely,
Charles D. Garland
Architect
EDD.
4�C�
C�
* No. C11991
J 10/31/2005
N� EXP. DATE
\OP CAI�FC�
74.854 Velie Way, Suite 5 11 Palm Desert, CA 92260 ❑ Phone: (760) 340.3528 ❑ Facsimile: (760) 340.3728
w
„99,
2 February 2004
REVISED: 9 FEBRUARY 2004
The City of La Quinta
Department of Building and Safety
78.495 Calle Tampico
La Quinta, CA 92253
Project: Single Family Residence for:
D. G. H. Development Corporation at:
X53=320 Aver d�Dia-� z�
L5-6 -u-i n tia', CA
Regarding: Project Observation and Field Revisions
To Whom it May Concern,
CHARLES D. CARLAN
Architecture, Interiors, Space and Land Planning
Structural Calculations
On 30 January 2004 1 visited the noted project site to perform code required structural
observations. I noted only minor blocking, nailing and strapping issues that were resolved at the
time of my visit except for the following. Shear wall "F" was not provided with the required 3x
PTDF sill plate required in the construction documents. Attached please find my remedial detail
to correct the missed 3x plating and studs. Please note that no special inspection is called for at
the retrofit anchor bolting because no uplift forces are applied to anchor bolts, only base shear
forces.
Therefore, once the remedial detailing has been provided, I hereby state that the project's
structure is in substantial conformance with the structural design intent as represented in
the construction documents.
If you have any further questions regarding this project please do not hesitate in contacting me.
Si
Charlds D. Garland
Architect
C? Q cC
r A
No. C11991
10/31/2005
EXP DATE j
0j A
74-854 Velie Way, Suite 5 ❑ Palm Desert, CA 92260 ❑ Phone: (760) 340-3528 ❑ Facsimile: (760) 340-3728
Charles D. Garland, Architect
74-854 Velie Way (Suite 5)
Palm Desert, CA, 92260 SATE: 216104 FAGE: �r
STRUCTURAL CALCULATIONS For: SINGLE FAMILY RESIDENCE —
DGH Development Corp.
La Quinta, California
111�'
Y
Charles D. Garland, Architect
74-854 Velie Way (Suite 5)
Palm Desert, CA, 92260 DATE: 216104 PAGE: �r
STRUCTURAL CALCULATIONS For: SINGLE FAMILY RESIDENCE —
DGH Development Corp.
La Quinta, California
NX -W < < ion.
v� -o
Architecture, Interiors, Space and Land Planning
Structural Calculations
27 August 2003
The City of La Quinta
Department of Building and Safety
78-495 Calle Tampico
La Quinta, CA 92253
Project: A Single Family Residence for:
D G H Construction
53-320 Avenida Diaz
La Quinta, California
Regarding: Truss Calculations
To Whom it May Concern,
I have been supplied with truss calculations prepared by Trussworks of Thermal, California for the
project noted above. Upon review of the truss calculation package, and in light of the structural
design documents, I find them to be in substantial conformance with the structural design intent
as documented in the structural calculations prepared by my firm for the noted project.
If you have any questions or comments regarding these issues or any other issue please do not
hesitate in contacting my firm.
74854 Velie Way, Suite 5 ❑ Palm Desert, CA 92260 ❑ Phone: (760) 340.3528 ❑ Facsimile: (760) 340.3728