9806-144 (SFD)i
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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 ! -� Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of -perjury that 1 `Am.,exempt from the Contractor's
License Law for the following reasons
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 Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
() 1 certify that in the performance of the work for which this permit is issued,
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.
,,pate:` ,rp4 Applicant—
Warning:
pplicant Warning: Failure to secure Workers'. Compensation coverage is unlawful and
shall subject an employer to criminal'pen'alties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a. permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this•application is made & each person at
whose request and for whose benefit work Is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2,,l�hy permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject. permit to cancellation.
I certify that I have read this application and state that the above information is
Correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
I$•ignature (Owner/Agent)' f =� Date !ir
PERMIT CONTROL#
BUILDING PERMIT
DATE VALUATION ��} 97, i}9� LOT TRACT
100
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ADDRESS hL-.kAGlf UN9oE E'a�l�iB,;A
APN l(a'1-lQr�-IFt3.`:
OWNER
CONTRACTOR / DESIGNER / ENGINEER
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USE OF PERMIT
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14
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1998
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION �E�OO RD
O4'�RATIOM
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BULL®ING
APPROVALS
MECHANA CAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
41
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.IC to Wrap
G
F.A.U.
Framing /
Q /
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans &.Controls
Party Wall Insulation
Conden to Lines
Parry Wall Firewall
Exterior Lath
%
Dr
ywatl-I . L!!p
lot AAO r,
Final
Final —
BLOCK1i ALLL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
B nd BeatD
Approval to Cover
Equipment Location
V
Underground Electric
D
Underground Plbg. Test
Final
r —
Gas Piping
PLLQ.DRfdBWG APPROVALS
Gas Test
Electric Final
Waste Lines
$
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Sewer Connection
p
/
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELLECT6�ICAL APfPROV�a
Temp. Power Pole
Underground Conduit
Rough Wiring
Love Voltage Wiring��
Fixtures
Main Service��'�
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
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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 7/10/98
No. 17314
Owner NameCharles. and Marilyn Meechem
No. 52-111
City La. Quinta
Street Dunlevie Ct.
Tract # Lot #
APIC# 769-162-002
Jurisdiction La Quinta
Permit #
Log #
Zip 92253 Study Area
Square Footage 2,510
Type of Development Single Family Residence
Comments
No. of Units 1
At the present time, the Desert Sands Unified School District doesnot 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 2,510 or $ 4,844.30 the property listed above and that,building '•
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be:_?ssued
Fees Paid By Palm Desert National Bank/Jeff Lohman Telephone: _
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by
Signature
Juanita Green
L
Payment Received - $4,844.30
Check No. 73514
NOTICE: Pursuard ot ,_ by Bill 3081 (CHAP 549, STATS. 7996) 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 nm the date on which the building or installation permit for this project is assued or on which they are paid to the District(s) or to another public entity authorized to
colled them on the Diafri '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
OnMnna 8411 Inc.
201 E, Fawth Street
P. 0. Box•2301
Cinrinnob. Ohio 46201
(013) 397.99713
charloo S. Moehem, Jr.
Chairmen
July 2, 1998
City of LaQuinta
Building and Safety Departmeni.
78-495 Calle Tampico
LsQuinta, CA 92253
To Whom It May Concern:
This is to Inform the City of LaQuinta that I will. not be leasing my
home at the Tradition Golf Club. This home is being constructed to be
used as my residence whop I am in the Desert and is not being used
as a commercial venture.
ea
Sincorely,
Y. MP .w rV • ...VY. •..r..., V. 1,
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE
❑ POST TENSIONED CONCRETE
❑ REINFORCED MASONRY
❑ STRUCT. STEEL ASSEMBLY
❑ ASPHALT
❑ FIRE PROOFING
❑
❑ OTHER
JOB LOCATION
/ N l Q `
C.v
60L� A (/vc) I- ^ u,y�
REPORT SEQUENCE NO.
TVP�F S CT}�RE
M,eC-0 MA,
PERMIT N0.
D9TE AV OF WEEK
MATERIAL DESCRIPTION
ARCHITECT
IN T0R HRS. CHARGED
ENGINEER
ASSISTANTS f HRS. CHARGED
INSPECTION
DATE
GENERAL SUB
CONTRACTORhj-�SVe") CONTRACTOR
ERLE%o
( aa"
COPY SENT TO CLIENT ❑
ON UED ON NEXT PAGE ❑
PAGE OF
CERTIFICATION OF COMPLIANCE
'HEREBY CERTIFY THAT I HAVE INSPECTED T.0 THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS, SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
10( SI NAT RE REGISTERED INSPECTOR
26 61114VI
DATE OF EP R7 REGISTER NUMBER
1 1 `4
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: 52-111 DUNLEV1E COURT
Use Classification: ' SFD Bldg. Permit No.: 9806-144
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CHARLES & MARILYN MECHEM Address: 6225 REDBIRD HOLLOW LN
City: CINCINNATI, OH 45.243
By: STEVE TRAXEL
Date: 1-20-99
Building Official
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