0207-026 (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 # Lic. Class Exp. Date„P
,,%%��
V� ate l"", - Signature of Contractor
• r�
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&RC. 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.
t I have and will maintain workers' compensation insurance, as required by
Sec ion 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 S`q'�L"!'i�, �rUlil'"s Policy No. 1615846-M2
(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 thayif I should become
subject to the workers' compensation provisions f f Secction 3700 of the Labor
Code I shall fort, with comply with lao e-provisF,onsj
Date;: {» Applicantw_
Y
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety Yi
.
for a permit subject to the, conditions and restrictions -set forth on hi$
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 riot 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 Stats� laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspectio ,urposes. _
Signature (Owner/Agent)�d�i2 / ! Date''
BUILDING PERMIT PERMIT# ,
0207.402 =;
DATE VALUATION LOT TRACT
JOB SITE ADDRESS73-Mi1�,°.t'7,gMWA �r
APN
OWNER &
CONTRACTOR / DESIGNER / EN (NEER
"DV.EW PIE.Rlv'E COXT'ORX11100119
55�5� .kZ Itil
44835 I KEP CAWYON RD
LAQUI£',1'TA. CA 92253
MIM 1=85yaY CIP.. 92.n61
C760)346-3222 (.Wld7 03031
USE OF PERMIT
45941 S.P. :uI°ia'. PERMIT DOFZ NOT MCLUDE 811,01 M W, .14LL U'•P. P004"
r
CW t'OM CONSTRUCTION 096:00 8F
POR.CHIPWPio 3, iS6.i?0 e
OARAt.3 YC'ARP'OR1' i" &DO SF
'ss A ,) con oir coNsu :I31:'i3";Z:Pm
32"A,364.00
`..am., STE FATA1V"Ry
ecyiN AUCTION FEE 201-000-418-000 vafnoo
PI<A14CHECK "F F, 1tgl<At1C�S��7-.39£S $I,a"fi5.3i
FEE DEPOSIT 101-000.439.318 _S1,900.00
MECHANICAL, ,FR ! i11+ UCd9�i21 •A� $I95.f?If
EUC 1'I#1CAL FEE 10.1.000.420 -nth
PLUMBING FEE 101-000-419-000 $225.25
S T IZZONG MOTION FEIR - RlFAID 101-00€ 441.000 $39,44
C#RADING FEZ '$15.00
DIsU'FIXO PER IKPACT MW SZ405.00
,ART. iN PUB1,117 1I..A.CES •1ir--3iL 2'70-000-445-000
03X1 • J°Cil'�`,C,�:ONS:iR C 1 014 AND tPT..� its' C;;�;�t�.CK
$6,662.29
_
-- -..I .
411,C��i+g),,00
Y y �y vL�Ee.,�y�yyp�k7iZ}ice*'lv"��iat:C�M)
1� PI
'. OJLf'�.7.� S: 4p�5,1.'�38d �rJ—M f:.+ r.F11 11TO `Y
SEP 0 6 2002
000E LAQUINTA
FNNANCEDEPT.
RECEIPT
DATE ^'
BY
DAT FINAL D
INSPEC�
c, �'
�
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
Y' Z 5
Exhaust Fans
O.K. to Wrap
-
F.A.U.
Framing
_ _
_6 _
Compressor
Insulation
Fireplace P.L.
—l� ��
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_
Final
BLOCKWALL APPROVALS
Final
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
Waste Lines 2�
Gas Test
Electric Final
Heater Final
Water Piping
_ _
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
U. U2_
Encapsulation
Gas Piping
Gas Test
/�
sQ U3 �`7
Appliances
Final
Final
Utility Notice (Gas) J� < t3 v > %
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: / q
lY t%/4C� U IJ" /t -- ✓� �[�'�% O Z
yl/� �� �� O 2 A!
/✓ (%
CERTIFICATE OF COMPLIANCE�-VIEDsc
Desert Sands Unified School District zq�c?o
47950 Dune
� Palms Road ¢ eERMUDADUNES r
Date 9/5/0'2 La QUinta7 CA 92253 RANCHO MIRAGE d
�• INDIAN WELLS ti
No. 23571 (760) 771-8515 `�,�v"n��P� QUINT �y
V INDIO
Q O L
Owner M/M/ Blake - APN # 703-400-13
Address 55-598 Rivera Jurisdiction La Quinta
City La Quinta Zip 92253 Permit #
Tract # Study Area '
Type Single Family Residence No. of Units 1 `
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 78-255 Winnie Way 4596 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8 ;
Unit 4 ' Unit 9
Unit 5 Unit 10 Y
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 (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 4,596 S.F. or $9,836.44 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 - Jody Jones Check No. 084747
Name on the check Telephone 760/346-3228
{ Funding Residential
By Dr. Doris Wilson ;
Superintendent
Fee collected /exempted by Monica Guillen $9,835.44 . $0.00
Payment Recd 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 Department/Applicant Copy - Applicant/Receipt Copy - Accounting
ID:
Feh'?5 [] p`;r4Vp D+str, [•:hristirtn
FEB 26'03 10:29 No..001 P.02
�itrtao Eng '!14 9""l
i
. I.
,
5
CAre
LL' cf IR7STIAN/
C . NSOMNG & DESIG14
4 vq7 114;
71.1 9'77 W.? Fe„
i chruary 2S, 2(103 � _
Mi. Troy Hullo, Stlperinhndent .
f.n(jrew fierce C:orpntation
44. 8,15 Deep CanyoA
Palin Desert, CA 92261
Re; blukt Resitlouce
l.a Quinld, CA (Our Job No. 02055)
Deur Mr. BUIIU:
of tild first
Pursuant to your izquec t, this ollice has made several
anchor Stills And slariitst on
to the �oU9 h +ldve ov>? 111rcted ]ware prin.,
pp tile ?concre a pnttr.` Minor
October 11, 3002. w"As to observe the placement of.
items, such as haldown:n; without reiforcing within their shea ' curies anj Mimrnlin rehat.clearttncr,, were brought to the.aliention of
the concrete fr:,iemarl art&were etrre•cted during the pre -slab V sit.'
This office rnac site Visit of the o of )die d ry,2U0 to ososorne herr quite mi ot), worelie. rough framing of tcor,r lid J ling Ott: milk -through.
t uaformar,:..� 'tire structural plans, most of die deticrtnt s isa;ted and fax:d to Mr..3ullo, with the intent that the
For the feln:,tning iterYts, A structure! observation report dale 2!12103,
contractV will perfurut the cwtrspurtdent fi'illow up along wi t tltc city,, official support to assure thr proper correction or pick -tip
of the Pandiug itettis...
Tl r, ',ough fraraiDS, after our Inst visit on the 4" of February 003 along'with the verification £ram Mr.13u110 tlt.at the pending items
wet .� corrcct(4; appeared to be in substantial conformance wit the struct ral plane.
These obr.'ervations are i ,tended unly to assist the frantiug c tractor in;cunformarce. with the strucMral pilins as they relate to this
residential dwelling pn/jact and are not to be On as " S ((clot lnsPectlutrs". The responsibility for such plan cnnfnrrnance, of
course, remains will* die rttclor. Please do not hesira(
to contac me at.my office should y -)u bave any farther. questions
regardine. the site observaticonton, nr with information included in t111s repoit�
;
Sincerely.
Dalt: cA . Glirt�t i
rn
�:
I
r -
SPECIAL INSPECTION S.ERVICE'
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool ,• Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (7160) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE O ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
❑
❑ OTHER a
JOB LOCA!7
e 1
FEPORT SEQUENCE N0.
_ ,„ `
TYPE ,ML!RE w Res,
(J` 'Y�®_`L'`'
PERM®NQ, O w v X �
- TE O
DAY OF WEEK
MATERIAL DESCRIPTION
ARCHITEC"V�,
HRS. CHARGED
ENGINEER k `
ASSISTANTS
HRS. CHARGED
INSPECTION
.DATE
GENERAL.^^ An� _- 11 SUB
CONTRACTOR �NG1GK.J1 QAC O. _ ,. CONTRACTOR
-
L�
y,
it
l S 0,\,-
0)<
0)<
COPY SENT TO CLIENT ❑
CONTINUED ON NEXT PAGE ❑
PAGE OF
CERTIFICATION OF COMPLIANCE
I, HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV
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.
I N ITURY
OF REGISTERED INS
CTOR
3
DATE�-
dF R
ORT
REGISTER NUMBER
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
I Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE TRUCT. STEEL ASSEMBLY ❑i
O POST TENSIONED CONCRETE 13 ASPHALT �gTHER
13 REINFORCED MASONRY O FIRE PROOFING
JOB LOCATION
g -asS o te- LJ! LA u ��-�a
REPORT SEQUENCE N0.
TYPE F STRICTURE L [� es
ST R
PE i yOO r) 0
s.
E O
DAV OF WEEK
MATERIAL DESCRIPTION -
-�3TJ
ARCHITECT
INS_PE&TO
HAS.CHARGED
ENGINEER �„�
7�7��11
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERAL n��T
- • r'- CONTRACTOR �NTSUB
RA�rC1T10R
,
001
I
IB.S l.E"D ot,Jele �r• .tom
3 - c
et,ne�2 ` C--Z�10 ' v �'L
LL yo-�. S •�-
COPY SENT TO CLIENT O
CONTINUED ON NEKT PAGE O
PAGE
OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV
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.
IGN //T..YRRE OF REGIS ED INSPECTOR
p
D E F REPORT REGISTER NUlk'. J
SPECIAL INSPECTION SERWCE�
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
`CSTRUCT. STEEL ASSEMBLY ❑ c Lj��
❑ ASPHALT THER -si4 /
❑ FIRE PROOFING -tiot ,N
JOB LOCATION I
g _ . . 1 n
REPORT SEOU.ENCE N0.
TVP S C
PERMIT NO.
DlT�� Off, OAY OF WEEK
&S-3RE
MATERIAL DESCRIPTION , A_3&
ARCHITECT
INSPECTOR' HRS. CHARGED
ENGINE"k�+ �
ft
ASSISTANTS HRS. CHARGED
INSPECTION. _ GENERAL
DATE - "CONTRACTORR4keu)CONTRACTOR
SUB
S
.6 C
1&S Lizwn .
D(A TIE&
S-&
tjO p (/ eJ-O 1 W& CpM-
8ie-b�QyQ. '-kit•
�. dS 'e i
COPY SENT TO CLIENT O
CONTI D ON NEXT -PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV
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.
IGN TURE F REGISTERED SPECTOR v
DATE F REP RT 1. REGISTER NUMBER