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0212-193 (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 729 B 1,117C. 513 1; 104 Daie ! -Signature of Contractor 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). ( l I. as owner of the prooertY, 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 S?WJ H rUN."D , Policy No. . 046-0•00909 ' (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 sha �� rJKi ith comply with those provisions? , > Date: J" 6 Applicant tZA.f~ ; �x „. .: '� r. 4 • ?ifrl :-.G , Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up. to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon -whose behalf this application is made &each per4-on'at whose request and for whose benefit work is performed under or pursuant'to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if. work is not commenced. within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I' agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) d� ;� -• �� _,X, =' Date �/ + "' `:`41 - -BUILDING PERMIT PERMIT# _ C+'Zl y��� n DATE VALUATIONLOT TRACT NIBJOB SITE ADDRESS ''I111a?11.�.lYi APN OWNER CONTRACTOR/DESIGNER/EN (NEER r 'r1;I` M. F_? T3.r" INBRLL i:W MAND. D VSA 9R110 ' TPl114 DEQ _17- ` i' CA 92211 ;J t3j1616-9335 LB116 (5851. USE OF PERMIT 11.21 R-111 IMN YD Wr.�LLINUI N ;,l Y.A.kIL, UL,.i�;:A Mi:, V1,.,D JP 3.. &VITal M U01% DW WMIM THE TiNDANICIR-R-RD PECir�' A..ty'l' Or 13'ry'r$ .�Ax^�"i t�P.Si tv gS 1c�t�f.F11:23Ci. c:USTO.1 090TRUCTION 6,439,061 f+ ��+vrR�:•YYf�?F�'1'Yfy 3�:•1.[.�� • C 0119 _ , CO.'kCEIR�.Y4;`.T�Y:1% 328,159`991A) �. tea. ya ?p �E'f�prikuk'�rD ME 101.000.418.000 $2,126,X Ia��Y,y,,1�,��.s��, 1:Gt9.-E,1�.?���d:��•-31P $1.;i'0J0.9°3: T*�E�Y� DX_1K111211pi' q� 1.4E nHAVI'9I'A1J67�..."Put ,1, .f°J,4<�►N..s,-,�Q :';�:A, O>9w ;iydO W S3M.6 �Ltb1+�+1fhIL'?ti'�''�a •' iUa �a!')db-�� "-iip0 �.rU3.��� .�31it`r°t�C1 /3i� ' ti)Si pA. T,52,94 OR2AOING MR, 101 0G04231 _000 1 �.Jt► }>E?'�iT+..1:.�;;�?„1d; .�rl:l�l�f°'r �'�.�:. xa,4if>I.i7fo • !.Rl 'ltz KYY� ACF PLACES > R V_S11.270 (r'Q�1-�6d w..�3q.9G �wi l..OID `+.�-�P1':> 3i�s.��ti:'i(�.4an.�r..>ipDyt�.71�ix(T ![.��.'(►� �yy [� " I 16LL•i.AJS .C���?t•G�6i1J..� YMMS. r./�y'� • d.�..�J,�A+IJ �LSitA17�1..7. .F'.4'.�f/, .7J�JZ•;"V\!'rT.. d"�W`�LAI.00 17T 7yt�Y�.'�..%7� APR. 0 . / RECEIPT BY DA IND INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts p ' Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck - Exhaust Fans O.K to Wrap 7Q 1 F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Q Q 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 - 03 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 Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Q Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power L v Final Utility Notice (Perm) �/ COMMENTS: ` I CERTIFICATE OF COMPLIANCE Desert Sands Unified School District z4C s do 47950 Dune Palms Road Q BE RMUDA DUNES r Date 4/3/03 La QUintaf CA 92253 RANCHO MIRAGE (] INDIAN WELLS _ �. '1 No. 24274 (760)771-8515 �,� PLLAQUDESERT �y 10-Q INDIO V © J Owner Sam & Alice Christensen APN # . 770.-340-012 Address POB 10340 Jurisdiction La Quinta City Bainbridge Is Zip!'. Permit # , Tract# 28867 Study Area Type Single Family Residence No. of Units 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 12 78275 Winnie Way 6439 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 , Unit 4 Unit 9 L Unit 5 Unit 10 Comments , At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patbsANalkways, residential additions under 500 "square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, Balling 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 ti This certifes.that school..facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $2.14 X 8,439 S.F. or $13,779.46 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/Provident Bank - Mark Coyle Check No. 92958 Name on the check Telephone 7601568-9335 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Shwn McGilvrey $13;799.46 s25-5-5 Payment Recd Over/Under Signature C 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 h Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Ccpy - Accounting May 07 03 11:04a RAM Development (760) 34G -383,3— P `TV. .SURVEYING, V - lfuuntlar}'-• Consrr c::ur. inpngrq:rhic Aeria: S✓rreps AtTP-Surveys-CPS-,':or su:l.n., May 6, 2003 % 02 cAj i ti kJ Mr. Timothy .R. Jonasson Public Works Director / City Engineer City. of La Quinta. 78-495 Calle_ Tampico La Quinta, CA 922534504 Re: Pad/Form Grade Verification City of La Quinta Lot 12 Tract No. 28867 THE TRADITIONS C.C. Dear Mr. Jonasson: We have performed_a field survey to determine the vertical location of the building pad and form for the above referenced project. The elevation's observed are as follows: PAD (DESIGN) PAD (AS -BUILT) 88.0 88.0 FORM (DESIGN) FORM (AS -BUILT) 88.50 88.51 These field observations are in substantial" conformance with the precise grading plans prepared by ESSI SHAHANDEH, CIVIL ENGINER., Sincerely, :.., . EDDLE SURVEYING MAPPING, INC. j o�AN� 5�� 'W �Z amp O o'„ N (w C Q NO.5570 # David L. Weddle, President EXP. 09/30105 \� L.S. 5570, Exp 9/30/05 in OF Nov 10 03 12:06p Jack Cunningham 760-777-42-89 p.2 NOV 10 2003-11:16AM RHM DEVELOPMENT 7603468833 p.1 Nov 10 03 12:52p Walling McCallum -Ltd 760,3600796 p.l w^LLINo s MccALL JM / LIMITED REGISTERED INSPECTOR'S WEEKLY REPORT JON TANDY 37630 'Medjool Ave. Palm Desert, CA 92211 Office 1760) 772-7192 Fac (760) 772-7193 Pager (760) 776-3338 TYPE OF INSPECTION PERFORMED ❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY�p ❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ REINFORCED MASONRY ❑ FIRE PROOFING 7 OTHER JOB LOC 6N _ LJc n s l�-�. L0. v EPORT SEQUENCE NO. TYPE OF RUCTURE PE MITNO.- DATE DAV 01 W`EEEK -'CHARGED MIERIAL DESCRIPTION S ARCHITECT t�ic c v PVSFIECTO HRS.. z� QS ENGINEER -so'-109- o 109 -INSPECTION ASSISTANTS MRS. CHARGED INSPECTION DATE GENERAL CONTRACTOR SUB CONTRACTOR _ •- _ ( i Al A511, inc 4, t ocnAN W 5 `- k, (b 1� 6 O NDff�-,• f � � ��i� W\ M COPY SENT TO CLIENT O CONTINUED ON NEXT PAGE O PAGE OF CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE INSPECTED TO 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. 4 • ATURE OF REG ERED INSPECTOR Z � I c ao�I DTTE OF REPORT REGISTER NUMBER