0305-256 (SFD)r
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
f ?19r? L' kd1t �« Y b. df I✓�
Date�•������ Signature of Contractor fl,;m'1�^t .•� ^rl�'C�-
i
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 MIEMPT Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
(N,; 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 -S' ctionr3700 of the Labor
Codeel`shall forthwith comply with those provisions'y ,1
Bate Applicant
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 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. Lagree 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.f't r
rgnOr/Agent) Date
r.
BUILDING PERMIT PERMiT#
r^
_
DATE VALUATION ` t � �t J LOT S _ .. TRACT BLK 2.14
JOB ADDRESS W-460 A:VAL°iNID �°,�si+.f�
APN a 8�=`. 4-012
OWNER
CONTRACTOR / DESIGNER / EN (NEER
HAMMS HE". UR
A1.4it�.LD Q TA:sf'LM.
69-100 e t 49:ti) �cr
1 C, cpa'. f:rn!
'Y CA 92234
PRD408 CA 92 -
(?60)324..4551 03LA 471Ce
USE OF PERMIT
fir+ Taq
IJAy tYVW_'-
A 1'l .:.. -3. 47Z"07 v4j ' Iti .A.T, S 4 Il° Uieti'{.p Q, r—M 9. .°° t"6i:.43"
- DRIVEWAY APPROACH Off 1s; T.M%,A,.VWSSED E`r';:1997 UAC 0344,5
�h.ltri3ir.t: ��i4bTldf VJt9'T•SL)U'S` BZt'dt:,�ITV;,I.PEItA!!t'k�'
TRACT CONSTFkI,It".'T +Oil
C+h.}l_Ft,OUC-AlklaORT 4'r: ,00 O
CONS 7 1i 1ICTION FEE e rt n l • COCK' -4) 8-00,3 $6.744"
•.
FLA1N, CHECK K1; I C51-wo-d39r311, $560.61
.
FEE DEPOMT 'Ilii -0.00M139-31; 3 ttiat�,G€i
M ZCHAW iGA9.lV•000 $S9.OfU
i 0 1 0 (11 () _4 20 W., D,
PL-Uh?€r INO Poor l9 01K,
MOW MOTION RX - X)MIO 1.01.0 Yl3-241-e)(*
OPLAOI14fJFEZ lfl.l .006
MV9L-GPER.'1M'RAC.' FEE . ZaAgdfds, ��
PRWISi Pl ,flAi
INVEST KI&T ION ME Z 0i
»« $isTB_-�WA4� 1Z, t.0M87AIUK',1'nf )A''AM-, P11"A'131C:'F-'lx or,
$4,753,40
JUN 0.5.2003 .
CITY OF LA QUINTA
L!___�FINANCE DEPT.
RECEIPT
DATE BY
DATE FINALEDINSPECTO
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
— Q
Exhaust Fans
O.K. to Wrap
-
F.A.U.
Framing
Compressor
Insulation
. 16 • v
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
3
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
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
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
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 dv
Final
Utility Notice (Perm) 7 �/
CERTIFICATE OF COMPLIANCEFt�sc
Desert Sands Unified School District
47950 Dune Palms Road li^ o
`,�
q .Q
BERMUDADUNES
bate 5/30/03 La Quinta, CA 92253 Cn RANCHO MIRAGE CJ
No. 24490 (760) 771-8515 �� INDIAN WELLS
PALM DESERT .y .
"� LA Q INTA
IO
�l O .YJ
Owner Hannes Scherber APN #
7714-094-012
Address 53460 Avenida Villa Jurisdiction La Quinta
City La Quinta Zip 92253' Permit #
Tract #. Study Areal-'
Type Single Family ResidenceNo. of Unirs 1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 - 53460 Avenida Villa'. 1807 Unit 6
Unit 2 Unit 7 .
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10;
Comments CC totals $3,866.90. Remaining balance of 8 cents paid in cash.
'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 1,807 S.F. or $3,866.98 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 OCMells Fargo & Company - Lavern Jacobs Check Not 0072503764
Name on the check
Telephone 760/578.8723
Funding (Residential ,
'By Dr. Doris Wilson
Superintendent
Fee collected /exempted by' S n M ilvr $3,866.98 $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 WE project is issued, or from the date on which
those amounts are paid to the District(s) onto another public entity authorized to collect them on the District('s) behalf; whichever is earlier. =
NOTICE: This Document NOT VALID if Duplicated.
Erribossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy Accounting
I
w
a
ri
m
r—
r~
r—
r-
LD
r—
m
N
(9
CD
CD
04to
to
M
CITY OF LA QUINTA SUB -CONTRACTOR LST
JOB ADDRESS Vf llo PERMIT NUMBER OWNER a G 2 � a BUILDER 04111 D
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stopppe of work and/or the voidance
of building ciermit. For each applicable trade, all information requested below must be comDleted by aDDlicant. "On File" is not an acceptable resnonse_
Trade / Ctassific a
Co Tactor
nt
g. ..:. ; ....
tate..Contractor sLicense.....
Wdrkers Coli nsai'
_ o. Ton Insurance.:::;'::;. `.. . City ausiness.License
Company Name
Classification
(e.g. A. B, C-81
License Number
(xxXxxxl
Exp. Date
lxx/xx/xx)
Carrier Name
(e.g. State Fund, CalCompl
Policy Number
(Format Varies)
Exp. Date License Number
lxx/xx/xx) (xxxxl
Exp. Date
(xx/xx/xxI
EARTHWORK (C 12)A,
U 1 A/
d 13
tl�3a 0
/1/DIV(
- 00 1 -7 98
762-
/Y
CONCRETE (G 8) .
/
FRAMIN.G..(C:5)
D14Vt D6L If-A-Y014..lJ
b
%30 O
F� /f
-110
5 -/C -O
STRUCT, STEEL IC -51)
?57 S 5
30 0
I�fk f
!4-0`/
MASONRY IC 291.. -
1
7S7 S7,S
YD bq/
rix/_`fYI I-
L41 10
`r(C/ •0`i
PLUMBING (C-36).
7 70
LATH. PLASTER (C-35). '
Of �! �� l L
q
C I
�!` �'S
3t -D�
�j�sf (�itC-C o�r� ..T
Lc� L' 7/loJ 7v `�
J -/ - U`i 3767
DRYWA
�i
1-�
'
i�
%!07
/Z/5-ohD
HV-AC .(C-201OA/
I In
LZO
a?& 58;�
/0-31-(,4
� �'cGL.
04
:..
ELECTRICALIC:101
OOUe fi-Le,/FLL
L
'ROOFING (C--39). .: :..
2 (//3 a r/'
C=3
Z g L Z 3
9/3a a3
F rn -r
2 0 0
Y4103 • i
SHEET METAL(C-J!:-, _::-
��
7 ff %
l!l jbG�f
n
Ehu r
:FL60RIPI
Vi A 4p/L
/J
k7 Sy
1lf30aV
y71O
- Q -o4
GLAZING IC 17.j'...: ,....
O [ e G/Iu00woa/ls �hc
G (0 1
8Z
713,103
S�"k`fe F9tvP
0 (/ $
4 0t 03 30 8S
1'131Xo33
INSUlATI0N (G-2} > :.'<.
tPq
4- IF V s/ NS Ae IoGfS
—
(.S/
q
//3o d3
FnDIv� v� l2 2 ��
�2V1- %i Z3 GBS
C (. 22 o dot
6��o p� /_8/9
- 6- c { f
:SEWAGE'DISP.;(CA2)
v 7
!�
7S
/1�30,v
r— e
10
PAtNT1NG (C 33}'.- °:
11
(1i 4 A C0/(
9
l �0 6
�M 1`
`-1 7/0
5-19 •o`/
CERAMIC.: TLE. (C 54.) ...'
04V 1044 . � �-0 it
�
Z $ / SIY
�I � l U
CRB.INETS tC 6.) ::; : '°`
�f, / t t
-
7
G� 0 d
l l/ OGN �.0 2 /
d - QUI 2 yU S
/(2 U) 5
Z Oj
/D �i o 3
FEAICIN6 {G>1s1.::::::":::° ;':
V(V1 'd8%.S
Sr
l / 6/0
9r
�/7/U
LAHQSCilP1NG:'.(C;71:'..:
V l D
�7 Srl S�
(!� f 0 0
riN1 ice.
�i 7/D
M -O'9(
POOL IC=531•.'.:':~'^
.S �. E ing Mud -1 A i��
f
• 14712 SW Schol.ls Ferry Rd , -
# 328
Beaverton; OR .97007
SIP Engineering
Consultants, LLC , 503-524-8268 Y
'.
503-213-6222 (fax)
1-2-04
David Taylor
Pacific Crest Mortgage -
68100 Ramon Rd Suite C-9 ,
Cathedral City, CA 92234 `
RE: Structural;Observation of House at 53460 Loa-Aventda, La Quinta; Ca
David, _
Sample observations were made of the above house to ascertain whether the
general intent of the construction documents is being followed. VAth respect to the "
structural items that'remain uncovered and easily observable, this appears to be the
case, with no more unresolved deficiencies remaining that I am aware of.
--'---------- ` 27' -
Mike Nelson, PE d Exp. 6/30 4C
x CN1\-
. �TF OF CAd�Fa