0304-073 (SFD)F1
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
t Professionals Code, and my License is in full force and effect.
License # Lic. Class" Exp. Date
F r
10
Daie� f�``'� Signature of Contracto f dd e
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.
... V 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:
CarrierSTATE I� NE) Policy No. , 1 :'
(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 wcrl�6rs' compensatlon provisions of Section 3700 of the Labor
C•pde, I shall fortNkith comply with"fi677",
6 Ir visions.
,,'bate: / / a; / :• -a o Applicant f 6a7 i
Warning: Failure to secure Workefg' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost'of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the/building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property,for,inspection purposes. i
Signature (Owner/Agent) `:! ✓.
-•-1`y 1
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE
APN
ADDRESS ,9 90QSF% S.1"A 13=1c�j[i�^vAi
7
OWNER
CONTRACTOR / ENGINEER
�t�a �N� A.\t°ISaR.iSa�7.a1L 3r�,e.7.w1..i:��
y/rDESIGNER
'�.L.t'�rw �,�i. `9� �1.Jt.{,.;:1��� \.`✓ .l.fU �i�
�C•p'"7 I3D:fAAT?I;IA)'C �`.,O•�2T
T�J:AkF Jl'xi�l$�:�
I1�fii�3t� t A. 9124M
IND10 ,CA 922`01
i'760)772-0222 COX 0 211;_Q:►
USE OF PERMIT
2168 .S._p. S- 70i P 1NNIT 0031.E MOT .tN.:LLYD1.F, 3f.ZICK IMAJA , a'C) .)I.BRA
Gott DMV1:5VAY A ?PRC3.k1:t;'f1.11�Yo St:S^:1,NUC1,f) F�.,A14 >r:`FCE1CK ff a Auf:
MULTIPLE P,,.Jk .t C«aHEf'.;K 09'Lk&5.0: T SPP
VUX,C':7WS2i1'fY.UCTION 7011'.00 S?
JUN
20 2003
Cir,
OF LA QUINTA .
FINANCE
DEPT.
R:ONSTj UIX11014 ME I �wk 14Q -T'0, ; -A d V,-0?,11 F JSSi,;` D
Fi<a M CHECK f1Z, 'f 01-00L' -43V- 3 ! R $S M120
F&Y" DEI'C I': 2GI �b) C➢ d• •"alp - ?SU,?IO
ViRCHANIT;C.t , Fek 101- 4X101-421 -000 , v
x
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a7°RtS'W) N(C VO)"l ME - i,,091D 101 _Q0 ),, .�i _000 $Ear- 7
MA.011010 iorly. '107 $i11.06
a DWFLOPER IMMACT ARE 9?14011.00
t:2iL��-E51;PL,:KN
SUB, � x C'T!!i . 0_3k7i+"('i'..T']7+�'!' (Y9 Mri, P1to'.IKE ►t
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RECEIPT
DATE
�•. %
BY
-
DAT JNA
IECTO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
t2 A
Underground Ducts
Forms 8 Footings
Slab Grade
Ducts
Return Air
Steel
A,
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
i17
F.A.U.
Framing
Compressor A�
Insulation
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 4 Lnr
.BLOCKW LL A PRO ALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVAL
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
Final. .
Utility Notice (Gas)
ELECTRIC
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 Prover
Final
Utility Notice (Perm)
PPROVALS
1 444
00
01
COMMENTS:
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GRANT DEED
The underni3ned grontO*) declare(a)
Documentary Vansfar tax is s_n=p City tax trartafer
' 1 computed an full value of property conveyed, of
{ I COttipUM On fall V" lass value of riens or encumb:mcss remaining at time of ate,
{ I Unincorporated Area City of
FOR A VALUABLE CONSIMHATION. reaptpt of which Is haraby acknowledged,
mm MINGS LAM t 0WAW, WIC
hereby QfWrr($1 to Copp.
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QrAL DFsWUPTION ATrAC13E'D FER-1-M AM M=- A FART MEOP:
DATED: rlx 9, 2002
STATE OF CAUFORMA
GOUNry OF _ :art egg rjQ6-" _
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besie-�€-esestateteay evidGAGO to be the persen(of
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inm uwt and aeknowtedged to me. eget hefsheitigey
executed the same in his/her/their authorized
t:wdt?fk*. ar;d filet by hisiherftt, r signatura(!t'1 on
the instrument the person(9I. or the entity upon
behalf of which rho pemnis) acted, executed the
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F"IiATtakURftiWAICEMAW
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trtess my hand and official seat. ANACCO "'STIONONLYtt NOTEVWM
EfFi CT�{]fi4 iItTIE SHAW tiEA1 P181P�f`1
$igrtature iHATI°i.Y(OFSCY;�cl3iil
AIL TAX 1'ATC-MENT AS D)RECTED ABOVE
PD -13 (Ray 4/941 GRAND oeEo
Qescription: Riverside, GA Document -Year DoclD 2003.42504 Page_ 1 of 2
Order: asaaa Commen
+sob 6811886 r-6se F.oa5ioo5
F-011
�=M
Lots 55 and 66 of Tract 21130, as dlOwn by map on file in Book 41,
maps. records of wverstde t+ounty, Call rr" Pages 37. 38 and $9 of
Excep;ing from said Lot 66 that portion descrbq as follows:
i3eginning at the SOuthwsst eormr of said Lot 56; theme North 3`10' 17" East; al
line of ;laid Jot, 101.01 feet; tthence ply along the Narlh line of said iot, a dist ��o� 10.50
West
Wt Mmm S� 9 05'2W West, 101.77 feet to the point of beginning.
miidu�ui��wa�r��uaiduii •..��._
Description: Riverside, CADocument- Year. DoclD 2003.42504 Page: 2 ot2
Order. asaaa Comment
I
fi
CHARLES D. GARLAND
011991 - Architecture, Interiors, Space and Land Planning
Structural Calculations
13 May 2003
The City of La Quinta
Department of Building and Safety
78-495 Calle Tampico
La Quinta, CA 92253
r
Project: A Single Family Residence for:
Indian Springs Country Club
Models 501 A and 501 B
La Quinta, California
Regarding: Truss Calculations
I
To Whom it May Concern,
I have been supplied with truss calculations prepared by J M W Truss of Cathedral City, California
for the project noted above. Upon review of the truss calculation package, and in light of the
structural design documerits, 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.
Sincerely,
Charles D. Garland
Architect
i
74854 Velie Way, Suite 5 ❑ Palm Desert, CA 92260 ❑ Phone: (760) 340-3528 ❑ Facsimile: (760) 340-3728
W")
2 December 2002
The City of La Quinta
Department of Building and Safety
78.495 Calle Tampico
La Quinta, CA 92253
Project: Indian Springs Country Club — all units at
Jefferson Avenue
La Quinta, California
Regarding: 2001 California Building Code
To Whom it May Concern,
Architecture, Interiors, Space and Land Planning
Structural Calculations
I am the Structural Design Professional of Record for all of the Indian Springs Country Club housing
units. The developer, Roger Snellenberger Associates, has requested that I review the newly adopted
2001 California Building Code (CBC) and advise them of any necessary changes that must be made to
any or all of the units (series 400 and 500 homes) within the noted development due to structural require-
ments contained in the 2001 CBC 4hat differ from the old 1998 CBC. I have reviewed the 2001 CBC and
found that the pertinent sections of the 2001 CBC are adopted in whole or part from the previous 1998
CBC from which the original structural design parameters were taken and implemented in all of the hous-
ing units of the noted project.
Therefore, I hereby state that in eight of the foregoing the Developer may continue to construct
their housing units using the structural design elements currently contained) in the approved con-
struction documents.
If you have any questions, or comments regarding these issues or any other issue please do not hesitate
in contacting my firm.
¢ �Z
Q
� * U No. C11 91 p �
Charles D. Garland fp EXP arE
Architect OF
74454 Valle Val, Suite 5 o Palm Desert, CA 92269 o Phone: (760) 34035U o Facsimile: (760) 3403726