9906-214 (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
(471203 � B. 0�13i{20f
Date 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).
(9y��) I, as owner of the property, am exclusively contracting with licensed
contractors to•'donstruct the project (Sec. 7044, Business & Professionals
C��ME
d�•
( x mpt,u der Section B&P.0 f 6 r is-reaas'onf'°`�' —o,'
Da ^f 1/� r� f
V �sf1 , Signature of Owne r'/ r �✓ ,. r1�
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).
i. ( I certify that in the performance of the work for which this permit is issued,
r 1 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
3subjecbto the workers' compensation provisions of Sectlon:3700 of the Labor
Co �I sha 1•forthwith comply with those.; rovlslons..
e*
Warning:
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $10000, 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
constructs p nd hereby authorize representatives of this City to enter upon
the above-mention/ed p,rot�perty for inspection purpo�seys.
vSignature (Owr��genY)
Y BUILDING PERMIT PERMI V906
W
DATE VALUATION :.3�y; LOT j TRACT 79004.
ADDRESS , 7th ti�5 DFAC`.GN DRIVE FuS !t
OWNER
CONTRACTOR /DESIGNER
UAARY & ✓gREi;AA
�/yENGINEER
riND'AUb
RkLM U.13SER11' CA 921261
,`760).-0€"- X228 COL -9' 3.1331
USE OFg7PERMIT
SNqqy DfARUANG
SF -D - W) 3:t> OCK WAUS vri POOL. tW.4T6 tat.,'L. Ft:,1.Jt"PUnl, c�
�'C:3r, i.t\4' 4td<.l.(3f3[I+Y�3 r'i 3 I�TCiAP�sC:3 i1 `: 3 Cd S A� 3' t`sf.^ 1973 (16' .
U.-44, 1531, 01iR O J( Al k+LICAIALF., IN 'RkiQ3J!!'C .T1
IMIS'3"OM i 0 +f 'MUC; t 1014 :3,0.33.00 SF
T'tJTt(�ilft?f S3C} 253.00 SE'
0o-i&,A0h CARIA 14' ' 769AA) S
' f, a yO
a
R11.AN 4"FEM FEE
�T1��;Ya'1af.'t f Gi �Oiltt +1w' 1�; 57501)
VIT.K S92.1k
_
• ELE-w`k�J[CIAL }ihFlZ12.34
S3CAINI371NQ FEE
k.: '' • '
Sz'P10NIG, M10111014 I - RISS ra
,ir•
A3IT ITv'3>8. BL'3C PLACES - idRSIX, 70i. -OW -255-0(J£?:
DEXP- OPER INAW,A1"T FIT .g.' 1,9 rrt
i. "t
1JFt-1'3:i? V1,, ANT) 14AN" (':i•iEc'i�.
LESS P1!.E-(� 47 3 �{�3 ti
•$7�C1:tJ�
1W -AL PERMi."I!'FEE:Fi•Qb1J€+"..NOW
1 ti
rw
RECEIPT
DATE
By/
DATE FINALED
INSPECTOR
at
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
K- d0 :5:,T
Combustion Air
Roof Deck
3— 6� 57
Exhaust Fans
O.K. to Wrap
__v0
F.A.U.
Framing
g%�- ozo .3-7
Compressor
Insulation
-,7
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall --Int, Lath
8=a 3 - po '5-T—
�_�-eo 5?
5 wi" 4�
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Hacks
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
_
- j,
Encapsulation
Gas Piping
_
Gas Test
/ • O
Appliances
Final
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
,Final L -O
Utility Notice (Perm) , p
COMMENTS:
�Cv
P.O. BOX 1504
Building �� UINT CALLE CALIFORNIATAMPIO
Address C�CcIi1��C LA QUINTA, ORNIA 92253
Owner t 1_x A-& I
Mailing
Address
City
� �
Contractor
wo
City/ IZip� Tel_
State Lic. City
& Classif. Lic. #
Arch., Engr., r
Designer !'rI
Address Tel.
CityPPZip State
� e441°12260 Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000)of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE — _ DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any Structure, prior to'fts issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or thathe is exempt therefrom, and the basis
for thealleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
17 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, Bufsness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
I 1 I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
17 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
n Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thF 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.
Date Owner
NOTICE TO APPLICANT: It, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and slate that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
con struction,and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of a0plicanl Date
Mailing Address
City, State, Zip
APPLICATION ONLY
BUILDING: TYPE'CONST. OCC. GRP. 11
A.P. Number T p
Legal Description �� r I rG S5470 "
Project Description
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
1.
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback fromtrop. Line
Side Street Center Line
Side Setbacl of cc��o((p��le
e%M
FINAL DATE RECTOR`t
Issued by: Date_ ,
Validated by: ®�
A
Validation: J
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
0
Notice:
Document Cannot Be Duplicated
Date 10/27/99
No. 19520
Owner NameGary Lohman
No. 78-551
City La Quinta
Tract # 28470-1
Type of Development
Comments
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Street Deacon Drive East
Lot # 5
Single Family Residence
APN # 769-162-001
Jurisdiction La Quinta
Permit # 9906-214
Log #
Zip 92253 Study Area
Square Footage 3013
No. of Units 1
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 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 3,013 or $ 5,815.09 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/PD National Bank/Andrew Pierce Corp. - Lohman Telephone _
Name on the check
By Dr. Doris Wilson �','•,.
Superintendent
Fee collected /exempted by Juanita Green Payment Received $5,815.09
Check No. 76051
Signature
NO' nCE: Pursuant of Assemt# Bill 3081 (CHAP 549, STATS. 1996) 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 tft date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them on the District('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
..
.0.)
'Tradition
ARCHITECTURAL DESIGN REVIEW
August 18, 1999
Mr. Greg Butler
CITY OF LA QUINTA
78-495 Calle Tampico
La Quinta, CA 92253
Re: Lohman Residence
Lot 5, Tract 28470-1, 78-551 Deacon Drive East
Dear Greg,
CITY Oir L.
()LsINi'4
'OCT 21 RECD
8U1LD/NG,4NL SAFE
Via First Class Mail
and Facsimile
Please accept this letter as approval for the above referenced residence to obtain a building
permit. Conditions that apply to this submittal will be forwarded directly to the architect,
Ms. Kristi Hanson.
If you have any questions or need additional information, please do not hesitate to call.
Sincerely,
Christina J. Dores
Architectural Review Coordinator
/cjd
pc: Gary Lohman
Kristi Hanson
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78505 OLD AvENuE 52 --• 1A QuiNrA --' CA 92253-1120 -- PHONE 760/564-3355 --- FAx 760/564-2356
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Andriw PiQrca Wporarion
44835 Dgop Cannon Road
Palm Desert, CA 92264
MAI(. TAX ATfiMI M:
SAA111 AS ADOVO
ID:
OCT 20'99 10:41 No.003 P.03
caaveyel. to - - . -. ---+
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FOR A VALUABLE CONSICM U'l7gN, sccolpi of which h hasty a dolowlska
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Coilnly of Rivoraldc State oraufbmla, dnarhdin
Lot $ Tract 28470-1 (See Exhlhk "A" Alt4chod f lercio)
Dated: September 11, 1998
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avow iu eaptt:ityo*. trA tbst by h{aA "*Mfr
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which IIIc porion 00140ecuttt) IhC lnatmnent.
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OCT 20'99 10:41 No.003 P.04
Got s of Tr= 28470.1, ea shown by trap on itle in book 263 pages 76 through 90
of maps, records of Riveeslde County, Calilbmis,
THIS DEED IS MADE AND ACCEPTED SUBJECT TO THE FOLLOWING:
1) Non-deliaQUcm rent CAM taxes asse111MM
2) All matter of Favors, including whiwut limitation, that cenaia Declaration of
Covemis, Conditions, Rutrictions aad Reservation of PA meats for the Traditioat
Community, recorded on July 25,1997 as Instrument No. 261677 end re-recorded August
is, 1997. as hi*= at no. 292176, bosh of Official records of Rlvaddc County,
California. whloh 16 inaorpotated by rott anco boWn sa If fully met forth at twath (the
"Declaration"). The Declaration Idoludes, among olhea mauers, ce"n arcbitactwal and
development guidelines and restrictlont whlob will apply to roe WrOmadon of a
mddenee on the above-described W.
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t
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PUBLIC WORKS CLEARANCE LETTER
FOR
CUSTOM HOME LOTS
Dear Builder: r'
Prior to issuance of a building permit, you will be required to'obtain clearance from the
Public Works Department for one, or more, of the following:
1. Verification that rough grading is complete, and the pad elevation certifications
prepared by a licensed surveyor, or engineer, are on_file in the Public Works
Department.
2: Verification that infrastructure improvements and other required tract -improvements
are complete, or sufficiently advanced to warrant building permit issuance.
I Prepare an engineered grading plan that provides for on -lot storm water retention,
and have it checked and approved by the Public Works Department. _
• Tract 26524 (Estancias)
• Tract 26769 (Mountain View Estates)
4. Prepare an engineered grading plan that provides for building pad grading in
accordance with the existing soils report and tract grading plan, and have' it
checked and approved by the Public Works Department.
• Tract 28034 (South Valley Estates)
FOR WTERNAL USE BY PUBLIC
TRACT:
LOT:
UBLIC WORKS AUTHORIZATION I A
F:%PWDEPrOOCSTORMSIPW CLEARANCE LETTER.cs
COMMENTS:
Am
AM
Concorde. -Consulting Group
Construction .Management • :Project Management • Engineering • Development
August 2, 1999
The Plan Checker
Building and Safety Department
City of La Quinta
California
Re: Plan Check # 9906-214 — Lohman Residence
Dear Sir/Madam:
As project Engineer of Record, this note is to certify that I have reviewed the truss
calculations for the referenced project and find them satisfactory as to the design intent
with respect to loads and spans
Please call me if you have any questions
Thanks
Dr. . M. Kripanarayanan SE
SS11n -4
o3 Z err
y No. S
`Pi�TT�'U C T Ue`@e
F OF C AOF��
722 S, Fremont Ave, Suite # 9 S. Pasadena, CA 91U30'el, �b24j 4p3"7451 Fra:b26) 403-7459
4511 n. Sonny Danex Su1tr3! E +Pali+a; Yji'1tyS�, ICA. 92104 TO (.760) 322 - 8fi26
20M Terrm Court SMS # T S"91 ; ICA— 93359'ft+ 4895) 297-'752 Fa -x: (805) 299-6424
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: 78-551 DEACON DRIVE EAST
Use Classification: SFD Bldg. Permit No.: 9906-214
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RL
Owner of Building: GARY & DIANE LOHMAN Address: 75-570 MARY LANE
City: INDIAN WELLS, CA 92210
By: STEVE TRAXEL
Date: 06-12-01
Building Official
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