9905-155 (SFD)t
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
4�f*640 s ✓3<i'�t3i
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I he 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 isnot 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 Policy No.
STNIVE F(J..1\1V 1 to 6-99 0t}W3 7'
(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 rovisions Section 3700 of the Labor
Code, I s h ith comply Wi , f1 e provi It s. '
jp� vy 7 �y
pate: ���r O'7' Applicant
Warning: Failure to secure -Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, -damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and.Safety
for a permit subject to the conditions and. restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees .to, &.shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null.and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize-rep�esentatives of this City to enter upon
the above-mentioned propertt�yy.ff000r�r insAectiiio• n p/yrp�oses. f
Signature(Owner/Agent) Date %
BUILDING PERMIT PERMIT
DATE 4' �VALUATION :+�.y�xn3 LOTZ TRACT xc�Q�u�Q
JOB SITE
ADDRESS 78--7 1 ��E A CON •�$�,fE:'E EAST
APN '169
OWNER
CONTRACTOR / DESIGNER / ENGINEER
I
. Tl-em,4, x ?'Ci o, S!7 V11.1 1:r A D t l''' %m
UAt.4+Y'+. t,J 1i11 {1.1/,x.1 %.AA��1,1't
tw.+4Y 6'IJ>
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�J, {!',.�4.J1:(Ii �V}pI,.JE�R..
CeVl drl} C?IT CA. 32214
,
USE OF PERMIT
rA 11 OTi�'; wliC .rNt ,l. Olt fgs'.Jl,L. L',i"JMMIANCE AV1114 ALL.,1"'COM- 1 I &
�r7'Atii 4,t+.'dtiS i%f(1l tl +1N18'I'iIM�:S�'t ZYl�Stifylsltki.� °SPY,C:lFS Al,"3.' f•1F ff,0_4 .tia
L ii 5'S 01 1vI C0INS1 R �f.,3t' 6 0N' 31' 2 4.4)* SF
C3A3tA3 S@?,/�'• ,itlYt +3i'� 70.0 SF
ESIINI. .ED COST OF CONSTRUCTION
` r,7,912 std
r~•c�:v,�6Ft;�.r4;'a't�:>td !�'� Qui-(it�:i-41�-�J13QD �1,;��7.:5+•i
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ELF AL 9 2 ti Ai.F; .. 10 1
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10140,241-000zr.7r3
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Aft #' !N PIJ3z IAC PL -A— .k ;`s - 4163:01101.••000-"B5 0100 &11938
&
"4 A;f L. C`fr)T_il'F5"['k f iAM) PLAN rt-TCK'
SSP 16 1999
yC,s
RECEIPT
DATE
BY J
DATE FINALED
INSPECTOR
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
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
=� . CJS
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
-UO Sr
S
.46vz
5-7
Final
Final
BLOCKWALL P ROVALS
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
- t
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
G'Lg
Appliances
Final
COMMENTS:
\
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole - S 7
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) r
M
Building
Address
3-721 �
WAVW EA5?" P.O. BOX 1504
78-495 CALLE TAMPICO APPLICATION ONLY
LAQUINTA, CALIFORNIA 92253
oer2 /h2 S H�1�2r21S /�/5G�
M G
,/ [..
^
-CONST. V
Mailing
BUILDING: TYPE OCC. GRP.
l
Address (f7 K ( VovkwuhAj A/
A.P. Number
65
Cit'
ZlpgTft,, I
Tel.
K_V 1 C r (A •
Legal Description
Project Description -7tZ1 T( QA„/ Q
Contractor \
7Wow A-/gh1 �
Address6&,tc
--CLAX 7f v7 - �1C�
City /
Zip
Tel �'"�
State Lic. 1
8 Classif. W
City
Lic. q
\�- Li /a,� t 7bS f?p/L 7Y J' t r �7�GA;
Sq. Ft. �iS� No. ( No. Dw. '
/
Size Stories Units
Arch., Engr.,
Designer M _ S ceoFNl AIZC11114/7ca
New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address
Tel. �,
ISS-7
City (
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Zip
GGT, rl-
State C.� '7
Lic. # C a
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{ 1
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-BUILDERDECLARATION
pl fro from the Contractor's License Law for the following
I hereby affirm that I am exempt
Estimated Valuation
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 its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
Law, Chapter 9
PERMIT AMOUNT
the provisions of the Contractor's License (commencing with Section 7000) of
Division 3 of the Business and Professions Code. or that. he is exempt therefrom, and the basis
lot the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars (5500).
Plan Chk. Bal.
l; I, as oner of the property, or my employees with wages as their sole compensation, will
do the wowrk, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
Professions Code: The Contractor's License Law does not apply to an owner of property who
Mech.
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
Electrical t
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.)
Plumbing
I 1 1, 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
S.M.I.
1
such projects with a contractot(s) licensed pursuant to the Contractor's License Law.)
Grading
Il I am exempt under Sec. B. & P.C. for this reason
Driveway Enc. '!
Date Owner
Infrastructure
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.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS �/ {a �QQ�
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg 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.
j
_ J
Date Owner
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should become
ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Codeyou must forthwith
,
comply with such provisions or this permit Shall be deemed revoked.
Minimum Setback Distances: w � 1 11
Front Setback from Center Line
a� t +• Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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.)
Side Setback from Property Line
Lender's Name
FINAL DATE INSPECTOR
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 state that the above information is correct.
Issued by: Date Permit
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Validated by:
Signature of a0plicant Date
Mailing Address
Validation:
City, State, Zip
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Date 9/16/99 APN # 769-161-005
No. 19320 Jurisdiction La Quinta
Owner NameHoward & Ruth Harrison Permit #
No. 78-721 Street Deacon Drive East Log #
City La Quinta Zip 92253 Study Area
Tract # Lot # Square Footage 3154
Type of Development Single Family Residence
Comments
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 3,154 or $ 6,087.22 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/ Guaranty Fedral Bank/ D. W. Johnston Telephone
Name on the check t
By Dr. Doris Wilson x
Superintendent r
Fee collected /exempted by Sylvia Carrasco Payment Received $6,087.22
Check No. 015307
Signature n'16L 7
40TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to .
tilled them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
AI_Ila-619--1999 12:36 1-10!3�D:'•1AN GUTWER NQNOX ELL
is •fir, r.,, i re 3 t
Order No.if',tiftii(i0an Title lrisl!ff10E CaIYlpar`f
Escrow No. r
Loan No. !
-aGq N.$J rii•r'Y t-'. _l:. Vii._
RECEIVED FOR
AT 8,00 O'CLOGJ{
JAN - 6 i99R
°WHEN RI:iORllEU MAIL TO: Doc. Transler Tax
Howard F. ;Harrison :=in
cy,`
Ruth K. Harrison FRiv. Co. Recorder rft' r r
iTT
17 Inverness Lane Fem s
Newport Beach, CA 92660 -"^""'ro"A
;MAIL TAX STATEMENTS TO: Space above this line for Recorder's Use
DOCUMENTARY TRANSFER. TAX $ 1 % D, S-0
"--.2iX—C=omputed.nn the.coctsidzration or value of pruperr'�
conveyed; Olt
SAME AS A-BOVE Computed on the consideration or value less liens or
encumbrances remaining at time of Azle
The Undersignd Grantor
Signature of Declarant or Agent determining tax -Firm Naute
APN: '769-
TRA: 020-015 GRANT DEED ql
1
FORA VALUA.BIJ! CONSIDERATION, receipt of wbicb is hereby acknowledged, -If)
TRADITION CLUB ASSOCIATES LLC., a Delaware limited liability company
hereby GRANT(S) to
HOWARD F. HARRISON and 10T11 M. 11ARRISOPI, husband and wife, as Joint Tenants
the. real property in the City of La Quintet ,
County of Riverside State of California,'described as
Lot -22 Tract 284 i0-1 (See Exhibit "A" Attached Hereto)
Dated; Decenber 19, 1997
State of California 1
) ss.
County of Riverside
On { o n r��gN L. before nee,
10-
gni1�.� v �►z.�
personally appearedi
Personally kaiowu to me (or proved to me on the basis of satisfactory
evidence) to be the person(s) whose name(s) is/are subscribed to the
within instrument and acknowle.dged to me that he/she/they executed the
same in his/her/their authorized capaciry(ies), and that by his/her/their
signature(g) on the-iastnunent the'peesdffMss "di the entity iipiiri behslf oi`
which the person acted, executed the imshument.
Wl IESS MY AND OFFICIAL
/SEAL
TRADITI I C UB AS FS L.I,C
a Ue[aw e it "tc� . iry ntpany
By:_' ---- -------
its: 0xB4'Vr'V6` ✓� G• P,C�B� e
Ely:
TERRIE MILLER �
U Coinm #1128852
o ' - NOTANY VOLIC CALIFOaNIA�
AIVERSIOE COUNfv
Comm Fxo INs(Gn 6 %001
(This area for official notarial ce41)
C'•`�ir JON TANDY
QFC 1) '1 37630 Medjool Ave.
81JI4 R 'Palm Desert, CA 92211
F'� Office (760) 772-7192
ISPECIAL INSPECTION- .Fax (760) 772-7193
^�' -�-4Pager (760) 776-3338
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF
INSPECTION
PERFORMED
O REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY O
O POST TENSIONED CONCRETE O ASPHALT O OTHER
O REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCATION j� ry �Q'�� � ^ ` �
j�1
REPORT SEQUENCE N0.
TY5S.'6OF T1iUCTURE I A(kck l C Lam\ �Ce�n''
FAD, 1{.�1 J
PERMIT N0.
;ATE 2
Ci1l'
DAV OF WEEK
MATERIAL DESCRIP �_,
ARCHITECTINSPE
TOR
HRS. CHARGED
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION GENERALI� \ of ` r `v\ CONTRACTOR i rv/LAr� N
DATE CONTRACTOR 1J �(�J J r 7
Lt)eA W (S
i� 3 a
A — ATMC L� o ZT
COPY SENT TO CLIENT ❑
CONT ED ON NEXT PAGE ❑
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.
SIG7ATURE OF REGIST RE IN-DSPECTOR
DATE OF REPORT REGISTER NUMBER �i
so Vil
H
El
Des
(ACC)
E
FD
(ACC)
E
(VIS) (Date)
(Date)
Remrks---_
mw■�■�a■�����■moiNMIimn,
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*Materials and weldments conform to plans and specifications and RISC, and AWS Dl -1
Shipping Mark Special Deputy Insp.
905 SHEL
J 1.
Johnson & Nielsen AssociatesCarl B.
SendHohnson
Nielsen
Per T. Consulting Structural Engineers Wen Y. Lin
641 Louise Drive • Suite 15 • Palm Springs • CA • 92262 • (760) 322-0583 • FAX (760) 322-0593 Lonnie P. Mount
J.nSteen T Thomsen
Los Angeles • Riverside 0 Irvine Palm Springs Jackson K. Wu
Com a t ` t�!d�T4
April 14, 2000 APR I RECD & N Job No. 24-203
James Cioffi Architect
2121 E. Tahquitz Canyon Way Suite 3
Palm Springs, CA 92262
Project: Harr o Residence
Lot 22;'Deacon.D.rive-East
The Traditions Country Club
La Quinta, CA.
Subject: Limited Structural Observation
Dear Mr. Cioffi,
On various days, a representative of our firm visited the site and performed walk through
observations of the above referenced project.
We did not observe the foundation excavations or steel placement;. however, we reviewed the
visible foundation anchorage, from above the slab, and framing for conformity to the approved
plans. Observed structural deficiencies were brought to the attention of the contractor and were
resolved. Based upon our observations at the site, it is the opinion of Johnson & Nie/sen
Associates, that the structure is in general acceptable conformance with the approved plans..
If you have further questions, please feel free to call.
Sincerely,
Johnson & Nie/sen ociotes
Jeph R. Venuti, P.E.
oject Engineer
C:%J&N-OF-1 \LETTERS%STRUCO-4. WPD
APR 13 '00 10:12 JOHNSON&NIELSEN PALM_SPRINGS P.1i1
Johnson &Nielsen Associates 5:' �mn
Niel=
Consulting Structural Engineers Wen Y. Un
641Louise Drive • Suite 15 • Palm Springs • CA • 92262 • (760) 322-0583 • FAX (760) 322-0593 Lonnie P. Mourn
Siem T Thomsen
-n Los Angeles • Riverside • Iryine • Palm Springs lecke . K. W.
April 14, 2000
James Cioffi Architect
2121 E. Tahquitz Canyon Way Suite 3
Palm Springs, CA 92262
Project: Harrison Residence
Lot 22: Deacon Drive East
�--= aco
The Traditions Country Club
La Quinta, CA.
Subject: limited Structural Observation
Dear Mr. Cioffi,
J & N Job No. 24-203
On various days, a representative of our firm visited the site and performed walk through
observations of the above referenced project.
We did not observe the foundation excavations or steel placement; however, we reviewed the
visible foundation anchorage, from above the slab, and framing for conformity to the approved
plans. Observed structural deficiencies were brought to the attention of the contractor and were
resolved. Based upon our observations at the site, it is the opinion of Johnson & Nielsen
Associotes, that the structure is in general acceptable conformance with the approved plans..
If you have further questions, please feel free to call.
Sincerely,
Johnson & Nielsen
2
J eph R. Venuti, P.E.
oject Engineer
C:U&N-0F-1 LLETTERSISTRUCO-4. W PD
,f
Certificate of Occupancy
City,of La Quintal
Building and Safety'Depiartment
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:
78-721 DEACON DRIVE EAST
Use Classification: SFD Bldg. Permit No.: 9905-155
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RL
Owner of Building: HOWARD & RUTH HARRISON Address:
Date: 10-05-00
POST IN A CONSPICUOUS PLACE