0112-159 (SFD)LICENSED CONTRACTOR DECLARATION
co I hereby affirm under penalty of perjury that I .am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
O =) ch License # Lic. Class Exp. Date
W
o Z ti ✓Date �Y ;t S� '+ Signature of Coni actorr/i;rz/z/
co0�` y /
J U CD OWNER -BUILDER DECLARATION
LL! UJ r I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z_ ( ) 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).
cr)() I am exempt under Section B&P.C. for this reason
N Date Signature of Owner
ON
0)U
d Q WORKER'S COMPENSATION DECLARATION
—
o 2 1 hereby affirm under penalty of perjury one of the following declarations:
O () 1 have and will maintain"a,certificate of consent to self -insure for workers'
X W LL compensation, as provided foi by Section 3700 of the Labor Code, for the
mJ Q performance of the work for which this permit is issued.
Q C) ( ) I have and will maintain workers' compensation insurance, as required by
O L) Q Section 3700 of the Labor Code, for the performance of the work for which this
IlLOf— permit is issued. My workers' compensation insurance carrier & policy no. are:.
cw Carver ';M4 2, READ Policy No. 161947242
g (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
3 subject to the workers' compensation provisions offSection 3700Fbf the Labor
Code, I shall forthwith comply;%Wh,those provisions. �' J
Date: 1,,..r� '..ron,Applicant 11 G` */ /�l
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
�1 any permit issued as a result of this applicaton agrees to, & shall, indemnify
map & 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, pplication 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. x
I'` ` 7
f� i r �
Signature (Owner/Agent) , °1f bpi /� �'.%1' Date&, r
_ - BUILDING PERMIT PERMIT#
DATE . VALUATION, .... LOT TRACT
_& - 11• r • $i",959450 LS 29611
JOB SITE
ADDRESS '*411- 11- D.EAE.:'ONDWfVXIV.F,. '
APN
170-VW024
OWNER
CONTRACTOR/DESIGNER/EN INEER
J77��"��g4Z�rl�ar�!&i�e.A,
� :{Sys,{'JtY110q�.1 COt�d,A�7'�°ykr�%C7�".I��ly+��1yant(tIOk
�SSC�
PUEMAN701-4 CA 94,166
(925)4.26,3000 MIX
USE OF PERMIT
1'G1X:VA1,9LY1C+WRA.1p t,
w&rt31 Cr1..4!'f�T..S'l�Ai,•I.�'I�GbLi£?3'id"9!'''1r�t;A�" �,l��itO.atcGN/C4'�t�!£1-°l.,i..P:YtiIG'�`:�I�T3�t
AU KWERAL &9TME LAWS, 3':ICLUD1' O THEENDAN UD REM
,ACT OF 1973 IF t PPLICA DLV,IS PRIQUIRED.
CU.710M CONSI•'IiUCT£ON V39100 S
PORC"b:aMAVO 5p'
.k%AWCARPC- RT 'iI 1,00 SF
E.+pSp':>�'I:k' t 'L`'�:D %:CiW air Chi£•".:L:RTI'•�'l.IJd�'N
:� .9594".
�yX�['��, ❑,� y+-
+� q�y►��+•� FXV
A �a,.GGRYdJ.�c�:V�X�I...,474.f,4e;Lt��'bA'di..aG .
C'ONS`I'aiUCTIO14 FPM 10;1-0 00-41 B-000 $1,318,10
P1,XH CHECK FEE 101-000-4339-M $406314
�15�1�E>ar,S1'1' 1G�1•-E�•0t?-�:a�->;�1�-�r��.f<I�
101.000-421-000
RLECTf~t1CAL FEE 101.000-120.000 3213.E
9
PLUM'BFI40 PFZ 101-000-419.000 $15:5.?3
"S"1'RO140 MOTION 1-1��T�SM 101-000-741-000 $x A
- OtiAOINU 11EK 101-000-4-23-ON,$20.100
—
D1s'VUO1'tER,IMty.,fe.CT REE SIAM,3
AILT IN PUBLIC 1" hers; 270-000-445-000
`s
AND1">.IAN,n7,,CK
1 T.,&� FIM 2?',t� .M'
00
S =1754 ,Lu
" `YMIU VEN w PUR NOW
„J'LD' 31,,
RECEIPT
DATE
BY ti
DATE FINALED
INSPECTOR
I
Y);
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
(gZ
Exhaust Fans
O.K. to Wrap
— C),?__
F.A.U.
Framing
20 Z
Compressor
Insulation
/ U '
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath_
Drywall - Int. Lath
Final
Final /a 3�
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
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
COMMENTS:
�J
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole .p L
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) ,p��
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 4/15/02
No. 23133
Owner NameJerome Soba
No. 78221 Street Deacon Drive West
City La Quinta
Tract # 0112-159 Lot # 25
Type of Development Single Family Residence
Comments
APN # 770-280-024
Jurisdiction La Quinta
Permit # 0112-159
Log #
Zip 92253 Study Area
Square Footage 3539
ON: Single Family Dwelling of 3539 sq. ft.
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
2.14 X 3,539 or $ 7,573.46 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 Mt. Diablo National Bank - Jerome Soba Telephone
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Crystal Scott
Signature Nvj_
Payment Received $7,573.46
Check No. 1000192822
40TICE: Pursuant to 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
rolled them on the DistrictCs)(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 - ApplicanVReceipt Copy - Accounting
GO UVIS ENGINEERING
• C A L I F O R" N I A
CALIFORN/A E-MAIL TO • SUPPORT@GOUVISGROUP.COM • SALES@GOUVISGROUP.COM
August 5, 2002
Jerome Soba
7026 Koll Center, Suite 211
Pleasanton, CA 94566
Re: Soba Residence at La Quinta
Lot25 782.21 Z>eAc&A-1 GJ�
G.E.C. Job# 21286
Dear Mr. Soba,
This letter advises that we have observed the structural requirements that are visible during
construction at the time of our site visit.
Gouvis Engineering believes that the as -built construction at the time of our visit (except items
noted on field notes) is in general conformance with our structural plans and relevant
correspondence issued by our office relating to the above referenced dwelling.
We observed the building in its framed condition prior to installation of drywall and stucco. We
observed the visual and accessible structural requirements. (Exclusions are items such as: size
of footings, reinforced steel in the foundations, roof and top plate splice connections and roof
sheathing).
This report is understood to be an expression of professional opinion by this engineer, which is
based on his best knowledge, information and beliefs. As such it consists of a report for only
structural elements (as above outlined) and is neither a guarantee nor a warranty, expressed or
implied for other trades or requirements of subject dwelling.
Respectfully Submitted:
Gouvis Engineering California
,Wike Houshmand Hanie Vinoya
Senior Vice President Project Manager 190FES
MH:HV. cb
to
080502a , -.
q; No. C042283
$ Exp. 3-31-04 A
�< AUG
01: CAtl4o
GOUVIS ENGINEERING GROUP OF COMPANIES WITH OFFICES IN. WEB -SITE: H7rP11WWW.G0uviSGR0uP.00M
4400 CAMPUS DRIVE, SUITE A • NEWPORT BEACH, -CALIFORNIA 92660 • (949) 752-1612 • FAX (949) 752-5321
2150 EAST TAHQUITZ CANYON, SUITE 9 • PALM SPRINGS, CALIFORNIA 92262 • (760) 323-5090 • FAX (760) 325-2863
FIELD OFFICES: SAN DIEGO • PLEASANTON • INTERNATIONAL OFFICE: VIETNAM
1 ,tON- "Mr, -. MOM �&, I N
ISPECIAL INSPECTION SERVICE:
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
0 REINFORCED CONCRETE O STRUCT. STEEL ASSEMBLY
O POST TENSIONED CONCRETE D ASPHALTOTHER
O REINFORCED MASONRY O FIRE PROOFING
0
J08 LOCA A? C,
r_-`- Il w-�.. Y
REPORT SEQUENCE N0.
TYPE URE.
PERMIT NO.
DAY OF WEEK
MATERIAL DESCRIPTION V
ARCHITECT
IN$UCTO�
HRS. CHARGED
V
ENGWC -0
�JSUB
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERAL P
CONTRACTOR Siolo A CONTRACTOR
]_
U"
T-9
W
�G
LaA,erbLFA
COPY SENT TO CLIENT O
(OkINUED ON NEXT E O
PAGE
OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV
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
G
SIGNAr
E "REGISTEREDNSPECTOR
I �.o (' c +�)I.
DATE OF REPORT REGISTER NUMRFR
•v•--r+.:.,�-. ., jr^..,'t'ti,.`..��'7r�n,��-., ,-c�-.,....�-ti.,.�.-..,.�' ' � ' �i w...-..T'-.•rr-�.•."'i.±-- �^ ..-f - i.r.r-...: ti-."�„✓'.�...-..�..•-r --
REGISTERED INSPECTOR'S WEEKLY R15PORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
,e
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY ,�❑ r
❑ POST TENSIONED CONCRETE ❑ ASPHALT OTHER 40 use, /
❑ REINFORCED MASONRY ❑FIRE PROOFING !/
JOB LOCAT"�I'OI2' _ ; &0" r ^ f^
REPORT SEOUENCE NO.
TYPE OFSTRUCTURE
PERMIT N0.
D�E?� J �
Il IJt�
DAV OF WEEK
MATERIAL DESCRIPTION
ARCHITECT
INSPECTOR
HRS. CHARGED
Lam—
fl „ u'y / /
cc� 1
ENGINEE r j jk�
WSU�iB�
ASSISTANTS
MRS. CHARGED
INSPECTION GENERAL I _ /1 i
DATE CONTRACTOR CONTRACTORJQ
7
r
\J
VR.
t i
I
A A
-
0
COPY SENT TO CLIENT ❑
�CON�TINUED ON NEX�P,AGE ❑
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV
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
0
--?/)-
)SIGNATURE ,1 REGISTERED1PNSPECTO� � { +j
C�-
4
DATE OF1REPORT REGISTER NUMRFR
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:
Use Classification:
Occupancy Group:
SFD
78-221 DEACON DR WEST
R3 Type of Construction:
Owner of Building: JEROME A SOBA
--1 —.,,,4, /4-u- .
Building Official
VN
Bldg. Permit No.: 0112-159
Land Use Zone: RL
Address: 7026 KOLL CENTER PARK WAY SUITE
211
City: PLEASANTON CA 94566
By: KIRK KIRKLAND
Date: 1-24-03