0302-116 (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'
� t,
6 r00 1i 1`11C. _ .b9„012V
e �'= 'gnature of Contractor
1.
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&RC. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
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:
c'an'er gTATZ i;i1'ND Policy No. U04'),ay-aY.filS-2t�03
(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 ii I should become
subject to the workers' compensation provisions of Section 0700 of the'Labor
Code, I shall forthwith comply with.those provisions. f I ' 1 /f
Dale: __” "4 t fipplicant 20'; 11 i 1! t.
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employerto 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. p
Signature (Owner/Agent)1- ! t �' 17 ` 1!'1IDate %, i N
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 16 TRACT.
JOB SITE
ADDRESS 784,151. JA_AC01 t]RX'V31?, %F.S
APN
770-210--015
OWNER
CONTRACTOR / DESIGNER / ENGINEER
MMM :77'!~4F MUNKCiAF ,
GtWA1:SON COA1,1rJRT-f'C"I'IOId
i? LI? >il t' CA. 92255
('7610)340-3462 CLIJ—# 1653
USE OF PERMIT
8)140LL4 FAItF9:lLY DW7 I S..1N0
Sl)-.13E.RMIT DOES NLY1' INCLUDE BLOCK WALL/POOL/I'A OR APVRONACt''t
DRTr1BWAY:C'OMPLIANC'R WITH ALL, til! I)ERAL .'r!, STATH LAW, Ct1C1,C1.D1N43
THE ZND.ANf1LRVD SPECIES ACT OF 1973 {16 U.S.C. § 1531, FT
CUSTOM f;t)NSTRUCTIC*) 3,61'2',0013F
PORCIVPM110 334.00 31?
OARIWEICARPORT 613.00 sip
piS'I'IMA'I`W COST OF COY'r(3-MVC-T CIN
297,E .30
CONSTRUCTION PKK 101-000.418.000 $1,132,50
PLAN CHECK (rF:Lr 101.000-439-313 11,080.135
YKE DEPOSIT 101=000-439-3 18 -MY."
'
MIX,HAN1CAL FEE 101-00fl-421-000 �1Q3.fl0
EL,Z(.`Tit.1CAL FRE 101 -:000 -420 -OW) SOL IS
PLUMI91AIt'3lYZE 101-000-419-000
STRONG MO`I'IO14 FRE • RPSID 1.01-000-2.91-000 11ft.W
0R..P►11i"1 O FR.,L t (3t-QOt7.42 t-000 $13.00
D V)~i OPER IMPACT, FFE �1,Ag4.0U
ART 1C f?L.A.'C S,,, RMC 270-000-dQ5-000 $24435
LIP -TOTAL C0NM7U(, 100 AND PLM CHECK
v 1ESS PFX..-P.Al'0, FFq
-X50.00
z0 G
m
TO'CAa, PERM)rf FEES IGLU: NOW
$4,87032
mZ
w
RECEIPT DATES BY`-•' INSPE`C�
K1•LI
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
I DATE
I 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
Compressor
Insulation
i O
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
®LOCIWALL 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
i
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole ZZTP®1�
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
� 1 �i L F1� AtiZ SQA
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03 (, �
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At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered pabosMralkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for Irving, 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 3,612 S.F. or $7. J29.68 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 OC/City National Bank - Sandra Hand Check No. 829374768
Name on the check Telephone
Funding Residential
i3y Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharon McGilvrey $7,729,68 0.00
Payment Recd Over/Under
Signature
NOTICE: Pursuant to Govemment 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 this project is issued, or from the date on which
those amounts are paid.to the District(s) or to another public entity authorized to collect them on the Distr dCs) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original -Building Department/Applicant Copy - Applicant/Receipt Copy- Accounting
L_
WEDDLE
SURVEYING MAPPING, INC.
Boundary • Construction • Topographic: • Aerial Surveys • ALTA Surveys • GPS • Consulting
May 21, 2003
Mr. Timothy R. Jonasson
Public Works Director / City Engineer
City of La Quinta
78-495 Calle Tampico
La Quinta, CA 92253-1504
Re: Pad/Form Grade Verification
City of La Quinta
Lot I Tract No. 28611
TRADITIONS C.C.
Dear Mr. Jonasson:
78.y6rAt�J .
PA�
We have performed a field survey to determine the vertical location of the building pad
and form for the above referenced project. The elevation's observed are as follows:
PAD (DESIGN)
43.5
FORM (DESIGN)
44.00
PAD (AS -BUILT)
43.5
FORM (AS -BUILT)
44.00
These field observations are in substantial conformance with the precise grading plans
prepared by ESSI SHAHANDEH, CIVIL ENGINEER
Sincerely,
WEDDLE SURVEYING MAPPING, INC.
David L. Weddle, President
L.S. 5570, Exp 9/30/05
P.D. Box 2020 • Cathedral City, California 92235-2020
68-625 Los Gatos Road • Cathedral City, California 92.234 • 760.322.7693
E -Mail: WedSury+aol.com • Fax 760.325.5465
1f14
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
78-194 Elenbrook Ct.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE
O POST TENSIONED CONCRETE
❑ REINFORCED_ MASONRY
STRUCT. STEEL ASSEMBLY ❑ C
❑ .ASPHALTTHER
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REPORT SEGUENCE NO.
TYPE OF STRUCTU
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DAY OF WEEK
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CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MX
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED: IHAVE FOUND THIS WORK TO COMPLY WITH THE, APPROVED
PLANS. SPECIFICATIONS, AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
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REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
78-194 Elenbrook Ct.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
O REINFORCED CONCRETE WRUCT. STEEL ASSEMBLY ❑
❑ POST TENSIONED CONCRETE 16 ASPHALT HER
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PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF M?
KNOWLEDGE ALL OF THE ABOVEAEPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE, FOUND THIS WORK TO COMPLY WITH THEIAPPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
I NAT RE 0 REGISTERED IN E TOR
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bAbE OF NEPORT REGISTER NUMBER
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
78-194 Elenbrook Ct.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-719.3
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
INFORCED CONCRETE CT STEEL STEEL ASSEMBLY ❑-_
F(3 ST TENSIONED CONCRETE ASPHALT O OTHER W
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PAGE OF
CERTIFICATION OF COMPLIANCE
'I HEREBYCERTIFY 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.
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DAI OF Fj1PORT REGISTER NUMBER
,SPECIAL I.NSPECTION SERVICE
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
78-194 Elenbrook Ct.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
O REINFORCED CONCRETE
❑ POST'TENSIONED CONCRETE
❑ REINFORCED. MASONRY
❑ STRUCT. STEEL ASSEMBLY ❑
❑ ASPHALT 1,g,1AR
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JOB LOCATION
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REPORT SEQUENCE N0.
TYPE F R TORE j Q
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D�1J
DAY OF WEEK
MATERIAL DESCRIPTION
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CONTINUED ON NEXT PAGE O
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.
SIGfpTURVOF REGIS . ED INSPECTOR
DATE OFR PORT REGISTER NUMBER
Joseph No k iisE
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-92260
Tei (760)-r164M
Lkmvwd by -the Now for
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October 20, 2(O3
The City of La Quinta
Department of Building and Safety
78-495 Calle Tampico
La Quinta, Cal'ifgMia=60
Re:Munkdale Residence
Lot 1, Deacon Drive West, Tract 28470, The Traditions
La Quinta, California
Gentlemen:
The construction of the structural framing portion of the subject residence has in my
opinion, been bormtructed in, -accordance --vvM the StIxtural 'Plans 'pnepal -by
Joseph N. Ciachini, P.E., dated April 17, 2003.
0,4 _r
N. Cic chini, P.E.
Joseph N. Cioclt1 1, P.E.
__P.0._80K_420G__--
Palm Deaqvtv CA.12260
Telb (7W)-T764W
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79"W
October 20, 2Q03
The Cityof La Quinta
Department of Building and Safety
78-495 Calle Tampico
La Quinta, Cal"922W
Re:Munkdale Residence
Lot 1, Deacon Drive West Tract 28470, The Traditions
La Quinta, California
Gentlemen:.
The construction of the structural framing portion of the subject residence has in my
opinion, been constructed -1h--accordance ..with the Structural 'Pians prepared by
Joseph N. Ciccoini, P.E., dated April 17., 2003.
N. Cicchini, P.E.