0311-167 (SPIN)F_
N (1)
W
O =) M
1,-0Lr)
I W
Q Z
CDo
..A J U co
wwr-
~a
U)
Z
M
L0
N
ON
U0)
a- Q
Lo Q 0
0 J J
co <
O
li 0)
It Z
cb D
�O
J
+ LICENSED CONTRACTOR DECLARATION
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
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
Liconse Law for the following reason:
(1� 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 102� 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.
(This:�se�tion need not be completed if the permit valuation is for $100.00 or less).
( bf 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 provisions of Section 3700 of the Labor
Code, (shall forthwith comply with those provisions.
oDate: 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 au.thorize-representatives of this City to enter upon
pert
the above-mentioned•pl'operty "for'(nsn purposes.
Signature (Owner/Agent) Jf� Date
r
BUILDING PERMIT PERMIT#
DATE-UALUATIOI`y LOT 0 i i-16 7 TRACT
JOB SITE
APN
ADDRESS D*PZ7_ 11R CLUD XAUW
OWNER
CONTRACTOR / DESIGNER / EN (NEER
. J01W R. DIXON
O W;t t-L�12J13[3t DER
f C'11�i�
USE OF PERMIT
4siiMIU . BUXIDINO
CHA ,Ofr OT USE &OCCUPAziC:Y'i Lr3'.MiT. READILY ACHIEVABLE BARRIER
REMO'V'ALAT PUBLICACCOMMODA.TRA4 FA.CILITIL9 TO INCLUDE EXTRY
THRE31-101.1D & RA1 T- ROOM REMODEL. X001 CIBC
VALUA,%TION
F..TM"rJ;:'D COI;(,'OF CONG11113CI.t;'.iON
2115W.00
�fi�31TLR�ASY.t��r�t,1R�..i/L+��s 1yl:iy.�E2Y/.FYA�
101-000-439-318
CMISTRUC:'11011 P33 101.000-X118.00) � . $94.00
p1lumnINGFzz 101.000.419.000 F $19.00
D Q �
NOV 191003
CITY OF LA QUINTA
FINANCE DEPT.
SUB 40TAL COMM RITCH` 01sT A131D.. PI A9 CHMI,
$104.10
Uss 1 Platy-pi'm FES
50100
TOTAL PE1T3ltt4'P TKES 311< R NOW
RECEIPT
DATE' f )
r
BY �._.,.i'
DATE FINALED
INSPECTOR
'a _.'. A • '.,.
OPERATION
DATE
INSPECTOR
OPERATION
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
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
POOLS - SPAS
BLOCKWALL APPROVALS
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:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fodures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
.JC
X
Bi" NCity
of La Quinta
Building at Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit i
ProjectAddress: '6-1-350 DESr,pTCI-UE5 PR .
0%,ner•sNamr JOHtJ
A. P. Number.
Addrt:ss: 30 T
Lceal Description:
Ciry. ST. Zip: 'pq LM Df S lee- CA 9 Z 2:60
Contractor. oWNE1e 6011 -DF -rt
FTclephonc:. FeO -1-750
Address: 5 J - 350 PSS eRT 0 W De,
jest Description: f 5C -S I DE GC I S UiJ DF.1?
City, ST, Zip: ba w.,im
C-aMl6 A. C4AAl66 QP OS.8 566. g7'FAC.HF. D
Telephone: -
y;:
i
State Lic. # : City Lic. !1:
Aich., Engr» Designer.
6d -z Gl-'_cx.6�
Address
Ss
City. ST. Zip:
Telephone:
- _c''�''' . =.
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Derno
State Lic. N:
Narne of Contact Person:
Sq. Ft.:
fi Units:
Telephone * of Contact Person:
imated Value of Project:2-600
APPLICANT: DO NOT WRITE BELOW THIS UNE
M
Submittal
Req'd
Ree'd
TRACKING
PERMIT FEES
Plan Sets
Plaa Check submitted
Item
Amount
Structural Cala.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cala.
Called Contact Person
Plan Check Balaace
Energy Cala.
Plans Oicked up
Construction
Flood plain plan
Plans resubmitted
INtchanical
Grading plan
2" Review, ready for correctionsrssue
Electrical
Subeontaetor List
Called Contact Person
Plumbing
Grant Detd
Plans picked up
SAM.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:..
Review. ready for correctionsrissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fm
Total Permit Fees
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/ Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if.that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law' to put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an employer and you are subject
to -several obligations including State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quints, CA 92253
(760) 777-70
FAX: (760) 7W0. _,--
OWNER'S' SIGMA
PROPERTY ADDRESS
PERMIT NUMBER(s)
Danny Crawford
From: Wally Nesbit
Sent: Thursday, July 29, 2004 9:39 AM
To: Danny Crawford
Cc: Greg Butler; Oscar Orci
Subject: Status of VUP 03-019 - Dixon - 51350 Desert Club Drive
As requested, the following is a brief summation of the case status:
Mr. Dixon has submitted a VUP application as of 11/13/03. It has not been approved'and is on hold pending his submittal
for an additional'structure for the site. This application allows Mr. Dixon a temporary CO until approval of his VUP. No final
CO can be granted until the VUP has been approved and Dixon carries out the conditions for that approval. My
understanding is that temp CO's run indefinitely, based on the Meat Market situation at Bermudas and Tampico.
Therefore, the provisions of Dixon's temp CO remain in effect and I would infer that no further action on your end is
needed until he takes further action through our Dep't.
We will be contacting Mr. Dixon in writing, regarding his intent to proceed on this issue. Please provide by 8/6/04, any
information you would like included as part of our correspondence to him. Thanks.
WALLACE H. NESBIT
ASSOCIATE PLANNER
CITY OF LA QUINTA
PH: 760.777.7069
FAX: 760.777.1 233
E-MAIL: WNESBIT@LA-QUINTA.ORG
W.H. Ne4&t
RIVERSIDE COUNTY FIRE DEPARTMENT
In cooperation with the
California Department of Forestry and Fire Protection
210 West an Jacinto Avenue • Perris, California 92570 • Fax 940-6910
3ecember 4, 2003
Tom Tisdale
Fire Chief
To: Wally Nesbit, Associate Planner
pmt the
From: Dale A. Evenson, Fire Safety Specialist C64 �1J�
5
uninco�rated
-- ---- - -,
areas of Riverside
The following conditions are requested foVUP=2003=019
County and the
Cities of:
Banning
Approved super fire hydrant(s) shall be located not less than 25 feet nor more than 165 feet from any portion of
Beaumont
the buildings as measured along outside travel ways.
Cahmesa
Blue dot reflectors shall be placed in the street 8 inches from centerline to the side that the fire hydrant is on, to
4•
identify fire hydrant locations.
Canyon Lake
.;•
Building plans shall be submitted to the Fire Department for plan review to run concurrent with the City plan
Coachella
check.
Desert Hot Springs
Water plans for the fire protection system (fire hydrants, fdc, etc.) shall be submitted to the Fire Department for
•,
Indian Wells
approval prior to issuance of a building permit.
4.
Indio
The required water system, including fire hydrants, shall be installed and accepted by the appropriate water
❖
agency prior to any combustible building material being placed on an individual lot.
Lake Elsinore
41
Fire Department street access shall come to within 150 feet of all portions of the 1". floor of all buildings, by
La Qainta
path of exterior travel.
Moreno Valley
Install a KNOX key box on the building. (Contact the fire department for an application)
4.
Palm Desert
4.
Install portable fire extinguishers as required by the California Fire Code.
Penis
4•
Any submissions to the fire department are the responsibility of the applicant.
Rancho Mirage
.;.
San Jacinto
4•
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
Jim Venable,
District 3
Roy Wilson,
District 4
Marion Ashley
District 5
EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE
82-67S Highway 111, 2nd Fl., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072
12/23/03
copy
CJ
P.O. BOX 1504 BUILDING & SAFETY DEPARTMENT
78-495 CALLE TAMPICO (760) 777-7012
LA QUINTA, CALIFORNIA 92253 FAX•(760) 777-7011
Dr. John R.- Dixon
.51-350 Desert Club Drive
La Quinta, CA 92253
Dear Dr. Dixon,
A final inspection was performed today at 51-350 Desert Club Drive with the following
observations. The approved accessible single .accommodation toilet compartment was not
constructed per the approved plans issued for this Project. I will red -line the office
approved set of Plans to reflect the as -built construction for public records. Please address
the following final inspection corrections noted below for issuance of a Certificate of
Occupancy and final approval for the change in use permit:
1. Provide written evidence of Planning Department Approval for issuance of Certificate
of Occupancy
2. Provide written evidence of Public Works Department Approval for issuance of
Certificate of Occupancy - - - -
Please contact me at (760) 777-7027 for any questions and/or assistance. Thank you.
Sincerely,
4e Yrdaor Jr.
Building Inspector II
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
7/8/04
Dr. John R. Dixon
51-350 Desert Club Drive -
La Quinta, CA 92253
RE: Change of Use & Occupancy Permit #0311-167
BUILDING & SAFETY DEPARTMENT
(760) 777-7012
FAX (760) 777-7011
Dear Dr. Dixon,
A final inspection was performed 12/23/03 at 51-350 Desert Club Drive with the
following final inspection corrections noted below for issuance of a Certificate of
Occupancy and final approval for the change in use permit:
1. Provide written evidence of Planning Department Approval for issuance of Certificate
of Occupancy
2. Provide written evidence of Public Works Department Approval for issuance of
Certificate of Occupancy.
Please contact me at (760) 777-7027 to final the open Permit on file. Thank you.
Sincerely,
ame . d Jr.
Building Inspector II
cc: file
Greg Butler, Building & Safety Manager,