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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
744091 Iile
Date' ll./t,f� Signature of Contractor—,.-
OWNER-BUILDER
ontractor
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&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 ST.A.Ti3F'D1h) Policy No. 4170540-10.1
(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 pr6visions'of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.'"rte^r
Date: 1�.✓.1r. 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;1of 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 inssl ection purposes.
Signature (Owner/Agent) " -Date
BUILDING PERMIT PERMIT#
DATE � ^ VALUATION LOTfl,'3102AMTRACT
JOB SITE i
ADDRESS s,51-fi2.5' DESIM, CLUB
APN
'770-182-007
OWNER
CONTRACTOR/DESIGNER/ENGINEER
SUM ViSM A DFVPZ.OPMF.N T
UN VISTA 13nNEE, LOPJed1EITIr CORP.
PO BOX 1144
PO BOX 1144
uk, CT:F.1N"rA. CA 92253
1.,A(UDIrA CA. 92253 —
`760YI,71-022 (:BX,ft 53914
USE OF PERMIT
I
COMM. 7024 SQ.Fr. 2 NT0P.Y' OT1FICE -SHZI. ,-SUILDTNO. TYPE V1d-
9P.ZT,N1:LF.RPD, 21.101 t'°OD0,
PORC'.i�.di ATIO 470.00 3F
QARAGF./(;",P0RT 100.00 sip
ffPf 1NKLER 7„494,00 3F
A/C .. C:t)il A41SX0.&L 6,924, DO SF
CONTRACT AMOU14T 304,656.00 US
KGrINA'M COST OF CONUMUCUOX
349X4O.6
PERmyrYEPL %m+TA/fliRY
CONSTRUCTION K-9 101.000-418.000 ' S014,30
PLAN CHECK FEE 101-000-139-318 31,219.,24
FEE DEPOSIT 101a000-439-318 -1+1,500.00
MECHANICAL FEE 1.01-000-42",11-000 $32i.!i0
EUC`! RICAL DUE 101-000.420.000 5307.43
PLUMBINt9I;ER . 101-0000-419-Ot'tCf $15COO .
ST.R.ONO MOTION FEE - COMM 100.000.241,000
0”. DTNQ FEE 101-000-423-000 515.41.1
I)C°d'F LOPER IMPACT FEE SIU01,00 .
ART IN PUBLIC PLACE' • COMP 270-600-441-060 . $1,7A9.n0
"wSM-IMAA1. C".C+NSTRTiC''1"1C32'C IWD PZ.;ts 4 CHECX
$21,217.89
SY05 PRE-PAJI)1E
-$1,500.00
I'
Lr,1 u T(Y.1'ALF.ERXf_rFIFS DW146W
$i,�1� rt9.B ►
I
0 E 18 2003
3 I
CITY OF LA.
DATE"-- , �
BY /
DATE FINALED /
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs L
Underground Ducts
Forms & Footings G
Ducts
Slab Grade
Return Air
Steel Q
Combustion Air
Roof Deck 7-9 •p_
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali 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 Pibg. 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:
40
�--
J
l 12 3 `O 8 /
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
Utility Notice (Perm)
Date
12/18/03
No.
25290
Owner
Sun Vista Development
Address
PO Box 1144
City
La Quinta Zip 92253
Tract #
Type
Commercial
Lot #
Unit 1 7
Unit 2
Unit 3
Unit 4
Unit 5
No. Street
51625 Desert Club
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
Comments 2 Story Office "Shell" Building.
IEDScyo
Q BERMUDA DUNES r
rn RANCHO MIRAGE
INDIAN WELLS
PALM DESERT .y
V LA QUINTA
4INDIO �rJ
D
S.F.
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 (spaces that do not contain facilities for living, 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 $0.34 X 6,924 S.F. or $2,354.16 have been paid for the property listed above and that
building permits and%or Certificates of Occupancy for this squarefootage in this proposed project may now be issued.
Fees Paid By CC/Palm Desert Nat'l Bnk - Richard Wasserman Check No. 086492
Name on the check Telephone
Funding Commercial
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharon MCGilvrey Payment Recd
$2,354.16 Over/Under
d99
Signature c
)�L
NOTICE: Pursuant to Government 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 District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
Craig Anthony
Fire Chief
Proudly serving the
Unincorporated
Areas of Riverside
County and the
Cities of:
Banning
Beaumont
Calimesa
Canyon Lake
Coachella
Desert Hot Springs
Indian Wells
Indio
Lake Elsinore
La Quints
Moreno Valley
Palm Desert
Penis
Rancho Mirage
San Jacinto
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
Jim Venable,
District 3
Roy Wilson,
District 4
Marion Ashley,
District 5
RIVERSIDE COUNTY FIRE DEPARTMENT
In cooperation with the
California Department of Forestry and Fire Protection
210 West San Jacinto Avenue • Perris, California 92570 • 909 940-6900 • Fax 909) 94G-691 0
December 20, 2004
r
City La Quinta
Building Department
Re: LAQ-03-bp-012
Vista De Montanas
The Riverside County Fire Depar-7
nting a fire and safety clearance for
occupancy at the following addresert Club Drive, La Quinta. Please call if you
Should have any questions.
TD/jl
FRANK KAWASAKI
Battalion Chief / Fire Marshal
S �
By TL
eSoucy
Fire Systems Inspect
EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE
82-675 Highway 111, 2"d FI., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072
Building
Mailing
Address
City
- Lk
Contractor
Address _
q 4
sios "`&t!t
P.O. BOX 1504
..78-495 CALLE TAMPICO
Dr- E56r-T r yuR LA QUINTA, CALIFORNIA 92253
City IZip
State Lic.
i & Classif.
Arch., Engr.,
Designer T
Address r1
030z- 090
APPLICATION ONLY
BUILDING: TYPE'CONST. 1/ — ,OCC. GRP.
A.P. Number 220-122—
2�O
Legal Description__"., -c V? .
Project gescription - Srm�w-7Sr�
k,Ity
Lic. # Lew
v�L`T,SLY�
CityIZi 76� IState I�G�
h�-I:a M 7 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 Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, after, 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
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged 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).
l: 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, Buisness 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.)
1-1 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
fl Copy is filed with the city. O 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 (8100) 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.
Date Owner
NOTICE TO APPLICANT: It, alter 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 abuilding 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.
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.
Signature of applicant —Date—
Mailing
ateMailing Address
City, State, Zip
No.
b��% Stories
Add ❑ Alter.0" �- Repair ❑
I
o. Dw. f l
nits >
Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep. 'Wo
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
ZONE:
BY:
Minimum Setback
Distances:
Front Setback fromVC
Rear Setback from 6
Side Street SetbaciSide
Setback from
FINAL DATE
INSPECTO�i�
Issued by:
Date Permit
Validated by:
Validation:
WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE