0301-339 (SFD)t+rl rir
LICENSE D�CONTRACTOR DECLARATION
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
WProfessionals Code, and my License is in full force and effect.
O =) M License # Lic. Class--•------Exp.:Date f
o ZO Date Ir, J11-2 Signature of Contractor
(D '
J U �
OWN ER-BUILDER`DECLARATION
WUJJ 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).
( ) I am exempt under Section B&P.C. for this reason
in
N Date Signature of Owner
ON
d Q WORKER'S COMPENSATION DECLARATION
NT Z wing declarations:
I hereby affirm under penalty of, perjury one of the following
LO Fa- O () 1 have and will maintain a certificate of consent to self insure for workers'
X W u_ compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q U ( ) I have and will maintain workers' compensation insurance, as required by
O Q Section 3700 of the Labor Code, for the performance of the work for which thisLO.
Il rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
v Z Carrier 5 ATE FUND Policy No. 0170346.193'
cb DD
V
J
(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 afire that if I should become
subject to the workers' compensation provisions o`f ection 3700 of the Labor'
Code, I shall forthwith comply with those provisioq . ��.,
Date: ?1 r Applicants ?.:
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 autht%ze repreyntative )of this City to enter upon
the above-mentioned property fowinspection purposes.
Signature (Owner/Agent)' -? 1 o Date�71� 3
BUILDING PERMIT PERMIT
f W017.139
DATE VALUATION rJf16, t 13790 LOT .28 TRACT M5}ytj
JOB SITE
ADDRESS �i krA�AE�t -�F. c
APN 770- -ou
OWNER
CONTRACTOR/DESIGNER/EN INEER
SANDRA,, W.i"G'N�.3 L
SIM VDA fAMNL OPa `T' CORI%
I.A.QF WfA Uf`* 92253
(760)I I.4722 Muf 534a
USE OF PERMIT
/
3t+1 �r�AtL a.0 ��� ;v H! t�ir c�tJiaL'.i{IV 9sWAl i1YNAeVJ%4:Y'. i:utw ..7CdP7SVl N., IAN .
W, WDERA L & STATE i,!•iWS. Te1Ci,VDfNG THE; ENDANGERED SPEOW,
ACT Or IM IF APPLICA'HI2, IS RZQUIR.FD. � r
P0XCK1PJk-T1d`*%. ' .00 Sr
(JARALOYCARP011T 31?
XS'13:N7A'rED 0+D:�'�' OF C014S�'IMM10-N
i.71ri 9Qi
��^-��++�� 77 � /
MUTT,
CO'NSTRUC'TION FEE 301-000-418-000 S1.6114.0
.
PLAN CHECK ME 101,-000-" c39,318 $11,365.45
;
%ECS DEPOSIT -1.01.000.439.318 -51,000,00
'
]VIECI•1I3.711C.AL FE.E 101-000-421-.000 $292.51
:
BLECTRI.CAL FFX JO,1.00.0-420-lit 0 ti3! .Pli
1PI. U MEIVOITZ 101-000-419-000 $314.50
STRONG MOT IOW .E - RMID 101.000.241.000 535.6$
GRADIND VIM IOff.-00(1 423-�lOQ S1r.Q0
'
DEVEI PERIMPACT PR SZ,40S,00
-Akf iN PUBLIC I>l. AC rt , 'RL17 1t 270-•000-1145-000 $4f►6.4 y
;
LfC 1701i AND PIM C:FTf?CK
$6,695.03
D f LESS SRU -PAID FEW
. 41000,00
MAR 2 1 2003" . 1r.1nWrIWIS DVE NOW
CITY OF LA QUINTA
FINANCI= DEPT.
RECEIPT
DATE
BYi/
DA'FIjIAL M
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_ as
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
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 I
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test..
Appliances
Final
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)
COMMENTS:
/
Comments
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 $2.14 X 4,603 S.F. or $9,850.42 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 CC/Bank of America Check No. 401252842
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharon MCGilvreKf
Signature
$9,896.00 $45.58
Payment Recd Over/Under
NOTICE: Pursuant to Government Code Section 66020(d)(1), this vYilI 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
�a��iuNt�`L•c
Certificate of Occupancy
U -
ti
iRATM
G�
OF Building & Safety Department
artment
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the .
provisions of the Building Code and the various ordinances . of the City regulating building
construction and/or use.
BUILDING ADDRESS: 52-860 LATROBE LANE
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0301-339
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: SANDRA MITCHELL Address: 9 CANYON COURT
City, ST, ZIP: NEWPORT BEACH, CA 92260
By: KIRK KIRKLAND
a't"t Date: January 20, 2004
Building Official
' POST IN A CONSPICUOUS PLACE
° �°�• ��� �t it
s `:;,CITY OF LA QUINTA
- '�'B'UILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
[7_ 777-7153
OwnerCADRA MITCHELL
Contractor 1 N N4Sq'A DEVE! [IPMF NT
- v
Permit Number 0301-339
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 52-860 LATROBE LANE
SFD/EXCLUDES WALLS/POOL/DRIVEWAY APPROACH.
COMPLIANCE WITH ALL FEDERAL & STATE LAWS, INCLUDING
THE ENDANGERED SPECIES ACT OF 1973 IF APPLICABLE, IS
TYPE OF INSPECTION DATE INSP.
TEMPORARY POWER
SETBACKS
U/G PLUMBING / WASTE
U/G ELECTRICAL / GROUNDING
FOOTINGS / STEEL
CONC5gTE SLAB
DO NOtT POUR CONCRETE UNTIL ABOVE SIGNED
i ROOF NAIL / PRE -ROOF
OKAY TO WRAP D'
f FRAMING COMBINATION
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL
INSULATION
' � COVER NO WORK UNTIL ABOVE SIGNED'
INTERIOR GYP. BD. (DRYWAL
EXTERIOR LATH _
GAS TEST <' L
I SEPTIC ABANDONMENT
SEWER CONNECTION
SEPTIC / GREASE INTERCEPTOR
MASONRY INS
FOOTINGS
BOND BEA
POOL /.SPA / WATER,FEATURE INSPECTIONS
PRE-GUNITE /SETBACKS w.
U/G PLUMBING
U/G AS
i U/G ELECTRICAL
PRE -PLASTER ALARMS / BARRIERS
FINAVINSPECTIQNS-
TEMP. USE OF PERMANENT POWER
ELECTRICAL
PLUMBING
MECHANICAL
PUBLIC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT.
FINAL
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR.00CUPY BUILDING
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
O REINFORCED CONCRETE 1701TRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE O ASPHALT
❑ REINFORCED MASONRY O FIRE PROOFING
O S �%
THEIR
J08 LOCAiR 1 d I Q 6
JV -1_ V
V , ��
REPORT SEQUENCE NO.
TYPE OS CT}�RE m /= tk 9�
(V� `/
PERMIT NO.
V
DAY OF WEEK
MATER L DESCRI ION
- S
ARCHITECT
iw%jWTOg1_
J •T
HRS. CHARGED
O I S M •A (it.)ENGINEER
`
ASSISTANTS
MRS. CHARGED
INSPECTION GENERALS . ILSSUB
DATE CONTRALTO V CONTRACTOR
RA V
o A&ee 5 h Ie jP As Lois
LX
Be
fio
e:t�
3 Slo
J
COPY SENT TO CLIENT O •
CONTINUED ON NEXT PAGE 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.
CA I(StIATURE,OF REGISTERED I&IPECTOR
DATE F RE ORT REGISTER NUMRFR
'I Y 1 ..
S
g _ D
P bSm BEL A= FiLofis i t �oU
fi i. ZiQl. She ire t$ iffi3C� B OEM
S tied fie) H®a
o P A� - C
W a Em M &i
OWN
w I
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
D REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY p�
❑ POST TENSIONED CONCRETE ❑ ASPHALT D OTHER
D REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCATION
.
R ORT SEQUENCE NO.
TYPE OF STRUCTLIEq
1
PERMIT NO.
DATE
DAY OF WEEK
MA IAL DESCRIPTION
ARCH TECT
INS E TOR
NRS. CHARGED
I Tj
ENGINEER
L-� I-
/ T M4
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERAL
CONTRACTOR
SUB ��
_ CONTRACTOR —
�' �\ -
- --
5La"
c�Sn
a
moo
O.
v -
t o
CS o
a
k s -A (-,3
COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE O GE
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.
O&Hf- o"
SI NA URE OF REGISTE0jpb INSPECTOR
(43 (C-R%zc 8y
DATI OF REPORT REGISTER NUMBER
A
ESI/FAE,Inc.
STRUCTURAL ENGINEERS & CONSULTANTS
PLAN CHECK REPLY
PROJECT:
JATISAN RESIDENCE. DATE Mar. 5, 2003
52-860 Latrobe Lane PLAN CHECK NO. 0301-339
La Quinta ESI/FME #: 3421
Plan Check by:
M. Mc ELROY PAGE NO. 1 OF 1
ITEM NO.
REPLY
3
They are specified please see revsised plans.
4
Shear transfer details are provided please see revised plans.
5
Provided please see revised foundation plans.
6
Guest bath walls are not bearing, but foundation is added for your request.
7
Already shown, please see attached plan.
A
- - 8
Already shown, please see attached plan.
9
It is the continuation.of BM19, shown on attached plan.
10
It is specified, please see revised plans.
11
They are specified, please see revised plans.
E S I/ F M E Copies To:
Structural Engineers (3) E.T.A.
By: Ali Egemen
FE S
O`L
1A�
No. 36840
d .6/30/04 nr",
r� CM1. \�
q�OF rs��FoQ�
Farhad Mansjiad , C-36840 . -
1800 El 1 th Street, Santa Ana, CA 92701 • (714) 835-2800 • Fax (714) 835-2819
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