0302-079 (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
7-4,4091
Date � ���, %��r• Signature of Contractor/
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 STATE FUNID Policy No. �x9-02-0A�tt7l�-�Gli3
(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` provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions"
,1)9te: <-/,Q) /r� -_X 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 applicator agrees to, & shall,' indemni
& hold harmless the City of La Quinta, its officers, agents and employee . D
2. Any permit issued as a result of this application becomes null and void
work is not commenced within 180 days from date of issuance of su
permit, or cessation of work for 180 days will subject permit to cancellatio .
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 buildi g
construction, and hereby authorize, representatives of this City to enter u n
the above-mentioned property for'insp%ection purposes.
Signature (Owner/Agent) !�" �� ---• +Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
05112n(x 939.1,%SA0 211. 28867
JOB SITE
ADDRESSJ.�„ Xd.P�aTROBiYF LANE
APN
7711x-.��.�-0 e1
OWNER
CONTRACTOR DESIGNER ENGINEER
•
yJMAE4
UOV V31TfADMD0PM,14 C7RP .
LAQ1.:IIld"TA CA 92253
�7iitia /'/ 1 1l2 icrIB 4.0 539 13
USE OF PERMIT
SINGLE FA'N.{UX DiRr"�:�l 190
SISI PP;6tMIT DOM 140T INCLUDE BLOCK WALIAPC IOWSPA ORAPPRO.t1.01H
DRIVFWAYX OM1'JylANC-9 W1TH .AfLL FEDERAL & 3TATE LAW,% INCLU DDIG
THE IrNDANOEI:ii.1i"s S!PFC W,...) ACT OF IM (I6 U.S.C;. $ 1531, ET
CUSTOM OM CONSTA.LI(' TIC'M 4,599,00 SI=
PORCH/PATIO 961.00 SF
0ARACHYCARPOId 1,00,00 8F
9X'1V,�t A7 COST OF Ct�NS" t�'G'�:014
r tgiYi� q
JG�.�v.I:�.�U.d Mull ,+ �'uivi.ltwly
CONSTRUCTION PEE 101.000.418--000 $11661AD
k' L A14 CHECIG F`PE 101-000-4.39-•319 $1,34,6.69
IEl/, DEPOSIT 101"000-439-318 41,000,00
Ii+lzcikAN101-000-421-000 $16L60
EI.�C'PiiICr1I.I ;!E;✓. '101!t 00.420.00 $256.97
PLUMBING PEE— 1.01-000-•419-000 $x17.00
S'iRi7NO I+fii3'I`ION YEZ - RESID 101-000.241.000 $14.15
f3Zi AIJi�4C1 ! 101-000-423-000 $19.00
"DW&OPER IMPACT FEE
.SRN W, PUBLIC PLACES RESM 270-000-445,0M,
SUB -TOTAL CCW, ,rRtY M01 -T AND PLAN CIMCK
-$1,000.00
U-11 p'� .S.(.y `•n�1NOW
ifs
T0
sy1 0.9
MAY 12 2003
CITY OF IA diQ11iVTA
FiNAfM_CeE t)F
RECEIPT
BY
DA17ALED
INSPECT
►gid
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- - 4
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
Q
Drywall - Int. Lath
Final
Final
o
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
COMMP.NTS:
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 - 0
Final
Utility Notice (Perm) 40
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 4,599 S.F. or $9,841.86 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/1 st Bank - Arinn Kerr Check No. 68801
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharon MCOilvrey $9,841:86
Payment Recd .Over/Under
Signature ('
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
Certificate of Occu ancy
-P
OF Building & Safety Department
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 variou's ordinances of the Cit regulating building
construction andlor use.
BUILDING ADDRESS: 53-000 LATROBE LANE
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0302-079
Occupancy Group: R-3' Type of Construction: VN Land Use Zone:'RL
Owner of Building: JON MAGILL Address: 9 14622 LODGE POLE COURT
City,.ST, ZIP: CHINO HILLS, ItA
By: KIRK KIRKLAND
Date: MARCH 1, 2004
Building Official,
POST IN A CONSPICUOUS PLACE
JOB ADDRESS
SFD-PERMIT DOES NOT INCLUDE BLOCK WALL/POOL/SPA OR
APPROACH DRIVEWAY:COMPLIANCE WITH.ALL FEDERAL &
STATE LAWS, INCLUDING THE ENDANGERED SPECIES ACT OF
TYPE OF INSPECTION DATE INSP.
TEMPORARY POWER
SETBACKS
U/G PLUMBING /WASTE
U/G ELECTRICAL/ GROUNDING
FOOTINGS / STEEL
CONCRETE SLAB
DO NOT POUR CONCRETE UNTIL ABOVE SIGNED
ROOF NAIL / PRE -ROOF —)X .
OKAY TO WRAP
FRAMING (COMBINATION) Ia
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL
INSULATION i
COVER NO WORK UNTI BOVE SIGN
INTERIOR GYP. BD. DRYWALL
EXTERIOR LATH
GAS TEST
SEPTIC ABANDONMENT
SEWER CONNECTION Q
SEPTIC /GREASE INTERCEPTOR I
MASONRY INSPECTIONS
FOOTINGS / STEEL
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE /SETBACKS
U/G PLUMBING
U/G AS
U/G ELECTRICAL
PRE -PLASTER ALARMS / BARRIERS
FINAL INSPECTIONS
TEMP. USE OF PERMANENT POWER Y/
MECHANICAL
PUBLIC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT.
FINAL / JOB COMPLETED
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
s
'CITY FLA QUINTA
oe
BUILDING'& SAFETY DEPARTMENT
I
..,777-7012
I -- -- •.-..-....
_ INSPECTION REQUEST LINE
777-7153
Owner
I A GI i .
L
Contractor SUN
VIS IIA DEVEtOPMENT1
Permit Number
POST ON
_
JO NSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS
SFD-PERMIT DOES NOT INCLUDE BLOCK WALL/POOL/SPA OR
APPROACH DRIVEWAY:COMPLIANCE WITH.ALL FEDERAL &
STATE LAWS, INCLUDING THE ENDANGERED SPECIES ACT OF
TYPE OF INSPECTION DATE INSP.
TEMPORARY POWER
SETBACKS
U/G PLUMBING /WASTE
U/G ELECTRICAL/ GROUNDING
FOOTINGS / STEEL
CONCRETE SLAB
DO NOT POUR CONCRETE UNTIL ABOVE SIGNED
ROOF NAIL / PRE -ROOF —)X .
OKAY TO WRAP
FRAMING (COMBINATION) Ia
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL
INSULATION i
COVER NO WORK UNTI BOVE SIGN
INTERIOR GYP. BD. DRYWALL
EXTERIOR LATH
GAS TEST
SEPTIC ABANDONMENT
SEWER CONNECTION Q
SEPTIC /GREASE INTERCEPTOR I
MASONRY INSPECTIONS
FOOTINGS / STEEL
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE /SETBACKS
U/G PLUMBING
U/G AS
U/G ELECTRICAL
PRE -PLASTER ALARMS / BARRIERS
FINAL INSPECTIONS
TEMP. USE OF PERMANENT POWER Y/
MECHANICAL
PUBLIC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT.
FINAL / JOB COMPLETED
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
Summit Structural Engineering
P.O. Box 813
270 North Main Street.
s Donnelly, ID 83615
(866)862-8148
` (208) 325-8148, -"
Fax (208) 325-8149
April 11, 2003
Sun State Components
P.O. Box 4077
4505 Mohave Airport Drive
Kingman, AZ 86402
Attn: Truss Designer
Subject:: Roof Truss Shop Drawings and Calculations
Lot 21 at The Tradition (Magill Residence)
La Quinta, CA
Dear Truss Designer,
The roof truss drawings by Sunstate Components for the subject project were received by
our office on April 10, 2003, and is approved. The submittal has been reviewed for
general conformance to the design concept of the project structural plans. The
fabrication processes, techniques of construction, dimensions, and quantities are 'not a
part of this review. Since the shop drawings were reviewed only for general conformance
with the structural plans, unless variations from the structural plans have been clearly
indicated, we may not have listed them. Our review of these drawings does not relieve
the truss engineer and the framing contractor from complying with the structural plans.
Yours truly,
SUMMIT STRUCTURAL ENGINEERING o? %%Nsb,,t�c
. c3Qy 1Pi H���iS Cm
m �
f. 0054193
x.12/31 /03
Benjamin Herbst, P.E.. C
OF CALF
CC: Rob Capets, Sun Vista
gH
cA2002jobfi1es\sv-191\191 trussl.doc ,
Residential. Commercial. Industrial. Land Develooment
~
- . ~ '. . ~^ . '- � I-` _^ . -. '. � '` � ^ . ~ ' ~ . ~ . ^ . .~~~~~-~_~ ~ . . . . . ~ ~ . _ . ~ . _ . -~ . - `- .' . .. ..~. ~ . ~_. ~' . .'. ~.'. . -
'
Summit Structural Engineering
P.O. Box 813
270 North Main Street
RECF.+, T- TT. Donnelly, ID 83615
(866) 862-8148
AUG. 1. 9 2003 (208) 325-8148
Fax (208) 325-8-149
August 15,.-2003. L� —J
Sun Vista Development, Inc.
P.O. BOX 1144
La Quinta, CA 92253
Attn: Rob Ca etz 3
Subject: Structural Observation'
McGill Residence
Lot 21.,@ The Tradition .
La Quinta, 'CA
Dear Rob,
Per:your request, we visited the subject job site on August 7; 2003 to .perform a structural
observation. While we were at the job site, we found several omissions and deviations'
.from the plans. .All missing items were installed and verified by -the superintendent -on
August 14, 2003,'and at that time we found the structure to be in general _compliance with
the .structural design concept:
If you have any questions, please give me a.c ill.
Yours truly, .
SUMMIT STRUCTURAL ENGINEERING
OQFOFESS/O�tUJ�
No. C054193
Exp. 12/31/03.
Benjamin Herbst, P.E.
sr CIVI\-
BH • 9rFOFCAIIiO�
g:\My Docur»ents\2002\jobfi,les\Sv-191\191_field1(cert).doc
�. Residential. Commercial. Industrial. Land Development