0301-161 (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
03,111/2(
Date =' f`'� Signature of Contractor Z
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.
N (I ) 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 OTATE FUND Policy No. . 1576410-.2002
(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.
/Date: " /2"A x " Applicantr. 2
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to,the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
.Signature (Owner/Agent) r Date-- %`Y"+'
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 1 TRACT
w / ::.14i.tiil Pl= 99
L
JOB SITE�{
ADDRESS s7,i 'IC k% t T 4�fI'
APN
77.1-271010
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CMUPORARY HOMIES
C'a1TJ7:R+W0RAR17 },CC3W_3
51310 ,P,°1 NWAMlVs'M
31:-70AVEN:d1'3ADEP iID
LA. QUWfA CA 92213
LA QUNTA CA. 92253
5
i
(760)J68-1404 C`11V$ 67155
USE OF PERMIT
4"133OUn FA1v0 LY DWI MUM
1521 5.. «: KRI= DOES NOT I'NCI UDE C+WCK WA U,1s0011 aR
DWYMAY. APPROM-11
TRACT CONSTRUCTION 3,9UOD NV
PORI".F31PATiO 49.00 SI'`
0ARAW ;ARDORY 46.1,00 Or
EYMAIXID COYT 011 4:'O.i?dMTRWIMN
:1? r ►TMEN SUMMARY
(111ONISIT .UICTIan FEE 101-0010-418.0010 $603.00
PLAN CHWK FTI101-000-439-318 $508:22
nEr",01111POSIT 101-300.439.318 4150109
MECH ANICA1, MVS 101-000.421-000 $59.00
P.UCTRICAL FEE 1011.00J0.4.7.0.000 E111A
PI..Wt INO € EE 101.-000•419-000 $1124,00
OR,ADINO FER 101.000-4223.000 WIN
D:Vr1,OPYRIMPACT FRE i4444f+rr, o
P1iG311139 PIAN 101- W-44.1-345 5190.00
SLIB-TOT 1U,C;:?NMUCTIONAND PLM CMCK
$3,930.22
LESS PR1r -PAW FEES
4250,00
D Q n PES' FERE VUR NOW
$.v0ta2
FEB 0 4 1003
Ciry r -
Flf4Agat_; � D3,�+v [A
BY /
D FIN D
INSPECT
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
lj
Return Air
Steel
:;,r
Combustion Air
Roof Deck
p vac
Exhaust Fans
O.K. to Wrap
_
-(57
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
j 9?-lq-
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
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
��� U3 _ ljL
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
`0 ,�3 oZG�_
Encapsulation
Gas Piping
Gas Test
• Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole =��- as -
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)
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 1,521 S.F. or $3,254.94 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/UBOC - Mark Kellogg Check No. 8168216
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Monica Guillen $3,254.94 So.00
PaymentRecdOver/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
AF
B)
EX
CA
bi
RC DISTRICT - PLANNING REVIEW FORM
This form is to be used by CDD staff: for review of single family dwellings in the RC (Cove
Residential) District per, Section 9.50.090 of the Zoning Code. Its purpose is to determine: 1)
that the proposed housing design does not duplicate the same architectural style of any house
within 200.feet of the applicant, and/or 2) if there is a need for .the applicant to file for Master
Design Guidelines. If the applicant does need to file a Master Design Guideline, please transmit
this information to the Building and Safety Department as part of your correction list. Please
attach additional explanations as necessary.
APPLICANT: , 1 e � (o
SITE ADDRESS: — q qo l�S2 (,U t?
APN —]-7 - a -71 - Q I CS CASE NO.:
LEGAL: LOT BLOCK n UNIT S.C.@V.L.Q.
CHECK AND APPROVED BY: DATE:
Inform the assigned Building plan checker -upon your assignment to this case. The CDD
Executive Secretary maintains a log book to track applications and assign case numbers.
REQUIRED ITEM
Y
N
COMMENT/CORRECTION
Verify legal and APN information
Consistent with MDG on file (as
applicable)
MDG filing required (5. filings
since 9/3/98)
Architectural variety within 200
feet of the surrounding area.
Architectural design features
OK
Other Requirements:
ROVED BY COMMUNITY DEVELOPMENT DEI'
DATE /12, yos .
IBIT 5-2- 2-L)
MAR 06 '03 11:40 FR TO 95686072 P.01i01
- 'REPORT 'OF•' FIELD 'COPAf''5
-�.`. O'N-::TES
I va:.a0oaTwo.: -A0 7.3 0Z.- cLlExr: h �.- Wit• - . .-.
d3 PROACT.
IUCLEAR GAUGE WPOAMATION ANO OAR,Y STANDARD
CALIBRATION NUMBERS
VARIATION. YERClNT.tH GAUGE ADJUSTMENT
% VARIATION FROM
-ALIBRATION COUNTS
FROM SHEETS
MOISTURE
LAST USE
:aucE TYPE>�%�! AMPBELL I MOIS`VRE
MOISTURE:
MOISTURE_ MOISTURE!
-
AOoe NO: 73 b DENSITY.
OENsrr-:
OENSITY: DENSITY:
OF TEST
uc: vn �nr�nm+avn
SOIL ID 0 VISUAL CLASSIFICATION OF SOIL I MAX. ORY DENSITY, PCF OPTIMUM MOISTURE. o
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COMPACTION MOISTURE GENERAL LOCATION:
REQUIREMENTS. % q!> REQUIREMENTS, I Al. -,^. `!o4e
EST
READING
1 QUOTIENT/
SOIL.
TEST
ELEVATION
MOISTURE
WET/ORY-
PERCENT
COMMENTS
NO.
-
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10 NO.
DEPTH. IN
OF TEST
CONTENT,
DENSITY,
COMPACTION
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J .SASE COURSE C . RerrsT OF Prt"ouS TEST .
4 - SUBBASE O - MOt,'TuRE IN Exc= OF SPECrrCATIONS
5 - SOL CDAJEM f E- MOLSTURE BSOW 5DfMCAnOItS
\ •. 6 O•fHER
** TOTAL PAGE. 01
0
Certificate of Occupancy
Building & Safety Department
This Certificate is issued pursuant to the requirements of Section', -109 oFthe California Building
Code, certifying that, at the time of, •issuance, this structure was,-,jn .compliance with the
provisions. of the Building Code and the various ordinances, of the -City regulating building
construction and/or use. -
BUILDING ADDRESS: 52440 EISENHOWER DRIVE