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0307-333 (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 # t�DDLic. Class Exp. Date 79!?'/46BMO. /ate/-" 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). 11 ( ) 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 TIO Policy. No. 80A3672 (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 ofection 3700 of the Labor Code, I shall forthwith comply with those provisio s.' Date:- �'j Applicant -. Warning Failure to secure Worker's' 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 purposesP "« Signature (Owner/Agent);--';:�„Date, i -k: BUILDING PERMIT PERMITq -.- _� o 0307-XI3 DATE” = -� . ; 'VALLUATION S LOT L TRACT JOB SITE ADDRESS 5d^-.&J.51a5_'.Nl~IUI�I'_l+i'. DRM APN 773--295-0916 OWNER CONTRACTOR'/ DESIGNER / EN (NEER IM,AWTAS A'TL 'A&9 t1VE:#I"tONT f3'R UP 51=103 AVEl=AVf.T_LA4202 31.103 AVINMA,.VILT.A;E#'A02 L A qU A CA 92253 L& QUIN-TA . Cly 9225.3 (760)?71.11523 ( B.I.A. 030 USE OF PERMIT i 40,E FA .,3C I' �W.FUM 1621 S.F. SSV PERMIT DOES NOT INICLUDE BLOCK 'f ML;L, l 00I.&PA OR DI:TV1, WAY APs ROAC H TRACT CON RUCTION 1,624.00 SF P6RC WPATI(3 : V1.00 SF 0A11.A.0F'XA11E'01d.'1' 6M.00 8F . RNIUUTR 3 COW OF CONMRUCIIION li�B,�213� C011NSTRUCT1ONFEF `102.000.418.000 gb37;4A PLAN t'.11WX FEE $543.76 IEEE DEPOSIT 101.000.439.315 4250,00 MECHANIC.ALTZE l®1,-Qt1fI-�1�,'I-Ot2G1 $39.00 BLECTRIC'•AL F 9 101.000-420,,00 i $119,02 Pd IJMBI140 FES 101.000-4.19-Q0© $I II,.4tG S'TRONO ilgOTIIOU.REE • RMID 101.000-141.000 $10.45 C9RA.i7ING FEE '101-0001.1'23-000 $13.00 DEVELOPER IMPACT $2240,00 PR ISE PLAN 101-000.441-343 $100.00 SII r.0 -TIAL CUI`1S1iiY�C- i�J AN P� Z AN' t�`T CK $4,5527.2:3 LE33 PRX-PAID PFM 42, 0,00 ��L/? AL P.i`�yi V911 �Y .!'rl:r"r3 7116JE S?6s+ V7CT kjye 2S2003 0F LA C DEPL A RECEIPT DATE L 4V BY/�� DA E FINALED INSPEC R INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Q Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck — - Q Exhaust Fans O.K to Wrap - F.A.U. Framing v Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath flr vmll _ Int I nth BLOCKWALL APPROVALS Set Backs Footings Bond Beam Final PLUMBING APPROVALS Waste Lines L Water Piping Plumbing Top Out Shower Pans Sewer Lateral Sewer Connection Gas Piping Gas Test !. Appliances 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) -� Final Steel Electric Bond Main Drain Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Gas Piping Gas Test Electric Final Heater Final Plumbing Final Equipment Enclosure O.K for Finish Plaster Pool Cover COMMENTS: POOLS - SPAS Date 10/27/03 No. 25127 Owner Atlantas Address 51-105 Avenida Villa #202 City La Quinta Zip 92253 Tract # Type Single Family Residence CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road La Quinta, CA 92253 (760) 771-8515 APN # Jurisdiction Permit # Study Area No. of Units Q�J�1F11rDs� fo ,c Q BERMUDA DUNES RANCHO MIRAGE �. INDIAN WELLS PALM DESERT y f?�LA QUINTA VO INDIO L� O 773-295-016 La Quinta 0307-333 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 2 52555 Eisenhower Drive 1624 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments Official Check #0737703986 in the amount of $3,425.36 in addition to $50.00 cash received to pay fees totaling $3475.36. At the present time, the Desert Sands Unified School District does not collect fees on garages/carports,'covered patiostwalkways, 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 1,624 S.F. or $3,475.36 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 OC/Wells Fargo - Art Lambrose Check No. 0737703986 Name on the check Telephone Funding Residential By Dr. Doris Wilson Superintendent Fee collectec Signature Payment Recd $3,475.36 $0.00 Over/Under 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 „99, 7 January 2004 The City of La Quinta Department of Building and Safety 78.495 Calle Tampico La Quinta, CA 92253 Project: Single Family Residence for: Atlantas Investment Group 1,837 Sq._Ft._Single-Fam ly Residence at: �- - 50-0senhow� er-Qn ---� La TUMta, California Regarding: Project Observation and Field Revisions To Whom it May Concern, ,i CHARLES D. GAR LAN O Architecture, Interiors, Space and Land Planning Structural Calculations On this'date I visited the noted project site to perform code required structural observations. At the time I noted only minor blocking, nailing and strapping issues that were resolved at the time of my visit except for the following: * Shear wall "E" segment had to be revised, at my direction to accommodate electrical and service entrance boxes. I directed Mr. Arthur A. Lambrose of Atlantas Investment Group to ap- ply a new, retrofit, holdown in order to provide an impenetrate shear wall segment adjacent to the subject service entrances. Please see attached detail. I hereby state that after the noted retrofit holdown has been installed, the project's structure is in substantial conformance with the structural design intent as represented in the construction documents. If you have.any fu er questions regarding this project please do not hesitate in contacting me. Sin I ��SD•G qc��� Ch es arland o -+ Architect * No. C11991 �r 1013112005 N9T EXp DATE FDF 74.854 Velie Way, Suite 5 ❑ Palm Desert, CA 92260 ❑ Phone: (760) 340-3528 ❑ Facsimile: (760) 340-3728 i # Certificate of Occupancy r - ^ M.1 J 1 of9 Building & Safety Department f F 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: 52-555 EISENHOWER DRIVE ` Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0307-333 t Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC R Owner of Building: ATLANTAS IN VESTMENTS Address: 51-105 AVENIDA VILLA #202 s G . k City, ST, ZIP: LA QUINTA, CA By: KIRK KIRKLAND k _ �t..t Date: APRIL 16, 2004 Building Official s POST IN A CONSPICUOUS PLACE