0104-106 (SFD)(V L[J
O :.f)
d
�W�
oZr--
O�
o
J 642 -
ILL!
I— a
Z
M
L0
N
ON
U_ °)
Z
rlQ-0
X W Y=
mQ0
a 0�
,It Z_
c0 =)
C)
J
L q
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
Dated 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 ofo the following declarations:.
() I have,and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for 6y Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
(Y), 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 Policy No.
KHMPT
(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 fo hwith comply with those provisions. � �
Date: C_1 - .,c; . Applicant $ ..._.,.` - 61
Waring: Failure to secure Workers' Compensation coverage is unlawful and
hall 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 B ldiq2liand Safe
for a permit subject to the conditions and restrictions S 9[4 jk
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed un or ursuAotp 2
any permit issued as a result of this applicaton agrees to, shall indemnify
& hold harmless the City of La Quinta, its officers, agent and Employees.
2. Any permit issued as a result of this application becom s null no V91%
work is not commenced within 180 days from date ofssuance of suA
permit, or cessation of work for 180 days will subject per
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.
�S nature(ner/Agent) °n- •- s P r:--Date.L ' 19hlt,
OF
BUILDING PERMIT PERMIT#
DATE ry VALUATION LOT 0104-1.E6' TRACT
13L145 T,;15
JOB SITE •"" -
'APN
ADDRESS, 52 9411 FJOIGIGIA" DRMC
OWNER
CONTRACTOR / DESIGNER / ENGINEER
JACK lvia: DM Z D YSt- T COVEE DEV 1:1C
COMI I ORM- 100 DEMON SYSUMS INC.
P'O BOX FN
.I.9e Ca. BOX 628
1A Q13IMA CA 92233
LA QCIW A CIA. 22253
(760)771-3593 CULA 5830
USE OF PERMIT
8DIT01aFaK3tdalyDWMLIN 3
SlrD( P NOT ElsOCyj�gK't11+�.yf4p�L/I.%1/P,iyYyCy?Ll,/S�.�P,Cf•�` Cy R
�k+'yKpR.7�y1fl�{f"JI)nC gra �T��i'sC7•.�iJgDE
p �p�( �p
DRS3t� 7'.�JY..�l,.1 A7+1��'Ek.�+..�,01 ..H. ii3.A;'i7 (l ER .9A. 3. 1al16 Aif434e'4w?A4 ON PLAN l+S�IWX
8F, krO.Fi MIJ1,TIi PLL PERMIT 1SW ANCE
TRACT CCiNat'1°RU"0j1014 I""t.00'uF
FORC HIPATIO ,H,00 S.is•
5 FF, WOOD FEI'1C3 9149.00 LIQ
G-ARMB 463.00 SP
.'{U611INN—I'M(i`i,h"Y(He COM'ARl[3CTIOK
9310604%)
CON`I RUC'1)WIl M 101 g0iMl A.18-000 561230
pI. at CL-1UX FEE 101-000-439-318 $129.36
MECHANICAL NiCAL PER 101 -WO -421-000 $60,60
L•. Y+y�P,;Z 101-�?lgUt0?•�e42tC�r••CI}�yTp0 ci3{S�. ty9
yEL:24p;�"(y'I�2i7y!y:.,&-
1011-:000-419-000
d- CJ�UIMAid4° O IrT , E011 -:00 -419-000
ST'RO-1411 MOTION TIE'L ., PY,310 101 -OW-24.1 4"%
Cd12A�T.a9A3p F.KK $20;00
DEVE-LO?WR RMRA, fq a i�i.+.M,
PRECISE ;PLAN. 101-000-441-34.5
��> .rte- 1 �r:..ip�j..d..3�r-� 3 � •�3SG.017
.1
0 2001 { .: -TOTAL CON CCiM -AM MAN AN Cl.0 K
$3,079.22
LR33 'PlUl-PAI D MIS
4350,00
AQUINTA MUM MMU MES3,IRE.Now
$2,929,12
E DEPT
RECEIPT
DATE
BY
DATE FINALED;' d.'I j
INSPECTOR
9
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
✓1 Z '�� .5�
Ducts
Slab Grade
6
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
3p. p
F.A.U.
Framing
—c7l 57
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
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
_
� ! S%
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
V !
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
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
1383
Utility Notice (Perm)
P.O. BOX 1504 APPLICATION ONLY Pl�ti S
Building L ,I► 78-495 CALLE TAMPICO '
Address �itJi-iCx�Ue! A QUINTA, CALIFORNIA 92253
Owner _ 1
mailing
Address
City Zip Tel.
U) Poo- v-) 1 672213
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereb/,al4n that I am licensld under provisions of Chapter 9 (commenci g wfth Section
99,Q7of@ ivisiory3 of_
the Bu pees„�and.Professiorls Code, and my license<s�n fulljorce and
) OWNER -BUILDER DECLARATION f
1 hereby gffirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit toconstruct, alter, 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 (E500).
t.; 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 I 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 contractors) licensed pursuant to the Contractor's License Law.)
0 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
r7 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 if the permit is for one hundred dollars ($100) valuation
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.
Date Owner
NOTICE TO APPLICANT: If, after 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 a building 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 aQplicant Date
Mailing Address
City, State, Zip
(BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number 772:1.-3>31-01)
,Legal Description CA`T l %f &(K �}S I U1Jt"i -1S
Project Description
Sq. Ft. i No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
r
Estimated Valuation
sr
PERMIT AMOUNT
Plan Chk. Dep
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Driveway Enc.
Infrastructure j
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
City
A t NTiA
Zip ::F—
Gi�2s3
StateLic.
& Classif. '��
Arch., Engr.,
Designer
Address
Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereb/,al4n that I am licensld under provisions of Chapter 9 (commenci g wfth Section
99,Q7of@ ivisiory3 of_
the Bu pees„�and.Professiorls Code, and my license<s�n fulljorce and
) OWNER -BUILDER DECLARATION f
1 hereby gffirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit toconstruct, alter, 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 (E500).
t.; 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 I 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 contractors) licensed pursuant to the Contractor's License Law.)
0 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
r7 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 if the permit is for one hundred dollars ($100) valuation
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.
Date Owner
NOTICE TO APPLICANT: If, after 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 a building 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 aQplicant Date
Mailing Address
City, State, Zip
(BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number 772:1.-3>31-01)
,Legal Description CA`T l %f &(K �}S I U1Jt"i -1S
Project Description
Sq. Ft. i No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
r
Estimated Valuation
sr
PERMIT AMOUNT
Plan Chk. Dep
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Driveway Enc.
Infrastructure j
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 4/1'8/01
No. 21904
owner NameJack McKenzie Desert Cove Dev. LLC
No. 52_940 street .Eisenhower_Drive
city La Quinta
Tract # BL 145 U15 Lot # 16
APN# 773-331-011
Jurisdiction La Quinta
Permit # 0104-106
Log #
zip 92253 Study Area
Square Footage 1,501
Type of Development Single Family Residence No. of Units 1
Comments
*Cashier's Check for the amount of $10,407.85.*
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 or replacement mobilehomes. It
has been determined 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 Government Code 53080
in the amount of
2.05 X 1,501 or $ 3,077.05 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/ PFF Bank & Trust.- Lisa Bailey
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Paula Ruiz
Signature '
Payment Received
Telephone
4
r tT
$3.077.05 f r'
Check No. 520999739
40TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) 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 sssued or on which they are paid to the District(s) or to another public entity authorized to
:ollect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
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, in order to determine the applicability of compatibility issues or need to require the filing of Master
Design Guidelines by the applicant. It shall be transmitted to the Building and SafetyAppartment s your
correction list. Please attach additional explanations as necessary.
�p�El
APPLICANT Construction Design Systems
52-940; Eisenhower Drive Lri V
SITE ADDRESS PSS��O
APN 773 _ 331 _ 01.1 BINNO.: CASE NO.: 2001-445
LEGAL: LOT 16 BLOCK 145 UNIT 15 S.C.@V.L.Q.
CHECKED BY: Greg Trousdell DATE:
Inform the assigned Building plan checker upon your assignment to this case
Secretary maintains a log book to track applications and assign case numbers.
The CDD Executive
REQUIRED ITEM
Y N
COMMENT/CORRECTION
Compatibility Review
Case logged and number assigned
Verify legal and APN information
Consistent with MDG on file (as.applicable
t
MDG filing required (5 filings since 9/3./98)
Consistency with street/surrounding area:
Colors
6 6
c aterials
6 rc itecture
t d
�9
D "qty
r.001
\ `dais
ase
'44l
Go0'toss o
t. ,6
o.
XM
CO
Other Requirements:
)S®l d- AL3
r
r
e 40, o ��
RC DISTRICT - PLANNING REVIEW FONO,,� �'r
This form is to be used by CDD staff for review of single family dwellings in the RC (Cove Resrtial)
District, in order to determine the applicability of compatibility issues or need to require the filing of Mas irk
Design Guidelines by the applicant. It shall be transmitted to the Building and Safety D partment s your
correction list. Please attach additional explanations as necessary.
Oc�ss\NG `op��l
APPLICANT Construction Design Systems
.,I y I, ��-
SITE ADDRESS 52-940; Eisenhower Drive
P
APN 173 _ 331 _ 011 'BINNO.: CASE NO.: 2001-445
LEGAL: LOT 16 BLOCK 145 - UNIT 15
CHECKED BY: Greg Trousdell
DATE:
S.C.@V.L.Q.
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
Compatibility Review
Case logged and number assigned
Verify legal and APN information
Consistent with MDG on file (as.applicable
MDG filing required (5 filings since 9/3/98)
Consistency with street/surrounding area:
Colors
Materials
Architecture
Other Requirements:
LENIPEL VENTWIRES, INC.
April 9, 2001
Ms. Nickie J. Gormley
City of La Quinta Building. Department
78-495 Calle Tampico
P.O. Box 1504
La Quinta, CA 92253
RE: Construction Design Systems Inc.
Dear Nickie:
Please be advised that the following plans have been previously approved for use in the Cove
area of La Quinta by the Planning Commission. The firm of Construction Design Systems, Inc.
has my permission to use the plans only at the following locations:
1. Plan BA -1: 52860 Avenida Rubio
2. Plan Malibu 1: 52840 Avenida Rubio
3. Plan Malibu 1: _ 53445 Eisenhower
Plan BA -1: 52940-Eise6hower ._
If you have any other questions, please call me at 760/564-1866.
TURES, INC.
A.P. Lench,
President j
APL:vI , fBR.LQved bw Per
O Planning Commission
O City Co il—..�---- -----
claCommu v OePL •---
Initials----
Case No. _........ ---- -----
Exhibit----
O With Conditions
P. O. BOX 450 * LA QUINTA * CALIFORNIA * 92253-0450
760/564-1866 * FAX 760/564-2627
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code, .
certifying that, at. the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 52-940 EISENHOWER DRIVE
Use Classification: SFD Bldg. Permit No.: 0104-106
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC
Owner of Building: JACK McKENZIE DESERT COVE DEV. LLC
'�out
Building Official
Address:
P.O. BOX 628
City:
LA QUINTA, CA 92253
By:
STEVE TRAXEL
Date: 11-13-01
POST IN A CONSPICUOUS PLACE