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'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
480121 C20 036 `t3Jf 09rdQalt:
D to eo'� , 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
,Sect ) ion 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 ' STAU Maj Policy No. F6410"9-02
(This section need'ribt be completed if the permit valuation is for $100.00 or less).
( ) I certify, that intheperformance 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 jirovisions.
Dater 1 its 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 L4or 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] --''' Date
f�'.�..
PERMIT PERMIT#
(BUILDING
,r VALUATION 02,1& LOT TRACT
DATE ,
�e1 it
ADDRESS Q A ' .e Tw.l
APN
'1174 -061 -OM
OWNER
CONTRACTOR/DESIGNER/EN (NEER
M1$1")%'V. cC Rp.
3)01.1 D1-'VFJ,0' -MMT CORr,
PO.BX: 291,32
76-921 RUMAWAY DAY
PAW"Di-mm CA 52261
E,:MW1DA.DtW.S C"A 92261
r
(760)360-8706 CBJ:.R 1576
f
USE OF PERMIT .
13J5 S6Z.1�"1'. l,.I'►�1?lt9,' 44fi .;(�.1r'1', C'1:�F�:l31:U1': 3petrttl2 Diner .n�)t.
ural# u Moak WaRe,154=00, •uc+w MW rp t. A neptWate PwTk it
M raquire'd for dkiveway► k0pr 1 fmm the Pub& Ww11s
t�,�i t ygyr
FR.%�C ,l{ e+i+f`�fX Gi4dCTdt•, 4 1,53100 8
TRACT
1POi�C}ill3.f1I'Yt7 24.60 SPS
O&RAMCARP60 440,P0 WF
X511 XLl.°END COPa`E OF CC11vtNfRIUMON
' "&iiRdtl ffi"i � t`S"' MM- ARY
CO?@SaY'RUCI3ION ring 101-000-418f,000 1008.00
PLAN CHECK FEE 101-000-4,39-318 009.31+
RK DEPOSIT 101-000-439-318 -2210,00,
1 ECHANIC'.A), FEE '101-00tI'421-000 $60.00
ELEC'UtIC.A L (TLE 101.000.420.000 $110,96
P1.IUM15EY OM,: 101-000-419-000 $127.59
STRONO MOTION PKE - I3ESI.I3 101.0004141.000 $9422
ON i1?>itti S+1?,E 101-000-4-23-000 $15.40
,011x. F'r.OPER I1yIPACT KE $3,40�.0t►
PIZEC1:at PI. AN 101-000-441-343 $190.60
.y
SuB-. ,T.' CONW.-RUC,,1.1,OI .ANI) PLAY CFT_,`tafe.
�1 y diJ. 6ryi
IOTA 5_`RWr 'n813' XOiW
DEC 18 2002
CITY OF LA t3UINTA
FINANCE DEPT.
RECEIPT
DATE i
�/
BY��
D FINALE ��
(NSP
I ..l t i
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
J7
f
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap_�
Framing
=� OZ
F.A.U.
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 ��' ��
BLOCKWALL APPROVALS
Final
POOLS - SPAS
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
���p . (,
��
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
or
,SLG -_
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 G l 5_7
Final
Utility Notice (Perm) �- ��
Date
12/18/02
No.
23967
Owner
DGH Dev. Corp.
Address
P.O. Box 2982
City
Palm Desert Zip 92261
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
4�J�IFIEDsc�O
C)
Q BERMUDA DUNES r
C/) RANCHO MIRAGE b
{� INDIAN WELLS
PALM DESERT ,y
^ LA QUINTA
1. 1T N0 `^
VVYYY O .YJ
774-061-003
La Quinta
1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 53060 Eisenhower Drive 1533 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
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 1,533 S.F. or $3,280.62 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/PDNB - Art Lamrose Check No. 085441
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Monica Guillen $3,280.62 So.00
Payment Recd Over/Under
Signature
t
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
93, _ 1/03 08:14
I
TOM - UATTUSO POOL CORP
CDFARIFACOSTAMESA -> 7607777011
FAX NO. : 7Ge7704920
NO. ?12
06 2003 05:00PI" P,
Cooperative Red Imported Fire Ant Project
Not (kation of Intent to move Soil from or within Quarantined
Areas of Orange, Riverside, and Lois Arigeles Counties
Ffj—Fk-C-�Owip-liance Agreement
Issuing C.;-ty: cc-�Inlv
Namc)
e , company Requesting Xoproval:
Person-.
.�:�.;rz»� �u. ! � �.i city^�l� __..._._.._!� Zi�:�^.
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4 91L.
,-xcavation U)cacion-: c .5 36J�70 5--e. r-)
s,, J:
\ '-R.r S
Quziritiry of Sci I (e -q. # Clibic Yards):
-knucipated. Date ofNfovemenE.--
Lfrgancy Level for Immediate Inspectio-n and Release: [Circle OnejlIt N! ed W ni
M!Moveirren' of Soil is
17, S POSSIBLE TO
1401d 1NV10VCTVfff',t 1J1MJJSTe C�,�cked - WE *WTILL CALL AS POSSIBLE
INSPECTION DATE ASIiD TIME.
T: o�'Traps: Trapped by__Date
ate'Ficked 'Up,
SollMo�,emenc is Scrict�y Prohibited for the Foll,)win2 Reason
n r%es Bro. 4cls ',)-w and irid
MA
�a��u,�vr�`a,,�
Certificate of Occupancy
-- __� - uicv
-
Icacoxnhn ��
OFT9� 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 various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 53-060 EISENHOWER DRIVE
Use classification: SFD Building Permit No.: 0210-255
Occupancy Group: R -3,U-1 Type of Construction: VN Land Use Zone: RC
Owner of Building: DGH DEV. CORP. Address: PO BX 2982
City, ST, ZIP: PALM DESERT CA 92260
By: KIRK KIRKLAND
Date: 6-20-2003
Building Offi al
POST IN A CONSPICUOUS PLACE