0305-177 (AR)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
516625 B1 01r���32C
r
Date' E ^r> -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 STNMFUND Policy No. • 1SDO97
(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
6cle, I shall forthwith comply with those provisions.
Date: Q s Z Applicant `•, w+ M
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) X �' - �1 p Date r' '
BUILDING PERMIT PERMIT#
03OS-17 fTRACT
DATE VALUATION LOT:
119 _-903= U TV,24890.4
JOB SITE
ADDRESS 79-815 LWAs
APN
772-001.0
OWNER
CONTRACTOR / DESIGNER / EN (NEER
�g�t315 LIMA
P 0 BOX 2767
LA Q. -UM. -A, CA 92253
P.Alm X3owr CA 92261
7�►0;1i73�i i5� CE1.41l, 6076
USE OF PERMIT
MEN 'SAI.., 51�+1'IZC1 .
ADDITION - PH11.'ILY TfaWX,'R,,A1+ID 43 SQ.PTXASITA A0D1'T10N TO
CUSTOM C'•0303'1?.UC.'TION 432.00 BF
Pi)ItCd%%1'°MO 94.00 SP
1r.FrWATvD ,l 0HT CSI.+ Colum'RUCTION
34 th •
PrP,mxr,f,. sum ky
CONSTRUCTION FEZ- • 10.1--000-418-000
P» CHECK
MWHANICr"AT.FEE 101.700-421-000 t➢A,�U
MI:CTIUCAL IAF% 101-OtiCi4 O-000 gip, Yx
l'I.Ci1kF0114 FEE,`101.000.419.000 X94 OQ
STR0ldt] MS3i'IO:FQ 'FEE, - RESID 101-0004A I -1000
?_. .1 '• UC"J"iOW.f#1mPLAN. C
$701.6'7
LESS, T'1W.-P MM
$0.00
SEF' 0 8 2003
CITY OF LA QUINTA "
FINANCE DEPT..,
RECEIPT
DATE'
BY '(`F /
DATE FINALED
INSPECTO
4
.4
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
1 !9- 2 -,3
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
/
Exhaust Fans
O.K. to Wrap
o
F.A.U.
Framing
Compressor
Insulation
6
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
-
Drywall - Int. Lath
Final
Final —
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
%
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Q.
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas) -�
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring '
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
x
X
6 23 6 /($ a� 03
� .f' i.�i- /i 9 �. O �5 �'t9F�• •(� � SG,/-,lc�t�i � I f -11f. �
Ci of La
City Quanta
D?� Building az Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: 78 1,5- Lt
O%vner's Name: T/f
A. P. Number: 7 / 7- Q 80 —01 0— 9
Address: — 7 9C5� u
Legal Description: iJ�—ZZ. Z-'P,�— Q
Citi•. ST. Zip: ( [ T-;&,
Contractor: �' N4�r—
FTelephone:
Address: 6
1 2 1::It eM--64 pt up
Project Description:
City. ST. Zip:
77<y—f -4 ��2`TV-/
Telephone: 2-7Z
r-n
State Lic. #.: 57 b City Lic. :
Arch.. Engr esigner:
Address• (- Z,.7�+-
V L,��r� l c. - Z
City. ST. ZipT--7-�
Telephone: �(,� 6 . Zg�
State Lic. #:'/ .
Name of Contact Person: �11.-. �-
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sy. Ft.: Z4 Z # Stories: l 9 Units:
Telephone # of Contact Person:
stimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING A
PERMIT FEES
Plan Sets
3
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed. ready for corrections
v I I
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check•Balance
Energy Calcs.
-
Plans picked up
Construction
Flood plain plan
Plans resubmitted -r
Mechanical
Grading plan
2"d Review, ready for correctio !issue
Ilectrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SAI.!.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'n/ Review. ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A,I.P,P,
Pub. Wks. Appr
Date of permit issue
t7
School Fees
Total Permit Fees
6 23 6 /($ a� 03
� .f' i.�i- /i 9 �. O �5 �'t9F�• •(� � SG,/-,lc�t�i � I f -11f. �
C7
a�
R
,r
l-
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:
M Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $0.00 X 432 S.F. or $0.00 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 Exempt - Frank Flores Check No.
Name on the check Telephone
Funding Exempt
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharon MCGilvrey Payment Recd $0.00
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
yw
YOUNG ENGINEERING SER VICES
•Engineering *Architecture -Surveying- Building & Safety Services
Letter of Transmittal
To: City of La Quints Date: 8/27/03 97
Project. 78-815 Lima
Attn: Ed Randall PC#: 0305-177(2 nCheck)
Tel No.: (760) 777-7012 Tract No.:
We are forwarding: X By Messenger By Mail Your Pickup
No. of Copies Description:
1 Set of redlined plans/revised plans
1 Set of struct calcs old/struct calcs new
1 Truss calcs
Comments: Plans are acceptable.
Thanks
This Material Sent for:
Your Files Per Your Request
Your Review z Approval
Checking At the request of:
Other
By: Eric Frenzel
Phone # 760-360-5770
77-804 Wildcat Drive, Suite C, Palm Desert, CA 92211 (760) 360-5770
Bronz Young
uo/ lo/ uJ Bull 1L.114 i•nn 1 vu uta uuiu
�t THE
C7ITRUS
COURSE HOMEOWNERS ASSOCIATION r --
January 17, 2003
Mr. Dan Kenney
r 78-815 Lima
La Quinta, CA 92253
.,Re: Architectural for 78.815 Lima, La Quinta, CA 92253
Dear Mr. Kenney:
Mernbers of the Architectural Committee have reviewed the application and the revised
plans that you have submitted to add a Casita and Courtyard wall to your existing home.
The Committee approves the application and revised plans.
1 Also, the Committee would like to express their appreciation for you willingness to
accommodate their earlier concerns about the location of the Casita.
When all work on your home has been completed, please notify this office in writing so
;f the improvements can be inspected and signed of by the Architectural Committee hind
your deposit can be returned to you.
Feel free to contact me if you have any questions regarding your architectural application
Good luck with your projects
j' Sincerely, \
i
BehaIfof the Board of Directors
Citrus Course Homeowners Association
I By: Torre Miller, Association Manager
P.O. Box 4772 Palm Desert, CA 92261-4772.73-550 Alessandro, Suite 5 Palm Desert, California
760.346.1161 - FAX 760.346.9918 - E-mail: drni@drminternet.com - www.citruscoursehoa.com
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY •�
78-194 Elenbrook Ct.�
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
CTION
INSPECTION
PERFORMED
C3 REINFORCED CONCRETE 13 STRUCT. ASSEMBLY
C)C)�
POST TENSIONED CONCRETE ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
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13OTHER 11 J` j L�•/
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DAY OF WEEK
MATERIAL DESCRIPTION a
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IN JSf�LIQ�
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ENGIN R ocok,��
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MRS. CHARGED
INSPECTION
-DATE --.
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COPY SENT TO CLIENT O w
CONTINUED N N T PAGE D
PAGE
OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS, SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
ATURE OF R GISTERED INSPE R
a S d3 4,b -�,�—
DA E OF REPORT REGISTER NUMBER