9809-264 (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
397975L3 / � /31!
qty �
at � Signature of Contractor
OWN ER-BLIILDERICLARATION
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).
( ) 1, 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
Se tion 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.
�rl AIT SU NID
(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 forth ith
' comply whthose provision
Date: Applica�
Warning: Failure to secure' orkers' Compensation coverage is unlawful and
shall subject an employer o 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 applicatoh 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/Agen Date
PERMIT # .
BUILDING PERMIT
DATE . /?Q99 VALUATION 5326,743.10 LOT2"4 TRACT 2ns�3ii
JOB SITE
ADDRESS
769 C►fJ WOW
OWNER
CONTRACTOR / DESIGNER / ENGINEER
HANwT- O MkPTS! ;k.ANO ."X;VI?C.C11 MEN T'
FRA1,1C P10 CAPVI. 'P.AP 7 ISEEI.f 11-INIt M
79687 COUNTRY CLUB Dili 9,201
79687 COUNT" CLUB C)R 11201
BL:1iMODA. DONES CA 92201.
BE[3:M1:!l:3A t: LINES CA 9=1
(760)345-7755 C"K0 1469
1313E .ArvH*1 iVMS INI
USE OF PERMIT
.h1T+Tlit E f?,i'..�l LY D�rvELLIN e
26 C:i712irtJ}�.MIE l�f ZiC
."sib- ��E�13'T i OEz', N -) s TZ'ct''% IDE BLOCi+;. W _L OR .i� l ;L
CUfVOAF"l. 00RISTI\IXT. iN 0,956.041 kiF.
;PORCAPATTIL) 507.00 !I
<:iARAi;}CICARKAd' 6flr'r.+7+) 13F
11ERii' I .5 XIV. SUMMARY
Gt)N&t7 U!;."f TON FEM 10:14M-418-000 $1,434.00
00-434-315 Vis, I X3,7!
RT, AN t`HF04 F -W WI -000-439-318
Pug TXI. 001 FT 101-O x-43;1-318 41750.00
AC.-CHATfICAL FEE 101-000-421-000 $117.50
r,.t.WIRICAL 'iCEE 101-000.420-0013 MA9.58
1y UMIirt O f -1E7 J OI -MO -414-000 $226.5
MONO tv3s'F.VT0N Tye'%, R1331D 101-OM241-000
<JRt\DMG, FRE 101-000-423-000
tNFRAN3'kii.i€:Tfjitl>~:T;M 225-Oi93-340 S6,ill1G.l9tt
ART PUAC"E S - RT;4 :: 70), -OM -255 -ow $56f.!T23
0 9.1(7FAI • (;.r*JMS i'RUC'110NI ANID PT,AN CRECK
'Q,R;?0.95
LESS VIRE-PAM FIELS
.
_$7,zow
sfi
Tail rA1.` 1f,, 1i11T FIXIS DUE NOW
S9.070.95
RECE P`
IDATF
BY �,
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs '2 3
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to WrapF.A.U.
Framing _ Q
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
BLOCKWALL APPROVALS
POOLS -SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
r Lateral
Pool Cover
Ywer Connection 0
Encapsulation
Gas Piping
Gas Test 70 9467
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) U L .
COMMENTS:
_
°
Building
C 4
P.O. BOX 1504 APPLIC
78-495 CALLE TAMPICO
,R} LA QUINTA, CALIFORNIA 92253
Mailing
Address 7f 0. al ArJu /zf� +
ADO
City OVAO%Zip ��+ Tel.
_/507PW l/Io,� 39` 5 -77 �',r
Contractor
ress
City
State Lic.I City
S
& Classif. f %7, S' Lic. a l54
Arch., Engr., --
Designer 6 ,0(5�- 4,ed14'��r��i�
Address .ry T 1.
,2,62i 0�170�I�i7G It ele— f 1
City - zip C State r,(�
J-4 4A." /FZ(06 (0 Lic. a
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is In full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm 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 to construct, 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 (8500).
F] 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 1 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 contractor(s) licensed pursuant to the Contractor's License Law.)
17 1 am exempt under Sec. B. 8 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 Co��mrt441 Rpe.n,salj n Insurance, ore certified –�c7o�yy��thereof. (Sec. 3800, Labor JA
)
Policy No.0 Company X124% �/ �/I�/%
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 (E f 00) 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 sof this city to enter the above-
mentioned property for inspection purposes.
Signature of a0plicant Date
Mailing Address
City, State, Zip
P El.6Te
ILDING: TYPE"CONST. OCC. GRP._ ?Z10 _C),rq
Number 7167 — 460-0 - 0// 2,
1 Description
Ict Description=
Sq. Ft.3 y 5'�. No. No. Dw.
Size Stories Units
New I1/ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Val
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
o I Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
-7F0
ZONE: R BY:
Minimum Setback Distances:
Front Setback from Center Line A
+� Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
u Side Setback from Property Line
FINAL DATE INS EC r R
Issued by: IDate ,- - _ Permit
Validated by: i
Validation: 311y nr- I
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
a
Date 3/12/99
No. 18451
Owner NameRancho Capistrano Development
No. 78825
City La Quinta
Tract #
APN # 769-600-011-2
Jurisdiction La Quinta
Permit #
Street Lima Log #
Zip 92253 Study Area
Lot # Square Footage 1
Type of Development Single Family Residence No. of Units 1
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 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:
Under Mitigation Agreement
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Mitigation Agreement in the amount of_
to
628.00 X 1 or $ 628.00 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/1st. Barik/Jim Avenell Telephone
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Adriana Gauto Payment Received $628.00
Check No. 49548
Signature qz��_
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) 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
collect them on the Dislrict('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
i
R
Dear Builder:
PUBLIC WORKS CLEARANCE LETTER
FOR
CUSTOM HOME LOTS
Prior to issuance of a building permit, you will be required to obtain clearance from the
Public Works Department for one, or more, of the following:
1. Verification that rough grading is complete, and the pad elevation certifications
prepared by a licensed surveyor, or engineer, are,on file in the Public Works
Department.
2. Verification that infrastructure improvenents and other required tract improvements
are complete, or sufficiently advanced to warrant building permit issuance.
3. Prepare an engineered grading plan that provides for on -lot storm water retention,
and have it checked and approved by the Public Works Department.
0 Tract 26524 (Estancias;
• Tract 26769 (Mountain View Estates)
4. Prepare an engineered grading plan that provides'for building pad grading in
accordance with the existing soils report and tract grading plan, and have it
checked and approved by the Public Works Department.
• Tract 28034 (South Valley Estates)
FOR INTERNAL USE BY PUBLIC WORKS DEPARTMENT
TRACT:
LOT: 3
PUBLIC WORKS AUTHORIZATION DATE
;;7f e S
FAPWDEPTIDOCS\FORMS%PVV CLEARANCE LETTER.ss
._I
TITAL
ENGINEERING
City of La Quinta
Engineering Department
78-495 Calle Tampico
La Quinta, California 92253
March 16, 1999
Dear Sir,
Based upon a field survey of Lot 23 of Tract 24890-4, the building pad elevation is in
conformance with the drainage plan indicating an elevation of 36.9. If you have any questions
regarding this matter, please do not hesitate, to call me.
Sincerely,
Lloyd W. Watson, P.E.
Watson & Christiansen Engineering
IIA4,4 i
77-684 Country Club Drive, Suite F-4 • Palm Desert, California 92211 9 (760) 345-7808 9 FAX (760) 345-4747
n
LIC. #557902
RANCHO CAPISTRANO DEVELOPMENT
P.O. BOX 980
LA QUINTA, CA. -92253
10-2-98
RE: ELECTRICAL LOAD CALCULATION MURPHY RESIDENCE L.Q.
3,956' @ 3 WATTS PER .0..11,868
GD........ ....................... ..... ....1,500
DW . . . . . . at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,500
T/C ............................... •.... •. ...1,500
SMALL APPLIANCE(2) .3 000
.............. ..... ..... ....
MICROWAVE.. •� .1,500
....... ...... ....
COOKTOP ..
........................ .... ... ....1 500
OVEN.................. •• .... 81000
....
WASHER ... ................. �• �........I.500
DRYER
.o�• 5,000
............... .... ... ...
POOL FUTURE.. ......4,500
LANDSCAPE FUTURE........... „ .....3,000
-FAU(3).................... ... .... .4 500
TOTAL ,
.................48,868
1ST 10 KW @ 100%=. ...............................10,000
REMAINDER @ 40%=...........: .15,547
...... ..... ...
A/C LOAD @ 100%=..... .. ... ... .18,000
.. ..... .....
TOTAL LOAD ........... .
...... ....e. .... .43,547
. . . . . .
DIVIDE BY 240v= ..............•.... .181.45 AMPS
USE 225 AMP SERVICE
rim- atj rwly 1 C , z)u r 1 is 111V
y '.
ESI/FME, Inc.
STRUCTURAL ENGINEERS & CONSULTANTS
March 8th, 1999.
RANCHO CAPISTRANO DEVELOPMENT
79-687 Country Club Dr. #209
Bermuda Dunes, Calffomia 92201
ATTN: Todd
RE: Roof Truss Calculations and Layouts on "Hildbrand" for RANCHO
CAPISTRANO DEVELOPMENT CO. (ESI/FME 199-8909)
Dear Todd,
We have reviewed -the calculations and layouts by THE TRUSS COMPANY
INC., they appear to comply with the requirements of our calculations and the structural
plans with the following corrections. Provide camber to trusses A10, Al2, A14, Al2A, A8A, 1-18,
AND H10.
The review of these drawings does not relieve the contractor from compliance
with the drawings and specifications. This check is only for review of general
conformance with the design concept of the project and general compliance
with the information given in the contract documents. The contractor is
responsible for confirming and correlating all quantities and dimensions,
selecting fabrication process and techniques of construction, coordinating his
work with that of other trades, and performing his work in a safe and satisfactory
manner.
Thank you for your attention to this matter, please do not hesitate to contact us if
we can be Of further assistance to you on this project
Sincerely,
1.921 E. CARNEGIE AVE., UNIT 3-J, SANTA ANA, CA 92705 - Ph. (949) 261-1811 / FAX (949) 261-8506