9904-043 (SFD)LICENSED CONTRACTOR DECLARATION
I he7rdby affirm under penalty of; perjury that l 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
3171546 13
1D1t0r,
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 16 construct the project (Sec. 7044, Business & Professionals
Code). e
O I am exempt under Section B&P.C. for this reason
Date Signature of Owner '
WORKER'S COMPENSATION DECLARATION
1 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
Sdction 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.
t INICARE f'IN(t3:vs;SlAI1913' el 1174,11
(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 si I forthwith comply with •those provifsiow�:
ate: G% 27 Applicant—
Warning:
pplicant 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
I
ddition 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 thieapplication 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 xfrom date of issuance -of such
permit, or cessation of work for 180 days will subject permit to cancellation.
16ertify 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
Zture
bove-mentioned prope�r�ty.for inspection"p�uNrposes.
V
(Owner/Agent) Date4
PERMIT# _
BUILDING PERMIT.
994)4.043
DATE ti r� = VALUATION S10,16-5,90 LOT 226 TRACT .216152
JOB SITE
ADDRESS 47-725 V IA Tri3OREINCE
APN
643.11,5-027
OWNER .
•t
CONTRACTOR DESIGNER / ENGINEER
p Y
1�i}l.iS de.Cy.�c.,i.t'7�C\ r.irlYi.li1.V 1`t li;.3y ir.iaL
p V
. Ci.)A4�..:',G�.L.v i.. .
510 i3.12.0�A010L1: W DWIVE, SUSS 208
157013K.C,X:3iwf•1OLLOW DR11/F, SUM 208
SAINTAAN1 A CA 132705
SF\N`MA.NA C'A. 42705
(7)4Y751. -91St MIX 41=185
-
USE OFppPERMIT
��^^ y' S;
ala
SiA`3CY1.rF:1.'�.A,i1�11:•Y DY JG
22¢,P� A14 3CR - Q rf.',; t�:k"si2;NW. DOE:S'NO;f.Nc"1 UDE BLOCK WALLS
'ap
'.r. RAC r� MS TRU TIt?N 2.013.00 3F
lCO�
GARA?#WQARP'ORT 642,t)7 SF
�YD��'y�'3;69A ED COS € F CON, � 'CTION
�(g� i
y U ¢ T �apy SUMMA
CONS RUCf1`0BiFEL 101-000.418000 '7rJ.3ff
PLAN (3�1ECK M 10!4%,419-318
,M.DEPOSIT , .101-000-X339-318 4250.00
NBECHAMCAL Ft"A 101-000421-000
PJ.AMUl+K FEB
Q.rIx41€0.1-000-2411.400 516.52
ORADNO, i tf1l-Offllj_�iZ3 00 $20,00
Cbi? itl�S"Tl?ilCiUf+:EFE 225.1200-443-342 -3,597.73
AT,Vr 1INP FALL C1?1'.ACFS REM,- 711-0110-2,55-0oo 5162.91
�, ft .'tt 1." 1.1 Cf " `±t1J !'1C3 AND PLAN tY}C1<(:i<$5,84.
M
LI f RE -lye` AD N,�1!•rS
-$250,00
`.g'�8"�,',f�„Ij;; �����:� $+" +'��1,9��.Ik; i1i6�D'f�V '
:��►39�'�3.��i
RECAN I
DATE
BY / 1/
=E
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPeCTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab .Grade
Return Air
Steel
Combustion Air
Roof Deck -Z —
Exhaust Fans
O.K. to Wrap 7-7—Q
F.A.U.
Framing 'f — g—
Compressor
Insulation — Q q
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath / q
Drywall - Int. Lath
Final
Final s
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
Heater Final
Water Piping T
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection L5 7
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
Utility Notice (Perm) /� /
����py�.,►WVM,nrg�tr:Fs,t�,y5�.Yn>{�i„ .s-....fw� �,'...;r�s�ly-. .w ,ar-ti;yv..•w a�.-[ wvwt+��. f. s.r .
P.O. BOX 1504
Building "j t ! } �Z 7 495 CALLE TAMPICO
Address t� S V 11 �. 1 p�� LA QUINTA, CALIFORNIA 92253
Owner (n� C
L.
Mailing ' j-7�
Address
City
� A,
Contractor /-11%
Address
City
(,� tBUI
0 � )0? A.P.
Zip zz4�71����7Ci" ���� Leg
BUIL
State Lic.„,:� City
& Classif. 5 ► xb `y Lic. #
Designer
Address Tel.
CityI Zip I State
Lic. #
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).
I.:
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 4/15/99,' F AFN# 643-110-027
No. 18574 Jurisdiction La Quinta
Owner NameLake La Quinta Comm., LLC Permit #
No 47-725 Street Via Florence r Log #
City La Quinta Zip 92253 Study Area
Tract # Lot # Square Footage 713
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 "c•n 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:
N '
EXEMPTION NOT APPLICABLE
This certifies that school facility fees,imposed pursuant to Government Code 53080 in the amount of
1.93 X : 2,713 or $5,236.09 the property listed above ani that building
permits and/or Certificates of Occupancy for this square footage in,this proposed project mzy now be issued,
Fees Paid By,CC/Life Bank - Robert Walker��71
TeleFhone x 9636
Name on the check
By: 'Dr. Doris Wilson
Superintendent
Fee collected /exempted by Ellen Patino Payment Received $5,236.p9t �tiL;
F Check No. 4400313
Signature
10TICE: 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 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 Districrs) or to another public entity authorized to
oll. 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 atll waivers.
Embossed Original- Building Dept./Applicant Copy-.Applicant/Receipt Copy - Accounting
Dear Builder:
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 improvements and other requi-ed tract improvements
are complete, or sufficiently advanced.to warrant building ':)ermit issuance. ,
Prepare an engineered grading plan that provides for on -lo: storm water retention,
and have it checked and approved by, the -Public Works Department'.
• Tract 26524 (Estancias)
• Tract 26769 (Mountain View Estates)
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.
• t
• Tract 28034 (South Valley Estates)
FOR INTERNAL USE BY PUBLIC WORKS DEPARTMENT
TRACT:
LOT: -Z,1-(,P
-(,P
F�IJu i
ELIC WORKS AUTHORIZATION DATE
FAPWDEPT\DOCS\FORMS\PW CLEARANCE LETTER.ss
COMMENTS:
F
City of .La Quinta.
Department of Building andSafety...-
78495 Calle Tampico
La Quinta, CA. 92253
RE: South Shore On Lake La Quinta
Plan, 3CR/ LOT 226 Phase III
47-725 .:Via Florence
To Whom It May, Concern
We have reviewed the- truss .;drawings and calculations by for the above
:reference project and find . them in substantial -:conformance with the structural framing
plans prepared for submittal to the City Of La Quinta .
Inland Trussjnc.
15457'Foothill Blvd
Fontana, CA...92335
Ph. (.909) 355-8787
Fax { 909) 355-8821
Ramon
c.c.: Steve Sante
78-995 Via Trieste
La Quinta, CA. 92253
FME ie:
y*el
0
W No $2345
Exo 12.316
CTU
�FAr nlkt►GQQ
. ESI/FME, Inc...
Structural Engineers
Date': 2-2.6-99
By :R.R.W_
1921 East Carnegie Ave., St. 3 J
Santa -Ana, California 92705
Company: CANADAY AND
CO.
Project Name: "
South Shore On
Address' 1570 Brookhollow Drive, St. 208
Lake La Quinta "
Santa Ana, .CA.
92705 -
ESI %.F M E Job
No.: 298-8 ........... -
Contact : Steve Sante
Project Eng.:
R.R.W.
Phone: T14 751-9151`
FAX-:- (714 751-9152
PH.:
(714)261-1811/Fax 261-8506
�X ;Phone,Conversation Field Meet'g I_
jMeet'g @ Client's ��
]In -House Meeting
City of .La Quinta.
Department of Building andSafety...-
78495 Calle Tampico
La Quinta, CA. 92253
RE: South Shore On Lake La Quinta
Plan, 3CR/ LOT 226 Phase III
47-725 .:Via Florence
To Whom It May, Concern
We have reviewed the- truss .;drawings and calculations by for the above
:reference project and find . them in substantial -:conformance with the structural framing
plans prepared for submittal to the City Of La Quinta .
Inland Trussjnc.
15457'Foothill Blvd
Fontana, CA...92335
Ph. (.909) 355-8787
Fax { 909) 355-8821
Ramon
c.c.: Steve Sante
78-995 Via Trieste
La Quinta, CA. 92253
FME ie:
y*el
0
W No $2345
Exo 12.316
CTU
�FAr nlkt►GQQ