BRES2015-007778-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
GORDON STEINE
51053 SORREL COURT
INDIO, CA 92201
Tit., 4 4v Qumz -
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
BRES2015-0077
53659 VIA STRADA
777200007
HIDEAWAY/WILLIAMSON/8910 SINGLE FAMILY DWELLING
$797,678.00
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 70001 of Division 3 of the Business and Professions Code,
and License' in full force and effect.fgct,
LicenseseQClass: � License No.: 1'
-Date: 1'' �y Contractor:L`� M�71'1 W
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State '
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for the permit to file a
signed statement that he or she is licensed pursuant to the provisions of the
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
3 of the Business and Professions Code) or that he or she 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
($500).:
(_) 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 and Professions Code: The Contractors' State License Law does not
apply to an owner of property who builds or'improves thereon, and who does the work
himself or herself through his or her own employees, provided that the 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 or she did not build or improve for the purpose of sale.).
(_) I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
(_)I am exempt under Sec. . B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C,).
Lender's Name:
Lender's Add
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/17/2015
Owner:
DANIEL WILLIAMSON
Contractor:
RUCKERMUTH LUXURY HOME BUILDER
P.O. BOX 13017
PALM DESERT, CA 92255
(760)250-4903
LIC. No.:
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 and policy number are:
Ca%0-1-certify
r: Policy Number: _
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 forthwith
comply with those provisions.
Date AAI •17 Applicant: —
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($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.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this 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 application , the owner, and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
employees for any act or omission related to the work being performed under or
following issuance of this permit.
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 1 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 upon the
above-mentioned property for inspection purposes,,
N, ./ � \. .
Daie: 4 `* Signature (Applicant or Agent): ASK
AJ -
ART IN PUBLIC PLACES - RESIDENTIAL 270-0000-43201
0
$1,494.19
$1,494.19 9/16/15
+° PAID BY s -;' METHOD
t "RECEIPT #
CHECK # • CLTD BY
� 4:
v.
RUCKER MUTH CORP. CHECK
R9240
1001 SKH
Total Paid for ART IN PUBLIC PLACES - AIPP: '.. $1,494.19 $1,494.19
.a r ;DESCRIPTION
ACCOUNT
QTY
li' AMOUNTS
PAID DATES;
BSAS SB1473 FEE
101-0000-20306 r
0
$32.00
$32.00
9/16/15
7 PAID. BY a' 4
* METHOD
< r ECEIPT # K >s
CHECK #
CLTD BY '
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $32.00 $32.00
" k f DESCRIPTION
> `ACCOUNT"AMOUNT
:'
PAID
DATE';
°
,PAID
DIF - CIVIC CENTER
252-0000-43200
0
$796.00
$796.00
9/16/15
r x PAID:BY x
METHOD
;RECEIPT # a ` ' E
� y` CHECK # _ f;
CLTD BY
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
,x ',DESCRIPTION ,.;3
ACCOUNT t..
QTY
AMOUNT;
PAID
tPAID DATE
w ,
,'
DIF - COMMUNITY CENTER
254-0000-43200
0
$129.00
$129.00
9/16/15
PAID BYa' zr
a
METHOD '
%< tRECEIPT#CHECK
#
BY
k;
.R,CLTU
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
e¢' ::DESCRIPTION'
,3 °, ACCOUNT a cx
s
TY
NT
PAID
PAID:DATE
�_.r..... ,.,..Q
xAMOU ,
m.
DIF - FIRE PROTECTION
257-0000-43200
0
$366.00
$366.00
9/16/15
..s.-A PAID BY ,r: `METHOD
s, :RECEIPT#
CHECK#
CLTD BY
;
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
ACCOUNT
QTY
4 AMOUNT
PARD
PAID DATE'
>
DIF - LIBRARIES
253-0000-43200
0
$344.00
$344.00
9/16/15
PAID BYE
METHOD
RECEIPT# „
CHECK#r`
CLTD BY 3
"<=;y
, _.,....
a
w -, ,.
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
DESCRIPTION F;{�;5 .','
`ACCOUNT
t'QTY
AMOUNT. j::f
F 'PAID #
PAID DATE`
PAID
y
DIF - PARK MAINTENANCE
256-0000-43200
0
$40.00
$40.00
9/16/15
'METHOD
f + a RECEIPT # s'
CHECK #
CLTD BY
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
DESCRIPTION;��
^'t�.xA000UNT ¢r
QTYy
"
*' y PAID
EAMOUNT,t
DIF - PARKS/REC
251-0000-43200
, ' 0
$2,048.00
$2,048.00
9/16/15
PAID BY R:r;
METHOD ' _.
f RECEIPT #
<:" CHECK #
°CLT 6B Y
,
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
t DESCRIPTION+:'"'� €
`ACCOUNT z
QTY,
I
PA9D &
PAID DATE.
-. .. ,_. I „
,>tAMOUNT
DIF - STREET MAINTENANCE
255-0000-43200
0
$116.00
$116.00
9/16/15
PAID'BY'A
METHOD rx
'y�
HECK #
Y
BY:
. z ..
.. .... . ry „ .
.. '.a3.,R.fiExC
rE..IPT-#,
_ a zCLTD
...
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
DESCRIPTION
ACCOUNTS ,
`,QTY
AMOUNT f
-•-: PAID qt
'PAID*DATE-
DIF - TRANSPORTATION
250-0000-43200
0
$2,842.00
$2,842.00
9/16/15
77
x PAID BY �` ; t, METHOD x a> CHECK # ;CLTD BY',.
T RECEIPT #
4 ,i , 4
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
Total Paid for DIF - SINGLE FAMILY ATTACHED: $6,681.00 $6,681.00
--DESCRIPTION�° ;
ACCOUNT
::QTY
AMOUNT
PAID "PAID
DATE..
_
«,.
TEMP POWER SERVICE
101-0000-42403
0
$24.17
$24.17
9/16/15
e _
PAID"BY E
,
' r METHOD
RECEIPT ,# �
� CHECK #
as CLTD BY:-,,
.a
� j z
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
°DESCRIPTION t
z $ACCOUNT
`;QTY*
' AMOUNT
r; aR PAID,'s €
PAID DATE`
TEMP POWER SERVICE PC
101-0000-42403
0
$16.92
$16.92
9/16/15
PAID BY ; t
METHOD s'
i (:RECEIPT' # r
CHECK #
+ CLTDSBYI,::'
s _
:
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
Total Paid for ELECTRICAL: $41.09 $41.09
L
' DESCRIPTION ;q ` -
` _
:; QTY
' "AMOUNTl
Y . PAID
PAID DATE
MI.ACCOUNT
,
RESIDENTIAL, EA ADDITION 1,000SF
101-0000-42403
0
$123.30
$123.30
9/16/15
PAID BY rF =3�
'METHOD � �4,,
f RECEIPT # :
CHECK #
: CLTD BY
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
'`DESCRIPTION
ACCOUNT
QTY
AMOUNT.
PAID -:
PAID DATE,
:_. :'.
�
RESIDENTIAL, EA ADDITION 1,000SF, PC
101-0000-42600
0
$50.80
$50.80
9/16/15
~'- PAID:BY
:h" METHOD s
RECEIPT #�
CHECK # a'
CLTD BY;
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
DESCRIPTION : �
a "-(ACCOUNT r
CITY
AMOUNT 4..
�PAID� :. ����
�PAIDDATE
p
RESIDENTIAL, FIRST 1,000SF
101-0000-42403
0
$145.03
$145.03
9/16/15
PAID 'BY h4L ; % ,
°p "W METHOD . + '
i'RECEIPT # vM;
CHECK #
CLTD BY°
p
g ,' ,
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
.t DESCRIPTION"? �k
1 ACCOUNT
fQTY,'
AMOUNT x
PAID��` °
PAID DATE
RESIDENTIAL, FIRST 1,000SF, PC
101-0000-42600
0
$47.86
$47.86
9/16/15
PAID BY :' +
RECEIPT # `CHECK
#
',CLTD BY',
x
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
Total Paid for ELECTRICAL - NEW CONSTRUCTION: $366.99 $366.99
h DESCRIPTION: Er
`-ACCOUNTt� `
;QTY`
¢ AMOUNT
PAIDi
PAID`DATE
RESIDENTIAL PRECISE GRADING -CUSTOM
101-0000-42408
0
$36.26
$36.26
9/16/15
HOME LOT >7KSF '
PAID; BY,
4 METHOD ,,c }:
$,' RECEIPT #} i
CHECK #
CLTD BY
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
r: f
DESCRIPTION 'ACCOUNT-
K: p
QTY
"AMOUNT
PAID
3PAID DATE
RESIDENTIAL PRECISE GRADING - CUSTOM
101-0000-42600
0
$181.29
$181.29
9/16/15
HOME LOT >7KSF PC
,
` PAID;BY `}
# METHOD.
`hRECEIPT #
'u'CHECK #
CLTD Bi,`
,
RUCKER MUTH CORP.
CHECK
R9240
1001'
SKH ,
Total Paid for GRADING: $217.55 $217.55
'>DESCRIP.TION` l
; ,a f' ACCOUNT fxi
QTY
} ., AMOUNT ':
`, PAID '
'PAID.DATE
CONDENSER/COMPRESSOR
101-0000-42402
0
$217.56
$217.56
9/16/15
RECEPT#71 , METHOD c
` s g F
CHECK # CLTD BY
{
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
2wDESCRIPTION.�• r " try
n5 r ACCOUNT T §
$QTYkr'"AMOUNT
PAID,', ' x
PAID DATE
t
f .
CONDENSER/COMPRESSOR PC
101-0000-42600
0-
$145.02
$145.02
9/16/15
PAID BY * ;
< METHOD, '
"''RECEIPT # _ ,szCHECK
# "€
CLTD BY`
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
- °
DESCRIPTIONr
�> A_
•,. .n
AMOUNT` z
c PAI Tp
:PAID DATE
EXHAUST HOOD
101-0000-42402
0
$24.18
$24.18
9/16/15
, 4 ac ,'
�' «METHODS
1 :RECEIPT #
CHECK # ' p'
CLTD BY
aPAID.BY
.,"
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
DESCRIPTION -=Et :•
r rtACCOUNT °;
QTY
�AMOUNT�
F .,PAID'` 4 <`
PAID DATE
�. -
EXHAUST HOOD PC
101-0000-42600
0
$9.66
$9.66
9/16/15
''i PAID BY
^, METHOD x
RECEIPT:k
CHECK #�+
r�CLTD BY `
z
s•
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
DESCRIPTION - { n
" W : ACCOUNT
AMOUNT' ' Y
PAID .; 'f
PAID DATE
FURNACE
101r0000'42402.
0
$217.56
$217.56.
9/16/15
"PAID BY , � r
`� METHOD t
'a =RECEIPT # '" °�
CHECK #
CLTD BY
. i''
T
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
DESCRIPTION "., '�_
.ACCOUNT
AMOUNT",
����tPAID6
P,AID'DATE..
.:...
FURNACE PC
101-0000-42600
0
$145.02
$145.02
9/16/15
{ g . % ; tPAID BY;'
_ METHOD ,
-RECEIPT #
CHECK #
CLTD BY
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
DESCRIPTION r: y°.`�
r,. ACCOUNT' ' `
QTYM
-AMOUNT E `
PAID DATE:
;&
;PAID�._Y�:>
VENT FAN
101-0000-42402
0
$132.99
$132.99
9/16/15
r PAID BY 3 �,
METHOD
RECEIPT #
F CHECK #
.CLTD BY '
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
Y
¢'DESCRIPTION '
'ACCOUNT
£QTY
AMOUNT"4-PAID
PAID DATE
-,
VENT FAN PC
101-0000-42600
0
$53.13
$53.13
9/16/15
PAIDBY �� �,��
,METHOD -
R��`RECEIPT#;:
;fa CHECK#
.CLTDBY"`
,
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
• ='`DESCRIPTION `+ *
$ ACCOUNT '.'
QTY
>.r AMOUNT',
'PAID Y *;
PAID`DATE,
WALL HEATER
101-0000-42402
0
$123.55
$123.55
9/16/15
PAID BY
€ 'RECEIPT #
<` CHECK#
CLTDrr
BY
:
,..
..
..w
RUCKER MUTH CORP.
-. CHECK
R9240
1001
SKH
'DESCRIPTION ; x x4 €
'' : -ACCOUNT
.:QTY
AMOUNT "'
PAID r
PAID DATE
._
�._
WALL HEATER PC
101-0000-42600
0
$60.45
$60.45
9/16/15
x PAID BY ; g - a
v''_ METHOD.x1
a 'y.1 RECEIPT"CLTD
BY
m
Fy
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
Total Paid for MECHANICAL: $1,129.12 $1,129.12
` DESCRIPTION *
' F,,.` ACCOUNT * ..
;QTY
AMOUNT
s PAID
'PAID DATE
.,
NEW CONSTRUCTION PERMIT
101-0000-42400
0 .
$916.45
$916.45
9/16/15
PAID BY =`"'§`METHOD
Y
LL
'RECEIPT #
CHECK #
CLTD BY
RUCKER MUTH CORP.- CHECK R9240 1001 SKH
Total Paid for NEW CONSTRUCTION PERMIT: $916.45 $916.45
>Y ° DESCRIPTION s 4
y ,' ':
ACCOUNT
QTY
t AMOUNT � X
, � •` r
PAID
PAID DATE'
1.y* s
. FE
i
NEW CONSTRUCTION PLAN CHECK
101-0000-42600
0
$798.20
$798.20
9/16/15
' _�.
wMETHOD +'� '
`-",44°.RECEIPT, # '
CHECK #
CLTD BY.I':'
x ,PAID'BY
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH '
',.-DESCRIPTION'
ACCOUNT 4 "
j':QTY
��a` AMOUNT
i , 'PAID z;PAID
DATE.
NEW CONSTRUCTION PLAN CHECK
101-0000-42600
0
$1,200.00
$1,200.00
3/4/15
4 PAID:BY'
METHOD�P: 'r
k RECEIPT#4 P
-`CHECK# i+
-CLTDBY'`,
to
DESIGN MIND STUDIO, INC.
CHECK
R3881
5442
SKH
Total Paid for NEW CONSTRUCTION PLAN CHECK: $1;998.20 $1,998.20
` DESCRIPTION "`
�ACCOUNT " �y.lAMOUNT
i `PAID
iPAID:DATE
,
BACKFLOW DEVICE
101-0000-42401
0
$12.09
•$12.09
9/16/15
PAID,BY
METHOD �` i e
�' RECEIPT# =f.�'
CLTD BY,,
�M
r
_ _CHECK#
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
""'
;
' S
QTY
' NT_DESCRIPTIONI"
PAID
'PAID DATE,
:_
BACKFLOW DEVICE PC
101-0000-42600
0
$4.83
$4.83
9/16/15
ryr, PAID. BY'.
I METHOD u e ' `
RECEIPT #
CHECK #',
CLTD BY„
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
DESCRIPTIONs,''x`
:.4 A000IINT : k::
;QTY
AMOUNT .yA
PAID 3
PAID:DATE'
„
BUILDING SEWER
101-0000-42401.
0
$12.09
$12.09
9/16/15
PAID BY.>�
METHOD •,
RECEIPT-4
#. CHECK # . mr '
CLTD BY `
a<
,
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
E-..:ACCOUNTamow:
QTY
AMOUNT'
x'- Y4t4PAID
PAIDDATEDESCRIPTION
BUILDING SEWER PC
101-0000-42600
0
$12.09
$12.09
9/16/15
PAID BYE s rs:: , ;
METHOD �,�
k
RECEIPT4,
,
9� CHECK #
CLTD BY
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
DESCRIPTION '
a
ACUNT
QTY
°" AMOUNT
PAID DATE'
FIXTURE/TRAP ,
101-0000-42401
0
$411.06
$411.06
9/36/15
PAIDBY
s� �' METHzOD
n RECEIPT. #
$z:
CHECK #
CLTD BY R
:;'
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
Eah DESCRIPTION a d
,aye ACCOUNT y F
:=QTY
'; k AMOUNT'
`* PAID
PAID DATE
FIXTURE/TRAP PC
101-0000-42600
0
$411.06
$411.06
9/16/15
.PAID -6Y `„ s `
-
METHOD ` `
Y
x L RECEIPT,# F ' ��
CHECK #
CLTb BY
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
DESCRIPTION �j =Y
, ' ACCOUNTS
`;QTY
*A1IIIOAT* <E
PAID'-DATEj
. ,
,
,PAID
GAS SYSTEM, 5+ OUTLETS
101-0000-42401
0
$36.26
$36.26
9/16/15
PAID:.BY I R
%s ' ; METHOD +
a RECEIPT #.'
CHECK # aCLT.D
BY
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
DESCRIPTIONy, ',
` ACCOUNT
AMOUNT ::DA
PAID
AID,TE
,:QTY
.
GAS SYSTEM, 5+ OUTLETS PC
101-0000-42600
0
$24.17
$24.17
9/16/15
A'p PAID,BY ` " ,
" 4
`;RECEIPT #
'CHECK #
4 'CLTD BY
,METHOD
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
;DESCRIP<TION'
WWF;- ACCOUNT "r"QTY
+.� &L.
'AMOUNT"''y
s� PAID
PAID DATE
t�
x_ -
Pr ..,.:
ROOF DRAIN
101-0000-42401
0
$157.17-
$157.17
9/16/15
METHODZ.
#PAIDBYE
RECEI
CHECK #,,
BY:!!PT
#.,CLTD
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
:DESCRIPTION x > { q "
x . ACCOUNT 4
: QTY
€ AMOUNT
:PAID 5 ';
PAID DATE
y r &, 4 ,
.
ROOF DRAIN PC
101-0000-42600
0
$157.17
$157.17
9/16/15
PAID
METHOD 3"
RECEIPT #
'r c
CHECK #9
CL BY
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
u .DESCRIPTION '`
_..��
r :' ACCOUNT a{„ .
t
°QTY
;,` *AMOUNT -¢`
4:
d," PAID
x n �`�:
PAID.DATE=
WATER HEATER/VENT
101-0000-42401
0
$24.18
$24.18
9/16/15
PAID BY esEg
'' METHOD '
"RECEIPT # t
�C HECK #
, ` y E::
CLTD B
,,
A
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
`DESCRIPTION =r� @
_` ^;ACCOUNT '
'QTY''
x PAID,°_�
IPAID DATE;`.
P
a'AMOUNT
WATER HEATER/VENT PC
101-0000-42600
0
$14:50
$14.50
9/16/15
PAID BY rf
METHOD a
';RECEIPT#tray
CHECK
CLTD BY
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
DESCRIPTION J
; v • jACCOUNT '" +r
QTY .
, <AMOUNTY
r €.PAID S
PAID DATE
WATER SYSTEM INST/ALT/REP
101-0000-42401
0
4 $12.09
$12.09
9/16/15
.d 41 PAID BY .
S �� , k METHOD
;RECEIPT #
CHECK #
` CLTDgBY%' `
,
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
#f x".DESCRIPTIONACCOUNT
`r
n UNT AMO
�, PAID
PAID;OATE'
_ . �..
.QTY
WATER SYSTEM INST/ALT/REP PC
101-0000-42600
0
$12.09
$12.09
9/16/15
PAID BY
sr METHOD
' t;
CHECK
'CLTD BY
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
Total Paid for PLUMBING FEES: $1,300.85 $1,300.85
DESCRIPTION
ACCOUNT
QTYAMOUNTc'T
° ' A "PAID , '
PAID'DATE
SMI - RESIDENTIAL •
101-0000-20308
0
$103.70
$103.70
9/16/15
PAID BY;<
€ ;METHOD ¢,:
:RECEIPT #
sa CHECK #
BY"`
y;
,6CLTD
RUCKER MUTH CORP.
CHECK
R9240
1001 •
SKH
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $103.70 $103.70
'.N DESCRIPTION':.= "
' °3 ACCOUNT _'
"QTY ;
; AMOUNT; $
' " PAID sr
PAID DATE
,' _
. ;
SINGLE FAMILY DETACHED
224-0000-20320
0
$1,837.44
$1,837.44
9/16/15
PAID BW'
• _
w ETHOD
_.
: • RECEIP.T #
``CHECK #
CLTD BY
RUCKER MUTH CORP.
CHECK
R9240
1001
SKH
Total Paid for TUMF - RESIDENTIAL: $1,837.44 $1,837.44
TOTALS:
!=
Description: HIDEAWAY/WILLIAMSON/8910 SINGLE FAMILY DWELLING
Type: BUILDING, RESIDENTIAL Subtype: DWELLING - SINGLE Status: APPROVED
Applied: 3/4/2015 SKH
FAMILY ATTACHED
Approved: 7/31/2015 JJO
Parcel No: 777200007 Site Address: 53659 VIA STRADA LA QUINTA,CA 92253
Subdivision: TR 29894-2 - Block: Lot: 255
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled: -
Valuation: $797,678.00 Occupancy Type:' Construction Type:
Expired:
t
No. Buildings: 0 • No. Stories: 0 No. Unites: 0
Details:. new sfd @8910 sq. ft: this permit does not include pool, spa, blockwalls, driveway approach, water features, bbq, fire pits. home is
fire sprinkled per 2013 crc codes. _
149
A
-- Applied to`
Printed: Thursday, September 17, 2015 11:05:06 AM
1of7
ADDITIONAL
CHRONOLOGY
CHRONOLOGY TYPE:.:
' STAFF NAM =
a ;' ACTIO.N DA E` COMPLETION DATE;. , NOTES
HUGO 760-799-5244 CAME IN AND WANTED A COPY OF
NOTE
PHILIP JUAREZ
7/20/2015
7/21/2015
CORRECTIONS GAVE HIM A COPY AT COUNTER & AND E-
MAILED HIM CORRECTIONS 0721/2015
Dave Muth builder came in and wanted an update on
NOTE
PHILIP JUAREZ
7/28/2015
7/28/2015
plans.760-250-4903
NOTE
PHILIP JUAREZ
8/3/2015
8/3/2015
SCHOOL FEE LETTER GIVEN 760-250-4903 ALSO GAVE INVOICE
AS TO TOTAL FEES DUE.
PLAN CHECK COMMENTS
FROM CONSULTANT
KAY HENSEL
3/16/2015
3/16/2015
STRUC RFC 3/16/2015 ,
RECEIVED
PLAN CHECK PICKED UP
AJ ORTEGA
3/30/2015
3/30/2015
PICKED UP BY ARCHITECT
PLAN CHECK SENT TO
STEPHANIE KHATAMI
7/21/2015
7/21/2015
OUTSIDE PC
Printed: Thursday, September 17, 2015 11:05:06 AM
1of7
PLAN CHECK SUBMITTAL
STEPHANIE KHATAMI
7/21/2015
7/21/2015
RECEIVED
SENT TO PLAN CHECK
STRUC TO ESGIL SINCE YOUNG DID THE CALCS. 1ST CK DUE
-KAY HENSEL
3/4/2015.
- 3/4/2015
CONSULTANT
BACK 3/25/2015
TELEPHONE CALL
JIM JOHNSON
3/26/2015
3/26/2015
CALLED GORDON STEIN DESIGNS TO INFORM HIM PLANS ARE`
READY FOR CORRECTIONS.
CALLEDYOUNG ENGINEERING TO INFORM THEM THE SOILS
'TELEPHONE CALL
JIM JOHNSON'
7/31/2015
7/31/2015
REPORT WAS NOT PROVIDED, ALSO CALLED GORDON STEIN
PLANS & GRADING NEED TO BE SIGNED,
CONDITIONS
CONDITION, .' : a" DATE DATE
DATE,:,..,.r
-. CONTACTSTATUS
REMARKS-
-t
:NOTES ' fi
TYPE <, ADDED REQUIRED
SATISFIED'
a
READY TO ISSUE
JIM JOHNSON 7/30/2015
--
PENDING PLANS NOT SIGNED
CHECKLIST
•NTACTS
zaNAMETYPE R:= NAME "'
¢DDRESSIGITY
=STATE ZIP
PHONE;"
- FAX T EMAIL
APPLICANT
GORDON STONE
51053 SORREL COURT INDIO
CA
92201
(760)250-4903
CONTRACTOR
RUCKERMUTH LUXURY HOME
P.O. BOX 13017
PALM DESERT
CA
92255
(760)250-4903
BUILDER
OWNER
DANIEL WILLIAMSON
1 RICKIE LN -
LADERA RANCH
CA
0
(760)250-4903
• • •
5"' � � '.-s,.� � � � ::. b ".. Pr
,.: k ^a -� ,�' .[ 'k'c%` :L..M � �! �.F - n • .t *" tii 4 �; v. � S Y � .q .,.k, �,u .« �" F%s�..t''
s � .x CLTD
"PAID
r"DESCRIPTION_ %ACCOUNT QTY
AMOUNT
PAID' DATE ::RECEIPT'# CHECK #X:' METHOD .PAID BYEr
=v e
.:.. ..�._ � r -'" P"-xa _� :. ai
.�'�'-. :"
i
" -m n .... ..
•.' .r
r �
^„� Vii? i' r �"'lr i, .:.a Pb
_. < .' ;. r •. , y ,mss ^a .'. _ Y".:..
ART IN PUBLIC PLACES - 270-0000=43201 0
$1,494.19
$1,494.19 9/16/15
R9240 1001 CHECK
RUCKER MUTH CORP.
SKH
RESIDENTIAL
Total Paid for ART IN PUBLIC PLACES - AIPP:
$1,494.19
$1,494.19.
BSAS SB1473 FEE
101-0000-20306
0
$32.00
$32.00
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
Total Paid for BUILDING STANDARDS ADMINISTRATION
$32.00
$32.00
BSA:
Printed: Thursday, September 17, 2015 11:05:06 AM 2 of 7
. "' SYS7fnAS
P....'
�<
'
DATE
RECEIPT'#
y CHECK #
METHOD
-tPAID BY
:DESCRIPTION ;
ACCOUNT
,.QTY`AMQUNT
PAID
„PAID
,
DIF - CIVIC CENTER
252-0000-43200
0
$796.00
$796.00
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
DIF -'COMMUNITY
254-0000-43200
0
$129.00
$129.00
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
CENTER
DIF - FIRE PROTECTION
257-0000-43200
0
$366.00
$366.00
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
DIF - LIBRARIES
253-0000-43200
0
$344.00
$344.00
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
DIF -PARK
256-0000-43200
_0
$40.00
- $40.00
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH,
MAINTENANCE
-
-
DIF_- PARKS/REC
. ' 251-0000-43200
0
$2,048.00
$2,048.00
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
DIF - STREET
255-0000-43200
0
$116.00.
$116.00
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
MAINTENANCE
DIF - TRANSPORTATION
250-0000-43200
0
$2,842.00
$2,842.00
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
Total Paid for DIF - SINGLE FAMILY ATTACHED: $6,681.00 $6,681.00
TEMP POWER SERVICE
101-0000-42403,
0
$14.17
$24.17
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
TEMP POWER SERVICE
101-0000-42403
0.
$16.92
$16.92
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
PC
Total Paid for ELECTRICAL: $41.09 $41.09
RESIDENTIAL, EA
101-0000-42403
0
$123.30
$123.30
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
ADDITION 1,000SF
_
RESIDENTIAL, EA
101-0000-42600
0
$50.80
$50.80
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH.
ADDITION 1,000SF, PC
RESIDENTIAL, FIRST
101-0000-42403
0
$145.03
$145.03
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
1,0005F
RESIDENTIAL, FIRST
101-0000-42600
0
$47.86
$47.86
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
1,000SF, PC
Total Paid for ELECTRICAL - NEW CONSTRUCTION: $366.99 $366.99
RESIDENTIAL PRECISE .
GRADING - CUSTOM
101-0000-42408
0
$36.26
$36.26
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
HOME LOT >7KSF
Printed: Thursday, September 17, 2015 11:05:06 AM
3of7
&; DESCRIPTION
." _ '.
7T!^;7
ACCOUNT4QTY
''
s
'.:
AMOUNT
^PAID
PAID QATE,
RECEIPT:#
CHECK #'`
"METHOD„
PAID
LBTYW-
�:
RESIDENTIAL PRECISE .
GRADING - CUSTOM
101-0000-42600
0
$181.29
$181.29
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
HOME LOT >7KSF PC
Total Paid for GRADING:' $217.55 $217.55
CONDENSER/COMPRES
.101-0000-42402
0
$217.56
$217.56
9/16/15
R9240
1001.
CHECK
RUCKER MUTH CORP.
SKH
SOR
CONDENSER/COMPRES
„101-0000-42600,
0
$145.02
$145.02
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
SOR RC
EXHAUST HOOD
101-0000-42402
0
$24.18
$24.18
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
EXHAUST HOOD PC
101-0000-42600
•0
$9.66
$9.66
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
FURNACE
101-0000-42402
0
$217.56
$217.56
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
FURNACE PC a
. 101-0000-42600
0
$145.02
$145.02
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
VENT FAN
101-0000-42402
0 _
$132.99
$132.99
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
VENT FAN PC
101-0000-42600
0
$53.13
$53.13
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
WALL HEATER
101-0000-42402
0
$123.55
$123.55
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP..
SKH
WALL HEATER PC
101-0000-42600
0
$60.45
$60.45
-.9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
Total Paid for MECHANICAL: $1,129.12 $1,129.12
NEW CONSTRUCTION
101-0000-42400
0
$916.45
$916.45
9/16/15'
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
PERMIT
,
Total Paid for NEW CONSTRUCTION PERMIT: $916.45 $916.45
NEW CONSTRUCTION
101-0000-42600
0
$798.20
$798.20
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
PLAN CHECK
NEW CONSTRUCTION
101-0000-42600
0
$1,200.00
$1,200.00
3/4/15
R3881
5442
CHECK
DESIGN MIND.
SKH
PLAN CHECK
STUDIO, INC.
Total Paid for NEW CONSTRUCTION PLAN CHECK: $1,998.20 $1,998.20
BACKFLOW DEVICE
101-0000-4240T--7F-O
$12.09
$12.09
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
Printed: Thursday, September 17, 2015 11:05:06 AM 4 of 7
SYSTEMS
Nil
Printed: Thursday, September 17, 2015 11:05:06 AM 5 of 7 cffwlyvrm�
r
57 7
77.7
7,777
BACKFLOW DEVICE PC
101-0000-42600
0.
$4.83
$4.83
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
BUILDING SEWER
101-0000-42401
0
$12.09
$12.09
9/16AS
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
BUILDING SEWER PC
101-0000-42600
0
.$12.09
$12.09
9/16/1S
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
FIXTURE/TRAP
101-0000-42401
0
$411-.06
$411.06
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
FIXTURE/TRAP PC
101-0000-42600
0
$411.06
$411.06
9/16/1S
R9240
1001
CHECK
RUCKER MUTH CORP.
10 1-0000-424011
$36.26
$36.26
9/16/15
R9240
1001'
CHECK
RUCKER MUTH CORP.
SKH
OUTLETS
1
_O
GAS SYSTEM, S+
101-0000-42600
0
$24.17-
$24.17
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
OUTLETS PC
ROOF DRAIN'
101-0000-42401
0
$1S7.17
$157.17
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
ROOF DRAIN PC
101-0000-42600
0
$1S7.17
$1S7.17
9/16/1S
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
WATER,HEATER/VENT
101-0000-42401
.0
$24.18
$24.18
9/16/15
R9240
1001
CHECK
RUCKER MUTH CORP.
SKH
WATER HEATER/VENT
101-0000-42600
0
$14.50
$14.50
9/16/1S
R9240,
1001
CHECK
RUCkER MUTH CORP.
SKH
PC.
WATER SYSTEM,
101-0000-42401,
0
'$12.09
$12.09
9/16/1S
R9240
1001.
CHECK
RUCKER MUTH CORP.
SKH
WATER SYSTEM ,
INST/ALT/REP PC
101-0000-42600
0.
$12.09
$12.09
F9/16/1S
R9240,
'1001
CHECK
RUCKER MUTH CORP..
SKH'
Total Paid for PLUMBING FEES: $1,300.85 $1,300.85
SMI - RESIDENTIAL
101-0000-20308
0
$103.70
$103.70
9/16/15
R9240
1001
CHECK
[RUCKER MUTH CORP.
SKH -
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $103.70 $103.70
SINGLE FAMILY
224-0000-20320
0
$1,837.44
$1,837.44
9/16/15
R9240
1001
CHECK
RUCKE R-MUTH CORP.
SKH,
DETACHED
Total Paid for TUMF - RESIDENTIAL: $1,837.44 $1,837.44
TOTALS: S16J18.58
Printed: Thursday, September 17, 2015 11:05:06 AM 5 of 7 cffwlyvrm�
r
,f
PARENT PRO.., .
JECTS
I
RETURNED
STATUS°REMARKS
'' '�
REVIEW TYPE,..,REVIEWER
SENTMATE.
DUEDATE a
OWNER:.
A
PATHNAME = _SUBDIR
'.ETRAKLT•:ENABLED. ;
DOC
3/26/2015.
JIM JOHNSON
53-659 VIA
53-659 VIA
0
&,NOTES
NON-STRUCTURAL
JIM JOHNSON
3/4/2015
3/25/2015
3/26/2015
REVISIONS REQUIRED
corrections
1st PLAN CHECK
53-659 VIA
0
STRADA.docx
STRADA_1.docx .
STRUC TO ESGIL SINCE YOUNG DID THE CALCS. .
-
7/31/2015
JIM JOHNSON
BRES2015-0077 SCHOOL
BRES2015-0077 SCHOOL
0
STRUC P/C ONLY
STRUCTURAL
KURT CULVER
3/4/2015
-3/25/2015
3/13/2015
REVISIONS REQUIRED
KURT CULVER
BRES2015-0077.DOC
BRES2015-0077.DOC
1
Please see the attachment for structural
comments from EsGil Corporation.
NON-STRUCTURAL -
JIM JOHNSON
7/21/2015
8/4/2015
7/31/2015
APPROVED
2 WK
STRUCTURAL CONTENT WAS COMPLETED BY
STRUCTURAL - 2 WK
YOUNG
7/21/2015
8/4/2015
-7/27/2015
INCOMPLETE
YOUNG ENGINEERING. PLEASE RETURN TO
ENGINEERING
PREVIOUS PLAN REVIEWER
STRUCTURAL - 1 WK
JIM JOHNSON
7/28/2015
8/4/2015
7/31/2615
APPROVED
I
Printed: Thursday, September 17, 2015 11:05:06 AM 6 of 7
sysrenns
Attachment Type .-.
CREATED
OWNER:.
DESCRIPTION•
PATHNAME = _SUBDIR
'.ETRAKLT•:ENABLED. ;
DOC
3/26/2015.
JIM JOHNSON
53-659 VIA
53-659 VIA
0
STRADA.docx
STRADA.docx
DOC
7/31/2015
JIM JOHNSON
53-659 VIA
53-659 VIA
0
STRADA.docx
STRADA_1.docx .
DOC
7/31/2015
JIM JOHNSON
BRES2015-0077 SCHOOL
BRES2015-0077 SCHOOL
0
FEES.pdf
FEES.pdf
DOC
3/13/2015
KURT CULVER
BRES2015-0077.DOC
BRES2015-0077.DOC
1
Printed: Thursday, September 17, 2015 11:05:06 AM 6 of 7
sysrenns
Type
- ..,z�.. n..- :,..
ATTACHMENTS
E LE
;OWNER ,DESCRIPTION PATHNAME _ ,-;SUB;QIR .,ET D
-, :�: •W .:: .......,:.,.: _ RAKIT NAB
2ND REVIEW - NEW CITY.
DOC
'7/27/2015 KATHRYN SAMUELS
STRUCTURAL TRANSMITTAL BRES - 0
TRANSMITTAL 2015-0077 (2nd).pdf a ..
_
2ND SUBMITTAL 2ND SUBMITTAL
DOC
7/21/2015 STEPHANIE KHATAMI -
CHECKLIST AND CHECKLIST AND s .0
f
COMMENTS 7-21-15.pdf COMMENTS 7-21-15.pdf "
4.
t.
�
� �
".�
� r
,
�
5
-Ar
,
.l
*
•.i�-
.
'��
+ '' •
„'- * - �.:
i4
f
�4+
K �•
�L'
y ..7...•, r'
,y.,'•
,.r-
.
��
, -�-
.,
a
.•
Printed: Thursday, September 17, 2015 11:05:06 AM
-
7 of 7
e
SYSTEMS
Building
Address
\ PO. BOX 1504 APPLICATION ONLY
78-495 CALLE TAMPICO
;isV�CI s+-tc�OL LA QUINTA, CALIFORNIA 92253
�SGc.f'�1,{G�- �/U I i 1 I G�Y1i15�71
Mailing r
Address
City Zip ITel.
Address
State Lic. City
& Classif. Lic. #
Arcn., Lngr., - A
esigner (So g ja" S46,
Address Tel
3 s Dry -P• -Q �D
Ity Zi ^ State
G�.i irJ (� 01-7_" ILic. #
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 Contrac-
tor'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 ($500).
❑ 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 and Profes-
sions 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, as owner of the property, am exclusively contracting with licensed contractors to construct 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)
01 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKER'S COMPENSATION DECLARATION
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
❑ Copy is filed with the city. ❑ 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 Workers' Compensation Laws of California.
Date Owner
NOTICE TO APPLICANT.., It, 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 applicant Date
Mailing Address
City, State, Zip
WHITE = BUILDING DEPARTMENT
BUILDING: TYPE CONST. DCC. GRP.
A.P. Number -1 7f 7
Legal Description
Project Description �� ✓tea�� G�
Sq. Ft.r
Size i
No. + No. Dw.
Stories ` Units
Me w Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT i
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
JA
IMIA
A
VD7T
CDMMUD
TOTAL
CONTACT INFORMATION
NAME: 65")
cyri 7,5+6,1
PHONE: 0-0.
Lf?14.(o ��
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setbackfrom Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
YELLOW = APPLICANT
PINK = FINANCE
Coachella Valley Unified School District
83-733 Avenue 55, Thermal, CA 92274
(760) 398-5909 — Fax (760) 398-1224
This Box For District Use Only
DEVELOPER FEES PAID
AREA:
AMOUNT
LEVEL ONE AMOUNT:
LEVEL TWO AMOUNT:
A:ITIGATION AMOUNT:
COMM/IND. AMOUNT:
DATE:
RECEIPT:
CHECK N:
INITIALS
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name: [Ehe H^ tdea� Date: September 16, 2015
Owner's Name: Daniel and Saroya Williamson Phone No.
Project Address: 53-659 Via Strada, LaQuinta
Project Description: New Single Family Dwelling
APN: 777-200-007 & 008 Tract #: Lot #'s:
Type of Development: Residential . XX! Commercial Industrial
Total Square Feet of Building Area: 8910
Certification of Applicant/Owners: The person signing certifies that the above information is correc- and makes this statement under
penalty of perjury and further represents that he/she is authorized to sign on behalf of the owner/developer.
Dated: September 16, 2015 Signature:
***********************************************************************
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code Gov. Code Project
17620 65995 Approval
Number of Sq.Ft. 8910
Amount per Sq.Ft. $3.36
Amount Collected $29937.60
Building Permit Application Completed: Yes/No
By: Elsa F. Esqueda, Director of Facilities and Maintenance
Agreement Existing Not Subject to Fee
Prior to 1/1/87 Requirement
Note:
Pursuant to AB 181 any room additions or enclosures of 500
sq. ft. or less are exempt from developer fees. Any mobile
homes being relocated within the same school district's
jurisdiction are exempt from developer fees.
Certificate issued by: Laurie Howard, Secretary Signature:
NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMEN" OF FEES
Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this Distinct provide (1) a written notice to the
project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of these
Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall serve to
advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of i he fees or performance of any other
requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether payable at this
time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This Certificate of
Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School District, and up
to three (3) such extensions may be granted.
M V:c/mydocs/devfees/celliticate of compliance form updated 3-2007 11/2010
Tiffs 365
t
RECORDING REQUESTED BY:
Title 365
AND WHEN RECORDED MAIL TO:
Daniel Williamson and Saroya Williamson
Order No.: 5104301233-51
Escrow No.: F8305
A.P.N.: 777,200-007-2 TRA: 020460
SPACE AS
GRANT DEED
DOC # 2013-0192837
04/24/2013 12:34 PM Fees: $21.00
Page 1 of 3 Doc T Tax Paid
Recorded in Official Records
County of Riverside
Larry W. Ward
Assessor, County Clerk & Recorder
**This document was electronically submitted
to the County of Riverside for recording"
Receipted by: TSTANLEY
THE UNDERSIGNED GRANTOR(S) DECLARE(S)
DOCUMENTARY TRANSFER TAX IS $ VM. oo
[ X ] computed on full value of property conveyed, or
[ ] computed on full value less value of liens or encumbrances remaining at time of sale.
[ ] unincorporated area [ X ] City of La Quinta
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
Marty Chilberg and Stacy Chilberg, Trustees of The Chilberg Family Living Trust dated 1/30/03
hereby GRANT(S) to Daniel J. Williamson and Saroya D. Willi as Trustees of +VNe, Daniel and Saroya Williamson Revocab e ECFIVED
Trust dated 4/1/2011
the following described real property in the County of Riverside, State of California
See Exhibit "A" attached hereto and made a part hereof.
Common known as: Vacant Lot, La Quinta, CA 92253
Dated: March 28, 2013
STATE OF GANf.6RNTA WA
COUNTYOF Iw )SS.
00 V I before me,
,Notary Public
personally appeared
-Mar a
who proto me on the basis of satisfactory
evidence to be the person (s) whose name (s) is/are
subscribed to the within instrument and acknowledged
to me that he/ she/ they executed the same in his/ her/
their authorized capacity (ies), and by his/ her/ their
signature (s) on the instrument the person (s), or the
entity upon behalf of which the person (s) acted,
executed the instrument.
SEP 18 2015
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT
The Chilberg Family Living Trust dated
1/30/03 A 11A
By.
Stacy
I certify under PENALTY OF PERJURY under the
laws of the State of California that the foregoing s3t�f�y Pub q
paragraph is true and correct. RICHARD W SIACHARSRI JR
WITNESS my hand and official seal.
My app Jul 11, 2015
�j
Signature /'c.AL� tj
(This area for official notary seal)
MAIL TAX STATEMENTS AS DIRECTED ABOVE
DOC #2013-0192837 Page 2 of 3 04/24/2013 12:34 PM
EXHIBIT "A"
PARCEL 1:
Lot 255 of Amended Tract No. 29894-2, in the City of La Quinta, County of Riverside, State of California, as per Map
recorded in Book 327, Page(s) 56 through 88, inclusive of Maps, in the Office of the County Recorder of said County.
Excepting therefrom to grantor, and its successors and assigns, interest in all water, minerals, oil, gas, petroleum, other i
hydrocarbon substances and all geothermal energy sources in or under said land or which may be produced from said i
land. '.
Except therefrom all oil, gas, minerals and other hydrocarbon substances, lying below a depth of 500 feet, without the right
of surface entry.
PARCEL 2:
Non-exclusive easements for access, ingress, egress, drainage, maintenance, repairs and for other purposes, all as
described in the Declaration.
APN: 777-200-007
Preliminary Report Page 10 510-1301233-51
DOC #2013-0192837 Page 3 of 3 04/24/2013 12:34 PM
J� 'r .Recorder
P.OLARRY W. WARD Recorder
rdeBox 751
COUNTY OF RIVERSIDE Riverside, CA 92502-0751
�f ASSESSOR -COUNTY CLERK -RECORDER (951) 486-7000
pec www.riversideacr.com
NOTARY CLARITY
Under the provisions of Government Code 27361.7, 1 certify under the penalty of perjury
that the notary seal on the document to which this statement is attached reads as
follows:
Name of Notary: Richard W Blacharski Jr
Commission #:
Place of Execution: King Counly WA
Date Commission Expires: 07/11/2015
Date: 04/22/2013
Signature:
Print Name: Peggy Layte
ACR 186P-AS4RE0 (Rev. 09/2006) Available in Alternate Formats
PLEASE COMPLETE THIS INFORMATION
RECORDING REQUESTED BY
AND WHEN RECORDED MAIL TO:
CITY OF LA QUINTA
Attn: CITY CLERK DEPT
78-495 Calle Tampico
La Quinta, CA 92253
DOC # 2015-0185588
05/05/2015 04:28 PM Fees: $30.00
Page 1 of 6
Recorded in Official Records
County of Riverside
Peter Aldana
Assessor, County Clerk & Recorder
—This document was electronically submitted
to the County of Riverside for recording—
Receipted by: CARAGON
ABOVE FOR RECORDER'S USE ONLY
CERTIFICATE OF PARCEL MERGER NUMBER 2015-0001
APN 777-200-007 and THE UNDERSIGNED GRANTOR(S) DECLARE(S)
APN 777-200-008 DOCUMENTARY TRANSFER TAX 1S $
CITY TAX IS $ 0
computed on full value of property conveyed, or
computed on full value less value of liens or
encumbrances remain
in at time of sale, .
Unincorporated area:1 X ICity of La Quinta
THIS AREA FOR
RECORDERS
USE ONLY
THIS PAGE ADDED TO PROVIDE ADEQUATE SPACE FOR RECORDING INFORMATION
RECORDING REQUESTED BY
CITY OF LA QUINTA
When recorded, return to:
CITY OF LA QUINTA
CITY CLERK
78-495 Calle Tampico
La Quinta, CA 92253
DOC #2015-0185588 Page 2 of 6 05/05/2015 04:28 PM
THIS AREA FOR RECORDER'S USE ONLY
CERTIFICATE OF PARCEL MERGER NO. 2015-0001
RECORD OWNERS
EXISTING PARCELS (Assessor Parcel Numbers)
Daniel J. Williamson and Saroya D. Williamson
777-200-007
Trustees of the Daniel and Saroya Williamson
777-200-008
Revocable Family Trust dated 4/1/2011
LEGAL DESCRIPTION OF MERGED PARCELS
See attached - Exhibit "A"
SIGNATURE(S) OF RECORDED OWNERS (Mu be Notarized
Pdnt Name/rate: Daniel J. Williamson, Trustee
ftnaLr
PrinlNam mue: Saroya D. Williamson, Trustee
n '
Piinl Name/Tdle:
nature:
PAN NaMHeW
S' natwe:
This Certificate of P cel Merger reflects Parcel Merger No. 2015-0001 as approved by the City of La Quinta.
Timothy Jonasson, City Engineer Date: 5
NOTARY ACKNOWLEDGEMENT
STATE OF CAL ORNIA )
COUNTY OF
On before me,
(Defe) (Af and Title of ofteq
personally appeared
( e(s) of Si917&(s))
who proved to me on the basis of satisfactory ev ce to he person(s) whose name(s) is/are subscribed to the
within instrument and acknowledged to me that he/she executed the same in his/her/their authorized capacity(ies), !,
e p n(s), or the entity upon behalf of which the person(s)
acted, executed the instrument.
and that by his/her/their signature(s) on t=the
I certify under PENALTY OF PERJURY y of the Sa of Californ' hat the foregoing paragraph is true and
correct.
WITNESS my hand and o tal seal
Notary Public
DOC #2015-0185588 Page 3 of 6 05/05/2015 04:28 PM
CALIFORNIA ALL- PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the identity
of the individual who signed the document to which this certificate is attached,
and not the truthfulness, accuracy, or validity of that document.
State of California
County of orae, }
On A�r)1 It:, 2-c 15 before me, ki,attal L' N1ikeli N, -+Ary public,
(mere insen nada am utle at leo icer) r
personally appeared _ Danitayiiliomfon nnii Surpy A 41�11iarnSC? h
who proved to me on the basis of satisfactory evidence to be the person(s) whose
name(s) is/are subscribed to the within instrument and acknowledged to me that
he/she/they executed the same in his/her/their authorized capacity(ies), and that by
his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of
which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that
the foregoing paragraph is true and correct.
WITNESS y/ n ?and official seal. ^r 6 KRISTAL L, MIKELS
f
Commission No. 2037047 i
NOTARY P UBttCCALIFORNIA h
s, ORANGE COUNry
e, My Comm Etpves AUG
UST 16, 2017
Notary Pub c ig ature (Notary Public Seal)
ADDITIONAL OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
�r}t tGay{� t l� %aY'C.ti Hennes _
(Title or description of attached document)
No ;l.t t' - t:vr S
(Title or description of attached document continued)
Number of Pages 3 Document Date
CAPACITY CLAIMED BY THE SIGNER
❑ Individual (s)
❑ Corporate Officer
(Title)
❑ Partner(s)
❑ Attorney -in -Fact
d Trustee(s)
❑ Other
2015 Version www.NotaryClasses.coni 800-873-9865
INSTRUCTIONS FOR COMPLETING THIS FORM
l his first complies with current California statutes trgarding nonan• trordir{g and,
ifneeded. should he completed and attached to the doeftmem. Acknowledgments
from wher.states may he completed for documents being sent to that stare so long
as the u-nrdurg does nor require the California notan• to riolate California notan;r
law.
• State and County information must he the State and County %%here the document
signer(s) personally appeared before the notary public for acknowledgment.
• Date of noturi7ation must be the date that the signer(s) personally appeared which
must also be the same date the acknowledgment is completed.
• The notary public must print his or her name as it appears within his or her
commission followed by a comma and then your titke (notary public).
• Print the nwne(s) of document signer(s) who personally appear at the time or
notarization.
• Indicate the correct singular or plural forms by crossing off incorrect forms (i.e.
Ite/she/t4ey- is les ) or circling the correct fonns. Failure to correctly indicate this
information may lead to rejection ofdocumcnt recording.
• The notary seal impression most be clear and photographically reproducible.
Impression must not cover text or lines. If seal impression smudges, rc-seal if a
sufficient area permits, otherwise complete a differem acknowledgment form.
• Signature of the notary public must match the signature on lile with the office of
the county clerk.
Additional information is not required but could help to ensure this
acknowledgment is not misused or attached to a different document.
Indicate title or type of attached document, number of pages and date.
Indicate the capacity claimed by the signer. If the claimed capacity is a
corporate officer, indicate the title (i.e. CEO. CFO, Secretary).
• Securely attach this document to the signed document with a staple.
DOC #2015-0185588 Page 4 of 6 05/05/2015 04:28 PM
A notary public or other officer completing this certificate verifies only the
identity of the individual who signed the document, to which this certificate
is attached, and not the truthfulness, accuracy, or validity of that document
State of California
County of Riverside
On May 4, 2015 before me, SUSAN MAYSELS, Notary Public, personally
appeared TIMOTHY JONASSON who proved to me on the basis of
satisfactory evidence to be the person whose name is subscribed to the
within instrument, and acknowledged to me that he executed the same in his
authorized capacity, and that by his signature on the instrument the person,
or the entity upon behalf of which the person acted, executed the
instrument.
1 certify under PENALTY OF PERJURY under the laws of the State of
California that the foregoing paragraph is true and correct.
WITNESS my hand and official seal. SUSAN MAYSELS
Commission # 2017258
Notary Public - California D
_ Riverside County
Signature M Comm. Expires Apr 13, 2.017
(seal)
DOCUMENT:
CERTIFICATE OF PARCEL MERGER NO. 2015-0001 re: APNs 777-200-007
and 777-200-008 - owner(s): Daniel J. Williamson and Saroya D.
Williamson, Trustees of the Daniel and Saroya Williamson Revocable Family
Trust dated 4/1 /2011
DOC #2015-0185588 Page 5 of 6 05/05/2015 04:28 PM
EXHIBI T nA �
PARCEL MERGER NO. 2015-0001
PARCEL "A"
LOTS 255 AND 256, AMENDED TRACT 29894-2, IN THE CITY OF LA QUINTA,
COUNTY OF RIVERSIDE, STATE OF CALIFORNIA AS SHOWN ON MAP ON FILE IN
BOOK 327 OF MAPS AT PAGES 56 THROUGH 88, INCLUSIVE, RECORDS OF
RIVERSIDE COUNTY, CALIFORNIA.
SAID MERGED PARCEL CONTAININ 41,172 SQ. FT. (0.95 ACRES)
ATTACHED HERETO AND MADE A PART OF THIS LEGAL DESCRIPTION, IS A
PLAT LABELED EXHIBIT "B".
SUBJECT TO ALL COVENANTS, RIGHTS, RIGHTS OF WAYS AND EASEMENTS OF
RECORD, IF ANY.
O VXNDD.
SUR`
U 0
* No. 4075
EXP. 6/30/16
PREPARED BY.
JAMES D. FEIRO L.S. 4075
DATE:/�� jI
DOC #2015-0185588 Page 6 of 6 05/05/2015 04:28 PM
EXHIBIT "B"
GRAPHIC SCALE
25 50 100 200
( IN FEET )
1 inch = 50 ft. 1 254 1 LO N86'33'27"W (R)
CURVE TABLE N 85'08'29" W
186.65
NO. DELTA RADIUS LENGTH ,2 158.64'
C1 06' 10 31
500.00
53.89
C2 04005'06"
86.00
6.13
C3 05'37'23"
178.00
17.47
04'4 10
972.00
80.34'
apt 7301090 28.01 '
W56� ppb ,
,a
001405 `�1 1,2�' P U E
PARCEL MERGER NO. 2015-0001
Prepared ft
FEIRO ENGINEERING, INC.
P. 0. BOX 12980
PALM DESERT, CA. 92255
JAMS D. EIRO DATE
L.S/ 4075
_Lot Line to be Deleted per
this Parcel Merger
=
-Parcel Merger Boundary
N $ p RC9x17" w R
� V
_
n
j QTR 1� sA•00�
�
A
�
S84'02'42"E_LR) j
�
+
1
W
N
.� O
'' No. 4075
Z
sh-
0 $6 008
Ea Me 32� 1.2pr
c
4LEXP. 6/30/16
PSS: 11os;o I
o
.4' OFCA1a
18 p 84,
N 80.09'29" W
L01 257 N8,3.21'34"W (R)
C2
I
PARCEL MERGER NO. 2015-0001
Prepared ft
FEIRO ENGINEERING, INC.
P. 0. BOX 12980
PALM DESERT, CA. 92255
JAMS D. EIRO DATE
L.S/ 4075
RECORDING REQUESTED BY:
Orange Coast Title Company
AND WHEN RECORDED MAIL TO:
Daniel Williamson and Saroya Williamson
Order No.: 1509109-10
Escrow No.: FS424
A.P.N.: 777-200-008-3 TRA: 020-160
DOC # 2013-0312117
06/28/2013 11:17 AM Fees: $18.00
Page 1 of 2 Doc T Tax Paid
Recorded in Official Records
County of Riverside
Larry W. Ward
Assessor, County Clerk & Recorder .
"This document was electronically submitted
to the County of Riverside for recording—
Receipted by: CARAGON
SPACE ABOVE THIS LINE
GRANT DEED
THE UNDERSIGNED GRANTOR(S) DECLARE(S)
DOCUMENTARY TRANSFER TAX IS $ 715.00
[ X ] computed on full value of property conveyed, or
[ ] computed on full value less value of liens or encumbrances remaining at time of sale.
[ ] unincorporated area [ X ] City of La Quinta
RDER'S USE
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
James K. McDermott and Margaret M. McDermott, Trustees Under Declaration of Trust dated May 11, 1990
hereby GRANT(S) to Daniel J. Williamson and Saroya D. Williamson, Trustees of
The Daniel and Saroya/Revocable Family Trust, dated April- 1 , 20.11
!NilliQmsarl
REC'EIVEDthe following described real property In the County of Riverside, State of California
See Exhibit "A" attached hereto and made a part hereof.
Common known as: Vacant Lot 256, La Quinta, CA 92253
Dated: June 21, 2013
STATE OF CALIFORNIA
COUNTY OF Sir
On J3"ne- before me,
Notary Public
personally appeare
7 C'
who proved to me on the basis of satisfactory
evidence to be the person (s) whose name (s) Ware
subscribed to the within instrument and acknowledged
to me that hei- / they executed the same in hist -her/
their authorized capacity (ies), and by h0t-4er/ their
signature (s) on the instrument the person (s), or the
entity upon behalf of which the person (s) acted,
executed the instrument.
I certify under PENALTY OF PERJURY under the
laws of the State of California that the foregoing
paragraph is true and correct.
WITNESS my hand and fficial se .
r
Signature '�'
SEP 18 2015
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT
Under Declaration of Trust dated May 11,
1990 _ A
Fy: Jaftnes K. McDermott, Trustee
M. McDermott�Trustee
JANIEL CALLAHAN
Commission # 1894753
i . Notary Public - California z
Santa Barbara County >
My Comm. Expires Jul 5, 2014
(This area for official notary seal)
MAIL TAX STATEMENTS AS DIRECTED ABOVE
DOC #2013-0312117 Page 2 of 2 06/28/2013 11:17 AM
Order No. 210-1509109-10
Exhibit "A"
Parcel No. 1:
Lot 256 (the "Lot") of Amended bract No. 29894-2, in the City of La Quinta, County of Riverside, State of California, as shown on a
Subdivision Map (the "Map") recorded on December 12, 2002 in Book 327, Pages 56 to 88, inclusive of Maps, in the Office of the
Riverside County Recorder.
Parcel No. 2:
Nonexclusive easements for access, ingress, egress, drainage, maintenance, repairs and for other purposes. all as described in the
Declaration.
Page 9
Pian Submittal
Job Site
Owners N
Number, Street, or PO
City, State, Postel C
Owner's Phone Nun
Owners E -Mail Add
Project Managers
Project Managers Phone N
Projed Managers E-mail A
Builder / Contn
Number, Street or PO
CRY, State, Postai C
Project Square
Building Permit Number.
Project Description: SFR
Exempt: O
(Materials may contain hazardous wastes and
are not subject to recycling provisions)
Construction Debris Management Plan
City Approval By
9/21/2015
53659 Via Strada
Dan & Saroya Williamson
Nate Rucker
760.275-9357
nategbruckennuth.com
Rucker Muth Luxury Homebuilders
PO Box 13017
Palm Desert, CA 92255
8,910
Date of City Approval
y/2//A
Materials To Be Discarded:
Product
Tons
Trash
16.93 Not recyclable
Product
Tons
Asphalt
0.00 Recyclable
Masonry (broken)
0.00
Brick/Block
0.00 Recyclable
Plaster
1.78
Cardboard
2.94 Recyclable
Scrap Metal
0.00
Commingled
0.00 Recyclable
Tile (floor)
1.51
Concrete
0.71 Recyclable
Tile (roof)
0.00
Drywall
0.53 Recyclable
Wood
22.28
Donated / Reuse*
0.00 Recyclable
Landscape Debris
0.00
*Describe Items
Totals: Rec cle Trash Projected Diversion:
29.81 1 16.9 1 1 r -63—.r/71,
I understand It is the property owners responsibility to submit copies of weight tickets or receipts to the District
Environmental Coordinator as these hauls occur. I hereby car* that completion, Implementation and adherence of the
Debris Management Plan (DMP) for the above named project shall guarantee that at least 50% of the Jobsite waste is
diverted from landfilling. The remaining material will be recycled or reused. I will divert, for recycling or re -use, remaining
materials generated from the first day of the project through the completion of the project In accordance with this plan. This
DMP is Issued in the name of the property owners) and shall remain their property throughout the construction and/or
demolition project A contractor serving as agent of the owner may obtain a DMP for the owner. However, the DMP is suit
lssu n the n e roperty owner(s) and the owner retains legal responsibility for ensuring that the provisions of the
DMP ad d to p party owners) and general contractor shall be kept informed of the diversion progress through
bMno ly orts. l -h uling, all refuse material from this project site must be taken to an72,
proved recycler or transfer
( S
Owner I Developer / Project Manager / Superintendent Date
5� CITY. OF LA QUINTA .SUB -CONTRACTOR LIST
JOB ADDRESS ARM - %A �7WAV-' PERMIT. NUMBER#j*-y'Zpltj.ppj7 OWNER 1PA01iG1► W�t.1.1AN1�� b BUILDERN�IG(G1Z ��� ��•
This form shall be posted on the iob with the Building Inspection Card at all times in a conspicuous place. Only persons appearing onithis list or their employees are authorized to work
on this iob. Anv chanqes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance.
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response-.
Tra de Classificatwh
....................
.................
Contractor
�
�cense....:.:.:..:..::::.:....::::.............:.:._:::.::::::.::::::workers..Co.m
Contractor. s. L
.ensation.1.n.....:..........................
.. .... ... F? ...................
Y ;.Busine$s:
icense::.....:>
Name
Classification
License Number
Exp. Date
Carrier Name
Policy Number
ExP . Dateto
License Number
Exp. Date
eComPan
e. . AB C-8
xx xxx
(x /xx/xx)
e:9StateFand, CaIComP)
(Format ries)
xx
xxxx
xx/xx x
xV
'��.1N�OMUM...
R�K'�'�C`.=1>2 `:
`.EL1:FtTH.....:... ..:1......:..: ),,<�.�`
s
co
A
q 6 a �f i
o
q. o
' t0
frD E s.
� � •
� �� _6 ZZ -0.
12- -1 y
_ 1
0 o0b? 3 Z
3 -3 I b
loam:"'
-:::;;;;:.<.
�p1�Soa (Aac�{ct
G-$
q oy .
i -ZS -11
t�� GI��P
Oltr A%b9
2-ll•►b
Ic88o9
b-;o-�6
F
6 o
rP.
� WLR
•.� -
2 -
67y 7 b
to - 1•
� 1 cb�J
28 3
AS 1
-16
o 0 9
� a 1 6
o -!
6
2
1 . • 6
-3
G 1
ri 1 t 1
- 'b o b
q
G 1 �1
� 1 al. W
PL;;UMBINGi:(.C:3:;.!:>:::::;>:;;:::>::>;::>:: �•�• M�A1��1��. ?J' 7� t -1 �' �f 7TH(. � ';'� t� 7
<�ATH`'PLASTER Cj�S.)`:#'
JOB ADDRESS V3'6r1`1 JtA 5*AVFA CITY. OF LA QUINTA.SUB-CONTRACTO..`` ll-
�� �. '
PERMIT. NUMBERZAtj AG`! MIAER�- R LIST a W%IAA ILDEI�
This form shall be posted on the iob with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance,
,.i L...❑.•1;....., ,..... c:-' -,-$, +—A. X11 hnl—, m..ot hn h., "rin Mlo" ie not n - r•nntnhlp rocnnnce.
`:) r .F-. ... P - . ..J,"'n•• •:Y4 .. 'r • - a'i..
w
"Q.t .� �h '., j' fC-:,✓�'i.. ':fi .ems.% `T,S �:
1 f at On'Y�' ).1 ` . O tr8 (:v� s ? 1?.. 45 ;Y. j� .SL t isLlcenOr'.
Tratle /';Class f c 1- .. < RIO, s., r. >�,C p �to..,..w. , .: _..... a.. .. h . at�eCpntraF o .:. 5...., ?
Com�:.CrtY�BusmcSS License
t•.:..., .k ,> : V es.p..-........9 ... _.. - ray. y. .
`•tlf '� t ae`.�-• Company Name Classification License Number
Exp. Date
Carrier Name Policy Number
Exp. Date License Number Exp. Date
a`" ftkK,l'`"'rs
(e.g. A, B, C -S)' (xxxxxx)
(xxlxx/xx)
(e.g. State Fund, Calcomp) (Format Varies)
(xx/xx/xx) (xxxx)' (xx/xx/xx)
x..,L,,< .". <•,,,,.x,='qa;, ,.,;', >,+:`
1,
�� �
•
•
EARTHWORK (C 1212 �, � i
GONCRET�y(Q 8) s�� ,
FRAMING IC,S); ��
STRUCT STEL fC,>1)'� _
•
MASONRY IC�29) •` �"�' •
PLUMB NG'IC 3G)
LATH PLASTER (C 5)
DRYWALL (C 9)
r
HVAC
x�F
ELECTRICALifC�"101$
ROOFING IC�39) ����E
T.
SHEETME AL 1C 43►Y �
IN�SU1 ATION
(C
SEWAGI DISP I,C-'421. 4 '
CERAMIC�TIL6.(C 54)
ch:
LANDSCAPING