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0205-084 (MISC)LICENSED CONTRACTOR DECLARATION Chereby affirm under penalty of perjury that I am licensed under provisions of Chap° 4r 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 746198 D CIO C /28102 Dat Signature of Contractor OWNER -BUILDER D CLARATION 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 STATE.. !+1)ND Policy No. 040-Q1 0009231 (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 Sny mariner so as to become subject to the workers' compensation laws ofPht!!�p�L�ions__- a- Date-.5� a"fornia, and agree that if I should become subject to the workers' compention provisions of Section 3700 of the Labor Code, I slfortwith comply Applica.,tll------- 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 aplication and state that the above information is correct. I agree to comply w,i' all City, and State laws relating to the building construction, and hereby a horize representatives of this City to enter upon the above-mentioned pro rty f. r inspection purpos "sem .----� 77t Signature (Owner/Agenj Da e BUILDING PERMIT PERMIT# ii2Ck5-(1#1B DATE VALUATION LOT TRACT .V 71[12 �,U) 1 _�- � • 211?�a ► ADDRESS SO -SW VISTAB01MA.'IRt" JOB SITE APN 772-1,00-001 OWNER CONTRACTOR/DESIGNER/EN (NEER ST'I+:WRRT WOODARD A & M CONSTRUCTION 51-370 MIK114 ABEftivfi317AI46 18-070Cr J-ECAbt7, Lk QUIR I'A CA 92253 LA QUI,TYA CA 922S3 USE OF PERMIT .ZYi` , CHU.%3.NEf US SUPPLEMENTAL PKkMIT TO CIRIC.HNAT.R 0112.167, RL"FL3sCTINt� D Q C:HANOE OF C0141'RAC T OR I ORAL UIRA Fkf CEDEPT- Y 7±SllMA T11a) CCAS E OF (','ONY11MUFfON 0" P KRMrr YKE ST}NIMA►aY SUPPLEMENTALPERMIT FEE 101.000-423.000 5.4,50 SUB -TOTAL CC1J+1 PUMION AtW Pf.,AN CHFC%( ' $4.50 JX23 1'Xis-PAWN 1;10!:9 S0.W TOTAL I'IaRMITFJD,' S n(7,E now $,M) RECEIPT DATE . f+ BY AT FIN E SPECTOR C INSPECTION RECORD ' � OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR It. BUILDING APPROVALS MECHANICAL APPROVALS Set Backs 7 Underground Ducts Forms & Footings - Ducts Slab Grade J Return Air Steel �. Combustion Air Roof Deck' 3 _ p 2 - Exhaust Fans 0. K. to Wrap PZ— L F.A.U. Framing U �— e Compressorki Insulation Vents Fireplace P.L. Grills ✓ Fireplace T.O. Fans & Controls Party Wail Insulation Condensate Lines ✓ Party Wall Firewall Exterior Lath Drywall - Int. Lath G — Final �- i Final jkOVALS _ POOL SAS BLOCKWA' L A steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Z " —d Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Oc9 — /LA r ,..j Qj -!r o 2_ c`t _ ei Final --/„� COMMENTS: Final Utility Notice (Gas) _ _ 02 ELECTRICAL APPROVALS Temp. Power Pole Ad Underground Conduit Rough Wiring Low Voltage Wiring _ Fixtures Main Service _ _ Sub Panels / Exterior Receptacles t G. F.I. Smoke Detectors Temp. Use of Power Co L Final MW Utility Notice (Perm) Bin At —� City of La Quints T V Bw7ding 8t Safety Division P.O. Box 1504,78-495 Calle Tampico Quints, CA 92253 - (760) 777-7012; Building Permit Application and Tracki.-ig Sheet Permit #La "'Piroject Address: 6b' -,FW XO%kmer's Name: A. P. Number: *T7 2_— Zgb — oo 1 XAddress: 5(—_310 Legal Description: XCity. ST. Zip: (,(�_- 42V i NTA Contractor: �� X Address: rTelephone: K Project Description: City. ST. Zip: �, �Z �� �✓l S /ON %o �icJt/M �`T�� Ozav - C)g� j )J��C��-� elephone: or sState Lic. # : It Cinv Lic. Arch.. Ener.. Designer: �(�©D &V0 Address: City. ST, Zip: Telephone:.. . ... Construction Type: Occupant}: State Lic. #: Project type (circle one): New Add'n Alter Repair Demo x Name of Contact Person: X Sq. Ft.: t�5 # Stories: ( # Units: Telephone # of Contact Person: (L � KEstimated Value of Project -��� � . APPLICANT: DO NOT WRITE BELOW THIS LINE q Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted O2 Item Amount Structural Cales. Reviewed. ready for corrections Y� Plan Ch -ck Deposit Truss Calcs. Called Contact Person Z d.y Plan Ch-ck Balance Title 24 Calcs. Plans picked up i Constru:tion Flood plain plan Plans resubmitted Nlechan",cal Grading plan 2" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- " Review, ready for corrections/issue Develop!r Impact Fee Planning Approval Called Contact Person A,I,P,P, Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees City of La Quinta Plan Check Corrections Date: July 25, 2002 Project Address: 80-880 Vista Bonita Trail Project Description: Truss and Mechanical Plan Revisions Applicant: Woodard / A & M (564-4418) Status: First Review Plan Checked by: Greg Butler (760) 777-7015 Return this list with next submittal. Resubmit two complete sets of plans, wet -signed by the person who prepared them. 1. Incorporate into Plan Sets the current version (Delta 9, 6/19/02) of Sheets rA-1, M-2, and Energy & HVAC for approval. 2. Provide stamp and wet -signature of Architect on all non-structural pages of Plan Set. As further information is provided and reviewed, additional corrections may be required. Returned for correction: Required for resubmittal: 2 sets — Unsigned Plans 2 sets— Signed Plans Non-structural correction list Non-structural correction list (with -esponses) END CORRECTION LIST Page 1 of 1 Suh�` Bin # Permit # d 2®� a�`�c Project Address: -t City of La Quinta Building 8T Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Trzcking Sheet .- i 1. �%I -� O�cner's Name: -)�- A. P. Number: `, (o .. Vnzb— 1 Legal Description: '1(La - 2 -Foo, c�O I g Contractor: - d ` .� Address: ,� (E, . Address: -jF !a _ 37 C X0<10J,OA Pr"4004` Cih. ST. Zip: - L� S� i Z2�3 !o , Telephone: -'E- (o 4_ 1 Project Description: v City. ST. Zip: -)e- QU u Telephone: S Z �� 1 6LP State Lic. Cite Lic. #: a Arch., Engr., Designer:� v "—i A*LDD ` ZLS,� . 1 C Address: 51-10 Q R� tri to &C h Cite, ST, Zip: (Juli !'1 G'C�'. ZZs 3 L00 QL 14 VLt Telephone, aC7-54 StateLic . # Name of Contact Person: �pVw CL6.q.i l.��k.� Construction ucti onT�Pe . Occupancy: Panc�• Project ect type(circle one): New Add'n Alter Repair Demo Sq. Ft.:."k4 S; # Storics: # Units: 1 Telephone # of Contact Person: -7t- '4 Z'Z , Estimated Value of Project: ' APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Itch Amount Structural Calcs. Reviewed, ready for corrections Plam Check Deposit Truss Cales. Called Contact Person Plar Check Valance • 3g'. oo Z Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mednanical Grading plan 2"' Review, ready for correctio issue 81t-2 Electrical Subcontactor List Called Contact Person T x7 Plunbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Gra Jing IN HOUSE:- 'ro Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A,I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees h Bin # City of La Quinta �- Bw7ding at Safety Division v Z O 5 -C ? l P.O. Box 1504, 78-495 CaOe Tampico La Quinca, CA 92253 - (760) 777-7012 Building Permit Application and Tracki.ig Sheet Permit g 'vProject Address: g%'3$D XOwner's Name: —effle-lr-,flerr "Mbf % -o A. P. Number: "7-7 2'-' Zg b —o o r X Address: 15(-3-to 52-zo-k o w-5 Legal Description: )City. ST. Zip: (,K-42u i 0xro C a--a— 7! Contractor: ITelephone: S&u_q L(1- AK Address: `�� �j (Q Project Description: Cin. ST. Zip: LAfE C �ZZJ lLF✓/5/ON %o PiSV4,7- 0?01 - 00 elephone: '5 lo "t $� 49 FI" G y0�/r F � /_ State Lic. # : Cin• Lic. #: -�P Arch.. Engr.. Designer:t�©p ty �.2Hf Address: City. ST, Zip: Telephone:Construction Type: Occupancy: State Lic. #: Project type (circle one): New AJd'n Alter Repair Demo X Name of Contact Person: X u Sq. Ft.: 15 �5 # Stories: ( T# Units: l XTelephone # of Contact Person:41141Z, O- o 'Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES 2 Plan Sets Plan Check submitted 6 / Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance itle 24 Calcs. Plans picked up r1> % ConstrLction 111ech2rical Flood plain plan Plans resubmitted Grading plan 2" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbiig Grant Deed Plans picked up S.N1.1. H.O.A. Approval Plans resubmitted Gradin; IN HOUSE:- 34 Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P' Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees Certificate of Occupancy City of La Quinta Building and Safety Department This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code, certifying that, at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following: BUILDING ADDRESS: Use Classification: Occupancy Group: SINGLE FAMILY DWELLING R-3 80-880 VISTA BONITA TRAIL Type of Construction: VN Owner of Building: STEWART WOODARD Building Official Bldg. Permit No.: 0205-084 Land Use Zone: RL Address: 80-880 VISTA BONITA TRAIL City: LA QUINTA, CA., 92253 By: BILL GORDON Date: 12/13/02 POST IN A CONSPICUOUS PLACE