0003-042 (SFD)LICENSED CONTRACTOR. DECLARATION
ffl,her'6by affirm , under penalty. of perjury that 1, am licensed under provisions of
6in� witWSecti
pter,9 (commencing on.7000)'of Divisi6n'3of the Business and
Professionals Code, and my License' is in full fo I rce .1 andeffect.
Lic. Class Exp.Date
• 740745
13 0 /3012(
IZI
Date 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:
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 (Se'6.,7044,13usin'ess & Professionals Code).
(f�;) -, -, 1; ''as owner of the property, am exclusively. contracting with licensed
�',contracto`rs to"corstruct the project (Sec. 7044, Business & Professionals
r, I am exempt under Section
B&P.C..for this reason
D ate Signature of Owner
WORKER'S COMPENSATION DECLARATION
Ihereby-1, affirm under penalty of perjury one of the following declarations:
"I have and will maintain acertificate of consent to self -insure for workers'
compensation,, as,provided Jor by Section 3700 of the Labor Code, for the
_!performance of the work for which this permit is issued.
)'5I,have and will maintain workers' compensation insurance, as required by
'
r'section'37oo of the Lkiir Code, for the performance of the work for which this
10��rmif is, issued- My,w6rke'rs'-compensation insurance carrier & policy no. are:
.13
.er..;,MDEMNITY INS.- OF Policy No.
4q9
,., z. I
(This section need not be completed if the permit valuation is for $100.00 or less).
I ),I certifyr'. that in the performance - of the work for which this permit is issued,
MV;all'not-employany person.in any manner so as to become subject to
the
k should become
f the Labor
and
P0 shall subfect an employer to criminal penalties and civil nes up to $100,000, in
.p,additi6nt6`the --cos„ of com-pe'n-sation, daniages as provided for.in'Section 3706
of th"e Labor Cdde', interest attorney's fe
es.
IMPORTANi`,Xpp4ic'tation is. hereby `made tothe Director of Building and S a*fety
for.,ar permit subject to' -'.the-' conditions 'and -restrictions set forth on his
VA '
Each person upon whose behalf this application is made & each person at
n r
whose request and for;�hos'e benefit work is -performid u-'dJ o pursuant t
56 I I.YV-!�-I III lit issued as alr'eis-u'lt "of this applicaton agrees to, & shall,' indemnify M
harmQS'the ,City of La Q,uinta,;its "'bif i c-ers;1 agents and employees.,,".
,?4-& 2.""Ani;y pi`erm`i issued as a
result o
flhisa'3p16tion ;ec6me's null and void if
workisnbt666reiced
" W'ithin',11 80'da- f`J-- f f " 6ch
ys - rom �( ate, o � issuance o * s
, il`3A',:Permit,,or cessation of work for 180 days will subject permit to cancellation.
,V� 'Ir .".. , - ' t4t:-: , . 1. , I I .
,t':l c'ettify-that' I have read this'a-p-pl-ic;'tion4-�'6d's"t�ate"t'h"at the above information is
l�,Lcorrect.,Iragre6',to-c-o-'m'i h ll'Ci
comply a ity,, and elating to the build-ing.
�166iikFU6tion,'Iah'd' a`u'thb'riz .' 1' of this'City to enter. upon
e representatives
Li'theione-d property for - irisp� ection p`brp6`s^es.
above -menti
�17 Date
• -,f170-4:-" 'PERMIT#
�A o
BUILDING PERM
0-
" 042
DATE VALUATION TRACT 4.:.r, $397,587.20 51
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR DESIGNER ENGINEER
CAPUAL PACWIC HOMES INC
4100 MAC Arf BUR BLVD #ZOO
h A -CM% T%T,-4
CIAPrf AL PACIFIC Hok&mm ]we
4, , ..", �4
4100 MAC AXIMM 1; VID'9200,,",
NEWPORT BEACH CA 92660
1
NEWPOW.CwPit, r'A",
(9�9)622-8400
;0
USE OF PERMIT
W.140121, FANGLY •DWIML-R40
SPIN PERMIT DOMi NOT INCLA)DE FiLOCK WALLS OR POOL.—
CUFYOM CONSTRUCTION 4.794,003F
.3
PORCH/PATI0 $38.00 sle" -
-OARAGEICARPORT 1,002,00 9F
a44
ESTIMIED COIST OF
49 397 3.20
PERbWf FkT NUAU"RY
CU14STRUCTION FEE 101.000-4)8-000
PLAN CHECK PLEE 101-000.439-318
M- E DEPOSIT 9-310
101-00o-43.
Z4:7 --
MECHANICAL FEZ W 1 -000:421 -ODO 50
ELECTRICAL Fn 101.000-420-000 S 2 6.83
v ,
PLUMBING FEE 101-000-419-000
STRONO MOTION FEE- RUID `101400-2411;00(1
011RADIND FEE 101-000-423-000:
'907, 06
DEV9LOPER IMPACFEE T v.
ART 114 PUBLIC PLACES - UWE 701-000-255 000 $74317"-,,,
"A.A
"44
• SUB IVILA&CON' VfRU(111.014 AND P)—W
U 354'
a
50.00
.111(yf" rEdIEKEr F EESDUE N OW'
"4
$5" A4-
75 t.
%
-!,Y�- j
e /r- t".
w.A'
RECEIPT ,L.
DATEDATE FINALED►INSPECTOR
&40 IN
zl�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE =
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— Cd
Underground Ducts
Forms & Footings
G(/
Ducts
Slab Grade
- —G7i
Return Air
Steel
Combustion Air
Roof Deck
(,G—
Exhaust Fans _
O.K. to Wrap
Framing
_ p (,4
F.A.U.
Compressor
Insulation
W
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
�G
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Building
—79 -
Address
Plan Chk. Dep.
Owner
t l
/ '
Mailing
i&196e 4232 ---
Address
City
Mech.
Address
State Lic.
& Classif.
Arch., Engr.,
Designer
Address
i•
TAh
• ���
,-/ P.O. BOX 1504 -APPLICATION ONLY
1 /
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
''% c,
Zip Tel.
Zip TeL
UILDING: TYPE"CONST. OCC. GRP.
.P. Number��-1 G� ' 23
egal Description LM 5 i2ACJ 2490
roject Description S Y 17
tar'r" CL;lq%CL4 aQTtrnJS
City /-r'9'1 5
Lic. # r��. Ft. [� No. / No. Dw
. V Stories Units
Tel.
CityI Zip I State I
Lic. #
LICENSEDCONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of Ihie Blusif\Ie�ss a/pZl Profes ons Code, and my license is In full force and
effeSfi _ _ _ . _. ? 1 W /__ _4 iV 14— C/ � /1/J
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 thathe 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).
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. d, however, the building
orimprovement 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'I 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.)
i] I 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 Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
fl 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 thg 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: ff, 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 Namef
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
New &--'- Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMITd7O
�' %-
AMOUNT
Plan Chk. Dep.
AUe/1;10S/.11"
10 `
Plan Chk. Bal.
i&196e 4232 ---
Const.
Mech.
Electrical
Plumbing'
S.M.I.
Grading
Driveway Enc.
Infrastructure
r•t
TOTAL
-
REMARKS
ZONE: BY:
Minimum Setback Distances: i f
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
J _
Jan -06-00 02:39P P.02
The Citrus Course Homeowners Association
January 6, 2000
Robin Koenemann
Capital Pacific Holdings
4100 MacArthur Blvd,, Suite 200
Newport Beach, CA 92660
Ref: Custom Home plan submittals for Lots 51 & 52
Dear Robin:
The Citrus Course Architectural Committee has reviewed and approved your plans for
construction of two custom homes on lots 51 & 52 on Pin& Street.
At some point we would like to review Precise Grading, Fence & wall, Landscaping, and
Pool plans when they are available.
Thank you and good tuck with your homes.
Sincerely,
On behalf of the Citrus Architectural Committee
Citrus Course Homeowners Association
By: Tami Lehman, Property Manager
Managing Agent: PCM -Desert Resort Management
73.550 Alessandro, Suite 5, Palm Desert, CA 92660 Ph. (760) 346-1161 fax (760) 346.9918
till
Y7I I NTA
4
OF7't�9� r e `L rOG & SAFETY, DEPARTMENT
777,7,012
INSPECTION REQUEST LINE
JjJL 777-7153,-'
Owner CAPI'I' CIFIC-Ii0.1VIES INC
s ;i"'I, PACIFIC IOIVIES IlVC
Cclkrlictor
0
J4 42,
Permit Number
POST ` 'N' JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
5N D
WALLS 'OR POOL
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK`,',
FOOTING STEEL
MAIN GROUND;SY$TEM'
GROUND PLUM ING
PRE-GUNITE
00 NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB , G
JOISTS & GIRDERS
ELECTRICAL GROUNDiWORK
DO NOT'.;POUR':CONCRETE UNTIL ALL ABOVE HAS BEEN.SIGNED '
ROU GH4ECTRI
C
i ROUGH PLUMBING ti
ROUGH,GAS;&'GAS TEST
a✓':xf
HEATING'&; VENT'- AC.
FIREPLACE
ROOF
BOND BEAM;.
O.K: T6WRAP
GROUT p 4' .0,8' .
FRAMING' ,
INSULATION
PRE=ROOF .,
I
COVER.NO WORWUNTIL ABOVE HAS BEEN,SIGNED.-
DRYWALL LINTERIOR.
EXTERIOR LATH
POOL"' PRE PLASTER;
FENCE & GATE-,::
SEWE SEPTIC TANK
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY -BUILDING
Certificate. of Occupancy
City of La Quinta
JBuilding and .
This Certificate issued pursuant to the requirements of Section. 1.09 of the Uniform'4yi1cling Code
certifying that, at the'time'.of issuance, this structure was in,componcp with the various bidinances
of.'ihe City regulating; building construction: or_ use. For the. following:
BUILDING ADDRESS: 78-845 P[NA
Use Classification: SM" Bldg. Permit No.-: GQ -3-642
9 0
Occupancy Group: R3 Type of Construction: VN Land Use.Zone: RL
Owner of Buildi'n-g: CAPITAL.PA-CIFIC HOMESINt..
Building Official
Address: 4100 MAC. ARTHUR BLVD#200
City:. NEW PORT'BEACH CA 92660
'By: KIRK KIRKLANd'
Date: 3-1.3-01
POST IN A CONSPICUOUS PLACE