0311-0067 (AR)48900 Avenida Anselmo
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
`Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date'
'
6914,05 - D F4T.C;l. d AGf2
/Datej°'^ Signature of Contractor --+- - t u 61
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason: k
( ) 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).
J ) 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 FWD Policy No. 046,6570-2130`3
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
.Code, I shall forthwith comply with those provisions/
Date+Applicant/*e?
j'Cf
Warning: Failure to secure Workers Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnity
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) '• ✓ ' . /%' t Date ° _ -
BUILDING PERMIT - PERMIT#
03114WTRACT
DATE / VALUATION LOT
f . j 0• c Ll ,558 tT 81 UQCzI: t
JOB SITE
ADDRESS 48-9WAVIMA
APN
'10
OWNER
CONTRACTOR / DESIGNER / ENGINEER
DAVM LP"014
Cs.mSIC B"iMJ)1;l?:31NC
48'900AVL- ANWWG
43-arC►t)IrOB'.D..PJVF-
CA 92253
WDIM V,T.ML8 CA 9221 G
(7150)7'12-1011 CRL4, 4999
USE OF PERMIT
. NWEN IIALADDrfION
viii b'Q. 7'. AT'iYITJO t 3'O R:t:,SI17[ td(."•3: = PNAS 311 iJlr PR031s' T .
[MASTER BEDROOM f g.A'i ii f CLOSET) PXRMIT D0,111:1007 INCLUDER
13LOCIC• WA1. "POOLOR SY.A. 2001 OODLS.
t
t
CITU010 CONSTRUCTION Sg3,tiQ X31;
R'ST 11$ATKJD CO STOF C:C.N YI'RUC3rIO%i1i•
44„%3X11
PFJV►'D;:i':t7, 9X 6ITi42'f?+ Al YY
CONSTRUCTION FEE 101 -000.41 g'-000 ' 1 $30 00
PLa4.1a C'H FEE1.41-t JO -1x39118 +` i $:521.31
MECHANICAL FU 10 n -000-421 -000 gni, 311
FiAACTRICl',iL .F'Lg . 101.000-4211-04102 1A V3.02
PIATMOING F"'ER 101-000-419,000 ` 169.00
STf80Ai'Ct MOTIOAt FLIE, iESID 101-0+00-241-000 wN $4,5.A
. i1 "i'(7' AT07 lL C?AY 4103 PWT tri t"
LESS PRI-; IPAT) FWS
$876,43
$10.00
3 0100 ¢ AL FF.RA97 F1KFN W E VOW
,.—
IIIIIIIIVIIIIIIVIIIIIII 71
IE
RECEIPT
DATE.j
B Yj /r
DATF FINALEQ
INSPECT
-
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
2 - 2Z57-
Ducts
Slab Grade
Z —
Return Air
10
Steel
p -
Combustion Air
Roof Deck
- /
Exhaust Fans
O.K. to Wrap
-
F.A.U.
Framing
-3 -
Compressor
Insulation
-3- 2 2-
Vents
Fireplace P.L.
Grills
Fireplace T.O.
a.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
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
Plumbing Final
Plumbing Top Out
I V
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
2 - - -Al
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) Y -'
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
78-194 Elenbrook Ct.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLYP 01Ci
❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER
O REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCATIONS
48
� ff
o b V
REPORT SEQUENCE NO.
TY P OF STRUCTURE - L Qum
Q— L ek p ��14 �t�-
PERMIT NU.
1 I •- -1
DATE
2- Z
DAY OF WEEK
MAT VIAL DESCRIPTION
,M
ARCHITEC
ed -
INS CTO
HAS. CHARGED
10
ENGIPT R � 11 � � �
ASSISTANTS
MRS. CHARGED
INSPECTION
DATE
GENERAL SUB
CONTRACTOR 1 d, bq so CONTRACTOR
2.1 Z-T�
2-9 4 q re,6,p,,r
Ch",S),
-2V�!,szroeA
rl 140
-,Q k U a (v S
f% O
S L q IL '
of\ci-
1 -e -
o S ®
b
�Ilk
�e 1.
c
rr ,..)
r
COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE O
PAGE
OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE All OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
S NATURE OF REGI RED INSPECTOR
Z q 1<ACN
DATE1OF REPORT REGISTER NUMBER
SPECIAL, INSPECTION SERVICE
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
.78-194 Elenbrook Ct. .,.
Palm Desert, CA 92211.
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
0 REINFORCED CONCRETE O STRUCT. STEEL ASSEMBLY JE Cy�
O POST TENSIONED CONCRETE O ASPHALT ❑ OTHER
O REINFORCED MASONRY O FIRE PROOFING
JOB LOCATION
'Y�-� � � kms\ � ��� C13� �"1(1 �M�l L6. C�v•..`�O�
REPORT SEQUENCE NO.
TYPE OF STRUCTURE
PERMIT NO.
DATE
DAY OF WEEK
MATERIAL DESCRIPTION
r��n'S
ARCHITEC
Af\ _g_ cAJ %J et
INSPECTOR
HRS. CHARGED
ENGIyEER r^nt
�J -
ASSISTANTS
T
HRS. CHARGED
SUB
INSPECTION I GENERAL I Lwsv
DATE CONTRACTOR CONTRACTOR
D � 2- 1 zt� L4 f e,)o °.,r ( Jpc>-A S
r a 1k,
S ko A'4 on A.�) G \
cid 0dAa Ijark 4<-) rno' Rajr
- y
I
i
V
t
COPY SENT TO CLIENT 0
CONTINUED ON NEXT PAGE 0
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS, SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
SI`NATURE OF REGISyAED INSPECTOR
%C0,4 !("�Kv L-`�q DATE%OF REPORT REGISTER NUMBER
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14 X 572 S.F. or $1,224.08 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By Cash - David Larson Check No.
Name on the check Telephone 760/333-1935
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by S ron MCGilvrey Payment Recd 1$0.00
$1,224.08 Over/Under
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original- Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
72 II
IIIIIIIIIIIIIIIIIIIIIIIII
CERTIFICATE OF COMPLIANCE
�tFiFas
IE
Desert Sands Unified School District
cyo
47950 Dune Palms Road
BERMUDAo
Date
1/30/04
- La Quinta CA 92253
to RANCHO MIRAGE (�
{� INDIAN WELLS
No.
25436
(760) 771-8515
PALM DESERT y
LA �
IN10 DIO
O
Owner
David Larson
APN #
658-300-008
Address
48-900 Avenida Anselmo
Jurisdiction
La Quinta
City
La Quinta Zip 92253
Permit #
0311-067
Tract #
LQGE 1
Study Area
Type
Residential Addition
No. of Units
1
Lot # No. Street
S.F. Lot # No.
Street S.F.
Unit 1 81
48900 Avenida Anselmo 572 Unit 6
Unit 2
Unit 7
Unit 3
Unit 8
Unit 4
Unit 9
Unit 5
Unit 10
Comments Master Bedroom/Bath addition
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14 X 572 S.F. or $1,224.08 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By Cash - David Larson Check No.
Name on the check Telephone 760/333-1935
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by S ron MCGilvrey Payment Recd 1$0.00
$1,224.08 Over/Under
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original- Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
.+
,SPECIAL INSPECTION SERVI_CE�
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE O ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
❑•
❑ OTHER
JOB LOC 10 '
V0 ``�- AO
REPORT SE�Q�UENCE ND0A.
TYPE OFg
IV,
PERMIT
3T IS -
r OF -WEEK
DESCRIPTION
ARCHIT
( .
MRS. CHARGED
6103
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION
DATECONTRALTO
GENERAL jj SUB
t�% _ _ W� CONTRACTOR
IAL
l , ' ` .. 044111 L!�:
COPY SENT TO CLIENT O
C INUED ON NEXT P E O
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
GN UR OF RECOSTEREO INSPECTOR
(71'I
DOE OF REPORT REGISTER NUMRFR
'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
O POST TENSIONED CONCRETE O ASPHALT
O REINFORCED MASONRY ❑ FIRE PROOFING
❑ uov
O OTHER
JOB LOC 0 ' �/� �qy�
, n A _ _ ` 1 w (� I �"_
REPORT SEOUENCE NO.
TYPE �{ SRE
yC '
_
PE$J�T NQ O O
CG/\ S "J
S
D O�
DAY OF WEEK
MATERIAL DESCRIPTION
ARCHITECT
Wye
IN R
,
HRS. CHARGED
ENGINEER ` .� .
ASSISTANTS
HRS. CHARGED
INSPECTION GENERAL
DATE CONTRACTOR
SUB
�CONTRACTOR
A 7P
Ell "t%%%-_ S u
h
vtiV--o o
I&K.Sl ev,
COPY SENT TO CLIENT O
CONTINUED NEX PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
EE OF REGISTERED DR JJ
DAh OF REPORT REGISTER NUMRFR