0206-027 (SFD)^' LICENSED CONTRACTOR DECLARATION
�
l[ hereby aff inn under penalty of perjury that | am licensed under pi6visions of
Chapter 9 (commencing with Section 7000 ofDivision 3ofthe Business and.
-
Qi'3noiona|aCode, and myLicense ioinfull force and effect.
u6onxo# un.olasm Exp. Date
~^,~
//0�te' g
"WN="`°=^"=" "EC^°"="Q~
|h o^perjury that |^mexempt from the Contractor's
License Law for the following reason:
( ) | as owner ofthe property, mmyemployees with wages astheir sole
oompensouio�will uothe work, and the structure ionot intended o,offered for
sale (Sec. 7044. Qysiness Prefestionals Code).
1, as owiaer of the PropdftjF.am exclusivOl? contracting w.ith licensed
contractors., to�6!oAtruct th/e project (Sec. 704t"- Business & Professionals
Date ,der S
Signature of Owner
WORKER'S COMPENSATION DECLARATION
�ler penalty oJ4,erjury one D�
l.-havetpEi&'wJll maintain"a-cighficat6 of. con to self -insure for workers'
compensati8n//�4 provide6-m5r Section 3700.,of the Labor. Code, for the
performance of th� work forwhic�this permit is is Lied.
1 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' insurance carrier & policy no. are:
Carrier STATE yUI14D Policy No. 1300990
secti8n need not be completed if the permit
valuation isfor $1less).
:1 certify that in the performance of the work for which this permit is issued,
I shall not eriiploy 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 0 the Labor
Crode, I shall forthwith comply with thoseTrovisions.
Warnin§: Failure to secure Workers' Comp6nsati?g coverage is unlawful and
shall subject an employer to criminal penalties la"Ind civil fines up to $100,000, in
addition mthe post oxcompensation, damages aoprovided for inSection o7ws
of. the Labor Code, interest anda«omo�v�oo�
� .
IMPORTANT Application is hereby made to the Director ofBuilding and Gafetq
for o permit ouWom to the conditions and restrictions vm 'forth on N�
'application.
1.Each pomonupon whose behalf this application ismade & each porson.it
whose request and for whose benefit work ioperformed under o,pumvamlo
any permit issued axa result o,this oppncomnagrees to, u eho|l,� imdomnity
Q hold harmless the City ofLaOuinta. its officers, agents and employees.
u. Any permit |uouod as o result of this application becomes null and void if
work is not commenced within 180 uoya from uaxo of ioavanno of such
po,mit, or cessation oywork for 180 days will subject permit mcancellation.
| certify that | have read this application and state that the above information io
correct. | agree mcomply with all City, and Stam laws relating mthe building
onnstmction, and hereby authorize representatives of this City to enter. upon
moabovo'menuonoUpmpo�yfor invpoouonpurposes.
' �
,
/Signature (Owner/Agent) Date"
'.
`
�EULDINGTERMIT J,
M& 117
'DATE VALUATION LOT 7 TRACT
JOB SITE
OWNER
CONTRACTOR DESIGNER / ENOINEER
(160)730-7431 MWI 106j
USE OF PERMIT
CH A W&CO Sr
�.(JICARfIRT
PM MIT FIRE 9UMWMRV
CONSTRUCTION FRE 101 -000-4.18-000 09040
FEE DEPOSIT 101,,000-439-318 4250100
ELECTRUI CAL FEE 101 .=-420-00o
PLUMDrNICI PEB 101 -000-419-00f) $17A,00
ORADJ'NG PEEE 101-000-423-000 $15.00
I B-1, AL CO UM101-TAW1)PLAXC_fW)CX
$.4,408.18
LRSS PRE -r TP,
4250,00
RECEIPT
DATE
BY
DATE FINALED
I INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
p
Ducts
Slab Grade
_�
p_Z_ !�
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
Framing
_a2 _�l 0 L� (�—
F.A.U.
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines t
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
Final
Final �l_
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
R - & -oi
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric i
Underground Plbg. Test ;
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
O
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole •rt 3 �O�
Underground Conduit
Rough Wiring
Low Voltage Wiring .
'Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Addy m ess s •$:;?— /,�'—'.,� Ile
Addr
Mailing
Address, dG� r7ic✓ �""
City lZip ITel.
re7- .A- c
ip
s�r:l"n°"c+�"`yv4�';•�F`P;- ,/~'+�i�'"�±f'ty�'i;5�"�1'iiti'i'"?�i�'"�'�P'i(�r},�rtt*, 4�; �51`•%�
f�U%�1GV
P.O. BOX 1504
78-495 CALLE TAMPICO
15—ee) f�A QUINTA, CALIFORNIA 92253
State Lic. City
.& Classif. 13 3,g j Lic. #
Arch., Engr.,
Designer
Address Tel.
City (Zip (State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5.Business and Professions Code: Any city or county which requires a
permit to construct, atter, improve, demolish, or repair any structure, prior to'Its issuance also
requires the applicant for Such permit to rile a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
C., 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. 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'1 1, 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.)
1-1 1 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
C71 Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it 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:
If• 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
Ihereby 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 it 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 a0plicant Date
Mailing Address
City, State, Zip
APPLICATION ONLY
BUILDING: TYPE -CONST. S OCC. GRP.
A.P. Number ;? 3 `rte( / 7" — y IC/
Legal Description /_ 197-
17/Project Description ✓ �� ������
Project
Sq. Ft.
Size
No. No. ow.
Stories Units
New 3-' Add ❑
Alter ❑ Repair ❑ Demolition ❑
r
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
?
Plan Chk. Bal
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
i1
R 3
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop..Lint3
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
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School _District
47950`Dune Palms Road
BERMUDA DUNES r
Date 7/3/02 La:Quinta, CA-, 92253
RANCHO MIRAGE (�
INDIAN WELLS
No. 23350 (760)'`771-8515 `fPLA ALM QUINTA y
.. INDIO yrJ�
a
Owner
Pacific Trades Construction
APN4
773-214-018
Address
52155 Avenida Obregon .
Jurisdiction
La Quinta
City
La Quinta Zip 92,253
Permit #
0206-027
Tract #
2
.Study Area
Type
Single Family Residence
No. of Units
1
Lot # No. Street S.F.
Lot # No.
Street S.F.
Unit 1 7 52155 Avenida Obregon
Unit 2
Unit 3
Unit 4
Unit 5
Comments
1431 Unit 6
Unit 7
Unit 8
Unit19.
Unit -16•
At the present time, the Desert Sands Unified School District does not collect fees on rages/carports, covered patios/walkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain fall ties', for.lgaiving, 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 65.995 Et Seo.
in the amount of $2.14X 1,431 S.F.. or $3,062.34, 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 CC Rancho Santa Fe..,Bank -.Frank Garcia Check No. 110963
Name on°the check Telephone 760/730-7431
Funding Residential
By Dr..Doris Wilson
Superintendent
Fee collected /exempte FC.rystal Scott $3,062.34
Payment Recd Over/Under
Signature
NOTICE: Pursuant to Government Code Section 56020(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.installatiori perniit.for this project is issued, or from the date on which
those amounts are paid to the District(s) or to ahotherpublic 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
REO�� REQUESTED BY:
AND WHEN RECORDED MAIL THIS DEED AND,.
UNLESS OTHERWISE'SHOWN BLL" W,
MAIL TAX STATEMENTS TO: t j S'•
h
David Ross Miller
1719 S. Tremont
S. Oceanside, . CA 90254 �,.• _
SPACE'ABOVE THIS LINE FOR RECORDER'S USE
1Y 773-214-018
:
t The undersigned grantor(s) declare(s): +�'
Grant Deed
Dbduimenta- transfer tax is $
computed on full value of property con'veyed or`~ -
computed on full value less value of liens and encumbrances remaining et time of sale,
/° (. • ) Uninco orated area:
rp ( );City of
FORA VALUABLE CONSIDERATION :,receipt�•of which is heeeby''acknowiedged,
BUILDING HORIZONS '
hereby GRANT(S) to DAVID ROSS.: MILLER, a martied':'man as= his -'sole° and. separate property
, and
C
the real property in the City of La Quince:
County of Riverside
Stale of Califomia, described as
Lot 7 of Block 2 .Unit No,.:
Santa Carmelita at Vale La Quinta,
:i
as per -dap recorded an Book Pages.;
t f Maps, Records of Riverside County,
California
Dated April .1 60 20102
Signature of Grantor
' State of California
County or ) S5,
_.
BUILDING HORIZONS
t5n before me,
personally appeared
- -"
BUILDIN.G . HOR=I'ZONS•
personally known to me (or,proved'to me on the basis. of satisfactory
-
t. evidence) to be the. person(s) whose name(s) is/are subscribed to the
.within instrument and acknowledged tome that he/she/they executed
the same in his/hedtheir`:authorized capa'ci(y(ies), and. that by
hls/her/their signatures) on'the Instrument th'e person(s);'or the entity.'
upon behalf of which the person(s) acfacl, executed the instrument.
' WITNESS my hand and official seal.
Signature
MAIL TAX STATEMENTS TO,
Forth 3195-4 (6-94) ' THI$ FORM FURNISHED BY COMMONWEALTH LAND,TITLE COMPANY
I
C
Certificate toff Occ-u an--c T
ti;.�of L;a Quanta
Bu�lding ,and . Safety .Department
This Certificate issued pursuant to the requiremehts of Section 709 of the Uniform Bui/ding Code,
certifyingthat, at #tie; time of issuance; chis structure .was in:comp/lance with; the carious ordinances .
of the City egu%ating byi ing�:constructian: or use For.the_ >fo/%wing:` :.
C
BUI:LD.ING*.A�DDRE-SS: 52-155 AVENfDA OB,REGO'N.
Use Classification: SFD Bldg. Permit No.: '02060'027
Occupancy_.Group; R3_ Type. of Construction: RN- Land <Use.Zone: RC
Owner of. Building; PACIFIC. TRADES -CONST Address:, 2551, STATE ST #111
City: CARLSBAD,CA 92008
By:, KIRK KIRKLAND
Date: 11-21-02
Building Official
POST IN A CONSPICUOUS PLACE