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9904-217 (SFD)LICENSED CONTRACTORDECLARATION 1,hereby affirm under penalty of perjury.that| am licensed under provisions of Chapter 9 (commencing With Section 7000) of Division 3 of i ffie Business and Professionals Code, and my License.is in full force and effect. lass Exp. Date 4-2 339 1 13 11-113 111201 to I hereby affirm under penalty of perjury that I am exemp from the Contractor's License Law fo r the following reason: 1� (�) 1, 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 salii-(Sec. 7044, Business & Professionals Code). 1, as owner of the property, am exclusively contracting' with licensed contractors to construct th6 project (Sec. 7044, Business* & Professionals 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' coMoensation, as provided for by Section 3700 of the Labor Code, for the pe . rformance of the work for Which this permit is issued. - have and will maintain.workers' compensation insurance, as required by Sect.i'oh'3700 of the Labor Code, . for the performance of the work for which this �ditriit i� issued. My workers', compensation insurance carrier & policy no. are: Caiiier­ Policy No. (This Section need not beCompleted ifthe permit valuation or less). �I cethe perform Brice of the work.for w hi��i permit is issued, compensation,I shall. not employ any. person % in any manner so as to become subject to the workers' compensation laws of �2 alifornia, and agree that if I should become Su6jd6t to e workers' compensa . tion proV%iions of Section 3700 of the Labor .0 hwith Comply wit se isions. Warning: F�ilur'e t6le,ciure- Workers' Com nLZori coverage is unlawful and shall- subject an employer to criminal penalties and civil f ines up to $100,000,. in addition to the cost of - provided mthe Labor Code, interest and attorney's fees. IMPORTANT Application. ohereby made mthe Director mBuilding and Safety for a ponnx subject to the conditions and restrictions on^ forth on his application. 1.Each person upon whose behalf this application ismade ueach person au whose request and for whose benefit work ioperformed under orpursuant m any permit issued aoo result ofthis app|iosoonagrees to, &ohan. indemnify m hold harmless the City o,LoQuinx^. its officers, agents and employees. u. Any permit issued as result o/this application becomes null and void if .work io not commenced within 180 uevo from date of ioouunoo o/ such po,mit, or cessation ofwork for 180 days will subject permit to cancellation. I certify that '| have read this applicationthat the above correct. I agree to comply with all City, and State laws relating tolthe buildingconstruction, and hereb,t authorize representatives of thikCity to e ter uponthe above-mentioned prope .for inspect' ur-poses.Signature (Owner/Agen) ate PERMIT # BUILDING PERMIT DATE VALUATION' S89,, - LOT TRACT. ADDRESS 51-174) AVENIDA ORREGON TRE, NAONT IS 1*11REIV10911 ,S(_J(_"TAN8IDE CA 92054 S UCTANSML CA 92054 USE OF PERMIT -MACT ClONSTRUCT ION sr PORCHMIM-10 36.00 kV 0ARA(JWC'AJ.WQW.I' 464.(W SF NU 1: 101-000-421-000 41500) WiXICTRICAL F&.. $123.76 PLUMH.1 NG FEE 101 -OW -4194)00 $128.75 GH-M)MMIF, 101 _1000-11.23-090 $20.00 RECEIPT DATE BY DATE FINALED INSPECTOR X- � t` '�`') . .'`[ ' 'I INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck —y Exhaust Fans O.K. to Wrap 17 F.A.U. Framing _ Compressor Insulation ll-qS Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath d f3F,e 3G ` 9,20- fp S% Final Fiat - 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 (4�3 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 Underground Conduit Rough Wiring Low Voltage Wiring Fb(tures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) k' ������ ,� t. � T.ry-�- -. -v..w..\,�F,�, `�;.r'r•c-f^csr ..,.... .�,.� �-_� ,�... ^1f rLj�ri{��vN�''L'iM•,�.< .e.,Y SY�c.y�;r�r:�',.:;.-:�tc..p{�+: r< P.O. BOX 1504 APPL CA I N Buildi4, 78-495 CALLE TAMPICO Address - LA QUINTA, CALIFORNIA 92253 Owner / Mailing BUILDING: TYPE C, N 0115b. GRP. Address {�4r't� +JT l A.P. Number CityZip Tel. 06 Ar"-,r"�' �;1 ej J % (�� ��ti Legal Description( �� T Contractor A , Project Desc iption, 1 --art � � Address�q`""!" City Zip Tel. 4 — Q' State Lic. City r % !£ Classif. tl� ��� Lic. # r G s Sq. Ft. `—No:__ r _.__,_.__No'Dw. Arch., Engr., Size Stories Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State _ Lic. # (� LICENSED CONTgACTOR•S €CLARATION I here affirm that\I am licensed under rovisions of Chapter 9 (commencing with Sectldn 7000) of Division 3 -of thEs u 1!n sand Professions Co es and my license is in full force and / effect. \ 1 �� j S j GNAT % DATE OWNER -BUILDER DECLARATION Estimated Valuation 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 AMOUNT requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT 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 o/ Section 7031.5 by any applicant for a permit Plan Chk. Dep. Za� subjects the applicant to a civil penalty of not more than five hundred dollars ($500). !7 I, as oner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 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, Mech. 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 Electrical t of proving that he did not build or improve for the purpose of sale.) I'i 1, as owner of the property, am exclusively contracting with licensed contractors to con- - Plumbing struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law 1 does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. such projects with a contractors) licensed pursuant to the Contractor's License Law.) Grading I'! I am exempt under Sec. - B. 8 P.C. for this reason Driveway Enc. Date Owner Infrastructure WORKERS' COMPENSATION DECLARATION Ihereby 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 r'7 Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($700). valuation or lass.) ,;a`. I certify that in the performance of thg work. for which this permit is issued' --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 ZONE: BY: _ subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:- '- -- comply with such provisions or this permit shall be deemed revoked. it , Front Setback from Center Line RearrSetback from Rear Prop.-Line— CONSTRUCTION rop:LineCONSTRUCTION LENDING AGENCYSide Street Setback from Center Line " 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.) Side,Setback4rom,P/roperty Line- -.- Lender's Name / ,� (✓� FFd '� Lender's Address - T This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR -•- expiration it work thereunder is suspended for 180 days. ! I certify that 1 have read this application and state that the above information is correct. Issued by: Date --u-111– �Y2rfTlyg�_ I agree to comply with all city and county ordinances and state laws relating to buildingf construction, and hereby authorize representatives -of this city to enter the above- mentioned property for inspection purposes. Validated by: Signature of applicant Date ��;� •'r �� Yom"•'' Mailing Address Validation: �..Je" a_t : �,Ji14 City, State, Zip WHITE = FINANCE YELLOW = APPLICANT PINK =i BUILDING DIVISION//// Notice: Document Cannot Be Duplicated Desert Sands Unified School'District 47-950 Dune.Palms Road La Quinta; CA 92253. 760-771-.8515 CERTIFICATE OF COMPLIANCE Date 5/7/99 APN # 773-215=008 . No. 18704 Jurisdiction La Quinta Owner NamePacific Trades Construction Permit # No. 52-170 Street Avenida Obregon Log # City La Quinta .Zip _ 92253 Study Area Tract # Lot,# Square Footage 1.445 Type of Development Single Family Residence No. of Units 1 Comments 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 or replacement mobilehomes. It has been determined 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 Government Code 53080 in the amount of 1.93 X 1,445 or $ 2,788.85 -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/Capital Bank of No. County -,D. Miller Telephone 967-0069 Name on the check. By Dr. Doris Wilson Superintendent Fee collected /exempted by Ellen Patino Payment Received $2;7�-&:85 Check No. 13071 Signature (� NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90ay, approval period in which you may; protest the fees or other payment identified will begin to run from the date on which the building or installation perm ii for this project is sssued or on which they are paid to the.Dislrict(s) or to another public entity authorized to wllect them on the District('s)(s') behalf, whichever is earlier. - Collector: Attach a copy of county or city plan check application form. to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting — Apr - 13. 1999 :'9:,y3A`,V,­--POWER BROKERS 1&.41 NI If Tj 11401.01 a $442 1.1:1422t; tip's Is;, t;vimvw to GROR L. VIUMM, 752W. INlolgo 1,.0 %IAIR 6 I -0141A I MIR WhAO., 0� N o - 0 4 9 2 P. 3/ 'PfO IVW Atflmdr Alin .6f1tiff Role. IN24fi0 airrearefis QUITCLAIM -DEED gillitI111160 oil' full VVIUVIOSIL blenz-at'd kilcullriwolleol Irlilainfe"D at ltma'clp note. li-V,Wyu toWdlil-I W 4114. 1411111111 ilia _ IMAUL it 800 the uiidcfJ;*qRIeJ aremirls), for wV01VOIJ111 Gansidul 811mil; 48LOW1 :of *h;.Il is dim II&FAV Icr"fro. t rekasp all" forever the 191fawftip damwi4od te61 Ptopemy-I Ittil cloy of caurity at mali of. WOW U -t B, ukdc 1, cg armalifi" tilt W 1 it do agnmW kiAfavWw at. ft WA*r of UTAT12 Q� mu: JV"" L IPA tA9saimui.t.,a wa Row Imisomally known io, fill; of% tile baiiii. to bo • vuV`OI'Iw,4fJ, the 1111 and.' lhu POVOW01 %V1161 ""a I hey 0 Self ate'lluatired upez tvanw. ti an 11110im If011im Towlic4iiiirsiO; u/ the imilir 11111 . al b ul i I all of -, Witr4h I(Il. , - MR. Oowa LI F fit 'MIS, Is! li.hra fl,lcl A! Ij • ;,%tllgIkf((AAIJ i?52 V1t -untj ton Pr. 8c, Arcadla ;0110 , 49 C) rV atfo %JOIN I -A lkildliky ."Nul A @#Pvt., - 'j,.; 11. ItI.1 I Is"' Usti 44 so—M. 1.0. 11 0 111 WWI, -w'.11' rV-I,?j I'll. f". 044 d Ved RC District P/annm Review Form This form is to beqused by CDD'staff for review of single.family dwellings in the RC (Cove Residential) District; in ordef.to 'determine -the., applicability of... compatibility issues or need to require.the filing of..Master'Design ;Guidelines by the ;applicant: I:t shall be transmitted to Building & Safety as your:. correction.list. `Please attach additional explanations as necessary. APPLICANT: 'PACIFIC TRADES PROJECT Avenida Madero ADDRESS: T A P.N : rr4- - 7%.3 S Ulm LEGAL: LOT.BLOCK -;-UNIT , S01P.. @ V.L.0. C K' D -BY: FRED BAKER BIN NO: C' CASE NO. 98-30 .:CHECK:DATE: Inform the assigned Building plan checker'upon-your assignment to this case. The CDD Executive Secretary maintains a, bg brook to track applications and assign case numbers. REQUIRED. ITEM Y ..;N;.; ; .r CO:MIVIENT/CORRECTION Case.logged:and.'number assigned Verify legal and APN-information Consistent. with 'MDG :.on.file (as applicable) MDG filing.required•(5+ filings,since 9/3/98) , Consistency with street/surrounding area: Colors . Materials Architecture OTHER REQUIREMENTS: The zoning code, architectural and landscaping'man uals;'.and/or'assignod inspector should be consulted where uncertainties arise. The. com'plete•d'�checklist`shall be maintained in the Building .& Safety address file.