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0105-281 (SFD)I LICENSED CONTRACTOR DECLARATION Thereby 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 t Date ar r Signature of Contractor- OWNER-BUILDER ontractor OWNER -BUILDER DECLARATION 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. J.,) 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 Policy No. (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 okCalifornia, and agree that if 1 phould become subject to the workers' compensationp(o(visions of Section 3700 of the Labor Code, 41 shall fo iwifh comply with'thosel rovvrslons.w j! Date: + +�'" moi. Applicantf i " VUarning:,Failure to secure Workers' Com ensation 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 cf such permit, or cessation of work for 180 days will subject permit to cancellation. y 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 CitNo enter upon ' the above-mcntioned property for inspection purposes. �. Signature (Owner/Agent)l tl, ky 61e BUILDING PERMIT PERMIT# DATE VALUATION LOT Q3,�, TRACT 4 /"• f,- tM3 5 1'I1?2 JOB SITE " APN ADDRESS 1025 AVEO DA 0S1-MGe,0X 7M314-4318 OWNER CONTRACTOR / DESIGNER / ENGINEER 1719 b��U- O 1' 1719 3 -XIMM MIr S 0C:9MS1r1*Y CA 192054 S ��°:�ANSWE CA 12054 (760,1967,0069 Chu. 1955 USE OF PERMIT SM - D?FUUMIT UOUS iqOT INCLUDE BLOCK, ir3'.A,:I.f, PML & SPA OR DTtT4f'IM AY APPROACH, OV MAWYMI S.Al2d 119UPE TRACT CONSTr2UCT)ON ?,382.00 SP P012Cn PA's'IO Iva. 00 1131'' 5 FT, WOOD PT?AVF. 200.0 LF 0ARACE 460600 'V 00n OF C9;}1.3U1��1C-tION 0'711'5.+0 PER�/��+�n [ 'p�p�y��3?��t�9s".t�1lAIRD ET FU QIx1''OMT 101-000.439-318 421% lid CONSTRUCT 1014 PRE 101-000-418-000 9593.50 PLAN CZMM RFD: 301-000-439-318 $vi901 M XCIiA gICAL rk?,E 10; -000-421-000 $59.50 I,:1sC'I`1tt.C'64.IJ TU 101-000-420-000 %104,07 Pk,YIMBINO FZZ 101-000-419•-000 S'T'R,C`?W0 LIMON )TER - R I D 101 -000 -MI -000 CPR.oi'DYNO If lull 101.OW1-ail3-000 51Bti.00 DWSLOPER IMPACT ME St.907.00 P&FiCASE. 101-0011.441-345 $tIDO.00r N - 1 TTB-'CM.AL C:'f)Y3'11ZUC,q'3.0N 11roD PLAN CHECK. $3,380.zs r -� -- Ill= PREI-PAD) la MIJ 42.50.00 i n �I7 II P-1—YES ME NOW i,'. , 2 5 2001 RECEI T E IjvA 'CE DEPi, BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs _ _ Forms & Footings //;70 _ Underground Ducts Ducts Slab Grade t'0 l ` Return Air Steel Combustion Air Roof Deck —4m Exhaust Fans O.K. to Wrap ? p S F.A.U. Framing _ ��'1 --C c Com ressor p Insulation _ Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath / 01 S ' 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 DI Plumbing Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection S —O ( ( Encapsulation Gas Piping Gas Test _ Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Poleli /-3 O r S 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) kffifidAw 617 P.O. BOX 1504 APPLICATION ONLY Building11 -415 CALLE TAMPICO Address 11LA QUINTA, CALIFORNIA 92253 Mailil BUILDING: TYPE'CONST.-OCC. GRP. Address —�qe A.P. Number -en le? City Zil;V JZp� Tel. 00(06) I �LegalDescription 172 Contractor aw Project Description Address City Zip Tel.. State Lic. City & Classif. A,11 Lic. # sc —Ft`/No. No. Dw. Arch., Engr_ s liLe,/V3/ Stories Units Designer Newv Add 0 Alter 0 Repair 0 Demolition 0 Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under Provisions of Chapter 9 (commencing with Section 7' of Division 3 of the Business and Professions Code, and my license Is in full force and effect. SIGNATURE 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,%.Iiness 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 PERMIT AMOUNT the provisions of the Contractor's License La., 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 Plan Chk. Dep. C subjects the applicant to a civil penalty of not more than five hundred dollars ($500). Plan Chk. Bal. [-2 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 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, provided that such improvements are not intended or offered for sale. It, however, the building Mech. or improvement is sold within one year of completion, the owner -builder will have the burden Electrical of proving that he did not build or improve for the purpose of sale.) rll, as owner of the property, am exclusively contracting with licensed contractors to con. Plumbing S',.c, I he 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 S. M. 1. such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading 1! 1 am exempt under Sec. B. & P.C. for this reason Driveway Eric. DateOwnerInfrastructure AA WORKERS' COMPENSATION DECLARATION Lru U 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 n Copy is filed with the city. 0 Certified copy is hereby furnished. TOTAL 7 CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) . eifyff tA 01:11KA I certify that in the performance of thp 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 QUANCE DE121 Laws of California. Date Owner -4i NOTICE TO APPLICANT., If, after making this Certificate of jExemption you should become ZONE: BY: subject to the Workers' Compensation provisions of the La&3r Code, you must forthwith comply with such provisions or this permit shall be deemed revoked Minimum Setback Distances: 7. Front Setback from Center Line -Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side 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 Setback from Property Line Lender's Name Lender's Address FINAL DATE INSPECTOR 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. Issued by: DatePermitI 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. Validated by: Signature of a0plicant Date MailingAddress Validation: City, State, Zip WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Desert Sands Uiiiiied.�School;Distric't­ 47-950`Dune' Palms Road Notice: ,. La Quirita,`CA 922'53:: Document Cannot Be Duplicated 760-771=851.5 CERTIFICATE OF COMPLIANCE Date 5/25/01 APN# 773-314-018 No. 22048 7Jurisdiction'. -La Qiunta Owner Name:Pacific Trades Constf`uctfon Perrin # O 105-281 a_t No. 527825 Street '`Ave'riida Obregon `' Log City L.a Quinta. Zip 92253 Study Area Tract # BLK172 _ Lot m 5 Square Footage 1,382. Type of Development Single FamO,Residence l . No. of Units 1 Comments At the present ,hme, the Desert Sand's( Unified School 'Distnct does not collect fees 'on garages%carports, covered patios/wail ways," residential •addrtio' ii' ;under $00 square feet, 'detached acces§ory, structures.or:replacement mobilehomes. It has been determined the above named'ownet is exempt from paying school fees af'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 2.05 X 1,382 or $ 2,833.10 the p"ropertylisted 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 North County - David Miller Telephone 760 967-0069 Name on the check By Dr. Doris W.ilson } l Superint6iderit Fee collected /exempted by . PauIa'Rutz - Payment Received $2 ' '833.10 = Check No: 082054 Signature NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you thatthe'90-day approval p.66clln 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 sssued or'on`which they are paidto'the"Dis`trict(s)",oito another public entity authorized to collect 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 waiver's. Embossed Original= Building Dept:/Applicant ` Copy - Applicant/ eceipt Copy - Accounting RC DISTRICT PLANNING REVfEW F,O.RM This form is to be used by CDD staff 'for review o.fsingle family dwellings in the RC (Cove Residential). District per.;Se'ction'9:50.090 of the�ioning. Code.: Its purpose is to:.determine: 1) that the proposed housb`des gn.-does not "du;plicate the same architectural style of any house within 200. feet of the.applic'ant, -and/or 2) ifwthere is a need for the applicant -to file for Master Design Guidelines If, the applicant does need i file a. Master -Design Guideline, please. transmitted this information to, the --Building and Safety-Departrrient,as p--art,-of your- correction list. Please attach add itional<explanations as necessary. APPLICANT Pacific Trades SITE ADDRESS 52-825 Avenida ,Obregon APN 773 314 018 CASE NO.: '20:01-'468-:; LEGAL: LOT 5 BLOCK 172 UNIT ; S C.@V.L.Q. CHECK AND APPROVED -BY:. Fred Baker_ DATE:. Inform the assigned 'B.uiI'd ing_.plan. checker upon your',assignment t& this case. The CDD Executive Secretary maintains a logbook to, t4ck..' pplic n' s and, assign case numbers. REQUIRED ITEM Y,N :COMMENTtCORRECTION r_ Verify legal and. APN information Consistent with MDG on file (as applicable MDG filing required' (5 filings -since 9/3/98) 0 MUNlTY:DEVEIOPMENT Df PT. Architectural :variety within 200' feet of ~. y ,_,._,:..DATE �..• the surrounding area: Colors 'C SENO Materialsv'- Architectural design features Other Requirements: 01/09/01 i FAX 17608049062 RECORDIN STED AND WHEN RECORDED MAIL THIS IJEE&A'ND UNLESS OTHERWISE SHOWN BELOW, MAIL TAX STATEMENTS TO: .. ..... ..... ... COI)DIONIVEALTH TITLE William Thomals Buffin Powe'r Brokers P.O. Box 1.34 La Quinta, CA 92253 tSPACE ABOVE THIS LIN E*' FOR RECORDER'S USE The undersigned grantor(-') declare(-'): Grant Deed A.P.N. :773-3-1 4=01 8 Documentary transfer tax is Ny) computed on full value of property. conveyed; or X )computed on f time full valueless value liens and encumbrances remaining at me.of" Unincorporated area; City of sale: FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Barbara Klostermann hereby GRANT(S) to David Ross Miller,a MarriedMan as separate sole and separte property the real property in the City-bf La..! State of California;aldescribed as Quinta CotjnyRiverside Lot 5 of Block 172 Unit -No. SA'nta 'Carmelita at 'Vale �L a Quanta, as per map recorded in 'Book 'qt, -Pages Ya Ifif ::.Maps., Records :of River County, California Da . led April 24, 2001 State of California County of )SS. On before me, Perso4lly'appeared" Barbara. IKhbsterrrtann personally known lb me (or proygid to me on the basis. -of, satisfactory evidence) to be thePfirsoa n me ' s is/are subscrIbed to the within instrument and acknowledged to me that hwske/ih-ey.*execui6d 14some in his/hedtheir auth6iized capacity(ies), and that by hls/her/their signature(s) on 'the Instrument the person(-'), . I . . or -.the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. Signature MAIL TAX STATEMENTS TO, Form 3195-4 (6-94) THIS FORM FURNISHED sy commONW"LTH" LAND, TITLE -,>C OMPANY A 62 and 5id.e Y William Thomals Buffin Powe'r Brokers P.O. Box 1.34 La Quinta, CA 92253 tSPACE ABOVE THIS LIN E*' FOR RECORDER'S USE The undersigned grantor(-') declare(-'): Grant Deed A.P.N. :773-3-1 4=01 8 Documentary transfer tax is Ny) computed on full value of property. conveyed; or X )computed on f time full valueless value liens and encumbrances remaining at me.of" Unincorporated area; City of sale: FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Barbara Klostermann hereby GRANT(S) to David Ross Miller,a MarriedMan as separate sole and separte property the real property in the City-bf La..! State of California;aldescribed as Quinta CotjnyRiverside Lot 5 of Block 172 Unit -No. SA'nta 'Carmelita at 'Vale �L a Quanta, as per map recorded in 'Book 'qt, -Pages Ya Ifif ::.Maps., Records :of River County, California Da . led April 24, 2001 State of California County of )SS. On before me, Perso4lly'appeared" Barbara. IKhbsterrrtann personally known lb me (or proygid to me on the basis. -of, satisfactory evidence) to be thePfirsoa n me ' s is/are subscrIbed to the within instrument and acknowledged to me that hwske/ih-ey.*execui6d 14some in his/hedtheir auth6iized capacity(ies), and that by hls/her/their signature(s) on 'the Instrument the person(-'), . I . . or -.the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. Signature MAIL TAX STATEMENTS TO, Form 3195-4 (6-94) THIS FORM FURNISHED sy commONW"LTH" LAND, TITLE -,>C OMPANY A 62 and 5id.e tO of Occupancy City of La*Quinta Building:and Safety Department This Certificate issued .pursuant to . the requirements of Section 709 of the Uniform -Rqi/ding Code; certifying -that, at the time of issuance, this structure was- in comp/lance with the variousordinances of the City regulating building construction: or use. For the following: BUILDING:ADDRESS: 52-825 AVENIDA:OGRE.GON. Use Classification:. SFD Bldg. Permit No.: 0105-281 Occupancy Group: R 3 Type of. Construction: VN Land Use Zone:-. RC Owner of Building: PACIFIC: TRADES `CONSTRUCTIO,N Address: 1719 S. TREMONT s City: S. OCEANSIDE, ...CA_ §2654:,. By: STEVE TRAXEL b'j^L Date: 09-0.6-01 Building Official POST IN A CONSPICUOUS PLACE IBM