0012-242 (SFD)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
04 l9l Rrbfessionals Code, and my License is in full force and effect.
M M License # Lic. Class Exp. Date
425381 . B 07/31/2(
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:
( ) 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).
O 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 Policy No.
STATU PU3.17 1 �bRp9t1�(10
(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
Warning:. Failure to secure Workers' Compensation coverage is unlawful and
Shall subject an employer to criminal penalties and civil •fines Up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forthon his
application..
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of .La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of. such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have, read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the'above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
BUILDINPERMIT PERMIT#
G
VDATE
VALUATION LOT TRACT
JOB SITE
APN
ADDRESS W-615 AIMMA OURS.00M
774-114-015
OWNER
CONTRACTOR/DESIGNER/ENGINEER
PA, C`Y.P'IC 17RA C(1149iM,01€014
PtvaU`ei 1'%iADFS CONOCRt3g;'lION
1719 v I ",om '
3719 a TA, ^WO +3T
S OCEM9011? C" 92054U
'1±� T�° tJ3v dna
�j2 a�4
��Oj967a(10+59 GST«4#
1955._
USE OF PERMIT
MOT A'F}MMY —DEd.1Yt40
SFD a PdMMIT DUES NOT INC L3,DR, V OCK WMA, BOOL SPA OR
AE3!'tP'KWAY APPROAC K 9T M.A.tl'.rIM, 8 -NN KUPE
TRACT C0N�7'I2.UCTION 1,382.w 3—
PORCHIPATIO law so, -
C. ARAO;C.l��ARPORT (31A, 91016.00
g FT. WOOD M_ ME moo LY
EMMA T1s COST OV C0114.51rR 7CTd'ioN ..
€ 7,195.00 '
Yl a°1' lfFittz ta' immuty
4;rJNSTRUC A 14'N ".E 101.000.411$-000 $�SifS.Sfl
PLAN CHECK FEE IM -000-439-318 $496.71
l<7WHA3a1CAL FEZ 101.000.421-000 $03.50
K1.I I-RICAL F92 vUt1.fl;
PLI)MMOIll+ . 101'000.419-000
3TRONO MOTION FE _ RVISID 10 1 -WO-241-000
GRADINVO Para i 01 biK90�423�0i$i°i . �d0.ftt!
OAVEWPER IMPACT irk
PREC ISK PIAN 101-00"41-345
IDFPOS)T 101-000-439-318< e 4l.ttU
•
S.FB•`f+JM:,, CC31<FMLIC'MOi3AM) PLI'N CIDAM
i
t..
$3,380,25
LEM FARE-k"..+SID REM'
t
4250.00
7('tY1'AL PEO- l `d' DUY, VOIfl/
RECEIPT
DATE
BY -
DATE FINALED
INSPECTOR
A
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs ?
Underground Ducts
Forms & Footings }
.a
Ducts
Slab Grade I
_
Return Air
Steel
Combustion Air
Roof Deck 1
,2. b
Exhaust Fans
O.K. to Wrap 1
12- -4:!> �r
F.A.U.
Framing !
a .
Compressor
Insulation
a7.p(,
Vents
Grills
Fireplace P.L. I
Fireplace T.O. I
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall I
Exterior Lath 1
_Z.C) t
Drywall - Int. Lath 1
I
}
Final
Final
F�w
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings 4
Main Drain
Bond Beam
Approval to Cover
1
Equipment Location
Underground Electric
Underground Plbg. Test
Final l
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines 1
Water Piping
Heater Final
Plumbing Final
Plumbing Top Out I
Equipment Enclosure
Shower Pans 1
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection 1
L`23 • of UT
Encapsulation
Gas Piping )
Gas Test }
-� _ p
Appliances 1
7
Final
COMMENTS:
Final t
Utility Notice (Gas) 1
ELECTRICAL APPROVALS
Temp. Power Pole I
Underground Conduit
Rough Wiring
Low Voltage Wiring !
Fixtures
Main Service 1
Sub Panels I
Exterior Receptacles I
G.F.I.
Smoke Detectors
Temp. Use of Power I
1
}
Final
Utility Notice (Perm) i
G(9 Ig- -?C�;-
Building
Address
Sq. Ft. 13
Size [
Owner
New ❑ Add ❑
Mailing
Address f I Ci S
. T QA r'",�
City
Zip
Cont- ctor
Address
c
City
lZip
P.O: BOX 1504
78-495 CALLE TAMPICO
(2,eo. it.-tD' LA QUINTA, CALIFORNIA 92253
aa3�lb7 00b65
State
Cla �
s
c.
& f.
Arch., Engr.,
Designer
Address Tel.
CityI Zip I Sta
Liat#
CONTRACTOR'S DECLARATION
under provisions of Chapttl( 9 (commencing with Section
and Professions Code, and Tny license is in full force and
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 fo'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 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 (8500).
I: 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 -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 contractors) licensed pursuant to the Contractor's License Law.)
1-7 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 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
n Copy is filed with the city. 0 Certified copy is hereby furnished. ,
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed i1 the permit is for one hundred dollars ($100) valuation
or less.)
1 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.
Date Owner
NOTICE TO APPLICANT: It, atter making this Certificate of Exemption you. should become
subject to the Workers' Compensation provisions of the Labor 'Code, you must forthwith
tw, 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.
1 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
APPLICATION ONLY
ILDING: TYPE'CONST. OCC. GRP.
1. Number -71,L)-w) '-0l
)al Description { I-,,, <-, t SIC, a_ ` /0
eject Description te
f �
l o,`,_! --1 0 t � ON CL
ZONE: BY:
Minimum Setback Distances:
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
Sq. Ft. 13
Size [
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
n_
Plumbing
t ,
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
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
1. .n 4
`'. Desert Si'ds Untfed School District
47-950 Dunc-Palm"s Itoad
Notice: T
La'.Quinta, CA 92253
Document Cannot Be Duplicated 760=7714515 -
CERTIFICATE ®F COMPLIANCE
Date 1/12/01 APN # 774-114,015
No. 2.1504 Jurisdiction La Quinta
Owner NamePacific Trades�Construction Permit # 0012-242
No. 53615 street Avenida Obregon Log #
City La Quinta zip 92.251 Study Area
Tract# 1311K 89U11,0 Lot # 5 Stauare Footage 1382
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 5.00 square feet; detached,accessory structures or:m'iri
'replaceent obileh`omes. It
has been determined -the above=named owner is ezempcfrom paying`school fees at this time due to the following reason:
XE TION NOT APPLICABLE
This certifies that school facilityfees iinposed-Oursuant to- . Government Code 53080 Jn.the amount of
2.05 X 1,382 or $'.2,833.10, • _ the_property,`listed.above_and_that building
permits and/or Certificates of Occupancy for ihisysquare footage'in-this proposed project may now 6e issued
Fees Paid By CC - Temecula Valley'Bank - David Miller TelephoneV 76'tt-967,=0069
-Name on the check
By Dr. Doris Wilson,
Superintendent
Fee collected /exe ted by' Annette:,Barlow Payment Received $2,83.3.10
_ _ e Cheek No.. 14485
Signature
g ..
Pr
40TICE: Pursuant of Assembly Bill 3081 (CHAP. 549, STATS. 1996) this will serve to notify you that the 90-0ay approval period in which you may �protest the fees or other payment identified
ibove will begin tonin from the date on which the building of installation permit for this project is sssued'or.on which they are paid to the District(s) or to'another public:entity authorized to.
Wect them on the'District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application'form`tordistricf copy for, all waivers.
Embossed Original- Building Dept./Applicant Copy - ApplicantfReccipt� Copy_- Accounting
"Certificate' o'.f Occupancy
City of La Quints
Building and Safety Department
This ,Certificate issued;: pursuant to the requirements of Section 909 of the Uniform Building Code,
certifying that, at the time of issuance; J this structure was in compliance with the carious -ordinances
-
of the City regulating bui/ding.construction.or use. For the fol%Win
g►:
BUILDING ADDRESS: 53-61'5.A.VENIDA- .OBREG.N
.,Use Classification: 'SF® Bldg, Permit �No.: 0012y 242
Occupancy -Group: R 3 -Type of Construction: -.. VN Land Use Zone: RC
Owner of. Building: PACIFIC TRADES CONSTRUCTION Address-: 1719.5 TREMONT-
City: S. OCEANSIDE,, 'CA. 92054.
By: STEVE TRAXEL
Date: 04-24-01
Building Official
POST IN, A CONSPICUOUS PLACE
' G®c-15-2000 03:45pm From -COMMONWEALTH -LAND TITLE+7603413215 T-642 P.001/001 F-903,
r..:.. .
RECORD== RZOURSTED BY;:
CHICAGO TITL COMPANY '`COMPANY,'
706't.8KC X2,07058276 j
')9"raSH RECORD A DQAIL TH11 DEED Agip,' j
UNLESS OTI;ERWISB "SiiahlN 'satow, .
XXTL TAX :STAR==S TO:.
DAVID ROSS MILLER
1719 S ."., TRiMONT
S. - OCEANSIDE_ CA 9'0254
A8OV$'.'THIS LINE 80R `RECORDRR" S USE;
' r
APN: "774-114-015)773-262-
z = :GRANT DERD.
, A
TneIrdersigned grantor(sJ...deciare(s):
Documentary transfer rax„is.; $50:'60
'YX)Computed: on full value, of property. •conveyed,. or'-
( } Computea dn',full.. value'.. less liens ,;andsencdmbrances.iemaining 'ac .time of sale.
• t } Unincorporated area: ( ) City of and
FOR A VALUABLE CONSIDERATION, receipt of which'is hereby acknowledged.
ROBERT°F. EBBERT and ELISE J. EBBERT, husband and wife as ]oint tenants
hereby GRMT (S) to .
DAVID ,ROSS MILLER, A.'MARRIED AS HIS SOLE AND',SEPARATF PROPERTY•
f
me r ro err i y:of'LA QUINTA,..Courity of•,Riverside, Scare of California,
�described `as:
Lcr, 22 -Block 82, _Unir'No: 10,, Tract Santa CarmeIira 'ai Vale'La Quinta„ as per map
recorded in Book 18, Page(s) 70 inclusive of maps, in, rhe'.office of the County Recorder
of said County:
and Loc "5, >31ock 189; Unir No 10, .Santa Carmeli'ta:ar'Vale'La- Quinta, as per map
recorded in Bdok.19, Pages 33-34 of.Kap$;. records of Riverside'County,
17a) *46xo tleaember IS, 2000
Scale of California
County of } S.S. ROBERT ''F EBBERT
On
before me,
personally appeared ELISE"'J_.'EBBERT^
personally known to me '(or proved=ro me on
Li~e basis_of satisfactory evidence).,, to be
the person (-;s) . whose'. name (s.) 'is/are 'subscribed:."
to the within instrument and:; -acknowledged to;.'
Tne tl a-,tie/she/Cheyt'e'xecuted =he "me” in
his/her/their a0rhorized capacity(ies)," and .-
that by his/her/their s:Lgnacure�(,§) on':Ghe !
instrument zhe.peisori(s)or Lhe entity upon.
behalf of which`the•aerson(s)''.acted*. executed
This form is to be used by CDD staff for review of,single family dwellings in the RC (Cove Residential)
District, in order to determine: the applicability of compatibility:issues or need to require the filing of Master
Design Guidelines by the applicant. It shall be transmitted to -the Building and Safety Department as your
correction list. Please attach additional explanations as`necessary.
APPLICANT Pacific Trades
SITE ADDRESS 53-615. Avenida-bb"regon
APN 774 - 114 - 015 BIN NO.: CASE NO.:... 2000-377
LEGAL: LOT 5 BLOCK 189"� UNIT /9 S.C.@V.L.Q.
CHECKED BY: wa T 1;)z TJtz shit
DATE: / 2-1,410")
Inform the assigned Building plan checker upon your assignment to this case: . The CDD Executive
Secretary maintains a log book to track applications and.assign case numbers..
REQUIRED ITEM
Y
N
COMMENT/CORRECTION
Compatibility Review
N �A
Case logged and number assigned
Verify legal and APN information
v+r'N%4/isz,o st�wvs �r5 ria r
w -o Aci s 8t?T
Consistent with MDG on file (as.applicable
MDG filing required (5 filings since 9/3/98)
o,.f ._c t�
Consistency with street/surrounding area:
DK
Colors
-t cusf_ .Xi co,-2^174cL
Materials
`''IS`Sfl&-� p' Aze.6t. rrw-v1+ta
Architecture
rro&- IV'Itccet
EjDN07T�c�f�S =
1. s r►•✓s7-
_ o#0.6�
0
nnih. Com fission
. . .
mmunity Desi Dept. 4z _ -� 20
p pl
!7 `Ci
Initia
s ....,,.__...
-case
No.
'XMith Conditions....,,_