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9912-154 (SFD)LICENSED CONTRACTOR DECLARATION ,Thereby at:•irm under penalty of perjury that I am licensed under provisions of ,`:GS apfer 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 595 54 i3 C9 06130/201 Yate� 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: ( ) 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, Business & Professionals Code). ( ) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 704.4, 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. ( 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. SI'AIT FUND IM -99 UNI T V;I10110 (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 Cede, I shall forthwith comply with those'pro'vlsions. yDate: .1 9 h.�_n Applicant r r _b „ 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, 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 correcy'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 fobinspection purposes. tSignature (Owner/Agent)+ t 41�,&u Date I l4 'fs -.BUILDING PERMITPERMITEI_�-� DATE VALUATION $92,987.40 LOT TRACT," 6189 L)19 ,JOB � ADDRESS i -J r� 1r�.P01�.. iF� cJs:�ri/li( APN 774 -11 -6 -OU `! OWNER CONTRACTOR /rDESIGNER / ENGINEER , 1* LL ApUtt TT 11 A 1-1U i.A 1-1UiA',�i. i,, f�1AiiIINEiZS PAZ C�ii;�101ur-'i.i.•i1: !� CC,, • �, 51370 AVENIDA BERMUDAS 541 E ROSS F.,A QUIN•IA CA 92253 EL CENTRO CA f7$%!) 35"172 CLI.# .,5537 USE OF PERMIT SIN(, IX fAilNIII L)WEl..l.INU 311 D - Pyr liUT DGES NOT iNCLUDE BLOCK. WAUS OR POOL TRACT. C 0143 i'P�C1 M. LON 1,492.00 SF , PORC'OPATKO \, gti.00 :"sly c,AxActhJCAJR"1' 463.00 SF 5 FT. WpOtt Qi Ci CP. Afi).00 LF \V "i +''g1t.A° COST Oi'O30S a ii'x` f'IL'7°� CONSTIit I -ION FFE 1e1-000-418-000 $608.00 , I'll, AN ( fii (7K. FFIF. 1.01-000-439-31 Ft A4ct8. s3 ELECTTi CIU, FEE $i {t1.98 PLUMB1Tdc FELT 1014X)0 -449-00U $tt(J.75 i I: f93CVNO MOTION FFF - RF'SIVK1 10!-(iM-21414)ilff $9_10 (74FC/\C){N(, t'f ff, 'U 10!- 0)42-- 000 .1 [A,NOP iNiF1r�C:'f' FEE (�� / $1,`)0'7.00 ' t°.KE FiE,PLAN 10,000-4.1t-34? $10t).(kl i�FTf1Hw-),,1T f -000-4319-3aR 4150'm f •� S1)Ff.:R)TA1., C; (- Ns,rRu(-,n()N AND P>►,AN (''11•TECK g3aa�f(,f)fi - lPss PRE -PAID FEES 4�sti.a0 w 'iUCAA. ;P'ERNIIII' .T+1+;8US +fiUC, NOW , s RECEIPT DATE BY/ DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set BacksUnderground Forms & Footings � Ducts Ducts Slab Grade _ ( Return Air Steel Combustion Air Roof Deck a - S - oo Exhaust Fans O.K. to Wrap Framing _ 2 F.A.U. Compressor Insulation �r Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Q;kV Final Final BLOCKWALL APP kOVALS POOLS - SPAS Steel Set Backs Electric Bond Footings -GD 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 Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection X DD Encapsulation Gas Piping Gas Test j Appliances Final 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) COMMENTS: LICENSED, CONTRACTOR DECLARATION Iherebi� affirm under. penalty. -perjury -perjury that I am licensed�,under provisions of Chapter 9 (6ommencing.with`,8ection 7000) of Division 3 of the.'Business and .Professionals Code -;.and my License.is in full force and effect. a -License #Lic.Class Exp. Date, i,' 595754. B C9 06/30/20( rS .Date, Signature of Contractor -OWNER-BUILDER. DECLARATION I hereby "affirm under penalty of perjury that,l. am exemot. rpm the Contractor's License Law for the following reason: - , ".; . ': " .7.. ( ) 1, as owner, of the property, or my employees with wages,aSJheir sole compensation, will do the work, and'the Structure is not intended or offered.for sale (Sec. 7044, Business & Prof essionals -Code). as owner, :of the, property, am:exclusively contracting withJicensed contractors to. construct the project (Sk.*-7044, Busin6ss,&�,,'i,,rbf6ssiO,nals Code). O I- am efor under Section B&P.C. or this.reason,:- 1 Date Signature of Owner WORKER'S COMPENSATION DECLAAA`fiON,.n""k I hereby affirm under -penalty penalty of -perjury one of the following declarations:;_ O I have and will maintain a certif icate'of consent to - self -Ansure or�,workers' - compensation, a - s provided for,by'Section 3700-of-the,"Labor- Code - 'performance of,We work or which this permit is issued have-and will, maintain workers' compensation, 6. , 'th Section 3700 of the Labor Code, for�.the'perforr�ance 6('th.'workforywhich; is 'permit is issued. My workers' compensation Jnsurance are, Carrier Pol icy. No. STATE FUND 229,r99;UNIT _1 0011090 (This -section need not be,completed if4h e.permit valuati6n'is for $_100.00:or.!les:s). O I certify that in the performance of the -work for which this permit is issued, become h I shall not employ any person in any * manner so as to bec e'su je ct.to t e workers' compensation lawslof California, and agree that if l'sho6ld 'become Subject to.the workers' compensation provisions of Section,3700-0the'Labor Code, I shall forthwith comply with those provisions. Date: Applicant 717 777 Warning: Failure .to secure Workers' Compensation coverage Is unlawful and Shall subject an employee to Criminal pen,alties and -civil up to -$:100;000, in addition to the cost of compensation, damages as providBdJor-iri:S6'tio`n 3706 of the Labor Code, interest and attorney's fees. IMPORTANT NT Application is hereby made to -the Director of.Bu-ildfng:a!10:Safety e . for a permit subjct to the conditions and restrictions 'Set. f6,rthl;"-,'.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 IN 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 Citytoenter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) Date fta PERMIT # BUILDING P9912-154 IERMIT DATE VALUATION $92,1$7.40 LOT 6 TRACT B189 U19 I I glero JOB SITE 53-:625-ANIENIDA.OBREGON APN774114-016 ADDRESS OWNER CONTRACTOR/DESIGNER/ENGINEER LA QUINTA PARTNERS PAZ CONSTRUCTION CO 51370,AVENIDA BERMUDAS 541 E ROSS LA QUINTA CA • 92253 EL CENTRO CA 92243 (760)353-9772 CBL# .5537:1, USE OF PERMIT SINGLE FAMILY DWELLING,o. SF6-PERMIT DOES•NOT INCLUDE BLOCK WALLS OR POOL TRACT CONSTRUCTION . 1,492.00 SF PORCIVPAT-10 _:Z 90.00 SF GARAGE/CARPORT. 463.00 SF 5 FT. WOOD FENCE 200.001F ESTIMATED COST OF CONSTRUCTION 92,987.40 - PERMIT FEE SUMMARY CONSTRUCTION FEE -�:,._.101-000-418-000 $608.00 PLAN CHECK FEE 1.01;,000-4397318 $508.53 MECHANICAL FEE 101-000-421-000 $53.50 ELECTRICAL FEE 101-000-420-000 $130.98 PLUM IINGFFE;-101.wI000-419-000 $110.75 STRONG MOTIO'NiFEE _'RESID `101-000-241-000 $9.30 GRADING FEE $20.00 DEVELOPER IMPACT FEE $1,907.00 PRECISE PLAN 101-000-441-345 $100.00 FEE DEPOSIT 101-000-439-318 4250.00 SUB -TOTAL CONSTRUCTION AND PLAN CHECK $3,448.06 LESS PRE -PAID FEES -$250.00 TOTAL PERMIT FEES DUE NOW $3,198.06 RECEIPT ATE' BY DATE FINALED INSPECTOR 4 uu'�cv L P.O. BOX 1504 APPLICA Building 78-495 CALLE TAMPICO Address �� _ ( _ m . (2E �.,o� OUINTA, CALIFORNIA 92253 Owner BUILDING- TYPE'CONST. Mailing OCC. GRP. Address A.P. Number -1 A — 04— OI 4v _ City Zip Tel. I _ r.,, , - ! el- - _ -I' , A -� m. r — Legal Description (-irt' (m Contractor P6, 2 Address 4.2 —G ^�ifl. a. �iLIL1t•I SJF,7A )D Arch.),Engr., Designer I Project Description Lic. # Sq. Ft. Size It New Ir Address Tel. a sty.- � - Z City Zip State 1 _ I G _ -- Lic. # LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the B,ess and Profes ions Code, and my license is in full force and usfn effect. . I Ai i ... 1i.. q Q' SIGNATURE 1 ` DATE J O NER-BUILDER DECLARATION I hereby affirm that I am empt 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 to *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 (commencing with Section 7000) or 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). 1] 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 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 contractor(s) licensed pursuant to the Contractor's License Law.) 17 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 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 1`71 Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation 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. 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 if 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 applicant Date Mailing Address City, State, Zip No. No. Dw. Stories Units Add ❑ Alter ❑ Repair ❑ Demolition ❑ imated Valuation PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL AMOUNT REMARKS I ZONE: BY: 4 � 0 Minimum Setback Distances: t 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 Desert:Sands;IInifiedPScb-ool District 47 950`Dune:'PalmsRoad. Notice:' y ` La Qumta,�CA:92253 Document Cannot.Be Duplicated 760-.771':'85.1.5 4. CERTIFICATKOF COMPLIANCE Date 1/3/00 APN # 774-114-016 No. 19867 Jurisdiction,.: La.q a:. Owner NameL.a,Quinta--NitnerS Permit # No. 53-625 Street Avenida�Obreggn Log # City La Quints Zip, 92253' -'Study'Area Tract # Lot # SquareFootage 14.92 Type of Development Smngle.Family .Resmdence ` '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,,resideniial additions under, 500 square feet; detached"ac`cessory structures." tructures``or replacement niobilehomes. It has been determined the,above-named owner,is exempt from:paytng.sehoolfees'at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees -imposed'' ursuant to' Government Code 53080. in the amount of 1.93 X 1;492 or $ 2,879;56 thep'ropehy listed'above.and that'building permits and/or Certificates of Oc. cupagcy"for this square footage:inthis proposed pioject.may:now�be issued Fees Paid By CCNalley Independent Bank/Augustuie Paz Teleptione 760-564-3023 Name on•the'check By Dr. Doris Wilson Superintendent Fee collected /exempted by Olivia Aguirre •Payment Received: $2;879:56 Check -No. 209525 Signature NOTICE: Pursuant of Assembly Bill 3081 (CHAPr549 STATS: 1996).this.wrll serve to.nobfyyoulhat ihe':90day approvalpenod mwNchyou'may protest the fees or other payment identified above will begin to run from lhe:date on which the building or installa8on pennihfor lhispro{ectisassued or'orrwhich they are theDistricl(s) onto another public entity authorized to collect them on the District('s)(s') behalf, whichever earlier: Collector: Attach a copy of county, or'city plam'clieck application form.to district. copy for,all:waivers. Embossed Original- Building Dept./Applicant , Copy - Applfcant/Receipt Copy Accounting Recor,Iinr gRCGua,•h d i31, ®® a. S>��i�2�'�� CHICAGO 7.ITLL-C(71viF'ANV ®��aaisees ®s.m®A Fee:a.®e RECORDING R9QUESTED BY: 'Paoli J"ot Dee T Tax Paid Q Rooarda'd In OfIdalal Reearda • CHICAGO 'TITLE COMPANY COMPANY County 4U RJverawe 99.9081K1 97066971 G®rY` �.. •Orae NN A6sgeser,';CougtyjClerk Ar Recorder WHML �O R� � II IIlI III !1111 1NI 1 ISI M' S U OAOl-1l1iE,. > Oa vCOR NOOOR Bras -' WILLIAM THOMAS RUFFIN Mae. P.O. BOX.134� LA QUINTA, CA 92253 A R [' . cow REfUNO. Nc�o e w e D20 -DSS ' The . undersigned' grantor (e) .declare (s) •: Documentary.transfer too is r $15.90 (Xxx) Computed .on fuT1=value of property conveyed, or, ( l Computed on full value 1se.a:liens.and encuthbrahc`bs-remaining at time of sale. ( ) Unincorporated ar6a. ( ) City cf' ., .. and FOR A VALUABLE CONSIDERATION,•receipt of which is: hereby acknowledged, WORLD DEVELOPMENT,; INC„ A•CALIFORNIA CORPORATION hereby GRANTS) to WILLIAM THOMAS RUFFIN, AN UNMARRIEDs•MAN DBA LA QUINTA PARTNERS the real property .in the City of LA QUINTA, County of Riverside, State of California, described as: Lot 6 of sl'ock•189, Unit No. .19, Tract Santa Carme.lita at Vale La Quints, as per map recorded in Book 19,.Page(s) 33-34 inclusive of maps:, in the office of the County Recorder bf said County.' Dated August 20. 1999 State of CaligorniaWORLD-DEVELO1.PMENT, `INC, County of RIVERSIDE �` S S. A CALIFO A CORPORATION On AUGUST 1T,". -J999= ,. .. before me, CHRISTINA BOhVIN.•NOTARYIPUBL'IC personally appeared BY JIM S L NBERGER , , N `J'ra.SNc (or proved;to me on B the basis of satisfactory ev' nce) to be dme/Title the person (s)_ whose name (i) is re. subscribedy to the within instrument.end acknowledged to me that dg she/they executed 'the same in /her/their authorized capscity(ies), and CHR1S71M(A. that .1^y is her/their signature (s) on the �On'mWe^p ))46195 Plotdry.Pubrq- calffornh instrument the person(s)., or the. entity upon RlvertidB.Counfy ' behalf of which the person,(s) .acted, executed + hh� ME�iresJult4,2607 the instrument: , . WITNESS my hs d leis e Signature MAIL TAX.STATEMENTS TO: (This area for official notarial seal) �� £ A 9tr18ON = S8.31H d3M0d Wd'9a.r: l 6661 L '380 t. d r' .R .. _ y RC District Planning, Review°E 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= app,lioabitity of compatibility issues or need to require the filing of Master Design Guidelines b,y the applicant. It shall. be transmitted to . Building &Safety as your correction list. Please attach additional explanations as necessary. y APPLICANT' ',,,,trr� �02►� ta- #_ PROJECT ADDRESS: ' 53-°625 Av.enid`a.,Obre on . - a APN: . 17:74-rr4 -1 6' Y 18:9 19 ` LEGAL: LOT' BLOCK UNIT ,.�� S:C'°@ V:L' :Q. CVD BY: Leslie. Mouriquand ' CASE NO. 99=1172 CHECK DAT BIN NO:.. E: 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. The zoning code, architectural and„ landscaoing'manuals, ;aridd/or'assigned inspector should be consulted where 'uncert-ainties arise ,Tte cyompleted checklist shall ;be Triainiained in the Building '& Safety addre' SS, Jile. a Certificate of Occupancy City .,of La Quinta. Budding qndSafety '"Department. This, Certificate' issued, pursuan t. to 'the requirements e mentsof 'Secdon 109 of th& Uniform, Buy/dinglto certifying that;: at the -a e ofJssuance,:th truciure was in comp/lance-with the various ordinances e. agul of the City r� i§ting,boi/dih.gconstructibnotuse, Fo i the f6116 wing: BUILDING , ADDRESS. AVEMDA OBREGON - Use Classification: SFD, B1dg.,P6rM-it No.: 991-2-1.54 :Qc6upahby. Group: R 3 Type of"Construction.: VN Land Use Zone.: -:,RC "Owner of Building:- LA QUINTA PARTNERS Address: 51 -370AVENID A* SERNUDAS. City : LAQLIINTX i" .CA" 92253 BY: STEVE TRAXEL Date: 06-29-00 Building Official POST IN A CONSPICUOUS PLACE