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0203-158 (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 ,Professionals Code; and my License is in full force and effect. License # Lic. Class Exp. Date 0715 112 Date r ` r_r�^ Signature of Contra ori "" 3 �� •�^^ '� OWNER -BUILDER DECLARATdON 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 constructAhe- project (Sec. 7044,• Business & Professionals„ Code). r, _ r () I am exempt under Section B&P.C. for this reason Date Signature of Owner 'r 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. w) 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 of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shalpforthwith comply with those.provlslons.,r.�' Date: �J�r�i>.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 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 t work is nocommenced 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/Agent2� -� -' �=•-•�•�_ � Datel,/�/��.`�"'� Fl , BUILDING PERMIT PERMIT# DATE VALUATION LOT 17201,^X.M TRACT j q.� y, y 7 M,",-13 JOB SITE / APN /it/G ADDRESS OWNER CONTRACTOR /DESIGNER / EN INEER �'C, 3 'd i f t4�a�i 7t�y Tt.�eyA•��1 +1'�ry."s�TRgA�'.3•E�,-S 3` 0X!1�'al UC,` :it�W q+ q Sys+e�y"�(11'i•,•�ADES i i 1 T 8 d.L?�f�:�AiC�o.9.�3 3 9 1 7 67 Lh.Li3,R:i0.0 1 Ci4mffiva ; CA .02054 ,.µ aUC::�,f�fi�ka9:Cx��. i. A 92054 USE OF PERMIT ' S—A) A PBRNIT I)OC S NOT 1;.4CUJDF. BLOCK WAS Pt3.OL OR DR (SWAY APPROACH 98' MASTER 119-10 BIWEEZE PJAN. TRACT CONXtR:0071015 SY ROR.CH/RATTO .i3f3 Sty 463.9(1 07F i ITS'. W00 9 FENCZ Xf9f3,44i) LV 11.`S' =A'= D 01318 av C`ONSIJUXIi."'ETON V1,98 L8 I.P•?m. CONSTRUCTION PRE 101 �,00 -4 18-000 S608.0 39-318 $509.9 101-�100-+i•A00 pPQI�.,+r'1�,p2y+dpCiw3tyECKP+1��Z A 01 -WO -42, -0 U15 D Ybg1'CI'iES.I^II4', .. i' l.;r.(:n 101 -WO -42,1-000 ZLIXTPUCAA..'f� E 101-000-420-000 t'I.121113I1dO1 101-GM41!�P100 STVZON0 NOTION' YES . I2kSI.l) 101 -f00 -24.1N-000 $9.:� � 6331.PyiXWO TP;•.:,%: 101-000-470-000 OD10 �'J,'f?SJ'�I,•013�ft F�:P:/E..�:'7' �� , n rf MCI 8E KI.Al4 101-000-441m-345 1}f'Iv DEPOSIT 101w0d"i0-439-318 4750A f " 000B—.00'! -AL COMIiU6101T AM P1`- W CrHT!A X �%� f rf�T'�. PEJO Y. 'S DLTF .'MQ"4t8° OF C • EDUINTq EPp / REC'tIPT DATE " - %. c -F9 BWi D TE FINALE INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS r Set Backs Underground Ducts Forms & Footings b Ducts Slab Grade Return Air Steel Combustion Air Roof Deck . 27o Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation • p z Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Latht _ c. - Final �:2`�.!/'t-- �!� BLOCKWALL APPROVALS Final POOLS - SPAS Steel Set Backs 1 Electric Bond Footings _ o Main Drain Bond Beam - e Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Water Piping _ Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection _ (o -O Encapsulation Gas Piping Gas Test 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 , OZ Final L? Utility Notice (Perm) COMMENTS: Building Address Tity/ "- P.O. BOX 1504 78-495 CALLE TAMPICO O �f2t'Gp 4) LA OUINTA, CALIFORNIA 92253 Vwner y Mailing Address City ZITel. DC. eft//f/l� e ip I Tel. State Lic. City r & Classif.%%S �a',"�e / LAc. # 1�w �M Arch., Engr., Designer Address I Tel. CityI Zip I State 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, 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 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). 17 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 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.) f 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.) 11 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 n 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 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 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.) 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 aGPlicant Date Maijing Address City, State, Zip Z44/V!CG //7L -,r 57o APPLICATION ONLY BUILDING: TYPE'CONST. OCC. GRP.- A.P. Number / ,?</, /1/1s ' 06-2 Legal Description L O 7-7 /3 L,e / F (9 Project Description �r /1,14 S ; )_ . e- l Sq. Ft. No. No. Dw. Size J Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ 1 itimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing 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 DA' Issued by: Validated Validation WHITE = FINANCE YELLOW = APPLICANT PINK = 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 4/2/02 APN# 774-11'5-007, No. 23093 Jurisdiction La Quinta Owner NamePacific Trades Construction Permit #0203-158 N0.53650 Street Obregon Log # City La Qunta Zip 92253 Study Area Tract # BLK188 Lot # 7 Square Footage 1492 Type of Development Single Family Residence No. of Units 1 Comments Single Family Dwelling, New Tfact Construction M 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 2.14 X 1,492 or $ 3,192.88. 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 Mission Oak National Bank - Trent Garcia Telephone _,760/5.78-9970 Name on the check =� By Dr. Doris Wilson Superintendent 41. Fee collected /exempted by Crystal Scott Payment Received` $3;192.88 Check No. 11664 ti Signature OTICE: Pursuant to Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified bove will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to ollect them on the District(s)(s') behalf, whichever is earlier. Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting r r RECORDING REQUESTED BY: AND WHEN RECORGEO MAIL THIS DEED AND, UNLESS OTHERWISE SHOWN BELOW, MAIL TAX STATEMENTS TO: David Roar Millar 1719 S, Fremont S. Oceart,eide, CA 90234 '3I f C1Sa— . SPACE ABOVE THIS LINE FOR RECORDER -5 USE The irndersipned grantor(s) deddere(s); Grant Deed A.P.N. 774-1'15-007 Documentary transfer tax is S ( xx) computed ort full value of Property con eyed, or t ) Compuled on full value leas value of liens and encumbrances rarttelning at time of sale. ( ) Unincorporated area: ( ) City of FOR A VALUABLE CONSIDERATION, raceip(of which is hereby ac;cnowledoeti, end GENEIVA F. MARKS hereby GRANT($) to DAVID ROSS MILLER, a married man as hid .'601e and separate, PrOp®rt"Y the real property In the City of La Quints Coun: of ' State of California, descrlbed as V Riverside Lai 7 of 87ock1 $8 — jTnft No, �_P Santa Carmelita at Vale La Quin t:a as Per map recorded in book Ibf Mpg, Records* of Riverside County, California Dated Februar 28 2002 S State of California Signature of Grantor) County of ) Or' be10ra me, GENEIVA F. MARKS personally appeared GENEIVA F. MARKS personally known to me (or orOV104 10 me on the basis or satlsfsetary _ evidence) to be 1111 person($) whose nami(0) Isiare subscribed to the + wit -lin Insbvmenl And aokrowledged to me trait he/she/hey executed ' the some in hia/hedtheir authorized capdgiy(!er,), And lhet by h!slheNthelr 9igheture(i) on the Instrument tha parson(s), or the entity upon beholr cf which the pervan(a) ailed, executed the Instrument. WIT, NES$ my hand and ctnoial et?81. SlAnoturo � N:<�, • MAIL TAX STATEMENTS TO, fit 'd, S9y$'ol! Stl ACH 83)Nd. KIM F, ?OH 1 'te,ll RC DISTRICT - PLANNING REVIEW FORM This form is to be used by CDD staff for review of single family dwellings in the RC (Cove Residential) District per Section 9.50.090 of the Zoning Code. Its purpose is to determine: 1) that the proposed house design does not duplicate the same architectural style of any house within 200 feet of the applicant, and/or 2) if there is a need for the applicant to file for Master Design Guidelines. If the applicant does need to file a Master Design Guideline, please transmitted this information to the Building and Safety Department as part of your correction list. Please attach additional explanations as necessary. APPLICANT Pacific Trades SITE ADDRESS 53-650 Avenida Obregon APN 774 - 115. - 007 CASE NO.: 2o0z- so2-1 LEGAL: LOT 7 BLOCK 188 UNIT S:C.@V.L.Q. CHECK AND APPROVED BY: Martin Maaana - DATE: 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 Verify legal and APN information Consistent with MDG on file (as applicable MDG filing required (5 filings since CITY OF LA OUIEVTA 9/3/98) Architectural variety within 200 feet.of IWAR 12 REC'g the surrounding area: suitD-- 11VU AND SAFETY Colors r@ Materialslanning y Council Architectural design features rnm ni y bev. Oen. Other Requirements: j3i No. h Conditions ,.,;..�........ ...�.,...... CaAf qg- t'vo@I .- ANOMeq- Roust, S) rM I VAr- To •-(440 0146- t4 P~q M2 F-)Li5 T I MA AG4ss TNS STgoen- Fors+ rw 41r&. ADJOINING LOT 36' BELOW SUBJECT PROPERTY NEW COMBO WALL 35" RETAINING WALL 'WI NEW 6 HIGH BROWN BLOCK WALL ON TOP EXIST.(OLD) 36 HIGH WOOD FENCE PROPERTY LINE 50.1 Fad. H.P. 5V� ar I 3 0 r - ---------------------- - - - - -- m i = y I I F • aUYU I _ I w � O nMJAx .• I I - - m I� I O -cSmm ^V- 3Ua O o O W Z J �J LL• O LL I Z ' a$3 ADJOINING LOT S2$ •.:f, I O BELOWSUBJECT PROPERTY , r • a g MIN MIN. w SET SET i BACK - - BACK ADJOINING LOT 37-0" - i ABOVE SUBJECT PROPERTY O PLAN THE BREEZE, F.F.: P-0" ABOVE THE CURB 3 PAD: 0'-0" ABOVE CURB MEASURED @ i Y CENTER OF LOT @ AVENIDA OBREGON U - ifO w 0 O LL w . m i NEW 6 i BLOCK WALL • t` i - i w - ?e 3 YGATE. w O LL v0-i ROLL-UP GARAGE DOOR J'd• .5, N 1'-0• •.R)• BLOCK WALL - CONCRETE DRIVEWAY Y �u RETAINNG U 5'•p WALL b N BLOC( WALL. j PROPANE TANK + PLANIINCS TO SCREEN ^ PR PERTY LINE S50.01 PROPANE TAN( l"--NEW 5' STUCCO=.—.—•—.—.— COVERED BLOCK WALL _ (3) QUEEN PALM WATER SERVICE - 15GALOREQUAL --El I . MIN. 112• TRUNKk-CU- RB DATUM POINT® DRIVEWAY APPROACH RECUIRES A - MID-POINTOFLOT - SEPARATE PERMIT AND INSPECTION FROM CRY OF LA QUINTA PUBLIC WORKSDEPARTMENT - - - AVENIDA OBREGON Certificate of OccupancyAr City of La Quinta Building and Safety'Department OF�°'� This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code, certifying that, at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building construction. or use. For the following: BUILDING ADDRESS: 53-650 AVENIDA OBREGON " Use Classification: SFD Bldg. Permit No.: 0203-158 Occupancy Group: R-3, U-1 Type of Construction: VN Land Use Zone: RC Owner of Building: PACIFIC TRADES CONSTRUCTION .Address: 1719 S TREMONT City: OCEANSIDE CA 92054 By: KIRK KIRKLAND Date: 9/24/2002 Building Official POST IN A CONSPICUOUS PLACE 4:' � • • 9