0012-141 (SFD)LICENSED CONTRACTOR. DECLARATION
I hereby affirm under penalty of perjury that f 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
. ' 42538}.
Date h %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 thestructure 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, fo . the performance of the work for which this
permit is issued. My workers' comp nsation insurance carrier & policy no -are:
Carrier Policy No.
STATE FUND 1�Df��9P DO
(This section need not be completed if t permit.4aluatiorris for $100.00 or less).
( ) I certify that in the performance of a 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' cornpensatioh provisions of'Section'3700 of the Labor
Code, I shall forthwith comply with those provisions.
Dater = -CApplicant
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 application agrees to, & shall, indemnify
& hold harmless the City of La Ouinta„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) A Date
BUILDING PERMIT PERMIT#
DATE / VALUATION LOT 49012-1.41 TRACT
W,.' MAG 9
JOB SITE , _. I - '
APN
ADDRESS
..,/� 0 AVE4) WA '0DR1?:f.y0,Tq
`
774-242-W?
OWNER
CONTRACTOR / DESIGNER / ENGINEER
PACIFIC4, 110009
�
s OCTWIMCIEF. C11h 92054
8 C9CWI1�"�� E CM 92054
Q60)967-0069 CB1,4 1955
USE OF PERMIT
Slr39 „ PERMIT, =PSNOT INC1,LJfl e DICK. W1#I,11}''O01JSP OR
DRIVT+:WAY'.dif"i'1< OACH �
y
cill
TRACT COiY�F0`1RUCTION 1,:-10.00 9p
'
S OR -CE PATIO X40 9F
0A,R.A.e:3RMARSIORT (MF.) 10,OdM20
5 IrT. WWI D PT!INCIlz; 3t10.s3D .v lg
r
:A,SMt1'X:MD C7£�N'"i' 6. F OO�.tV'f`� 4a'OC.`�l�+C O
:93r'si�
PEW. rr 6'1 % OWMARY 3 . .
WNSTRUC'-T101•F RE 101-000.4118-000 $612,50
pl,,AN C:HW 91i ks 101-000-09-218 $505.69
M EC HAN]CA1. -421-M S40.0
ty,1,Z" 2IC;AL.FEIt. Ioi-O'00�,120-000 $111:24
P1,iii1t4BUT10 FEE; :1>31.04JC9.4,1ax.C10C3 S110115
STkOlsdrl�,9iJ`f%:3'31�51.q'f�,Sdta 1.�yg.�+I20�?A1•Oi�J *9.:35
,,
GRADING FEE 520,00
;Y .
JDtV'FJ,,0PER IMPACT .IW
PTtFC1 , FLAW 101.000.441.315 .. ffiIM0
101•.000-4301338 42150,00
Y
SUB-TOTALCONST'ter 14,tl►tM YLAN CIMCK
z a PRF_,PtJPFM-!3
4250,00
RECEIPT
DATE
BY
r ` ti •-�.
DATE FINALED
INSPECTOR
I
�" -�� '�/� • �`f �J J Ver -
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
I INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
p
�'�
Ducts
Return Air
Steel
Combustion Air
Roof Deck
3 - -ol
Exhaust Fans
O.K. to Wrap
, pt -C
F.A.U.
Framing
t
Compressor
Insulation
— lam_ o
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
-,Li
Final
Final
BLOCKWALL APPROVALS
POOLS -SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
3
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
- -p -
Encapsulation
Gas Piping
Gas Test
p
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole _ p L
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final 5.�
Utility Notice (Perm)
COMMENTS:
Building r //
Address `� i-
ti-Sli, S,�
V
ITu r
,.
P.O. BOX 1504 APPLICATION ONLY
78-495 CALLE TAMPICO C
bml {p QA QUINTA, CALIFORNIA 92253 P
Address t
CityZip Tel.
li _ A... t
Address
ty lZip
State Lic.I City
& Classif.�y��� 3 f Lic. #,�{
Desigy.
ner ,
Address Tel.
City \ (Zip (State I
Lic. #
LICENSED CONTRACTOR'S DEIJLARATION
irm at I m licrrsed.under provisions of'C1 ter 9 (cb mencing with Section
ion of th Busitess and Professions Code, and my lic rise is in full force and
OWNER -BUILDER DECLARATION
I hereby affirm that I aft exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susine s 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).
(_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.)
II 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.)
I1 I am exempt under Sec. B. 8 P.C. for this reason
Date Owner
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
r7 Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed 11 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
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 a0plicant Date
Mailing Address
City, State, Zip
LDING: TYPE'CONST. OCC. GRP.
`
. Number "Mr- -) 7 q \ C wItI —oo—)
al Description
ject Description -
t 1 u >i C'C 5 t2
Sq. Ft. (�C) No. No. Dw.
Size Stories Units
New O Add O Alter ❑ Repair O Demolition O
DEC 0
Estfmateo valuation
I PERMIT I I 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 DATE
INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: - La Quinta, CA 92253
Document Cannot. Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 12/18/00
No. 21361
Owner NamePacific Trades Construction
. No. 54-410 - Street Avenida Obregon
APN # 774-242-007
Jurisdiction La Quinta
Permit # 0012-141
Log #
City La quinta Zip 92253 Study Area
Tract # Lot # 9 Square Footage 1500
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
2.05 X 1,500 or $ 3,075.00 the property listed above and that building
6,11
permits and/or Certificates of Occupancy for this square footage in this proposed project may ndik be�issueds , -
Fees Paid B CC / Capital Bank of North Count �-
y p Y Telephone r-,/60-967•-0069
r s.
Name on the checkfi¢", • ;'
By Dr. Doris Wilson
Superintendent -r�
_.
Fee. collected /exempted by Annette Barlow Payment Received $3,075.00
664r_�_o
Check No. 079522
Signature
40TICE: Pursuant of 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
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 paid to the District(s) or to another public entity authorized to
bllect 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
Dec -04-2000 02:470" From -COMMONWEALTH LAND TITLE +7603413215 T-239 P.001/001 F-277
RECORDING REQUESTS 33Y S �- L(
ORANGE COAST TITLE COMPACOMPANY
. 10525KC r-192387-1 6 V V �lp
.
B, IUM RECORDED MAIL THIS DX= AND, I e
MMFSS OTURRWIS! $$OWN BELOW, .
MAIL TAX STATEMENTS TO:
DAVID ROSS MILLER
1719.SOUTH TREMONT
S OCEANSIDE, CA 92054
LSTRT9 7.TMP PAD DCe+nonvfl, ..n.'
GRANT DEED "N; 774-242-007
The undersigned grantor(s) declare(s):
Documenrary transfer tax is 520.90
(XXX) Computed on'full value of property conveyed, or
(. ) Computed on full value less liens and encumbrances remaining ar- time of sale.
( ) Unincorporated area:.( ) City of , and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
WILL M. CARGILE and JUNETTA CARGILE,
hereby GRANT(S) Lo
DAVID ROSS MILDER, A MARRIED MAN AS HIS SOLE AND SEPARATE PROPERTY
the real property in the City of LA QUINTA, County of Riverside, Slate of California,.
described as:
Lor. 9, Block 266, Unit No. 24„ Tract Santa Carmelita-at Vale La Quinta, as per map
recorded in Book 19, Page(S) 44-45 inclusive of maps, in the office of the County
Recorder of said County.
Dated November 14, 2000
Srate of California
!4
Cour.zY of j S . S . WILL M. CAROM.)✓
;!
On
before me;'
personally appeared JUNETTA CARGILE
personally known to me (or proved to me on
,l
cne basis of satisfactory evidence) to be
the person(s) whose name(s) is/are subscribed
to zi a within instrument and acknowledged to
me that he/she/they executed the same in
i
his/ner/their authorized capacity(ies), and
that by his/her/their signatures) on the
instrument the person(s), or the entity upon
behalf of whxch the person(s) acted, executed`;jl;
rhe instrument.
''tip
WITNESS my hand and official seal.
Signature (This area for official notarial seal)
!;
MAIL TX STATE&W=5 T0:
41.
f! i
v
Certificate of Occupancy
City of La Quinta
Building and Safety Department OFTMt°
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:
k BUILDING ADDRESS: 54-41.0 AVENIDA OBREGON
Use Classification: SFD Bldg. Permit No.: 0012-141
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC
Owner of Building: PACIFIC TRADES CONSTRUCTION Address: 1719 S. TREMONT
City:. S. OCEANSIDE, CA 92054
By: STEVE TRAXEL
Date: 05-09-01
Building Official
POST IN A CONSPICUOUS PLACE