0006-127 (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.
Li •ense # Lic. Class Exp. Date
36.920 : L3 M130/2(
I t ]C,, f\0
., I
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).
( ) 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'
-6om`pensation, 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:
CarrierccPi 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
worker`s' compensation laws of Califofnia1• and agree that if I should become
subject to the workers' compensati,•/ provisions of Section 3700 of the Labor
C./de,,.1 shallforthwithcomply with
,se q�ijo_visions.
,Date: 1' 14 TV Applicant t1 k0
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City�and State laws relating to the building
construction, and hereby authorize91"ti,on
pr . entatives of this City to enter upon
the ove mentioned property for inpurposes.
kv Signature (Owner/Agent) 1 Date
M
I�-00 BUILDING PERMIT
DATE VALUATION LOT
1{)50.50
PERMIT #
QW6427 TRACT
10
a'3LY.U5 U24
JOB SITE APN
ADDRESS '14_435 Aer.F:NIDA 013REC°ON 774-241.-02:1
OWNER CONTRACTOR / DESIGNER / EN (NEER
LA QUIN TA PARIUMS C-ONMOR RY T OA+
PO BOX 450 v 513'10 AVL-" 1MA BMWIMM
LAQUJNTTA CA., 92253 LA.QXMgTA CA 92253
(760)W-1962 Cmil 6259
USE OF PERMIT
MNCIL4E.1 AiMY DVMLLM(3
VD -PERMIT DOLS NOT INCI.,UDE BLOC+14:1, ALIS' Ott. PCIGAL
TRACT CONST.RUCTI0N I,Snoo w
-
P� PIMP.ATIO 3$.00 SF
- 0-ARAOFMAILPORT (V) 0,074.$0
5 FT. FOOD nNCE " 200.00 LTt'
ESTI ►ATM COsa`J1' OJT CONSl't°iI UC 014
93,0W.50
PERM, M 5UADUIRY
.�
CONSTRUCT10N 1+'LF 101-000-418-O00 a612,5A
T
PLAN CHECK FE -9 101-000-439-318 $513.45
�~
A11$CHAXICAL FEE 101.000-421.000 $0100
ELECTRICAL FIE 101-000-420-000 $131.30
}
r= �� s
f.-5
PlIU1V213I1O EE 101.000.419000+ $1l0.?5
STRUT -40 M0TION FEE- RESI17 101-000-241-000 $9.31
OPLADI-90 PER 101:-000.423.000 $20.00
7 4j-1
DEVELOPER. IMPACT FM $1,907.00
.�
J
PRF.C19PLAN 101.000.441-345 9100,00
FEE DEPOSIT 101-000-439-318 =$3'50.04
SUB -T'OT'AL CONSTRUCT ON AND PLAN C`%�i.,CY, '
$3,464.31
LE -33 FRE-PAMMS
-$250.00
TOUL PEE P MS DUE NOW
51=4.31
RECEIPT I DATE
DATE FINALED I INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade Z gReturn
Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap O - — ov S
F.A.U.
Framing 57
Compressor
Insulation _ y, - .o J
Vents
Fireplace P,L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APP OVALS
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/ Q s q
Water Piping ff �� /
Heater Final
Plumbing Final
Plumbing Top Ouf
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection . ( - p S
Encapsulation
Gas Piping
Gas Test / Z —O l S
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:
Building
Address
f 4ks� ) /4--''( '(4./CIC
P.O. BOX 1504 APPLP
78 495 CALLE AMP'CO Gl�LRA�O{11NTA, CALIFORNIA 92253
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number "774 • 2-1 • V�'�-/
Legal Description &)T/0 1 ""c"k x'66
Project Description '51&,r L4 T-A.V tc tt' ,r> ��
Mailing
Address - ,b
City JZip
_Z 'C� ITelt1l 4)U/1_'74
Addres1: - � � 4-4-o
t )✓5-M . I < ::, I �-K 4'- /
State Lic. City
& Classif. .1Zj�J� �� Lic. # y,
Arch., Engr.,
Designer LOOC4
Address�U � Te)...�
City Zip State
L A 6)U/A-;7-f4 e_Y ? 2 (:' Zj 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.S,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).
l: 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.)
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.)
11 1 am exempt under Sec. B. & 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. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed 0 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 aliplicant Date
Mailing Address
City, State, Zip
SLY
Sq. Ft. / No. ' No. Dw.
Size Stories Units
New is Add ❑ Alter ❑ Repair ❑ Demolition ❑
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
Estimated Valuation
PERMIT
Plan Chk. Dep.
AMOUNT
Y�
Plan Chk. Bal.
k
Const.
Mech.
Electrical
Plumbing
7
S.M.I.
Grading
Driveway Enc.
,
1► 1. f
It"\
y li
,
Infrastructure
v`� U L"_J
r
TOTAL
REMARKS
a
`T
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
99ecardinQQ Aaquamd 9v
1CArGO TOYLE COMPANY
Clac'.Aaa rrmmmm a a°CCOMPANY COMPANY
9969031109C 99066/9/
' mer ua -AM,
19
AOBNW g. mut;,C
and emvs� uux�c
47755 VmA 'Ism
zA 017311rA. CA 9RA53
77/� y/ ac,,) f
GRANT DEED • ' ' i
a►rOZo•�a3i5' .
�'hI tnd9�rr�igned rssreneorlel deelgza`eJ 1
ptaaumgnC4 tranafeer!r tax a /lips, 0
� I o�o�yeid au1 tuli viiga 7 oroUrt and ve ror r
Y nd un en
aninoonporarted srma t CiCr os etltei�ino ac tiro of sole; Q .
1"OR ,A gALWV13,l1 ccili�iCggRT,�OM, ,and
eW acknowt�rdreceipt as Mh4oh le her ,
't'
Mt+WIOA, 1tyATSB OP 77f13 PMRMOA R�vo
NXCO1fBA CA6L8 TVVT DATao APA:L R
a5. 1986 dnd O=p KhRM( ,
A
NXDMR
harmby mvm(a) to
ROPWO p, 1l9U,OOC and ByLvxA R0144 , hush
and rand Nita 06 joint tenants 0E3A C /0
o
the ,reel property in the City aP ,r► Qr7I1n'
davcribed Bae ,—OaI`Y of Rivsrdide,. otato o! C41iForms,
ldit J i i
Loge a and 7 In 8lo�k 253 end Loo 0 thveugh le, i cluofve In Bloc �6g
enSt 110, 26, A�tnct,� Catmel4Ca at Val
ls� satpa 1♦ &Vd f3 4L'. 1+° Guintp.s►rp by Nap oat Tile in Back
netaa AvOupt 3./, /g! llfRpO� raaordo�Pa -ftiv j gidq Cln+o Silorpi4
Rate Of Cq iearny�,
County bt 0 -it
onev
) s.e, as�rs0
before MN ,, —
�►,A' � � D�ttoart�i•ly aQPerlre4 a
I
personally known eat be for proved to me on
rhs bgoda of satiasactdr evidenoel Cv f1e
Che ppvreon(A Mhotaa naM@Y Idence ptq IM bed
cv tile w r. T) Snserumar>t and 9CIUv„1
�achat oho/they eaoe+tad the name Lin
to
Her r authorized r;at�aoiGy 1� and Hurn �r 0 �
t by /11er/t;hait' e>;tmap�q tel on thq
L4P -'"m
SnakruBwne' the pare®h (o , Or the entity / M''� � `s,r,�`
bahelf Of which the parson Wt acted, excuaed
the inotrumaet, a
NTWBSB my hand d ot[it:,i 3 0
14,41L 4'N! ►Qr (Thir3 area for afFlt:3al notarial, epgl) .
EiE'd '
3DIA?d3S 8�wmSno W820;0T 00,u60 Nnf
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, 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 Lendel Ventures
SITE ADDRESS 54-435 Avenida Obregon
APN 774--- 241- 021 BINNO.: '��-L3 CASENO.: 2000-237
LEGAL: LOT 10 BLOCK 265 UNIT S.C.@V.L.Q.
CHECKED BY: Greg Trousdell 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
Compatibility Review
Case logged and number assigned
Verify legal and APN information
Consistent with MDG on file (as applicable
MDG filing required (5. filings since 9/3/98)
Consistency with street/surrounding area:
Colors
Materials
o Architecture
Other Requirements:
Certificate of Occupancy
City of La, Quinta
Building and Safety Department .0F
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
ofthe City regulating building construction or use. For.the following:
BUILDING ADDRESS: 54-435 AVE.NIDA OBREGON
Use Classification_,. SFD Bldg. Permit No..: 0006-127
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC
"Owner of Building:~ LA QUINTA PARTNERS Address: P.O. BOX 450
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
d Date: -03-26-01
Building .Official
l POST IN A CONSPICUOUS PLACE
. j
La Quinta Partners
r Post Office Box 134
La-Quinta, CA 92253
July 11, 2000
City of La Quinta
Building and Safety Dept.
Post Office Box 1504
La Quinta, CA 92253
RE: Plan Checkfor 54-435 Avenida Obregon
To Whom It May Concern:
Please be advised that as owner of the above property, I have hired'Robert Kellogg to build
the project under his General Contractors License number 736920. Accordingly, please
remove Lendel Ventures from the Permit Application.
Thank you -for your attention.
Sincerely,
La Quinta Partners