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9902-0179 (ELEC)co N � _UO;Q ✓ 2 Z o cc a • 'LL n 11 m -;a <U O.0 • z r r 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 /Datei C20 /47 'Signature of Contractor- ^ 1:131/19 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' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. t(�) 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. {-111•J.1 TY MUTUAL WC2-6521 210-019 (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 ode, I shall forthwith comply with those. provisions. Date• • / f*Applicant 6s 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 authorize representatives of this City to enter upon the''above-mentioned property for inspection pur oses. / 77 Signature (Owner/Agent/t J, ',t c,Pc.„np Date` ""l BUILDING PERMIT DATE 05/13/199 VALUATION s100. 1 LOT PERMIT # 990x-179 TRACT JOB SITE ADDRESS f4010 AVENIDA ALVARADO APN OWNER CINDY JOHNSON 54-010 AVEN IDA ALVARADO LA QUINTA CA 92253 USE OF PERMIT ELECTRICAL CONTRACTOR / DESIGNER / ENGINEER SERVICE EXPERTS OF PALM SPR1NCS lNC: 139 S. GENE AtTrRY TRAiL PALM SPRINGS CA 972,53 760)323-9210 CFL# AiC CO.NLilsN .OR RELOCATION crALUA.TiON 800.O(i LS ti ii ST.IMATED Cost OF CONSTRUCTION PERMIT 'FEE SUMMARY MECHANICAL PIE 101-000 .421-000 f ,.Er.71 R CAE. F1?F 101.000-d20 0O0 5 f iotiEl '51.5,00 Sl113:TOTAL CONSTRUCTION 17ON AND PLAN CH1:CK. LESS PRE -PAID VFES TOTAL FEIN DUE NOW Sri 300.00 $11.1x► So 00 $ 34#M1) 1101111113 059 . RECEIPT DATE BY Ds7IJALEQ/el INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings 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 Encapsulation Gas Piping • Gas Test Appliances Final COMMENTS: • - • • • - .• • . • • Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring ,.1-7(� Gg2 F(gr J r Low Voltage Wiring Fixtures Main Service• Sub Panels Exterior Receptacles G.F.I. Smoke Detectors • Temp. Use of Power Final C Utility Notice (Perm) �� ! [ Vrf (•� NOTE: With proper validation this form constitutes an encroachment permit 110411111111 60 IE CITY OF LA QUINTA APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS Subdivision Improvement Permit — Class III DATE• June 16, 1998 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION Avenida Chillon at 54-010 Avenida Alvarado (Street address or Description of Location) PURPOSE OF CONSTRUCTION Install concrete stairs Sketch (attach construction plans if appropriate) in Right of Way DESCRIPTION OF CONSTRUCTION 3' X 12' stairs DIMENSION OF INSTALLATION OR REMOVAL 3' X 12' SIZE OF EXCAVATION, IF NEEDED _N/A APPROXIMATE TIME WHEN WORK WILL BEGIN APPROXIMATE TIME OF COMPLETION 2 days ESTIMATED CONSTRUCTION COST $ 400.00 (Including removal of all obstruction, materials, and debris, backfilling, corn - SEE ATTACHED CONDITIONS NOTE: AT LEAST 5' CLEAR SPACE BETWEEN THE BACK OF CURB AND THE FIRST STAIR STEP SHALL BE PROVIDED. paction and placing permanent resurfacing and/or replacing improvements) In consideration of the granting of this permit, the applicant hereby .agrees to: Indemnify,.defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or property happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application. Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started. Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of La Quinta and to pay for any additional replacement necessary as th esult otlis work: David Ross Miller 1719 S. Tremont Name of Applicant (please print) Pacific Trades Construction Signature of Applicant or Agent S. Oceanside, CA Business Address (760) 967-0069 Telephone No. same same Name of Contractor and Job Foreman Business Address 425381 1955 Telephone No. Contractor's License No. City Business License No. H.R.H. 75-1290-98 Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit — Class III Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Minor Improvement Permit — Class IV: See attached schedule Inspection Fee Permit Fee $ 100. Penalty Cash Deposit -Surety Bond if required TOTAL: $ 100. Receipt No. Received by Date Recorded by 2760 PERMIT VALIDATION PERMIT NO 2760 DATE APPROVED 6/16/98 EXPIRATION DATE 6/16/99 DATE IS UED By 424 Telephone: (619) 777-7075 Administrative Authority Desert Sands Unified School District Notice: 82-879 Highway 111 Indio, CA 92201 Document Cannot Be Duplicated 619-775-3500 CERTIFICATE OF COMPLIANCE Date 2/27/98 No.. 16682 Owner NameDavid Ross Miller 1IIIIIIIIIII[iII11111IIII 61 IE APN # 774-203-001 Jurisdiction La Quinta No. 54010 City La Quinta Tract # Street Avenida Alvarado Lot # Permit # Log # Zip 92253 Study Area Type of Development Single Family Residence Comments Square Footage 1393 No. of Units 1 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-tlie ',following reason: - y J f EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 1.93 X 1,393 or $ 2,688.49 • -71 in the amount of } . 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/Capital Bank of North County/David Ross Miller Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Rosita Jones Signature Telephone 564-0273 Payment Received $2,688.49 Check No. 052364 NOTICE: 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 collect 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 Building h t Address �4 -oi 0 t f� l ! U N.R * 6 4 4 a d tra P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Owner 1�c c'? Zl15�. Mailing Address (') I Ci S - i, rtivr.� r City Zip c? Tel. 5101 - Contractor, Address 9-562 -005 1III1IIIIIIII1 IIII 62 IE I APPLICATION ONLY BUILDING: TYPECONST. OCC. GRP. LI - eJ3 -- D I A.P. Number Legal Description 41:t)'(c—r Zy ISI 2c3 Project Description r• 0• City Zip Tel. \V-11\-? C 8State Lic. I 'c -3 Classif. � � City Lic. # Arch., Engr., Designer Sq. Ft. f �C1 Size No. Stories No. Dw. Units New ❑ Add ❑ Alter 0 Repair 0 Demolition 0 Address Tel City Zip State Lic. # I LICENSEO'CONTRACTOR'S DECLARATION'��'`� I hereby, affirm that I am Iicensedyunder provisions of Chapter 9 (commencing yith Section 7000) cit Division 3 of the Business and Professions Code and my license is'[✓full force and SIGNATURE ""'"""1 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, )reprove, 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 (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 contractor(s) licensed pursuant to the Contractor's License Law.) i7 I 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. El 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 (8100) valuation or less.) I certify that in the performance of tfrp work. for which this permit is issued, I shall not employ any person in any manner s as to become subject to the Workers' Compensation Laws of California 4� Date Owner 1 NOTICE TO APPLICANT:-'ll,--ah'er—making thts 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 it 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 a{ plicant Date Mailing Address City, State Zip Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. PAID S"J•va Mech. Electrical JAN 3 0 1999 Plumbing S.M.I. Grading CITY OF1 QU NMS Driveway Enc. Infrastructure TOTAL -2 o. Jo 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 FEB.20.1998 5:16PM COMMONWEALTH • RECORDING REQUESTED EY: OLD REPUBLIC TITLE COMPACOMPANY 98.7143KC 105709-13 WHEN RECORDED MAIL THIS DEED AND, UNLESS OTHER:7ISE SHOWN BELOW, MAIL TAX STATEN:MINTS TO: DAVID ROSS MILLER 1719 S. TREMONT S. OCEANSIDE, CA 92054 -6-3 -1 IE NO.038 P.4/4 SPACE ABOVE THIS LINE POR RECORDER'S USE APRT: 774-203-001-4 54-- 0/C) AVO. ALVA,4rP0 GRANT DEED The undersigned grantor(s) declare(a): Documentary transfer tax is $9.90 (XXX) Computed on full value of property conveyed, or ( ) Computed on full value less liens and encumbrances remaining at time of sale. ( ) Unincorporated area: ( ) City of , and FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, ROGER L. SCHWARTZ, TRUSTEE OP THE ROGER L. SCHWARTZ TRUST, U/A DATED SEPTEMBER 28, 1993 hereby GRANT(S) to DAVID ROSS MILLER, A MARRIED MAN AS BIS SOLE AND SEPARATE PROPERTY the real property in the City of LA QUINTA, County of Riverside, State of California, . described as; LOT 24 OF BLOCK 253, SANTA CARMELITA AT VALE LA QUINTA, UNIT NO, 24, AS PER MAP THEREOF RECORDED IN BOOK 19, PAGES 44 AND 45 OF MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA Co, Dated January 26, 1998 State of County,..5 g/0 f erl`l=�'.-/- • } S.S. On `- t.��-ttc c_e 1. , t q6-1 < before me, f @: 1. r . r ,'[' 0 ( a 0 c114 , personally apO'gred personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to Mt, that he/Phe/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the pez`eon(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. Signature C 4, a MAIL TAX STATEMENTS TO: ROGER L, SC F,RTZ, TRUSTEE OF THE ROGER L. SCHWARTZ TRUST, U/A DATED SEPTEMBER 28, 1993 cetherine R Care * *0Y Commission cCG70183 ,,,; , Expires September 10; 2001 is'area for official notarial seal) •