10-0281 (SFD)✓•
LICENSED CONTRACTOR DECLARATION
• I hereby affirm under penalty of perjury that I am licensed under provisions of
I— ' Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
CO, • Professionals Code, and my License is in full force and effect.
ch License # Lic. Class Exp. Date
O6 0 M96
a�67,t WSJ 13 .• ✓� ,✓� d�`��. In
Z Date -/ 'Signature of Contractor /4/74
' ! i's-to
co O
N -J U OWNER -BUILDER DECLARATION
WW I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
Z_ ( ) 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
u7
Date Signature of Owner
ON
C7
Q WORKER'S COMPENSATION DECLARATION
p 2 2 I hereby affirm under penalty of perjury one of the following declarations:
i- O ( ) 1 have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
O .Q performance of the work for which this permit is issued.
< ( 90 have and will maintain workers' compensation insurance, as required by
O Q Se tion 3700 of the Labor Code, for the performance of the work for which this
CE 1— permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier Policy No:
TATE 11UW) 1242713-97
< (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 1 should become
subject to the workers' compensation provisio s .of Section 37010 of the Labor
Code, I shall forthwith comply with those,provi ions. (1 r
Date. i 4 r-r�i'Applicant +� f r
'Warning: Failure to secure Workers' Compensation coverage is unlawful and
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 purposes.
Sign Lure (Owner/Agent) �. r�-,a <t - -. Date l ,i'
BUILDING PERMIT PERMIT#
DATE✓1 yVALUATION LOT 091048 TRACT
�
1✓ D' tO kit12,819.70 16 MX. 251TIIA.
JOB SITE ' /
ADDRESS -
APN
54--A.60 A ENIDA ALVARA +O
'774-203-009
OWNER
CONTRACTOR / DESIGNER / ENGINEER
DONALD S3 11, TERRYIL N
ETF VALLEY CONN'i`>uUCHON
PO i'3OX 1261
54860 AVE. .ALVAY O
LA Q'W.NTA CA 92253
LA. QtTINTA ca.0 Z$3
(760):4 6 4 -4844 Mild' 1961
USE OF PERMIT
.-
•
_
----
,
SINGLE FAMILY riwututqa
c
SOD. PERMIT :oOi NOT INCLUDE'8 OCKWAI LS/POC)>i 1L?RIVEWAY
APPROACH. ,
_
TACT CONSTRUCTION 1,641,0 SP
PORCH/PATIO 140.0f1 SF
-
(IMAC}t/C",A.RPORT (F) 9,465.40
5 )'r, WOOD FENCE 200.0O J
ESTIMATED cosi OF CONSTR :3CLIOz r
102,81%70
;
MORT VIM SUMMARY
CONSTRUCTION FEE 1010000-418.000 $034.00
,i`
PLAN CHEM FEE 101-000-439-318 $::16.34
^t:
,G"EE DEPOSIT 101 -000.439 -31.8 -USD, al
' '
MECHANICAL FEE 101-000-421-000 $6(1.01!
ELECTRICAL MR 101-000-420.000 E11S,62
¢"
NLIJt BINC.I FEE 101.4100-419-000 '•; $1113.73
sTRomo MOTION- FEE - RFSlD 1014100:441 .000 $10.214
ORADIN0 FEE 101-000-423-000 $7,0-00
DEEROPER IMA.ACT FEE $1.907.011
PRECISE PLAN 101 O0O-444..345 $100.00
ITH-':OTA ' C"1�' 014 AND PLAN CHECK
$3,509.99'
k'15S3 1I.S..iSS PRE -PAID 1417,3
4250.00
Vt-T03.410SatnliT MS DITE NOW
0'25,59
. .. �
1111111111111111111 06
NA 'SIE1
RECEIPT
DATE
BY i.,t j ''';:NN,
57,7) —I O /
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
c_�
Underground Ducts
Forms & Footings
/ a(
S
J
Ducts
Slab Grade
2[
Retum Air
Steel
s?
5-
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
• '
Roof Deck
3-3 o(.
3 1-? D(-,
O.K. to Wrap
/ 2„7.... -Framing 3 -o c
'5Insulation i a.-.3' o[
S›
. S 7
Fireplace P.L.
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath 1— 34-0(,
$7
"
Drywall - Int. Lath
,t� 2-1- c9 e
SI
Final
Final
31-.2-(,0 (
APPROVALS
57
POOLS - SPAS
BLOCKWALL
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
Electric Final
Waste Lines/
-/
.G(�
Heater Final
Water Piping
5
Plumbing Final
Plumbing Top Out
�/
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
f�.-a (
•
S7
$�
Pool.Cover
Encapsulation
Sewer Connectiorr-'
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
.
"
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
/
.�
Elf
Utility Notice (Perm)
:,/
IIIIIII VIII III VIII IIII 07
IE J
51--I(6°
Building 1.%. A
Address 1 1 L
will, 4 4, athir: . p - (e.g_s
P.O. BOX 1504 APPLICATION
78-495 CALLE TAMPICO
L \/ rIt\, it QUINTA, CALIFORNIA 92253
fin/ w 7 -,Q/2 V 1-4-m--) i t 7r)A/
Mailing �n 'l/
Address '� !'.�C� / cc/
City
9/Ar/-7*
Zip
Tel.
Contractor
FA) S7 V4 L L / Gvn/57-,21.472CA/
Ad v
City Tel.
/C./•}G2/Arra Z; s 3 , 5--.704/14 5/'/
State Lic./ City
& Classif. c!� Lic. #
BUILDING: TYPE-CONST.0-4, L OCC. GRP.
A.P. Number
7 74/- a o 3-0o9 -
�-.-
Legal Description
,Lat / 6L.K UM r -r
Project Description 5 r !�l 6-L FSM r L L L /A/6 --
Arch., Engr.,
Designer S,6 L F
Sq. Ft. / / s•-- No.
Size t0 . Stories
No. Dw.
Units
New
Add O
Alter 0 Repair 0
Demolition 0
Address
Tel
City
Zip
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 i B liners and Professi_ s Code and my license is in full force and
effect. //.4� Prof
SIGNATURE -VDATE
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).
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, Bulsness 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.)
11 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 contractors) licensed pursuant to the Contractor's License Law.)
tl 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 entified copy .ther�eoof. Sec. 3800, Labor Code.) -71
PolicyNo./c2 �
) i 3 Company��� ILL -RAM / N u1%./
Copy is filed with the city. ID Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100) valuation
or.less.)
l I certify that in the performance of the workforwhich 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.
1 certify that I have read this application and state that the above information is correct.
1 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 properly for inspection purposes.
Signature of applicant Date
Mailing Address
City, State Zip
Estimated 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 frorri1Property Line
FINAL DATE INSPECTOR �+
R J
Issued by' Date Permit
Validated by'
Validation: ' +
WHITE = FINANCE YELLOW = APPLICANT
PINK = BUILDING DIVISION
r- NOVI °8
I, IE
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
EAST VALLEY CONSTRUCTION'- DONALD & TERRY HAMILTON
SITE ADDRESS Lot 16 ,Avenida Alvarado
APN 774 - 203 - 009 . •BIN NO.: CASE NO.:
LEGAL: LOT 16 BLOCK 253 UNIT 24 S.C.@V.L.Q.
CHECKED BY: Wally Nesbit
2000-322
DATE:
9/z /op
.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
x
P,) 1/\
Case logged and number assigned
x
Verify legal and APN information
X
,v � 0.,,, se si=r, r. it= z v,)
Consistent with MDG on file (as.applicable
x
/.-, /woo c. (cert- f
MDG filing required (5 filings since 9/3/98)
V
No "2 i,,,,; , 4.,,vv
Consistency with street/surrounding area:
Colors
Materials
Architecture
X
0K
XNO
r sh-o --),%.,
X
0K
X
VA4/6 5 /4 -of 0/ v^ c - i � s4 -)f
/°(.r► M.Y, v-) �� ; /
Other Requirements:
.
- L.)42., (L7 . /'.fit G f C 01...- sesrri/-,
- 4/4/4.('7 SPrcviz dw"4i2/ o/u.,Eg
Notice:
Document Cannot Be Duplicated
Date 12/13/00
No. 21346
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Owner NameDonald & Terry Hamilton
11111111 IIIIIIIIIIIIIIIII 09
IE
APN # 774-203-009
Jurisdiction La Quinta
No, 54-160
City La Quinta
Street Avenida Alvarado
Tract # BLK253U24
Lot # 16
Permit #0010-281
Log #
Zip 92253 Study Area
Type of Development Single Family Residence
Comments
Square Footage 1641
No. of Units 1
*Received a cashier's check for $6,728.10.
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 imposedpursuantxo
Government Code 53080 in the amount of
2.05 X 1,641 or $ 3,364.05 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project mayfnow be issued
Telephone 760-564-4844
Fees Paid By CC / 1st Bank / Terry Hamilton
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempt by Annette Barlow
Signature
trA
Payment Received $3,36.4.05
Check No. 57196*
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
Certificate of Occupancy
City of La Quinta
Building and Safety Department
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 incompliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 54-160 AVENIDA ALVARADO
Use Classification: SFD
Bldg. Permit No.: 0010-281
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC
Owner of Building: DONALD & TERRY HAMILTON
Building Official
Address: P.O. BOX 1281
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 05-22-01
POST IN A CONSPICUOUS PLACE
IWO 08
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
EAST VALLEY CONSTRUCTION - DONALD & TERRY HAMILTON
SITE ADDRESS Lot 16 . Avenida Alvarado
APN 774 - 203 - 009 BINNO.: CASENO.: 2000-322
LEGAL: LOT 16 BLOCK 2 5 3 UNIT 24 S.C.@V.L.Q.
CHECKED BY: Wally Nesbit DATE: 9/2 a
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
>.
l/A
Case logged and number assigned
Verify legal and APN information
,
,L,(4,,,,,,) -,,,:,isr e c,,;2;, :10-,-,--,
Consistent with MDG on file (as.applicable
iv, .- ih/),,
MDG filing required (5 filings since 9/3/98)'
,,.,,, :,110,Z F -((- i "IG
Consistency with street/surrounding area:
Colors
Materials
Architecture
XN,)
T -5?'1-t ---) 'Ar
X
' K
@
U,42 r t S a "^ l L% /-12-3,,-1
Aro ✓y 3:�-, 4.'"\-) i.,) r / I`"
Other Requirements:
_ 0 , (6'7 774'2 C f c L, s1 „�
— U L'L (('r S / C. C% : e'~' 2 Al-// L 0 'i,e,