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9907-0104 (SFD)LICENSED CONTRACTOR DECLARATION •}• �i , l'hereby affirm under penalty of perjury that I am licensed under provisions of ' 1-- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and tV W f' Professionals Code, and my License is in full force and effect. O' D M " License # Lic. Class Exp. Date F Q t i3 �tkKh.") h a w�,rttn � z° r- ate/2 1Signature ,y,,.:.Contractor • J 1-C) ▪ ' OWNER -BUILDER DECLARATION HWW I hereby affirm under penalty of perjury that I am exempt from the Contractor's a. U)' 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 8 -Professionals Code). co () I am exempt under Section , B&P.C. for this reason to N Date Signature of Owner ON rn d Q WORKER'S COMPENSATION DECLARATION pZ I hereby affirm under penalty of perjury one of the following declarations: I- CC 0 ( ) I 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 J Q performance of the work for which this permit is issued. CO < V ( ) I have and will maintain workers' compensation insurance, as required by O 0 .Q Section 3700 of the Labor Code, for the performance of the work for which this C1 Z permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier Policy No. co .'•,•, • 1491'1 '1Rf ♦'111 1'i, I.i(U�44 ll; '.. '_4� ,'141.1 J (This section need not be completed if the permit valuation is for $100.00 or less). (ter) 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 subje6 to the workers' compensation provisions of Section 3700 of the Labor Vie, I shall forthwith comply with those Rrovisions. it5ate• it !a Applicant --'It A L r C�. )t Warnincd: 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./l 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 bove-mentioned property for inspection purposes. /i ignature (Owner/Agent n L) C. - ? . Q.. 4. £/L. Date .-I 1r BUILDING PERMIT PERMIT #9.14,7-144 DATEt VALUATION m1,3.339.50LOT 4 TRACT 1111(264I.)!ti JOB SITE ADDRESS 14-325 t0VENilki Ai, 2�Liit'i .kg APN 774-235.01G OWNER 1 .Sr•4.' `.1 .1(1L tit r: 44. ♦ .4,.x,4...4 t-220,\ Vt.'.iV1i)11 CAaiti'1147,1t LA (,)0IN+f't\ CA 91.2.5.3 CONTRACTOR / DESIGNER / ENGINEER t,t r•V ('4 dUV GEN t1U•,1T r'I, rrf, qC"I'//It) r. 1....,% !nN\)4 S1... t.4341 ♦ •Jl,1 U1.. 41..4. Ji -220 t1 A t.iN71i)[\ CAR LA r;tUfN'i'A - i.:A 92. S3 1760ISi1/l-?SI 1 (71:11.0 11 1 c . USE OF PERMIT :+ Ili +.ri.it PA -Mil, l Vljf i.LiN . i :.1;7.) - l'i.tlitl 1111, ES %r'.i l INCLUDE til.: A7% V4A.1.L C.a.!'ll'JL.. J`l..AN l.ilist--i.'. i'ut. J J'4J' '1.i-' '1;147,., i'+Jk . hrt Ir; r'IPI.N INS!JAINi.;l'; t.)1' .irlftrli i'LAN'l'1'111. T1Z..ACT ta.•iv: pljit..T :; ON I, 5.1i, . cS31. 1 t'O7lLti/{'1111tt1-1 77.(n) S/' tleiKA1 ti•Ji. tlrtaJt.tk'1' 4' t.f.0 :iI' S t'l'. V0.)4_11.) r.;r;,N,.'t '.010 tn,1 LI; • 0'i, {rYnR tY44.!.4*.Vr 4_14•' 4."«h♦V 44e,4Y.'ri!J17,r i'r i4Nit a 14.7. '. i.17% riV,>t:c V (,*.ltsi't'1'iri,11171'i+_)N FEt. 101.1)1'1'1-i1tx-1,i(16 Xt.t!.ytl t'I.4tki r'114;41.'. I:I:f; i11l-4111?.4z+a.'4tR t1"- t+' *j•(('� 1'• 1. • t •r• 101 000 1',i !V.° , +^,01/ .!:•L,I['+.Y1r.:'t�..[t: .VA'V+IJ••t,i !•4111 ,gil.Vtr r.i.liCiitl.Crr,i, FP.A =u(-iO4-i20-000 SO1.2.t-• ('r.ts .IN(NO161.ti r 1.4)i4)00+-.4 9.04.4) it'- ' :riltiIN" 1 t-MiltIN1717t7-11P.,Itr1 IIII- i?(lrl'+:lr.ON) K4't1 1 \ fTT i �� rll t'i 1 1 {.. T Ci.,J ::.1T3 •'i 1. 1 090. 23.O:4. •..14.116 f'iGt:4.:i?:lit't,A1'i it)i-tJCiv••i•it :+•1S 11;!',14) VI E t.)Fin t'1' (111-ilt)i).4:t9-.41t'-s2.:A),441 174:1.'';:4 Tlilr:t; IMPACT Ft 17 1 1,'x17 on • X1)K=1%-trA1.((T'!Srir1Te.-r{ )N ANr) P1.AN('1Wi'1: 1 C;:!t'' :'11r l';' l'? t:1-'l'c• t't.) l'AI, 1'4':FiAM Ft' t'1';C S f111.11. ;NOW • �� r',IIIIIIIIIIII1IIIIIIIIIIII f-i'11,C/22 441'4,14 Cil ' f '"''' a 1 - = t'' r' :, 1.'+•) t• • lr-,4 �J ' / ril; t' ,-til r ,. - to r T t 1 ... _ ' -t. ty 4'11114~1 12ti/l l,i1 `)2 h»t,e0, 11 I E RECEIPT DATE BY' DAF¢ 5INA E[�OD INSPECTOR •4 • INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs 77 Underground Ducts Ducts Retum Air Combustion Air Forms & Footings ® 0 Slab Grade 3 Steel ODeck /// S7 57 Exhaust Fans F.A.U. Compressor ?(1j O.K..K. to Wrap Framing Insulation p_2610-0 f� �� 7 Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath c Drywall - Int. Lath 7 /� Final Final �� POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs r�� Electric Bond Footings �`i' �1 .,--,o -.Ole, ' 97 Main Drain Approval to Cover. Equipment Location Bond Beam 7 $4, Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines / /8� Q� J— Heater Final Plumbing Final • Water Piping Plumbing Top Out Equipment Enclosure • Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Encapsulation Sewer Connection —4/-24/ y4 / L Gas Piping 4 ` Gas Test (' " AppliancesG Final COMMENTS: , Final• (0466 Utility Notice (Gas) ELECTRICAL ELECTRICAL APPROVALS Temp. Power Pole 2i 3gsgt. S r Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final U Utility Notice (Perm) 7- I l -ate ., . 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 in compliance with the various ordinances of the City regulating building construction or use. For the following: BUILDING ADDRESS: 54-325 AVENIDA ALVARADO Use Classification: SFD Bldg. Permit No.: 9907-104 Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC Owner of Building: JACK CLARK JR. Building Officia Address: 51-220 AVENIDA CARRANZA City: LA QUINTA, CA 92253 By: STEVE TRAXEL Date: 08-10-00 POST IN A CONSPICUOUS PLACE :T..1s. Hof.nr.4 45' ;ta`s':X :: tiy.:r�is�...c.,,,,5,•-t-;:c�►-r-+o'2+'•""i..•>t",ry"�`:nti.'r`.r. , _'T~�. 1 I1101111111III Il��� eft 12 °%°I\ o dsf id Q P.O. BOX 1504 l Building�`/ I \ 78-495 CALLE TAMPICO APPLICA O 11'9 r� Address 1 ja cJ� \ Joy Ca..4 b LA OUINTA, CALIFORNIA 92253 Owner Ja41 1.. Cla.vk.. Mailing ' /J Address c-31 © Ave,r City Zip Tel. Contractor` lk SIL Clew [G j y, Address BUILDING: TYPE•CONST. OCC. GRP. A.P. Number 1,-rt4 — sc (AL -1 Legal Description l O j bl VG1L z L I \/hi k Z4 Project Description City Zip Tel. State Lic. & Classif. City Lic. # Arch., Engr., Designer Sq. Ft. Size No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ 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 the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER•BUILDER DECLARATION 1 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 live hundred dollars ($500). O 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 Caw 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. 11, 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.) 1'1 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.) 17 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. 0 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 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, alter 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 applicant Date Mailing Address City, State, Zip Estimated Valuation PERMIT AMOUNT t Plan Chk. Dep. 2.50 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 Issued by' Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT Date INSIpAlg dermit JUN 2 9 1999 .spa 1 lJ1 � ;^ i4-i111�V 1e PINK = BUILDING DIVISION Notice: Document Cannot Be Duplicated Date 12/28/99 No. 19851 Owner NameJack Clark, Jr. Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE IIIIIIIIIIIIIIIIIIIIIIIII 13 IE APN # 774-235-016 Jurisdiction La Quinta No. 54-325 Street Avenida Alvarado City La Quinta Tract # Lot # zip 92253 Type of Development Single Family Residence Comments Permit # Log # Study Area Square Footage 1506 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 the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.93 X 1,506 or $ 2,906.58 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/Valley Independent Bank/Jack Clark, Jr. Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Signature Olivia Aguirre Payment Received Telephone 7760,-56473511 4 :l. r $2,906.58. 4 1• Check No. 209506 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 Rec'olding Rnownt:n0 r�), C - lCAGo TITLE coMPAhiy, RECDRIING REQUESTED BY: CHICAGO TITLE COMPANY COMPANY 53.$411 KC 970652673 w"6aWO. :A. ,L. CLARK, JR. - 540350 Ave zDA HERRERA LA Q[1 NTA, CA 92253 5W2s-, ec A ik444 Y � w 9 • Ca low ••••••••16 [ gal 61 ew .1, GRANT DEED ASN 7.? -2 5_d 016=7 The undersigned grantor(e) deelare(a): aocuirPntary transfer taut is $15.95 (XXX) Con;puted on full value of property conveyed, or ( ) computed on full value less liens and encumbrances remaining at time of sale. ( ) Unincorporated area: ) City of _ 4nd FFR h vAt,UABT+R CONSIDERATION, receipt of which is hereby acknowledged, mask J. SARDO, ae to an undivided Sok interest and PETER CJAMARDO, as to an undivided 2sv inCerelgC and SALVATORE CAMARDO, as to an undivided 25W interest, as joint tenants hereby GRANT(S) to JACK :, - CLARK, JR., A MARRIED MAN AS HIS SOLE AND SEPARATE PROPERTY Che real property in the City of LA =PTA, County of Riverside, stets of California. described ea: LOT 4 OF BLOCK 264, OF SANTA CARMELITA AT VALE LA ODINTA, UNIT NO. 24, AS SHOWN 3Y N.Ap ON FIL! IN BOOK 19, PAGES 44-45 OF MAPS, RECORDS OF RIVERS= COUNTY, CALIFORNIA Dated February G. 1999 State, of California Cour)' of c,4 D/LSC• &' ) 5.S. On. /EP 1 if.4 1'^q aefoee me, IQ,O_ 22&41 S c. )h r!✓__ _ _1�,f.:, .1 a(D•� personally appeared _�.'.r�•,/ [. /lrffjJ/�1� rizil.ovite _L�+ tid X 0U personally known to me (or proved to me on the bnsia of satisfactory etvidenee) to be �;he: pzrmoekia, wroee riame(e) idintc subscribed r.e ti:e within instrument and acknowledged to ;:e that 1 Ef they executed the same In *07`.:sef7their authorized capscity(ie91 , and that by hkObe..7Chefs eignatgre(w1 on the instrument the petaon(s), or the entity upon behati )1: of 'whieh the person (s) acted, executed the Instrument_ WI N1SS my hand nd of 1 •01 seal. eign;,ture MAIL TAX STATEMENTS _ TO: • PETER CAMARDA sALVATTRC CAMARDO 1999.339611 OW90 1999 99.88 ' c.r 1 RON'AID S, COMtN aimi Commission *1132513 r NoIWY ?unfit • Caln•1110 son ,Diego cos"! gaZg/ISAIN 1111111 1111 I I 111111// 14 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 applicabitity of compatibility issues or need to require the filing of Master Design Guidelines by the applicant. It shall be transmitted to Building & Safety as your correction list. Please attach additional explanations as necessary. APPLICANT: Jack Clark, Jr. PROJECT ADDRESS: 54-325 Avenida Alvarado APN: 7.74-235-016 LEGAL: LOT 4 , BLOCK 264 , UNIT 24 S.C. @ V.L.Q. CK'D BY: Leslie Mouriquand BIN NO:. CASE NO. 99-90 .CHECK DATE: •id /7i 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 r.,}'.. ,\ .. : \ ,.\. : n•\4wE. iii ur.v\'•.`••`n'4 t• 4 `. 4\,C. itiu"l:Ni >� i\r �'\`4't \ \. •' {�i?.:, v ...... .A . . ��hh •:,{,A�{``'4.ii:{j•<,:•:\L'{'Linty ,: h�}�\:) `y.T:.Qn'i'`�� } `� L}Z.{\.:; . $ `C•in .,7: vi.,{..r:{ } +.C�4 „ vJ\`�i'�<{ ;:`i'�,4�i��y:`,^\ 4\. �4��1:L4n�' +,, `1J"}• ..'.k .} •\\�`C:q;;}{�.\L��,t•,:..4��\\4 n!r"4if`:4 ,hi� 1�. `.\\: ,ice \\ti. ti}. `f�•.�\�+� '��•' r, ;0}'`\�•}•k`h�.ha}u\\4\v�Q�'4i\\{' >: �4� }A�...�•:�}C}�1,•1..•'\4\+. vi V.V^J%J l%.JTl\d .. ., ::�.. •` \• ":..�}�,\� ::{�)\.��::{;�•}}}�i�::•���`.,�1{�:`::•:.�:•h1,.d�\:•}}:{:i�,�•{:>.{{�^tri'.•.:'.•�\y.',.......:?::}{��w,x•`:•`..}'i'h.�. 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) d' 7 - oZ7 -- ' 9 . Consistency with-street/surrounding area:. . • Colors Materials Architecture � l^+ !/ OTHER REQUIREMENTS: • . ���% ��'u41 . r I?, (": /' . g. / ;7(3/f .. The zoning code, architectural and landscaping manuals, and/or assigned inspector should be consulted where uncertainties arise. The completed checklist shall be maintained in the Building & Safety address file.