9905-0085 (SFD)54495 Avenida Alvarado
K4' 64, LICENSED CONTRACTOR DECLARATION
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s,. I hereby affirm under penalty of perjury that I am licensed under provisions of
a— = Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N.w Professionals Code, and my License is in full force and effect.
O = M License X172$ Li c. Class . Exp. Dat/3)/204
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o Z ,Date V r 1 ° f %•` Signature of Contractor' -'#4 -4. - - 7;',0-..-.....e. °Oh -
J U c, - OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ a 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). •
() , Iam exempt under Section , B&P.C. for this reason
Dte' • ' Signature of Owner
WORKER'S COMPENSATION DECLARATION
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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.
(a:') 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 STATE FUND Policy No. 229-99 UNIT 0004483
(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
Code, I shall forthwith comply with.those provisions. ,
1/Date.
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 costof compensation, damages as provided for in Section 3706
f 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 insjiection purposes.
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,Signature (Owner/Agent) /!, e, , I e <. 3' d
Date r .i'. >Al;
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BUILDING PERMIT p.1 905_085 ..
DATE 79VALUATI0N $89,1819.85 LOT i2 TRACT EI..K264 (324
.„6-//e) il
JOBSFTE ' 54-495AV.EN1DAALVAH..aIO
ADDRESS
APN 774-235-024
OWNER
CONTRACTOR / DESIGNER ENGINEER
WILLIAM L MORTZ
WILLIAM RUSSELL ROGERS
53.160 AVENIDA JUAREZ,
56-900 JACKSON
LA QUI'NTA CA 92253
THERMAL CA 92274
(750)399-1200 CBL# 5449
USE OF PERMIT
3NCI, E'FAMILY DWELLING
.:T .L- 1--Zili ii i iNCitDi Z1.i,It i1. w ALL, A'
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PLANS. P.ERIvIFI DOES NOT INCLUDE POOL
TRACT CONSTRUCTION 1,414.00 SF
PORCH/PATIO 20.00 SF
GARAGE/CARPORT 510.00 SF
617, WALL 15.00 LF
6FT, WALL 41:00 LIF
5 FT, WOOD .FENCE 120.00 LF
4L'STIMATE.11 COST OF CONSTRUCTION
89,189,85
PERMIT .FEE SUMMARY
CONSTRUCTION .FEE 101-000-418-000 $.504.50
PLAN CHECK FEE 101-000-439-318 $499.80
FEE DEPOSIT 101-000-439..318 =$250.00
MECHANICAL FEE 101-000-421-000 S47.00
ELECTRICAL FEE 101-000-420-000 $123.19
PLC1M 11NGFFE 101-000-419-000 S12}l.`:S
STRONG T.v1OT.ION FEE - KES/D 101-000-241-000 $8.92
.
GRADING FEE 101-000-423-000 $20.00
. 1LNFMetva.S F 225-000-443.342 $1,952. 4
PRECISE 101-000-441-345 $100,00
PLAN
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
53,474.62
LESS PRE -PAID PE -ES
-S250.0(1
TOTAL PJRA41T FEES DUE NOW
$3,224.62
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DATE
BY.
DfTEgINAL D gm
INSPECTOR
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INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set BacksAt-
5z
Underground Ducts
Forms & Footings
$_
Ducts
Slab Grade
r7—r9---45-7
Return Air
Steel
Combustion Air
Roof Deck
, fp'
S 7
Exhaust Fans
O.K. to Wrap
% • 2 9
57
F.A.U.
Compressor
Framing
Insulation
R24 - Q s.
S 7
Vents
Grills
Fireplace P.L.
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
--c 4
7
llLath
DrywallExterior - Int. Lath ?-----4?
/1/ 3e/f 4
S
Final
POOLS
- SPAS
Final
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
0Q4
5T
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
y y
Heater Final
Water Piping
J
eLr
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
S7
Gas Test
/L- Ip t
Appliances
Final
COMMENTS:
•
_
Final
!y
Utility Notice (Gas)
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Y
ELECTRICAL APPROVALS
Temp. Power Pole ______6
(7 F9
S_
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)
)
S
-FE.B.16.1999 6:54PM COMMONWEALTH IIIIIIIIIIIIIIIIIIIIIIIII 33 _,'
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RECORDING REQvESTED BY:
-Orange Coast Title Company
98 .8191 KC R-172554--1
WHEN RECORDED MAIL THIS DEED AND,
UNLESS OTHERWISE SHOWN BELOW,
MAIL TAX STATEMZNTS TO:
William L. Martz
53160 Avenida..uarez
La Quinta, CA 92253
NO.332 P.1/1
SPACE ABOVE THIS LINE FOR RECORDER'S USE
,yD * h APN: 774-235-024-4
Vrn1i1\ 1 JJ
54415 M. A4VaRApa
The undersigned grantor(s) declare(s):
Documentary transfer tax is $12.00
(XDC) Computed on full value of property conveyed, or
( ) Computed on full value less liens and encumbrancep remaining at time of sale.
( ) Unincorporated area: ( ) City of , and
•
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
DALE L. BUTLER and PEARLINE BUTLER, TRUSTEES UNDER THAT CERTAIN DECLARATION OF TRUST
DATED JULY 9, 1990
hereby GRANTS) to
WILLIAM L. MORTZ, an unmarried man
the real property in the City of LA QUINTA, County of Riverside, State of California,
described es:
LOT 12, BLOCK 264, UNIT NO. 24, SANTA CARMELITA AT VALE LA QUINTA, AS
PER MAP RECORDED IN BOOK 19, PAGE 44-45 OF MAPS, RECORDS OF RIVERSIDE
COUNTY, CALIFORNIA
Dated November 30, 1998
State of California,.
County of .&A,Ur [
On
before me, hot A'
G
} S.S.
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personally appeared
Li L. _R(. j r M2 l ►N D
e r -41.414 tt4T L
(or proved to me on
the basis of satisfactory evidence) to be
the person(s) whose name(s) is/are subscribed
vo the'within instrument and acknowledged to
me that h-eke/they executed the same in
h f'ke.r/their authorized capaoity(ies), and
that by hisihar/thei.r signature(s) on the
instrument the person(s), or the entity upon
behalf of which the person(s) acted, executed
the instrument.
WITNESS my
Signature
nander offic12) se
MAIL TAX STATEMENTS TO:
SAME AS ABOVE
DALE,.. BUTLER, TRUSTEE
723111LZe-, 4Rce-?"-e-dP
PEARLINE BUTLER, TRUSTEE
MA At1041 z
Latey Pdgc -- t'x
Car:la 1
ORANGECOUNTY f
Mf Cbmm. Ep$es DCC 27.1473
(This area for official notarial seal)
11111111111 1111111111113 4
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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
Building & Safety as your correction list. Please attach additional explanations as necessary.
APPLICANT: RUSTY ROGFRS, riFsP.P' RF„sARcH DEsAgrop44ENT
PROJECT
ADDRESS:
. 54-495 Avenida Alvarado
APN: 774-235-024
LEGAL: LOT 12 , BLOCK 264 , UNIT 24 , S.C. @ V.L.Q.
C K' D BY: LESLIE MOURIQUAND
BIN NO: See BuildingCASE NO. 99-52
CHECK 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
>:f:l. ii`/1
Case logged and number assigned
Verify legal and APN information
Consistent with MDG on file las applicable)
MDG filing required (5+ filings since 9/3/98)
6Gtco tam 7'4'3
•-Gonsis-tency-with street/surrounding--area:
Colors
•
Materials �
Architecture
neica.QPrsm4-
OTHER REQUIREMENTS:
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.
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
Date 5/10/99
No. 18718
Owner NameWilliam L. Mortz
CERTIFICATE OF COMPLIANCE
IIIIIIIIIIIIIIIIIIIIIIIII 35
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APN # 774-235-024
Jurisdiction La Quinta
Permit #
No. 54-495 StreetAvenida Alvarado Log #
City La Quinta
Tract #
Lot # 12
Zip 92253 Study Area
1,414
Type of Development Single Family Residence
Comments
Square Footage
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'aniount of
1.93 X 1,414 or $ 2,729.02 the property listed above an'ci that building
permits and/or Certificates of Occupancy for this square footage in this proposed project -may now be issued
Fees Paid By CCNIB/William Russell Rogers
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green
Signature
G
Payment Received
•
Teiephone 39911200 �-
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Check No. 195014
$2,729.02
NOTICE: Pursuant of AssJ(nbly 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
r
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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: 54-495 AVENIDA ALVARADO
Use Classification: SFD
Bldg. Permit No.: 9905-085
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC
Owner of Building: WILLIAM L. MORTZ
04/A4/1 -
Building Official
Address: 53-160 AVENIDA JUAREZ
City: LA QUINTA, CA 92253
- By: STEVE TRAXEL
Date: . 12-30-99
POST IN A CONSPICUOUS PLACE