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0009-118 (SFD)LICENSED CONTRACTOR DECLARATION, [;,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 # Lia Class Exp. Date ate _ 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). .wr (' ) I, as owner of .the property, am exclusively contracting with licensed contractors:to construct the project (Sec. 7044, Business & Professionals XE• Code). aA ' O 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. Se)• I have and will maintain workers' compensation insurance, as required by ction 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' I I Policy No. nivlg COm'p INs Fv A542451-00 (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' p,erson in any manner so as to become subject to the workers' compensation'l'aws of California, and agree that if I should become . `subject,to:ttae wrkers' :binpensati n provisions of Se ion 3700 of the Labor Code,Wailure th,coalply wit i se �"ovisi Date'Applicant Warnisecure Workers' Compensation boverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor, Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a' permit subject to the conditions and restrictions, set forth on. his application. 1:,Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued -as a result of this application becomes null and `void if "work is not commenced within 180 days from date of issuance of sucti permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building, copnstruction, and hereby authorize, representatives f this City to enter upon the above mentioned propertynsgectio pu s. `Signature (Owner/Agent) ate171L. BUILDING PERMIT PERMIT# DATE'4j ttJj n . VALUATION LOT ����_ TRACT ^ f `G1�LJ� 5�171'ft ' JOB SITE APN ADDRESS 51-M A MAMi}NMi3MA 773 -ISI -cm OWNER CONTRACTOR/DESIGNER/ENGINEER 7-A.QUIN',f:APARItNM X0r.CKW Mr-2CYUr, MIK F DEWMi fJ1?MUN1 a OB`3:iS.:134 77.564 AC:t7MM1 .kY C&UP, D1 LA QVI1`3'IA CA.- 92,u53�y di1:.I;11 �1$".s� �'`I CA 92211, 1 Q60)408-3.495 CS3 $133 USE OF PERMIT M01C YAMMY MY -R 13WO SED -PERMIT FyCSL+,;: 1•JC,1'i INGIdt D9 81,10CX `iAi'ALLIPCCaLAPA OR APPROACH I: �Ml?,WAY' ' TRACT CONSTRUCTION 1,749.0 OF PORC.•I'1IPATIO 1-79.00 Sii7 5 FT., WOOD FENCIE 200,00 LF W.@ M 516.61) 3F EgI~or cogs OF C ONSMAY :I`a''ON 109,110.7o PEP .a �W MARY MAdgT UCTiON NEE 1014X) IB -001 PIAN CHICK FRZ Cil -000-439-311. $553.33 M,513H.011CA.FEE 101.000.421.000,.- 355,30 ZLIMTRJCA1, FEE 101. -000-420-000 *.130.00 laLUVIBTtr3C# FEE, 10I.000-419.000 3116173 STRI^sI•ib3 MOTIaM NINA • RA II3 101.000-141-000 t, X10.91 ORu1'k1,RIO1•'f ItJIPo001)* a3a� t1 $20,f�0 .0WI rf..,r.WPER II1IPACT VX30 PRXX13E P LAN 101-000.4.41-345 $100.00 V99D'0031T a 101--000-439-3117 4230.00 U. M 'ria "=Ci JS�^"k�illc'�°i4 IOi L�3+ll 1�1.1A41 CMC $3,559.99 IMS I M -FAM YEW 4250,00 6 TA,� : KTOU M DUE NOW r 7� RECEIPT DATEBY ( ' DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms& Footings _ 9�O 7 57 Ducts Slab Grade Return Air Steel Combustion Air Roof Deck _ 31 LS - CJ / 57 Exhaust Fans O.K. to Wrap i�. (� O ( 57 F.A.U. Framing _ 7 Compressor Insulation 16-7 Vents ' Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath 'i Drywall - Int. Lath C Final I_�3ZCdt 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 Water Piping _ Z - a �� �T Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection$7� Encapsulation Gas Piping Gas Test % O / r7 Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole �Z( oI S7 Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power S� Finaly!�-( Utility Notice (Perm) ' •- _ • , •._�, _. .. .. .• 'a:.'4 M�• � .. ?• s. . y ` _ r • .-`moi A �.. ,,. • .. 'l010(0 9- 1 �gTAtyl � uu�,tcu P.O. BOX 1504 APPLICATION ONLY Building �/ 09�An �O INTACCAL FORN A ALLE 92253 'Address ����//// r O ner I � (JAMN&SU Mailing BUILDING: TYPE CONST. I""•OCC. GRP. a 001 Address Po � A.P. Number T — (MI / ~y� I� Cityit Zlp �714s ��� +Tel. Legal Description 1L 4*r q W(� o 4 C ntrac or �,- )o p1 "^ �M u 'T Project Description 1. )1 l ,. 1)o% r t r \t/ ZipZ•t T1� State Lic. © City & Classif. � Lic. # Sq. Ft. (% � No. No. Dw. Arch., Engr., Size L+ 'c Stories Units Designer New Add ❑ Alter ❑ Repair ❑ Demolition ❑ Add ess ,.► Tel. Ci •y\��z10 I State Lic. # LICENSED CONTRAC'TOR'S DECLARATION I hereby affi m the 1 am lice ed uuutt1��gnnnttt-4arAlovisions of Chapter 9 (commencing with Section 7000) of �vi on 3 the Busi ssd rofessions Co and my license is in full force and effect. „ ..�=� GNATUR L -r \ DATE OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law fo(the following d j reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a 1 permit ro construct, alter, improve, it to file or repair any structure, prior to,itstoms issuance also requires the applicant lor,,such permit to lila a signed statement that he is licensed pursuant to PERMIT /+�'"j� AMOUNT 'the provisions of the Contractor's License Law, Chapter.9 (commencing with Section 7000) of Orvision 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for Ihe�alleged• exemption. Any violation o/ Section 7037.5 by any applicant for a pe d Plan Chk: Dep.."-� subjects the applicant to a civil penalty of not more than five hundred dollars ($500). I' I, -as Plan Chk. Bal. owner of the property, or my employees with wages as their sole compensation,.will �' •t do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisnass and COf1St., Professions Code: The Contractor's License Law does not apply to an owner of pioperty who - _ builds or improves thereon and who does such work himself or through his own employees, Mech. 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 Electrical of proving that he did not build or improve for the purpose of sale.) I 1 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing_. struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law doesnot apply to an owner o/ property who builds or improves thereon, and who contracts for S.M.I. such projects with a contractors) licensed pursuant to the Contractor's License Law.) Grading I'7 I am exempt under Sec. B. & P.C. for this reason Driveway Enc. +•,,,a .;» Date Owner Infrastructures 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.) Pol l No No. Company - opy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is /or one rhundred oilers ($100) valuation or less.) I cer 'fy that in the perform nc of the work.for which ttr - it is issued, I shall not employ y person in any man er o as ecome silbjec to Workers' m 0nsalion Laws �I' Dal Owner NOTICE T APPLICANT: If, atter making'h is Certificate E emption you shit become ZONE: .t BY: subject to the Workers' Compensation provisions of the ebo Code, you must forthwith Minimum Setback Distances: Comply with such provisions or this permit shall be deemed revoked. Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line Ihereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line Lender's Name Lender's Address FINAL DATE INSPECTOR 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. Issued by: "'"•' Date _ Permit 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. Validated by: R Signature of applicant Date Mailing Address Validation: City, State, Zip WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Desert Sands Unified School District 47-950 Dune Palms Road;. " Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760=771-8515 " . r Z, CERTIFICATE OF COMPLIANCE Date 12/6/00" APN # 773-151-009 No. 21289 Jurisdiction ;La Quints Owner NameLa Quinta Partners Permit # 0009-118 No.'51-889 Street Avenida Montezuma Log # City La Quinta Zip _ 92253 Study Area r Tract # , Lot #:, „` -Square Footage 1748 " , Type of Development. Single Family Residence _ - No. of Units 1 - r 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 niobilehomes. 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 fee's imposed pursuant to Government Code 53080' '% in the amount of 2.05 X 1,748 or $ 3,583.40 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 / 1st Bank /Dick Scott f t 11e phone ,760-408 3495 Name on the check By Dr: Doris Wilson r ,� Superintendent - < hr �, ' Fee collected /exempted by Annette:Barlow 'r Payment Received $3;586.40 Check No. 57148 Signature NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to collect them on the District('s)(s') behalf, whichever is earlier. - c:ouector: Attacn a copy of county or city pian cnecK application torm to mstrrct copy for au waivers. Embossed Original -Building Dept./Applicant Copy - Applicant/Receipt 'Copy - Accounting - V Gfis ep-19--000 09:59am From -COMMONWEALTH LAND TITLE RECORDING REQUESTED BY: , CHICAGO TITLE COMPANY COMPANY 9633KC 207055132 MON RECORDED MAIL THIS DEED ANA, UNLESS OTHERWISE SHOWN BELOW, MAIL TAX STATEKENTS TO: wiuiam Tho=s Buffin P_0. BOX 134 LA QUINTA, CALIFORNIA 92253 +7603413215 T-743 P-002/002 F-753 r -J PACE GRANT DEED THIS LINE FOR RECORDER'S USE APN: 773-151-009 !:-;I -889 The undersigned grantor(s) declare($): Documentary transfer tax is 527.50 (xxx) Computed on full value of property conveyed, or ( ) Computed on full value less liens and encumbrances remaining at time ofsale_ ( ) Unincorporated area: ( ) City of FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, MARY K. KRAMER, a married woman as her sole. and separate property who also acquired title as M_ KATHLEEN KRAMER. a married woman as her sole and separate 'property hereby GRANT(S) to WILLIAM THOMAS aUFFIN, an unmarried man the real property in the City of LA QUINTA, County of Riverside, State of California, described as: Lot 9, Block 28, Unit No. 2, Tract Santa Carmelita at Vale La Quinta, as per. map recorded in Book 18. Page(s) 55 inclusive of maps, in the'office of the County Recorder of Said County. Dated February 151 2000 State of California County of Contra Costa } S.S. on February 28, 2000 1' before me. Robin•L.Lance `x, personally.appeared Mary K Kramer and M. Kathleen KraMer personally known co -me (or proved to me on the bast; o. satisfac!::ory evidence= ro oe the person(s) whose'name(s) is/are subscribed to the within instrument and acknowledged co me that he/she/tney executed the same in his/her /their authorized capacity(ies), and that by his/ner/heir signature(s) on the instrument the person(s), or cne entity upon behalf of which the person(s) acted, executed the instrument- °' ROBIN L. LANCE � 0 COMM. 0 1216816 Q - NOTARY PUBLKlAuFORNIAO CON IRA COSTA COUNTY COMM. EXP APRIL 12 2003 WITNESS any nand and off i al.„Se Signature G��jh�� (This area for official notarial seal) MAIL TAX STAT MNTS TO: same as above 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 NW SW Development SITE'ADDRESS 51-889 Avenida Montezuma APN 773 151 _ 009 BIN N01., 3C CASE NO.: 2000=317 LEGAL: LOT 9 ✓ BLOCK 2 8 L,161T 2 C_�S.C:@V.L.Q. CHECKED BY: Greg Trousdell DATE: Inform the assigned Building plan checkerupon your assignment to this case.' The CDD Executive Secretary maintains a logbook 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 w��OQ MDG filing required. (5 filings since 9/3/98) tot Consistency with street/surrounding area: Colors aterials ecture P QR N0. Other Requirements: yq 7i .Z7 Certificate of Occupandy.:Oj City of La Quinta Building and Safety- Department' OF 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: 51-8.89 AVENIDA MONTEZUMA Use Classification: SFD Bldg. Permit No.: 0009-118 Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC. Owner of Building: LA QUINTA PARTNERS Address: P.O. BOX 134 City: LA QUINTA, CA 92253 By: STEVE TRAXEL Date: 08-21-01 Building Official POST IN A CONSPICUOUS PLACE