SFD (0105-277)77540 Calle Madrid
0105-277
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 ;ny License is in full force and effect.
License # Lic. Class Exp. Date
789340 F 1;3
Date 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).
( ) I, as owner of the property, am exclusively'contracting with licensed
contractors t6 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 perialty 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.
( ) 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:
Canter Policy No.
3T,Jf YE,1 YND 044000202X?
(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. provi i6s.`"
Date: .dd pplicant
Warning: Failure to secure Worker; 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 Cityto enter upon
the above-mentioned property for inspection purposXo- D
Signature (Owner/Agent) /F•--•-- "'. :-sater
r
BUILDING PERMIT PERMIT#
r
DATE VALUATION LOTlj ,, ,°,?,'y7 TRACT ,
MAMAO 12 BILK 288
JOB SITE
APN
ADDRESS
77-540 Q&LIX, MADIM
774-2u-.024
OWNER
CONTRACTOR/DESIGNER/ENGINEER
A ri , A? € . z. CAIT HO a ktrZ,DE.W INC'
' a:.DnS NIC
P&L.. VdF 4'fCA1\41yy3[atj
" I ` 995 « b. ✓.✓M. .l'1.4f. A.AY ,l fXUE
UE
✓655111 I F :,,1 i.UPIDG `b!f AMAMI' 1
RdUt51„.+MIf.+tr CA 91211
PATIIJv Li7L5&"U : CA 92211
Q 60}-Zae-0277 C`814i 6373
-
,
USE OF PERMIT
N !pp ff ,qy vv qq pp yy q r y,t
S7d GUE daAWLY,• D Y9JflF.r1.WG
'
SYD PERMIT VOir.S NOT.INC.,3..iiM f3.f.,CL':b' .i' .f'i1.dL?DOUSPA. OR
'DR lV9WAY All RIDAC11, 34 kW TLIV EL6 MA2T ER.
TRACT CO4aMU—CTIU?i 1,62&00 S
GA RACI 420.0f; 31e
ENTM x4 C -OS OF COMMUk'^"•. 1 .N
,-W,,632.40
CONST UC 1014 'FEE 101 ^00(s,,41 S-000 SO -26.00
PLAN CHIS :4: FRE, $319.x4
FEEDEP091T IOla t (J 13 5't +4250,00
IMPMHANIC AL FTM 1 C11-000.421-000 $53.50
E1. N 3')2YC°M..1.-SK 101.000-420.000 $113.90
:u'Z.UM1811ti 0 Mr, '10i -C100-419-000 $119.25
'1:a.OW MOTION !'fKE - MIND 101-000-241-000 M66
CMAD'IHn FE?, 101-0004123-000. $20.00
DEVI!,10Pv11IMPACT KE ` l'or oo
1: REC.;13Z zaLA141 W 1400-441-,'345 $100.60
nlY.1". 3:-MIAL C ON'SY,fR1:JC'I:,TONAM7PLAW CHWX
$3,468.54
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
_
Q
/
(
Underground Ducts
Ducts
Slab Grade
l
Return Air
Steel
_ .Q
Combustion Air
Roof Deck
, , d
$'T
Exhaust Fans
O.K. to Wrap
Framing
Insulation
Fireplace P.L.
. g. o.
_L$_®(
9 Q (
G
$,T
-p. T
s
F.A.U.
Compressor
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_
Final
BLOCKWALL APPROVALS
Final
POOLS - SPAS _.
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover `
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
Plumbing Top Out
_ _
/b
or
S C
Heater Final
Plumbing Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Gas Piping
Gas Test
Appliances
_ _
(`
Pool Cover
Encapsulation
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
Utility Notice (Perm) & -D!
/,0 tf
`Z_7^ 540.
P.O. BOX 1504 APPLICATI ONLY
Building 78-495 CALLE TAMPICOS
Address ( i ` I . LA QUINTA, CALIFORNIA 92253
'.MER,'cAA/ Io.KE
anuiy q t' /
Address — f I—LDi ZG7 /'>rvr
City Zip Tel.
%/-,-f Ph -err: r ZZI % 1Gd-zaD-Uz i
" Contractor
Address
p
State Lic. I City
& Classif. —78 cY 5^L.16 Lic. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 o1 the Business and Professions Code, and my license is in full force and
effect.
3LGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness 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, 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 l 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.)
i 7 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I herebyaffirm 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, 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.
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
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number 71 V —Z 1% v O Z y" 9 O
Legal Description LdT 12- %SL.K V
Project Description S' it Q
Sq. Ft. % Ozg No. No. Dw.
Size Stories Units
New C3/ Add 0 Alter O Repair 0 Demolition 0
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 from Property Line
FINAL DATE
Issued by: Date
Validated by:
Validation:
i
CITY OF LA OU.INTA
WHITE = FINANCE YELLOW = APPLICANT PINK BUILDING DIVISION FINANCE DEPT
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
` 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 5/24/01
No. 220.45
Owner Name All American Home Builders, Inc.
APN # 774-211-024,
Jurisdiction La Quinta
No. 77-540 Street Calle Madrid
City La.Quinta ` Zip 92253
Permit # 0105-277
Log #
Study Area
Tract # BLK 285 Lot # 12 Square Footage 1,628
Type of Development Single Family Residence
Comments
*Received Cashier's Check in the amount of $10,012.20
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
2.05 X 1,628 or $ 3,337.40 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/ Ist.Bank - Mark Tuvell Telephone 760 413-8291
i" Name on the check
By Dr.. Doris Wilson
Superinteii0g4t
Fee collected /exempted by Paula Ruiz Payment Received -7$3,337.40
i
Check No. 58172
Signature -
t,
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
tolled them on the District('s)(e) 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
RECORDING REQUESTED BY:
RE/MAX Real lAWO Consultants Esc row
Division
AND WHEN RECORDED MAIL TO:
AND MAIL TAX STATEMENT T0:
All American Home Builders
76995 Florida Avenue
Palm Desert, CA, 92211
Crider No, 515052-1
Escrow No. 01 -00127 -DS
Parcel No, 774211.024!
ABOVE
GRANT DEED
THE UNDERSIGNED GRANTOR(S) DECLARES) THAT DOCUMENTARY TRANSFER TAX IS $36.30 and CITY S
X computed on full value of property conveyed, or
computed on full value less liens or encumbrances remalning at the time of sale.
unincorporated area: La Quinta And
FOR A VALUABLE CONSIDERATION, receipt of which Is hereby acknowledged,
Jon Michael Whittaker and Mary Sue Whittaker, husband and wife as joint tenants
hereby GRANTS to All American Home ;Builders, Inc., it Califormia Corporation
the following described real property in the County of Itiverside, State of California:
Lots 12, Block 286, Santa Carmelita at Vele La Quinta, Unit #26, In the City of La Quinta, County of Riverside, State of
California, as per map recorded in Book 20, page 50 of Maps, in the Office of the County Recorder of said County.
Date
Ion Michael Whittaker
STATE OF CALIFORNIA )
. . MS.
COUNTY OF }
Mary Sue Whittaker
On before me the undersigned, a Notary Public in and for said County and State, personaiiy appeared Jon
Mloha®1 Whittaker and Mary Sue Whittaker 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 me that
heishelthey executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the
instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
WITNESS my hand and official seal.
Signature
A
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 All American Home Builders
'i-- S'qo
SITE ADDRESS ? Calle Madrid
APN 774 _ 211 - 0 2 4 BIN NO.:
LEGAL: LOT
CHECKED BY:
12 BLOCK . 285
Wallv Nesbit
CASE NO.: 2001-455
UNIT S.C.@V.L.Q.
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
Compatibility Review
i✓
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)
Consistency with street/surrounding area:
Colors
ECVD FOR PROCESSING L ` bl
(DATE)
SSIGNED TO L_ _- Materials
(INITIALS)
Architecture
OK r
Other Requirements:
Wmyed br,p
Planning Commisston ....,....._,,,,.
City Council.
Community Oev. OepL .- . 772.
itiais
t
xhibit
With Conditions_
(OA
-r ASSIGNED TO
nNmei s
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: 77-540 CALLE MADRID
Use Classification: SFD Bldg. Permit No.:
Occupancy Group: R 3 Type of Construction: VN Land Use Zone;
Owner of Building: ALL AMERICAN HOME BUILDERS INC
Building Official
0105-277
RC
Address: 76-995 FLORIDA AVE.
City: PALM DESERT, CA 92211
By: STEVE TRAXEL
Date: 10-23-01
POST IN A CONSPICUOUS PLACE