SFD (9905-372)77560 Calle Madrid
9905-372
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 my License is in full force and effect:
License # Lic. Class Exp. Date
5 24
Signature of Contractor
S . / it
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 to, 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 penalty of perjury one of the following declarations:
() I have and will maintain a certificate of consent to self -insure for workers'
corm• pensation,'as provided for by Section 3700 of the Labor Code, for the
pert. erm nce of the work,for which this permit is issued.
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 FWD Policy No.,
STAT!" 11 ! fuapq
. n"D ..a:• irN-7'r-1 V4 ); iS
(This section need not be completed if the permit valuation is for $100.00.orless).
() 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.
Date: Applicant
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 cost of compensation; damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Applicationis 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 resttsft 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. I spection purposes.
Sgi"nature (Owner/Agent)" y ry y Date's I,
PERMIT #
BUILDING PERMIT
49s ''. .X12
DATE VALUATION $95499120. LOT . 13 TRACT C3LIQ84 026
JOB SITE
ADDRESS 7.564) Ci 1. r. E1. 10° AD IID
APN : 774-212,012
OWNER
CONTRACTOR/DESIGNER/ENGINEER i
LVANORE MMICIN'
,,';v JOWL CONN, -I, UICMIGN MAINAOU, 1,4111.,,. .1
68-$42H MWOSILLO RD ...
41445 BOARDWALK, SUA f t 12
CATHEPRAL MY CA 922,34
PALLNUASEWr CA 92211
,,W)340,4445 t A1.0 5903
USE OF PERMIT
yMLENM,` l.,tz44
LIt.'D -Pmow•l' Doss. wxr :-mia. .-, 13ith" IC Ww. otL.por)L.
;l,'s.t3fl:IF
45ARAGMARPORT 486.00 5F
5 fat'. WOLA) FLIM »IV. :?t3FZi.flfJ i -F
..
FJ . '33.i1 ,$''ll ks'!k. 'r2t .i(}.4^•{ > Q ' ( 1 $ J.;:.f.gt}
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! 'N S Ct.T
t4y"f14"K ?F &'. f t -t 44t 9'4\#. 55 `-:}i3 S
0111ANy
21 ^^$r ,
[[1 /R,
:vffiCt ANI:':AL 17116
Yb 1
ib131.54
-
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a-
1 '97Tr.I YU.4 41frt)- . V).flts
;s
.PRECIK, t.L..Atv6
I9 <11 oT.c s»e , it .f1t"•?' f tsfr, $1,9(rmo
81,I1B-i''c 1AL. f.:()NS'1'U)t" i'1t}tN AXID .L'9...AN CH11'r-K
S3,42RJO
RECEIPT
DATE G p y
' ) I
BY/ J'
.I .& r
DATE FINALED
INSPECTOR
' .
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs _ _
Underground Ducts
Forms & Footings S 7
Ducts
_ Z! G
Slab Grade C
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final 3
Wa
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 _ _
s
Heater Final
Water Piping 1 / Q g
Plumbing Final
Plumbing Top Out 111 /
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection ! - - QS' S%
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final: /
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp Power. Pole f
-L
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final 3 p
Utility Notice (Perm)
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 11/5/99 APN # 774-212-012
No. 19555 Jurisdiction La Quinta
Owner NameEleanore Cannon
No. 77-560 Street Calle Madrid
City La Quinta
Tract # BLK284U26 Lot # 13
Type of Development Single Family Residence
Comments
Permit # 9905-372
Log #
Zip 92253 Study Area
Square Footage 1552
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 arndunt of>, r
1.93 X 1,552 or $ 2,995.36 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now i issu a
Fees Paid By cc/Union Bank_ of CA/Gen. Cons. Mgmt.
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by
Signature
Name on the check
Juanita Green Payment Received
Check No
te
Teleph6►ra .'340- 4452
$2,995.36
6528610
NOTICE: Pursuant of As mbly 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 frPm the date on which the building or installation permit for this project is sssued or on which they are paid to the Distdct(s) or to another public entity authorized to
collect them on the Distnct('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
Building 1 ' e {
Address . [ f
Owner
Mailing
Address
City ,.. Zip .
tractor ( t,
4 4a"
P.O. BOX 1504
1 1r K ti -495 CALLE TAMPICO
!i. Abe LA QUINTA, CALIFORNIA 92253
APPLICATION ONLY
BUILDING: TYPE'CONST..
t i ) l y OCC. GRP.
I t lC f ct, A.P. Number—
Tel.
`
;4 Tel.
1! -- ;-'' Legal Description ,t Yl- F(I ro I I \ i 1 f;- , ti -i X' Z:.
I,\ 1 __ _ __ _ . _ _ _1 Project Description
CitykZip Tel.
State Lic. City
& Classif. - t b4 (1 Lic. #
Arch., Engr.,- y -•
Designer (V 1Designer }f (L
Address I Tel.
iSq. Ft. ; No.
Size l Stories i
t New 1K Add ❑ Alter O
t r•. tl V' ,. t
City
C1, '►R, _` Zip State
Lic. #
(` LICENSED, CONTRACTOR'S DECLARATION
1 hereby affirm -,that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division'3 of the Business and Pigfessions Code, and my license is in full force and
U J 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 (5500).
(_2 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 I 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
doesnot 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.)
1-1 1 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.%i company } f +• ) I
177 Copy is filed with the cii+!. O Certified copy is ereby 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 ing work for which this permit is issued, I shall not
employ any person in any man sos to become. subject to the Workers' Compensation
Laws of any
p California.
1. t,.bec _m subject
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
No. Dw. i
Units
Repair ❑ Demolition ❑
PERMIT AMOUNT
Plan Chk. Dep. ^ S
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 t-
++ Side Street Setback from Center Line
f
if Side Setback from Property Line
FINAL DATE
Issued by: & 1 ,,9permit
Validated by:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION t
1
RECORDING REQUESTED BY:
•CHICAGO TITLE COMPANY COMPANY
98.7985KC 87009838
WHEN RECORDED MAIL THIS DEED AND,
UNLESS OTHERWISE SHOWN BELOW,
MAIL TAX STATEMENTS TO:
ELEANORE L. CANNON
68842 HERMOSILLO ROAD
CATHEDRAL CITY, CA 92234
523758 o0
RECEIVED FOR RECORD 6.- /a, 99
AT 8:00 AM
P�, DEC -2.1998
Doc. ID
Transfer Tax
ocuded in O P-1111 -
R1�1. -- - ----- {?r f fi-'=-1 +Count.. Caw r'
2 f oordar
SPACE ABOVE THIS Lf19 ffiFOR-, Z)RDER' S •USE
APN: 774-212-012-2
��-o to - o1 s_ GRANT' DELI) 77- %o CAt.,.F.
The undersigned grantor(s) dec e s
Documentary transfer tax is 18.15
(XXX) Computed cn fu',11 value 'oaf- err_y conveyed. or
( ) Computed on full value less liens and encumbrances remaining at time of sale.
( ) Unincorporated area: ( ) City of and y
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
WILLIAM R. RILEY, TRUSTEE OF THE WILLIAM R. RILEY TRUST DATED 1990
"1
.hereby GRANT(S) to
Q
ELEANORE L. CANNON, a widow
v
•the real property in the City of LA QUINTA, County of Riverside, State of California,
described as:
LOT 13 IN BLOCK 284 OF UNIT 26, SANTA CARMELITA AT VALE LA QUI NTA, AS PER MAP
RECORDED IN BOOK 20, PAGE 50 OF MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA
Dated October 11, 1998
State of California
County of Riverside } S.S.
On _ November 10._1998
before me, Kelly C011ier
personally appeared
William R. Riley
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 he/she/they executed the same in
his/her/their authorized capacity(ies), and
that by his/her/their signature(s) on the
instrument the pern(s), or the entity upon
behalf of which the erson(s) acted, executed
• the instrument. �}
1
WITNESS my han Oq off cit seal.
C
Signature
MAIL TAX STATE NTS T4:\ SAME AS ABOVE
0
'WILLIAM R. RILEY, TRUSTEE
OF THE W-TLLINVII R,. RII;.FY TR?:JS- DATEp
i990
E�°'mtv
ves Mir �: I999 .t
a
My Comm. ExVires May Q
is area for official notarial seal)
:
0000i
l./ t ► IIN'TA .
RC District- Planning Review Form MAY2 7 RECD
This form is to be used by CDD staff for review of single family dwellings in the RC`s( oSeA
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: GENERAL CONSTRUCTION MANAGEMENT
PROJECT
ADDRESS: Corner of Avenida Ramirez and Avenida Madrid'
002a
LEGAL: LOr BLOCK
CK'D BY: GREG TROUSDELL
NITi'2>- L S.C. @ V.L.Q.
BIN NO: ASE NO. 99-6.8 CHECK -DATE:
Inform. the assigned Building plan checker upon your assignment to t
Executive Secretary maintains a log book to track applications and assig
case. The CDD
case numbers.
REQUIRED ITEM Y N
COMMENT/COR CTION
•:n\\}.}•.,;: \: ,:i•:rr,:n \••.} .'.h'{} ''},:.: ti'\\: ,\\. \.ti \
J}'.}G:!T '''Jy? : 3'i.:.I4}:1}:(:,I:::A!}•:}::.At \:•\}`\ .\n {} :,*,:>#.L i}' \\\T{\ . • L :::. t;E;\ ' }v'v'h. ' ~\ n • ,rtlI
' }\: \. h. @..,. _
..'..
,•':`.4\:
C :KXl;1101% .. ....:.
4\Vi
Gri.
\ µ v
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 Wth-street/sure unding area:.
Colors
v .S
Materials /t I
Architecture C
OTHER REQUIRE
e
.
tro-
The zoning codet40itectural 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.
-.'
Certificate of Occupancy
City of La Q-uinta
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:
Use Classification: SFD
Occupancy Group: R 3 Type of Construction:
77-560 CALLE MADRID
Owner of Building: ELEANORE CANNON
FQM
Building Official
vn1
Bldg. Permit No.: 9905-372
Land Use Zone: RC
Address: 68-842 HERMOSILLO RD.
City: CATHEDRAL CITY, CA.
By: STEVE TRAXEL
Date: 03-14-00
POST IN A CONSPICUOUS PLACE
92234
HOU 29 '99 12:49 FR
2r,�; rnfor�nc tion
7 .ToBuild On
Engineering • ConswMing • testing
TO 9-7791516 P.02/02
REPORT OF FIELD COMPACTION TESTS
TESTED FOR: GARY COVEL PROJECT: 77-560 CALLE MADRID
CONSTRUCTION MANAGEMENT, INC LA QUINTA, CA
41-865 BOARDWALK, STE 112
PALM DESERT, CA 92211
DATE: November 23, 1999 OUR REPORT NO.: 073-90297-2
TEST DATA: (1) Fine to medium sand. OPT. MOIST.TES
MAXIMUM COMMENTS' WATER WET PERCENT S
pec . 90$ Min
SOIL ID LAB DRY *
NOT DEPTH ELEVATION NUMBER DENSITY CONTENT DENSITY DENSITY COMPACTION
i -- • _
1 i 811 FG 1 116.0 11.4 117.7 105.7 51.1 1 - A i
-- .... ..... ......._...
---- ----
i
2 811 PG 1 116.0 10.7 118.3 106.9 92.2 1 - A
3 6 FG 1 116.0 10.9 116.8 105.3 90.8 1 - A
4 8" FCy 1 116.0 11,1 117.1 05-41 90_9 11 - A -- --(
TEST LOCATION: -
NW corner of house ,pad.
NE corner of house pad.
SE corner of house pad.
SW corner of house pad.
NOTES: TESTS PERFORMED PER ASTM D2922-96 S ASTM D3017-96 'COMMENTS: i. FILL MATERIAL A. TEST RESULTS COMPLY WITH SPECIFICATIONS
DENSITIES SHOWN: Lbs: per cubic foot 2. SAACJKFILL B. PE�CENT COMPACTION DOES NOT COMPLY
WATER CONTENT Pe[cent of dW weight 3. B E COURSE WI H SPECIFICATIONS
PERCENT COMPACTION: Base G on maximum dry 4. SUBBA$6 C. RETEST F P EVIOUS TEST
density obtained on sample indicated by 5. SOIL CEMENT D. MOIgTURE IN�XCESS OF SPECIFICATIONS
soil I number. 6, OTHER E, MOISTURE BELOW SPECIFICATIONS
(1) ASTM D 1557, procedure A
TEST INSTRUMENT: STANDARD COUNT M: D:
REMARKS: PSI did not monitor the material placement. ADJUSTMENT DATA M: D:
Respectfully submitted,
TECHNICIAN: Juan Nunez Professional Service Industries, Inc.
THES£ TEST RESULTS APPLY ONLY To THE SPECIPIC LOCATIONS NOTED AND MAY NOT REPRESENT ANY OTHER LOCATIONS OR ELEVATIONS.
REPORTS MAY NOT BE REPRODUCED, EXCEPT IN FULL, WITHOUT WRITTeN PERMISSION BY PROFESSIONAL SERVICE INDUSTRIES, INC.
rof9ssional Service Industries, Inc. • 42-240 Green Way, Suite C • Palm Desert, CA 92211 • Phone 760/341.5790 • Fax 760/341-5794