SFD (9811-143)51990 Avenida Madero
9811-143
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
p rofessionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
Date C 'T"KI Signature of Conta ctor ("ot /3il0
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'
compensation, as'provided"for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
( f 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:
Cartier Policy No.
(This section need Not be completed if the permit valuation is`f r $Qi%' 0.00 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.
`bate: 'J `} 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 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 StateJaws relating to the building
construction, and hereby"authorize representatives, of this 'City to enter upon
the,above-mentioned property for inspection purposes
Signature (Owner/Agent) "" Dater t 0"'
BUILDING PERMIT PERMIT# " tA• ,
s
o
DATE VALUATION LOT 3 TRACT
9811-14
JOB SITE _
APN Y
ADDRESS
"
MADERO?7 1C A1
-AYMIDA
OWNER CONTRACTOR / DESIGNER / ENGINEER''
DAVID ROSS MILLER PACIFIC T1tADES CONSTRUCTION
1719. S 1RE1v1OM 171.9 .S ME
S OCEANSIDE CA 92054 S OCEANSIDE CA 92054
f76V)967-0069 CBL# 1955
USE OF PERMIT
SFD - PEMIT INCLUDE I'N' ERICM &'REAR WOODEN FENCE. BLOCK
WALL & POOL .NOT INCLUDED.
i
"TRACT CONSTRUCTIO.bf 1,400.110 SF
' PORCYVPATIO 175.00 5F
GARAWCARPORT 506.00 SP
o FT. WOOD FENCE .130,00 LF
USTIMATED COST OF CONSTR(lMON'
89,37ss.It1
PERMIT FEE SI11YtIv1ARY -
CONSTRUCTION FEE E 101-000-419-•000 $594.50
PLAN CHECK FEE -1 101-000439-315 $500.97
FELT DEPOSIT 101-000-439-318 •4250.00
MECHAMICAL F.U.: 101-000-11.21.000 Sg3.50
ELECTRICAL FFE 1.01-000-420-000 $122162
PLUMBING FEE 101-000-419-000 $12:f.50
STRONG MOTION F F'E - RESM 101-000-241-000 $8.94
eR.ADINOM -101-000.123-000 _$20.00
FNkRAS'I'12UC':!01.13,k' 225-000-4433-312 51,933.60
PRECISE PLAN 101-000=441-345 $100.00
SU; TOTAL CONSTRUCTION AND PGAN CHECK
$3,461.63
L.1;SS PRE -PAID FEES
-$250.00
TOTAL PERMIT TELES !DUE NOLO
53,211,63
RECEIPPT f
DATE ^ %1
BY(/ '
DATE FINALED
INSPECTOR
INSPECTION RECORD
T OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
zDucts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
_
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
—Q
Compressor
Insulation
—12 _
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS -SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole ,yL
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) 8 g
COMMENTS:
Building yl
A AA....
• 4 4 "
P.O. BOX 1504
^ 78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
\," tlUc
Mailing
Address 11 5
City
Contractor ,
C.
Tail to 0 k
Zip c Z
1 (7
BUILDING: TYPE CONST. /OCC. GRP.
A.P. Number
"? (,(j `! (a 7- UU V)
Address
PcO^•C L
City Zip Tel.
State Lic. `JC City
& Classif. Z S Lic. # r 9
Designer
Address Tel.
Cit Zi State
City
\ n P Lic. #
LICENSE' CONTRACTOR'S DECLARATION
I herebyy affir tha I urn lice sed,under provisions oPCfiapter 9 (commencing with Section
000) of DI. Ision o Vha Business and"Professl ons Code, and my licendae is in full force and
OWNER -BUILDER DECLARATION
I hereby affirm that\l 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 rile 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 'hat 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
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.)
I1 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
r7 Copy is filed with the city. O 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 thq 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 it 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 a0plicant Date
Mailing Address
City, State, Zip
WHITE = FINANCE
-
APPLICATION ONLY
Legal Description
ect Description
Sq. Ft.
New ❑
No.
Stories
Add ❑ Alter ❑
n
No. Dw.
Repair O Demolition ❑
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
P Side Street Setback from Center Line r
Side Setback from Propert
y Line
y IR
FINAL DATE INSPECTOR
Issued by: Date CON
A mit
Validated by:
C
Validation: `h 199
YELLOW = APPLICANT PINK = BUILDING DIVISION ♦ r
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
Date 2/5/99
No. 18329
Owner NameDavid Ross Miller
No. "51_?? treet
City La Quinta
Tract #
CERTIFICATE OF COMPLIANCE
Avenida Madero
Lot #
Type of Development Single Family Residence
Comments
APN# 1,13 -X5.4 -01,,;L,
Jurisdiction La Quinta
Permit #
Log #
I
Zip 92253 Study Area
Square Footage 1400
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 1,400 or $ 2,702.00 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 Capital Bank/Davud Ross Miller
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Ellen Patino
Signature
Payment Received
Telephone 619-967-0069
".
Y
$2,,702.00
, t• , rte"'•, _
Check No. 11614 ` ",:,
VOTICE: 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
."act 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
.M111VO ' . I J
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: PACIFIC TRADES
PROJECT
ADDRESS: Madero
7=2 f 18 01 X
APN:
773-154-012 3144 A8'
INM01301 uINnwwOO AG' a31108ddd"
LEGAL: LOT- 13 ,.BLOCK 31 , UNIT S.C. @ V.L.Q.
BIN NO: 5C CASE NO.gs-24 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:
11 REQUIRED ITEM I Y I N I COMMENT/CORRECTION 11
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)
Consistency with street/surrounding area:
Colors
Materials
Architecture
OTHER REQUIREMENTS:
_3 -
The zoning code, architectural and landscaping manuals, and/or assigned inspector should
be consulted whereuncertainties arise. The completed checklist shall be maintained in the
Building .& Safety address file.