SFD (9911-001)52010 Avenida Madero
9911-001
q LICENSED CONTRACTOR DECLARATION
I %reby,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
?x.5754 BCC
eDa e t t 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 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 ithe
performance of the work for which this permit is issued.;
( ) I have and will maintain workers' compensation insurance, as required by
Sec ion 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 Policy No. 41
'; KI
(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
subjectoto the workers' compensation provisions of Section 3700 of the Labor*
Codd shall forthwith comply with those provisions.
' Applicant
Date: ! d :x i
1 '
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 1 '
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 cancellatidn.
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
bove-mentioned property for inspection purposes.
Signature (Owner/Agent) Date t
BUILDING PERMIT PERMIT#
DATE f p VALUATIONa31 .LOT. 1 TRACTJOB iW y!
ADDRESS r 52. 010 .` '1Ci1ti DA lV1.tPs,. iRO
APN i % i g1•i l
OWNER
CONTRACTOR / DESIGNER / ENGINEER
USE OF PERMIT
S:#NGL
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bVi I' R s!€.r-*VtN 23iJ.13t41i`f'i Af,)
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•
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PRlik,IS PLAN 10l 600-444-:#451 5t0omo
f=f°1: o9F? ("t;;l'i' ;!}).:if( }-4'i -;3lfk • n' f►.a}(!
;QUA—'"M*ACONISTRIK' ON AN"') dale. ("144 -VK
TOM, PPAMIT FEES 011,4111 NOW`
oe
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
0. K. to Wrap
Z/-—
Exhaust Fans
F.A.U.
Framing
Insulation 7
S,
%ZZIr
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
l C
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
s%
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
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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) r
4
P.O. BOX 1504
Building 78-495 CALLE TAMPICO
Address LA OUINTA, CALIFORNIA'92253
`/ UJ %L_Irt A.4 Tti.nu e e E tJ 'i x
Mailing
Address S7_ d aUG ilS rt1
City / Zip Tel.
Contractor
Nisif _ Frn. i rs-n. I /"N_ k-1,111 f CZ
ress
I'A Z-2 z S'64 .-
State Lic. City
& Classif. 4, ! t,7 <4 Lic. #
Arcn., tngr.,
Designer
Address Tel.
CityZip State
1 . 1i-+, _ _ _ 7 Lic. #
LICENSED CONTRACTOfi'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I 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 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
Division3 of the Business and Professions Code, or Nat.he is exempt therefmm, •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.)
1'1 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.)
i7 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. Company
n Copy is filed with the city. ❑ 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 (E100) valuation
or less.)
I certify that in the performance of thg 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 properly for inspection purposes.
Signature of a0plicant Date
Mailing Address
City, State, Zip
Q
3 c-A
APPLICATION ONLY
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number X ' 1
r 7 1 "2 r nom;
Legal Description X l
Project Description
1 -DA
Sq. Ft.' /
No. No. Dw.
.
Size ,
Stories Units
9
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Crn.Ttrracr
MAI
Estimated Valuation
PERMIT
AMOUN
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
INSPECTOR
Issued by:
Date Permit
Validated by:
Validation:
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
CERTIFICATE OF COMPLIANCE
Date 11/2/99 APN # 773-203-001
No. 19536 Jurisdiction La Quinta
Owner NameLa Quinta Partners Permit # 9911-001
No. 52-010
City La Quinta
Street Avenida Madero
Tract # BLK27 U3 Lot # 1
Type of Development Single Family Residence
Comments
zip 92253
Log #
Study Area
Square Footage 1409
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.airiount of
1.93 X, 1,409 or $ 2,719.37 the property listed above_and=that building
permits and/or Certificates of Occupancy for this square footage in this proposed project `cnQy now be issued;
Fees Paid By ccNIB/La Quinta Partners Telephone -,564-,8470
Name on the check
By Dr. Doris Wilson j • 1
Superintendent
Fee collected /exempted by
Signature
Juanita Green Payment Received $2,719.37
Check No. 202519
NOTICE: Pursuant of sembly 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 ru rom 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 D trict('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
OCT.28.1999 10:49AM COMMONWEALTH
RECORDING REQUESTED BY:
CHICAGO TITLE COMPANY COMPANX
99.9035KC 9705690a
WINNNL O%RW&M JDLOWNO'
:
WILLIAM THOMAS HUFFIN
C/O POWER BROKERS
LA QUINTA, CA 92253
P
GRANT DEED
NO. 049 P.1/1
5 LINE FOR RECORDER°S USE
The undersigned grantor(s) declare(s);
Documentary transfer tax is $22.00
(XXX) Computed on full value of property conveyed, or
( ) Computed on full value less liens and encumbrances remainin
( ) Unincorporated area: ( ) City of g at time of sale.
, and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
BENITO CINTRON and SANDRA CINTRON, husband and wife as joint tenants
hereby GRANT(S) to
WILLIAM THOMAS BUFFIN, AN UNMARRIED MAN DBA LA QUINTA PARTNERS II
the real property in the City of LA QUINTA, County of Riverside, State of California,
described as:
LOT 1 OF BLOCK 37 OF SANTA CARMELITA AT VALE LA QUINTA, UNIT NO. 3, AS SHOWN
By MAP ON FILE IN BOOK 1a, PAGE 59 OF MAPS, RECORDS OF RIVERSIDE
COUNTY, CALIFORNIA
Dated October 28, 1999
State of California
County of ) S.S.
On
before me,
personally appeared
personally known to me (or proved to me on
the basis of satisfactory evidence) to be
the person(s) whose name(p) 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 person(s), or the entity upon
behalf of which the person(s) acted, executed
the instrument,
WITNESS my hand and official seal.
Signature
MAIL TAX STATEMENTS TO:
BENITO CINTRON
SANDRA CINTRON
(This area for official notarial seal)
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:PAZ Construction
PROJECT
ADDRESS: 52-010 Avenida Madero
APN: 773-203-001
LEGAL: LOT 1 , BLOCK 37 . , UNIT 3 , S. C. @ V.L.Q.
CKBY: Stan Sawa
'D
BIN NO:. CASE NO. 99-154 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
/{'.J '/^ • . .:. . a.. .. .. i. : ]. 'fir.. /.., ..a n.. a.n ...:,..n3... \•..: k:...,. n., ....: .A::: a:•.v....::.n.,:,}., ii :::i}i:::LL.::^:i::;:}}:.v:i (ii:ii:::+ Si : .. .Cts... ..
ViJ.7H: ' .Y... ' "M"`.•::7 .L:ii.71..
Case logged and number assigned
Verify legal and APN information
1
Consistent with MDG on file las applicable)
hi
1i,
MDG filing required (5+ filings since 9/3/98)
N
A
Consistency -with-street/surrounding area:.
Colors
Materials
Architecture .
t,
•
OTHER REOUIREMENTS: '
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.
y - As
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
ollowing.
BUILDING ADDRESS:
Use Classification: SFD
Occupancy Group: R 3
52-010 AVENIDA MADERO
Type of Construction: VN
Owner of Building: LA QUINTA PARTNERS
Building Official
Bldg. Permit No.: 9911-001
Land Use Zone: RC
Address: 52-995 AVENIDA MENDOZA
City: LA QUINTA, CA .92253
By: STEVE TRAXEL _
Date: 03-28-00
POST IN A CONSPICUOUS PLACE