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SFD (9812-066)53745 Avenida Madero 9812-066 LICENSED CONTRACTOR DECLARATION' (hereby affirm under penalty of perjury that I am licensed under -provisions of Chapter b (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 VIVO! - yDa te Signature of Contractor ­O.WNER-1BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors t License; Law for the following reason;, -'l:"as -owner, of the*property,,pr my employees with wages as,their sole compensation, will do the work, and the structure is not intended or offered fog sale (Sec.- 7044, Business & Professionals Code). l,,as:owner of the 'I prop . e - rty, , am . exclusively contracting with licensedl ", on tors; `J c ii k " `to construe the project (Sec. 7044; Business & Profess onals Code).'. .1 am exempt under Section __B&P.C..for this reason Date, Signature of. Owner WORKER'S' COMPENSATION DECLARATION j hereby afiii,rn''und4r penalty' of perjury one of the following declarations: I have and %vill.maikainl,,a'certificate of cdRsent, to self -insure for. workers' compensation, as. provided fobby Section 370 O.of the Labor Code', for t'6e perfofmance of the work -.for which this permit,is issued. (V),.l`h_ave and,will maintain, workers' compensation insurance, as'required by 86diion 3700 of the Labor Code, for the 'Perforrriance'of the work for which this permit is issued. MY' w&k rs- compensation insurance carrier .& policy no. are: Policy No. (This Section, heed not be completed if the permit valuation is for $100.00 or less). )4Tc6rtify that in:.ihe performance of the work for which this permit is is'sue'd, Fshall hot 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 Su6ject,td the workers' compensation' O)Vi . stpnsref Section .3700 of the Labor '0 ly with % 0 Sgh l fortf 11 1 or'Wisi 7: 7 pplii 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 f6r in Section' 3706 of the. LaborZ&de, interest and attorney's fees.. IMPORTANT• Appli c*ation is hereby made to the Director.of Building and Safety for-, a..perrfift •Subject -to the conditions and restrictions. 'set forth on his application. 1. Eacli persori upon whose'b6half this application is made & each.person'at 'It who's-erequest and for whose benefit work is performed under or pursuant to any',r I . pemit issued as a re - sult of this . applic . ato I nagrees to, & shall, indemnity &' hold: harmless the City of La Quinta, its officers, agehi's and employees. L.'.i.Aniy. permit issued as a result of this application becomes hull and void if ':.Work is not commenced within 180 days from date of issuance of such Pe'rmii,'or cessation of work for 180 days will subject permit to cancellation." fy.t.hat I have read this . application and state that the above information is Correct.' l'agree to comply with all.City, and State laws relatin o the, building construction,: and, hbrebyszuth'orize Ito enter *$1 I - irepresentatives of this upon e , the abqV6-mentioned property for in I t, purposes. % pec.ion, purposes. 7 0 n gept)., w er/A BUILDING PERMIT' PERMIT# DATE VALUATION _% LOT .TRACT 42 BJ.94.Uj a JOB SITE ADDRESS 33-745 IVEMDA AWER0 APN774-102-024 4)WNER CONTRACTOR/DESIGNER/,ENGINEER MAL VUL) 'R.OS S 1\4 K. L. M PACIMTRADE, I,,(- RUCT(k 1119 Is T -P %40vil 1711 ) 3 71UN"KiNIT S OCEANSIDE CA 92054 S OCEANSIDE, CA .920.54 (760)967 000 (`$Lff 1955. USE OF PERMIT M) "PERMIT KX368 NOT 1W01L-0 s BLOCK WALLS Oil POOL. TRACT CONSTRUC.710N 1,470.00 S:V, GX.RkVGVCARPO1ZT -5:14.00 8F 6 WOCII10 Fklf4CE 120,00 UF E—STMAJED COS11 GOV alkv%l trx-pi .in PERMIT FRE SIMMARY CONSITW G110M F P:F> 101-000-4119-000 $603-50 PTIANCILTIP101K rTMI io i _0004i9_31 9 SM9, . 14 FEE DEPOSITI ME-40HANICAL F-139 1017000-4211-000 JE UECT R1,C At, VFW 1014KIV-420-ON 'PUP -41V1401 F01: 101A)0-419-000 $117..591 GRADING rM S20.00 INM-ASTIPCOCTUREFE-E 21125-000-443-34 52,029. iO PRFrI f "T3 V) I AN, 101,01'1{- 41--145 SUB-Ir-TKI, CONgrRUCITON! AND PLAN CHECK ILESS Pkk-PAID FUS 4"250.00 "RYS'AL PE JKNM' FEES DUE NOW' , A"t REC IPT DATE BY DATE FINALED INSPECTOR U 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 Exhaust Fans O.K. to Wrap F.A.U. Framing P 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 Final 22 BLOCKWALL AP ROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings OC 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 OX 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 !o 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) 1174S COMMENTS: /)" /' • , P.O. BOX Building 1/- _/I i A , ^ 78-495 CALLE TAM TAMPICO Address ,r.+f 1, V . LA QUINTA, CALIFORNIA 92253 Mailing Address C, City 1101 9 "t Contractor VAC. k Address 12 dCo p o2 APPLICATION ONLY BUILDING: TYPE'C S+*T. OCC. GRP. d+v T A.P. Number Zip2/ Legal Descriptions 4.. o -r I 1 `t- `f ♦ Project Description S • % ' i m Zip j Tel. State Ljc. cit'( Z.- ` I Lic.# 1 8 Classif. T Arch., Engr., ` Designer Address Tel. City IZip 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 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.Susiness and Professions Code: Any city or county which requires a Permit to construct, after, 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 (8500). 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 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.) 0 1 am exempt under Sec. B. & P.C. for this reason I 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. ❑ 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 lhg work for which this permit is issued,'I shall not employ any person in any manner so as to become subject to the Workersr`Compensation Laws of California. '1' 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 it work thereunder is suspended for 180 days. I certify that 1 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 WHITE = FINANCE Sq. Ft. + y ^ No. No. Dw. Size j V Stories Units New ❑ Add ❑ . Alter ❑ Repair ❑ Demolition ❑ t'I _stimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc., Infrastructure r 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 f Issued by: Date Pe mit A A Validated by: - gyp(] Validation: DEC 0 8 1998 +6 .CITY OF 3 ,--i r , YELLOW = APPLICANT PINK = BUILDING DIVISION 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 2/5/99 APN # 774-102-012 No. 18328 Jurisdiction La Quinta Owner NameDavid Ross Miller Permit # r No. 53-745 Street Avenida Madero Log # City La Quinta Zip 92253 Study Area Tract # Lot # Square Footage 1470 Type of Development Single Family Residence No. of Units Comments 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 1,470 or $ 2,837.10 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/David Miller Telei. phoner Name on the checklire By Dr. Doris Wilson ` Superintendent g• . Fee collected /exempted by Ellen Patino Payment Received Check No. 11620 Signature IOTICE: 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 bove will begin to run from the dale 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 ollect 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 j'.+fir {J q'}r - e _ s n - A. - Q ,. • " i RC District P/anninai 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 de'termine'the•applicabil-ity 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, additionaI explanations, as necessary. APPLICANT: WORLD DEVELOPMENT PROJECT ADDRESS. Avenida Mader®' APN: _ ' 774-102—(h2 LEGAL: LOT. 12 ,.BLOCK. 194' UNIT j "S.C. @ V.L.Q; C K•' D BY: STAN SAS ,, F BIN NO: '2D CASE NO. 98-28 , CHECK DATE: 711 Inform -the assigned: Building plan'checker;upon your., assignment to this case. The.'CD.D i Executive' Secretary: maintains a log book to track applications and assign' case numbers. r: M REQUIRED"ITEM` TY N COMMENT/CORRECTION ' :AU .... x.. .: .....x•.xy....,v.;; a}}}•.:..v \::: w.: ^:::: .}::::n.v\\ •..•.\w. •.vvvv. v.. , .. \ -0.:C . :}\, \ 4•:. p •}\C•}:•}}}}}}}:•}:•}}:•}}:•}:•ri?::':•}:4}.. v. .: n':.} .; },•.M1v::: nv: v: v:......4 \ C : ti, . \4•, fi ... v\\v:. .v.{v:.v:::•..::•}.v..:. ::.i•C•.}•s::r::: •nr •::a::. .,•,n....... ♦ •:. \ :•{{'.,:: }. }., , . ' •. \ '•W' :::.v;: w: ::•:.::... .........: ........ .: .....4+rrf•''?i4{i:•:j;::.;T.,;,v{: t.. x.y:::.lti..... av •:.v:yv.. ,,} . \.::{: {v(';}}. .v.•?:,:,:,:i.•iii i{}•?{:: '?}1:: :•.v .: {ti{: .. vi •. ... R. `3n..k}ii t i'1i\ . .. \ .v \hC•, +h+$ { ::.J}.}:•}}.;....}}:...,• :{?•''•'.':+:::.., •}: \•}:: }: •}}::.: \ ,.. \. +}. 4}}: vim\. • ;.}}}}:::. :....}:•...:.v. n. :iii?iii::; •.. .a ' :• . ..:.r[:?•. :::. ..:.:::>}}:•:>}+:?•}:•:?•::.:.•n.. :. ::.::::::::::\•:::....:.... k;;:•::wv:•}:•}:?a::{}::;:•`: i:`:•::{.}:::::::\;;.:.!.:.•:::}::}..:+<??r?•±;.:$}:.}...?.?•::..•.}.+.,.}:.}•:.hert•:}}:.?t.;..w.p.}:•`.+ +c•: •i.'t: Case logged''and number assigned Verify legal and APN information' SQA. Irc cljk.L ,za'Y ,el - Consistent with -MDG on file las applicable) MDG filing required (5+ filings since 9/3/98)x. y Consistency with street/surrounding area: , Colors j , v Subs: i i GoK ' SG Materials Architecture OTHER REQUIREMENTS: . - _ Ic rircn' I oirJ' no } - u nduL• po The zoning code, architectural andlandscaping manuals, and/or,assigned inspector, should be consulted where uncertainties arise. The completed checklist shall be maintained .in the y Building &.Safety address file. " `` r • f.