SFD (0003-115)53765 Avenida Madero
0003-115
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
4-0510 111201
Y
DtZ Signature of Contractor s
V
OWNER=BUILDER DECLARATION t
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). f
() 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.
( ) 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:
Carrier COPolicy No.
N.
(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
workersf ompensation laws of California, and agree that if I should become
subject to the workers' compensat1oo provisions of Section 00 of the Labo
C 'I sh 'll forthwith comply withA ose provision
VDate: j: i 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 State laws relating to the building -
constrd6tion, and Hereby authorize representatives of this City to enter upon
the above-mentioned property for'ihspection purpos s
,Signature (Owner/Agent) ( Date 1
- i
_ t
PERMIT# ;
BUILDING PERMIT
4
DATE VALUATION $`8,38 1.10 LOT 1TRACT 1 ,10.t11y
/on n
ADDRESS -r .3-765 _ 'VE{i.E 7.0 . Ei 'iA . iYY ..R.Cii JOB
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
C='A . C`♦: i'
iiS?i `:'.•l l.E'" ct. ;i:i: i V` r.::. iy:
77:04 it i:OU141'11 Y CLUB DR.. 113
77-564 tl CC3UN FRY CLUB DR
PALM (A 92.211.
PALM DIESER 1" CA 92211
(760)403.3495 c RIA 0133
USE OF PERMIT
S1Nk._,L 3'.A.NIIIA UWbAA,1NU '
ak 1 ! - I 113.k`t."i 131 ! i titll l, i1J1ti 1 ;NJ1_ L 11.1 ir) WALLS
Ir'!'. W0 QL)1,"hNC U101.00 Lf,
VITY r 'amts W19"a
iP
9. A:J i6.SO .,d t ir'.I.d e . V {F•LL .IIJ'1.f.1,
C;CiA? t'KUi '1'1(7Si .ir':i h'. 1:111-W00-4le-000 $5wj.00
Pt.A'NT CfWrIC FFF
Ab1tJt . J Un
t117X!LNNT . A.+1Ki104/J Ll^+n1t`n
i7,UM 101-000-426-600 S 129,20
111,.tlN4.6ING,0-'1 t01-000-419-000
wTt OM'j 1N40TF()N PPI. _ RIZ131}) .1fll-nt>1 • ni-at)
10.1-•000-423-000 a o.66
Oil 1/L?,.t. PER,' "ACT FEE
11ttCf.3.!✓.l'.LAN 101-000-44.1-345 300.00`
T. -Or. T)r1P0Ak1r l(1(-i011_41(01191
:.J
"Af .C(l'NS'I'1tf,iC.;?'iClN ANl) P! AN C:}t 1;K
414„5{}
LTE':t PFif.,'-'.t •tan.:% F'L .)
.,,} -!
TOTAL PERMIT f"CES DVE'Now
$3,164-s,
A
RECEIPT
DATE
By.,
E INALE
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
1, INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS.
Set Backs
oe
Underground Ducts I
Forms & Footings
_
Ducts
Slab Grade
Return Air i
Steel
Combustion Air y
Roof Deck
t3
Exhaust Fans
O.K. to Wrap
-` co
F.A.U. p
Framing
_
Compressor i
Insulation
6
Vents
Fireplace P.L.
Grills j
Fireplace T.O.
Fans & Controls t
Party Wall Insulation
Condensate Lines j
Party Wall Firewall
I
Exterior Lath
Drywall - Int. Lath
}
I
E
Final l
Final
POOLS - SPAS
BLOCKWAL A PROVALS
steel
Set Backs
rj
Electric Bond I
Footings
Main Drain I
Bond Beam
Approval to Cover
Equipment Location l
Underground Electric i
Underground Plbg. Test i
Final
Gas Piping I
PLUMBING APPROVALS
Gas Test
Electric Final i
Waste Lines
Heater Final I
Water Piping
/ _
Plumbing Final l
Plumbing Top Out
(
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster i
Sewer Lateral
Pool Cover i
Sewer Connection
(
Encapsulation f
Gas Piping
I
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
,ZCg7
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
'!GTI
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
P.O. BOX 1504 APPLQTION ON Y
Building /p 78-495 CALLE TAMPICO L
Address -76 ; LA QUINTA, CALIFORNIA 92253 l S
Owner z(( j
I V BUILDING: TYPE•CONST. OCC. GRP.
Mailing
Address -7-7 -17'L . 0 (3
A.P. Number
City Zip .Z' Tei. _ ' Legal Description P'0 « I V lift
\O&VA k
Contractor 1 / project Description
Address
'1 644 coUK4---(Ity
hu,t\
State Lic.City
& Classif. "'<135-1O Lic. # Sq. Ft. No. No. Dw.
Arch-, Engr.,
Size ` Stories Units
Designer Q Q Qµ lV6 Nek Add O Alter O Repair 0 Demolition ❑'
° rc 7/1 v Tel.
Cityrl x Zip State 11
Lic. #
LICENSED CONTRACTOR' DI
CLARATION
I hereby alfirm that I am licensed and r provis' s Chapter 9 (co ."'S
h Sion
7000) of Division O the B ess antl rotes ns d and my e e is i!Rtfoce?
rnc}•_effect.1f. VF;J
SIGNATUREDATE
OWNER-BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 703 1.5.
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 PERMIT AMOUNT
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 •Plan Chk. Dep.
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 Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.
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, Mech.
provided that such improvements are not intended or offered for sale. If, howevgr,the building
or improvement is sold within one year of completion, the owner-builder will have the burden Electrical -
of proving that he did not build or improve for the purpose of sale.)
I 1 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
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 S.M.I-
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
i! I am exempt under Sec. 8. 8 P.C. for this reason
Driveway Enc. .•
-Date Owner Infrastructure 4
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self-insure, or a certificate of -
Worker's Com nsati n rance,r certi 'fid c p t +eof„/Sec 3 Og, Labor Code.)
Policy No. Company(i )
n Copy is filed with the city. 0 Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
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 1
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should become - ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) Side Setback from Property Lin
Lender's Name
Lender's Address FINAL DATE INSPECTC
This is a building permit when properly filled out, signed and validated, and is subject to
ly
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. Issued by: Date —Permit
1 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. Validated by:
Signature of a0plicant Date Ty O
Mailing Address Validation: J' 1
City, State, Zip
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Date 3/17/00
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
No. 20178 Jurisdiction
Owner NameRichard Scott
No. 53-765 Street Avenida Madero
City La Quinta zip 92253
APN # 774-142-013
La Quinta
Permit # 000-115
Log #
Study Area
Tract # B197,U19 Lot # 1 Square Footage 1409
Type of Development Single Family Residence No. of Units 1
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 1,409 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 may;now,be. issued
Fees Paid By CC/1st Bank/Richard Scott
Aeleph6ne 760-408-3495
Name on the check
x--,
' —'
At "% s
By Dr. Doris Wilson
r
Superintendent
" , ' : -
•.
Fee collected /exempted by Mary Ann L. Borja
Payment Received xX n
%lj 9.37
IJI'Allf A /////J 1
Check No. 54045
Signature
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) 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)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for a0 waivers.
Embossed Original- Building DeptJApplicant Copy - Applicant/Receipt Copy - Accounting
Id 1 ,... lluv. c.lyiJ �•11r1'i l.ul•II•IVI�IWLHLIh
�1�-�--�: ' Rmcordin Remo: ifid a
e CHICAGO ftc- CCMPAI� Y
■ RECORA,M RRQU99MM 8Y;
■ CHICM0 IrITLN COMPANY COMMY
99.9236KC 97057307 p-1)3
WH'1N IMCORDID MAIL THIS DHBb A=,
MMESS OTt3M NIS$ SHOO wr4c 1,
MAIL TAX 9TATEXIM1'S TO&
R:CMM SdOTT
PALM DE ERT61CA 92255
02) 1,5
T7 LJ +lw 2.,-013 Ic u Ll GRA,
The ur;da-Vaigned granhor(e) declye s) ,
Documentaxy tra4afer tax is 43 .2
l7IXX� Computed on full value of propperty conveyed, or
��necpd on full value lees liens and encumbrances
rpoxated arena ( ) City of
Ivu. cf37' P. 1/1
remaining at time of sale,
and
FOR A MUML,E CONSIDERATION, receipt of which it hereby AcknowledSed,
K VIN A. MICKUBMR, a ainlR].e man as to Lox 1 and
KEVIN A. XNICKERBOCIMR and pAM ZIMMER W I CO-TRUPTEE9 OFA THE ERICA RINALDY TRUST
AMEEMI`D)y T OF 1981 AND AS A=IzD NOVIIi M 19 , 1985 as to Lot 2
hereby GRANT (9) to
MCHARD L. SCOTT AND CLAUDIA, J'. SCOTT, HUSBAND AND WIFE AS JOINT TZ MANT9 AS TO LOT 1
AND WTLLXAM TI MW, B1TFKbT. AN UNMt#RIt= MAsi AS TO LOT
the raa� property in the City of LA QvINTA, County Of Riverside,
described as; Stilts of California,
Lot (e) 1 and 2, Block 197, Unfit No, 19, Tract Santa Carmelite at Vale La Quints, ae per
Map recorded in Book, 19, Page(s) 33-38 inclusive of Maps, in the office of the County
Recorder of said County.
aatQ4 October 4, 1999
state of California
County of g:s) S'S.
On --Q c r� c.p ?1 / t 9
before me, - - crhAti,
personally appwe
Ina r-wgg-
(ar proved to ine on
the basis Of: aatisfactory evidence) to be
the person(k) whose name($) is/a" eubsozibed
to the wichin instrument and Acknowledged to
me that he/*Wbber exeCuted the same in
authorized eapatcity(des.),, and
that by his/1er,/tiej-j- signature (11 an t4e
instrument the person(h4, or the entity upon
behalf of which the p®reon(R) acted, executed
the instrument.
WITNESS my hand and official seal
Signature
MAIL TAX 5T S 0e S AS ABOVE
61 —1 00 OQK$R, INDIVIDi;T7`t.T,
30
E UM CO -TRUSTEES
P.
�A. ,
I A. CK&RB CICBR, CO-TRVSTRE
MAO MN MC PAO"D
COMMWan N 116077
NotCW Public . C.CgC b
LM Arise" CQu►d1/
Mvcamm,e�r�x�nzr�
(This area for official notarigl 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 the Building and Safety Department as your
correction list. Please attach additional explanations as necessary. 1.#'
APPLICANT Northwest - Southwest Development, Inc.
SITE ADDRESS 53-765 Avenida Madero
APN 774 _ 142 _ 013 BIN NO.: 5C, CASE NO.: 2000-199
LEGAL: LOT 1 BLOCK 197 UNIT S.C.@V.L.Q.
CHECKED BY: Fred Baker
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
Case logged and number assigned
Verify legal and APN information
p�pENT DE
Consistent with MDG on file (as applicable
EXHIBIT
MDG filing required (5 filings since 9/3/98)
;
Consistency with street/surrounding area:
Colors
Materials
Architecture
Other Requirements:
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
53-765 AVENIDA MADERO
Bldg. Permit No.: 0003-115
Type of Construction: VN Land Use Zone: RC
Owner of Building: RICHARD SCOTT
Building Official
Address: 77-504 A COUNTRY CLUB DR. 113
City: PALM DESERT, CA 92211
By: STEVE TRAXEL
Date: 07-17-00
POST IN A CONSPICUOUS PLACE