SFD (9908-210)54245 Avenida Madero
9908-210
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions.of
/.sChapterE3 (commencing with Section 7000) of Division 3 of the Business and
1'i;rofessionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
526236- 1301'1
Date r + Signature of Contractor
OWNER -BUILDER DECLARATION -
1. 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.
( JI, 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 Policy No.
WXi'Fs PUND 1, t57-95
(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
subject to the workers' compensati&hIprovisions Of Sectiofg 3700 of the Labor
Code, I sh¢IJ fodhwith comply with those rovisions.
Date: 10 t >f 7`1 Applicant—/
r
jWarning: 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.
I 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: f ihsspiection,p dDate
e
Signature (Owner/Agent) RR
fr Y
BUILDINGPERMIT PERMIT#
DATE joil'S/1 ;VALUATION 899,,?% f> aU LOT TRACTJOB
SITE
ADDRESS 54-24SAV'.3'NIDA MADERC)
APN 774" I92-013
OWNER
CONTRACTOR/DESIGNER/ENGINEER
PAPADIFIf? t~'ONST11y111U .""tIGN
PARADISE, C'ONNS11[ICTiON'
948NE 102ND, SURE 103
948 3NE W2ND, SUM 103
KN ] .-AND (.7R f77220
PORTLAND OR 912210
(503)956-4217 CPL0 5773
USE OF PERMIT
tiNi. L' :i ,Ailrl .L. DWL_K . `'
rV 1
9:RA(7 C+:riJSTRUf A i(; W 4"165,0 x F
P0ftC1VPA;fi1Q 1'03.00 Sf+
f1Ft (?i'lC s l2Y' 3i2'f' 458.tn) SF
. q yp'? LY'.S.E .l9.s0 .6i°n it iP. t.o:a I A A1L{' ' ,flY,A
lr.i+•jsli b.l ti'7f
Pf,'RK(TFEF, SUMMARY
CONTVR(f(,.CK)N FE -2 It1i.- }i } 41 iaiifJ Gi+EZ tN?
Pf.:AN(71.1f"G`,i•C.`Fflir Y.111.(lagy-e? 3IR xe.t1
AW.01AXICAL RX, 101-M-421 -WO SODA)
100 VLr1i420_000 apFa, lJ Sp;f
,
I1Lf;,fN4Bl V0 HX 101-000419-9w S 5,50
STRONGM.()[IC FFICT - 441) IM -000-174114a
2.yy}}2,
rrt)
ffRA?i40 Lmx10.1-01?n"Y: 'IftiU N. W .U a
:'017NEWI'E i 111 'r1(`1 1 $3,it +,Gtl
PRk.ViSE P4.,AN
T+'► f^ l•i'1' .'t1'1. 8!)1D-4; 'a-pis, .. jh`ify:fh:r
. ,
`I :{9y"'S i.I J, :t V;• 7 ' ),fl._t•1L yF j J j'q. S`I i. 1"t r '\{ 77`./ R t'.'`t,
4GL
t 1
LMSS
tg
'4t:i'4;AL i'&?WMJ Ik`E01+Y lir8TENOW
RECEIPT
DATE
BY la,
DATE FI ALED
INSPECTOR
tl ?J O
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Fors & Footings
��
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
jl - % Q Q
-572
Exhaust Fans
O.K. to Wrap
L2 -1S—
5 Z
F.A.U.
Framing
/2 -2
57-
Compressor
Insulation
/Z. y7 -
$
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines•
Party Wall Firewall
Exterior Lath
5 7
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam -
2� 2- ��
SJ
Approval to Cover
Equipment Location
Underground Electric
Final
G D
Underground Plbg. Test
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines _
S�
Heater Final
Water Piping
_gyp �ZY
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
1D_L
g T
Encapsulation
Gas Piping
Gas Test
Appliances
/
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
3 - QQ
Jr 7`-
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 (Per)
rp
4 4 "
P.O. BOX 1504
Building _ 78-495 CALE O
Address QUINTA, CALIFORNIA
92253
Mailing P x
Address
Gity / \ Zip _ Tel. /
C_1Jl.J ln3 "+ 7 7' 2 z- / Gl'.s
Cont actor 1
(- AZA Ig96._ . t2v 7i J
Address
State Ljc./ I y
8 Classif. (o Sc.Li#
Arch., Engr., + , `
Designer C G?iC, 1.%r: iG CY( P
Address Tet
lee
r ity Zjp' State
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 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
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 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 11, 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.)
fl 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
r7 Copy is filed with the city. ❑ Certified copy is hereby furnished.
e
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 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
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
con struction,and hereby authorize representatives sof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant —Date—
Mailing
ateMailing Address
City, State, Zip
I -et, Q lP /0,A jP VOO N L L
BUILDING: TYPE'CONSTT. OCC. GRP.
A.P. Number –7-74 ''-11 z — v
Legal Description ` r /z iCIG c7 S T)
Description
Sq. Ft./4&G No. No. Dw.
Size Stories Units
New 21' Add ❑ Alter ❑ Repair ❑ Demolition ❑
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
6
Rear Setback frtom Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by— I 1qQ1; Date Permit
Validated by: _-
Validation:
WHITE = FINANCE YELLOW= APPLICANT
PINK = BUILDING DIVISION
TAC ".Vit« s Dft-4n
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
`} , 50 '
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
6
Rear Setback frtom Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by— I 1qQ1; Date Permit
Validated by: _-
Validation:
WHITE = FINANCE 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 10/18/99 APN # 774-192-023
No. 19480 Jurisdiction La Quinta
Owner NameParadise Construction Permit #
N0.54245 street Avenida Madero Log #
City La Quinta zip 92253 Study Area
Tract # BLK258U24 Lot # 12 Square Footage 1465
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 1,465 or $ 2,827.45 the property listed above and that'building`? r
permits and/or Certificates of Occupancy for this square footage in this proposed project may --n,& be issued .
Fees Paid By cc/1 st Bank/Paradise ConstructionTelepmome 48-34951-1 01
Name on the check
4 '.:
.p
By Dr. Doris Wilson ;:,
Superintendent
Fee collected /exempted by Juanita Green Payment Received $2,827.45
,i Check No. 52053
Signature
NOTICE: Pursuant rssembly Bill 31181 (CHAP 549, STATS. 1996) this will serve to notify you that the 9D -day approval period in which you may protest the fees or other payment identified
above will begin to n 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
collect 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
FROM :
/"uitl3!'-3'i?%ah'^"Q {jRDID,
Q PLEASE L INSTRUMENT TO:
DENNIS YOST
PHONE NO.
NO COR FILED
Oct. 08 1999 04:04PM P2
523044
RECEIVED FOR RECORD
AT 8:00AM
MAIL TAX STATEMENT TO:
Z ,7 PAID DEC —2 1898
. TrarlsfAr?ax
q
Riv. Co. Reoafder
ESCRow No. 21T834-2
TITLE NO. ran:— ..
APA:SPACE ABOVE THIS LINE FOR RECORDER'S USETRA*pl
: 7 _ 2- THE UNDERSIGNED GRANTOR(SI DELCAREIS)
fi
DOCUMENTARY TRANSFER TAX ISE 35.75 e E
X Computed on full value of property conveyed, or
GRANT DEED " Computad on full value less liens & encumbrance*
remaining thereon at time of Bale. .
$ Unincorporated area: City of LA QUINTA and
FOR A VALUABLE CONSIDERATION, receipt or which to hereby acknowledged,
MUMBIL, INC.
hereby GRANTS(S) to
NORTHWEST -SOUTHWEST DEVELOPMENT, INC, AN OREGON CORPORATION
the following described real property in the County of RIMMIDE,
State of California:
LATS 12 IN BLOCK 258 OF SANTA CARMELITA AT VALE LA QUINTA UNIT
N0. 24 AS PER NAP RECORDED IN BOOK 19, PAGES 44 AND 45 OF Mn,
IN THE OFFICE OF THE COUNTY RECORDER OF SAID COUNTY. PARCEL
NO.: 774-192_023
Date: -max 04 %
MUMBIL, INC
WILLIAM R. HOWARD,. PRES.
07/16/1999 08:50 5032548654
.hAy 15, 1999
City of LaQuinta
BLa7dirag Department
PO Bax 1504
LaQuinta, CA 92253
This letter authorizes )
my behalf for any and
process in the City of 1
Pdradise Construction
948 NE 102nd, Suite 103
Pbrtlan4 Oregon 97220
Ph:(503)256-4217
YOST INSURANCE PAGE 01
Lench H of Lench Design group to sign on
eats relating to the building permit
4.
PLAN: YS -2
ATTIC VENTILATION
ATTIC AREA: 1,465 SQ FT
458 SQ FT
TOTAL 1,923 SQ FT
1,923 SQ FT/ 300 = 6.41 SQ FT REQUIRED
8 VENTS / 14" X 18" VENTS (1.17 SQ FT X 1.5'SQ FT)
8X1.17SQFTX1.5SQFT=
14.04 SQ FT
LESS 50% VENTED AREA
7.02 SQ FT
ACTUAL NET TOTAL SHOWN
7.02 SQ FT
LENDEL: EXCELIMY DOCSICALCSIATTIC YS2
9/6/99
4
Certificate of Occup
ancy
City of L.a'.Qu'inta
Building and Safety Departm'.ent
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
54-245 AVENIDA MADERO
Type of Construction: VN
Owner of Building: PARADISE CONSTUCTION
Building Official
Bldg. Permit No.: 9908-210
Land Use Zone: RC
Address: 948 NE 102ND, SUITE 103
City: PORTLAND OREGON, 97220
By: GARY HARTMAN
Date: 4-7-00
POST IN A CONSPICUOUS PLACE