SFD (0102-207)54300 Avenida Madero
0102-207
LICENSED CONTRACTOR DECLARATION
(,hereby affirm under penalty of perjury that l 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
'1828324 13. 190 Dori 1 /7(
Date 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
rDate - f 6 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 Policy No.
EXEMPT
(This section need not be completed if the permit valuation is for $100.00 or less).
A( -)'J„certify that in the performance of the work for which this permit is issued,
(1561 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.
,Date: Applicant—
`Warning:
pplicant 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
work is not commenced within 180 days from date of issuance of suc,
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 inspection purposes.
.. f L
6ignature (Owner/Agent) r r Date)
BUILDING PERMIT PERMIT#
,
DATE/LOT LOT ( ,_20 TRACT
tag_ W10
JOB SITE
APN DO -A
ADDRESS
!W3(g) AWAT DA XADERQ
OWNER
CONTRACTOR/DESIGNER/ENGINEER
RICHARD SCO'( "1'
X' ACA -1t^ HOMO,,
PO TBOX) 0612
77 564 A C.QUIVRY rXATB 1 RM1 M"4TE 113
PAT Im DRIM” r CA 92211.
W 1Y'is",M?6z , CIA 9223.1
C-160)408.-3495 f"Blit Z953
USE OF PERMIT
ffil.`d IST.41 Rai3..L11,.A
SYD 1s:0:l AIT 3rJ 11tS NOT MC:L,UT Y_ BLOCK WI UJPCICtUSRAlif,l✓PROACH
TRACT f.'Ut7STRUC ION 1,421.00 OF
PORC"A`iIO 36.00 Sp
GAIIA'awalknPORT 91906,00
5 .[ T. W0010 Fk",XrZ U0,00 ]LY
,t"'STMAIRD 4 0156 .i' 010 COM URI
wo 'm 3.0
p:Mj rS m R
.Pi 4'N C;H,FX4 FEZ 101 -000-49- 18 $500.1-
500.1_000-4121.000
_000-4121 -000(►.9i0
Pa GT1F,1ti;_k1,FEE 102 -OW -420-000 $3-9,44
T'U06aiDa121 TOR 101 -000-4-19-000 "f 11,0117$
STStOIX31 Id1C7'F1L3Af : XtiP,SID 101-000-241-000 U.93
O13ADINO FEV, 101.000 4233.212121 SX90
f)MILOPEA IMPACT XUL?
ta141? ::I 3 i 1 1 e_'t1 101.000.441.345 W0.00
1721f, DEPOSIT
-
Nit)
'. °tA`r 4 ai'39.411Tety 7'1:G P A1 iI 1:^1~ ll: 'a -HICK
0.
$3,434
FE %+ 6 2001"' L.E193 M-PAtDFE-03
4715 i:f.o
Y ve LA 11U*41
T(YrW4 P".TaL RAI F,Lr FIS."DS E NOW
$3,160.474
S St
/
RECEIPT
'DATE ,- f
B,Y? 'C V
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
- BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
o
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
O
S7
Exhaust Fans
O.K. to Wrap
6 — b- O /
$T
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O..
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
7
Drywall - Int. Lath
i
Final
Final 1
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
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
7
Final
Water Piping
I -
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Piaster
Sewer Lateral
Pool Cover
Sewer Connection
_a .- O (
Encapsulation
Gas Piping
Gas Test
=r0 — O
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
_
ELECTRICAL APPROVALS
Temp. Power Pole
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)
g 6_
4
f ' ftrCv
P.O. BOX 1504
Building 1r y wi/U► /1 78-495 CALLE CALIFORNIAO
Address 7itiG Li CC J LA QUINTA, ORNIA 92253
owner p, (A ✓ L 5 ( U 1 (t I
Mailing
Address " U Y
Citav
Zip9 , Tel.
Z Tel
4q
Contractor
1-4-, 14AQ_4-
City . ZiP49 G. i..I / l Tel
a 3
,
State Lic. City
& Classif. ZZ zr Lic. a Q' 5
Arch., Engr.,
Designer
Address Tel.
City I Zip I State 1
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Sectlon
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 Contractors License Law for the following
reason: (Sec. 7031.5,Susiness and Professions Code: Any city or county which requires a
permit to construct, atter, 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, 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'N,,as owner of the property, am exclusively contracting with licensed contractors to con-
struclgthe 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.)
i ] 1 am eJrllemmpt under Sec. B. 8 P.C. for thireason
Date wG,
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.)
Pollii y No. Company
Vopy 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 perform-eof th work for whiaCthis permit js=i sued, I shall not
employ any(person in any meso beco - su ec to the Wo kers om—nsation
Laws !Z)fgc ia.
Date Owner
NOTICE 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 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 allcitytand county ordinances and state laws relating o building
construction, and hereby aut borize repr€sentatives -of this city to enter t e %ova
mentioned property for inspec Ton pur66ses.
Signature of applicant /, Date
Mailing Address__ r I
City, State, Zip
dal S 4-a ' oy—
p
APPLICATION ONLY 1 S
LDING: TYPE'CONST. OCC. GRP
A.P. Number
Legal Description jj /,e}
li/X`S I F—
Project Description cow w (Q A
ZONE:
BY: A
Srthl_LA ZR A-0096 141$04 G IO OlI49— 3(p O
Sq. Ft.
Size
No. No. Dw.
Stories Units
New Add ❑
Alter ❑ Repair ❑ Demolition ❑
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Estimated Valuation
Issued by:
PERMIT
1! AMOUNT
_ _ ♦J U
Plan Chk. Dep.
Plan Chk. Bal.
Validation:
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE:
BY: A
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:
t,
F .. d "
Validation:
T4 Ur- L
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
CERTIFICATE OF COMPLIANCE
Date 2/26/01
No. 21709
Owner NameRichard Scott
No, 54-300 Street Avenida Madero
City La Quinta
Tract #
Type of Development
Comments
Lot #
Jurisdiction
Zip 92253
G02.
APN # 774-232-093
Permit # 0102-207
Log #
Study Area
Square Footage 1421
Single Family Residence 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
2.05 X 1,421 or $ 2,913.05 the property listed above and tliat bhiltiing
permits and/or Certificates of Occupancy for this square footage in this proposed project maymnow be'issued
Fees Paid By CC/1st Bank - Shirley McElroy Teienhone',' 760-r'408-3495
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Annette Barlow
Signature ("
Payment Received $2,913.05
Check No. 57967
40TICE: 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
:oiled them on the DistrictCs)(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
___..._._..__....... _ ...
9/01 10:2. FAX 17608049062
E(;ORDING REQUESTED BY:
AND WHEN RECORDED MAIL THIS DEED AND,
UNLESS OTHERWISE SHOWN BELOW,
MAIL TAX STATEMENTS TO:
Richard.T.,L. Scott
P.O. BX. 1.0612
Palm Desert, Ca.92255
COMMONMVEALTH TITLE
GI Yil WJ
WJUUl
SPACE ABOVE THIS LINE FOR RECORDER'S USE
The undersigned grantor(s) declare(s): Grant Deed A.P.N. 774/232/002/003
Documentary transfer tax is $
( XY) computed on fill value of property conveyed, or
( ) computed on full value less value of liens and encumbrances remaining at time of sale.
( ) Unincorporated area: ( ) City of
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
George Smith
hereby GRANT(S) to
Richard L. Scott
the real property in the City of La Quints
60-49
State of California, described as
Lots of Block 261 Unit No,
County of Riverside
, and
, Santa Carmelita at Vale La Quinta,
as per map recorded in Book Pages mf Maps, Records of Riverside County,
California
0
a;cd Signature of Grantor
State of California )
County of —)SS.
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(s) is/are subscribed to the
within instrument and acknowledged to me that he/she/They executed
the same in his/her /their authorized capacily(ies), and that by
his/her/their signature(s) on the instrument the person(sj, 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, Gamok ar, aba"s
Form 3196-4 (6-94) THIS FORM FURNISHED BY COMMONWEALTH LAND TITLE COMPANY
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. .
APPLICANT PACIFIC HOMES
SITE ADDRESS 54-300.Avenida Madero
APN 774 _ 232 _ 002 BINNO.:
LEGAL: LOT 12 BLOCK 261
CHECKED BY. Fred Baker
CASE NO.: 2001-403
UNIT
DATE:
S.C.@V.L.Q.
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
Consistent with MDG on file (as.applicable
MDG filing required (5 filings siince.9/3/98)
EXHI
_
31T
'Consistency with'street/surrounding area:
Colors
Materials
Architecture
CASE
NO.
Y
Y
Other Requirements:
❑ Customer Deposit
❑ Other
TOTAL $
flemarks:
*opY to:
Water Service
Cash
Check Cashier
Money
Order CVWO-43B (11189)..,
0
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
N11 nv
083200>>.
3 01
'
Date,
iceivedFrom:
.40$J3u LACOS A CliffC•r..0
W MLLIa E'506-7 .
(dress:
:count No. ; i tG_ OS7, ' 0 0
Lot(s)
Tract
i[ C ' .300
arviceAddress , . ,r
G.A. Code
<Meter(s)
ti Services)
I Backflow(s)
l
I House Lateral(s)
] Detector Check(s)
I Meter Surcharge
Sanitation Capacity Charge
t
W.S.B.F.C.
] Temporary Construction Meter
7 Turn on Charge
}
Uncollected Account - Name
7 Inspection Fee - Tract -
Fee -
Plan Check Fees Water I Sewer -
r
Tract -
❑ Bond Payment - A.D. - Bond
i,
Assmt..
❑ Customer Deposit
❑ Other
TOTAL $
flemarks:
*opY to:
Water Service
Cash
Check Cashier
Money
Order CVWO-43B (11189)..,
0
Certific-ate 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
i of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification: SFD
Occupancy Group: R 3
54-300 AVENIDA MADERO
Type of Construction: VN
Owner of Building: RICHARD SCOTT
Building Official
Bldg. Permit No.: 0102-207
Land Use Zone: RC
Address: P.O. BOX 10612
City: PALM DESERT, CA 92211
By: STEVE TRAXEL
Date: 10-05-01
POST IN A CONSPICUOUS PLACE