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SFD (0102-205)54324 Avenida Madero 0102-205 LICENSED CONTRACTOR DECLARATION :: to 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 '4 470 /U ,/Date Signature of Contractor 1 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 the performance of the work for which this permit is issued. X) 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. (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 t9 the workers' compensatio .,'' j ov Ii i gns of Section 3700 of the Labor Coda_ h II o h ith comply with t o oy 10 S. Date: Applicant 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. '§ 'T IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions fset forth on his application. KM 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 SII any permit issued as a result of this applicaton agrees to, & shall, indemnify 1,1 & hold harmless the City of La Quinta, its officers, agents and employ 2. Any permit issued as 'a result of this application becomes null and Vad I Y 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 authoOze. representatives of this City to enter upon the above-mentioned property or irttspet'tlon purposes. '8ignature (Owner/Agent) V/ Date i BUILDING PERMIT PERMIT# DATA VALUATION LOT ()1,f)2 2LkJ TRACT r I ` %0'F d.l JOB -SITE' APN 003 ADDRESS ._ "W--324,E3;NTINVAb&7YKrZ0 774402-9 8-,` OWNER CONTRACTOR/DESIGNER/ENGINEER PALM 171'?. , 'i' CA 92211 '1 FIAI. M, 7 ;HaMi'I' CA 92211 (760)4M-5495 MR. 2953 USE OF PERMIT LINO SYD - 1PER SIT OUBS'NOT INC:?.. DE BLOCK `s✓AWt3GD4.+fsPA OR APPROACH DR35IMAY °iii"d:i4.f:7' C4aNs'd'!'RUC TION 1150110010E VORCHIPATIO 58,00 SA 0ARAMM"'RPORT %074.0 5 Fr. WOOD rENC E 200.00 'LP P; " UT 1" 1.c OR".ARY CON101TRUC;'T,OW .M. 101-000- .1 V-000 $612.50 PyLKN Cfr VIC°K:11,9 101-000-439-'318 $51:3.45 ME MAMCAL VER '101-{DDO.421 -00u 860100 9Lt,C-TXIC",AL MV 101 -•ONO -4204.000 $1,V30 PLi)MM0 ."IR 101-000-419-01(K) $110,75 S t'IIONO MO TIfiN IEI - 'Ft=R) 101-•000.241-000 $4.31 0:31 AD1110 01 101-000,423-000 $20.00 FY[r MII,O.S°,!?:R'I 1-MPACT Yk $i94(%7.w :['tiEMSF t 1.AX4 I ' 101-0 00-443-345 MUD Pa iDE"s)S1'1' t 101.-000.439-119. R 1 2001' 0 S T,TCYTAI.,C1C>1MAiFMMAg1lP7J?i' CF3:Lt".1C. 0.31 ;CESS P-R&PAR :11M 425l. ou LA ITAAL .ITIMT MMS D"4.7'E NOW 3,2. 431 t RECEIPT IDATE ) y Y BY DATE FINALED INSPECTOR 4 I •, I INSPECTION RECORD k OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs,- Forms & Footings y / '��8 Underground Ducts Ducts Slab Grade ( Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap ('P� _ J S F.A.U. ' Framing6- S®/ — Compressor Insulation (_� . sl 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 POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings ! Main Drain Bond Beam r 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 j l r Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral _ Pool Cover Sewer Connection ef'.0 Encapsulation Gas Piping Gas Test _(� 6 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) Building Address T4ht 4 4 Owner rr Minimum Setback Distances: _ -- G.,VIGI Front Setback from Center Line Mailing Address . ' ^ [ Y, clim No. / Stories TTZID - " P.O. BOX 1504 n 78-495 CALLE TAMPICO C:_) LA QUINTA, CALIFORNIA 92253 Conctor ,PNcr Add77;'64-r&6Q►JTa N49 9k - P;1 1, Zi Z2 t Tela State Lic. City L5 .► & Classif. $ ?j Lic. # 0 3 Arch., Engr., Designer Address Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70001 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). 1 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.) A 1 am exempt under Sec. B. 8 P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, o e t,Ic e of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800. L r • d78III _ Policy No. Company r7 Copy is filed with the cityl O Certified copy is hereby furnished, n 6 e L0U, Jr CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURf I CF"y / `` ,,7 (This section need not be completed if the permit is for one MAr d tlMolli /($10 I ti or less.) I certify that in the performance of Ing 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 Ihereby 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 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 property for inspection purposes. Signature of aCPlicant Date ` Mailing Address City, State, Zip APPLICAMON ONLY ILDING: TYPE'CONST. OCC. GRP. '. Number 'i tal Description W t 11 2 b i urtt r 24 ZONE: BY: Minimum Setback Distances: _ Front Setback from Center Line Rear Setback from Rear Prop. Line Sq. Ft. L Q Size No. / Stories No. Dw. Units New Add ❑ Alter ❑ Repair ❑ Demolition ❑ Issued by: Date Permit Validated by: Validation: Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure k TOTAL V%ARKS 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 CERTIFICATE OF COMPLIANCE Date 2/28/01 No. 21717 Owner NameRichard Scott No. 54-324 Street Avenida Madero City La Quinta Tract # Lot # Type of Development Single Family Residence Comments ao3 APN # 774 -232 -902 - Jurisdiction La Quinta Permit # 0102-205 Log # Zip 92253 Study Area Square Footage 1501 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 1,501 or $ 3,077.05 the property listed above and that buildiiigZ permits and/or Certificates of Occupancy for this square footage in this proposed project may now,beissued' ' Fees Paid By CC/1St Bank - Richard Scott Telephone 7601,408X495 Name on the check f jay By Dr. Doris Wilson f:.+•; l:f. z Superintendent Fee collected /"ptedabbyAnnette Barlow Signature Payment Received $3,077.05 Check No. 57978 VOTICE: 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 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 :ollect them on the Disbict('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 10 O1/,q Olj 25',,FA evz X'17608049062 LP6ORDIN46'ROUE STt_EDBY ' AND WHQtRECORDEO MAIL THIS DEED AND, UNLESS OTHERWISE SHOWN BELOW, °" "MAIL: TAX STATEMENTS TO: '? :R_ichiir . T..L - ' Scott ' P.0-'Bx t.' .0612 Palm'Desett, Ca.92255 COMMONWEALTH TITLE SPACE ABOVE THIS LINE FOR RECORDER'S 1,1SE The undersigned grantor(s) declare(s): Grant deed A.P.N. 774/232/002/003 Documentary transfer tax Is $ ( Xx computed on full value of property conveyed, or ( ) computed on full value less value of liens and encumbrances remaining at time of sale. ( ) Unincorporated area: ( ) City of and 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 Quinta County of Riverside State of California, described as l Lots :Eock . 261 Unit No, , Santa Carmelita at Vale La Quinta, as per map recorded in Book pages 6f Maps, Records of Riverside County, California Dated 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 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, ea a as abE►:rr f.r 4;FOrm 3195-4 (6-94) THIS FORM FURNISHED 13Y COMMONWEALTH LAND TITLE COMPANY ,fin', 'x• ' r r 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 54-324 Madero i APN - - BIN NO.: -CASE NO.: 2001-398 LEGAL: LOT 21 BLOCK 221 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 ftfftfra no PT PROVED BY C 7E a Consistent with MDG on file (as.applicable XFI B T MDG filing required '(5 filings since 9/3/98) ASE N0. Consistency with street/surrounding area: Colors Materials Architecture Other Requirements: Certificate of Occupancy City of La Quinta Buildinga'nd 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 ADDRESS: Use Classification: SFD Occupancy Group: R 3 54-324 AVENIDA MADERO Bldg. Permit No.: 0102-205 Type of Construction: VN Land Use Zone: RC Owner of Building: RICHARD SCOTT Building Official Address: P.O. BOX 10612 City: PALM DESERT, CA 92211 By: STEVE TRAXEL Date: 10-05-01 POST IN A CONSPICUOUS PLACE