SFD (0107-317)54800 Avenida Madero
0107-317
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
Date Signature of Contractor
UILDER•DECEARATION
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 rontracting 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.
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 to the workers' compensation provisions of Section 3700 of the Labor
Code; I shall forthwith comply with-thyse provisions: {%
Date's , _-'2,/, .. e W Applicant )(d / ,.A n: a7• a . C fl d ° «
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 pursua
any permit issued as a result of this applicaton agrees to, & shall, in(?f ify
& hold harmless the City of La Quinta, its officers, agents and emple S.
2. Any permit issued as a result of this application becomes null ands if
work is not commenced within 180 days from date of issuance o h S
permit, or cessation of work for 180 days will subject permit to cance ati n:
I certify that I have read this application and state that the above inform tion Is C
• correct'l agree to comply with all City, and State laws relating to the b ilding
construction, and hereby authorize representatives of this Cityito enter upon
the above-mentioned property for inspection purposes. i
Signature (Owner/Agent) f ` ''- t r_ Dater` ,
PERMIT#
BUILDING PERMIT ;
DATE VALUATION LOT TRACT
4 J ,. d '1 t,1 E'l`m .,,,> • r
JOB SITE
ADDRESS
'
7 74
:EN
OWNER
CONTRACTOR/ DESIGNER/INEER
:48so .AVR AUVMU05
54.880 ME. tlL.'4raR W)Q
kQUD.. rA CA 922.53
I_A. CJ.WrA . 'CA 92253
USE OF PERMIT
'y
Q rA !+ p ! y P p• q
11'J i3J.RC. t d'9L i .1&.•2. 7V J['.3 J 71V 43
4
EtFD3«(2WZ XbT RIC 1AIMP Pl'.FGpL OR DRIVI sld".P,.'Y APPROAC3'1. 120 LF COM30
? , 't'.4 . i tl'I ' t 3. 3d 't1 .1 ,.L.T,t D . .1 '• t kt s ;!vr 1Z ;PsI 1 • JI . t .ta .AS`.P►Fid
Khmil.T01148 CODES
TRACT CONOTRUCT1109 1,697,00 OF
CAWZA WC.+?eIPJIOP.T 437.00 SY `
g Tr'r. iit &J.:L 69,00 I..,Ii
'C aST O,Ir t d NS'.('f. ETC-U.0K
I(?n IKY1 -40
,•,M'p ¢'n jy'` : ' f. •; ,'1HD
^ '•/ ' / " ' FLT
y'i^ .I:iJAJ\E•H .fi LT Y+B9%1C.84Y J,1II Y
.
PLAV 014ECK MW 103 -000439-31
3: ef'OMI 10 i "I6'V'(39- 31 8 42% 00
YE RAN7uYL YEE 969,0€
tsll °:'r(GI•f A;8 I rL:' 101-000-420.000 $116169
P1 UMBTHaDUE 2t9?til Q41 4i: • J(1iB 1. 9,2
STRCYNG MOTION OW - MESW 101 ••0t10 -2,A1-000 $10.06
`
0RADING RX, £U1-000-42.3.001 $20.00
DOVELOPER WI.PA.CT 9!9.9- $1,9nm
PRW1130Z PIAN 101-000-441-345 9104.0¢
CONS t RUC'1 HQ ' 1 Lr' • 101--000-419-000 $07.00
e
u LESS PP.&UPF W FEEZ
425"O`6o
P 2 6 20.01 TCVrJ _T4;RA_r 11S DUB NOW
OF LA QUINTA
FIFIANCE DEPT.
.
RECEIPT c^'
DATE"
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
C ++
Underground Ducts
Forms & Footings
/ .t1
V`` '
Ducts
Slab Grade
Return Air
Steel
Roof Deck
_ _
_ 2
Combustion Air
Exhaust Fans
O.K. to Wrap
_
F.A.U.
Framing/
Compressor
Insulation
_7
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
_
D s/ }
ST
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
8 /y ` !
(
Heater Final
_
Water Piping
`
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas TestA_tE_1_
Appliances'
ttt
Final
COMMENTS:
Final
/ /Zv, ,,iKr L (
%G, [ 2— S 4 Z 9'GL
Utility Notice (Gas)
(l I
l
1 -2 2 2ZZ/
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
3
Utility Notice (Perm)
Building
Address
Owner
Mailing
Address
City
//
Contras
Address
T4ht
"
P.O. BOX 1504
78-495 CALLE TAMPICO
% LA QUINTA, CALIFORNIA 92253
APPLICATION ONLY
BUILDING: TYPE'CONST. OCC. GRP.
01 ' `;L x r. A.P. Number
Gity Zip Tel.
State Lic. City
& Classif. r '— Lic. k Ci
Arch., Engr.,
Designer w yt Pte.
Address Tel.
CityI Zip I State
Lic. q
LICENSE CONTRACTOR'S DECLARATION
I hereby of 'rm that I am lic ns d and provisio 's of Chapter 9 ( encing with Section
7000) of DI on 3 of the Bygin s n . f s i s Code, and se is in full force
and
effect. X//
G
NA ' DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors 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:
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 thealleged 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 I 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 (hereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
i'! 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. (Sac: 3800, Labor Code.)
Policy No. Company
r7 Copy is filed with the city. O 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 (5100) valuation
or less.)
Icertify that in the performance of lhp 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, It, aftermaking 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
ame
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 a0plicant Date
Mailing Address
City, State, Zip
T
Legal Description
Project Description
ig &C l / f
Sq. Ft. No. No. Dw. .
Size Stories Units
New ❑ 1 Add ❑ Alter ❑ Repair ❑ Demolition O
NOT
_
Estlma ed Valuation
PERMIT AMOUNT
Plan Chk. Dep. ZSR
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
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 9/26/01 APN # 774-265-003
No. 22539 Jurisdiction La Quinta
owner NameEast Valley Construction Permit # 0107-317
No, 54-800 street Avenida Madero "g#
City La Quinta Zip, 92253 Study Area
Tract # BLK275 Lot # 22Square Footage -1687
Type of Development Single Family Residence No. of Units 1
t
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
2.05 X 1,687 or $.3,458.35 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may nobe_issued; .
Fees Paid By CC/Terry Hamilton Telephoc "5644844 '
Name on the check
r
By Dr. Doris Wilson - - .: 1 14
Superintendent
Fee collected /exempted by Juanita Green Payment Received ' $3,458.35
Check No. 61107
Signature 'L)<
NOTICE: Pursuant 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
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
OLD RE E ®®c sly 20®z -2S3400
RECORDING REQUESTED BY: 06/27/2001 ea:00A Fee:8,00
Fidelity National Title Company Page 1 of 1 Deo T Tax Paid
Recorded in official Records
Escrow,No, 42795 -CB County of Riverside
Title Order No. Gary L. Orso
Assessor, County Clerk & Recorder
When Recorded Mail Document I
and Tax Statement To: 11111
Mr.1 1111
anHamiltonI
dIl
Mrs.f llf
Donal_. 111f
d_ If
G. _ f I
11
._. Ilflf
11111
1111
111f
Ifl
11
f.
P,O. Box 1281 _
La Quinta, CA 92253M s _U1 PAGE SUE DA PCOR NOC°R
SW
l I
I
'Y)GRAD CDPY
"Tid) r— NT DEEJ.. ,
REFUND -
T h ie-./—u0ersignn.ed.-ggrantors) .deciare(s)
Documentary transfer tax is $41.80
I X I computed on full value of property conveyed, or -
[ I computed on full value less value of liens or encumbrances remaining at time of sale,
[ I Unincorporated Area City of La Quinta
FOR A VALUABLE CONSIDERATION
Woman receipt of which rs hereby acknowledged, Alice Tipton, An Unmarried
hereby GRANTS) to I Donald G. Hamilton and Terry J. Hamilton, Husband and Wife as Joint Tenants
the following described real property in the City of La Quinta
County of Riverside, State of California:
Lot 22 of Block 275 of Santa Carmelita at Vale La Quinta, Unit #25, as per map recorded in Book 19, Page 51. of
Maps, in the Office of the County Recorder of said County.
DATED: June 4, 2001
STATE OF CALIF-QRNI.4
O / _ before me,
personally appeared
P9X69F1aIIVI-A0AA4n to roe (or proved to me on the basis
of satisfactory evidence) to be the person(s) whose
namesre-subscribed to the within instrument and
acknowledged to me thatey executed the
same in ' er their authorized capacity(ies), and that
by hiAj their signature(s) on the instrument the
person(s), or the entity upon behalf of which the
person(s) acted, a uted the instrument.
Witness my ha d d official seal.
Signature
Alice ipton
.,
CATHERINE AN BOYO
COWL # 1197866
( rt• NOTARY PLMUCd:AUFORNIA
WERSIDE COUNTY 0
<" Fa COMM. EXP. NOV. A, 2002 ''
r
MAIL TAX STATEMENTS AS DIRECTED ABOVE
FO-213'(Rev 7/96) GRANT DEED
c
a 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 per Section 9.50.090 of -the Zoning Code. Its purpose is to determine:
1) that the proposed house design does not duplicate the same architectural style of any
house within 200 feet of the applicant, and/or 2) if there is a need for the applicant to file for
Master Design Guidelines. If the applicant does need to file a Master Design Guideline, please
transmitted this information to the Building and Safety Department as part of your correction
list. Please attach additional. explanations as necessary.
APPLICANT East Valley -Construction
SITE ADDRESS 54-800 Avenida Madero
APN 774 _ 265 CASE NO.: 2001-526
111 111111,
CHECK ND APPR BY: nn eAt aae s 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
Verify legal and APN information
Consistent with MDG on file (as
applicable
MDG filing required (5 filings since
9/3/98)
Architectural variety within 200 of
the surrounding area:
olors
.....t
O d o Ma eria o
ed
igslon0
oat
A chi c u I e i f e tt
0n
G D
v Dept.
tity
Other Requirements: ln t
s
'
Cas
EX
b►t ondti
ions
' 0
ith
r
'Certificate -of Occupa
icy
City of La. Quinta*
Building and'Safety Department ti
`"o>F
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: 54-800 AVENIDA MADERO .
Use Classification: SFD Bldg. Permit No.: 0107-317,
Occupancy Group: R-3 Type of Construction: VNN Land Use Zone: RC
Owner of Building: EAST VALLEY CONSTRUCTION Address: 54-880 AVENIDA ALVARADO
City: LA QUINTA, CA 92253
By: RICHARD KIRKLAND
Date: 03-25-02
B Id' ui •Off'
ing icia
(O POST IN A CONSPICUOUS PLACE
I
I
STAN
DA►RD SERIES
39 - WOW Hw" flm9
PIN 70QA07M REV. A 000
BR -b36 , . SOF-36
BRFl-36 'BVI -36
TNs iIrdo on mar al of ennbleu to obnin a cead a 4 de d
stand d 1 ons t amore bb" lam -
Do ra; •alder or RmdOy me ffrephO or bs OWPotte O ur*W any
d=mswm Any modiifiWm Or wraw. of"1hplex swm,
indobtp but nm Imtred to the *"Isco, chUnnry Wnponeam AN,
acoeswftmay Wdme wornw.ponpsandww#*dOWM '
and court msult in an unsafe WW potefttie4lj►dW s
WORTOM TO ASSiM FROM AUGWW Of OLAS$ OQOf&
9WALL tests MWLAM tib A sWW AIM PUM MOt4if -'
USM SjpMS AS OEMSSARY AT SM AND= Sly! 1pfl.
1
PLEASE KiAlpl MS MANUAL FORRfulm Ruvwx
RETAIN TRSE INSTRUCT" 6e U t ttso. a t• eoo
FO* FUTURE REFERENCE t
-d wuzv:OL OOOF- I£ " O0