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SFD (0007-124)51545 Avenida Martinez 0007-124 , 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. 'Lidense # Lic. Class Exp. Date Vale , i; Signature of Contractor OWNER -BUILDER bECLARATION 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-i6tended 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. ( ) 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 Califomia-art ad gree that if•I should become supject to the workers' compensation provisions of Section 3700 of the Labor Bode, I shall forthwith comply with those provisions. ate: Applicant Warnirig: 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 construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. lei • ature (Owner/Agent) - - • - Date ` t' BUILDING PERMIT PERMIT# DATE VALUATION LOT 0007424 TRACT DKI14TJ12 JOB SITE APN ADDRESS, ,. •,.o rf :9 2 :I b aA a "i:I.IVF. 773 -172 -OW OWNER CONTRACTTOR/ DESIGNER /ENGINEER CONTRACTOR ' -S. w 0VrkWVBpPRWA", PO'DOX 60 •.. LA QTJD rA CA 92253 CBLO 'USE OF PERMIT SIP.IC LE FAM DWEL L)NO S1jD • PERMIT BrOPS NOT INCL.UME BIDCK WALL, OR POOL TRACT CONSTRUCTIaN 1,526,00 SP PORCH/PATIO 459.00 SF GAR.AWCARPORT 546,00 3F 9 FP, WOOD VENCE 200.00 L F911MAIXD COST OF CC)MS:I' UC':CION 101X9.10 1MRWr F17. WhWAR CVAI&TIRUC:TION FEE 101-000.418.000 $646.30 PLAN CKXQK FEE 101-000.439.318 3s9.i;9 M'E.CHA3NIICA1, FEE t 101.000-421.000 $60,00 EL.IXTRICAL YU 101.000-420-000 Stsa, 3 PLUMBING FEE 101000.419.000 511613 STIRONO MOTION t+LE - ILESID 101-000-241-000.. $10.14 OPIADD10 FEF. 101-0004U-000 $30.00 DEVELOPER. IMPACT ltUP $1.9".00 PRECISE PLAN 101-000.441.345 $100,00 ART rN PUBLIC PLACFS . R0st[ 701-000-235-000 $3.42 FELZ-DEPOSIT 101.000.4.19-318 4230,00 6VB Te>`I,€ L CJWIRLYC7109 AND PLAW CBECK $3,53.1.53 MUSS PRE -PAID FM -$250.00 'MAU PM41T T . +' + N DIN, NOW RECEIPT DATE BY % DATE FINALED INSPECTOR •'11 INSPECTION !RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS -Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap -6C F.A.U. Framing f Compressor _ Insulation/ 4 L _ Fireplace P.L. / Vents Grills ` Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS - SPAS 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 Final Water Piping _ Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection /Q 1 Encapsulation Gas Piping —`' Gas Test Appliances Final 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) COMMENTS: B aG STAfF J / f ' itrCv SI - 545 AVE RP,9, i v167- P.O. BOX 1504 - / - APPLICATION ONLY Building 78-495 CALLE TAMPICO Address LA QUINTA, CALIFORNIA 9203 ( Owner A Mailing Address P 'City Zip Tel. r- . ` to /4 7 4 A'"o Contractor Address ip I Tel. . . State Lic. Tcr-Ict &Classif.. # Arch., Engr., Designer 1 Address Tel. i City '" Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section effect of Division 3 of the Bu iness 7d Prrofessions Code, and my license is in full force and lie effect. / SIGNATURE -aSF . 1 IC (1 '. 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, after, 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). 1J I, as oner 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.) I7 I am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 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 n Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed it the permit .is for one hundred dollars (E 100) valuation or less.) 1 I certify that in the performance of thg 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 if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. 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. Signature of applicant -Date- Mailing aleMailing Address City, State, Zip ,, j 1 r'_ O, BUILDING: TYPE"CONST. _ I" OCC. GRP. A.P. Number C " C. 0 —3 ` Legal Description \ Project Descriptioni N-e % R /►t , l.J - L r . i5t-arK a4 uillt 1`L Minimum Setback Distances: Sq. Ft.- — -- Size + ` i t t No. •' ' " " No. Dw. Stories Units New ¢r'r"' Add 0V; Repair ❑ Demolition ❑ fIs3Z Side Street Setback from Center Line Side Setback from Property Line .All FINAL DATE INSPECTOR ( —, (9' ;Y-0$GV Estimated Valuation Date Permit PERMIT Plan Chk. Dep. y 61 AMOUNT ,, r J i Plan Chk. Bal. _ Const. Mech. Electrical 1 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 Date 7/18/00 No. 20733 Owner NameWally Miles CERTIFICATE OF COMPLIANCE APN # 773-172-005 Jurisdiction La Quinta Permit # No, 51-545 Street Avenida Martinez Log # City La Quinta zip 92253 Study Area Tract # Lot # 3 Square Footage 1526 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: Nkl EXEMPTION NOT APPLICABLE s This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount" N 2.05 X 1,526 or $ 3,128.30 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 Bank of America / Wally Miles Telephone - 771-4824 Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Sheryl Simmons Payment Received $3,128.30 Check No. 400610156 Signatu NOTICE: 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 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 WHEN RECORDED MAIL TO AND MAIL TAX STATf-MENTS TO NAME Richard G. Crockett ADDRESS P.O. Boat 1440 CRI' La Quirda, CA 92253 STATE & ZIP TnI E ORDER Na GRANT DEED ESCROW Na Am Na 773-141-003 .! '1-545 AV6AAxrW67- THE UNDERSIGNED GRANTOR(s) DECLARE(s) DOCUMENTARY TRANSFER TAX is E CITY TAX s computed on full value of property conveyed, or computed on full value less value of liens or eamkmanoes rerruairting at time of sale, Unincorporated area: Cly of LA QUINTA, and FOR A VALUABLE CONSIDERATION, receipt of which is hereby admawledged, WALLACE S. MILES, AN UNMARRIED MAN hereby GRANT(s) to 5 WALLACE S. MILES, AN UNMARRIED MAN AS TO 1/2 INTEREST AND RICHARD G. CROCKETT, AN UNMARRIED MAN AS TO 112 INTEREST AS TENANTS IN COMMON the foil"ng described real property in the County of Riverside State of California: Lot 3, Block 114 of Santa Carmelita at Vale La Quinta Unit No. 12 Tract, County of Riversied State of California, As per map recorded in book 18, Page 79 of Miscellaneous maps, in the office of the county recorder of said county 773-141-003 WALLACE S. MILES SATE OF CALIF0fWIA ) co Y OF K / P%' jr/ lJ S -S. On Q O og before me,i i (r> ert nam and We of the arrtce>1, personat<y appy Ila C pnd 1,41 Iawwn ledged to me (or proved to me on the basis of and;,nowto me that helsh e>oe the same in h > be i to the within irustrument s j [f r authoreed and that by hisr si ture sj on the instrument the Ior the entity upon hetuaff of which the persor sf acted, orecrRed the irustrtar ri W"p,S my tend and official sea]. MICHELLE RAMOS _Cort>mbdon 012453 Notcry public _ Calfforrtt0 z f8vemide County MyCarnmooffiD- 200 Sig t1% 49Li I wallt17An0M BY M'FWARr ME OF CAUFORMM INC. GRNMEMMW 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 RICHARD CROCKETT SITE ADDRESS 51-545 Avenida . Martinez APN 773_ 141 _ 003 LEGAL: LOT 3 BIN NO.; CASE NO.: 2000-960 BLOCK' 114 UNIT 12 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 A PRO D $Y CO UNITY DEVELOPMENT DEPT Consistent with MDG on file (as applicable MDG filing required (5 filings since 9/3/98) . C AT U Consistency with street/surrounding area: Colors Materials Architecture Other Requirements: - - -CITY OF LA QUINTA ,50,CONTRACTOR LIST F-.Rb_,k10DRESS ' PERMIT NUMBER - OWNER - - - ILDER - - _' - - - - -- _-_ .. _ -- - - - - This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons pear/ n this list or their employees are authorized to work on this job. Any changes-to this list must be approved by the Building Division prior to commencement of work. Failure to corrT ly will result in a stoppage of work and/or the voidance of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response. Trade h Classification :>::>::: > ::><: Contractor .;.::.>::;; ;:::, :::.;:;:;;:;:. ,.; ..... <.:> :::>::>:;::> ;:.....>.... n Irisura Busm...:. >. • State: Contractor s License Workers:.Com ensatao nce ... Cit Company Name Classification License Number Exp. Date Carrier Name Policy Number Exp. Date License Number Exp. Date (e.g. A, B, C-8) (xxxxxx) (xx/xx/xx) (e.g. State Fund, CalComp) (Format Varies) (xx/xx/xx) (xxxx) (xx/xx/xx) EARTHWORk 161 2) _ Di 2C R t/¢.c 9 71, 57 /17 CONCRETE (C-8) -. p, i/ 7 "7 • CIA $-F 2 %</,-5- ✓ / Z / op FRAMING (C Ii) JZ fi / . N T,ve c.✓ v -0 1 Ci o c 2-!;- b A/ •/%S 3 ° s3o ✓ ✓ STRUCT STEEL MASONRY (C-29) PLUMBING IC-36): o ,u T 6 G — $' 3 S" 7 3 / clA c A t z/ R y-oo dR LATH; PLASTER (C 35), 6 B C _$ 3 7S7 -w-ov 3 31 .2 L-.), Gl , i marll,_5 b k o 91?-51 S` G DRYWALL (C-9) fi A Co,uJ 7 C ^ $' % 7.S ` /. -p/ ✓ - -oU :3 2q1 C /AiL E , T/ D Lkitona a¢ro HVAC IC 201' cap N>'D / G, C ' Z Z7 / Z 2 %7S ° A, ELECTRICAL (C-10) , A E 2 / L 'nl i /c • 0 o d 2-5 © d 3 d b^ O fit/ G LU3 ROOFING (C 39) . 0 N 4EE RoaF c '3 7 s' Z C_ x/ , / l ,- O -® yi 7p°1 ?;? •o 'v FLOORING 10i rxpa 0. G k I C-17 70 oy ZINQ 3-3/•0 A, ;U/) INSULATION IC. 2) . ` ` /q 6a (oD.f I R Ti ,J - , j - • o / I + 4` 3 9/ •LS •O / SEWAGE DISP 10-42) p !} 1 l ,YJ _ C, -,a v ✓ cc p `✓ - -oil 3/'2 C jl / =p Ivo PAINTING (C.'33 R iao v Tu avpK/ , ,vt c C - _ 2 -L cY f rA S Ob ✓ 'l! -c c ./ ` G :S / S CERAMIC TILE (C-54) ::; o a 6D E d -r CABINETS ex e --r- f y-l3-O FENCING rtf NaL= N L / , Z 7yo 9 / G.av Fx - -r ,A -rr 3 3i ._6A,, ,, , "E'. t N ' /oa 2 LANDSCAPING ' O - - _ .... _ bre •_ POOL (C-53j>.:. (A-&Arz- -MAY /ba - /0/,W0/A/G.