SFD (0106-056)51552 Avenida Martinez
0106-056
f ; 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
47321 (A
Date /t Signature of Cop14actor = J
OWNER -BUILDER DECLARA ON
I hereby affirm under penalty of perjury that lram 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). F
( ) 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 tobecome subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensatio provisions of Section 3700 of the Labor
Code, I shall fo with comply`with the provisions.
<" Date: a7 " Applicants= f '
`
Warning: Failure to secure Workers" Compensation coverage is unlawful and
shall subject an employer to cr mjpenalties 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 1 -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 purpo l s.
`,. -•.y
,Signature (Owner/Agen-ttr-- +- Dated sd
BUILDING PERMIT PERMIT#
DATE VALUATION. LOT TRACT
9
qp qq `
Vli 7.4 YtJa+.'Ri' 21 L71IX 113
MIX
JOB SITE
APN,
ADDRESS
OWNER
CONTRACT OR / DESIGNER / EN (NEER
y
4245 0 COOK UTk`.'`MS-1 7, X120
76.545 NOTAR.L,1MTIME
PAC-.U:D S'M CA 9221d 1
B-MMUDA.DUMB CA 9220.1
(760)360.4116 CrBIX 309.4
USE OFPERMIT
.G
NSGUE.YW&L D LL
fg Y#.?gp• .P9g. rMIT WAS NOT TIN LURE iT .GiG.K'f<VALLS, POOL 'sR F]Pwtill:'i, ° Y
RRS", "A 6OS9Cr l ' •
'RACT`'L'C?2w''OTIUMT1014 u no,0910
iai f i i Aa gf3 35.00 Sir
(WRLAC.WCARPORT MAI w'F
EM"M1'lID COST OF CO:iYSMUCT70H
%7„455.20
1a•''; , R;Ci MEE ,'`C3'M1;/9.ARY
CONVYRUC'.7!'1'9IWA 101 -000-43 S -OW MOM
PLAN C'D1'RtM. fltpll 101-000-439-:118 028.59
101-000,439%,318 4250.00
U'RC:}9ANIC AL FES' 1111-000.421-000 $66.10
F U:r''i'X10AL Z 101.000.42.0. 00 SIKS`>"
PLfrMBINO!9.8 101 :130.0
9't'RC+M MOTION 117M . MID 101, WG-240 -OW 6933
ORADINOV12,11, 101-000-423•-000 $20.00
i 1 zf ' .f a ca.. t r• 1 1•:3 . a aUu.fJa
I;I a n.. " ' jj d'ti fi.1d 4J.flA J.' CVLJ' 1yAa12.44 i
J f.'1k7.710
D n MEN)
4250,00
AUG 22 2001 • x ., !
CITY OF LA QUINTA
FINANCE DEPT.
: :
RECEIPT
DATE '
'BY
DATE FI ALED
INSPE R
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
. MECHANICAL APPROVALS
'Set Backs
5
Underground Ducts
Forms & Footings
.Q t
Ducts
Slab Grade
/
Return Air
Steel
Combustion Air
Roof Deck
_ Z
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Insulation
j &
3 07—.-
TZ
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_a 8 • p Z
Drywall - Int. Lath
Final
31 IFD>Z— —
Final
POOLS - SPAS
BLOCKWALL APPROVALb
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
7
5
Heater Final
Water Piping
l0/ g/a
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test3p
rOZ_
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) ABG
A s0
0(06 -
Building
Address
Owner _
P.O. BOX 1504 APPLICATION ONLY
/1C" f j/1 - i ) • . LA QUINTACCAL FORNI
''f/A 92253
mailing /,
Address 7 (.,c,o coo e- .5 ,7 ,
City/'2 Zip Tel.
Contractor
b 5 r { ,✓J
Address
City Zip Tel.
360
State Lic. City
& Classif. ?3 Lic. # 3a
Arch., Engr.,
Designer r,. S
Address Tel.
Y r_ Z,0(v — , : L>c 57g_ -7 341C - ,j3C (-
City Zip State
%9L41 L jG r / 3 4 v Lic. #
LICENSED CONTRACTOR'S DECLARATION
I 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
SIGNATURE lam' 1 i v ✓ DATE
/Y V OWNER -BUILDER DECLARATION
I heleby affirm that I am exempt from the Contractor's License Law for the following1.
reason; (Sec. 7035, 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 (8500).
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'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.)
I'] I am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's C mpensation Insurance, or a certilied copy thereof. (Sec. 3800, Labor Code.)
Policy No. r✓ -t C..) —,Company L L_/1 G. n
17 Copy 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, performance of thii work for which this permit is issued, I shall not
employ any p rson in a y man` er so'as to become subject to the Workers' Compensation
Laws f lit rnia.
Date S Owner 1 f ff_— _'`
NDTIC TO APPLICANT: If,rafter ma nyth' is Certificate of Exemption you should become
Subject to the Workers' Compg°nsation provisions of the Labor Code, you must forthwith
comply with such provisions orithi 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.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives sof this city to enter the above-
mentioned property (or inspection purposes.
Signature of a0plicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number 77.3
Legal Description DC7 O L rC /3
Project Description `S F
Sq. Ft.r No. , No. Dw.
Size, S J Stories Units
New)6 Add ❑ Alter ❑ Repair ❑ Demolition ❑
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech. F.
Electrical
Plumbing
S.M.I.
Grading
Driveway
Infrastruc r
TOTAL I (FINANCE DEPT ,I_.II
AMOUNT
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
Notice:
Document Cannot Be Duplicated
Date 8/20/01
No. 22394
owner NameBuilding Horizons
Desert Sands Unified School District .
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515.
CERTIFICATE OF COMPLIANCE
No. 51-552 Street Avenida Martinez
APN # 773-142-004
Jurisdiction Palm Desert
Permit # 0106-056
Log #
city La Quinta zip 92253 Study Area
Tract # BLK 113 Lot # 21 Square Footage 1599
Type of Development Single Family Residence
Comments
No. of Units 1
@ City of La Quinta, verified new address (formerly known as 52-120 Martinez).
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:
EXEMPT
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
0.00 X 1,599 or $ 0.00 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project mariow be issued
CY
Fees Paid By Exempt - Coign Franklin 4Telephonet 760=360-6118
Name on the check +y
By Dr. Doris Wilson
Superintendent
Fee collected /exe ted by Annette Barlow
Signature
Exempt
Check No.
$0.00
NOTICE: 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
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
4 C
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 BUILDING HORIZONS
SITE ADDRESS 51-552 Avenida Martinez
APN 773- 142 - 004
LEGAL: LOT 21
CASE NO.: 2001-502
BLOCK 113 ' UNIT
CHECK AND APPROVED BY: Fred Baker. 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
Verify legal and APN information
Consistent with MDG on file (as
applicable
AP
ROVED BY C M UNITY DEVorl' DOWN! WEPT
MDG filing required (5 filings since
9/3/98)
B
EX
IBIT
Architectural variety within 200 feet of
the surrounding area:
Colors
Materials
Architectural design features
Other Requirements:
F a5 j
DOC a a
aatmaota0 galRr7lp It,
11
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CALZF
♦ At.t/. c0ar.
r.a. 4101 1"0
4 quince, Co.$2251
e t -.4 ..r • • Me w aw
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The W10evel"I'd ar"tarlel "alarefe,, 0oelrm "" trumfer tan to f :0.05
A4141afa0A'41 Nlat'd 80.1 771-147-001 lad 771.107-000
Islempted an 1011 Tstra of
prer•rt7 Conway".r
-tv" WAM
00.4 J01056728 t ) Ouspated Im et• cult 14400 loss 1t4141s ra
memo M.1 704111Ja
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barabr 0aAr7(s) w MU& M Mafmrm. .
1M. a C41. a7aia.
IM following $sal propory in the L gsl•ta, alearelde Ca"tr, 41ba1941 01 Qallfaralal.
deearibe0 "' "041 711 W 33 la at@" 117. fYp QWMM At 10Y &a (>7>ra'd taro ao.
If Of abaos bW at se "'a L SMA t0, rap(•) ►r. 10 Us Miss of tho coma? me"",
s/ Aire"Aft tansy. ta„ t.
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In Au
aIl.r I5. M00 MCOM W. UsmN41nlgned, t. ut• 1e, Me Ytea President
mmnwllr eMsar W t. arta laden and•
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be be the $ansate/ Mose
marib) A,Nara sabecrued to lbs glib" tosttmaa41t
a41f ee641r:ayaf to M that aoieb•/"of asswatad W
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%be ,ewes($) or the eatlaf rpa• behalf of •alab for ty,pab.at757aa
$snarls) AKef. allocated %be Isebrvoeat. eptle -CONCOM
41it•eso ar bud Red official m41•l. rMt'nern Ope1L1f0a
eLgYgre t,(.jZ(w .
(Ibis atss for ecflmLal satarlal mail
MIL Tai mTaTFg re TO, •.0• ami 3110. Y Islets, V. aii57, .
£0 h£0'oN fh:Z6 l0, E61L0 "aeaaa 557904£091.7 ~ 1SV07 39NV80
Clarendon National Insurance
Processing Center D -BILL: FIRST FRANKLIN FINANCIAL IS PAGE: 1,
r.u. Box ubuts/, ban uiego, UA UZltsb-bUts/ lvr,w
A: 1
ARROWHEAD GENERAL INSURANCE AGENCY
402 W BROADWAY, STE 1600
SAN DIEGO, CA 92101
KEVIN THOMPSON AND
BETTY SLIMKO
51552 AVENIDA MARTINEZ
LA QUINTA, CA 92253
: AH01819482
6/25
YulL1l i
RODUCER: 69051 (760) 773-5807
DUNN & LEWALLEN INS AGENCY, INC.
71-537 HWY 111 STE I
RANCHO MIRAGE, CA 92270
(if different from Insured address)
to 6/25/2003
HOMEOWNERS DECLARATIONS 12:01 A.M. Standard Time at the Address of the Named Insured as Stated Herein.
COVERAGE PROVIDED WHERE PREMIUM OR LIMIT OF LIABILITY SHOWN FOR THE COVERAGE:
- - - - - - - - SECTION I - - - - - - - - I - - -SECTION II- - -1
COVERAGES A.DWELLING B.OTHER C.PERSONAL D.LOSS E.PERSONAL F.MEDICAL
AND LIMITS STRUCTURES PROPERTY OF USE LIABILITY PAYMENTS
OF LIABILITY 139,000 13, 900 69, 500 27-1-800----300, 000`- 1-1000,
FOR LOSS UNDER SECTION I, WE COVER ONLY THAT PART OF LOSS OVER THE DEDUCTIBLE
STATED: $500 LOSS DEDUCTIBLE
SUMMARY OF PREMIUM
BASIC PREMIUM $471
ADDITIONAL PREMIUM $118CR
TOTAL PREMIUM $353
TOTAL PREMIUM $353.00
POLICY FEE $40.00
TOTAL POLICY $393.00
POLICY SUBJECT TO
THE FOLLOWING SURCHARGES, CREDITS,
ENDORSEMENTS AND FORMS:
FORM NO
EDITION
DESCRIPTION
LIMITS PREMIUM
HO 00 03
4/91
SPECIAL FORM
HO 04 77
6/94
ORD OR LAW - 1000
HO 04 90
4/91
REP COST -PERS PROP
$46
HO 04 16
4/91
PREM ALARM/FIRE PROT
$9CR
NEW HOME CREDIT
$114CR
DEDUCTIBLE $500
$41CR
AHHO-10
2/95
CA INS GUARANTEE ASN
AHHO-7
10/98
CA HOMEOWNERS ENDMNT
AHHO-9
2/95
LENDERS LOSS PAY END
HO 01 04
4/99
SPEC PROVISIONS CA
HO 24 90
1/93
WORKERS COMPENSATION
UG 105C
5/97
CONSUMER AFFAIRS
UG 112A
7/94
INSURANCE DISCLOSURE
PNCN
5/01
PRIVACY NOTICE
** IMPORTANT **
POLICY
DOES NOT PROVIDE EARTHQUAKE
COVERAGE
1ST LOAN NO. 0001951631 2ND CITY OF LA QUINTA
MTG FIRST FRANKLIN FINANCIAL CORP MTG 78495 CALLE TAMPICO
ISAOA/ATIMA LA QUINTA, CA 92253
3 ADA STREET
IRVINE, CA 92618 .
OCC: PRIMARY PGM: ELITE TERR: 028 BUILT: 2002 FRAME PRT CLS: 004
* END OF POLICY DECONS
Date Issued: 08/01/02 I
TI
Countersigned by: L
Authorized Aepresentative
`Z*%7:1
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, Title 24, State of California, in the building at
- - - ,rOAr
_ TAve Martinez, La Quinta, CA
'5;'( S15-
-CEILINGS:
TYPE: BLOWN IN MANUFACTURER: Certainteed THICKNESS: R-38
WALLS:
TYPE: BATTS MANUFACTURER: Certainteed THICKNESS: R-13
GENE TRACTOR: BUILDING HORIZONS LICENSE*
BY:RA ONvV f:5-5',')70 TITLE: 6 e6m/wy
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
B V TITLE: OFFICE MANAGER DATE: 05/21/2002
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, Title 24, State of California, in the building located at
51-552 Ave Martinez, La Quinta, CA
CEILINGS:
TYPE: BLOWN IN MANUFACTURER: Certainteed' THICKNESS: R-38
WALLS:
TYPE: BATTS MANUFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: BUILDING HORIZONS LICENSE # Y 3a ( 6
BY:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
BY: wV TITLE: OFFICE MANAGER DATE: 05/21/2002
Certificate 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
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification: Single Family Dwelling
51-552 Avenida Martinez
Bldg. Permit No.
Occupancy Group: R-3 Type of Construction: RL Land Use Zone
Owner of Building: Building Horizons
Building Official
0106-056
RC
Address:
42-600 Cook Street Ste #120
City:
Palm Desert, CA., 92211
By:
Daniel P. Crawford Jr.
Date:
5/31/02
POST IN A CONSPICUOUS PLACE