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SFD (0103-177)51565 Avenida Martinez 0103-177 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 4 OWNER -BUILDER DECLARATION i 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. t,r)j 1 have and will maintain workers' compensation insurance, as required by Secfion 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workeis' compensation insurance carrier & policy no. are: Carrier Policy No. STATE, IFUNT> (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 those provisions: Date:^ `►; - --11? Applicant `^ Warning: Failure to secure Workers bompens ton co erage 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 fo application. 1. Each person upon whose behalf this application is made & eac kvOd whose request and for whose benefit work is performed under or any permit issued as a result of this applicaton agrees to, & shall & hold harmless the City of La Quinta, its officers, agents and 2. Any permit issued as a result of this application becomes null work is not commenced within 180 days from date of issuan a permit, or cessation of work for 180 days will subject permit to cc ncellation. C 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. Signature (owner/Agent) ' t- Dater • }-41 BUILDING PERMIT PERMIT# DATE VALUATION LOT ZD10:3- Y TRACT JOB SITE APN 114 ADDRESS OWNER CONTRACTOR/DESIGNER/EN (NEER P.AWM "t'RA? RIS CONETMIC-71014 PAU1i'IS li t Kb ) :]« t CC3 ; LC(C"11014 S ()MMANSME CA 920,5 1 OarEMIMV CA 92054 ("i60,)9fi-0069 rIML 1.9,"115 USE OF PERMIT «SIN(31.81'Wtol"T DWELL 0 P.F"i b' DOES W07' I?+iC°L83 `k , B L DCK 1VA1JJ1P0OWPA OR . tPPIIJOACH 1)R1fi'ZWAYWM`Ft,.R old FF MPE 98 ?RACT C0NYt` UCTION 1,392,00 SFPi:JFtCHIPRrio 109.64 SF OA AG 7MARPOWC (SY) 9,016.00 5115. WOOY) F.',? M11 010a Go .jr f EsiffmXTED COR" OF, CONYMUCUnow 87,195.00 ITER 1)4POSI 10'1.000 431,?4w318 41%00 :U1!` "`t Ts'LiC" "3A`fiiF.C 101_00CI_44,8_i00 $185.50 PLAN ('H%C*.X FBF 101.000.439.318 MUM I R9s,.1:i.FRNWA!, MEbE 101w -00"214W $55.50 PLt;r"M1tl:it MY, 101-Wa-41.9-000 $110.1/5 0R.A=40 FZZ 101.000.423-- V)0.00 09MC?3xC;17: IMPACT FIR sil"907,0o PRECISE PIAN 1,X31-f3(Y0.k4 3, -3+t i164,OfT MRS$3,980.25 -T' :AL C0.1- ':t7 lwli~` ION AM PLM C. Jt O—M $3,980.25 R 3 0 2001 YZIM : :&B-PAM . 4250.00 ITY OF LA OUINTA FINANCE DEPT RECEIPT DATE ( ,rt BY 10, DATE FINALED INSPECTOR I- 1 _ IIS - E INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings Ar0b Underground Ducts Ducts Slab Grade Return Air Steel Combustion Air Roof Deck _ O S"T Exhaust Fans O.K. to Wrap F.A.U. Framing C_ $ O ( S 7 Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath e, _ Final 1 ( o S7 Final POOLS - SPAS BLOCKWALL AP ROVALS 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 Waste Lines "L g Q Electric Final 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 Encapsulation Gas Piping Gas Test '', ( Z Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole ,L • !r% ,f S,! Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final G j t9 Utility Notice (Perm) S y v l l 3 -1 1 u l'ItrCv P.O. BOX 1504 Buildings , / 'f8-495 CALLE TAMPICO Address:. r ILA OUINTA, CALIFORNIA 92253 Owner ; a _ _ ,_ .._. ' mauing !/ Address /"74 5, City Zip Tel. Contractor !! / Address .01 p State Lic. City & Classif. -9v Z +5 :3 g Lic. # Arch., Engr., Designer Address Tel. City (Zip (State I 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 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 fhat. 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). 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.) II 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 contractors) licensed pursuant to the Contractor's License Law.) i 7 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. (Sec. 3800, Labor Code.) Policy No. Company n 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 ($100) valuation or less.) 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 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. 1 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 ateMailing Address City, State, Zip ,yr.....; ,. ,..,v cr- ems.--• ..,wv. ••=.r : >= +;w' N = r.1. APPLICATION ONL BUILDING: TYPE'CONST. OCC. GRP. A.P. Number 77 3 - 111 -66 Legal Description 16 'i _ 844-41"10 Project Description No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ (Estimated Valuation % PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS AMOUNT' ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line r; Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date F Validated by: MAR 06 20-0-1 a Validation: aff AAWS s WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Notice: Document Cannot Be Duplicated Date 3/30/01 No. 21822 Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE Owner NamePacific Trades Construction No. 51-565 Street Avenida Martinez city La Quinta Tract # Lot # Type of Development Single Family Residence Comments APN# 773-141-004 Jurisdiction La Quinta Permit #0103-175 Log # zip 92253 Study Area Square Footage 1382 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 1,382 or $ 2,833.10 the property listed above and tha4 building permits and/or Certificates of Occupancy for this square footage in this proposed project mwy-now be,ssued Fees Paid By CC / Temecula Valley Bank - David Miller Telephone 860-967-0069 Name on the check "•. By Dr. Doris Wilson Superintendent Fee collected /exempted by Annette Barlow Signature Payment Received $2,833.10 Check No. 15198 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 I d 14 101/00/01 10:25 FAX 17808049082 COMflfONWBAC.TH TITL>S RECORDING REQUESTED BY: I AND WHEN RECORDED MAIL THIS DEED AND, UNLESS OTHERWISE SHOWN BELOW, MAIL TAX STATEMENTS TO; William Thomas Buffin Power Brokers D-0. Bex 134 La QuInra, CA 92253 SPACE ABOVE THIS LINE FOR RECORDER'S USE 00 The undersigned grantors©rant Dead A.P.N. 773-141-004 ) declare(,); ----y--- Docum®ntary transfer tax Is $ ( x,) computed on full value of property conveyed, or ( x) computed on full value less value of Ilene end encumbrances remaining at time of sale. ( ) Unincorporated area; ( ) City of zr.L FOR A VALUABLE CONSIDERATION, recelpt of which Is hereby acknowledged, James Patton M.D. Incorporated Employee Trust ►haraby GRANTS) to David Ross Miller, a Married Man as his sole and separate property the real property in the City of La Quinta , County of Riverside State of California, described as Lot 4 of Block 114 Unit No. Santa Carmelita at tale La Quinta, as per map (recorded in Book Pages mf Maps, Records; if Riverside County, California Dated March 6 20'01 Stets of California ) County of —)SS. On before me, ,personally appeared I James _Patton M.D. Personally known to me (or proved to ma on the basis of satisfactory evldanae) to be the parson(,) whoas nomo(s) Israre subscribed to the i 'thin instrument and Acknowledged to me that ho/rhelthey eK.dutad e Same In hlalhar/their authorised capaaty(i.a), and that by to/her/their signature($) on the Instrument the person(s), or the entity pon behalf of which the person(,) acted, executed the Instrument. ITNESS my hand and oMplal seal. ipnature MAIL TAX STATEMENTS T0, Signature of Grantor James Patton M.D.- C...,4nZ 'd,_0Z!6'ON SMOH HMOd WdH:l !0aZ 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. r APPLICANT 'Pacific Trades SITE ADDRESS 5.1-565 Avenida Martinez APN 773 _ 141 004 ' BINNO.: CASE NO.: 2001-421 LEGAL: LOT CHECKED BY 4 BLOCK . 14 , Wally ,Nesbit UNIT S.C.@V.L.Q. DATE: 3 7 /01 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 ✓ v/fl Case logged and number assigned Verify legal and APN information / Nor i.. ° tiu3 .•'E Consistent with MDG on file (as.applicable 4g MDG filing required (5 flings since 9/3/98) t/ Consistency with street/surrounding area: Colors F Materials Architecture ✓ wv s• . . Other Requirements: ARMSim by pis Q Planning Commission . .... O City Council )=ommuni eK Cept. Initials ._.,....,...._ owylo -M,,tt f4, q -s vs cv2o s s ,•,,v✓r ,asn ``£s '~ Exhibit r... A(With Conditions J 0 *Certificate of Occupancy City of La Quintal 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: SFD Occupancy Group: R 3 51-565 AVENIDA MARTINEZ Type of Construction: VN Owner of Building: PACIFIC TRADES CONSTRUCTION Building Official Bldg. Permit No.: 0103-177 Land Use Zone: RC Address: 1719 S. TREMONT City: S. OCEANSIDE, CA 92054 By: STEVE. TRAXEL Date: 07-12-01 POST IN A CONSPICUOUS PLACE