0005-106 (SFD)51845 Avenida Martinez
0005-106
./" `" ICENSED CONTRACTOR DECLARATION
I he ebyl'aff+M._9_Mer penalty of perjury that I am licensed under provisions of
,Chapter 9„(co , mencing with Section 7000) of Division 3 of the Business and
Frofe'ssionals.Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
Pate Signature of Contractor
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). -
(, r) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). I
() I am exempt under Section B&P.C. for this reason
az,
y rr
Date ; S_ ° L C} Signature of Owner 111e _3.:) - 1
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 those provisions.
Date: S' ' Gu Applicant - >z. `, - l
Warning: Failure to secure Workers' Compensatlon 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.,
Signature (Owner/Agent) M ' -Z `a 1 Dated A'
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0005-1 06 TRACT..
ALKI17 U'12
JOB SITE
APN
ADDRESS 51-845 4AiVXTRWsVMl TUIRM
773-175'01.7
OWNER
CONTRACTOR / DESIGNER / ENGINEER
WALLYR1vlII. i
OWITMI 3U LDER
k Oz39; 604
LA Quw k CA 92253
C 1L
USE OF PERMIT
X703' E PAW. Y [Did E [WG
S1yD PERMIT DOES NOT INCLUDE HLOCK 'titlALL OR POOL „
TRACT CONSTRUCTION 1,526.10 SF
PORCHIPATIO . . 439.00 SE'
0.ARAd3FJCA33P0RT 3.46,00 vF
5 FTz WOOD MCF 209 00 ),F
:krty"1 :1 13TKD COW OF coi91
CONaT'RIJC2ICr1FEE 301-000-418-000
PLAN CHI<.i, iw IW.9 $539,89
IU W-HANICAL FEE 101.000.421.000 $60,00
ELECTRICAz. M- Z 191-000-420-000 $133.03
PUMAS +iC1 FEE 101.000-19.000 $116,73
STRO14CI MOT1014 n - i tL )1;) 101-000-241-000 $10.14
OW)IN ET, 101-400-$23.000 3X00
DT V RLOPER. IMPACT FEZ $1,907.00
PRECISE PLAN 101-000-441-345 $100.00
1 .j r.. t
ART IN PUBLIC PLACE;; - PFS1'r- 701-000.255-000 $3.42
.►
-
FRE DEPOSIT 4250.00
w.. i w.r f•
,
L)
.ffU--L- OTAT,. (1102 &MUC PION' AND P1'.,iAA1 CIM
USE! PRE -PAID IM9.
4250,00
TOTA-1. PERMD17 FEIES DVE
RECEIPT
DATE
"BY
DATE FINALED
INSPECTOR
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 Q
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing 3 _ Qp ST
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath - / _ OO C?"
Drywall - Int. Lath
Final 7
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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
Electrio Final
Waste Lines
Heater Final
Water Piping S- L4 co
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
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) (
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 5/9/00
No. 20424 Jurisdiction
Owner NameWallace S. Miles
No. 51-845 Street Avenida Martinez
City La Quinta
APN # 773-175-017
La Quinta
Permlt # 0005-106
Log #
zip 92253 Study Area
Tract # BLK117 U1 Lot # 5 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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
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/Union Bank of California/Wallace Miles Telephone_ 760=771-4824
Name on the check
By Dr. Doris Wilson
Superintendent,
Fee collected /exempted by Mary Ann L. Bo6a Payment Received
Check No. 2004528324
'
Signature
N0710E: Pursuant of Assem TY Bill 3081 (CHAP 549, STATS. 1998) this will serve to notify you that the Wday 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 01strict'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
SALE ESCROW INSTRUCTIONS
THIS DOCUMENT WILL AFFECT YOUR LEGAL RIGHTS - READ IT CAREFULLY! DT
Escrow No.. 99.9091
TO: COMMONWEALTH LAND TITLE COMPANY Date: 08/11/99
72855 Fred Waring=°Dr. Page: 1
Suite A5
Palm Desert, CA 92260.
(760) 836-3726
Escrow officer:,DIANA C,` Tf IUNEY OMTANY WHICH IS LICENSED
THE ESCROW HOLDER IS CO
BY THE CALIFORNIA D AONWEALTI-I LAND TITLE CNT OF INSURANCE
will hand you or cause to be handed you upon signing of $ 500.00
Buyer, or his agent.mount " " * " ' 12,000.00
these instruction,
ouaaddptionalosit nfunds the aprior-to closing in the amount of ........
..$
Buyer will ha y
$ 12,500.00
TOTAL CONSIDERATION
additional funds and instruments required from me 10 enable, and whenou to ORANGE ANGE1th COASTese
TITLE
and any
instructions, which you are to use on or before Riverside, State of Calif rnia viz:
COMPANY can issue a Standard Policy of Title Insurancoun0 ofs form, with liability of
$12,500.00, on. real property in City of La Quanta, County alif nia 92253
Commonly known as: Assessors Parcel # 773-175-017, La Quinta, C E
Lot 5, Block 117, of Santa Carmelita'Unit No. 12, as per map thereof '_--•
recorded in Book 18, Pages 79-80 of Official Records of said Coun.y• and hydrocarbons.
Except any reservations of record ;of minerals; oil«. gas, water, carbons y
Showing title vested in:
WALLACE MILES, a Single Man
Free from encumbrance except:
n which
A.
Current general and special taxes for the fiscalteduelor payableis escrow closes, and
taxes for the ensuing year, if any, a lien no ye
B. The lien of supplemental taxes, if any, assessed
anndpursuant
Taxatioon Codeprovisions
the State ofChapter
3.5 (commencing with Section 75) of the Re
California.
C. Special improvement assessments, if any.
w
D. Easements, rights, rights of way, covenants, conditions, restrictions and reservations
record.
ki
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.
40
0
APPLICANT WALLY MILES
SITE ADDRESS 51-785 Avenida Herrera
APN 773 _ 172- 014 BINNO.: CASE NO.: 2000-207
LEGAL: LOT 2 BLOCK 6 0 UNIT 5 S.C.@V.L.Q.
CHECKED BY: Stan Sawa 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
Consistent with MDG on file (as applicable
MDG filing required (5 filings since 9/3/98)
Consistency with street/surrounding area:
Colors
Materials
Architecture
.
Other Requirements:
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/ Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law to put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an employer and you are subject
to several obligations including State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under Stare
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760)777-7012
FAX: (760) 777-7011
TURE / DATE
.RTY ADDRESS
PERMIT NUMBER(s)
_ b, _ r
TY OF LA QUINT jM,B-CONTRACTOR LISTJOBADDRESS %9s- A /I FG PERMIT NUMBEROf ' lOWNER - . X - ILDER
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only personspear' n this list or`i eir employEies 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 co y 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. '•un I-ue" is not an acceptaDre response.
_............
Trade / Classifrcation
Contractor
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