SFD (9906-195)52680 Avenida Martinez
9906-195
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
291728 B 0Ri3112
D to 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).
( . ) 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.
ST A77., rut1ID .'-2`.t-'Y; LRdIT tN10,13
(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
Coded shall forthwith comply with those provisions.
e: Applicant
V
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 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 haws 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) - f .✓ Date
BUILDING PERMIT PERMIT 06->IV.41
DATE / 1 VALUATION , (,{) LOT It) TRACT JILL 14.1
s / 52-"0 A1*1 N(0A RiART1NV.
APN 773-302-029
ADDRE
OWNER
CONTRACTOR/DESIGNER/ENGINEER
LA QUINTA PAWITIFIkS
WILL1A1t1 RUSS131.1.1t(h: ERS
53-170 AVENIDA BE'tMUUAS
it)900 IACKSON.M'
LA QUIMI'A CA 92253
'FRERMAL C'A 92274
(7 ;4)-199-17(00 C'[iJ,tt 5,139
r
USE OF PERMIT
:ilWiLE FANOI UW11"LUM-1
ST,D - PE-RMiT INCLUDES 32(.F 5' OARUIiN ALI0(;IL WALL AS Wif) WN ON
51'1'151'I -AN. M)(A. NUT INCLUDIU).
•1RAC i' CO3diTR11Cr1!.)N 14(o VA) IF
PORCI i/1''AT10 93.00 SP
UAl AQ1t XIM(PUR T 443,00 :1,'
61 1. WA11. 12 tt!t LF
VI' W(x-)1) i-ENCF 2Utt.4y11 LF
M11 XYTM COSTO F CONST It UCI ION
PC, Rte IT F ITI:ir SUMMARV
(_*0NS'fRUCTIf N FEL,* 101.ft)-411(-000 116311) 50
Pi AN(1W,('K PTV Iffl-rM.414-'219 *.VO) Vtt
NIC I1ANICAL 1771: 101 J.K1i) 121 •000 30 ((►
jU.Eq `rK1CAL Pits 1011 d/00 -420-0(k') 31-44.9-1
PlAfl RINC1 xFE 101-UW-419-OUO S13.3,N)
TVIK)N(i ki,1• oN vvv . krRf17 101- I -oo n fV
ORAJ)114r; FEE 181 No -123.000 52000
IfV1 tZ 1:+f1111t_k1lKisl l:fi Z -tftH)-4.13-z•a2 Yl.int.i+Y
IIH0 '188, PLAN 1ti1 (1(lU 411-?1ti SZ .I>•1
I:;;►: 1 }:Cu iyi'i' 1i11-(i(tf?-.t'i '."i}K .S^Sfl tll)
S1 III-11')i'A 1. (Y)N1s rR!.X_1103N ANn PI ,AN rl HiC!:
$3,73717
USS ITE PAID FEES
$.250 00
i[T)TAI. PERMIT Fk:F-S 01fF, N0NV
$3.477.37
RECEIPT
DATE
By —'''
DAtE INALE
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
O'
Return Air
Steel
Combustion Air
Roof Deck
— Q S
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
— QQ
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final>
BLOCKWAI AP ROVALS
POOLS - SPAS
Steel
Set Backs
— Y7
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
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas) —
ELECTRICAL APPROVALS
Temp. Power Pole -77
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) — 00
COMMENTS:
,
a
Building
Address
Owner
maning
Address Z 7
X City j
h . y
Contractor
Aaaress
T4tyl 4 4 "
P.O. BOX 1504
78-495 CALLE TAMPICO
'(f N Z-LA QUINTA, CALIFORNIA 92253
I
APPL CA4.
J
,I BUILDING: TYPE'CONST. OCC. GRP.
own 0;, A.P. Number 1,31 - 024 -rt, 7-P,
ZipTel.
Zi f E , .J Legal Description 10 C fel T111r-a i' If 1-M f-
Project Description k..' [%tfrr c_
P
i Tel.
"-S,I tea
State Lic.I City
& Classif. Lic. III
Arch., Engr.,
Designer X— i' X1 H
Address Tel.
CityI Zip State
X-0 5z 7 S 3 1 Lic. a
r LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I.am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 oflhe'Business and Professions Code, and my license is in full force and
effect.
SIGNATURE ` ,•f • 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 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).
lJ 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
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. ❑ 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 (E100) 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, atter 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.
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 Dale
Mailing Address
City, State, Zip
Sq.
e t. 16 o iw No. No. DW.
Stories
Add ❑ Alter ❑ . Repair ❑ Demolition ❑
,fvkw.
4
Estimated Valuation
PERMIT I AMOUNT
Plan Chk. Dep.
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 7/14/99 APN # 773-302-028
No. 19040 Jurisdiction La Quinta
Owner NameLa Quinta Partners Permit #
No, 52-680 Street Avenida Martinez Log #
City La Quinta zip 92253 Study Area
Tract # BLK143 Lot # 16 Square Footage 1605
Type of Development Single Family Residence
Comments
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
1.93 X 1,605 or $ 3,097.65 the property listed above and thai;Luiitlir.g,
►-140: -' ...
permits and/or Certificates of Occupancy for this square footage in this proposed project w bq issued
Fees Paid By ccNIB/William Russell Rogers Tel4196ne 9 .12w00
,'y
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Payment Received $3,130.00
Check No. 195182
Signature
NOTICE: Pursuant of Asslynbly 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 dale 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
v
RECORDING REQUESTED BY:
FIDELITY NATIONAL TITLE COMPANY
99E.N8749KC 521457 pp qq
WHUNL 00g Rq S D LOWND'
L TA S]*Elyy
LA QUINTA PARTNERS
P.O. BOX 134
LA QUINTA, CA 92253
SPACE ABOVE
GRANT DEED
IS LINE FOR
The undersigned grantor(e) declare(s);
Documentary transfer tax -is $19.25
(XXX) Computed on full value of property conveyed, or
( ) Computed on full value legs lens and encumbrances remaining at time of sale.
( ) Unincorporated area: ( ) City of and
FOR A VALUABLE CONSIDERATION, receipt of which ie hereby acknowledged,
HARRY D. BOURGEOIS, TRUSTEE and Subsequent Trustees of the Bourgeois Family Trust dated
December 20, 1989
hereby GRANT(S) to
William Thomas Duffin, an unmarried man.DBA
LA QUINTA PARTNERS,
the real property in the City of LA QUINTA, County of Riverside, State of California,
described as;
Lot 16 & a portion of Lot 15, Block 143„ Tract Santa Carmeiita at Vale La Quinta, as per
map recorded in Book 92, Page(s) 18, Unit 15 inclusive.of maps, in the office of the
County Recorder of said County.
Dated April 28. 1999
State of California / U
County of C/ 1
} S.S. HARRY D. OURGEOIS, T USTEE
On
:/
before m4" -- 177
-.•+_/ 5 pefsonally- appeared
personally known to me (9—iraY a rn ma nn -_
the basis of atiS a^ leo be
the person(K whose name is/ re subscribed
to the within ins rumenr.and acknowledged to
me that he/ w ey executed the same in
hie/h /t it authorized capacity(i and
that' by hzs/h/tr si nature , . on the
instrument the person( or went upon
behalf of which the perso ) acted• xecuted
the ' strument.
WITH S my h nd and f tial s
Signature
MAIL TAX S 1A I EeLV rJ TO; SAME AS ABOVE
I
E
(This area for official notarial seal)
HOLE SMITH 6
COMMISSION 01126364
Notary Public • California
ORANGE COUNTY
My Commisslan Explrof
FEBRUARY 6, 2001
E
(This area for official notarial seal)
eco
I
• ?/' I : ir:nt _ anninn Rpvi
/Ice, • /a g/99
oS
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 applicabitity of compatibility issues -6r need
to require the filing of Master Design Guidelines by the applicant. It shall be transmitted to
Building & Safety as your correction list. Please attach additional explanations as necessary.
APPLICANT: W. R. ROGERS
PROJECT VIP
ADDRESS: 52-680 Avenida Martinez
APN: 773-3027028
Q4
LEGAL: LOT 16 , BLOCK 14 , UNIT PQ , S . @ .Q.
CK'D BY:' Leslie Mouriquand er
g
BIN NO:. CASE N0. '99-81 CHECK -DATE: ..2 —!3 -9 1
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.
REPOUIRED ITEM
Y I N
COMMENT/CORRECTION
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::<., .... . •.. ., \ ...; ,J SEEKS ..; .+..
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Case logged and number assigned
Verify legal and APN information
__
= ad // G 1,Z13
Consistent with MDG on file (as applicable)
✓
MDG filing required (5 + filings since 9/3/98)
Consistency" -with -street/surrounding area:.
Colors
Materials
Architecture
~ C f B
v
o
9 V G r Lf SI M, k r i -e P) B ccS r—
door — use -
OTHER REQUIREMENTS:
Gf e re P7 e, /C va.-lO f
This h a cis e r1:o ids 4
The zoning code, architectural and landscaping manuals, and/or assigned inspector should
be consulted where uncertainties arise. The completed checklist shall be maintained in the
Building '& Safety address file.
PLAN-: B -3D
5/3/99
ATTIC VENTILATION
ATTIC AREA: 1,605 SQ FT + 463 SQ:FT = 2,068 SQ FT
2068 SO FT =
300 6.89 SO FT REQUIRED
. 8 VENTS - 14" X 18" VENTS
8 X 1.17 SQ FT X 1..5 SQ FT = 14.04 SQ FT
LESS 50$ VENTED AREA = 7.02 SQ FT
ACTUAL NET TOTAL SHOWN 7.02 SQ FT
PLANS SHOW 8 VENTS
B -3b '
ELECTRICAL LOAD CALCS
DESCRIPTION
CKT
VOLTS
CKTNO.
AMPS
OF
UNITS
VOLTS -AMPS
PER UNIT
TOTAL
VOLTS -AMPS
120 V. MULT OUTLET CKTS
GEN LTG @ 3 W PSF 120 15 1605
3 4,815
SM APPLIANCE CKTS 120 20 2
1,500 3,000
GRI CKTS. 120 20 1.
1,500 1,500
SUBTOTAL
9,315
120 V. SGL OUTLET CKTS
DISPOSAL
120
20
1
2,400
2.,400
DISHWASHER
120
.20
1
2,400
2,400
LAUNDRY
120
20
1
2,400
2,400
HOOD
1.20•
3
1
360
360'
SUBTOTAL
7,560
FIRST 10,000 V-A @ 100%
10,000
BAL V-A @ 40%
2,750
SUBTOTAL
12,750
RANGE
230
40
1
9,200
9,200
A/C (LARGEST-FAU OR A/C
230
30
1
6,900
6,900
TOTAL V-A
28,850
SELECT SERVICE SIZE
TOTAL V-A
1230 VOLTS
1
28850
230
125.3 AMPS
r
ELECTRICAL LOAD CALCS
DESCRIPTION
CKT ICKT
VOLTS
AMPS
NO. OF
UNITS
VOLTS -AMPS
PER UNIT
TOTAL
VOLTS -AMPS
120 V. MULT OUTLET CKTS
GEN LTG @ 3 W PSF 120
15
1605
3 4,815
SM APPLIANCE CKTS 120
20
2
1,500 3,000
GRI CKTS 120
20
1
1,500 1,500
SUBTOTAL
9,315
120 V. SGL OUTLET CKTS
DISPOSAL
120
20
1
2,400
2,400
DISHWASHER
120
20
1
2,400
2,400
LAUNDRY
120
20
1
2,400
2,400
HOOD
120
3
1
360
360
SUBTOTAL
7,560
FIRST 10,000 V-A @ 100%
10,000
BAL V-A @ 40%
2,750
SUBTOTAL
1.2,750
RANGE
230
40
1
9,200
9,200
A/C (LARGEST-FAU OR A/C
230
30
1
6,900
6,900
TOTAL V-A
28;850
SELECT SERVICE SIZE
TOTAL V-A
1230 VOLTS
28850
1 230
125.3 AMPS
r
F:tr
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: SFD
Occupancy Group: R 3
52-680 AVENIDA MARTINEZ
Type of Construction:
Owner of Building: LA QUINTA PARTNERS
Building Official
Bldg.. Permit No.: 9906-195
Land Use Zone: RC
Address: 53-170 AVENIDA BERMUDAS
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 1-27-00
POST IN A CONSPICUOUS PLACE