SFD (0202-306)53025 Avenida Martinez
0202-306
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
336192 B•I
9Date 1 i r L j eft Signature of Contractor t
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
o
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 "fA,,T ; iN,D Policy No. 16411 I942
(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: ., f e 1 Applicant
Warning Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La'Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
BUILDING •PERMIT PERMIT#
DATE / VALUATION LOT TRACT
F9 r f < %3£ , 7'.13fl 1 RL -K,21)8
JOB SITE
ADDRESS'^SY. i i): dbdPi il4 I i-1(Df•$IS.3
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
NEW)4W_MC1.M DY, V. M_ Rp.
'YMISIAltd9. L SMIZI DS
45-675 OLP",Y`DkME
45675 C}UIU-JtY 3.51Mv?
I.1 1alr CA, 92213
iiiFF `ryY 1'i4Cd'gi v-'d, .g ry B CA
}5 ",210 1
(7 C7 N,f ?+F-.i+020 CMU a7 r9
USE OF PERMIT ,
:itA1C"xl S..'r'!i??i'ilaLY k WX1.L31J G
SI+ ?^ 1 i;1714+lI'T 00 MICL't DE,, BUICK WAIJLi , P001, Of ' .1t,T10`Z%V,-,Y
TRACT CL" NST11,'.JCTION food w SF
W.-R'.O'1MARPORT 510..00 Ste
l
CONX, OF COMMOX, M1014,
86,667.60
Y.ia RbUT M 94yJA.l62. AR
C:45I'IIVERi<CT10AI PTE 303•000-418-010 Va1,0o
PIAN Crit✓ K P 121 1014.300 -439 -:IS V25.32
FEE DF PQ31T 101-000-43,9-31S 4230.01)
MECH A:NI+<'A.L FEE 101-000-421-000 $13.50
1
FRAKO T RIC.AL ITZ 101-000.4.20.000 W8.12
i
PI.,ETMIND FFIFE 1101-000-419-000 $I M00
ORADI'No FEE. 1131-000 423-000 fiill.C►0
CZEi•rl.OPER IMPACT F -17K S1,1n.00
i' UEC°ISK Pl. kx 1P1 a000-441-345 °ji 1fst1.00
;SMA. TOT AL C."C%iS .LI"(1710N AWL)PLAA.3, OVICK
'$13,,081.61
,,,. 1¢Is;, i ' '• :i? i J,F'i ,
, • 2 1:1.C+[1
r
l,AiZUII4'IM
_
y
RECETPT
DATE 0
BY° h/
DATE FINAL D
INSPECT OS
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
lJ
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
• 0 Z
Exhaust Fans
O.K to Wrap
40 Qj
F.A.U.
Framing
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
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
Water Piping
j
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection 7
10Z
(,
Pool Cover
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 _ 4i
Utility Notice (Perm) - DSD
COMMENTS:
W 0,; ..o 50,6'
Building
Address
Twyl 0 4 a"
. BOX 1504 APPLICATION ONLY
,/,=5 CALLE TAMPICO
1*e_A)667- TA, CALIFORNIA 92253
VINIMF
Mailing
Address
City Zip Tel.
Tt -, 71
Contractor
City
t_.-
Zip
Tel.
jt,
Sq. Ft.
Size /3
g4o
State Lic.
Ne Add 0 Alter 0
City
& Classif.
Lic. #
Arch., Engr.,
aA1A4t,'e 70
6*"&+tr
Designer
Address2
t 0
I/SD
Tell., -
5& / /j
City Zip State
Tf+ I Lic. #
LICENSED CONTRACTOR'S DECLARATION
I here bZfirrn that It am licenesed under Provisions of Chapter 9 (commencing with Section
7000) of ivision 3 of he Busin as 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 that he is exempt therefrom, and the basis
for th
Pie alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civilpenally ofnotmore than five hundreddollars f$500).
l__1 I as o ner of the property, or my employees with wages as their sole compensation, will
do ihe wwrk, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
0
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 imp ovemenf 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.)
' ' 1, as owner of the.property, am exclusively contracting with licensed contractors to con-
rtruc I 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.)
1-1 1 am exempt under Sec.—B. & P.C. for this reason
L
Date Owner — k I - —
WORKERS' COMPENSATION DECLARATION "
I hereby affirm that I have a certificate of consent to self-insur%' or a certificate of
Worker's Compensation Insurance, or a certified copy thereof (Sec. 38Qb, Labor Code.)
Policy No Company ".; I —i .1 . —
n Copy is filed with the city. 0 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 thp work for which this permit is issued, I shall not
e=anyiperson in any manner so as to becomesubject to the Workers' Compensation
L Cal fornia.
Date -Owner J A
NOTICE TO APPLICANT., It, 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 CodeJ
Lender's Name
Lender's Address K'.
This is a buildin
g errnit v;hen properly filled out, signed and validated, and is subject to
expiration it work ereunder 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
con s truction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of a0plicant .,I , ,
—Date
Mailing Address
City, State, Zip
,DING: TYPE'CONST. OCC. GRP.
Number_72,q. -o(q -6 13
,I Description 4v -r \ L.V,_ 'log
lct Description -<. 4 1>
4
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
Sq. Ft.
Size /3
No.
Stories
No. Dw.
Units
Ne Add 0 Alter 0
Repair 0 Demolition El
aA1A4t,'e 70
6*"&+tr
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S. M. 1.
Grading
Driveway Enc.
Infrastructure
r LL)
All 11 LJj I
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 3/12/02
APN # 774-061-013
No. 23041 Jurisdiction La Quinta
owner NameNew Millenium Dev. Corp.
No. 53025 Street Avenida Martinez
city La Quinta Zip 92253
Permit # 0202-306
Log #
Study Area
Tract # BLK208 Lot # 1 Square Footage 1412
Type of Development Single Family Residence
Comments
Family Dwelling of 1412 sq. ft
No. of Units
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
2.14 X 1,412 or $ 3,021.68 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 1 st Bank - William Shields Telephone 760/360-6020
Name on the check
By Dr. Doris Wilson -
Superintendent
Fee collected /exempted by Crystal Scott
Signature
Payment Received $3;021.68
Check No. 61411
10TICE: Pursuant to Assembly Bill 3081 (CHAP 549, STATS. 1996) this w ll serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
ibove 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
ollect them on the DistrictCs)(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
u1tly nCyuesw
RECORDING REQUEJSTE rstAmerican Title gpnlpa
Re/Max Real Estate Consultants/Escrow
Division
AND WHEN RECORDED MAIL TO:
AND MAIL TAX STATEMENT TO:
Dalip Tibb
77123 Iroquois Drive
Indian Wells, CA, 92210 (,
O
Order No.
Escrow No. 01-00569-Klr
Parcel No. 774-061-013-7, 774-061-014-8
bZo-o(5—
DOC a 2001-328173
10/28/2001 08:00A Foe:G.00
Page 1 of 1 Doc T Tax Paid
Recorded in Official Records
County of Riverside
Gary L. Orso
Assessor, County Clark & Recorder
1111111111111111111111111111111111111111111111111111111
M
s
U
PAGE
SIZE
DA
PCOR
NOCOR
SMF MISC.
I
A
I R
L
COPY
LONG
REFUND
I NCHG EXAM
GRANT DEED '
THE UNDERSIGNED GRANTOR(S) DECLARE(S) THAT DOCUMENTARY TRANSFER TAX IS $55.00 and CITY $
X computed on full value of property conveyed, or
computed on full value less liens orcumbrances remaining at the time of sale.
unincorporated area: OR City of La Quinta and
FOR A VALUABLE CONSIDERATION, ZLof which is hereby acknowledged,
The Estate of Carol V. Harford, Camille D. Warren, Executrix
hereby GRANTS to Goldtibs, Inc., a California Corporation
the following described real property in the County of Riverside, State of California:
EE
AM
Lot 1 and 2, block 208, of Santa Carmelita Unit No. 20 as per map thereof recorded in the Office of the recorder of
Riverside County at page 38 of book 19 of maps.
Date September 10, 2001
The Estate of Carol V.
By: 9amilla D. Warren
STATE OF
1 } S.S.
COUNTY OF 4- Cid. Q
before me, t e undersigned, a Notary Public in and for said County and State,
person ly appeared'. Camille D. Warr personally known to me (or proved to me on the basis of
satisfactory evidence) to be the person(s) w se name(s) is/are subscribed to the within instrument and acknowledged to
me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on
the instrumi •th.e erSon(s);pr.the entity upon behalf of which the person(s) acted, executed the instrument. .
WITNESS 6fficial'seal.
Signature' _
My fission Expires
PATRICIA IAMPIETRO 10-21-05
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 .p.urpose 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 isa 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 William Shields
SITE ADDRESS 53-025 Avenida Martinez
APN 774 - 061 - 013 CASE NO.: 2002-621
LEGAL: LOT
1 BLOCK 208
CHECK AND APPROVED BY: Greg Trousdell
UNIT ' /ZO S.C.@V.L.Q.
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
Verify legal and APN information
Consistent with MDG on file las
e o
applicable
MDG filing required (5 filings since
/ /
9/3/98)
Architectural variety within 200 feet of
the surrounding area:Ic
yy\or
J
aye
Architectural design fea
'
• •
Other Requirements: SUILOdjV
f D
ZiA
C°