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SFD (0106-015)53445 Avenida Martinez 0106-015 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 425381 Date i''= % 'Signature of ContracLo= 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. (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 p`rovisionsof-Section 3700 of the Labor Code, I shall fprthwith comply with tho provisions. Date:Applicant— Warning: pplicant Warning: Failureto secure1Norker` r s Compensation eovera a is unlawful and shall subject an employer to criminal penalties and civiHines up 0 $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'Cauthorize representatives of this City to enter upon the above-mentioned prope y`for inspection purposes. Signature_ (Owner/Agent) Date n A° .._ UILDING PERMIT PERMT# ti DATE VALUATION LOT TRACT . j/029 0'."S t1 10 14T "It 1.7.111 1Tn JOB SITE ADDRESS - 53 -445 AVWXW9A r%4V?,T;trtrZ, OWNER CONTRACTOR/DESIGNER/ENGINEER' 171.93TEX.7.40147.1 1719 3 WY114014T USE OF PERMIT `O a t° .t f`A'-d t7TF '9dC1'1' IDdC, LTOI 1 ! £:!t::f 'ihn ..T,,[, ;a:;l. ,. F.,I'i ;#'tir'L 1 v' • 1,423.00 OF, - .NC:tiLt: a .P ,,';t'.l FKRhw.,, WE SUMMARY CON s1'RUCS10N M. 1.31-000.419.000 WOO PL.A1.1 9 :& s er M-0 101-C 0-42P.,3 8 MID. 17 MECHANICAL FEE 101.000-4.21.000 $60,00 E11WITRICAL FEE 101-000,420-000 $129.44 NAITADiNO Ff X 101-000-419-000 0175 'ROM MOTION i 91F a RF-S.O 101-01*-241-1000PY $8.9s 1R.l 3 INN R.F. 101,,F.`i7W"+ 23-000 $20.00 01WIMOMP1 IMP.AVY YZZ$3., ti'7.tip @rokTECIRE PLN 101.000.441- h* 8tta:4it3 u1, aJ1?1>.O Ci" 101-000-139-318 .$50.00 . o . C. ' C '.lrl . i L ' .ia.{,n. 44 ' »!?i0. '..-[Pr $3ydl; l ," P LUSS RRB-PAID M93 7aN19 4250.00 2001 y pp/ J/ yy AA y p y v . hq @ &y Dur—Now l.C1M.1 I.ScS'6.4pVh d 5: .8'iL"s1J ,6Y 4d8i .A Li Xl+ ka a?I`.Ja'y"Y CITY OF LA OUINTA FINANCE DEPT RECEIPT DATE ;'/ BYr, DATE FINALED INSPECTOR "'•^ ': ijB .paw...., .;i :,:er:ic b ,*,G; f,•• INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs _ Underground Ducts Forms & Footings 1 �C fj l ., / Ducts Slab Grade Return Air Steel Roof Deck / Z �y ( Combustion Air Exhaust Fans, O.K. to Wrap _(y/ !r7 F.A.U. Framing Insulation Co ��% Compressor 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 9�� ,S,T: 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 Electric Final Waste Lines Heater Final Water Piping 61�C91� ` Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection '57 Encapsulation Gas Piping Gas Test !�. �?.(�/ Z57 - Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPR VALS Temp. Power Pole 7� 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) _�� p Building Mailing Address t City , Zip c&ty/ 4 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 In 1 /2 e? 'S </ I '74l -> , c,G Contractor f Address ip State Lic. City & Classif. /?// 2 f 3 .9 Lic. # / 5 Arch., Engr., Designer Address Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm,+ hat I am lice sed under provisions of Chapter 9 (commencing with Section 7000) of Division,3 of the Business a d Professions Code, and my license is in full force and effect. \" I w SIGNATURE E ' DATE +OWN E,,R-BUILDRDECLARATION I hereby affirm that -I am aexempt from'Atle Con ractoes License Law for the following reason: (Sec. 7031.5,64!sli qss 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 (E500). I--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 or completion, the owner -builder will have the burden 11 of proving that he did not build or improve for the purpose of sale.) I 1 I, asowner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Lew 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.) 1l 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, alter 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 havereadthis 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 aOplicant Date Mailing Address City, State, Zip 7 APPLICATION ONLY BUILDING:- TYPE'COfNST. OCC. GRP. A,P. Number ! / -+rr i / /' % / , - ;! 2. - Legal Description Project Description" • r A WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Sq. F -Size f !j 7 / No. No. Dw. Stories Units New / Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. 2;J 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: r A WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION ' Notice: Document Cannot Be Duplicated Date 6/6/01 Desert Sands Unified School District 47-950 Dune Palms Road r La Quinta, CA 92253 760-771-8515 ,CERTIFICATE OF COMPLIANCE No. 22089 Jurisdiction Owner NamePacific Trades Construction No. 53-445 Street Avenida Martinez City La Quinta zip 92253 APN # 774-091-021 La Quinta Permit # 0106-015 Log # Study Area Tract # BLK211 U20 - Lot # 10 Square Footage 1421 Type of Development Single Family Residence ; Comments i 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: t EXEMPTION NOT APPLICABLE _ ..This certifies that,school facility fees imposed pursuant to Government Code 53080 `iii the amount of ,., 2.05 X, 1,421 or $ 2;913:05 the property listed above and -"that building y .. _ t. permits an&or Certificates of Occupancy for this square footage in this proposed project in' a}F;now be issued Fees Paid By cc/Temecula Valley Bank/Juan Rodriguez Telephone 967-0069 Ful Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Juanita Gfe-en- '" ` Payment Received Check No. 15894 Signature $2,913.05 .t NOTICE: Pursuant of embly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notifyyou that the 90 -day approval period in which you may protest the fees or other payment identified I above will begin to runm 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 Dis ictCs)(s') behalf, whichever is earlier. a Collector: Attach ,a:co of coup or ci anfcheck application form to district co for all waivers. PY h' h'_P _._ PP PY Embossed Original- Building Dept./Applic'aut' '''.'Copy - Applidiiht/Receipt Copy - Accounting 04/21 3'_08:57 - FAX 17608049062 C011 IONWEALTH TITLE POIVER BROKERS X002 RECORDING REQUESTED BY: CHICAGO TITLE COMPANY AND WHEN RECORDED MAIL TO: DAVIS ROSS MILLER 1719 SOUTH TREMONT S. OCEANSIDE, CA 92054 �- 4�S' >�ue• il� THIS SPACE FOR RECORDER'S USE ONLY= ESCROW NO. 0153134 -KC TITLE ORDER No. 0170,56500 INDIVIDUAL GRANT DEED APN 4774-091-021 & EP THE UNDERSIGNED GRANTORS) DECLARE(s) DOCUMENTARY TRANSFER TAX is $30.25 [XI computed on full value of property conveyed, or [ ] computed on full value less value of liens or encumbrances remaining at -time of sale. [ ] Unincorporated area [X ] City of LA QUINTA, AND FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, WILLIAM THOMAS BUFFIN and MICHELLE RAE BOFFIN, husband and wife as joint tenants hereby GRANT(s) to: DAVID ROSS MILLER, a married man as his sole and separate property the real proper in 4 -64y of LA QUINTA, County of RIVERSIDE, State of California, described as: Lot 10, Block 2'11, Unit No. 20, Santa Carmelita at Vale La Quinta as shown by Map on file in Book 19 Page 38 of Maps in the office of the County Recorder of RIVERSIDE County, California. commonly known as:,. APN 774-091-022, LA QUINTA, CA 92253 DATED April 24, 2001 STATE= OF CALIFORNIA COUNTY OF On before me, a Notary Public in and for said State, personally appeared personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose 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 ospscity(isa), and that by his/her/their signatures) on the instrument the persoh(S), or the entity Upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and offlclal seal. Signature _ Mall tax statements to: SAME AS ABOVE 'e ICHELLE RAE BUFFIN r (This area for official notarial seal) N 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. Overs /Z4,sry APPLICANT PACIFIC TRADES RECVD FOR PROCESSING / S 61 (DATE) SITE ADDRESS 53-445 Avenida Martinez ASSIGNED TO CC (INITIALS) APN 774 - 091 - 021&022CASE NO.: 2001-470 LEGAL: LOT 9 10 BLOCK 211 UNIT CHECK AND APPROVED BY: dally Nesbit Zo 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 MDG filing required (5 filings since 9/3/98) Architectural variety within 200 feet of the surrounding area: Colors Materials Architectural design features ? ed ,0 ft O City Council )XCommunity Dev. Dept., -6-Ms o Initials-. .. . _. Case No. 12C tel- Exhibit x..4.'4 v WRIVIM >I- ...:- . .. 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 fof/owing: . BUILDING ADDRESS: Use Classification: SFD Occupancy Group: R 3 53-445 AVENIDA MARTINEZ Type of Construction: Owner of Building: PACIFIC TRADES CONSTRUCTION Building Official Bldg. Permit No.: 0106-015 VN Land Use Zone: RC Address: 1719 S. TREMONT City: S. OCEANSIDE, CA 92054 By: STEVE TRAXEL Date: 09-21-01 POST IN A CONSPICUOUS PLACE