SFD (0004-063)53585 Avenida Martinez
0004-063
t LICENSED CONTRACTOR DECLARATION
rf 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
59575.4 N1 C9 % 06/30/2(
f Date JUDO
gnature 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
( ) 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.
(.. 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 STATE FUND Policy No. 329-00 'UNIT 0011090
(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
G/ode, I s all forthwith comply with those'p'rovisions.
Date: - I4 Applicant_i / <«
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, indemnity
& 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
the7bove-mentioned property for inspection purposes.
S gnature (Owner/Agent) Date
4 .
PERMIT #'
BUILDING PERMIT I "'
DATE VALUATION LOT O 44 063 TRACT
JOB SITE
ADDRESS
W-
APN a
-7L .
OWNER
CONTRACTOR/DESIGNER/ENGIN ER
AGUSTIN & EVAPAZ
PAZ CONSTRUCTION CO
52995 AVEN3DAMLNDOZA
52995 AVM4MA1YRMOZA
LA QLM4TA CA 92253
LA Qi:11 TA CA 92253
(760)564-3023 CBU. 5537
'
USE OF PERMIT
M3l:.3I . AIv MY DVJFJ-LWf3
-
SFD-PFPMIIT DOES NOT TNCLUDRE ELOCK WALLS OR POOL -
.a
TRACT CONSTRUCTION 1,421.00 OF
PORCH PAT10 35.00 SF
GARAGE/CARPORT 500.00 OF
51 "r. WOOD "NCZ 200.00 11111
ESTCti!IATIM COST OF C>O.NgrRUCTION'
99,M,60
»ETiA r 117KE RTA41 ZY
CONSTRICTION FEE 101 -000-41 8400 $594.50
PLAN CHECK FEL 101.-000439-318 $500.07
MECHANICAL FEE 101-000-421.000 $60,00
ELEC:T,IR.ICAL FEE 101-000-420-000 $129,24
PLUMBING FEE 101.000-419-000 $110.75
CIRAD1NG FFE 101-000-423-000 $20.00
DEVELOPER IMPACT FEE $1,907:00
PUCISE PLAN 101-000-44 3 -343 $100.00
FEE UVOSIT 101.000.439-318 4250.00
STM -1 CYCY.I'AL CONS '1 RUCMON AND XPL AM CE ECK
$3,421.56
ZF.-•S :PRE -PAM n.y.S
^$250.00
'I?OTA& 1'F';ltlirl T 1+'!1+,8 DUE NOW
$3,171...'56
RECEIPT
DATE BY /
DATE FINALED
INSPECTOR
,. ( LAA,—
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
Set Backs
Forms & Footings
APPROVALS
MECHANICAL APPROVALS
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
C?ZD `S7
Exhaust Fans
0. K. to Wrap
_(— G`O
F.A.U.
Framing
— G v S 7
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
CIO
Drywall - Int. Lath
Z3- 57
Final
BLOCKWALL APPROVALS
Final
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
c�
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
—Z:"tJ
Encapsulation
Gas Piping
Gas Test
• —��
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole y - 19 - w a —
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) i
COMMENTS:
IVA
44
i Id- fi
t ± _} P.O. BOX 1504 - l
78-495 CALLE TAMPICO APPLICI ON ONLY
Address
Building LA QUINTA, CALIFORNIA 92253 UU
:5 r 5 ".,, , .r,
Owner
AC a BUILDING: TYPE'CONST. OCC. GRP.
Mailing
Address5 , r A V u _ ti+ MZ Ab. A.P. Number--) 4
City Zip Tel. 4 -Z44- V L- 2
Lb ✓ 1'ia 2 2 ` S A L• Legal Description
Contractor Project Description 3 Wit- n 7 ' n a ^u "Y7
61— )LA r)
Address `
City Zip Tel.
State Lib. City
& Classif. S 515 Lic. # S5 31 Sq. Ft.( 4 Z ( Stories No.UniDW
Arch., Engr.,
Size
Designer l.ef, ,µ D New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
P• a a
City Zip State
I _ - _ I X. C__ 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 u sttness and Prof ssions Code, and my license is in full force and
effect. k7 tlll:1 4 soyo
SIGNATURE r DATE
/OWNER -BUILDER DECLARATION
I'hereby affirm that 1, m 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, after, 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).
(J 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"1 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 Cqompensation Insura nqce//n or a certified copy thereof. /Sec. 3800, Labor Code.)
Policy No. C 24_ CO/71109 pany
171 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 (S100) valuation
or less.) /`
I certify that in the performance of thg or % for which this p rmit is issued, I shall not
employ any person in any manner so asrtofbecome subject to tl e Workers' Compensation
Laws of California 1 after
(/ _
Date_Owner
NOTICE TO APPLICANT., If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provis ns of the Labor Code, you must forthwith
comply with such provisions or this permit shall bep'deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby 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 Date
Mailing Address
City, State, Zip
imated
PERMIT
AMOUNT
Plan Chk. Dep.
CSU ..-
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
SfJ
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 4/14/00
No. 20294 Jurisdiction La Quinta
Owner NameAgustin & Eva Paz
No. 53-585 Street Martinez
city La Quinta zip 92253
APN # 774-131-016
Permit # 0004-063
Log #
Study Area
Tract # Lot # Square Footage 1421
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 1,421 or S 2,913.05 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 CCNalley Independent Bank/Agustin Paz
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Mary Ann L. Bora Payment Received
r
Signature
Check No.
Telephone x_760-861-2872
. 41
-
216272
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 19%) this will serve to notify you that the 9"ay 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 ensued or on which they are paid to the Dlstrict(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 DeptJApplicant Copy - Applicant/Receipt Copy - Accounting
APR. 6.2000 3:59PM COMMONWEALTH
ZEM
RECORQING REQUESTED BY:
CHICAGO TITLE COMPANY COMPANY
9777KC 207055818 pp qq
WH6NN
I. EL A 00 Rpp Q LOWND'
S EME:
AGUSTIN PAZ
and EVA PAZ
52995 AVENIDJA MENDOZA
LA QUINTA, CALIFORNIA 92253
NO. 471 P.1/1
s`
SPACE ABOVE THIS
GRANT DEED
FOR RECORDER'S USE
The undersigned grantor(s) declare(s):
Documentary transfer tax is $16.50
(XXX) Computed on full value of Property conveyed, or
( ) Computed on full value less liens and encumbrances remaining at time of sale.
( ) Unincorporated area: ( ) City of and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
MARK A. SODEN, TRUSTEE OF THE SODEN FAMILY TRUST INITIALLY CREATED MAY 1, 2985
hereby GRANT(S) to
AGUSTIN PAZ and EVA PAZ, husband and wife as joint tenants
the real property in the City of LA QUINTA, County of Riverside, State of California,
described as:
Lot 4, Block 244, Unit No. 23, Tract Santa Carmelita at Vale La Quinta, as per map
recorded in Book 20, Pages) 25 inclusive of maps, in the office of the County Recorder
of -said County.
Dated March 21, 2000 -
State of California
County of S.S.
On
before me, }ti,., F c c , Q•aoTlr
, personally appeared
(or proved to me on
the basis of satisfactory evidence) to be
the Person (#) whose name (J) is/qre. subscribed
to the within instrument and acknowledged to
me that he/mhoobboyr executed the same in
his%4 "Pir authorized capacity(irers) , and
that by his/1a=/t4wii5, signature (P on the
instrument the person((), or the entity upon
behalf of which the person(f). acted, executed
the instrument.
WKA.
SO EN, TRtrSTEE .
ANNE; MANSOUR ry
_- Comm[Won# 1228545
Notary Public Co
flforrk s
Orn►mee county :; ' .
Mycomm. 5qYmJul 11,WOOMROWIVOW
D03
WITNESS my han nd official seal.
1W -
Signature (This area for official notarial seal)
,MAIL TAX STATE NTS T0:
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.
APPLICANT LA QUINTA PARTNERS
SITE ADDRESS 53-585 Avenida Martinez
APN 774 - 131- 016 BIN NO.: CASE NO.: 2000-215
LEGAL: LOT 4 BLOCK 244 UNIT 23 S.C.@V.L.Q.
CHECKED BY: Leslie Mouriquand DATE:'v —D
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)
V
Consistency with street/surrounding area:
Colors
Materials
Architecture
v
Other Requirements:
APPROVED
B
E
C
BY COMMUNITY DEVELOPMENT DEPT
DATE
SF K