SFD (0009-049)54420 Avenida Martinez
0009-049
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
782.4 B ITIC %') 'f $/31!9( _
Date ` Signature of Contractor <- '• i` ` -'
f
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.0:,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.
(0 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 UFMPT 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 sjiall fo hwith comply with t ose pro -Vision's 'e, /%
atCa { Z i Applicant—
De:
{
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
Zure
ove-mentioned property for inspection purposes.
r.(l
(Owner/Agent) t f ' f1 r` Date t '
BUILDING PERMIT PERMIT l7
DATE "EVALUATION LOT 00()9-049 TRACT
" )U1018).0 11 -
JOB SITE t
APN
ADDRESS 54-420AVFJVDAMM,.r1T J9Z ::1
774-254--M
OWNER
CONTRACTOR/DESIGNER/EN (NEER
PJMJARD SCorr
.*1?.L111C:-100, .
7'7564 A COCIN7RX CI.TT.G DL'e1V'+'h tjuiT'1v 11:►
'77564 A CO[3 I I2Y CLUB 377uIB, QUIT :113
PXM DEMRT CA 92211
-PALM DFBER .f CA. 92211.
(°760 406-3495 C.BLA 2.953
USE OF PERMIT
811ATOLIV, FAhmy 1ywLT'frLD.40
SFD - PLylt.'MIT DOES NOT INCLUDE 13t.00:1C 1Jit.P.z.I..OP'CxauspA cw }
DRIV'YWA.Y .APP110A01.
TRACT CONSTRUCTION SF
PORCHMATIO 58.00 SY
OAR,ACIFJC;AIIFC+RT (SF) 9,074,80
5 ' r. WOOD 3304CE 200.00 L9'
,t
MIAWED O0,7A 01fi COdYtJF. IZU(7170 Y
1'1IRMT.f'1✓L SPRY
CONSTRUCTION FEE 101-000-416-000, $612.50
PL.A f CREC:K H%E 101-000.439-318 $513A15
MECHANICAL FEE 101.000-421.000 $60.00
ELZCTRIC°AI,.FFE 101-000.420-000. $131.30
PLUMB1NCIFEE 101.000-419.000 3114.75
-_1
STR NO MOTION FBE - RESID 101-000-241.000 $9.31
; . >
ORADINO FEE. 1019000>421.1100 = $20.00
. F e
I3LrVIMDPFR IMPACT FEL' $1,90'7.00
; t
PRECISE PLAN 101-000.441->345 $100,04
t ' ; '
FEE DEPOSIT 101-000.139-318 -$250.00
y,.ss • f
SUB-7XYEAL CONSTR UC13OLS "D P L AK C.klECle
I J $3,46431
33 PRF-F'.ATf) I=
-10250.00
TO'N'AL PE l.> 11'M DIX NOW
RECEIPT
DATE
I lcc,
BY F i }
DATE FINALED
INSPECTOR
-1
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
—O
Exhaust Fans
O.K. to Wrap
- oc> 57
F.A.U.
Framing
,Z —/� _ ap 57
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
Z O
POOLS - SPAS
BLOCKWALL
APP OVALS
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
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
— O j
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole _ 00
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.O. BOX 1504 APPLICATION ONLY
Building 78"495 CALLTAMPICO
Address 54'4-ZV NMjrt"QUINTA, CALIFORNIA
92253
Owner ` j' I C H-64 U
Mailing n BUILDING: TYPE'CONST. OCC. GRP. (
Address tU f'✓ #!/ A.P. Number r f / C
tt1 jl _ Zip ` Tele' Legal Description 1 1 0 ` i 2-1
Contractor Pik 10
C_ ffo m E Project Description
Addle YtA G v L
I '1 ' t +` '` Zr _ , Tel
State Lic. City
8 Classif. Lic. N DZ9 Sq. Ft. ( / ' No. ' No. Dw.
Size Stories Units
Arch., Engr.,
Designer New Add 0 Alter O Repair ❑ Demolition O
Address Tel. rn _ I
ciZip State
ty
'vl Lic. N
LICENSED CO TRT R'S DECLARATION
I hereby affirmihat I am I cense undBiWor 9 (commencing with Secti n7000) of Divisi n $ of th sines ndsi my license is in rr I d
effect. 9V
rL
SIGNATURE ATE
OWNER•B ILDER DECLARATION I
Estimated Valuation
I hereby affirm that I am exempt from the Contractors License Law for the follow' g
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which require a
ermit 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 pursu nt to PERMIT AMOUNT
the
rovisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Divi 3 of the Business and Professions Code, or that. he is exempt therefrom, and tI % basis f
for th alleged exemption. Any violation of Section 7031.5 by any applicant fora permit Plan Chk. Dep.v""c.+ J
subjects a applicant to a civil penalty of not more than five hundred dollars ($500). / i
l; I, as oIS er of the property, or my employees with wages as their sole compe sation, will Plan Chk. Bal.
do the wodt and the structure is not intended or offered for sale. (Sec. 7044 Buisness and Const.
Professions C e: The Contractor's License Law does not apply fo an owner o property who
builds or impro s thereon and who does such work himself or through his n employees, Mech.
provided that su improvements are not intended or offered for sale. If, how er, the building
or improvement i sold within one year of completion, the owner -builder wit have the burden Electrical
of proving that he di not build or improve for the purpose o! sale.)
11 I, as owner of th property, am exclusively contracting with license contractors to con- Plumbing
struct the project. ( ec. 7044, Business and Professions Code: The Co tractor's License Law
does not apply to an `wner of property who builds or improves thereon and who contracts for S.M.I.
such projects with a contractor(s) licensed pursuant to the Contractor's Lice se Law.)
` Grading
17 1 am exempt under Set; B. & P.C. for this reason
Driveway Enc.
Date owner infrastructure
A
WORKERS' COMPENSATION DE LAR TION
I hereby affirm that I have kertificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, a certified cop hereof. (Sec. 3800, Labor Code.)
Policy No. Compar.
• n Copy is filed with the city. ❑ C rflfied coy is hereby furnished.
,// TOTAL
CERTIFICATE • F EXEMPTION FROM REMARKS
WORKERS' COMP NSATION INSURANCE
(This section need not be completed it fh p rmit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance 0 thg wo, .for which this permit is issued, I shall not
employ any person in any manner s 7771as to b me subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If,11-112
making this CertifLLcate o! Exemption you should become ZONE: BY:
subject to the Workers' Cmakprovisions o heLabor Code, you must forthwithMinimum Setback Distances:
comply with such provisions orrmit shall be deemed r yoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line-
Ihereby affirm th there is a construction lending agenc or the performance of the
work for which this p rmit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line
Lender's Name
Lender's Addres FINAL DATE INSPECTOR
This is a buil ing permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify thail have read this application and state that the above infor ation is correct. Issued by: Date Permit
I agree to c6mply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to
en
lei the above•
mention if property for inspection purposes. Validated by:
Signa re of applicant Date
Mailing Address Validation:
Ci State, Zip
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Date 9/12/00
No. 20982
Owner NameRichard Scott
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
APN # 774-254-008
Jurisdiction La Ouinta
Permit # 0009-049
No. 54-420 Street Avenida Martinez Log #
City La Quinta zip 92253 Study Area
Tract # Lot # Square Footage 1501
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
2.05 X 1,501 or $ 3,077.05 the property listed above and that building.
- _Z
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 / Dick Scott Telephone ;760-4"08-3495
Name on the check
'rc
w
By Dr. Doris Wilson r'
Superintendent
Fee collected /exempted by Annette Barlow Payment Received
w � Check No. 56357
Signature �l '���
X3.077-05
iOT10E: Pursuant of Assembly 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
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 Distdct('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
r. L •%. C. .-cr uwJ>' dtHI"I _R, VMMU WtHL I N
RECMING REQUEVED -9Y
CHICAGO TITLE bOMMY COMPANY
99,930= 97067641
wig
RICiiM sCo'TT
54-430 Avon&da $ftrt2"z
L* Quftta, CA 97.7.93
w
CvRA111'T DEED
NO. :565 P. 1/1
The undersigned grantor (s) deoe r e
Documentary transfer tare is WK
jXiCC Computed on ful% value of pr rty conveyed or
`( OCOT. ted an
full
value
le aCi ns And encam ranCas remaining at time of sale.
and
FOR A VAY+UMN CONSIDB ATION, receipt Of which is hereby ackn*vIedged,
9RVCC3 GALVA1QEK, 44 t»trrioa mu
hereby GRANT (J9) to
RXCK"D SC= and CLAMXA SCOTT, husband and wife as joint tenants
the real property 'ias the City of LA QL9=NTA, County of Riverside, State of California,
described as,
Tot ii, 8;1dck 301, Unit No, 27, Tract Santa Carmelitd at Vale La Quir3ta, as per map
regorded in &oak 19, Page(s) 83 inclusive of M05, , in the office of the County Recorder
of said County.
Dated Noveder 22; 1999
FD, (11-0 7- z -..
state of California
County of Rivreraids
pn Nov9 } s,g, 1l=C GALVAX9K
e ®s
before res, istina aivia ` '
Bruce
peraonaliy appeared
a Vac e
,
(or px'oVad to rte on
tho basia of satisfactory evidence) to be
the Porson(s) who3a name(®) Fare subscribed
to th® within in®t;rument and acknowle8gad to
TP9 that4W/eke#1!a>ay executed the same in
C0444 authorized C*PUCity(ies) , and
tbLgt by /!-sigaletturels) on the
instrument the parson(si), or the entity upon
behalf of which the person (s) acted, executed''
the instrument.
WITl` RSG Ory fi'i seal .
signature
MAIL TAX STATEMENTS T4: ssue an above —
.
CNRIStINA SWIN
Commission 0 1146703
Rrvor3lds Cauflty
MY COMM b PIM Jul 14, 2001
('Phis area for official :notarial seal)
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 PA -(t El -C— 4 _O MEt2,
SITE ADDRESS
54-420 Avenida Martinez
APN 774 - 254 - 008 BIT NO.:
LEGAL: LOT 11 ✓BLOCK
CHECKED BY: Greg Trousdell
301
CASE NO.: 2000O3-302
✓ UNIT 2 7S
C.@V.L.Q.
1
DATE:
f
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 num/bers. 'A
REQUIRED ITEM
Y
N COMMENT/CORRECTION
Compatibility Review
Case logged and number assigned
at
Verify legal and APN information
n /
Consistent with MDG on file (as.applicable
P
v m
o Go
MDG filing required (5 filings'since 9/3/98)
1 '
Consistency with street/surrounding area:
\ S140. 0.
N
Gas s
G Colors
6
O i h Go.
aterials
MH
c •tecture
Other Requirements:
A5
/3 /l f la - Z
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: . R3
54-420 AVENIDA MARTINEZ
Type of Construction: . VN
Owner of Building: RICHARD SCOTT
Building Official
Bldg. Permit No.: 0009-049
Land Use Zone: RC
Address: 77-564 A COUNTRY CLUB DR. #113
City: PALM DESERT, CA 92211
By: STEVE TRAXEL
Date: • 03-22-01
POST IN A CONSPICUOUS PLACE