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SFD (0008-419)` LICENSED CONTRACTOR DECLARATION hereby affirm under penalty of perjury that I am licensed under provisions of 4Chapter 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. bless Exp. Date 4"--q ;. , B w,I6 I fix, f1 A� Signature of Contractor T I 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 ( ) 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. • '=p ( ,/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: Carier Policy No. 2TATtr #f1.1`ND 14 M-00 (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 sh611 forthwith comply with those provisions. - Date: g , ` +'� 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 compjK with all City, and State laws relating to the building construction, and hereby authori a representatives of this City to enter upon the above-mentioned property fo inspection purpose . Signature (Owner/Agent)'`- ` Date-� BUILDING PERMIT PERMIT# DATE VALUATION LOT S-419 TRACT 4 S'?;1,1':; 14.11-113 JOB SITE' ' _ APN ADDRESS OWNER CONTRACTOR /DESIGNER / EN (NEER 1719 5THEMONT 0MI M. 1rX CA 92054 S" OCRA3 SME CA 92054 - 06q)96'7-0069 C.Bul 1955 USE OF PERMIT � l ro DOV—S ?_�iOT iNCLIUDE ;gyp yyj ��1 ff qqP TRACT GOU9it U TION 1,xq-00 SH Ys'C2ACi3MATIO 24.00 Sly GA13.M)t?KAR?PORT ('31.) 10,83520 3 Fr. 'E7 C30.0 viWert, 200, 40 ;lr MA19D C01—pr OF �CO.�FI��.'d�'iiCT ON 93,304m) Qty a ��'�' ro' 11',18TR43'�". i'loAi TOU 101 $612.50 PLAN CHECK vita 101-OOt-439-318 $505.69 MKICH LAICAL FUf M-000421-000 21.000 S49.00 P irXTRICAL FR40, 1411-000.420-000 $111.2A PLV F &Z S110.75 ."a'&'RO110 MOTIOi€ FE7 • REZ11? 101. • 000441,000 $9.35 101-000-423-000 $20.00 PRECISE PLAN 101-000-441-345 5100.00 1t1+ 421_""• °i 3Z'1' 1014=439-318 • 25.0.00 SUS -=AL tv:ONM`:UCU014 AIM L iW C"IM . $3,425.53 LESS J1W,-PtJD FE ES 4250,00 T(Y]rA1., ['.X1SWf F EEFr DI U.Rb NO 99 a4uPjS P aYxtr'�11.� RECEIPT DATE BY/V. DATE FINALED INSPECTOR cf rn r INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings _ �� �j% Ducts Slab Grade _ ((�� Return Air Steel -Combustion Air Roof Deck Z 'Y% Exhaust Fans O.K. to Wrap F.A.U. Framing �Z . Zp -ea 217- Compressor Insulation /—Z - z L • oe Si 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 �� � = O ( 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 Heater Final 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 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) COMMENTS: 19. L -D C -r- 4) 52- (6::21 P.O. BOX 1504 APPLICATION ONLY Building C3�% 78-495 CALLE TAMPICO Address Z. Z LA QUINTA, CALIFORNIA 92253 Owner , sav �� Hca SS h ti \l �r'L BUILDING: TYPE'CONST. OCC. GRP. Mailing Address `, `�0.tt ��`U� A.P. Number City Zi Tel. / %C� ����� ��� ;"^%(ovi �C� _Q Legal Description ` l ress C Z% k\ Zip State Lic. City 1 S & Classif. 1�>q Zr ' Lic. N Arch., Engr., Designer Address Tel. City Zip State \ I Lic. N LICENSED CONTRACTOR'S DECLARATION nVicensed under provi§ ons of Chapte 9 (commencing with Section Business and Professions Code, and y license is in full force and OWNER -BUILDER DECLARATION I hereby affirm Ihat I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5, usiness 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 thaf. 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 ($500). !: I, as oner of the property, or my employees with wages as their sole compensation, will do the wowrk, 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. It, 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 ownerof 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.) F) 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. ❑ 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, 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 1 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 Date Mailing Address City, State, Zip Description Sq. Ft. ' No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition O imated Valuation PERMIT } AMOUNT Plan Chk. Dep. ` 2 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 t Rear Setback from Rear Prop. Line Side Street Setback from Center Line P Side Setback from Property Line . t FINAL DATE INSPECTOR'- Issued by: rr^ Date Permitt) A Validated by:t �1 Validation: t WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION 6 $ /A 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 11/15/00 No. 21213 Owner NameDavid Ross Miller No. 52-621 street Avenida Mendoza APN # 773-302-017 Jurisdiction La Quinta City La Quinta zip 92253 Tract # BLK143U15 Lot # 4 Type of Development Single Family Residence Comments Permit # 0008-419 Log # Study Area Square Footage 1500 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 1,500. or $ 3,075.00 the property listed above and tliat bililding permits and/or Certificates of Occupancy for this square footage in this proposed project mays ow be issued Fees Paid By CC / Capital Bank of North County / David Miller Te4�phone ;760;967-0069 Name on the check ,, r,IF 1 By Dr. Doris Wilson Superintendent 1,. Fee collected /exempted by Annette Barlow Signature Payment Received $3,075.00 Check No. 079035 40TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified Ibove will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to :ollect them on the District('s)(s') behalf, whichever is earlier. Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting Aui-29-2000 06:14pm From -COMMONWEALTH LAND TITLE +7603413215 7-979 P.001/001 F-991 2 RECORDING REQUESTED BY: CHICAGO TITLE COMPANY COMPANY 10083KC 207056773 wHk Ya° RMEROPO D' DAVID ROSS MILLER 1719 S. TREMONT S. OCEANSIDE, CA 92054 SPACE ABOVE THIS LINE FOR RECORDER'S USE GRANT DEED 24167- 7�t�'r The undersigned grantor(s) declare(s): Documentary transfer tax is 844.00 (XXX) Computed on full valueof property conveyed, or - Computed on full value less liens and encumbrances remaining at time of sale, ( ) Unincorporated area: ( ) City of and FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, WILLIAM R. RITEY, TRUSTEE OF THE WILLIAM R. RILEY 1990 TRUST nereby GRANT(S) to CAVID ROSS MILLER, A MARRIED MAN AS HIS SOLE AND SEPARATE PROPERTY tre real property in the City of LA.OUINTA, County of Riverside, State of California, described as: Lot (s) 3 and 4, Block 143, Unit No. 15, Tract Santa Carmelita at Vale La Quinta, as per map recorded an Bocx ie, Page($) 92 inclusive of maps., in the office of the County Recorder of saad County. Dated June 19, 2000 state of California County of } S.S. or, nefore me. _ personally appeared personally known to me (or proved to me on the nasis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the wi-thin instrument and acknowledged to me that he/she/they executed the same in nis/her/their authorized capacity(ies), and tnat by his/her/their signatures) on the irstrumenc the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. Signature MAIL TAX STATEMENTS TO: WILLIAM R. RILEY, TRUSTEE (This area for official notarial seal) �7 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 PACIFIC TRADES SITE ADDRESS 52-621 Avenida Mendoza APN 773 - 302 - 017 ' BIN NO.: CASE NO.: 2.000-304 LEGAL: LOT 4 BLOCK 14 3 UNIT CHECKED BY: Greg Trousdell DATE: Inform the assigned Building plan checker upon your assignment to. this case. Thl Secretary maintains a log book to track applications and assig�ca�se numbers. .C..@V.L.Q. CDP Executive I& REQUIRED ITEM Y' ° N" COMMENTXORRE 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) Consistency with street/surrounding area: S; Colors e d• I r` \Nn Materials Architecture 3 Other Requirements: 4"b • 3P 3 tertificate of Occupancy City of La Quinta Building and Safety Department - This Certificate issued pursuant to the requirementsof'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 fol%wing: BUILDING ADDRESS: 52-621 AVENIDA MENDOZA Use Classification. SFD Bldg. Permit No.: 0008-419 Occupancy Group: R. 3 Type of Construction: VN Land Use Zone: RC. Owner of Building: DAVID ROSS MILLER Building Official Address: 1719 S. TREMONT City: OCEANSIDE, CA '92054 By: STEVE TRAXEL Date: 02-09-01 POST IN A CONSPICUOUS PLACE x,11 9 �;. P.O. Box. 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLr TAMPICO (760) 777-7000 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7101 June 24, 2005 Riverside County Assessor To Whom It May Concern: APN# 773-302-017 Enclosed please find a copy of the building permit, assessor's page and grand deed for the above referenced APN #. The correct name, address, and permit number are: Mr. Armando Arzapalo 52-621 Avenida Mendoza La Quinta, CA 92253 Permit #05-2067 If. you have any questions, please do not hesitate to contact us at (760) 777-7012. Sincerely, Therese M. Vella-Finorio Senior Secretary Enclosures M r. C. A020"7'0/;r- POR. N112 SEC. /2 T. 6S P. 6E THIS M.4P /S .FOR r_ ' - ASSESSMENT PwposQ ONLY 1� n27 3 73--3vv o CALLE+ + j ENS£NADA Sx-y6o M _ o Sa o2 '7 ) ~ W J ME, 1 OLD Na NEM' M+,: 5z-yll 00�' r 303-,-1,4 21 rOArE JOJ-2J 2e, 17 /3 /. 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OS J SZ-bai . sz�/7 6 h o /9 b y e4.01. <z _4/r /6 ® ® 7 ti /5 O Q 8 Q � Z-6 go /,14.25 Sz-c9S /4 /0 ® 9 `° QO SZ -6 o4.3-7 52-700 /3 O 5z -71s @ /0 Q W 52-7/o ^1 /2 O SZ -73r ® // M 30 30 .a . 3 0 3 t . 79.99 80.0/ • NOGALES + 52=�20 o h v1 ASST SSYJJ rS WAP BK -773 Pe. 30 RIVERS/OE C01WTY, CALIF. C©c,n KU0AjS"A�Z- C-P JUN-05-2003-THU 01:34 PM ORANGT TITLE FAX No. 9098258895 MUM '1W�' ;TRF pip, DOG w 2002; mm a IIECOfIWIMof1EGtJef1lA OY: ".02W0Nt 444m les�8-M ORANGE COAST TITLE COMPANY p+M s or Il Ore T tale ft&d �M AIL TOt Masrdad in official Ilessrds ats►t`y M MivsrsiM OKY L. arm MR, & MRS. JOEL AAYAPAL0 Maeaaar, la my Clarb t# peserder A CHC AVEH)1)A MENDO=A LA QUiNYA, CA Ax253 ••-• I fY a r rw,6 1 tris �J�sfi► l ■ I ..1 �__ir, rpr�. I t ...� i'ICllow NO, 01 52D 1 t•KC T1hE CtIDER NO. 141 e40341 INDIVIDUAL GRANT DSD APN Y773 $02.016 THE UNDERSIGNED GRANTORIS) DECLAAEIe1 1 3- Sq l DOCUMENTARY TRANSFER TAX Is / i 64.00 IX) Computed on full value at prgpaty eorivaV)ad. or I camouted on full value ass value of Items or almumbrwwas femalning at time of aala. i I Unincorporated ores IX 101- of to Oulnte, AND FOR A VALUABLE CONSIDERATION, moot of which is h8tooy acknowledged, DAVID RODS MALER, a Msn#ed Man, fs hie >aN end sepoWe mpafly hereby GRANT(aj aa: JESUS JO9VARZAPAL0 mW CATALINA ARZAPALO, Har hand and Wife as JGint Tenants the last prapsrty In the dry of Le QUlnta, County of RIVERSIDE, Stats of Calffornia, descdhed as; Lot 3 Urdt Me. IS. 810Ck 143, Gants Csrme is at Vats La GuM a as shown by Mtlp on Ale In Book 18 a� 0 BZ of Maps In thf► office of the County Aotwdsr of HIVER81015 County, CsitfarNa. commonly known as; 52.621 Avvnide Mendoza, t,5 Quinta, CA 02253 0011190 February 1. $001 STAYcoon pp DI iGO on eja rap SAN Wu On >• r before incl, ,[( I lY a II a Notary Publio in end fol .std slM. P61eAnally opeered��� P41r69rll V 1R141Wl119 Me In' proved to me op the britt vt 911161 hely avldit+arl la be lhapareonlU WIW&4 arn41I41)1e/11141 6ubMMbed 10 the Wlthln 11104M)'1161111♦nd auk"Wiedead to ,no chat hN11haAh6y executed Ilin eelno in h1a/harlthelr aulhont41d mWealtytle.f, and 11h I th"Itholr.lyla,tur41fel on the mrtrum41M the p41raplW W th41 eadty upon b41ltep of WhWh the Fltraonfel "ted, a7tevut the Inptr ant. WkTNtif t,ry teat- and lob 11e y +titnatwi. Mau tax statOnrente to: Ito S MIf.L;iR K .uV COL CONK & t;ep34114 OTAJiY FUe610tALIi01ge4 fteffluft --A IYN% cram Ina ofttotal notanel 06101 Description; Riverside, CA Document- Year. DoclD 2001.82291 Page: 1 of 1 Order: BK -06.06-2003 12-15-32 AM Comment: P. 005/005