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SFD (0201-217)LICENSED CONTRACTOR DECLARATION I hkereby 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 07M 117 DateSignature of Contractor'> V. 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 �ation 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: Cartier DTATZ FUND Policy No. 1294990 91 (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 y- 5 -- Date: ^r �� -r f• ° 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, 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 the above-mentioned property for inspection purposes. ; Jy Signature (Owner/Agent) '=y - Date is-rJ� BUILDING PERMIT PERMIT# DATE % VALUATION LOT 02--01-2 Y TRACT 199;1 15110 17 .BLK 142 JOB SITE APN . - ADDRESS .52-010 AW.11 A AWNW ZA '773-3034,407 OWNER CONTRACTOR / DESIGNER / EN (NEER DAM It .7MT3.,UR P MV(C `MAt9C°C}MVIZIMM70N 1719 SOU11.1 MRMONT 17 i 9 0 TRYWCOT CYCIRWIME CA 92054 3 0CLAMM CA 920:54 (760)967-0069 69 C•`RUX 1955 USE OF PERMIT S°lD.LWITf)OFS NO?6POOL, CA, DkTV%JtY il"iOAryH••KiilOR TRACT COMS'TRUCTION %U PORCHIPAT40 '3u.iii3 SY 0AWAICA.R1'(MT 310.0 Sr a Irr. `61.tOOD P'-MCE 200;00 i r ry .I<M.'%1U) COti'.1;' OF C:01` N-11 13 '".E'iov �,�,333.10 , yy y�,�{, gp ��y a, y,g� � A: ��.S6L% .dG l3 L• F, SUIP J.�Sd KKY, CONSTRUCTION FRIP, 101.0,00.418-000 9:594,50 PLAN CISIMIK .01T#19 101.-000-4-29-31,8 $500.12 MRCH1010AL Flit I 01 -WO -421 -,COG I6P,OM !IIXCTR.ICAJ, FEE 101—DOO-42"00 �Iz>.ff9 P1UMF31.A1C3 VEE 101-000-419-000 $110171 S'i'1YiC3'ND MOT10'A YBE — 92 -SID 101-000-741..Ca�Jt3 C1R ADWY..:j FLIL 101-000.4233 000 �A4,4t1 1? F,.t,0 n IMPAC T pn 51?m f?0 PRECISE PLAN M-000-441-345 Si M60 X10, TWPOS1T 101-000-,439-318 •11400.00 ® t3 - Ufi „ C C NS ti lice ,14140 PLAN CITIa : ®MISS s3,u0.0 Pr1.R_1'iWXT41:I^>;3 4250,00 FEB 15 2001 L ' &9'YYjrZ$ DIA; NOW V,M)_ 34 RECEIPT DATE f Y" G,� DATE FINALED INSPECTOR r/ INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings _ A. OA 2z, Slab Grade . Ducts Return Air Steel Combustion Air Roof Deck - p L Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation , v Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath ..2, -70,9 - 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 Gas Test Electric Final Waste Lines Heater Final Water Piping _ -o Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection • p Ti 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 i Final .S OC— Utility Notice (Perm) COMMENTS: Building Address <� Owner 11) 611111, Mailing Address - f rl { /ive.-7/ City1 Zip Tel. Contractor / /�.11r.�'/i/ ✓? /,+ f�,� ick Aaaress ty s12, RIGAIX P.O. BOX 1504 APPLICATION ONLY 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 State Lic. City & Classif. fir-? 2 "3 -, I Lic. # Designer Address City I Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed underaprovisions of Chapter 9 (commencing with Section 7000) of Division,3 of the Business and Prof. ssions Code, and my license is in full force and effect. SIGNATURE -!. DATE OWNER-BUJLDER DECLARATION I he affirm that 1 am exempt from the Contiattor'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'Rs issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to theprovistons 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 ($500). 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, 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 workthimself 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 completiony the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) II 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 fo an owner of property who builds or improves thereon, and who contracts for such projects wiN a contractors) licensed pursuant to the Contractor's License Law.) I'! I am exempt under Sec. B. 8 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 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 sof this city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip bZ_j / -�% UILDING: TYPE'CONST. OCC. GRP. .P. Number —2 7 73 ! 7 egal Description r 7/2_ roject Description Sq Ft.. No. No. Dw. Size f // % 2.- Stories Units Newt© Add ❑ Alter ❑ Repair ❑ Demolition ❑ PERMIT AMOUNT Plan Chk. Dep. r% Plan Chk. Bal.t" 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 i FINAL DATE INSPECTOR Issued by: DatePermit Validated by: e Validation: IP - , 0 3 1001 WHITE = FINANCE YELLOW = APPLICANT PINK= BUILDING t 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 2/14/02 No. 22948 owner NameDavid R. Miller No. 52-660 Street Avenida Mendoza City La Quinta Tract # BLK 142 Lot # 17 Type of Development Single Family Residence Comments Tract Construction 1421 s.f. APN # 773-303-007 Jurisdiction La Ouinta zip 92253 Square Footage Permit # 0201-217 Log # Study Area 1421 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 1,421 or $ 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 CC/ Mission Oaks National Bank - Jose Zaragoza Telephone 760-835-9120 Name on the check By Dr. Doris Wilson - Superintendent Fee collected /exempted by Nicola Wong Payment Received $2,913.05 p Check No. 1143 5 Signature—/�Lwe'«. �� l YmA NOTICE: Pursuant to Assembly Bill 3081 (CHAP 549, STAT"96) this will serve to notify you that the 90 -day 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 sssued or on which they are paid to the District(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 Dept./Applicant Copy - Applicant/Receipt Copy - Accounting ;ilk RECORDING REQUESTED BY: I AND WHEN RECORDED MAIL THIS DEED AND, t9 UNLESS 07HERWISE SHOWN BELOW, MAIL TAX STATEPAENTS TO: a David Ross Miller 1719 S. Tremont S. Oceanside, CA 40254 SPACE AaOvF THIS LINE FOR RF_C0R19t-R'3 USE e� P4 The undersigned grsritor(s) declore(s), Grant Deed A.P.N. 773-303007 & 008 Drocumantary transfer tax is $ . cs ? camouted en full value aP Property tronvoyaQ, or 6 0 Comouied cn full value 1048 value of liens and encumbrances remaining et time of solo, !: ) Unir cotporstae area: ( ) City of / . Fi✓ i%4 � FORA VALUABLE CONSIDERATION, renalpt of which Is hereby ecknowladged, and LEO PRESS hereby GRANTS) to rAVID ROSS MILLER, & rarxiel3 man as hid 'mole and separate property the Mal property In the City of La Quinta State of Callforrtle, descrlbed as 'County of Rive. -Side 16&�17 of Block 142 Unit No, Santta Cartnel.ita at va.la La Quints, as per map recorded is Book -� Pages - �r Mapes Records of P.iverside County, Caliiortia feted November 30, 2001 Signature of Grantor State of California ). County of ) - Or, b®fore me, LEO PRESS Peraonalt appeared LIFO PRESS' Y^ personally known to me (ef proved to mo on the bash ofsgtlytanol , evidence) to be the pgrson,(e):wrose narno(>t) Ieiare subscribed to the wNPlln inatrurnent and ackrowledged to rTe that heJahershoy exevjted the sena In hiehaNtheir aythatirad aopgCity(ies), erd that by h„slher/thair Signature(s) or;►he;Inofrurnen! the perjes). , rt the entry ` upon behalf of whlch the Parsori(a) acted, executed the lretrunMent. WITNESS ;ny hand and otr08l seal. Sign eatulro MAIL TAX STATEMENT6 TO, I Cn►rm 110C l Oi Jv 1. I'l 1i J'J J71�l1( 6)N RC DISTRICT - QD PLANN. f4 This form is to be used by CDD staff for.review of single family dwellingsin`1'Ke-R" ove 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. I APPLICANT PACIFIC TRADES SITE ADDRESS 52-660 Avenida Mendoza APN 773- 303 - 007 CASE NO.: LEGAL: LOT 17 CHECK AND APPROVED BY: BLOCK 142 2002-605 Wally Nesbit UNIT 15S.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 /i/919c(cl 'r A Consistent with MDG on file (as applicable 4// MDG filing required (5 filings since 9/3/98) Architectural variety within 200 feet of the surrounding area: WC Q"Z s 10 Q� <"�"'� �x.,si�,,�—�✓ �x<snn� Colors Materials Architectural design features Approved by: Other Requirements: E] Planning Commission eso ------ O City Council Vcommunity Dev. Dept. ---- ! � 2 'Initials Case No. A C- - 0z' "A ----- Exhibit 1154- VVIS14 Certificate of Occupancy City of La Quintal Building and Safety Department -:This Certificate issued pursuant,.to the requirements of Section.,1,09 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: SINGLE FAMILY DWELLING Occupancy Group: R-3 Type of Construction: 52-660 AVENIDA MENDOZA Owner of Building: DAVID MILLER Building Official x/ rd Bldg. Permit No.: 0201-217 Land Use Zone: RC Address:. 1719 SOUTH TREMONT City: OCEANSIDE, CA 92054 By: RICHARD KIRKLAND Date: 06-26-02 POST IN A CONSPICUOUS PLACE