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SFD (0201-218)k. LICENSED CONTRACTOR DECLARATION I,: ereby 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. _B 07/3142t /Date f', f��d� Signature of Contractor, --^-tet *`~ ! 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). ( ) 1, 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 .$ection 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 :1`1'ATy, FUND Policy No. 1280004/ (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. ,%Date: " k ✓-• ,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 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. %S gnature (Owner/Age-_nt),^� ti �• BUILDING PERMIT PERMIT# DATE VALUATION 0201-21-8 TRACT VALUATION LOT � /[)j 1 :• �•"f l `,1 � IJG+ dl��t3�JfJ d,c'^�V !� d�S.titr 1•P� i JOB SITE ADDRESSDC�7rx& APN 7wl,4=4••a OWNER CONTRACTOR/DESIGNER/EN (NEER DAM, R MrCLER PACK: ` pUorks C:0143TR UMi 10ky x"71 91.y0TY�E� 7MEMOM 17193 IrREMOMM .. 00-22, UlDt CA. rZ054 $ 0 C=EARRIX7: , C A, 92054 USE OF PERMIT 0,101E RAWLY VVIR11.9.10 t PO" PERMIT DOYS *1401'.61C..f:117s 9A.,=VWJ%L-L!4 P001.,, P, IXfVE AY APPPIOACH.MMTEP. &I. TRA( 5MR R >11r 1=C51 C 1�1k A'!'1 I 90.00 Sp �a0AlA _ �yCriPE,Of�1.^P�S�.JI�'I` E`1�` 5 ° Y.nM.tt 11AA C40Sr £3IF CC3MM1~'It.V10M 92d3vP.40 %'!% T?9'CiSF�' l Q)1 �CC%t�.9.9;1 e�-40.93ti C014 i.Rt3tt"t`lON M' 101 A,001.418-000 �fi0fi.�3^u P1414 CRUCK, MR, 101-000-4394 .418 SS 0g.3',s M�..rtiHa1VICA7..FIM 101-00.1- 21-000 V 3.;j0 M?,9 CTR1.CA1, F: U, 101:.000.420-000 $1301,08 PLUMBINO PUE 101 -00' 0-4,19-000 $110.75 S1`%IOM W:►'i'WIN' FVWt • 1.Rq. [D, 1011 -000 -MI -0 00 $4,30 CRAD1140 ,M9 101 -000-423-000 U0-00 DWE UOPER IMPACT FEE 5/1907/015 P1?. "CINE PlIA14 101 -0-N),4411-345 $101:00 S� &M-1.OTALT -. C MITI.:TIi3N AWD MW (MUX M? y4 8.06 Q PTR:....° "Y"S ME NOW Ftp 15 2002 CffYOfFL.AQllt REC °' �y / 4 BY» ` DATE FINA/LED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings _ _ Ducts Slab Grade % ' Return Air Steel Combustion Air Roof Deck - - Z X05 Exhaust Fans O.K. to Wrap .p F.A.U. Framing Compressor Insulation , Z Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath O�Z Drywall - Int. Lath Final m Final 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 I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping '3/x`8 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 COMMENTS:. 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 — - - UtilityNotice (Perm) Building Address Fr- • ��trG(� F1� „�.. fes, �2.QGt�-�� P.O. BOX 1504 APPLICATION ONLY 781495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Mailing Address City ` Zip Tel. Contractor Address City jZip I Tel. State Lic. City & Classif.1-? d Lic. # Arch., Engr., Designer Address Tel. CityI Zip. I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7008) of Division 3 of the Business and Professions Code, and my license is in full force and ellect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am 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, 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 ($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 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.) 111, 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.) 1-1 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 nwpy 1 Copy is filed with the city. ❑Certified rcopy is hereby furnished. t 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 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. 1 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 BUILDING: TYPE"CONST. OCC. GRP. A.P. Number en ;g Legal Description Project Description SgiFt. No. No. Dw. Q "Size Stories Units New V. Add ❑ Alter ❑ Repair ❑ Demolition ❑ PERMIT AMOI�NT Plan Chk. Dep. 2 v Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure r TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setbick from Center Line Side Setback from Property Line rt FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Val WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING x 3 2002 Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 Date 2/14/02 No. 22949 Owner NameDavid R. Miller CERTIFICATE OF COMPLIANCE APN# 773-303-008 Jurisdiction La Quinta No, 52-670 Street Avenida Mendoza City La Quinta zip 92253 Permit # 0201-218 Log # Study Area Tract # BLK 142 Lot # 16 Square Footage 1492 Type of Development Single Family Residence No. of Units 1 Comments 1492 sT 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 1,492 or $ 3,058.60 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 Zaragosza: Telephone, 760-835-9120 Name on the check By Dr. Doris Wilson~ Superintendent r ti Fee collected /exempted by Nicola Wong Payment Received $3,058.,60 Check No. 11434 Signature ` ,�'CA� "V�_ NOTICE: Pursuant to Assembly Bill 3081 (CHAP k49PATS. 1996) 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 Mfflding 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 i RECORDING REQUESTED BY: AND WHEN RSOORDED MA;L THIS DEED AND, ® UNL&Ss OTHERWISE SHOWN BELOW, MAIL TAX STATEPAENTS TO. David Rosa Miller 1719 S. Tremont S. Oceanside, CA 90234 00 i' I I SPACE AROVE THIS LINIs FOR RECORDER's USE The undersigned giartor(s) declare(s): Grant Deed A.P.N. 773-303-007 &� 008 Documentary transfer tax is $ . computedart full value. of property eonveyel, or ( ) computed an full value lass value of liens and enwmbrtances remaining at time of sale, { ) Unincorporatam area: ( ) City of _ `� FOR A VALUABLE CONSIDERATION reo®I t of which Is hereby ecknowledged and �% L�0 PRESS hereby GRANTS) to DAVID ROSS MILLER, a marz*ed man as hid '®ole and separate p,operty the heal property in the City of La Quinta State of Callfamia, described as County of Rive. -Side Lot _Mo.&_ 17 of Block 192 Unit No, .--- --.- ..��, Srittta Carmel.ita as vale &.a QuY�at®, as per snap retarded in Book` 6f ,tap®, Records of Riverside County, California Dated—_ No'v'ember 30, 2001 State of Catirornla ) County of ) On betfore me, personalty appeared LEO PRESS Personally known io me (er orcv6d to ma an the basis af.etsttsfaCtpy Avtdence) to be the W6011(2) whose narto(!) le(aare subscribed to the a41111n Instrumant and ackro%Oodgsd to rn® that helsherthey executed tha sena In hlehadtheir authorized OOPOVIy(ies). Ari that by hlsiher/their signature(s) or, the Insffvmend the person(s), or the enUty upon behalf cf whlch the parson(s) acisd, executed the InfiVurlent. WITNESS my hard and cfclC seal, signastur® MAII_ TAX ST.ATEMENT6 -0, I I �nvvnQlsPC/1� d 97G? 0N d-3,A0,3�tl\'S0'!I1 i�-J; �.A-0 1j (�� V7It D RC DISTRICT - PLANNING REVIEW FORM JANnE�U CITY OF LAQUIN1 PLANNING DEPARTMENT This form is to be used by CDD staff for review of single family dwellings irr-tte Re "(eave-��--- 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. APPLICANT PACIFIC TRADES ADDRESSSITE Mendoza APN 773 - 303 _ 008 LEGAL: LOT 16 CHECK AND.APPROVED BY: CASE NO.: 2002-604 BLOCK 142 UNIT %S- S.C.@V.L.Q. Wally Nesbit 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 U�Y /�✓�P`�`—�Ys �wN 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 CDCa25 IU 6 �_ /VUNi�_ Cew✓S!S(i,-T &,177* � iCiS ••�(, �i2 Ll Approved Other Requirements: O Planning Cornmissloii 0 ity Council Communit De %. Initials Case No. ® Exhibit Dep . e o L'7"-�"'-'� 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: 52-670 AVENIDA MENDOZA Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0201-218 Occupancy Group: R-3 .Type of Construction: VN Land Use Zone: RC Owner of Building: DAVID MILLER Building Official Address: 1719 SOUTH TREMONT City: OCEANSIDE, CA 92054 By: RICHARD KIRKLAND Date: 06-26-02 POST IN A CONSPICUOUS PLACE