SFD (9805-033)v LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed'under provisions of .
F- Chapter 9 (commencing with Sectiori 7000) of Division 3 of the Business and
N V; Professionals Code, and my License is in full force and effect.
o. c+, License # Lic. Class Exp. Date
74841.4 13 4730100
t,Da- to Signature of Contractor!„
OWNER -BUILDER DECLARATION i
I hereby affirm under penalty of perjury that I am exempt from the Contractors
License Law for the following reason: i 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). .
O 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
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:
Cartier 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 shall forthwith comply with those provisions.
.,Date: Applicant 9 -
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.] 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.
yS g ature (Owner/Agent) ' r1 " `lam, ... Date,
er•
a...
PERMIT # CONTROL•#
BUhLDING •PERMIT Y �.
DATE VALUATION.. LOT 9845•-033 TRACT o �
/•> s1oostl6.90 17 11161 _0.
JOB SITE. �
APN
ADDRESS
52,930 a4VE.NfDA MEtNlfl(YZA
7'73„33:3-010
OWNER �''
CONTRACTOR/ DESIGNER/ ENGINEER
SANT NIATHEWS .
M. CONSTRUCTION. AND DEVELOPTsWNT
PO BOX 806,
P.O. BOX 806
PALM -DESERT ' CA 922161-0306
PALM DESERT CA 92261
�.
('760)324-3840 C8L# 5229
USE OF PERMIT v
pE9E:1Z'C .ti0Alia i")ESICEJJ+ft�tS
C+i7i'-f c+1
c n•r n T r rrn
-5i!D`v:PER.NffT DOES N(7T fIrCT.UDE BLOCK WAIJA OR P00%
A 14
rQ DEG
21 1998
C"r ' OTS 1.6 52,00 ti�F
7`ly.`RA�
yyC�ONSTRI-}
PORC•1-VP. 10 45.00 S Y
OF
g eeaa pp
U��lV�"� <
G.ARAOF.lCARPORT .4 8,00 iF' .r0TY
LA
6 FT. WOOD MqCE 200.00 LF
EN fMATED COSTOF CONST RU I ION
l oU:,5ubm)
PERMIT FEE. StiTi1IMAR-Y
C014STRUC'TION FU .101-000-41.8-000 $643.00
P LAN C.f. , F , F F E 101-000-=439-318 $544:89
fu r3SPOSIT 301-000-439-318
WIEC;HANWAL.F•E8' 101•-000-421-000 $417.00
ELECTRICAL TICAL KE 10.1-000420-000 $136.043
PLUMBINGFEE lot -00041,9-000 Si57.50
S�rP.ONGMC)TI.O.NFF,F,�oZES''iD' 101-000-243-000 $10.06
ORA131NG FFA 10.1-000423-000. .
NF•R,%.!3'rRUCTU`f0'_- .VFE 225000_:4143_342.1 $? 21:1.A9
,t - TSE PLAN .10.1-000441-345 $23.00
Af2'G Lq mi.TF3L1C PI<A.CE3 - :REofir 70.1-000-255-000 $1A7
sC�!'3=TOTAL CONSTI?UCITON AND PLAN CHECK
53,79. A9
1.E,SS PRE -PAID FES
^$750.130
TOTAL i'E.4itMIT FEES DUE; NOW
S3,546:.49
RECEIPT
DATE
BY /
DATE FINALED
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,_ _
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
(
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
—t —
Final
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines—ls
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
! /j'-��
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice
l
(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)
s_e�?� � c� � r/
Notice:
Document Cannot Be Duplicated
Date 12/11/98
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
No. 18098 Jurisdiction
Owner NameSam Mathews
No. 52-930 Street Avenida Mendoza
City La Quinta zip 92253
Tract # BLK 147 Lot # 17
Type of Development Single Family Residence
Comments
APN # 773-333-010
La. Quinta
Permit #
Log #
Study Area
Square Footage 1,652
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
1.93 X 1,652 or $ 3,188.36 the property listed above and that,bu,)lding
permits and/or Certificates of Occupancy for this square footage in this proposed project -may, now>,be issued
Fees Paid By CC/Bank of America/M. Cons. & Development !Tplephone4 32413840
Name on the check a
rk
B Dr. Doris Wilson r �'
Y 4A
Superintendent �;
Fee collected /exempted by Juanita Green Payment Received $3,188.36
Check No. 2006243253
Signature
NOTICE: Pursuant of Asserry 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
will begin to run from a 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
�i
QW4C-E GOASTTITLE CO. qrp- i- VvLD `jk FiECORD
AT E.:0 AM
RECORDING REQUESTED BY:
Al;p iQllb
fig WHEN RECORDED MAIL TO: P A I D
D-oc Ttarc;i�! Tax
SAMUEL E. MATTHEWS
78636 Gorham Ln.
RN. Co. Rw)order
Palm Desert, CA 92211 Few. .
SPACE ABOVE THIS LINE FOR RECORDER'S USE
A GRANT DBE D
The undersigned Grantor(s) declare(s): Documentary transfer tax is $ 11.00
o veyed, or
computed on full value of pr,
PARCEL NO.: 773-333-010(X)
ASSESSOR'S 0 -T
TITLE ORDER NO,: R-1,63946-3. computa?rl on the ful.). value laps lions or
ESCROW NO.: 982318JR encumbrances . remaining at the time of sale
-F1 A 0 2
FOR A VALUABLE CONSIDERATION, receipt of which is acknowledgedt
LAURA KATHLEEN GILL, A SINGLE WWAN
ca"t" DAvxD DowornG, a single nan
'AKAT LAURA K. GILL
hereby GRANT(S) t67SAMM. F. KATT1IFWS. 'a wifigle men as him sole and separate property
Witness my hand and official seal.
i q n n t u r s-
r. NANCY,RANDALL
Comm. # 1107300
044GS C01;NrV
kp-r Cwr- fvtwo�,
(Thiq-ar-a for official notarial seal)
04AII. TAX fi?ArFHFWTS TOzCA 2 2!)',
P 0 - 110A I
on before me, the undersigned,
'The following real property
in the city of LA QUINTA, Riverside County,' State of
Californias
ptinonally kii,,wit to m-, (or proved to me on the basis
described as: Lot 17 in Blcx:k
147 Santa Carmelita, at Vale La Quints, Unit 15 an shown
j
- e -
nam -(s) "is/AI stib"t rib -d to the within instrument
by Kap on file in Book 18,
Pagn(s) 92, in the office of the county Recorder of
Same In hiSill0l/theil. author -d cnpaciLy(ies), and
Riverside County.
that by hie/her/their signature(s) on the instrument
the person(s) or the entity upon behalf of which the
C
Date: March 11, 1998
CHARLES DAVID DOWbING
STATE OF CALIFORNIA
CCXJIM or., N-1
I no;A
LAURA KATHLEEN GILL AKA LAURA K. GILL
Witness my hand and official seal.
i q n n t u r s-
r. NANCY,RANDALL
Comm. # 1107300
044GS C01;NrV
kp-r Cwr- fvtwo�,
(Thiq-ar-a for official notarial seal)
04AII. TAX fi?ArFHFWTS TOzCA 2 2!)',
P 0 - 110A I
on before me, the undersigned,
Pei sons I 1 y apiY, a U A 6.
ptinonally kii,,wit to m-, (or proved to me on the basis
Of Shtl9fACtOt-Y PVjdOtlC-P) to be the ppraon(a) whose
j
- e -
nam -(s) "is/AI stib"t rib -d to the within instrument
and ackncwlodood to mc- that--4iv-/nhP/I.hPy Pxpcutod the
Same In hiSill0l/theil. author -d cnpaciLy(ies), and
that by hie/her/their signature(s) on the instrument
the person(s) or the entity upon behalf of which the
perpon(s) acted, executed the instrument.
Witness my hand and official seal.
i q n n t u r s-
r. NANCY,RANDALL
Comm. # 1107300
044GS C01;NrV
kp-r Cwr- fvtwo�,
(Thiq-ar-a for official notarial seal)
04AII. TAX fi?ArFHFWTS TOzCA 2 2!)',
P 0 - 110A I
CITY OF LA QUINTA SUB -CONTRACTOR LIST K�-
BUILDER C&A4 e�CVM,2�t
rnA4k,_�'>
JOB ADDRESS �52 1-30 Aoe-n4-ps VA"ozA PERMIT NUMBER OWNER
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
gari ky npplirnnt Ainn File" is not an acceDtable resDons6.
of. building permit.' i -or
eacn appicabie tfdUt:, all
"7777=7J.—I.,
Contractor
1WLfU00LVU UV %JvV 111UOL
77
'is Insurance
State. Compensation:: ... ...
Contractors License' Wo'r
Business Licensecense
F Trade Classification
Company Name
Classification
(e.g. A, B, C-8)
License Number
lxxxxxxi
Exp. Date Carrier Name
(xx/xx/xx) (e -*9. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)'
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
_1
-- , - -,
L4
22 1
EARTHWORK -(C: 12),--
J 71C) 047 �r�
L-42�
CONCRETE" (C-81
FRAMING (C -5)
A .15. C, covy—_6,x�,
-it t3�_ 1
-2-21M
L+ _ZL4
STRUCT. STEEL (C-51)
MASONRY (C-29)
PLUMBING JC -36)
L_OLk I
H 30 -cr
LATH, PLASTER (C -351
q
DRYWALL (C-9)
-ILK?:;- L+ (c-4
4-30
455-7
- YJ
HVAC IC -20)
PA
(e
itpeiAt4vk a
>
fC5 o L �6 A
Gc(, 9.5)
ELECTRICAL IQ -10)
ROOFING (C-.39)
'142)4IL-4
LA -3a -dz>
SHEET METAL (C-43):'.-::
FLOORING (C-15`)
T
CCC>—
L -Ifo 3
1 I - q)
2�L4 t 0
13 -Ti..
GLAZING (C-17)
INSULATION (C-21
ovk oo
-�o f z
ct-z�q �j
-AZj
SEWAGE PISP.'(C42)::-
PAINTING 1C.33)
9
LtgL4 Li
-------
5 12
71_19
CERAMIC TILE (C-54)
vv� - ee�oc;�10-111
CABINETS (C-6)+
-IL425
z 07
FENCING (C-13)
_C0
6 Z -Z 9
LANDSCAPING (C-27)
POOL (C-53).
_J1
z
Cert/flOdcupan�-
cate o -f cy a�
City of La Quinta
,r V
Building andSafety Departinent
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 fol%win
BUILDING ADDRESS:- 52-930 AVENIDA, MENDOZA
'Use Classification: y SFD Bldg. Permit No.: , 9805-033
Occupancy Group:, R 3 Type of Construction: VN Land Use Zone: RC
Owner of Building: SAM MATHEWS Address: P.O. BOX 806
City: PALM DESERT, CA 92261
' By: STEVE TRAXEL
" Date: 1 1-1-99
Building Official
POST IN A CONSPICUOUSPLACE
1
_.EEI
1 _
Cert/flOdcupan�-
cate o -f cy a�
City of La Quinta
,r V
Building andSafety Departinent
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 fol%win
BUILDING ADDRESS:- 52-930 AVENIDA, MENDOZA
'Use Classification: y SFD Bldg. Permit No.: , 9805-033
Occupancy Group:, R 3 Type of Construction: VN Land Use Zone: RC
Owner of Building: SAM MATHEWS Address: P.O. BOX 806
City: PALM DESERT, CA 92261
' By: STEVE TRAXEL
" Date: 1 1-1-99
Building Official
POST IN A CONSPICUOUSPLACE
1
_.EEI
Charles -D. Garland, Architect
33-163 CAthedral Canyon Drive
Cathedral City, CA 92234 -
4 page: date.- .31/1
STRUCTURAL CALCULATIONS FOR:
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33-163 CAthedral Canyon Drive
Cathedral City, CA 92234
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33-163 CAthedral Canyon Drive
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