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SFD (0104-090)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 4 2518 1 07M I& DateSignature of Contractor ;� ��`�'` '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). 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 Se ion 3700 of the Labor Code, for the performance of the work for which this pdrmit is issued. My workers' compensation insurance carrier & policy no. are: Carrier Policy No. aIi'A'1R PUN 1'�$ta+?9fi-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' compensaton,,provisions of Section 3700 of the Labor Code, I shall forthwith comply with t� ose provisions. pp Date: ^: �•' f A Iicant `r —' '- ! VI — Wa`rning Failure to secure Workers' C9m pen satil cover, ge is unlawful and shall subject an employer to criminal perialties and cilil fines up to $1.00,000, 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. Signature- (Owner/Agent)------� �•s'" Date BUILDING PERMIT PERMIT# ' j' DATE 1' VALUATION LOT `(��,�}.�j TRACT JOB SITE ADDRESS �y�{yyyp� ,�yyph eyp ::]APN ,�: y,i[ A9.YEYw�1:2d3SSf����'A'n41� 774-W2-020 OWNER CONTRACTOR/DESIGNER/EN INEER 1DAI:D ROSS 11AT XER PACU IC COMMUM ION P:0. BOX '7?2 171.9 0 MAt OOT 1:A tivUMA, CA R253 3 OC3i.€ LN`'i Y, CA 92054 060)%7-0069 C'BIA 1955 USE OFPERMIT ':?�S�F:E'u9 .11`.i d3 aiit�f''�k C.Lf i➢t�.irk.£:Cf�'L IQ.,111Z'1V1iIVIA.Y.APIa1;.E?ACH-OR 11001. A1iAUR %. i { TRACT C:ONSTRIX'1'0H 11421.00 qr POPICWPA` IO 36.04 SF S rx° l WOOD PENCE 209.00 IS EgJ`:�Ral .11.. a D COST OF d:'C MIRI iM1014r;3:3�:.�i o ygm,IR, 901ev"ay 1? 911, DFP0 SIT 101 8 4250.00 ['{G.�/0}0-439ry-a31 lrlO. NIS, I.AX ¢ ION VEP, 101'k#`a'�.4 �! T1^ODO 094.50 P,V,KN C 'HV.CK YRZ .101-000-439-318 Mo, 12 N13T,C'&ANICIA114 .Fitz 101-006.421-000 $60,00 FUNCTFUCAL "S 101.000 420.000 $120,44 ' 1lulvHP.40 FEE 101-000-419-000 $110.95 S T t4OM M0710H F.9L - USID 101.000441--000 $8.03 C, R.AniNa ME 101-000,423,-000 � 1SI.Ih9 D WELOPft -iZAPAC t` FileE l;,i0 r,f3ti ,PlILVAU . A PLAAI _ 1iJ1 0900.-c1a 1 _3 $'tf10.SA — Ali M) A-411 CHEM $3,430.74 ld 4250.00 TOT K4 . X:P',?'. 5 DUN NO &,1811x'7`4• FA01 MAY 1 1 99 1 CITY OF LA OUINTA riNANCF PT RECEIPT�' 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 �dl 5? ' Exhaust Fans O.K. to Wrap —( F.A.U. Framing r�=2�=0C 5? Compressor Insulation 7=2 t S-7 Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath �p; • OL S7 Drywall - Int. Lath 7— (0—a L S T Final/�CJ/�� _ Final �r 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 _ _ `� Heater Final Water Piping--`� eS� 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 ( L 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 Finalv_— [4_D_D Utility Notice (Perm) f41 —I Desert Sands Unified School District ' r 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 5/11/01 APN# 774-062-020 No. 22005 Jurisdiction ' La Quinta Owner NameDavid Ross Miller Permit # No. 53-155 Street Avenida Mendoza Log # city La Quinta Zip 92253 Study Area Tract # Lot # 8 Square Footage 1,421 Type of Development Single Family Residence No. of Units 1 Comments 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 - Capital Bank - Juan Rodriguez Telephone 760,45125 i Name on the check By Dr. Doris Wilsonw' Superintendent Fee collected /exempted by Arlene Garcia Payment Received $2,913.05 Check No. 081873 Signature S NOTICE: 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 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 .. � VAI 1�v/ t O 1 Buil Add rdess4 3/ 7//L Ov�,ie Owner T&Y/ 0 acv P.O. BO)c 1504 78-495 CALLE TAMPICO •/». LAQUINTA, CALI =ORNIA 92253 Mailing Address City Zip Tel. C,�c �r.t•s c rl =� V?_ US 5/ 7f�1�-`%f 7-�by Contractor —,-,) r r. , ress Zip State Lic. City & Classif. 851 Z 5 3► j Lic. # Arch., Engr., Designer Address Tel. ty (Zip (State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section '7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. l SIGNATURE Ji 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 live 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.) I 1 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 to an owner of property who builds or improves thereon, and who contracts for such projects with 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 the work. for which this permit is issued, 1 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 a0plicant Date Mailing Address City, State, Zip APPLICATION ONLY BUILDING: TYPE'CONST. OCC. GRP.- A.P. Number % %el— 04?— ?— -016 Legal Description .4� fl ,6/eylk, .Z 0 - Project Descriptionr ! ZONE: BY: — N inimum Setback Distances: Front Setback from Center Line ! Rear Setback from Rear Prop. Line Side Street Setback from Center Line e Setback from Property Line F WHITE = FINANCE YELLOW .= APFLICANT CIlY OF l FINgry- PINK = BUIL Sq Ft. No. "Six Stories No. Dw. Units New Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Flan Chk. Dep.— FlIan Chk. Bal. Const. t Mech. Electrical Plumbing &.M.I. Crading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: — N inimum Setback Distances: Front Setback from Center Line ! Rear Setback from Rear Prop. Line Side Street Setback from Center Line e Setback from Property Line F WHITE = FINANCE YELLOW .= APFLICANT CIlY OF l FINgry- PINK = BUIL 01/09/01" 10:25 FAX 17608049062 CObt IONWEALTH TITLE 0002 RECORDING REQUESTED BY: AND WHEN RECORDED MAIL THIS DEED AND, UNLESS OTHERWISE SHOWN BELOW, MAIL TAX STATEMENTS TO; William Thomals Buff in Power Brokers" B.O. Box 134 La Quinta, CA 92253 SPACE ABOVE THIS LINE FOR RECORDER'S USE The undersigned grantor(s) declare(s): Grant Deed A•P.N-(;774-062-020 021 Documentary transfer.tax is $ ( sY) computed on full value of property conveyed, or 5 .- �� A �a 7.lt.1 ( �) computed on full value less value of liens and encumbrances remaining at time of sale. ( ) Unincorporated area: ( ) City of and FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Clyde Burk hereby GRANT($) to David Ross Miller, a Married Man as his sole and separate property the real property in the City of Lauinta County of Stale of California, described as Q y_ Riverside Lot 8 & 9 of Block 207 Unit No, Santa Carmelite at Vale La Quinta, as per map recorded in Book Pages mf Maps, Recordsof Riverside County, California Dated March 20, 2001 Signature of Grantor State of California ) County of ) SS. Onbefore me, Clyde Burk ,personally appeared . personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose neme(s) is/are subscribed to the ~— within instrument and acknowledged'to me that he/she/they executed the some in his/her/their authorited capacity(ies), and that by his/her/their signature(s) on the Instrument 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 Form 3195-4 (6.94) Tuic �.,o.. .... __...._. 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 53-155 Avenida Mendoza'. .APN 774 _ 062- 020 BIN NO.: -723 CASE NO.: 2001-435 LEGAL: LOT 8 BLOCK 207 UNIT S.C.@V.L.Q. CHECKED BY: Stan Sawa 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 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: Colors Materials Architecture V l Other Requirements: Ol✓ -r �� j01 �, , '�o f MiTek� MiTek Industries, Inc. 3033 GOLD CANAL DRIVE SUITE 200. RANCHO CORDOVA CA 95670 USA FAX (916) 631 8225 TELEPHONE (916) 631 7811 Re: D11191 PACIFIC TRADES/STD VAULT DUTC J I The truss drawing(s) referenced below have been prepared by MiTek Industries, Inc. under my direct supervision based on the parameters provided by JMW Pages or sheets covered by this seal: R6015626 thru R6015634 My license renewal date for the state of California is September 30, 2004. /ss61 / C�G�7 53 � . 'b w Y', N _ f. . C0499i9 Exe 9-30-03 JUN 12 2009 q FOF CALL%� May 14,2001 Yu, Ray The seal on these drawings indicate acceptance of professional engineering responsibility solely for the truss components shown. `The suitability and use of this component for any particular building is the. responsibility of the building designer, per ANSYrPI-1995 Sec. 2. . M= *Certificate of Occupancy City Quinta of La B.uilding 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: 53-155 AVENIDA MENDOZA Use Classification: SFD Bldg. Permit No.: 01.04-090 Occupancy Group: R 3 Type of- Construction: VN Land Use Zone: RC Owner of Building: DAVID ROSS MILLER Building Official Address: P.O. BOX 722 City: LA QUINTA, CA 92253 By: STEVE TRAXEL Date: 09-19-01 POST IN A CONSPICUOUS PLACE