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SFD (0107-306)LICENSED CONTRACTOR DECLARATION Fhereby affirm under penalty of , perjury -that I am licensed under provisions of `Chapter 9 (commencing with Section 7000) of DMsion 3 of the Business and Professionals Code, and my License is in full force and effect. License # Lia Classf•' Exp. Date Dater"Signatu"na of Co'ntrac, , OWNER -BUILDER DECLARATION ' I hereby affirm under penalty of perjury that I am exempt -from the Contractors License Law for the following reason: 1, as owner of the property, or my employees with wages as 0i6iFsole Compensation, will do the work, and the structure is not intended or offered for sale (Sec. 70,44, Business & Professionals Code). - )..'I, as owner of the, pfoper(y, am exclusively contracting with licensed contractors to cbristruct. the project (Sec. 7044,-, Business &,Professionals Code). O I am exempt under Section B&RC.'for this reason Date 'Signature of Owne'r WORKER'S COMPENSATION DECLARATION :r92 ,'.1 hereby affiri-n,under-ppnalty of perldry one of the following declarations: O I have and will maintain a certificate of consent to self -insure for-`W:6`rk"e'rs' .compensation, as p'rovided for by Section 3700 of the Labor for` th e;,-. �r e performance of the work for which this permit is n, Issued.: , I have and will maintain wor*kers'.compensatio, : insurance, as required by Se6fion 370.0.6f the Labor Code, for the performa6' the work for which this permit is Issued: -My workers' compensation insuriai n89- carrier & policy no. are: Carrier Policy No. x6v. "''(This section- need not be completed if the permit valuation is for $100.00 or less). 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 `g4d8jgbt to the workers' compensation. provisions,of-Section 3700 of the Labor ""Cd6j shall forthwith comply with those provisid . ns. _ie: 3- �/, Applicant e 'm: W6rni.In g: Failure to secure Workers' Co , pensation coverage is unlawful and shall subject 'an employer to criminal penalties,and civil fines r8p to $100,000, in addition to, the cost of compensation, damages as provided for in Section -3706 6f. , 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 h 0§` application.,' 1.1ach 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 appliciton 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'fr6m date of issuance of s.uphr- 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.tothe building, construction, andhereby authorize. representatives of this City to enter upon," - .the above abbve-mentioned property for inspecti'o'n"'purposes. 7 <1 ,iWnat6r�e (Owner/Agent)DateO-', 0- Li e BUILDING PERMIT PERMIT# DATE" ,t VALUATION LOT 01.07-3% TRACT 1. R7 131120 JOB SITE APN ADDRESS' ] OWNER CONTRACTOR/[ FNbINFFR D.A.") RML LY, Zi R P.AMICTRADF-3 COXIMRUCTIOW V117 -201MIERTKIMONT 1719 a TIREMOITT I ONE CA 92054 9 OCUNNISM -CA 912034 USE OF PERMIT :I.4)= )OMS N07' INCLIVY&I PWI, BLOCK WAL14 09 CIANIEWAY AMIROACIA, (99 WS CisBOS MASTYR) 1,mo.w SF PoRouPATasp 24.00 SY O.A.RAWCARP003 512.00 3F yr. *00.13 RIN CIX? ly RU_nW. ATL6 C067 1FCONGMU=014 • W3,504,40 PEE bX00,MT 101-OM439-'3?W -92,"MOD CXn43TMJCTY,CXN1 YERF, 1014M.418-000 $612.50 PLAW CHECK FRE i oi f onoo-439-318 8109169 M WHAN I CA 4. P% S -000 $49.00 F1,-.at°TVt CAL P42, Z 101.OLIO-420-000 STRWNG AbOTION'TiTIR - ,WID 101-00{ -241-000 $9,15 2, 0, VJ t'*Z'Y'E1A)PX,R IMPACT FM PRM. SE PLAN 101-000441-1143 3 (M.014 AND PIAN ONWX $3,425.53 DFIMS XS3 TIRV-PM U.00 -$25( AUG 131001 1 .2002 ft—R-NUT MV DIUS Now CITY OF LA UINTA FINANCE DEPT. RECEIPT ]DATE DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings _ �J .� / �'� Ducts Slab Grade ` r Return Air Steel Combustion Air Roof Deck • O ( 57 Exhaust Fans O.K. to Wrap -� F.A.U. Framing Insulation Z .,,p/ $��! EJA�'�Z7/7-1 y7 Compressor 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 lit/�� S POOLS -SPAS BLOCKWALL AP<3ROVALS 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 _ �Q��l- Ci _ ,S Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Q=�f'. ,S� Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) .ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voftage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) 1Y—( , p / cr7 ,... .. � . i v . -... -..� �;. - ", .Y rnntyyr ... ..iB•rX.,ipr^fir �'."`_'Wtil�� ...� - -r j�. b eT �T44 ult�Gt/ P.O. BOX 1504 Building / 78-495 CALLE TAMPICO Address LA OUINTA,.CALIFORNIA 92253 vwncr r Mailing Address / 7.1 5, �c City lZip Tel. Contractor Address ty p State Lic.I City & Classif.1– !z ;_7 S –",g I Lic. # Arch., Engr., Designer Address Tel. City (Zip (State Lic. # ` LICENSED CONTRACTOR'S DECLARATION f I hereby a�ilttm that I am 11cen�ed under provisions of Chapter 9 (commencing with Section 7000) of DivisP n 3 of the BLsine3 and Professions Code, and my license is in full force and effect. � GNAT DATE O*NER•BUI ER 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 whichrequires 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 thealleged 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-builderwill. 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 doesnot 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. 8 P.C. for this reason Date Owner t• WORKERS' COMPENSATION DECLARATION f. 1 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. O 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, 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., It, 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. r 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 permitwhen properly filled out, signed and validated, and is subject to, expiration if work thereunder is suspended for 180 days. I certify that l 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 applicant Date Mailing Address City, State, Zip t� APPLICATION ONLY LDING: TYPE'CONST. OCC. GRP.— � Number 77 V- 0'9 �) (JOY al Description Z-6 /-7, ject Description r 4� z Jf`"• /:5-00 No. sizeStories No. Dw. Units New C/ Add ❑ ','Alter ❑ Repair ❑. Demolition ❑ Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE—INSPECTOR Estimated Valuation Issued by: PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal.. Validation: Const. t Mech. Electrical Plumbing S.M.I. .""• Gradind'" Dryeway Enc. Infrastructure ^' TOTAL REMARKS ZONE: BY: j 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 FINAL DATE—INSPECTOR Issued by: v Date i Peit Validated by: Validation: i JU. L 1 7 2001 L WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING�DIVISION CITY OF LA QUANTA L FINANCE DEPT All'° a, Desert Sands Unified School District 47-950 Dune• Palms Road Notice: La Quinta, CA 92253 r Document Cannot Be Duplicated 760-771-8515 , CERTIFICATE OF COMPLIANCE ti Date 8/13/01 t APN # . 774-093-004 No. 22371 Jurisdiction La Quinta .Owner NameDavid R. Miller Permit #0107-306 No. 53-340 Street Avenida Mendoza Log # City La Quinta zip 92253 Study Area Tract # B213U20 Lot # 21 Square Footage 1500 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 1,500 or $ 3,075.00 the property listed above and•that building permits and/or Certificates of Occupancy for this square footage in this proposed project may ow be issued Fees Paid By CC/Temecula Valley Bank - J.R. ';cele hone 760-967-0069• Z p y Name on the checkI Zc1 By Dr. Doris Wilson 4 Superintendent "•' Fee collected /exempted by Annette Barlow Payment Received $3,075.00 Check No. 16562 Signature OME: Pursuani of Assembly Bill 3081 (CHAP 549, STATS. 1998) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified Bove 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 3Ilect them on the Disfict(•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 r 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•that building permits and/or Certificates of Occupancy for this square footage in this proposed project may ow be issued Fees Paid By CC/Temecula Valley Bank - J.R. ';cele hone 760-967-0069• Z p y Name on the checkI Zc1 By Dr. Doris Wilson 4 Superintendent "•' Fee collected /exempted by Annette Barlow Payment Received $3,075.00 Check No. 16562 Signature OME: Pursuani of Assembly Bill 3081 (CHAP 549, STATS. 1998) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified Bove 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 3Ilect them on the Disfict(•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 01/12/01 14:30 FAX 17608049062 RECORDING REQUESTED BY: AND WHEN RECORDED MAIL THIS DEED AND, UNLESS OTHERWISE SHOWN BELOW, MAIL TAX STATEMENTS TO - David Ross Miller 1719 S. Tremont S. Oceanside, CA 90254 [NIONWEALTH TITLE v Wluu w SPACE ABOVE THIS LINE FOR RECORDER'S USE The undersigned grantor(s) declare(s): Grant Deed A.P.N. 774-093-004 Documentary transfer tax is $ ( %--X) computed on full value of property conveyed, or ( ) computed on full value less value of liens and encumbrances remaining at time of sale. ( ) Unincorporated area: ( ) City of FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, D. Zuckerman and hereby GRANT(S) to DAVID ROSS MILLER, a married man as his 'sole and separate property the real property in the City of La Quint'a County of Riverside State of California, described as Lot 21 of Block 213 Unit No, Santa Carmelita at Vale La . Quinta; as per map recorded in Book Pages (Df Maps, Records of Riverside County, California . r Dated July 17, 2001 Signature of Grantor State of California ) y County of )S-5. D. .Zuckerman On before me, ,personally appeared D. Zuckerman personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose nerna(s) is/are subscribed to the - within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized ' capacity(ies), and that by hlslher/their signature(s) on the Instrument the person(s), or the enuty ` upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. Signature MAIL TAX STATEMENTS TO, slsae -a s above I Form 3195-4 (6-94) ' THIS FORM FURNISHED BY COMMONWEALTH LAND TITLE COMPANY 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 per Section 9.50.090 of the Zoning Code. Its purpose is to determine: 4-4-7-- 1 ) -4.7--1) that theproposed house design does not duplicate the same architectural style of any'�a -ao house within 200 feet of the applicant, and/or 2) if there is a need for the applicant to file for ?b 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 SITE ADDRESS 53-340 Avenida Mendoza APN 774 - 093 - 004 CASE NO.: 2001-518 LEGAL: LOT 21 BLOCK 213. UNIT -S.C.@V.L.Q. { CHECK AND APPROVED BY: Wally Nesbit DATE: AFco ?- /9 of 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 ow.vt/1 1"( -no - Consistent with MDG on file (as. applicable MDG filing required (5 *filings since 9/3/98) ✓ N /tricc,C/1 D,Css Architectural variety within 200 feet of the surrounding area: Colors Materials r ved by, Architectural deWA featur ? /�t. f•�-i rQG 99-,00 'i I Cjity Council. tials n� - .,_......... se No.C. Zack i- Sib hibit .,,...,..,. . lWith Conditions...r f 'Certificate. of Occupancy City of La. Quinta- Building and Safety Department, OFTM°``4 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:. 53-340 AVENIDA MENDOZA Use Classification:. SFD Bldg. Permit No.: 0107-306 Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC Owner of Building: DAVID R. MILLER Address: 1719 S. TREEMONT City: OCEANSIDE CA, 92054 _ By: KIRK KIRKLAND Date: 11-27-2001 Building Official POST IN A CONSPICUOUS PLACE I =