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SFD (0212-079)i, LICENSED CONTRACTOR DECLARATION ;I hereby affirm under penalty of perjury that I am' licensed under provisions; of s".t -=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 # i Lic. Class Exp. Date ` Date j Signature of Contractor 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'& roffessionals Codei t ( ) I, as owner• of the pro erty, am exclusivel,,q�bontracting with' licensed contractors to,construct the broject (Sec. 7044'- Business-& Professionals Code). O 1 am exempt' under Section B&P.Csfor this reason Date .�/.'✓J Signature of Owner r! WORKER'S COMPENSATION D ChARATION I hereby affirm „under penalry)o perjury one ofa�the following declarations: () I have and will maintain a`c rtificate of cor� ePto self -insure for workers' compensation, as provided f�irrbq Section 37�f 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 I the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier &I policy no. -are: Carrier 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. r// Datelei 'ti Applicant— Warning: pplicant 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 or his application. 1:' Each person upon whose behalf this application is made & each person whose request and for whose benefit work•is performed under or pursuant D any permit issued as a result of this applicaton agrees to, & shall,�indemni & hold harmless the City of La Quinta, its officers, agents and employee 2. Any permit issued as a result of this application becomes null and void work is not commenced within 180 days from date of issuance of suc permit, or cessation of work for 180 days will subject permit to can 11 do I certify that I have read this application and state that the above information i correct. I agree to comply with all City, and State laws relating to the buildin Construction, and hereby authorize=representatives of this City to enter upon the above-mentioned property for inspection purposes. —Signature (Owner/Agent/) _L _ r ' '� �• DateLs PERMI - BUILDING: PERMIT • - , DATE �r ` r . • ` VALUATION LOT TRACT °JOB SITE�. ADDRESS n�,I�i/u1�5+1`i1�i:$$.•' . APN OWNER F„ \: a' CONTRACTOR /DESIGNER / EN (NEER 52 RW AVRIMMAd';fS;,:f s.Q USE (O���FFyy�P+g�ERR``MII'T py: p� Y . w A873 S..,F. SFD: PIMMIT 1XIIES' l OT Tei: LU'9F.. EPW ::K; W- ALA'e Oft _. 'al'�FV iPWAY..€ PP.l ACH TRACT CONS', I<UC TIalJ PQRCiV'P.A t'i0 fStE y$,. - • Ear1T'JINr.a',if Iras.T' OF c ow ;t::R t ON (: fmsuu,CTION ME 10i��a;►�r..st]�bi3� ` �3�3,aG P?Iydripi ;Ff�$�1K$'Ir 1(A'j»t!a>3'�•I6a4-31'81`, 56,1.102 PER DEPOSIT . ,� 3 Q! �trJ°)nf9:3'`3-,3'� i� •; , •gW.90 >ti1Y.Ci➢FrIV.f":RL. Er!?C ' 107.-2t�4a•.A;Z . - 9p!! t t .c ))� n MM// n}�,, 11 rr��,, ttp t Sryv,� t dd� o FEE � ,6.c1/C Si�14�' S'aA+1'i✓ru� � "��� A�!'%'�^��JIt3i"M'64!^`J�1�4 vAti197 • nD"H$112.00t ¢ .°• ' 9'1'OAI0,MC3VOW FU-M.111ID x:^11 ? f7 4'j-fi`�10 �f:.1 j ;, r DVE;U3Pr,, R I +/IPMT PEE PR. 3S.P1.A2d kki -000-441-14V $100,40 ,li A►+3u(?}r{'�E�b/K f(i'Y FEL zjey'., JUN 192003 '01 nemMn, V.E'sm�f'_ CITY OF LA QUINTA -FINANCE DEPT RECEIPT DATE.' ` BY DATE FINALED INS PECT0 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 a2e Exhaust Fans O.K to Wrap F.A.U. Framing - Compressor Insulation W Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath ` • Q Drywall - Int. Lath p a Final Final BLOCKWALL APPROVALS 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 — 70 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans CK for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole _ Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Nein Service Sub Panels Exterior Receptacles G. F.I. Smoke Detectors Temp. Use of Power Final i Utility Notice (Perm) COMMENTS: CERTIFICATE OF .COMPLIANCE Q� WZ • Desert Sands Unified School District 47950 Dune Palms Road_ ¢ BERMUDA DUNES r.. Date 6/19/03 La Quinta , CA 92253 RANCHO MIRAGE CJ � INDIAN WELLS 771-8515 91 -PALM DESERT No. 24577 (760 ) � /LTA QUINTA �y 101 INDIO Owner .Roque Herredia `APN # - 774-093-011. Address '52860 Avenida Villa - Jurisdiction, La Quinta City La Quinta Zip 92253 Permit # 0212-079 Tract # blk 213 Study Area Type Residential Addition No. of Units 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 14 53460 Avenida Mendoza 1878 .'Unit 6 Unit 2 Unit 7� Unit 3 Unit 8 • - v Unit 4 Unit 9 Unit 5 Unit 10. Comments ` M 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 (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that 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 ' Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $2.14 X 1;878 .S.F. or $4,018.92 have been paid for 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 OC/Washington Mutual -Bank.- Roque Heredia Check No. 331507618 Name on the check * Telephone 760/564.0486 . Funding Residential 6y Dr. Doris Wilson Superintendent Fee collected /exempt by Shar Gily ey $4,018.92 $0.00 ' Payment Recd Over/Under Signature NOTICE: Pursuant to Government Code Section 66020(d)(1)7onich to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the datebuilding or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID -if Duplicated Embossed Original -Building Department/Applicant, Copy -Applicant/Receipt Copy - Accounting oaoarl wo tacnonho std 1 f i _ t� t , s'• A�: r n°iT�'�� SeCOd>bMNcw • gib. IY4 7af AlT{l�If� TO 'asRM MOtlseatl Sera 7p I - Roque 8 Carmen Heredia b ----�+ c" 52-860 Avenida Villa. 92233 � LLa puinta, CA oaoarl wo tacnonho SPAM Maw ONCOttOf "un WILY ANT DEED (INDIVIDUAL) The undsnlpned grantor($) tlecure(el: Documentary transfer tax 11 1 1 3. i ( ) Computed on full value of prdparty 40111v6y80. or ` ( X ) Computed on full value lose value of Ilan* and enoumoronc" rsmelnlnp at time of sale. " v i i U rcerFacuad e c (Y. ) ^•fr�r Lr Tex Perces No. JOHN E. E. SMITSON, a single man FOR A VALUABLE CONBIOERATION. HEREBY GRANT TO ROQUE HEREDIA and CARMEN HEREDIA, husband and wife as Joint Tenants the foal property In the County of R i V M r s i de Stott of California. described as: Lot 14,, Block 213 of Unit Na: 20, SANTA CARMELITA AT VALE LA QUINTA, as shown by Map on file in Book 19 page 38, of Maps, Records of Riverside County, California. F 1'd { ^ t • �' I _ 'JOHN E. SMITSON j�l�T Dated Ji `r— 1 C� I ^ (Indlvlduel Aeknowtodgment) STATE OF CALIFORNIA �I✓1'p,':rr:ii County of , Y_ on this z day of �f5 ,In Ina rear 10 yCL- Worm me. the understgnso, a Notary Puotic 1n and for sold County and etale, porsonally appeared •• / r I 7' •. �: +! - p,Wsonslly known to me (or proved to rm on the oasis of satisfactory ovldence) to b* lht Perot" whose memo su0t011Ded 10 this instrument entl acknowledged lnsl exsCUtttl It. �/ OFFICIAL SEAL AITNE88 my harfd',i id 111c a seal JEROME MARCUS ;a7Tr.Ar PJ&IC-CAt INAWA ��/���'+/':l? • ? : -l. 1itnr'Iva1. arltt IN Ft YE SIDE CWNTY Notary PUOI1c In and for sold feounly ono slate. .,�. • PAY COn,m k •D, 1 to June 11. 1 OW MAIL' 7 AS 0114ECTEO ABOVE CO -37 heredia prop - RV: 1990 00194660 1 of 1 1 f i SPAM Maw ONCOttOf "un WILY ANT DEED (INDIVIDUAL) The undsnlpned grantor($) tlecure(el: Documentary transfer tax 11 1 1 3. i ( ) Computed on full value of prdparty 40111v6y80. or ` ( X ) Computed on full value lose value of Ilan* and enoumoronc" rsmelnlnp at time of sale. " v i i U rcerFacuad e c (Y. ) ^•fr�r Lr Tex Perces No. JOHN E. E. SMITSON, a single man FOR A VALUABLE CONBIOERATION. HEREBY GRANT TO ROQUE HEREDIA and CARMEN HEREDIA, husband and wife as Joint Tenants the foal property In the County of R i V M r s i de Stott of California. described as: Lot 14,, Block 213 of Unit Na: 20, SANTA CARMELITA AT VALE LA QUINTA, as shown by Map on file in Book 19 page 38, of Maps, Records of Riverside County, California. F 1'd { ^ t • �' I _ 'JOHN E. SMITSON j�l�T Dated Ji `r— 1 C� I ^ (Indlvlduel Aeknowtodgment) STATE OF CALIFORNIA �I✓1'p,':rr:ii County of , Y_ on this z day of �f5 ,In Ina rear 10 yCL- Worm me. the understgnso, a Notary Puotic 1n and for sold County and etale, porsonally appeared •• / r I 7' •. �: +! - p,Wsonslly known to me (or proved to rm on the oasis of satisfactory ovldence) to b* lht Perot" whose memo su0t011Ded 10 this instrument entl acknowledged lnsl exsCUtttl It. �/ OFFICIAL SEAL AITNE88 my harfd',i id 111c a seal JEROME MARCUS ;a7Tr.Ar PJ&IC-CAt INAWA ��/���'+/':l? • ? : -l. 1itnr'Iva1. arltt IN Ft YE SIDE CWNTY Notary PUOI1c In and for sold feounly ono slate. .,�. • PAY COn,m k •D, 1 to June 11. 1 OW MAIL' 7 AS 0114ECTEO ABOVE CO -37 heredia prop - RV: 1990 00194660 1 of 1 Ul i Y Ur LA. UUINTA SUB -CONTRACTOR LIST _ JOB ADDRESS 5-3-1160 RW /t,o,-ID024 PERMIT NUMBER OWNER L4 E �L� 4aUILDER R-0QV E 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 auttiorizedL•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 of this permit. For each applicable trade, all information requested helnw mimt hp r-mmnlatorl h" nnnlir!Mnt 111rin ril-" r,.,+ ..---L.i_ _ Trade / Classification Contractor 7F.State. • ----- ------ ------ -- --...r..,.,•,•,. Contractor's License ..� ..r.F.....,.....a. ..... . .... .� nva a� a�,t,cNIaUIC•IC5IJVIWC. Workers Compensatior Insurance City Business License Company Name Classification (e.g. A, B, C-8) License Number (xxxxxx) Exp. Date (xx/xx/xx) Carrier Name (e.g. State Fund, CalComp) Policy Number (Format Varies) Exp. Date (xx/xx/xx) License Number (xxxx) Exp. Date (xx/xx/xx) EARTHWORK (C-12) CONCRETE (C-8) FRAMING (C-5)-- % / �/ 6�45 /' � 1 �2 6�'SI �' e 7 7�S�.�J y7 ��SI �� Kl� F03 l�J G � V FoUmA dzlq'/ � 7 98 ©�` 157 "99 io �� o� O c/ O� -� -2 702— 3 /�S STRUCT. STEEL (C-51) MASONRY (C-29) PLUMBING (C-36) LATH, PLASTER (C-35) DRYWALL (C-9) Sj1Ti11JE 16?4aln13 HVGG 97 oeZINU(—-- 7 �P 7f 9 70 E E ,::PV 2- 3 ©/- 244D�� ,a6 7 2,6 Z -7-o HVAC (C-20) ELECTRICAL (C-10) gal (e ei(z /NUJ- c0 0', cam- c�Zoonu? Qo ROOFING (C-39) SHEET METAL (C-43) 0 �llj U? FLOORING (C-15) GLAZING (C-17) INSULATION (C-2) SEWAGE DISP. (C-42). ���`F� s� �'' e' 7! 7" I l� �` 03 a"�i G.e/n4P- dC9zgSGl— zod3 e96 % C� ZA7O PAINTING (C-33) . CERAMIC TILE (C-54) .'. CABINETS _(C-6) WO % FENCING (C-13) LANDSCAPING (C-27):'ele POOL (C-53) W