SFD (0004-069)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that ]'am licensed• under. provisions of
Chapter 9 (comm encind/with''Section 7000) of Divisiori-3;of the Business and
Professionals Code; and my License is in full force and effect.
License # Lic. Class Exp. Date
s
425381 07131/2( ..
Date • •Signature of Contractor A%'
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's___
License Law for the following reason: .!
(.,f I, as owner of the property, or my employees with wages as their solei -
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)., 11 1 1 1—
V4.6n 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:
Carrier STA.TI: FLv NIr Policy No. 12809904
(This section need not be completed if the permit valuation is for $100.00 or less).
() 1 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 thpos`e provisiong'�
`Date: 4' Applicant �� _Li?/ A t�-Q "
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 Ouinta, 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) Date
PERMIT#
PERMIT
-BUILDING .�
DATE VALUATION LOT t OW4`06� TRACT
- UO $9I.6n.70 lul,
JOB SITE.
'1
]APN
ADDRESS 53-465 AVUWAA01MO.ZA
77"92-
OWNER
CONTRACTOR/DESIGNER/ENGINEER
DAVID O WIER.
P.A.CsMIC TRADES CONSIRMOTION
719 S IPRIMC>NT
1719 S ATEMONT
C-`-'-` CP; --ops^
S OC'1+If i DE CA 92054
r ` - ; n i 2 c� ?
n
.5..0ceas,i L 9i a3
G 9Fi7-0069. CBS:# 1935
C� )
USE'OF PERMIT
�+
�11Y �:.ef:.!•i9LY=.43..S .tJ V71+S.aL.J.TY 1.7
L
SFD-PE 2MIT DOES NOT 1NCLIUDE BLOCK WALLS OR POOL. '
TRACT CONSTRUCTION 1.473,00 OF
PORCHIPATICI %.60 5F
0AliACMCARPORT 463.00 SF
51<T. WOOD FENCE 200.00 LF
.FIT TED COST Off' CONlSMUC7f7fON
97.,x. it1
1s'ERiAE 1!`E SIMMA RV
CONSTRUCTION PEE 101.000.418-000 4603.so
P,.AN CHECK FGRE 101-000.439-318 $514,10
A/ ECI•i.AWICA1, FEF" 101.000.421-000 $66.50
L+Lr (TRICA.L FEE 101-000-420-000 $130.39
PLUMBINO F" 101.000.419.000 $133.50
STRO'N O MOTION FEE - REa1D 101-000.241-000 '$9.16
T
ORAOING FEE 101.000-423.000 ' - $20,00
INFRASTRUCTURE FIFE - ___._ -22aY QQ-443-342
PRECISE PLAN - 101-000.441-34.5 _ ; 2a",
j'oo
FEE DEPO.51T w 101-000-439-318 - 4250.00
_
c�gY77��Cr ,,4y� t pc� �y AT �1TTe�t�• pT A' �+� 1 n t�rt�
•� SM—i Vl.aCrt COlv.�si':V�.A10sV.0 D.P.L.ANT C1"i�'CK'
M43 PRE -PAID E03
4250.00
3.'OJAL1k'ERMIT:�XIESD.I1O
RECEIPT '
DATE % BBYY ✓ /
DATE FINALED
INSPECTOR
V
tw
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
411,1170W
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
,
Exhaust Fans
O.K. to Wrap
—ea, S
F.A.U.
Framing
6 -7 —Sz
Compressor
Insulation
— pa
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 i
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
Heater Final'
Water Piping
O
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
/
Pool Cover
Sewer Connection
GX0
Encapsulation
Gas Piping
j 777
Gas Test
— p
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole p 08
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) 57
COMMENTS:
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
425381 l3 07/3112(
Date 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 & Professionals Code).
( ) I, 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 mainiain 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:
Carrier ST,A fI- FUND Policy No. 1280990-0
(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
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.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0004-M9 TRACT
04125M. VlfG«38.70
JOB SITE
APN
ADDRESS TIm m miaOr
'774-01740
OWNER
CONTRACTOR / DESIGNER / EN (NEER
DAVM G 1o+LILLF- t
PACIFIC TRAMM C,ONMLlC 014
l 719 S T '040gT
17 3 9 5 TLREMONT
8. OCIMNSIDE CA 9205.1
S OCERRSIDE CA 02,,0 4 ,.
(760)967-0069 CI dif 1955
USE OF PERMIT
VD -PERMIT DOES NOT INCLUDE BLOCK WALLS OR POOL'
TRACT COQTRUCTION 1,4 :96? Sly
POR.Ci}i/PA t^i'O 561.00 SF
0ATt.nC1E!'CARPORT 463,00 SF
SFT. WOOL MC;E 200.00 LF
EFF)MUTED COSrf OF C0M.f:1!UMO.1V'
Fv—R r jt w 9iYmm?r. y
MNSTRUCTI0141TEE 101-000-413.00 1603.50
PLAN CHECK FSE 101-000-439-328 $514.10
MECHANICAL YEN 301.000.421-000 $66.30
ELECTRICAL FEE 101-000-420.000 $130.39
PL.UMDINC IEEE 101.000.419.000 S133,30
S'fRONO MOTION FEE • RESID 101-000-24.1-000 $9,16
ORANNO FEE 101000.421.000 SX00
I1+ FRASTRUC`i'UREFEE 225-000-441.342 $7,006.26
PRECISE MAN 101-000-441-'W $25.00
FEIN DEPOSIT 101-000-4-39-318 -$(.250.00
BUD MAL CCINSIRITC1110 xAid}MAXC"FXCX
$3,30.43
USS ME -PAID FEES
4250,00
TOTAL QLt'R:Wf FEMS DUE NOW
$3;25841
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 7 10,p
Ducts
Slab Grade Z.5
Return Air
Steel
Combustion Air
Roof Deck
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
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
Heater Final
Water Piping —4510 57;
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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole o a a $
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)
COMMENTS:
aa� �
Building2
I
• �Ijlll��� � S - ��
P.O. BOX 1504 APPLICA ON ONLY n /
A� 78-495CALLE TAMPICO d V
Iter tJT�nZA LA QUINTA, CALIFORNIA 92253 Al A
UW'7;f1L)1P /1t%/1,11C.-%' I
Mailing
Address/7/9' 5, Me1 ay_)T"
City Zip Tel.
L
Address
State LIC.LIty
& Classif. � .1-!," 3 / Lic. # 9 Y
Arch., Engr., �1
Designer 1.4%C T�/
gr5lC•i% d?-0C/j_
Address Tel.
1•0•Pnx 45 v 1 ZO,1?4 - 2,e
Ity .4ip
2 I Zip I State
C► L// /f�. Cr /3 Z_ s a Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under• provl's'tbns of Chapter 9 (commencing with Section
7000) of Division 3 of the Business a�1dP.df� slbns Code, and my license is in full force and
effect.
SIGNATURE
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 lila 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
!or 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 live hundred dollars (5500).
[:
I
Notice:
Document Cannot Be Duplicated
By
I
Date 4/11/00
No. 20269
Owner NameDavid Miller
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-5515
e
CERTIFICATE OF COMPLIANCE
Jurisdiction
APN # 774-092-023
La Quinta
Permit #
No, 53-465 Street Avenida Mendoza Log #
City La Quinta Zip 92253 Study Area
Tract # Lot # Square Footage 1475
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 1,475 or $ 3,023.75 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 of North County - Don Rogers Telephone
Name on the check d
Dr. Doris Wilson
Superintendent
Fee collected /exempted by Ellen Patino Payment Received x'03 0
t
Check No. 17410
SignatureYZ
IOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) this will serve to notify you that the 9"ay approval period In which you may protest the fees or other payment identified
ibove 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
ollect them on the Districtrs)(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 DeptJApplicant Copy - Applicant/Receipt Copy - Accounting
APR. 6.2000, 10:37AM COMMC4FALTH
RECORDING REQUESTED•BY: r
CHICAGO TITLE CQMPANY COMPANY
9493KC 207055036
WHEN RECORDED MArL THIS DEED AND,
UNLESS OTBERWXSE .SHOWN BELOW,
MAIL TAX STATEM MTS TO: _
DAVID ROSS MILLER ,
' G1A,, 1 DEED
DPN: 774M092-023-2 I,
53- `��5.. I�•I � NI��oZA
The undersigned grantor(s) declare(s); a
Documentary transfer tax is $22.00 -
(XXX) Cocmputed . ori full' value of property conveyed, or .
( ) Computed on full -value less liens and encumbrances remaining at time of sale.
( ) Unincorporated area: ( ) City of , and
FOR A.VALUASLE CONSIDERATION,.receipt of'which is hereby acknowledged,
WILLIAM R'. RILRY; TRUSTEE OF THE WILLIAM R. RILEY 1990 TRUST
hereby GRANT (S.) `to '
DAVID ROSS MILLER, A MARRIED MAN AS HIS SOLE AND SEPARATE.PROPERTY
the•real-property in the City -'of LA QUINTA, County of Riverside, State of California,
described as:
Lot 11, Block 212,.Unit No. 20, Tract Santa Carmelita at Vale La Quinta, as per map
recorded`in Book 19, Pages) 3B inclusive of maps, in the office,of the'County Recorder
of said County,
Dated March 7, 2000
State of California
County -of RIVERSIDE } S.S. 'WILL AM R,. RILEY; TRUSTEE
On MARCH 29, 2000
before me, KELLY COLLIEP.
personally,appeared
WILLIAM R.•RILEY
personally known to me (or proved to me on n
the basis of satisfactory evidence) to be
the persons) whose name(s)' is/are subscribed, ,
to the within instrument and acknowledged to
me that he/she/they executed the name in
his/her/their authorized.capacity(ies), and 0 KELLYCOMCOLLIER
that by his/her/their signature(s) on the NOTARI' AI, 01'22,14=g
�-CALIFORNIA D
• instrument the rson(s) , or the entity upon COAiM 91DECOLINTr �
behalf of which h ,per ( acted, executed ExpjjNS6,2003-�
the instrume t.
WITNES y ha n fio s 1. ,
-signatu e.• (This area 'for -official notarial seal)
MAIL TAX S NTS T0:
r, ;
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 53-465 Avenida Mendoza
APN 774- 092 - 023 BIN NO.: � -Y CASENO.: " 2000-214
LEGAL: LOT 11 BLOCK 212 UNIT 20 S.C.@V.L.Q.'
CHECKED BY: Greg Trousdell 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
YL Architecture
Other Requirements:
�N1iY pEVEL
APPROVE DATE �
BY
N1�1T
PME
l
T DE
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V561 d Z �—
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rt CASE Np. r�