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SFD (0002-001)LICENSED CONTRACTOR DECLARATION I he:3�'y afCrio 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 Date ► Iitk Signature of Contractor y -- 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 affi(m 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. _J_) 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 Policy No. 4�� 7ro n y.di »p f !t f ^rIT r t e ani (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: b /2- Applicant%�C--G-- Y " Warning: Fa re 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 inspectiog, purposes. Signature (Owner/Agent) PERMIT # BUILDING PERMIT DATE / VALUATION LOT d TRACT 1''`I <b' � 1'? S - `"N JOB SITE ADDRESS��ia:it�iL�s'� APN OWNER CONTRACTOR / DESIGNER / ENGINEER �l�ffT r Y 1A.b tai-TsC'¢,1 1�1'.N,`�ac .a(tt 6iJri f4d 1 Larl4!l i:7 9 ��iyy_,..,:.yyeeV112«.R^�aa1Pa 15119 s !I'4�..��1w9�.91N' td qq•6•,wre>., �ets. :* o IA IK.AONI 11 �`F 1•'I,!V'1?\to_ ('A 92'74 111H°1 MAi, CA 9?,, -4 3 USE OF PERMIT �T �i�iL�,1•Ji!t1fL� i,%�1^'i�;>l,l,it�id• Ji°9,1 • 1�Y.t��lL l iJ�Jf.:i &L'ta i f C+iL.'i.%}7,?f,',, I.Si.I �.t�w N 'ii.L,:v i +i� Y�a';: cJ� ie.,�,.191A4) F CiA�tt34if'.{t<:.€1�9"YJli`�' �iitd,4!�3 cif• S VT. WOCOI) Ft-�N(15 Lt Q'', T1 °dAT D CONT Of" 0 "NY!`k(J("'t'J0N I lit; I0,k4VU-41h-iAW f�tl+ xa 41i.'!'[U>N1fx.':11__ ti LtL k t"1Z1t„eft, 4;esl S01 -4X0 -A9-(M k;', #0 el1(4 AACl"V I'lltp J�FF_Rtfl �10143,M) "A) -010 1TIA” LOdrf, R 121,►' 071 FIT, ;i3Ok,:v w i0i,-UUU-4' 1-11y ?�i►Sca Aad► ltllJt)-ri.��t N T. f'd iti �'►"v'1 4 f if 1N AXT) Py 1N°. t 41•C t1�9ov lYll=. s [♦�t�y M �p } t., ff�.•.. � � LAC V+LB.N'"i1V�14� �J �.��+f'���'„`f Of, V, ��.1VC a RECEIPT DATE 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 q — s _ pp Exhaust Fans O.K to Wrap =a — 0 F.A.U. Framing S — j -cam Compressor Insulation S y_ oa �r Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath — (o --per �7 Drywall - Int. Lath 3 •(x.00 FinalZ^�� s Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs / Electric Bond Footings L�/ 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 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 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 Final Utility Notice (Perm) 0002 -COI Building 41 Address [[ I 'P.O. BOX 1504 ,, ` 78-495 CALLE TAMPICO 1OM4d Z4t.A QUINTA, CALIFORNIA 9225; manury Address —qnV c. a t Cites / Zip ITel. 5 S/ 6 Contractor S J1' �. & Classif. h 1� ! — Arch., Engr., Designer Address City I hereby affirm that I 7000) of Divisiogq3 of 1 effect. I , l y Tel. City Lic. # Tel. i� Zip (State Lic. # CONTRACTOR'S DECLARATION `r t under provisions of Chapter 9 (commencing with and Professions Code, and my license is i full fi 1,,i WNEIi-BUILDER DECLARATION I hereby affirm that I amAexempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Businesv and Professions Code: Any city or county which requires a permit to construct, after, 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 five hundred dollars ($500). FT 1, 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 Prbfess!on,Code: The Contractor's License Law does.not apply to an owner of property who bdilds or improves, fhereohrand who does such worlghimself or through his own employees, provided that such improvements are not intended or gffered 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 I I, as ownerof the pro.psrty,�am-ex'ctusively contracting with licensed contractors to con- struct the proiect. (Sec. 7044, Business and Professions Code: The Contractor's License Lew 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.) 1-1 1 am exempt under Sec. B. & P.C. for this reason r' Date Owner 1 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 a, n Copy is filed with the city. O Certified copy is hereby furnished. S; 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, atter 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 I hereby 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 it work thereunder is suspended for 180 days. I certify that 1 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 Wspection purposes. Signature of applicant Date Mailing Address City, State, Zip WHITE = FINANCE YELLOW 1, 1, j.. I .DING: TYPE'CONST. �'� OCC/C. GRP. Number J Description �Z ,/r.I •�6 r %1 /r;tl� tct Description "F � AS S'ER U4 r Sq. Ft. Siz9 No.o. Dw. Stories Units New Add O Alter O Repair ❑ Demolition ❑ Estimated Valuation CW PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. !Const. ✓ Mech. Electrical Plumbing S:M.I. Grading Driveway Ens ' t* i Infrastructure = r y fn TOTAL`;! <' REMARKS Co C ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Y Rear Setback from Rear Prop. Line1_4) ►Side Street Setback from Center Line Side%Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: APPLICANT PINK = BUILDING DIVISION Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 3/9/00 No. 20138 Jurisdiction Owner NameW.R. Rogers No. 53-485 Street Avenida Mendoza City La Quinta zip 92253 APN # 774-092-024 La Quints Permit # Log# 0002-001 Study Area Tract # Lot # Square Footage 1539 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 1.93 X 1,539 or $ 2,970.27 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 rF r fF'� Fees Paid By Cash - W.R. Rogers Telepho n 739 1200 Name on the check q '' e PC *' By Dr. Doris Wilson -� sa�� L Superintendent �' 'e '' y Fee collected /exempted by Mary Ann L. Bora Payment Received Check No. N/A Signature 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 DeptJApplicant Copy - Applicant/Receipt Copy - Accounting NOTE: With proper validation this form constitutes an encroachment permit CITY OF' LA QUINTA APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains and other like public works" improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS Subdivision Improvement Permit — Class I II DATE: H91%X 2/$/ UU Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION Nn.; CDRNFR C61,TM,A & MIENDOZA (Street address or Description of Location) PURPOSE OF CONSTRUCTION PREPARE HOUSE PAD Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION 1sIL1: & COMPACT PA;! SEE kTA.CRED CO` DI'TIARINS DIMENSION OF INSTALLATION OR REMOVAL 80'x*40 SIZE OF EXCAVATION, IF NEEDED ti APPROXIMATE TIME WHEN WORK WILL BEGIN 2/9/00 APPROXIMATE TIME OF COMPLETION 1/173/00 ESTIMATED CONSTRUCTION COST $ 2,000 (Including removal of all obstruction, materials, and debris, backfilling, com- paction and placing permanent resurfacing and/or replacing improvements) In consideration of the granting of this permit, the applicant hereby agrees to: Inderrmnify,.defend• and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all penalties, liabilities or loss resulting from claims or_court-action and arising out of any accident, loss or damage to persons or property happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application. Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started. Comply with all,applicable City Ordinances, the terms and conditions of the permit'and all applicable rules and regulations of the City of La Quinta and to pay for any additional replacement necessary as the result of thi; work. Signature of Applicant or'Agent ST; 56900 J"ACitSON. y 399--1200 Name of Applicant (please print) Business Address Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. 291--77.7 oil FII:E Contractor's License No. City Business License No. STATE 17UND Applicant's Insurance Company PoliI Number FEES: Subdivision Improvement Permit —Class III Public improvements: 3% of estimated construction costs Private improvements- "3%of estimated construction.(,.osts Minor. Improvement Permit — Class IV: See attached schedule. Inspection Fee Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: $ I fffl _ fm) Receipt No. Received by Date Recorded by PA u y 2000- PERMITS VALIDATION 4.4 QUINT PERMIT NO. 3133 DATE APPROVED EXPIRATION DATE ' /1)9.1 `100 _ DATE ISI$UE 4 c/i:,/00 Administrative Authority Telephone: (760) 777-7075- V { f RECORDING REQUESTED BY: CHICAGO TITLE COMPANY COMPANY 9492KC 207055035 WHUNLMAOLO�AXRRIM ENTSDLOWND' WILLIAM R. ROGERS 56900 Jackson Thermal, CA 92274-9660 r CERTIFIED TO BE A TRUE AND EXACT COPY OF THE ORIGINAL BY: '5::h. . .*'%(2 v COMMOWNEALTH LAND TITLE CO. SPACE ABOVE THIS LINE FOR RECORDER'S USE APN• 7 GRANT DEED 53 - "6 AV f, AWoo za The undersigned grantor(s) declare(s): Documentary transfer tax is $20.90 (XXX) Computed on 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 VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, WILLIAM R. RILEY, TRUSTEE OF THE WILLIAM R. RILEY 1990 TRUST hereby GRANT(S) to WILLIAM R. ROGERS, 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 12, Block 212, Unit No. 20, Tract Santa Carmelita at Vale La Quinta,'as per map recorded in Book 19, Page(s) 38 inclusive of maps, in the office of the County Recorder of said County. Dated January 6, 2000 State of California County of Riverside } S.S. On February 15, 2000 before me, Kelly Collier . , personally appeared William R. Rilev personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(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 his/her/their signature(s) on the instrument the pe�son(s), or the entity upon behalf of which the persons) cted, executed the instrument. / WITNESS. my harp ap' official • se 1. Signature ------ MAIL ----MAIL TAX'_STAT MENTS TQ same as above WILLIAM R. RILEY, TRUSTEE (This area for official notarial seal) KELLY COLDER Ui.�^• COMM. # 1223426 NOTARY PUBLIC -CALIFORNIA L� \ 6R RIVERSIDE COUNTY 0 COMM. EXP. JUNE 6, 2003 1 (This area for official notarial seal) PWj CITY OF L,i G?l ►In�T�4 FEB 2 9 REC'D nni REVIOW 80' , . 1NG Hlvc 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 . Building & Safety as your correction list. Please attach additional explanations as necessary. APPLICANT: 53-485 Avenida Mendoza PROJECT ADDRESS: . APN: LEGAL: CK'D BY: BIN NO: 774-092-024, Z12 Z� LOT iZ , BLOCK, UNIT S.C. @ V.L.Q. Stan Sawa CASE N0. '2000-186___ ..CHECK -DATE: Inform the assigned Building plan checker .upon..y.our..assignment to this case. The CDD book to track applications and assign case numbers. Executive Secretary maintains a log The zoning code, architectural and landscaping manuals, and/or assigned inspector should be consulted where 'uncertainties arise. The completed checklist shall be maintained in the Building .& Safety address file.