SFD (0103-173)LICENSED CONTRACTOR DECLARATION
r 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 E'J , r4..,.� 07/.,'1/21
Rate ""t" 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 costruct the project (Sec. 7044, Business & Professionals
Code). T
( ) I am exempt under Section B&P.C. for this reason
Date Signature of Owner
Y
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 Policv No.
STATE BLIND
1290990-1)1b
(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 provisibns.
Date:-trlApplicant ^�
Warning: Failure to secure Workers',,Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set fort
application.
1. Each person upon whose behalf this application is made & each s
whose request and for whose benefit work is performed under orp t o
any permit issued as a result of this applicaton agrees to, & shall, amn fy
& hold harmless the City of La Quinta, its officers, agents and a ye s. .
2. Any permit issued as a result of this application becomes null a Vol if
work is not commenced within 180 days from date of issuanc of su h
permit, or cessation of work for 180 days will subject permit to ca cellatio .
I certify that I have read this application and state that the above infoirnation is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
1.
(; r.. g, . Date
�gnature (Owner/Agent) ,.
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
ijs92,95 87AQ
JOB SITE
APN
ADDRESS
54-040 AMMA. ITak)CYCfi
7"f�"r- �a -�r
OWNER
CONTRACTOR / DESIGNER / ENGINEER
1 "WIFIC iTiAM1l �`i�k� � Ct�SC°I J1r1
'A i�'T.. 1719' a ll, 1R�iC 117lGyld
1719 ; �1 .51*1i7
1719 0 TIREMO ,
3 WEANTRUDE Cis 92!'x.
a OCReAVSXfr. CA. 592W
USE OF PERMIT
t
str0 p -PERMIT DUBS NOT 1N0,11W, Zbt=K °i"nf1>LL900S73.,/SPA, O
TRACT COXA T' R=301; 1,49ZV OF
:i ORCH11 PA` .10 90.00 S.11, 4
i MI:$PM13R1 OAT (FF) 9,074.80
$F T. WOOD ; CE 20n.00 @,,T'
COU 0.1P CONSIl+ilY6w. ON
-ISMWATED
1?7.3DbLYd.i..L A3 �4L 4Y 6.ilVA.S'Y.0.f1s�bF
C(3HOT1ti 111014 'FFI 101-000-418-000 S08100
FLAW C,`.liECK PEPT lot-000-4:11ga31.8 $:509.53
ME;Ey1i MI 1, 0 A L N'1 EX 101.1000.42.1.000 01.4.30
ELW;1V•C.,L 1K'M 101-000.420-00 $130.99
PL'C,T'3Jl'BING FES. 101.000.419.000 1116,75
STRONG MOTION VU, • RESID 301 -000 -x.11 -0x70 $9.30
O?sA1 INO RE 101-000-42'3-000 S;20A
Trip' 1011LO'P 7MP.A,IC11.PRB $1,907.00
V1Mk 3'?MP (a>SFT 101 -WO -439-316 47.50.00
1111
E AL Ct7A3�.1'.F�:i:TC'1°(C` M A14D �'LA CPMOZ.
KI; DR
AR 3 0 2001 IZZIS PFXI . P= I . S
'. 4250.00
CITY OF LA QUINTA
FINANCE DEPT
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
S7
Underground Ducts
Forms & Footings
'[
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
-?,Z — O (
Exhaust Fans
O.K. to Wrap
C,=�§ -p(
T
F.A.U.
Framing
c'=�Q. m (
s?
Compressor
Insulation
A/, O(
57
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath >
�1
Drywall - Int. Lath
Final
Final
96�
_
ST
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
_
f �7�f%
S
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_ p (
Encapsulation
Gas Piping
Gas Test
l Z- )
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
it J,
b�l�
Utility Notice (Perm)
li m
6
f 6� u�l'ItrGv
P.O. BOX 1504
Building+ �/ 78-495 CALLE TAMPICO
Address �G�.;'Yn/ }fes �Gj'%.l�!/.��1 LA QUINTA, CALIFORNIA 92253
Mailing j
Address /7 / 9 sT-
City lZip Tel.
Contractor
Address
Zip
State Lic. I City
& Classif. �� Lic. #
Arch., Engr.,
Tel.
City IZip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 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.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5.Wsiness 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 th
requires e 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).
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 contractor(s) licensed pursuant to the Contractor's License Law.)
i 1 1 am exempt under Sec. B. & 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 a
r) Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg 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., 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
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 if 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 inspection purposes.
Signature of a0plicant —Date—
Mailing
ateMailing Address
City, State, Zip
ck
APPLICATION ONLY
LDING: TYPE'CONST. OCC. GRP
A.P. Number /� /'"� ^�f) -7,
Legal Description
Project Description
No. No. Dw.
Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
_A
Estimated
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line ,
Side Street Setback from Center Line
Side Setbackffrom Property Line
FINAL DATE INSPECTOR
/q
Issued by: Daten �Perrttt
JF
Validated by: MAR 1 9 pp,
-�
�// -- wu 1
Validation: ✓17 r r4s. _ , _
-+ Q�r�►
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Date 3/30/01
No. 21821
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Owner NamePacific Trades Construction
No, 54-040 Street Avenida Mendoza
city La Quinta
Tract # Lot #
Type of Development Single Family Residence
Comments
APN # 774-232-003
Jurisdiction La Ouinta
Permit #0103-173
Log #
zip 92253 Study Area
Square Footage 1492
No. of Units 1
ious certificate issued for 52-040, should have been 54-040. Also made changes.
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 1,492 or $ 3,058.60 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- David Miller
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Peggy Reyes Payment Received
Signature
Check No. 081199
10TICE: 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
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
ollect them on the DistrictCs)(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
f -
Telephone 760-96710069
47
l g 4
$3,058.60
Check No. 081199
10TICE: 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
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
ollect them on the DistrictCs)(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
0?;!qq/0110:25 FAX 17608049062
RECORDING REQUESTED BY,
AND WHEN RECORDED MAIL THIS DEED AND,
UNLESS OTHERWISE SHOWN BELOW,
MAIL TAX STATEMENTS TO;
William Thomas Buffin
Power Brokers
B.O. Boas 134
La Qui,nta,' CA 92253
CO1IMONWEALTH 'TITLE. Z 0.0 2
l -7 a'l L cn" 2-1
z-Cr—_2c
SPACE ABOVE THIS LINE FOR RECORDER'S USE
The undersigned grantor(s) declare(s):
Grant Deed A.P.N.74-2.2-3 0-0-2_/_0-0.3
Documentary transfer tax is $
( %y) 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,
Chester Frangipami
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
Stale of California, described as
, and
Lot 20/21 of Block 295 Unit No. Santa Carmelita at Vale La
Quinta, as per map recorded in Book Pages mf Maps, Records;of Riverside
County, California
Dated - February 26, 2001
Signature of Grantor
State of California )
County of ) SS. _
On before me, -
Chester Frangipami
,personally appeared
Chester
personally known to me (or proved to me. on the basis of satisfactory
evidence) to be the parson(s) whose names) is/are subscribed to the
within instrument and acknowledged to me that he/she/they executed
the some in his/her/their authoriLed capacity(ies), and that by
hls/her/their signature(e) 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 3196-4 (s -ea) THIS FORM FURNISHED BY COMMONWEALTH LAND TITLE CnnepaRm
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
m8 -ND oZ*4
SITE ADDRESS 547040 Avenida Ms#dQ-r�
APN 774 _ 223_ 003-BINNO.: CASE NO.: 2000-425
LEGAL: LOT 20 BLOCK 285 UNIT S.C.@V.L.Q.
CHECKED BY: Fred Baker 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
APP
EXHIBIT
OVED BY MMUNITY DE I DEPT
TF Z)n(i
MDG filing required (5 filings since 9/3/98)
CA
E NO.
Consistency with street/surrounding area:
Colors
Materials
Architecture
OtherRequirements:
Certificate of Occupancy
City of La Quinta
Building 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:
Use Classification: SFD
Occupancy Group: R 3 .
54-040 AVENIDA MENDOZA
Type of Construction: VN
Qwner of Building: PACIFIC TRADES CONSTRUCTION
Building Official
Bldg. Permit No.: 0103-173
Land Use Zone: RC
Address: 1719 S. TREMONT
City: S. OCEANSIDE, CA 92054
By: STEVE TRAXEL
Date: 09-14-01
POST IN A CONSPICUOUS PLACE