SFD (0206-084)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 (Y7/3I/2(
000 -ate
!' ��
_� 0 Signature'of•.Contractor r
OWNER -BUILDER DECLARATI,ON_,-)
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 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.
(A I have and will maintain workers' compensation insurance, as required by
S•€ction 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 STAT UND Policy No. 12809§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. rovlslons f
Date: `�71',' 'Applicant- _� x'""`-�- .'•�
Warning: Failure to secure Workers' Compe`risation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forthr on his
application. z
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, inde'mn'ify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) --..� ....•. r Date%/��l
t BUILDING PERMIT
DATE VALUATION �.1 LOT
,� j1,12
OWNER ,+u .y !Tr CON
y y�y �1
TRAMES 0.rd�7,1V�;i.Y .V�%A,LON
2551 BrAn Mr—M.0 X11.1. .
CARUGAD , CA 'WOW
PERMIT #
OMEN
APN
CONTRACTOR/DESIGNER/
TRACT
;i3,e:K 134
P..A.URC °%R�M
2ti51 wrr. r 1P,II1
(76030.7431 ` C 4. 1955
,r
USE OF PERMIT �• j
• L�1i.�TC4i,i:- F�A�,Tv.�'�;Y' 1��3��t°� •
5110 • LOT 17;1 lJild 3.1. I'gRA41T WE$ NOT jRMI IDE P004 SPA
OR Da.I �'�, AY APP110.&€:[
TRACT CON' SIMUCTION ISF
QA13-40MAUOF1 58 , J sp
�r4.'2A. F,/d.' 4s(N iYd.&4a,�4i,i:Aot
•Q��ry,�y;� A y, �,y�� S}y�•�� q,� tLibi].LAIYAF.(;�
k:� pl'm7Altr 47rL:IE ,�J Vd178iYd.6A&` Y.
ebOTxS:t'RUOITIO]N FXE
1011.000.418.000
$ .
PJ AN CHECK ,F,
101-000;-439-,318
$500.13
IME DEMMIT
101.000.439.318
42%00
MEC1;ANICAII re -19
101400-421-000
$60.00
ELECTRICAL FEE
101-00042"00
$120.44
I'F.f91t8MIG ME E
101 0610-419-000
$l lfl z
VT TONG MOTION FU ALUM
101 -000 -241? -000
°4 'O;IAf(t Ir
00.423.000
101x000-423-000
$eil1.0A
f3N:FI OPER. IV. PACT FES
31,9i1i.4a
PRxCISE PLJ1,14
101-000-4,41-345
$1 1Ct,t30
Wrl- MAL CONTSTRUMOM AND Pl..M, 4' .a O—K $3,430.74
70TH , F. fiM1tLUJiill" ME Now V3,16034
juN
R EIP ^�®F DATE—_. `:' ,1 BY-�. - DTE FINALED INSPECTOR
V
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
iJ'
Return Air
Steel
A
Combustion Air
Roof Deck
t
Exhaust Fans
O.K. to Wrap
O
F.A.U.
Framing
Insulation
02_
Compressor
Vents
Fireplace P.L.
Grills -
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final l� 2
BLOCKWALL APPROVALS
POOLS--SPAS4=
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping-$
_
0 �--
Heater Final
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
O� U
Appliances
Final
Final
Utility Notice (Gas) P
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 PowerQ�
Final
Utility Notice (Perm)
COMMENTS:
r
Notice:
Document Cannot Be Duplicated
Date 6/17/02
No. 23296
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, 51390 Street Avenida Navarro
City La Quinta
Tract# BLK134 Lot '# 17
Jurisdiction
Zip 92253
x VIEDS,
'Q' BERMUDA DUNES L
tO RANCHO MIRAGE
INDIAN WELLS b
• a� PALM DESERT ,y
LA QuiNTA
Q.INDIO 1+�
APN# 773-104-008
La Quinta
Permit # 0206-084
Log #
Study Area
Square Footage 1421
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
2.14 X 1,421 or $ 3,040.94 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 Missio Oaks National Bank - Frank Garcie Telephone 760/730-7431
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Crystal Scott Payment Receive
Check No.
Signature
Received
$3,040.94
12062
IOTICE: Pursuant to 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
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
:olled 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
m2O6 - Oev
Building
Address
r 4�,
C??
• �IGG�fiV
P.O. BOX 1504 APPLICATION ONLY
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Mailing
Address 7/e7SD 7l—e&
Qt ITel. '))
/5a X3
Contract/or
Address
City lZip Tel.
State Lic. City
j"Arc8 Classif0-�,�,,f � s' Lic. # ` 7j—
Arch.,
h., Engr.,
Designer
Address Tel.
City IZip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I 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
Ihereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness 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 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 in
ealleged 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 (8500).
l: 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'I I, as owner of the property, am exclusively contracting with licensed contractors to con.
strucI 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 contractors) licensed pursuant to the Contractor's License Law.)
1'3 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
n Copy is filed with the city. ❑ 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., 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
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 permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I 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 a0plicant -Date-
Mailing
ateMailing Address
City, State, Zip
BUILDING: TYPE'C^OONST. �,� Q OCC. GRP.
A.P. Number / _3 `Y/ `
Legal Description
Project Description
L /V A S -•e
Sq. Ft.
Size
No. No. Dw.
Stories Units
New4d- Add ❑
Alter ❑ Repair ❑ Demolition ❑
1
Estimated Valuation
PERMIT
AMOUNT '
Plan Chk. Dep.
M a
Plan Chk. Bal.
a
Const.
Mech.
Electrical
/
Plumbing
S.M.I.
Grading
Q
Driveway Enc.
114 j,.
Infrastructure
7 i
F 0�
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 Setback from Property Line
FINAL DATE INSPECTOR>
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT
PINK = BUILDING DIVISION
RECOkL)!NG REQUESTED BY:
AND WHEN RECORDED MAIL THIS DEED AND,
UNLESS OTHERWISE SHOWN BELOW,
MAIL TAX STATEMENTS TO!
DAVID R. MILLER
1719 S..TREMOUNT
OCEANSIDE, CA 92054
%%LoT /b s 1-'Voo 6u4
3_�o�f.. D0 �
SPACE ABOVE THIS LINE FOR RECOROER'S USE
The undersigned grantor(s)declare(s): Grant Deed I A.P.N. 773-1g —QQ Ob9
Documentary transfer tax is S
( xx) computed on full value of property conveyed, or
( ) computed on full value less value of liens and encumbrances remaining at lime of sale,
( ) Unincorporated area: ( ) City of
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged
BRYANT RUGG
hereby GRANT(S) to DAVID ROSS P111dLER, a married man as his 'sole and separate property
the real property In the City of La Quinta
State of California, described as
County of Riverside
i
—,and
Lot 16 & 17 of Block 13 4 Unit No, Santa Cartnelita at Vale La Quinta,
as per map .recorded in Book Pages mf Maps, Records of Riverside County,
California f
Dated MAY 6.6 200Signature of Grantor
State of California )
County of ')
On before me, BRYANT RUGG
personally appeared
BEVANT P1Tr1r•
personally known to me (or proved to me on the basis of salisfa:tory
evidence) to be the parson(s) whose name(s) is/are subscribed to the
within instrument and acknowledged to me that helsheNhey executed
the same in his/heNtheir authorized capacily(ies), ands that by
his/her/their signature(s) on the Instrument, the peraon(s), or the entity
upon behalf of which the person(s) ectad, executed the instrument
WITNESS my hand and official seal.
Signature
MAIL TAX STATEMENTS T0,--satae`a s al�av�
- I
Form 3196.4 (6-94) i THIS FORM FURNISHED By COMMOl!A ALTN,LAND TITLE COMPANY
jF
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:. .
1) that the proposed house design does not duplicate the same. architectural style of any
house within 200 feet of the applicant, and/or 2) it there is a need for the applicant to file for
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 51=3.90 Avenida Navarro
VAIP"N , 773 - 104 -'008 CASE NO.: 2.00.2-658
LEGAL:. LOT 16 BLOCK 134 UNIT
CHECK AND. APPROVED BY: Greg Trousdell DATE:
S.C:@V.L:Q.
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
Consistent with MDG on file (as
applicable
MDG filing required (5 filings sinceems%
9/3/98)
ate
Architectural variety within 200 feet of
the surrounding area:. o�ed b
0 pia I �1
omm� • D
lsslo
'
�• . • . .
Gale
X�11b�t
on
Architectural design f ttp�
on
► , nA P►
CmF
Other. Requirements:
pY 2 4 REV R a Z
L--
OU
a
Certificate of Occupancy
City of La Quinta g
Building and Safety Department MOFTM
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
ollowing:
BUILDING ADDRESS: 51-390 AVENIDA NAVARRO
Use Classification: SFD Bldg. Permit No.: 0206-084
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC
Owner of Building: PACIFIC TRADES CONSTRUCTION Address: 2551 STATE STREET #111
City: CARLSBAD CA 92008
By: KIRK KIRKLAND
Date: 10-22-02
Building Official
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