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SFD (0103-175)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7.000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License ,# Lic. Class Exp. Date bate 52 010 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). ( ) 1, 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. ( .) 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 *barrier & policy no. are: Carrier Policy No. 9T.ATEFUNP 1236990.91 (This section need not be completed if the permit valuation is for $100.00 or less). ( ) I certifythat 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 hose provisi ns. Date: c ., Applicant- Warning: pplicant ---' �- Warning: Failure to secure Workers' Compen jationgoverage is unlawful and shall subject an employer to criminal penalti s and civil fines up to $100,000, in addition to. the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set application: 1. Each person upon whose behalf this application is made & ePlPincl ryeei whose request and for whose benefit work is performed under any permit issued as a result of this applicaton agrees to, & sh & hold harmless the City of La Quinta, its officers, agents an l2. Any permit issued as a result of this application becomes n II andwork its not commenced within 180 days from date of issu nce a permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above 11formation is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for.inspection purposes. ' Signature (Owner/Agent) ��" t Date/./ -I A Z a Cir F BUILDING PERMIT PERMITN DATE / VALUATION LOT 0103-i 5 TRACT JOB SITE "��! APN ADDRESS 51_3" A.VWMA NA"VARRO 17;1W -1454M OWNER CONTRACTOR / DESIGNER / EN &NEER PAC:51C '1'NX)M C' ON-SMU(:'1,'9ON' PA�",T MIC, TRADES C' ONErrRUC!"l10N 17.19 S TIM400T I? 19 a 'T ' M014 S WRASS R r. A 92054 S oct4wam CA. 92054 (-fc-0)967a0069 C''" L0 1955 USE OF PERMIT Mr.) , PKRIN 17' Ot RS NOT YNCT~. IDE TSY,.'"XCK''c A.U41POICIU'SPA OR .e1,1'P.i. OAkCH 1ANWAY Mh,. TER 81,08' `4'PiACT COM'PRUCTION 1,42'1M 21; PORCHIP.ATtO 3$.00 SF 0ARA02dCAR.PORT (SF) 9,996,00 3 P7. WOOD VENO 3GA.AA TsTr FWMAIC'M C`off.' OF:>~;E'yNSMUCIM'ON M' DXPOUIT 101•000-439-318 4250,00 COze'S+,T1aUCrION [W 101-0004118-000 4a. PLAN CREC:'.1*, MR. A 03.1006,4S9^3'18 x 19,12 AAECd1,Py't'1tCA.1.170, 101 _000-421-006 $60. t3 .r?fl. °h.'MICAL P'TK 101.000.42 7=000 $129,44 > lIUMJ9IND ?FIX 1,01 -000-419-00 $110.75 STR,0140 MOTION FM - U310 1031.010-7A3-000 .93 OP.,.a4DINOVEZ 101 _000-4213 -000 $20,00 D.W. E 'PIM IM;P ACr TARE -1 31,07.00 'PRECISE PLA14 101-000-441,345 I t 9.li..r L Ci.l2RMRlTMON Ad?lir" PI—IM-4 MOM $3430.74 g 2001 �..� ��:�w��e� �� •��S�.Oa - '. WYAL nMMT YM D VE NOW OF LA QUINTA NANCE DEPT RECEIPT DATES f BY DATE FINALED INSPECTOR 17! Ir �e rf . TJ, INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs _ � _'f ` Underground Ducts Forms & Footings .0 Ducts Slab Grade _ a " Return Air Steel Roof Decks _ -7-a. Combustion Air Exhaust Fans O.K. to Wrap `o( i"Ey( F.A.U. Framing Compressor InsulationS�� j. ®l Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath 7 Final 6� o� �'Z Final 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 LinesHeater Final Water Piping . �o0.(7_ ft�7 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) P.O. BOX 1504 Building}l 78-495 CALLE TAMPICO Address c�� :/!%/"�1%LI�C�� LA QUINTA, CALIFORNIA 92253 Mailing Address `1 �� S City Zip Tel. 6CL �tx, Scckdyi I we yG7-00C/` Contractor Zip , State Lic. City & Classif. .5 iss I Lic. # Arcn., tngr., Designer Address " City( Zip ( 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 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 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 thealleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty or not more than live hundred dollars ($500). 1-; 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 or completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) ('1 I, asowner 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 contractors) licensed pursuant to the Contractor's License Law.) I'7 I am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 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. O 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 thF 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 shell be deemed revoked. f 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 if 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 -01 this city to enter the above- mentioned property for inspection purposes. Signature of a0plicant Date Mailing Address City, State, Zip APPLICATION ONLY .DING: TYPE"CONST. OCC. GRP. Number I Description 1034& __ 'AW sct Description AS 611; S No. No. Dw. or Stories Units Newer —• Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT X;F, AMOUNT Plan Chk. Dep. , �u Plan Chk. Bal. rs 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 St -Deet Setback from Center Line Side Setback from Property Line • FINAL DATE INSPECTOR Issued by: Date —Pjr Validated by: NAR 12 2001 y Vi- LA UU060 Validation: WHITE = FINANCE YELLOW = 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 4/9/01 APN # 773-145-004 No. 21860 Jurisdiction La Quinta Owner NamePacific Trades Construction Permit#0103-175 No. 51-520 Street Avenida Navarro Log # City La Quinta Zip 92253 Study Area Tract # Lot # Square Footage 1421 Type of Development Single Family Residence No. of Units 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 1,421 or $ 2,913.05 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 - Juan Rodriguez Telephone 7E0-9670069: Name on the check 01 By Dr. Doris Wilson;^,,',� Superintendent Fee collected /exempted by Peggy Reyes Signature Payment Received $2,913.05 Check No. 081297 NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to collect them on the District('s)(s') behalf, whichever is earlier. Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting _ ..5 FAX 17608049062 CO DIONWEALTH TITLE l II -10 002 RECORDING REQUESTED BY; AND WHEN RECORDED MAIL THIS DEED AND, UNLESS OTHERWISE SHOWN BELOW, MAIL TAX STATEMENTS TO; 5 i - 52.0 �J.-44 William Thomais Buffin. Power Brokers D.0. Box 134 La Quinta, CA 92253 ISPACE ABOvE THIS LINE FOR RECORDER'S USE 'The undersigned grantor(s) declare(s): Grant Deed A.P.N. 773-145-002 Documentary transfer tax is'$ ( may) computed on full value of property conveyed, or ( X ) computed on full valueless value of liens and encumbrances remaining at time of sale. ( ) Unincorporated area: ( ) City of and FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Hector .& Helen Gonzalez hereby GRANTS) 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 2 3 of Block 110 Unit= No. Santa Carmelita at Vale La Quinta, as per map recorded in -Book 018 Pages 079 tnf Maps, Re cords;af Riverside County, California Dated February 5, 2001 4 State of California ) County of ) SS. On before me, ,personally appeared 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 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, Same..ag ALM— Signature of Grantor Hector&Helen Gonzalez Form 3196 (6.94) THIS FORM FURNISHED BY COMMONWEALTH LAND TITLE COMPANY 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 51-520 Avenida Navarro APN 773 _ 145 _ 00.2 'BINNO.: J CASE NO.: 2001-424 LEGAL: LOT 23 BLOCK 110 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 mirm nip ^j% DATE Consistent with MDG on file (as.applicable MDG filing required (5 filings since 9/3/98) BST Consistency with street/surrounding area: Colors Materials Architecture h Other Requirements: Certificate of Occupancy ' CL% City of La Quinta = g Building and Safety Department OFTM 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 51-520 AVENIDA NAVARRO Bldg. Permit No.: 0103-175 Type of Construction: VN Land Use Zone: RC Owner of Building: PACIFIC TRADES CONSTRUCTION Address: ' 1719 S. TREMONT City: S. OCEANSIDE CA 92054 By: STEVE TRAXEL "'�d�► Date: 06-22-01 Building Official POST IN A CONSPICUOUS PLACE