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SFD (0110-137)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 Date./A. Signature of Contractor tt OWNER -BUILDER DECI�ARA IT 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 pr6pert r� am exclusrl—contracting With licensed contractors to construct-the�pr�ct (Sec. 70;44, $usiness &Professionals Code). C - (/ O I am exempt under Sectn B&P.C. for this reason Date Signatuife of Owner WORKER'S COMPENSATION DECLARATION I hereby -affirm under penalty of perjury onelaf the following declarations: () I have and will maintajl�)a.e tificate of cosient to self -insure for workers' compensation, as providedor Section 37trof the Labor Code, for the performance of the work'for 'hi this permit is shed. ( ) 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: Carver..? r�"d�, ;� Fld'1� Policy No. 1 ✓3��+iY-01 (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 N11 subject.to the •workers' compens�tlon provislons,,of,.Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date:/ /.- f✓_ . •�J APPlicant Witrning: Failure to secure Worker t,,,Compensati n coverage is unlawful and,- shall nd -shall subject an employer to criminal penalties and civil fines,V,, 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 A_ S +'')1 - PERMIT�# PERMIT .BUILDING �dkil 1 DATE VALUATION TRACT, yV q RpK 102 JOB SITE APN ADDRESS $2_465 A4HAVAIMO 1 773•• y�^OE1 OWNER. CONTRACTOR / DESIGNER / ENGINEER tiI Dvtt' M t PACMCI7kMSCONS M=Cf 110 0 17 19 }/gY31M.; 9O]T GDAVID �a��.•. 9261% S CCZARIMECA 9205 _ USE OF PERMIT ly i)Np'w'Swr, � AR1kEy Maly K 3.i • Pa;�t. `1 t` .X�, 42L! ibC .'i�wktD (t' .i�L7A 5'NOT :fifCAXIDE' R1,10ICK WALL-% , PQIOUOP.A,, OR WAWr 79,4YAPPROACH 711ACT C:0N3'2'AUCTIaN 1,402.00 3:F G S5' QMAMMAUORT 46100 0P Irr. WOOD FENCE 200.tt,0 s� i 5• E5TIMATSID COST OF CONMUMION 92 987.40 yR�IYya�+�/u�.�,.�+��.`9a(l!�'�tMQrFlJsysL7Bi?sF�.S @ h fn ifVd�S SlMCIVION 1W 101 -WO -418-000 PLAN C;1'Efd IX FIFE, 1 C11, "Q3a'�- 4 �5�� � i �• �i« liL:�3 :' t,X�� Tf,H .': �#�. fIS,� 101-000-420-000 1'ld �Jj.L:1 't FFE 101-000-419-000$L1U,'7 ,.• Sl Rett A,�'t T.i�J3�F L+i!°.xr.0 Y!} y30' 101-000-2414M.49. f1 x CRADWO R.9 101 -OW -423-1)'00 V20100 0i.2,VFJ,.gAE.r1 04PACT FW.kp PTFIfiS'4IwJ i'Jj$f�C�9�C]i0U�44�3491.^•31.8 rat mpb,t' ' .$'l2IU500.,�00A ' ytil�?:EC`% f�2��' .i t�ehT�"9 p:i,�.�J' • ��r4��.Ue� it LMS. PRE-PAWFEES f®V 2001 15MOW 4256,00 PERMIT DUE CITt; OfFL.P�i�i�iiva IFI��h9i� C43✓�'. RECEIPT DATE III- BY DTE FINALED 6 P: INSPECTOR f a� • Z INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING Set Backs APPROVALS — Z7/�/ � MECHANICAL APPROVALS Underground Ducts H Forms & Footings Ducts Slab Grade Return Air Steel Roof Deck _ �Z _Lt �' Combustion Air Exhaust Fans O.K. to Wrap Framing _I _ / //dam � ` F.A.U. Compressor Insulation ! �C� O 'Z_ Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exteriot Lath Drywall - Int. Lath r•— (� Final '� 6-7 ffi BLOCKWALL APPROVALS. _ Final , POOLS - SPAS steel Set Backs 1 Y/7, Footings "r ` Bond Beam 3�0 / J ( Electric Bond Main Drain' Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Waste Lines�l `� G �� Gas Test Electric Final Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster ewer Lateral _ ewer Connection`� l�` �( Pool Cover 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) Buildin Address FS0,7 41 b 5� 14 (Ir AloU ! 0-D LA Owner Mailing Y Address, City Zip Tel. Contractor 4 P.O. BOX 1504 ` 78-495 CALLE TAMPICO APP 4 Q"(:; -IC LY P UUINTA, CALIFORNIA 92253 Aaaress AU Zip Tel.. 1, -3e7 -q_ /ZV0J State Lic. I City & Classif. f � Lic. # Arch., Engr., Designer Address City IZIp Stae —1 I Lic•# LICENSED CONTRACTOR'S DECLARATION I hereby affirm that Imam licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of tfiet8usinesa and Professions Code, and my license is in full force and etfeot. �t..� _S IGNATTUURREDATE OWNER -BUILDER DECLARATION I he 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 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 (5500). I.: 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 of, 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.) IA 1, 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 properly who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) I'? I 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 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 -of this city to enter the above. mentioned property for inspection purposes. Signature of applicant Date Mailing Address 'City, State, Zip BUILDING: � IV, TYPE'CONST. OCCC. GRP. � 7- A.P. Number Q .2 Legal Description /,9 ' "?-.( Project Description rrwLt_ G te_- � Ft. size Stories `� Units size New.Add O Alter O Repair ❑ Demolition ❑ 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 eea i FINAL DATE INSPECTOR Issued by: Date Permit) Validated by: C ti h n �r V P✓ f�.iy Validation: f LA ,.- INT* WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. el. 72 zsn—( 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 Setback from Property Line eea i FINAL DATE INSPECTOR Issued by: Date Permit) Validated by: C ti h n �r V P✓ f�.iy Validation: f LA ,.- INT* WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Di ri - Pl nniRe view F 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 applicabitity of compatibility. issues -6r need to require the filing of Master Design Guidelines by the applicant. It shall be transmitted to . Building '& Safety as your correctiori list. Please attach additional explanations as necessary. APPLICANT: W. R. ROGERS PROJECT ADDRESS: 52-465 Avenida Navarro APN: . 773-274-021 LEGAL: LOT' 10 , BLOCK 102 , UNIT ,S.C. @ V.L.Q. CK'D BY: Stan Sawa BIN NO:. CASE NO. -121 _ ..CHECK DATE: a �� -Inform. the -assigned -Building -plan -checker up.oh. your_assignment to this case. The CDD Executive Secretary maintains a Ib:g-li.00k to -track -applications -and assign case numbers. REQUIRED ITEM Y N COMMENT/CORRECTION ..,. ..:,... • ..,.>..,::. . x.::•\v:•: •, ••a 'M1\•;.;•.: �R.a::;.:t:. :w•r;.,:,xx::.�:::t<, :< z?<:.<:v •i t:i>3K\� C: e•'�:;\ •\Z�v:`a\^c:':��^� .~y:•.\\'.•'.�:�� �`w::.'w'\4ti�•2. �, .S�\`• t�\��2•k,.•�C:n.,.,. t..`, t� ,.,•. :y ,• • :�\,a,�..h o<S`� x• !P. x a\\�......\ : \ \, \ •. ,. \\ ,\\\f+\� \\, 44\\t\?',�: \\�ti �+\ , µ�i:}r}n a h.\ �'vC?a'3.ti', . 11 13.E.V 111Y;I 1 1 x�` .1 -IN -..: -.. n a Case logged and number assigned Verify legal and APN information Consistent.with MDG on file las applicable) V MDG filing required (5+ filings since 9/3/98) Consistericy -visth-street/surrounding area:. Colors Materials Architecture V \j OTHER REQUIREMENTS: Uee— e _Ajo 'apP►'���-- bv� . PI av►n l✓1p� �rnv�n �t�v�- U u'� 003 �e_A v -UA The:ioning 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. Certificate of Ocicupanc Y .� City LaofJ �. Building and Safety Department Of 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: 52-465 AVENIDA NAVARRO Use Classification: SFD Bldg. Permit No.: 0110-137 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC t, Owner of Building: DAVID MILLER Address: 1719.S. TREMONT City: OCEANSIDE,, CA 92054 By:. RICHARD KIRKLAND a Date: 04-09-02 Building Official t ' POST IN A CONSPICUOUS PLACE '