SFD (0007-156)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
it
Date /� '7 Zignature of Contract�A
OWNER -BUILDER DECLARATION '
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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, 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.
( ) 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 A policy no. are:
Carrier STATE FUND Policy No. 220.00 UNIT 0004483
(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 1•should become -
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with th se`_rov sion
Date: N + -1 Applicant,:
-;✓
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 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.
- �k
Signature (Owner/Agent),-' Dater"
BUILDING PERMIT PERMIT#
DATE VALUATION Qy'.�ry [ LOT TRACT
kc -It WFD7�Ss1W _
JOB SITE i
APN
ADDRESS 52 -SM AV MWA NAVAE RO
' 773-304-016
OWNER
CONTRACTOR/ DESIGNER / EN (NEER
'CAIUIGfT K4SA00&-1 F XC
VMLMN1 RDS50.,L ROOM
P.O. BOX 3578
56900 JACKSON VT
PPLZv3 D+1W Chi 92261
MERMAL i CA 92r/4
(760)399.1200 CBIJI .1954
USE OF PERMIT
IG k1; :FA1_9_Y.' DWFL1.WG
SPD -PERMIT DO'Ef NOT :NC:LU119 BLOCK WALLS O1C` POOL
T"CT CONSTRUCTION 1,421.00 9F
PORCHIPATIO X00 SF
GAt AGFIC,AkiPOR:T (S'F") 9,996.00
5 F?. Wool) .41 CE 200.00 LF
ES;iDAA17,D COS".0 OF COASTRUC'C Oil
MOW M 9UAIRY
CONSTRUCTION FES: 101.000.418-000 4594.50
PLA1d CHUCK Fft 101.0G30-139-318 $500.12
MECHANICAL FEE 101-000.421.000 $00A
LCLE.0 RIC:,AL FEB 101-000-420-000 $129,44
PLUMBINO FEE 101-000=419.000 1*I10.75
STFtC?NO NOTIO14 FEE . RESID 101-000-241-000 $0.93
C1RADINO FEF 101-060-42.3-000 520,00
I]EWLOPER IMPACT WE $1,909.G0
PRECISE- PLAN 101-000.441.345 $100,04
r —E DEPOSIT 101-000-4397,318 $�st7.p0
�Y )t
e MM-'1`OTA'L COl �°AT1S2,"1'1`ox AND P:�.�3' �`:272;�.: C
$3,430.7
u I.= PFR -PAM TIRES
4250100
R�
� OSY6L:M P.J L ui• MOM : ] '
i;00, r i
JUL 2 6 2000
.PITY oLA, QUINT.
„
RECEIPT
DATE "`r,,�
BY< j
jj�J
DATE FINALED
INSPECTOR
lz:�:5111
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
I DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
`�
Underground Ducts
Forms & Footings
16 • J"
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
- ,�
Exhaust Fans
O.K. to Wrap-
dv SF•
r��
F.A.U.
Framing
$
Compressor
Insulation
! 7
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
-
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
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
�l /_ _ '
Heater Final
Plumbing Final
Plumbing Top Out
`
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
p -d0
Encapsulation
Gas Piping
Gas Test
_ p
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
-O
Utility Notice (Perm) I
P/y# AAA—)
�Gtf/
T;; Y154L.. if f..O. BOX 1504
Buildingr ,��T 78-495 CALLE TAMPICO
Address 2 TSS" AU ' u NA(� LA QUINTA, CALIFORNIA 92253
owner
'�nVO� --W-r &hvA� 1tJ
Mailing G
Address F•Q 3 5-7 O
City Zip Tel.
Ran &Atj- IiL24 t -77/-/670
Contractor
til . R .
Address
City Zip Tel.
State Lic. City
& Classic _ 2 Lic. N
Arch., Engr.,
Designer SKfip l �lvc.µ-
Address
City (Zip (State I
L 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 1 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 rile 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 thathe 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 of not more than five 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 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 ownertof property, who builds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
FV I am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
Ihereby 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. 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 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: IL alter 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 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 sof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant ---Date-
Mailing
ateMailing Address _
City, State, Zip
APPLICATION ONL
LDING: TYPE -CONST. OCC. GRP.
Number 7 --�04 40 K,
al Description
Description
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
= S -
.0
s9. Ft. a
(Side °, r;�
No. No. Dw..
Stories Units
New Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
Ur U-0
PERMIT
AMOUNT
Plan Chk. Dep.
..
Plan Chk. Bal.
w
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
L
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
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Date 7/26/00
No. 20779
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
'760-771-8515
CERTIFICATE OF COMPLIANCE
Owner NameStarlight Management, Inc.
APN # 773-304-016
Jurisdiction La Quinta
Permit #
No. 52-555 Street Avenida Navarro Log #
City La Q*ta . Zip 92253 Study Area
Tract # Lot # Square Footage 1421
Type of Development Single Family Residence No. of Units 1
Comments
*Payment made with cashier's check for $2,913.00 and .05 cents cash**
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, $!ilding '�
' 9 a
permits and/orcertificates of Occupancy for this square footage in this proposed project mays vK be' ssued '
T.
Fees Paid By CCNalley Independent Bank/Larry Shields Teleph ne 760:399 1200 ;
Name on the check
•
j}I �
By Dr. Doris Wilson,
� y�4
4r C ��^rz -
Superintendent
y ._41:4
Fee collected /exemp ed by Annette Barlow
payment Received $2,913.05
Check No. 216595
Signature
IOTICE: Pursuant of Assembly, Bill 3081 (CHAP 549, STATS. 1998) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
Dove will begin to run from the date on which the building or installation permit for this ;project isS ssued or on which they are paid to the District(s) or to another public entity authorized to
ollect them on the District('s)(s') behatf, whichever is earlier.
Collector: Attach a copy of county or city plan check, application form to district copy for all waivers•
Embossed Original- Building Dept./Applicant 4Q,0 - Applicant/Receipt Copy - Accounting
I
I
9
1034PM COMMONWEPLTH
REQUESTED BY: .�
TL$ C00ANY comPANY
20` OS6336
0
• Urti id 'ScOtt
eta Circle Vast
CA ��,2211
Cil kNT REED
....�� 1.
-5-zl 5M7�_
signed grantor (B) declare (s) s �14.'JO
ry transfer tax is at time as sale,
puted on full value of property conveyed, or , and
putedAontcull value
le) sC Xeity s and eZcumlyr�cee remaining
ncorp
ed
YX8LE CONSiDURAT.ON, receipt of which is Hereby acknowledged,
tJR�IV8R9'r2'Y � • --
r (g) to
nqc A A "am WR1POIIAI 110'
property in the City of LA QVINTA, County of Riverside, Stare of California,
lock iia, unit ) „
Tract Santa Carmelita at Vale La Quinta, as oer map
in
in Book iS, page
(s} 92 inclusive of maps, in the office of the County Recorder
county.
�1May 8,
Casip9rAAn,gel es
���. wpww www www
ins, tiv A,,. t��; 1 c a n .
pereonally appeared
wrwww—w ww Y
� ww.s mww...wwwww.
i I � ww ww
;ly known to me t to be
soca whosf► name co subscribed
within insta^�m9nt avd acknowledged. to
t ,�j e./4 y exeoUted the same in
eiar authorized capacitY (�< , and
'y his hem signatu: eXT on the
or t e entity upon
t�Ument thepsrsCn d
oxn
of which the pare(4 acted, execute
st�rument . /
i S my han and of ficial sea}..
i ure '
AX 5TAT -MENTS
LOYOLA MxRYMOUNT UNZVSRSTTY
Name tie John A. Oester
Vice President-�ueiaoss b
3Y
Name/Title
i
I
WWW A. 1 ALWH
IIYfA11 * 126114 1
NowLsMOO CMMV
J
Ally Cart►rr1.6�i'ei AAc�+ 17.2
(This 8^C!4 idr, oft'icial notarial seal)
0
I
III
5-1
. 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 W. R,. ROGERS
SITE ADDRESS 52-555 AVENI DA NAVARRO
APN 773--304 016 BIN NO.:
LEGAL: LOT BLOCK_
CASE NO.: 2000-2.72
1WZ"
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 assignedAvvro
Ve b�
Verify legal and APN information
O PI nning Commission ...r........
0 City Council .._._........
Consistent with MDG on file (as applicable
10
Ccpmmunity v Qep�
nits s
MDG filing required (5 filings since 9/3/98)
lExhi
Cas _-•-.•••••�••MAW N
i
Consistency with street/surrounding area:
0 With Conditions...,.... ..�.......
Colors
Materials
'
Architecture
i
Other Requirements:
r