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SFD (0110-309)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 n Date:r� -�� Signature of Cotractor � s 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 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 & policy no. are: Carrier STATE FU143 Policy No. 1U090-0 14 (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,.provisions. Date: J1 f,. cc'•�' ' Applicant ,l Werning: Failure to secure Workers'fCompensa on Covera_ge 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 agr3es 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. S Signature (Owner/Agent ""e—", Date / j �•- �+ I PERMIT# BUILDING PERMIT. DATE VALUATION S103.1.a).70 LOT TRACT RIx 14 A JOB SITE ADDRESS .5.2•-71-.--�AV .A'fIDAAK4AVARfao APN .T73-3,04-4)24 OWNER / CONTRACTOR/DESIGNER/ENGINEER 1'919 a °i:R. T.4019T i 1719 S IRFIT 99T. OCEANS= CA 9204 8 OCHAMME CA 92054 CB0, 1,955 USE OF PERMIT >� ,' D : ST K A 4C VYN CUU170101mmn, ' a!4,'•:, 1' 001;l�f.F°.A, 0R DRIV fAY,�1,f'k'2LOACH { TRACTt;f9NSTi2.t?CTI(Xti 1,1K DO SF P101',4."Wrm 69.00 S2f (1. IIA9,] ICA1bN)RI' 468,40 3F" r rsmm , km co.y'T of t;:131��`= =ON 103,.160.749 'COMITRAXT10*9 FU 101-M-418-000 M 14 CIMIK TSF% 101-000-431.0-318 Il�'3i1.3+i 1�L 1`i 101-000-439-318 -3250.00 101-000-421.-000 `S40150 I+1..LC!'3t1.Ctls1, FRE 101-000-420-000 00-420.000 $13 AS PLIUAADiNl0 YXE 101-000.4119••000 $1,14.00 fiROWI JAMiON FPS - RNSM 10).4100-241-000 $100 G11AIr NO I 1.01.000-423.100 $29.00 TRYx�� A)PER IMPACT FEE S1,007,00 taREXISMPLAiE A i� • �rkF113-°Tz,.yr axrr,xc��'A11�x< N®V 0 5 2001 1` M04- FE 1MES DU flow t� CAffOFLAQJ6i 1A FINAP C!H SEPT. RECEIPT DATE 45,- BY DATE FINALED INSPECTOR S yi.,. a .1 INSPECTION RECORD OPERATION DATE j INSPECTOR OPERATION DATE INSPECTOR Party Wall Firewall BUILDING APPROVALS MECHANICAL APPROVALS Set BacksUnderground Forms & Footings _ (p • 0� Ducts Ducts Slab Grade 00 Return Air Steel Combustion Air Roof Deck f'Z -� Exhaust Fans O.K. to Wrap , _ / /� //�� F.A.U. Fireplace P.L. / — F " ? Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath 9_ //,, / Z �Z (O 47 Final Set Backs Footings Bond Beam Lines I Sewer Final BLOCKWALL APPROVALS PLUMBING APPROVALS ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice Final Electric Bond Main Drain Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Gas Piping Gas Test Electric Final Heater Final Plumbing Final Equipment Enclosure O.K. for Finish Plaster Pool Cover Final COMMENTS: POOLS - SPAS P.O. BOX 1504 APPLICATION ONLY Building t— ^� . — 78-495 CALLE TAMPICO Address .� / > /�Ul //��C'�I�fJU LA OUINTA, CALIFORNIA 92253 �l�Q .3 a� Owner BUILDING: TYPE'CONST. OCC. GRP. Mailing . •� Address��%�% r 7,_e'l �� A.P. Number / CityZip Tel. / 04111 /��'S/lf.( ",/' "/ t �� W' "'�(?�_G�'t 'Legal Description Contractor ,) , f _ f Project Description 757 Address'�� City Zip Tel State Lic. City & Classif. j! �� 3 Lic. # /) 5_ Sq.P`)/ t. No. No. Dw. Arch., Engr., SiZP /7 /°� Stories Units Designer New f/ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel CityZip State 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 effec� SIGNATURE DATE OWNER -BUILDER DECLARATION Estimated Valuation 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 AMOUNT requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT 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 basisr- for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit Plan Chk. Dep. \ ✓ J subjects the applicant to a civil penalty of not more than live hundred dollars ($500). I I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. do the work, and the structure is not intended or offered for sale. (Sec. 7044, Bulsness and Const. 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, Mech. provided that such improvements are not intended or offered for sale. If however, the building of improvement is sold within one year of completion, the owner -builder will have the burden Electrical 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. Plumbing Strutt 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 S. M.1. such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading I 7 I am exempt under Sec. B. 8 P.C. for this reason Driveway Enc. Date Owner Infrastructure 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.)ItiIli Policy No. Company n Copy is filed with the city. ❑ Certified copy is hereby furnished. - TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS F VINT 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., If, after making this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 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.) Side Setback from Property Line Lender's Name Lender's Address FINAL DATE INSPECTOR _ This is a building permit when properly filled out, signed and validated, and is subject to INSPECTOR— 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. Issued by: Date Permit 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. Validated by: Signature of applicant Date Mailing Address Validation: - City, State, Zip WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Notice: Document Cannot Be Duplicated Date 11/5/01 No. 22640 Owner NameDavid Miller Desert Sands Unified School District 47-950 Dune Palms. Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE No. 52-715 Street Avenida Navarro city La Quinta APN # 773-304-024 Jurisdiction La Quinta Permit # 0 110-3 09 Log # zip 92253 Study Area Tract # BLK 141 Lot # 1.1 Square Footage 1714 Type of Development Single Family Residence Comments No. of Units 1 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 1,714 or $ 3,513.70 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 - JR Rodriguez Telephone 760-967-0069 Name on the check s' By Dr. Doris Wilson Superintendent r Fee collected /eze pted by Annette Barlow Payment Received $3,513.70 Check No. 084645 Signature l•� !� NOTICE: 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 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 Oi/12/01 14:90 FAX -1'1608049062 RECORDING REQUESTED BY: AND WHEN RECORDED MAIL THIS DEED AND, UNLESS OTHERWISE SHOWN BELOW, MAIL TAX STATEMENTS TO: David Ross Miller 1719 S. Tremont S. Oceanside, CA 90254 COMMONWEALTH TITLE SPACE ABOVE THIS LINE FOR RECORDER'S USE The undersigned grantorGrant Deed A.P.N. 773-304-024 s) declare(s): - Documentary transfer tax is $ 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, ENDRIK & CLARE HAKE 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 State of California, described as ,,County of Riverside , and Lot 11 of Block 141 Unit No. , Santa Carmelita at Vale La Quinta, as per map recorded in Book 'Pages mf Maps, Records of Riverside County, California Dated September 4, 2001 State of California ) County of ) Sg On before me, ,personally appeared ENDRIK & CLARE HAKE personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) Ware 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, Signature of Grantor ENDRIK & CLARE HAKE Form 3195-4 (6-94) ' THIS FORM FURNISHED BY COMMONWEALTH LAND TITLE COMPANY D; RC DISTRICT - PLANNING REVIEW FORM CITY OF LAQUINTA PLANNING DEPARTMENT This form is to be used by CDD staff for review of single family dwellings m e ove 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) if 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 p Cq, Cidi etf/> S" 2 • -3-d- SITE ADDRESS 5-1-715 Avenida Navarro. 4-7 13 1,"s APN 773 _ 304 _ 024 LEGAL: LOT CASE NO.: 2001-548 BLOCK 141 UNIT S.C.@V.L.Q. CHECK AND APPROVED BY: Wally Nesbit DATE: 9 A 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 Gwo S is SZ -,moi f Verify legal and APN. information Consistent with MDG on file (as applicable MDG filing required (5 filings since Ll 9/3/98) Architectural variety within 200 feet of the surrounding area: -7 M 94'/ sn.-G 'i -n. Colors Materials Architectural design features 6a,)roved bjE Other Requirements: O Planning Commission _..:.__.._.. Council ommunity Day, Dept, Z �� Oity als r.•.. --&"•*W IN wpwpwwp� Inst Ca a 'N . Ex ibi! _ - 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 52-715 AVENIDA NAVARRO Type of Construction: VN Owner of Building: DAVID MILLER Building Official Bldg. Permit No.: 0110-309 Land Use Zone: RC Address: 1719 S. TREMONT City: OCEANSIDE, CA 92054 By. RICHARD KIRKLAND Date: 03-15-02 POST IN A CONSPICUOUS PLACE