0007-108 (SFD)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 I Exp. Date
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
Lice Law for the following reason:
(v) 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
Brate °; _ %� Ann!- Signature of OwnerG4141 2MRR
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
(v) 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 Policy No.
(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
3 Code, I shall forthwith comply with those provisions. ,
Daie: �l /G "`�pplicant9aklfthe,e L,! `t,?
v
U
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.
Sig"nature (Owner/Agent) �Jft{` ri t"''Date
BUILDING PERMIT PERMIT l/
DATE VALUATION LOT OW -1.06 TRACT
W119= $f37,titJ� U
JOB SITE
APN
ADDRESS 51410 .VENA CARRANZA
-
OWNER
CONTRACTOR/DESIGNER/ENGINEER
&WLMANZ,!', L MARTI )EZ
M9 PERANZ A L MaTWEZ
LA QUWTA CA 92253
CBIS
USE OF PERMIT
MOLE 1:.F1UZY Z AMLL dO
5FD - PERMIT DOES NOT INCLUDE BLOCK' L'tlALUPOWSP.A OR
DRIVEWAY APPROACH
TRACT CONSTRIUCTIOIN 1,392,OD 3F
OARAOFJCARPOWr (Sip) 9,7'11.60
3 FT. WOOD FENCE 200,(10 IN
HfiTROAM COST OF C:UNS'IR-UMION'
67,007.20
PEM, TKEE Si3'ouRy
GUNSTR UC°TION FEE 101-000-418-000 085. a0
PLAN CHECK'. FEE 101-000-439-319- 54194.98
NIFICHNNltwAL ME 1(31-000.4?,1.000 $53.50
1:1.,1?,C1 RRC ,L PEZ 101-004-420000 $107.14
PLtiMOTNO FEE 101.000.419.000 $104,75
STR.OT40 MOTION ITZE - RESID 101-000-241-000 $8,70
ORADING FEF 1.101-0004423.000 $10.00
10.EVZLOPER IMP, C -T F'EE $1,907.00
PRECISE PLAN 101-000.441.345 $100,00
FEE DMSIT 101-000-439-318 Vi0:0o
F:
♦ q66
� X
a
SIM -TOTAL CON ARD 1?LAR C..`.k?1..C1.
�3,,�`P 1.57
IMS PRE -PAID MO
-$250,00
► R TOT 1~" E� FEES DUE Now
s1TVA i A Q11 1
RECEIPT _
DATE
BY y� f,
9 NALED
INSPECTOR
}���f.'Ci'1`f
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground,Ducts
Forms & Footings
_
C,y
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
��
Exhaust Fans
O.K. to Wrap
_
_
F.A.U.
Framing
S
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Party Wall Insulation
�
Fans 8 Controls
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
`
Final
Final
_
POOLS - SPAS
BLOCKWALL AP ROVAL'S
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
_q
Heater Final
Water Piping
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)
5 y
o
/ P.O. BOX 1504
APPLICATION N
Building / ' /� 78-495 CALLE TAMPICO L I
Address4/ G y�LA QUINTA, CALIFORNIA 92253
Owner e J
BUILDING: TYPE'CONST. OCC. GRP.
Mailing
Address 7 f% s
A.P. Number � � t•'''�-�'�"'�'
Cit. Zip -,ATel. )
�` Legal Description l � %�
Co *tract6r Project Description
Address A
City Zip Tel.
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. DIN.
Size
Arch., Engr., Stories Units
Designer New Add O Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Ch pier 9 (commencing with Section
7000) of D1 igii n 3 of the Busines, nd Profe(s�giss Coode, and'rnt,lice is in full force and
effect. (Y1V��`nR�-(r[�f[I� 0 1l\`,�b4�8 N5=
SIGNATUREb DATE
�A
OWNER -BUILDER DECLARATION Estimated Valuatiorir / c
I hereby affirm that I am exempt from the Contractor's License Law for the following !
reason: (Sec. 7031. S,Business and Processions 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 lot such permit to file a signed statement that he is licensed pursuant to PERMIT AMOUNT
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 o
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep.
subjects the applicant fo a civil penalty of not more than live hundred dollars ($500).
l] I, as owner Olathe 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, Bussness 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. f
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 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 �1 M-
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 S. M. 1.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
1-1 1 am exempt under Sec. B. & P.C. for this reason Grading , ..:: c'
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.)
Policy No. Company `
F] Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (5100) 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
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 a0plicant Date
Mailing Address
City, State, Zip
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
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 8/15/00
No. 20889
Owner NameEsperanza L. Martinez
No. 51-410 Street Ave. Carranza
city La Quinta
Tract #
Lot #
Type of Development Single Family Residence
Comments
APN# 773-082-008
Jurisdiction La Quinta
Permit #
Log #
Zip 92253 Study Area
Square Footage 1392
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 1,392 or $ 2,853.60 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 CASH - Sammy Labastida
Name on the check
1
Payment Received x;$2,853.-60
Check No. N/A
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Ellen Patino
Signature
—h,&j�
Telephone `1771.-,
VOTICE: 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
:ollect 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
PAU tSERT ESCROW, INC. ROW, INC.
1
RHEBA WEST ! !
PRESIDENT 9
2261 -
0
111 7s7!
74-041 Highway 52
(760) 568-2787 P.O. Box 879
FAX(760)568-49S2 Palm Desert, California 9226 I
TIONS
ESCROW OFFICER: Rheba West
ESCROW NUMBER: 982039RW
DATE: January 13, 1998
On or before January 29, 1998,
I buyer, will hand you the sum of
$9,500.00 of which $9500.00 has been
deposited herewith, balance of down
payment and closing costs shall be
in the form of a bank wire or a
California cashier's check,
CONSIDERATION
Cash through'Escrow
TOTAL CONSIDERATION $
9,500.00
t
9,500.00
I will deposit or cause to be deposited into escrow any additional funds and/or
instruments required from me to enable you to comply with these instructions which you are
authorized and instructed to use and/or deliver, provided on or before CLOSE OF ESCROW you
can obtain a standard owner's policy of Title Insurance containing the usual printed
exceptions of the title company, with liability in the amount of $9500.00 covering that
certain real property located in the City of , County of Riverside, State of California,
described as follows:
Lst 17 in Block 67 of Santa Carifielita Unit No. 6, asperMap recc_ded in Book 18, Page (s)
67 r:: 'laps, in the Office of the County- Recorder of Riverside-Coifnty.
Property c.c=nonly known -as- Vacant_Land/Avenida Carranza, LaQuinta, CA 92253
AS;SESavR PARCEL NO! 773-082-008
Showina title vested in; ESPERANZA_L. MARTINEZ a married woman'as her -sole -and separate
property
FROM ENCUMBRANCES EXCEPT:
1. General and special Taxes for current fiscal year not yet due or. delinquent,
including• any special levies, payments for which are included therein and collected
therewith.
2. The Lien of supplemental taxes, if any, assessed pursuant to the provisions of
cAapter 3.5 (commencing with section 75) of the Revenue and Taxation Code of the state of
California.
3. Covenants, conditions, restrictions, reservations, easements, rights and rights of
way of record, if any; and the exception of reservations of oil, gas, or mineral rights,
if any.
Make only the prorations and adjustments indicated by an "X" as of CLOSE OF ESCROW:
(x) Taxes*
*Seller and buyer are aware taxes are subject to re -assessment, in accordance with the
Statutes of the State of California. Any proration of such taxes are to be handled
outside this escrow.
PALL, DESERT ESCROW, INC. LICENSED BY THE STATE OF CALIFORNIA, DEPARTMENT OF CORPORATION'S
BUYER ANN SELLER His:E' RBr.^_ 7.13D AGREE TO THE GENEZRAL PROVISIONS ATTACKED HERETO AND MADE
the real property in the City of La Q.ui nta County of R.i versi de
State of California, described as
Lot 17 in Block 67 of Santa Carmelite Unit No. 6, as per Map recorded
in Book 18, Page 67 -of Maps, in the office of the County Recorder of
Riverside County.
Dated January 14
STATE OF CALIFO / }ss.
COUNTY 0 'G� �5 }
On JA k .99A . before me,
personally,otppeared
personally known t 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) !d, executed the i ument.
WITNESS`m a d offici eal.
Signature
RHE^BA NEST
Commisslon # 1123410
N
otary pubiic- — Califomla
Riverst,� County
MY Comm, Expi cs Feb 24-2001
r
ROGEL 0 MARTINEZ
e Na`cry Pu--. •- C difornlo
Rus c;,:unty
+ My Caron, Ex;mes Feb 24.2W1
(This area for official notarial seal)
1004(1/94)
Page 2 of 2
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 Esperanza Martinez
SITE ADDRESS 51-4'10 Avenida Carrp-a�nza
APN 773 - 082 - 008 BIN NO. -
LEGAL: LOT 17 BLOCK 67
CHECKED BY: Leslie Mouriquand
_ CASE NO.:
UNIT S.C.@V.L.Q.
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 1
Case, logged and number assigned
Verify legal and APN information
Consistent with MDG on file (as applicable
/yW—
MDG filing required (5 filings since 9/3/98)
Consistency with street/surrounding area:
Colors
Materials
Appmy diC ecture
' P!?nning Commisa�'31. .M.......w
=WM
� `G
C017,101
her Requireme'ii�yr Dept. i liM�ri:
0000300
s
i
Fred She
Structural Engineer 15475 Seneca Road, Suite C, Victorville, CA 92392 (760) 955-7522
1274 E. Center Court Dr., Suite 208, Covina, CA 91724 (626) 915-8601
Aug. 10, 2000
City of La Quinta
Building & Safety Department
Attn: Plan Checker
Ref: Truss Calculations
Dear Sir:
I reviewed the truss layout and truss calculations prepared by the Trussworks in Thousand
Palms, CA for the above referenced project. The design of the trusses are in accordance with
my design intent.
Should you have any further questions, please feel free to call me. Thank you.
Sincerely,
Fred Sheu
Structural Engineer