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0103-176 (SFD)C/)r C14 O M O In W o Z r r-- 0' C H(0 IW- a Z M Ln N p N U < CL Q o: ,rr Lo la— O . X W LL m Q U dL0H rn `ZIt_ ob J 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 ,,i/��1 42 381 B � � `, 07'/31/2F 4/ate x�"" Signature of Contractor �� ,`�`�•, ��� OWNER -BUILDER DECLARATION / I hereby affirm under penalty of perjury that I am ex'empflfrom 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 DateSignature 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. 1 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. STATE 1230990 -jai (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' compensatioh.provisions of Section 3700 of the Labor Code, I shall forthwith comply with those p[ovisions. ,Date'z ,.'r•r `%'� Applicant— Warning: pplicant Warning: Failure to secure Workers' Compens tion overage is unlawful and shall subject an employer to criminal penalties and civil'nes up to $100,000, in addition to the cost of compensation, damages as d for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set on Is application. 1. Each person upon whose behalf this application is made & whose request and for whose benefit work is performed under rs ant to any permit issued as a result of this applicaton agrees to, & s I , in mnify &hold harmless the City of La Quinta, its officers, agents a mp1 yee 2. Any permit issued as a result of this application becomes II and void if work is not commenced within 180 days from date of issuance rr permit, or cessation of work for 180 days will subject permit to cancellation CITY I certify that I have read this application and state that the above ' • FII correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspe\ction purposes. � iynature (Owner/Agent) i - Date�'r'I BUILDING PERMIT PERMIT# DATE VALUATION LOT ()J0$-1 16 TRACT JOB SITE APN ADDRESS 52 OWNER CONTRACTOR/ DESIGNER/ EN NEER qMUCvp.19y PAM X. TRDn 014 Y PA( - 'IC rLa)D2 «{D1yE[ d 1- f'119 a °=10f0.41 ' 1719 3 TRW 401-T,r, S OCEANWEK CIA 92054 S (r_1r.*dWU:)11 CA 920,14 60p, I•(mg C.S14 1955 USE OF PERMIT :HYD - PERMIT !7>;3FS NOT INC;I. UDE BLOCK WA' J.1.;P001, A OR APPROAO,l DIRiVYWAPY' 1tf1A5'I'.iSR 41 W,/ TRACT CONSTRUCTION 1,• 81.00 PF PORCH/PA2I0 46.00 S� 0>o kAWW2,;+" ORT (U) 9,996401 5 A"C. WOOD PENCE 200.0011P ti X SK1 aT" Cogr OF Yft"MrrTfEE� NWWI t�.,Y I;`FE DI OHIT 101.000.439.318 4260,09 C'C9Hrriulk'.;"i'(ON FER,f 7,01-000-416-000 0".50 PLAN CHY= FrF 101,OW-4 t9-318 S600118 MMfE#i'NICAL FEE 1014)00421-000 $60.00 F oEC"T11.1.CALFFY, 101-000-420-000 WPM F'LI7lt D)23O FEE 101 -000.419 -(WO $130.73 STA.0140MOTION F0. - RKSID 101.00.241 �=) $$,93 ORAMHO PEP 10) -0:00.423-WJO $20.00 r)X' ',L01PXR. IMPACT FEN PRECISE,PIAW 101-()0(M, 41-343 �1ti0.Of� O 1 OTAL iSST I.1SIONJPD K✓iW Ydgy �J I♦ 3 W.74✓1 S-1,430.74 3 0 2001 LESS :PI ;-s� 1111n, I 425Q00 TOTAL � � OF LA OUINTA -NCE DEPT RECEIPT DAIEk BY DATE FINALED INSPECTOR r UJ 4l INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings —� 5� Underground Ducts Ducts �3_ Slab Grade Return Air Steel Combustion Air Roof Deck _ Exhaust Fans O.K. to Wrap �'}.� L F.A.U. Framing ig.-O'( ��1y 7 l Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall /r�J Exterior Lath Drywall - Int. Lath I • (��O ! _ Final 7/ c�- G 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 Lines _ _ _ ' S Heater Final Water Piping t®� Plumbing Final Plumbing Top Out t� Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Sewer Connection _ %% ,�I �/ B LJ"t Pool Cover Encapsulation Gas Piping (� r Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole�0� 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 78-495 CALLE TAMPICO t<5Z,1/ LA QUINTA, CALIFORNIA 92253 Address '� i n � , Owner Mailing Address ' , ? City Zip Tel. Contractor Wel- State Lic. City & Classif. F ii -, // / Lic. # Arch., Engr., Designer Address Tel. CityI Zip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7DO01 of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION Ihereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,8usiness 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 ($500). f: 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 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 doesnot apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Il 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 f7 Copy is filed with the city. 0 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., g, 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. IN Signature of applicant Date Mailing Address City, State, Zip J_ APPLICATION ONLY P tck. BUILDING: TYPE -CONST. OCC. GRP A.P. Number 77 _3-2-A V Legal Description ( /`aZk - 7 Project Description No. No. Dw. ,1Z 1 Stories Units New O Add O Alter ❑ Repair O Demolition ❑ Estimated Valuat PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS AMOUNT 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 •� s Issued by: Date Permit RQ Validated by: �11F11f� oU MINA Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION S Notice: Document Cannot Be Duplicated Date 3/30/01 No. 21820 Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE Owner NamePacific Trades Construction No. 52-085 City La Quinta Tract # APN # 773-215-014 Jurisdiction La Quinta Street Avenida Carranza Zip 92253 Lot # Type of Development Single Family Residence Comments Permit # 0103-176 Log # Study Area Square Footage 1421 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 1,421 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 iiow be issued � V Fees Paid By CC / Temecula Valley Bank - David Miller Telephone' - Name on the check By Dr. Doris Wilson Superintendent `�v j `•_' ' \~ Fee collected /exempted by Annette Barlow Payment Received $2,913.05 Check No. 15195 Signature NOTICE: Pursuant of Assembly Bill 3081 (CHAP 509, 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 G1/09/01 10:25 FAX 17608049062 COMMONWEALTH TITLE RECORDING REQUESTED BY: AND WHEN RECORDED MAIL THIS DEED AND, UNLESS OTHERWISE SHOWN BELOW, MAIL TAX STATEMENTS TO: William Thomals Buffin Power Brokers B.O. Boy; 134 La Quinta, CA 92253 SPACE ABOVE THIS LINE FOR RECORDER'S USE The undersigned grantors) declare(s): Grant Deed A.P.N. 773-215-014 Documentary transfer tax is S ( may) computed on full value of property conveyed, or ( ti) 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, James & Eileen Patton M.D., trustees hereby GRANT(S) to David Ross Miller, a. Married Man as his sole and separate propert'y' the real property in the City of La Quinta Coijnty of Riverside Stele of California, described as Lot 4 of Block 79 Unit No. , Santa Carmelite at Vale La 10 002 , and Quinta, as per map recorded in Book Pages mf Maps, Records of Riverside County, California Dated February 23, 2001 State of California ) County of On before me, ,personally appeared am c P. Eileen Patton M.D. personally known to me (or proved to me on the basis of satisfactory evidence) to be the parson(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the some ' in his/her/their authorized capacity(ies), and that by hls/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 a s above Signature of Grantoi James & Eillen Patton M.D. Form 3196.4 (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 52-085 Avenida Carranza APN 773 _ 215_ 014 B1NN0.: CASE NO.: 2001-422 LEGAL: LOT 4 BLOCK 79 UNIT S.C.@V.L.Q. .CHECKED BY: wally Nesbit DATE: 3/3 �0 � 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 7/-A Case logged and number assigned Verify legal and APN information A107— Consistent with MDG on file (as.applicable MDG filing required (5 filings since 9/3/98) Consistency with street/surrounding area: Colors Materials Architecture /vvn� S�ro�.•� r&WOEnents: »t ❑ F'lann,rcq Commission ❑ city Council —�_— Community Dev. Dept. °l Initials Case No.� ©U�r-,r .4,�P���,,,,r /!1-5ou- . (� uV c, -t- cs c�rs�7 w/s�r�9 With Conditions r .NOTE: -OVERALL HEIGHT. MAY NOT EXCEED 174", ,---TERM. CAP (2) 14"X 1 e" MEASURED f ROM 'PAD TO FINISH ROOF .�/ ATTIC VENTS ).H. 0 _. ch ,SHEAR PANEL (—.MIN. 26 GAUGE2'—B" GAL. WEEP SCREE F= 1:;t 4:--> ELEVATION SCALE 114" (6) 14"X18" ATTIC VENTS TERM. CAP PLIGHT /4063' SHEAR PANEL f.. O a O O 6 F- C Q a SHEAR P LE F 6�. Sy q .f - J 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: Occupancy Group: SFD 52-085 AVENIDA CARRANZA R 3 Type of Construction: . Owner of Building: PACIFIC TRADES CONSTRUCTION Building Official vim Bldg. Permit No.: 0103-176 Land Use Zone: RC Address: 1719 S. TREMONT City: S. OCEANSIDE, CA 92054 By: STEVE TRAXEL Date: 07-18-01 POST IN A CONSPICUOUS PLACE