0102-162 (SFD)CO
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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
�Daate r° ' - %` 'Signature of Contractor ti
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&RC. 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 Policy No.
STATRFIAM 1280150"1-01
(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
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with?those provisions.
Date: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 compensatio1n, 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
BUILDING PERMIT PERMIT I/
DATE VALUATION LOT Oil 02-162' TRACT
°V21,1011". tv£r)ms. I
JOB SITE
APN
ADDRESS
52-92Di�'�El�ei'�rA CA1,�'�.IZA, WIA '
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OWNER
CONTRACTOR/DESIGNER/EN IN EER
PACIR TR/,•i.1J.':.a COW1w117MCM014
PACDW TRADES C~`•i1'.�e�'ZTE.1SCMON
1719 -5 IREMONT
)? 19 U TIUM.011TIr
N OC:R,&MC3,:S CA. 92054
y 00,0193TUE CA 92054
1760)967,0069C tEk 1955
USE OF PERMIT
SRP) . PF.RMiT DOME 140T I: WY.U.I. F BLOCK. T*",t#f.;f, P0.0)J.,PAJAPPP.0ACH
1'Ft.d'>•CT C0148'IRUCTI N 1,421,00 BW
PO£R4::1.1'dM`10 36.00 St'
WRAOFAIARPORT (-'W) 01996.00
UnIUMD COW Or, COWSMUMION
MmIrlt+'33:E r MMf3RIT
C'CyMMUC� �`It4g41" RIZ, 101-000,418-000 $394.50
P,LAX CHFC K FEE 101 -CO -439.318 $300.12
I IMCIP 4NlC AL FY2 101.000,421.000 UOM
R19CTRIC; AL FrY, 2 0) _000-<4."'.t}-t30ti $129"M
PLYLIMBING ."MR, $110.7.5
=1'1 DWO MOTION FM > It', SYO W3
011A,C 100 RY, 101.000,423.000 $20.00
139I'38Ir'.t,CIPFiL E@a9PAC T :qM1 $1,007.00
P 100.0 CPAs, 101-0+00-441 x434,' ; $160140
1IRB.11KPOWT 101-000-4.39-318 4250.00
fig®2?�B, •' ` AJ. C:'0i>�'+1tRUC".tTON AND
$3,430.14
pk��.q. �C�1��.4':K (�� �(
FEB 221001 , �3 a Y . DTJF-NOW
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RECEIPT
DATE Y r ;
BY -"
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Q'
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
-� Z –O ( s�
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
S"%
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath _7+
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
Gas Piping-
ipingPLUMBING
PLUMBINGAPPROVALS
Gas Test
Electric Final
Waste LinesL
l �O�
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)
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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
425381 T3 07/31422
Date Signature of Contractor
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 STA a'1? 11`UND Policy No. 1280990.01
(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
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: 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 Ouinta, 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) t Date
BUILDING PERMIT -PERMIT#
DATE VALUATION LOT 0102-462, TRACT
U',1l22n" G r941�. iJl
JOB SITE
APN
ADDRESS �i_920 AlTIMAf1,CAH`1?,AA7fd.
��`J
773-322-OM
OWNER
CONTRACTOR/DESIGNER/ENGINEER
PA,01KC :.VPA*0E3 C0N;a7'IRT. (M_ QrkT
PACU4C 1:1 M)ES C0NOTRUC1709
1719'31.=.M0 TiA
1719:'XKHMONT
8 U'C,"�'•r'? IWI DE SLA 92059
8 YXC'EAN:�'T E CA 92054
(760)967-0069 CBLO 1955
USE OF PERMIT
er3]NGLEI RAMM 79MIM0
;SFD " Y'UMIT ;?OPM 140'1' INC:LUDS $LACY.: Vi%A1..t.dPO0LJ'aPAIAPPF2.t: A� H,
DRFVy 9WA Y' -MASTER 3. i (09 ,100DR)
TRACY CONSTRUCTION 1,421'0' 31'`
1~OR"aHWATIO 36.(Al Se
(IAR2 OEICARPORT (14, 01"6.00
3 FT. WOOD PPINCLe 200. DO 1,P
11rS"211?1<. M COST OF 0:1NNI"' UC170M
a9,33'. to
PYRA FL% S'�@ M]AARY
CONSTRUCTION Fn, 1.01.000.4-10.000 5$04.50
PLA14 CHWK FEE 101-00W-439-318 $300.1.2
MECHANICAL FEE 101.000.421-000 $60.00
'1
I lXCiR1Ca.L :FRE 101-000-420.000 9;19:4x4
'z:
r 1.UMBINC11?Ft 101-DOO-419.000 $110.75
ST'ILONO MOTION tiF. E • REBID 101-000-241-000 $3.93
ORAD §4O RE 101.OW-42:3-000 $20.04
171 )SEWPU IMPACT PEE $1,907.00
rPREC13E 1'L4N 10143i 0441.345 $100110
7FZ OXWOSIT 101_000"439-318 .$350.00
SUB-Ta1"AL C(3W,C13.I3-711),' IM :4 Ly.a�l°��c��p.ITIe��:,,.'(('1
.� {{��](��t�. q{
1d4r4.T1�Y .t:.xV/rM1'.P.' R'R.4Li'' :R'.L". S
�uyj�,.p.//3���Q�.'Y����}}t►�
-!I.250A 00
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RECEIPT
DATE
BY
DATF FINnAL D
i Ae� o -/
INSPECTOR
INSPECTION RECORD
r.
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
. O /
Exhaust Fans
O.K. to Wrap
.p/
F.A.U.
Framing
, p
Compressor
Insulation
p
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
. / �" "
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_
3-��, /
Encapsulation
Gas Piping
Gas Test
_
• Q�
Appliances
tY—
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)
. Q
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
Date 2/22/01
No. 21686
CERTIFICATE OF COMPLIANCE
APN # 773-322-009
Jurisdiction La Quinta
Owner NameDavid Ross Miller
No, 52-920 street Avenida Carranza
City La Quinta zip 92253
Tract #
Lot #
Type of Development Single Family Residence
Comments
Permit #
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 now be issued
Fees Paid By CC/Temecula Valley Bank - J. R. Rodriguez Telepbgne
Name on the check
v r Y
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Annette Barlow
NZZ" 1^
Signature
(/
Payment Received
Check No, 14821
$2,913.05
10710E: 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
;ollect them on the Distrid(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
s
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 527920. Avenida Carranza
APN 773-_ 322 _ 009
BIN NO.: CASE NO.: 2001-400
LEGAL: LOT 18 BLOCK 157 UNIT S.C.@V.L.Q.
0
CHECKED BY: Gree Trou sde 11 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.
/_0kZIL s/ 9°
REQUIRED ITEM
Y
N
COMMENT/CORRECTION
Compatibility Review
Case logged and number assigned -
Verify legal and APN information
Consistent with MDG on file (as.applicable
MDG filing required (5 filings since 9/3/98)
Consistency with street/surrounding area:
Colors
�ive
Archito
Gas
Other Requirements: EXh�
e
b
m
S10
09 h
th (',
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.9ept.
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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
52-920 AVENIDA' CARRANZA
Occupancy Group: R 3 Type of Construction:
Owner of Building: PACIFIC TRADES CONSTRUCTION
~l d�
Building Official
Bldg. Permit No.: 0102-162
VN Land Use Zone: RC
Address: 1719 S. TREMONT
City: S. OCEANSIDE, CA .92054
By: STEVE TRAXEL
Date: 06-21-01
POST IN A CONSPICUOUS PLACE