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0104-288 (SFD)N o�Lf) r; LU r� IX O Z r` (CD 0 H� CD J ~a U) Z 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 r� /f;�3 J;'y 06//3012( fate �` ^ ^ ^'Signature of Contractortip ` J —i 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. Se. �) I have and will maintain workers' compensation insurance, as required by ction 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., SIATrE FUND M-00 IMIT 00110% (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 Se tion 3700 of the Labor Code,,I shall forthwith comply with those provisions. Date: Applicant 4 Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is'hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or ursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for, inspection purposes. r S�nat r O /A ent) f { Date BUILDING PERMIT PERMIT# DATE VALUATION LOT 0:04-283 TRACT SMSM.ICD lt! I i.t 30 JOB SITE APN ADDRESS S4-94.5 AW.KDA (�ARNUMA 774,2".072 OWNER CONTRACTOR/DESIGNER/EN &NEER Jeed++iyyXE'���tiMgqk�pp,,,&��,�yy�.AA�9pph��: PAZCON"IrrRTtIK",f,'i'.y�U}^��i yP�AZ- x'2.995 AV.WTIi B'Sl.Y'�.'r1Y.16'� ZA gE�..-U/�ry � 52-9g:�,t'"i�Fd:..`�V)DC1.1YJd:.s%3tJ_/VLAE�u LA c 0110;A Cdr 92,253 LA QT:.i`.�'I'A CA 92233 ;7Fri9)5 4.3023 MIA 5.537 USE OF PERMIT �W�}j.rN r���ISWJ-1iVR .L.' 1y.^.n' 7.fd.tt)Y ♦J it D-PE'Rl>, IT EX)ES'NOT MC;l.%f.70it. >`f1,LIC:KWilAI•fZ F:)::.1V1?WAY APPRO.PACa$ ' l°!� ��!��'�, �JXA 9`�1:� `t�'.�v� t'•/5::. ,, a a:...1 . • TRACT CUlklS'1'&OCfION 1;ld0 f1g Byl \ b'ORC,"144PA 1'IO 40.00 5p 5 FT. T't"7t)OD ' I N-34'CE 200.00 U? GARACIP. 489.01) N F.11 +? ;1:.fd) �'�? T �) ' C:`43.t 1X►"iXC:` `5.4 D S �e .:Z47 iCNSTRUC'ICfS FHR 101-000-418-000 SM -00 PLAM 4HiCK*EF . WK 16 101-W)-421-000 9610 LqJXC—r1C.(C./ L FFR 1 G'1.000 -420-0(X) $120.84 PL$.['MUMO."IF, 1.01.000419.000 W215 S fR 013140 .HDTION FBM - REEK) 101-000.241-000 $14.99 CiU;03NQ17FM 101-000-423-000 $20.00 D7E�,'Lr&LO LER IMPACT Pitt a $1,.W1.00 PR-F:t°ISI P1AM4 101-000-441--345 $160..00 'tIC.' loyl AM III" CHECK $3,510.64 1".3 PRE -PATS) 117,13,96 a 250.100 J .6 FFMIX d �I'r26 DVE NOW APR2�� A CI f MANCE DEPT EIPT DATEBY 2 DATE FINALED INSPECTOR - r;t t tK al INSPECTION RECORD 4 OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings _ Underground Ducts Ducts ,/�a Il Slab Grade S Return Air - Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap Framing n —.0 t_ l..r / F.A.U. 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 APM3ROVALS 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 Waste Lines _ �% Electric Final Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Sewer Connection Pool Cover Encapsulation Gas Piping Gas Test �/� /Q�� t _ Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole o O/ 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) -17r/ 1 - 1 7 3� I� 0 A i b Building Address Owner --I Z., i1`4-j I, - Address '62 ` q q S av cs FEE City Zip Tel. � , Contractor Address nu c Iv{ ra r_10_Llb- Zi p Tel, State Lic. city. & Classif. lGt s ��t iLic.# 3 a 5 -\ Arch., Engr., Lh Designer St �`ry Address Tel. City Zip 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 effect. 51r,NATURE DATE OWNER -BUILDER DECLARATION 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 parmft fo construct. atlee. Improve, demoffsh, or rapmr any structure, p1101 to 4:r Issuance also, requres the applicant For such permit to NO a sryned stafamenr that he is licensed pwsuant in the Provisions of lire Conrreclors License Law, Chapter 9 (commancing with SBchbn 7000) of 0/06forf 3 of the eusrnesa WhI Professions Code, or Ihaf he is exempt therstMM. and the bsais for the alleged exemptlen. Any vioialkm of Seclloa rd31.5 by any applicant for a permit subjocfs the appff"m to a cive penaity of not male Than five hundred dollars ($500). F] I, as owner of the properly, 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, Bukooss and Proress+ons Code: The Contractor's License Law does nal apply 10 arr owner Of p1werty who builds or rrFpeovas thereon and who does such work hfrnsoff or through his own employees, prodded that such "Ptovemsntg are not intended or offered for safe- ff, nowaver, the building or Improvement Is Solo wllhln one year al Completion, the owner-buNdor *0 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 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 ) 17 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 - _ r7 Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE t Thra section need not be completed if the parmif is for one hundred dollars (S1o0) valuation or le s s -J I certify that in the performance of trig work for which Ihis permits ia.issued, I shall not employ any ppeerson in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT., If, alter making this Cadllrcale oT Ex tml you should become subject to the Workers' Compensation provisions of fhe Lebo L`cdo, you must forthwith comply with such provisions or thfs permit shaft 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 1 have read this appllcatlon and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building conslruction, and hereby authorize representatives -of this city to enter the above - mentioned property for inspection purpoaea. Signature of applicant -Date- Mailing Address City, State, ZIP 4 Qd4m I IC 9 P.O. BOX 1504 APPLICATI NLY 78-495 CALLE TAMPICO —� Lz% OJ?s,J 7 -,, LA QUINTA, CALIFORNIA 92253 11LDING: TYPE'CONST. OCC. GRP. P. Number") - 2 - Z Z gal Description - •__�' 10 o t_ Dject Description L zt -kr-i '- 1-_ •.. L� 1rT to rIF� r, Sq. Ft. `�y . No. No. Dw. Size 1 l fStories Units New i3, Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I- Grading Driveway Enc. 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 Sid ack fromnope y FINAL DATE III Issued by: Date_ Permi Validated by: APR _. 4 2001 Validation: UINTA FINANCE DEPT 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 4/26/01 APN # 774-294-022 No. 21948 Jurisdiction La Quinta Owner Name Augustine & Eva Paz Permit # 0104-288 No. 54-945 Street Avenida Carranza Log # city La Quinta zip 92253 Study Area Tract # BLK309 Lot # 10 Square Footage 1788 Type of Development Single Family Residence No. of Units 1 Comments 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 1,788 or $ 3,66.5.40 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 / Valley Independent Bank - Augustine Paz Te,ephone Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Annette Barlow Signature I J.vvyq& Payment Received $3,665.40 Check No. 244507 JOTiCE; Pursuant of Assembly Bill 3061 (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 rbave 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 ;ollectthem 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 ay �` o w BERMUDA DUNES r RANCHO MIRAGE a ►" INDIAN WELLS PALM DESERT mb S LA OUINTA 30 INDIO �7 Desert Sands Unified School District 82-879 HIGHWAY 111 0 INDIO, CALIFORNIA 92201-5678 a (619) 347-8631 City of La Quinta Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 December 10, 1985 Re: Avenida Carranza, La Quinta, Lot 10, Blk. 287, #26 Gentlemen: The developer of the above referenced lot has mitigated its impacts on our overcrowded schools by payment of the amount of $628 per unit to be applied to the cost of district educational facilities made necessary by such new development. Sincerely, '� L -�. ,I '— J-1�1 John D. Brooks Assistant Superintendent Business Services JDB/crm a in c 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 PAZ Construction C9r u mmc i) SITE ADDRESS 54-945. Avenida Carranza APN 774 - 294 - 012 BIN NO.: CASE NO.: 2001-447 LEGAL: LOT 10 BLOCK 309 UNIT _ S.C.@V.L.Q. RECVD FOR PROCESSING 11-1 CHECKED BY: Wally Nesbit DATE: (DATE) ASSIGNED TO Inform the assigned Building plan checker upon your assignment to this case. (IWWIDD Executive Secretary maintains a log book to track applications and assign case numbers. REQUIRED ITEM Y N COMMENT/CORRECTION Compatibility Review c/ i✓ �jt 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) Z-f,.ck "y-,I� .f4VL- Consistency with street/surrounding area: Colors Materials Architecture t/ Other Re uirements: g Commissiorat.. .uncil 't DeY. Dept. z `7 —r 7tials c. ©� - '113 -- �---' -- Exhibit ----- �With Conditions - 1it0 - . �I.,,.. ---1r -- --. - . O O C •O,, CCb 0 CD (D cC) CD •�' n ~' 0 C:� \, c: 0 z c��� �' D C cn w m � CCb cn C oz cn `a' * c 2 m .. � O R° O v D o y j C ocn D � lb•�? � rim% O zN 0 C CD D O 1+ O �' Q Z o zz C Cb 0 -Ph ,CCb 'y CCb O C cn Q- < ° o ram- p ED CD Z z y m 0 � � c � cb �' cb n -i 144 D N C7 O :3 m r v CC)m C D v A � o m � D D< o 3 z C o m N N m m z o z D o � ° a `D n D .. N v � 1 1-1 - -\ —' w o N , 3 D 00 00 Op f C,� y `CD i sr' "4 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: R3 54-945 AVENIDA CARRANZA Type of Construction: VN Owner of Building: AUGUSTINE & EVA PAZ Building Official Bldg, Permit No:: 0104-288 Land Use Zone: RC Address: 52-995 AVENIDA MENDOZA City: LA QUINTA, CA 92253 By: STEVE TRAXEL Date: 09-17-01 POST IN A CONSPICUOUS PLACE