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0012-246 (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 Exp. Date Date/ '�� Signature of Contractor—,' 7)­-rs-S.% 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 I am exempt under Section , B&P.C. for this reason e /• x. ' e, ) . Signature of Owner -1 a✓. -f � r 1 , k - WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ( ) :1 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. 13TIA"Ta n, N, 00044V (This section need not be completed if the permit valuation is for $100.00 or less). (v) I certify that in the performance of the work for which this permit is issued, 1'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:j 7 3- d Applicant .2 f1 F?. l -e r,-,?- -) 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. t 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. v'Signature (Owner/Agent). Date' aL7 • lf� BUILDING -PERMIT PERMIT# - DATE VALUATION LOT TRACT ALK 9ITI JOB SITE APN ADDRESS SX449 AVERM:A 1 :10 771.2-52-022 OWNER CONTRACTOR / DESIGNER / ENGINEER LINDA MAZ AR WILUAM POSSE- LL POOM9 211 C idas Di USO 56900 J.F?uC,MON 371' 11:34CiN.UM CA 92024 `,i:MMr,` L CLQ 922*74 (7Wp99-1200 C13U 1954 USE OF PERMIT MOLE FA3NS[I X D2MG SFD»PE?•R'f FAT DOPS NOT INCLUDE 3L0C:1CWtLLWP00LJL7R17X11Y.F Y APPROACH 'BRACT MNOTRUCTI0N 1",�3�.ni� gy 1?0PL'wUTIO FA.00 SE' C3d*,,4LAW 506;00 SIP MWATE J COY' OF COM M17 0111 103,507,-M Com. 1 RUC TION r. UI 101.000-418-000 $653,30 PLAN C''HWg ME 101-,000-439-318 $545.50 M OFi,. 0ISI T 101.000.439-318 42%00 r+IJP 2 1-�xt�"a21-Of1r� ��o.00 RL9CTPJ(,:83 L OW 101-000-420-000 PI.f3MBI3+4A FSE 101-000-419-000 97t ONO MOTION N Mt< - IMID 101.000.241.000 S7F 1k40 t 1� 101 -OW -423-000 $20.00 DW PER .IMPACT RIZ $1.907.00 PRFfZI,1SZ PLA.W 101'-b0*,4A 1-343 g1Co. 0o RUB-IOTAL.. STR.i3CT109 ARD PLAN CEM.0% $5,5495.33 \ IMS PRE-PAIDF't'M 4250,00 T" PEMM FEES DW NOW V2��0 �nj ®rj 1.11 p�rR '.: RECEIPT FJATE' Bi. Y DATE FINALED INSPECTOR a r rt ✓ % ,s' -.k'� t r INSPECTION RECORD OPERATION DATE I INSPECTOR OPERATION DATE (INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs f_� �� 1� Underground Ducts [ Forms & Footings U Ducts [ Slab Grade Return Air ; Steel Combustion Air Roof Deck O.K. to Wrap ,� C , C��- _ 3/ g/dZ � Exhaust Fans { F.A.U. } Framing 7y p-— 3%62�G Compressor } Insulation -- — �'� Vents } Fireplace P.L. ` Grills [ Fireplace T.O. Fans & Controls [ Party Wall Insulation Condensate Lines [ Party Wall Firewall [ Exterior Lath Drywall - Int. Lath _ t i Final�"�-- Final [ POOLS - SPAS 1 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 _ Z=�2 Z 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 i • Gas Piping I 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.L Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) Notice: Document Cannot Be Duplicated Date 1/22/02 Desert Sands; Unified' School District 47-950 DuneTalms'Road La Quinta;,CA'92253 760777.1-8515 CERTIFICATE OF COMPLIANCE No. 22850 lurisdiction Owner NameLinda Ceasar No. 52449 Street Avenida "Rubio City La Quinta Zip 92253 APN #, 773-252-022 La Quinta Permit # 0012-246 Tract # BLK9 U 1 Lot # 11 Square Footage Type of Development SingleTamily Residence Comments Single Family Dwelling' 1703 sqK Log # Study Area 1703 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;703 or $' 3,491.15 _ 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 OC/Washington"Mutual Bank'- Linda Ceaser Telephone "Name on the check By Dr. Doris' Wilson Superintendent Fee collected /exempted by Signature Nicola Wong Payment Received n Check No. C Li aim $3.491:15 985590794 U NOTICE: Pursuant to 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 'issued or on which they are paid to.the Disirict(s) or to another public entity authorized to tolled them on the Distrid('s)(s) behalf, whichever is earlier. k Collector: Attach a copy of,'county or city plan check application form to district copy for all waivers. F Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting TAii 0 4Q ul',K,rcv iig d P.O. BOX 1504 APPLICAN ONLY Address Al495 CALLE TAMPICO Building /�/ �J 0 LA 0UINTA, CALIFORNIA 92253 ((� _ `�/ 7 / Owner L /V o q C -5a /t., s 1 BUILDING: TYPE'CONST. OCC. GRP. Mailing _ 02-2— Address r ! G37�/�e-C J�'Rell © 613 - % A.P. Number /% fr�71�Q s 1zfip--)0,;l!t- 9 P t ContractoProject Description rf I Address / 14 City Zip Tel. L- (4) crime 77/-1.7G State Lic. J City & Classif. Lic. # Sq. Ft. No. No. DIN. E Size 2 f 2 Stories I Units Arch., Engr., c� Designer Z I L O ;� Ne'wl,(4 Add O Alter ❑ Repair ❑ Demolition ❑ ,Tel: �:_ .t .. Me• . - ... 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. SIGNATURE 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:cAny city or county which requires a permit to construct, atter, 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 thabhe is exempt therefrom, and the basis for thealleged 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 (5500). - I: I, as oner of the property, or my employees with wages as their sole compensation, will do the wowrk, 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.) ll 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 whocontracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) 1-1 I am exempt under Sec. B. & P.C. for this reason Date Owne 1-•!!r �.0 �iil cam+! -yam 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 n Copy is filedwiththe city. O 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 ($100) valuation or less.) I certify that in the performance of thg work -for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Ihereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and issubjectto expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives sof this city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip w Estimated Valuation PERMIT AMOUNT Plan.Chk. Dep. ZSt� u Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading !” Driveway Enc. Y infrastructure r h t s TOTAL *^-- REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR ` Issued by: Date Permit Validated by: Validation: DLC 19 200�'� 3 WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISIO•' T * fir LA Ue j , y Escrow EQ ra r q� qcr C O WHEN RECORDED MAIL T0. LINDA M. CEASAR oCQ : 78-365 Highway 111. 1142 Uj co U co s La Quinta,, CA.92253 W$ or Uj's LINETOR RECORDER'S USE MAIL TAX STATEMENTS T0: , j DOCUMENTARY TRANSFER TAX$..-Q.-::.VES�,�)`I�r.•••GA}��E• -^ Computed on the'considerat6n or value of property conveyed; OR• same as above Computed onthe consideraticn or.value,less liens or encumbrances remaining at time,of sale..; Signature'of Declarant or'Agent determining tax --Firm Name tlPN '173—Z5Z-�L`Z--• GANNT'DEED FORA VALUABLE CONSIDERATION; receipt of which is hereby acknowledged LINDA M. CEASAR, an unmarried woman hereby GRANT(S) to LINDA MAE CEASAR; Trustee of The Linda Mae Ceasar separate property Revocable Trusts ated July 3, - 1986 V)the real property in the City of ; La Quinta v. County of Riverside State•of California, described as RN Lot 11 in -Block 9 of .SANTA'° CARMELITA AT VALE LA',.QUI°NTA :Unit No, 1 as.,per map recorded in -.Book 18 .Page 46 of- Maps, in'the office of the County Recorder of Ri_'verside' County; C1 a.fc,rni.a: d. TIrst Amektin ?itle Company has recorded thni instrument:by,'eQuest as -fan accomrtiodetion only and has notexemmedait`ta� ropulanty and siifflctancy;or ea to is effecf upon'tha trthi to any reel pmperty ttiaf nre>;`fit described herein. Dated_ February 15, 1994 7-/ v„ } a easar STATE'OF CALIFORNIA }ss. COUNTY OF Riverside } On February 15,_-094, before me, Candice E. Davis personally appeared- Linda'M. -,C6' sar personally known to me (o onK:. ev+esase)-to be°the personj4whose nameois/ar ubscribed toythe within s � r taNQicE F: pns instrument and acknowledged to me thk'4 a/shelf " executed the same. a } A x:'#.997175 in #+ie/her/tbei authorized. capacity tyeS� and that; bye/her/t#a signs '. +S N '�a �JUIEORPWI . Fursr�de Count'y turejs�on the insnt the-person(�jor the entity: upon behalf of which " rti, tV�►tCorren.Etreslurl:13,1997 tfe person(Wct ° ; ` outed tfie instrument '' WITNESS m nd offcial seal. his area for official notarial seal Signature R ) MA -T ATEM6 iS AS DIRECTED ABOVE 1002 (1/91) 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 explanationsas necessary. APPLICANT X. R.. Roger's SITE ADDRESS 52-449 :Aveni:da.Rubio APN 773 - 252 - 022- BIN NO.: 71 CASE NO.:- 2000-379 LEGAL: LOT 1 BLOCK 9 UNIT 1' S.C.@V.L.Q. CHECKED BY: Fred. Baker DATE: 0 Inform the assi ned-Bui�ldin plan checker ---upon` our'assi nment to this case. .The C� utive g g P., Y g ._ / Secretary maintains a log book to track applications and assign case numbers.. REQUIRED ITEM Y R N coENT/TO�� s 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) to,ean. G Gym �r Consistency with street/surrounding area: Colors Materials o Architecture Other Requirements: } h (Z' G r e-� (614, ".( 10 - CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVE® DATE Ste`` O BY )wCATIOItarso . f4e pforgn-s-ppc-- -- ►1-z%Io2 Certifica-te-of Occupancy City. of La Quinta Building and"Sa,fe"ty-Depa:rtment This. Certificate issued pursuant to the. requirements of Section. 1~09 of 1he Uniform. Oui/ding CQc e,_- certifying -that,. at the time "of.issuance; this s ructure was in corrip/iance .with the various ordinances of the :.City regulating building cons#ruction-- or, use... For the following: BUILDING ADDRESS: 52-4'49 AVENIDA RUBIO _Use.Classification: SINGLE FAMILY DWELLING ' Bldg Rermit'No.: 001,2=246.. Occupancy Group:' R-3 Type ;of .Construction: VN - Occupancy Use Zone: RC Owner of Building: LlNDA-CEASAR Building Official Address: 211 ' CALLE :DE SERENO City: ENCINITAS, CA _92024 By: RICHARD KIRKLAND Date: 07-11-02 POST IN A CONSPICUOUS PLACE