0002-099 (SFD)LICENSED CONTRACTOR DECLARATION
I heleeby 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
595754 6 C9 06 30 20f
Date ? t A t Signature of Contractor f ii//All I • l
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 3'700 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.
STATE F1UW.D !.P,111, (in 11090
(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. J
Date: Applicant—
Warning:
pplicant 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.
Signature (Owner/Agent)_ • '� �iA / Date '3 -1 4- 7✓nj
1_.-_-_..11 —
? I�IJ«v BUILDING PERMIT ~ ' PERMIT#
fDiJf)2_099
DATE • VALUATION '.^9e��t� x .10 LOT TRACT BI WL (J17
JOB SITE ADDRESS 52-•905 A V•�i�l, H.: A RUBIO
APN 773-312421
OWNER
CONTRACTOR / DESIGNER / ENGINEER
V A 1'.1 'Dn{3 TuTargC
l.-7. \,�'./Al•AA's £FIs. /.lrl.Ji,aa
pA°Y l�fin"[C'T}�i't�•1^ifiT.i f'�!'i -
�l-^i.r..�l..,r.•: �:{tJwtJ \. calJ.iv .,,•../ ..
1'C) 130d 134
odl E It OSS
I,A C;1JIN'1'A - C.A 92253
E'1:, CENTRO CA 922=1.3
(76M351_9772 r,'111. . 55Y7:
USE OF PERMIT
ti�IVi.iL•Fs h'Att�ILi.1' L)C+ViJl..Lu'�#i:P•
;
JI- - Pi:l`<i IT DOESS NOT fl CLUDE BLOCK WAj,LS Vif POOL (LQ13 S -i
TRAt �C1 C Clv aMUl,: 1'�.OW L-121.00 3l'
'IZACl-i PATIO 35.11+) SF
%J,&KAQ1XAJ.kV )R'1' 5110.00 :5;:''
5 1•-T. WOOD 1•-1.� NCE 200.00 LF
fA' ii'D.1�Jptl ki:8a i�°+.� T vOlia% '�.:aii ia7•�r Y.I.v�Aivi��
991125130
CQNSTRUC.TION F.E13 101-000-418-000 $59+4.56
K. AN CHECK F'FI� 101-000-4:19-3 ). R $5A10 IT!
.r.,,-'
i'.:s
4
1-16C•t!'eIC Li.. FILL; lul ilihi-.42Ci►-r3ti0 $i:ty.24
PLUMBING ISE 101.-0100-419-000 $110.71
4
OR Ai?dNE'r F'r, , 11) 1 -000 -423 -OM
L)EVEICIPER IAV ACT I ET,
PREC.1.3h_ PLAN 101-000-441-345 $IUU.uU
'a
14 ' U.EI�C)51'1' 1014)(1-439-:+ltd
S1.11 :X T'.A f . ('QN45M.t K:'TAND0N ANP1,AN CHI CK
X164'? 1 -16
LESS ly:'.E-a .611.`/ FEFIS
6'()•1'/al.. 6'1N.NI T's+"VY-S I: UEf!:NC11i'
RECEIPT
DATE
/6
Y,4
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Z'
Ducts
Slab Grade
7-
Return Air
Steel
Combustion Air
Roof Deck
3 -3 1 - CXR
Exhaust Fans
O.K to Wrap
C/ —14-.& v
F.A.U.
Framing
5/- d, po_
Compressor
Insulation
l�- �(o - 0C)
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
G'
Final
Final ZPOOLS
- SPAS
BLOCKWALL AP ROVAL
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
r. , Qo
sr
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
�Z�
'Z
5
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
3-31-00
S.
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
3-1
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)
Building
•
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Mailing " I
Address
City lZip
Contractor
%ity P
State
Zip
;Z Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm tha6l'�m licensed un er provisions of Chapter 9 (commencing with Section
7000) of Division 3 p"9 the Business and Professions Code, and my license is in full force and.
effect. I`—dI/ll/t_ I— -I—I.C)�
OWNER -BUILDER DECLARATION
I hereby affirm til t 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
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
file 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 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 ($500).
1-2 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 or 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 or sale.)
I l 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 confractor(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
1`7 Copy is filed with the city. ❑ 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 (Ef00) 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 or 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 it 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 applicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE'CONST. / OCC. GRP.
A.P. Number 3 7 -- r) 7.1 ri-ix 0 } 1
Legal Description L4-7rr 9, Btaut 1'"th) U"rr 1-7
Project Descriptions ✓ G t € ► aka+ k Ly � !>• x, rE+-
Sq. Ft.
Size 14 Z
New
- 1 t.
No. No. Dw.
RtnriPc 1 Ilnitc
Add ❑ Alter ❑
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
Repair ❑ Demolition ❑
AMOUNT
t
City
L
Zip
Z I_eS
Tel.
-I 60 1611 —
State Lia
& Classif. �.�
City
Lic. #
Arch., Engr.,
Designer
Address
Tel.
%ity P
State
Zip
;Z Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm tha6l'�m licensed un er provisions of Chapter 9 (commencing with Section
7000) of Division 3 p"9 the Business and Professions Code, and my license is in full force and.
effect. I`—dI/ll/t_ I— -I—I.C)�
OWNER -BUILDER DECLARATION
I hereby affirm til t 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
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
file 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 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 ($500).
1-2 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 or 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 or sale.)
I l 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 confractor(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
1`7 Copy is filed with the city. ❑ 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 (Ef00) 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 or 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 it 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 applicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE'CONST. / OCC. GRP.
A.P. Number 3 7 -- r) 7.1 ri-ix 0 } 1
Legal Description L4-7rr 9, Btaut 1'"th) U"rr 1-7
Project Descriptions ✓ G t € ► aka+ k Ly � !>• x, rE+-
Sq. Ft.
Size 14 Z
New
- 1 t.
No. No. Dw.
RtnriPc 1 Ilnitc
Add ❑ Alter ❑
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
Repair ❑ Demolition ❑
AMOUNT
t
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
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
Notice:
Document Cannot Be Duplicate
Desert SandslUniFied School bistcict�
47 950 Dune.Palms'Road
P' r
La Quinta; CA 92253
Duplicated
760-77,1-8519'.1
CERTIFICATE``OF COMPLIANCE
Date 2/14/00 APN # 773-312-021
No. 20021 Jurisdiction 'La Quinta
Owner NameLa Quinta Partners 'Permit #0002-099
No. 52-905 Street Avenida Rubio
City La Quinta zip: -.-92253
Tract # B170, U17 Lot # & Square Footage
Type of Development Single Family Residence
Comments
Log #
Study Area
1421
No. of Units 1
At the present time, the Desert Sands. Unified School" Distriet doe's,. 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:
r
EXEMPTION,^ NOT' APPLICABLE
This certifies that schootfacility fees imposed pursuant to Government Code 53080 in the amount of
1.93 X 1,421 or $ 2,742:53 the property -listed above and thgbuilding
permits and/or Certificates of Occupancy for this square,footage iirthis proposed project may now be issued]
Fees Paid By CCNalley Independent Bank/Agustur}Paz Te�ep§one
Name on'the check -
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Mary Ann: L. Boa ' :': Payment Received $2,742.53`
Check No. 209653
Signature
NOTICE: Pursuant of Assembly Bill 3.081 (CHAP 549 STATS. 1996) this will serve to notify you that the 90-dey 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 orinstallation pard for;this project Is sssued'or on whi` h 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: t %�
Y
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
Pf?COfd;r�i� �?:{E�,e^t d By i-1/62/2996
',U 1`99,.9-481943
C r7 Pvl h�A PV'Y
C 1'1`/02/ 1999 08 : 00A Fee :6.00
F'iIC.�GtJ,TJ7. :_ Page 1.of.'1 Doc T Tax Paid
RECORDING REQUESTED BY: Recorded In'Official Records
Gounty,of Riverside
CHICAGO TITLE COMPANY '.COMPANY Gary L. ;Orso
99.9179KC 9.7057191 Assessor, County,Cierk 8 Recorder
WH�a R�A��. �S EO�ND I11111gg IIqq .11�L TA� TEMENTS ��:
M I $ I U - .FACE I SlzE . ,I -DA• I PCOR yIOCOR I SMF .I IASL.
WILLIAM. THOMAS BUFFIN
P. .4 BOX 134
LA QUINTA, CALIFORNIA 92253
. - A•,..I R_,,_I,..cC .I COPYl,ONC REFUND NCHG EXAM
,77 3-3i z
63RANT DEED, "52 46� AVWMA 12va►o - --
The undersigned grantors) declare(s) j c
Documentary transfer tax is "515.95
(XXX') Computed. ori full value of pr.o�erty conveyed., or
( ).Computed°:bn ful1:value less liens and encumbrances remaining :at time of. sale..
(41A*i. Unincorporated area.: (:x' ). City ;of and
FOR A VALUABLE CONSIDERATION, receipt of. which is*here:by acknowledged.
,DOROTHY R.:ARNOLD,
hereby GRANT (S).to'
WILLIAM THOMAS BUF.FIN, AN UNMARRIED:MAN'DBA LA QUINTA_.PARTNERS,II
the.real property in the City of LA QUINTA,"County of Riverside, State of California,
described as:
t A. Block 170, Unit No- —1 , Tract Santa Carmelita at Vale La Quinta, as per map
recorded in-Book'19, Page(s) 19-20 inclusive, of maps': in the office of .the County
Recorder of said.,County.
Dated September 17, 1999
State of California
County of (os A-n,ie-teS. } S.S.
on >e,21p,ai.b-e r- .30"
before me,,. j) -(,,,a_ 6a.tc ..-e- ,
persoha.11y appeared
,personally known to (or proved .to 'me ..on
the basis of satisfactory evidence) to:be.
the person'O whose,name(sJ is/aiL .subscribed
to the within .instrument and acknowledged tc
me that•#e/she/t-hep executed -the same'in
ins/herdt4 e, i_r authorized capacity ( isms) and
that by tis/her/their signaturetsi on .the
instrument.the person(` , or the entity upon
behalf of which the personN acted, execu.t'ed
the instrument.
WITNESS my hand and official seal:
Signature
'( MAIL TAX.STATEMENTS TO:
DOROTHY R. RNOLD
AQ4 aJA•C.M16<IA:N I''C�?N Hf.YG �4d.00 POQKM�Yi�ee
-v. �!. # 121. 2 ;821
R
NAT
s
2
lC . d'GELf S COUNTY
J,me.11; 2003
0
U.:. C.:al.c=.:a..•:.��:}.c9c >v Cfum/I Pfl n:+u 4r N@ S n a .
(This area for official notarial seal)
RC DISTRICT. PLANNING REVIEW FORM I 0 RfC'p
BUILDI
This form is to be used' by CDD staff-'forreview of:siilyngle fam"dwellings:in the;RC (Cove ResidentiidT Ery
District, in order to. determine .the applicability of compatibility issues, or need ;to require the filing of Master
Designs:Guidelines by the applicant .If shall be aransiutted fo the Building and Safety Department as your
correction list.' Please attach additional:-explanation's as necessary., z
APPLICANT La Quinta--Partners
SITE ADDRESS. 52-905 Avenida Rubio'
APN 7 73 _ 312 - 021. BIN N04 CASE NO.: 20,00-189
LEGAL: LOT'. .8 BLOCK - 170 UNIT 17S.C.@V.L.Q.
CHECKED BY: Greg TrousdelT y. DATE:
Inform the assigned;,_Building pl'an,checker,,upon;,your'assidnment to this, case. The CDD Executive
Secretary maintains a'log book- to'track.applications and: assign case numbers.. 4
- J
REQUIRED.ITEM` Y N . COMMENUC RRECTION
compatibility.Review
Case logged and number assigned
-M
.OP
Verify legal and APN"information
Consistent with' MDG ;on file (as applicabl XN
MDG filing required t(5 filings�since 93/98)`
Consisten t�reet/surrotinding area
\� Colors
�. rf
°�� ✓ _ j :�,rj� �N`( Materials
Architecture
l
. a
Other- Requirements:
hr..
,*-'Certificate
Cer'tifica4te of 0cc.0 ancyT.
-
Cit 0fLadu ton.
Bi�Id�n: and Safe;V. ={
9.1rtment
This Certificate issued pursuant fo the requirements ;of Section, 109 of;the 4Uniform:gui/ding. Code,
certifying that, at`t/ie�Nhe;of issuance, this structure..was in comp/fiance with the various ordinances:.
of the City egu/ating.bui%ding`constructio i or use. For the fo%%wing: '
- BUILDING: ADiDRESS. : 5.2-905 -AVE IDA RUBIO.y
Use Classification' _QP ' =61d rPerrnit 'No 0002-099j
POST IN A CONSPICUOUS PLACE
ro
Occupancy Group: _ W3,,... Ty'pe':of,Constructio:n: VN ` . Land Use Zone: RC74
Owner of Building: LA QUINTA,PARTNERS Address: P.O.. BOX 134
City:,. LA.- UINTA,` SCA. ,92253.
.
..By: STEVE TRAAL.
Date: 06-07-00
Building Official
POST IN A CONSPICUOUS PLACE
ro