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9811-141 (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 /�. • ci5�303 E3 i 1/3t3�rti0 vDato % 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 SeC,tion 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 F f,NI ) (This section need not be completed if the permit valuation is for $100.00 or less). ( ) 1 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 worker (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. oC arte: -- Applicant . + 7- -. K ♦v..y.. 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) "I f Date %- c. PERMIT # BUILDING 'PERMIT y DATE VALUATION S".33L20 LOT q TRACT/4,- /Cl ,3IR CY JO ADDRESS .ria -445 AVF3410A Rifi110 APN •\: r7�072-�:jg OWNER CONTRACTOR/DESIGNER/ENGINEER WII.I,IA ITRIITI3L1? TRICiBLE CC7NS'17RUCTION CO., INC. 80-655 AVENUE 43 80-655 AVENUE 43 INDIO CA 9220.1 INDIO CA 92201 (760)141-9755 CBII# 5291 USE OF PERMIT :§NGLi: I+�> 1v lig Y lli r i,i..iNi3 R iFO - PERMIT DOES NOT INCLUDE BLOCK WALLS OR -L PAID � R 91999 trLA °1' CONSTRUh'"I lON 1,612.00 1") 17 -.1-Ty 1� �y PORCHiPA'! ick 215-KII)0 3F 427AKi `F EI'STiR,rME D COST OF CONNST ROC'TION 99,332.20 9'.I;1iA3AT PEW S UAWA1} Y ct)NS"1'ttllf"t'lc)'i�SFEE 101-000-418-000 �(i39.5C► P1 AN ("11Fi X fi T; 101-f1t3f)-434-319 FM. 11.0LLOsi'f,!05•0(X5-4.39 318 -S vgD.OK► NlliCHANICAL Fal 101-000.421.000 Srti�i,ilFi 1:1.3;71TOCAL FFX 101-000-420-000 5128.46 PTJm1fNQFtIP I11141f .11Iq_ATf) RIrR71. Sl`ttC:NG MOT[ON OEM, - I'.E.SIV 101-000-2>x1.-000 59.9.3 OCtrej IND Fil 101-000-423.000 1NFRA,14T_2UG'1'tYRL? FIX 22,`-(113)44:0342 X2.4.57:;7 PRVC-INF Pf AN 101-000-441A41% S1far?t(at :+IJP TC:iFA1, C(:iN,WRI ICFION .ANO PLAN C'I IECK JXSS PRE -PAID FEES 4250.!30 'i'C1 FAI, .PRkM1 T F 16'M DUE NOW $.3,5341.96 It, RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERAT ON 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 Exhaust Fans O.K to Wrap F.A.U. Framing =��— $ ? Compressor Insulation - / Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulatior Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. lath S Final ! 5 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 - - , Encapsulation Gas Piping Gas Test /f-1 i 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) Building Address GGG Mailing Address 9/-) — Zip T4&t 4 4 " P.O, BOX 1504 78-495 CALLE TAMPICO 'n LA QUINTA, CALIFORNIA 92253 Address Fzip Tel.City-TA/ ity _Tn/�.0 9,;d0 :3�7-9 State Lic. City & Classif. b 9 5.I Q 3 Lic. # t", q Arch., Engr., I .J rte! Designer Tel. City Zip State ��11n� Flrvale 0,91 � 9 3 n7 Lic. # C— 7(/33 I LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70001of Division 3 of the Business and Profession Code, and my license is in full force and effect.e .� �'�...s�. `-"'r.�L..L //- �D •F. 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 permit to construct, after. 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 live hundred dollars ($500). 17 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, Bulsness 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.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 pursuantto the Contractor's License Law.) 0 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified cop thereof. (Sec. 3800, Labor Code.) Pot icy NOh3j ,7JP/! Company _S rol C,ifnta lr.J.SAt.&'0 (WCopy 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 ($100) valuation 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. Date Owner NOTICE TO APPLICANT: If, 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 is4sued. (Sec. 3097, Civil Code) , Lender's Name C f7A) IP AC 1600'3 F.rJJ0;iC. Al _(Wr•t/+c e S Lender's Address N Q 6 Q k 9 -C(i 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 slate 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 sof this city to enter the above- mentioned property for inspection purposes. Signature of a0plicant Date Mailing Address City, State, Zip APPLICATION ONLY BUILDING: TYPE'CONST. OCC. GRP. A.P. Number `T74 - 0-n7- _ oI q Legal Description 1)7 - Project Project Description PJe w Didell f,Jr., I Sq. Ft. I v 1 2 No. No. Dw. Size Stories :,,o; C! Units New O Add ❑ Alter ❑ Repair ❑ Y7 Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep.a: CG. UV Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION TOTAL= REMARKS p V t Q l t t��'►0 ZONE: L BY: r 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 Duplicated Date 3/9/99 No. 18432 Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE .OF COMPLIANCE APN # 774-072-019 Jurisdiction La Quinta Owner NameWilliam Tribble Permit # No. 53-445 Street Ave. Rubio Log # City La Quinta Zip 92253 Study Area Tract # Lot # Square Footage 1612 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 1.93 X 1,612 or $ 3,111.16 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/Bank of America/William Tribble Jr. Telephone. Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Ellen Patino Signature F. Payment Received $3nj 1:16--,- 6 '."Check CheckNo. 2006245662 i.14��• 10TICE: Pursuant of 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 ibove 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 Dislrict('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. William Tribble 760-342-9825 03/01/1999 12:01.:28 PM P.2 REGORDINO REQUESTED BY:' RECEIVED FOR RECORD AND WHEN RECORDED, MAIL TO: AT 8:00 AM 0 William Tribble 80-655 Ave. 43 Indio, CA 92201 G DEC 23.1998 Roomded In Ctlir- ftwm of t;Nmddt► 0W* Caftft =L_�_ ✓� Q /1 �� _ C� THIS SPACE FOR RECORDER'S uSE ONLY ASSESSOR'S PARCEL NO.: 774-072-019-7 The undersigned Grantors) declares) that the DOCUMENT TRANSFER 1 TAX IS: c L.< TITLE ORDER NO.: $ _ 18-15 County, s City ESCROW NO.: 18046,-004 xx computed on the full value of the interest of property conveyed, or computed on the full value less the value of liens or encumbrances GRANT DEED remaining thereon at the time of sale — OR transfer is EXEMPT from tax for the following reason: FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Henry C. Griswold, trustee - hereby GRANT(S) to William Tribble, an unmarried man all that real property situated in the City of La Quinta County of Riverside , State of California, described as: LOT 9 IN -BLOCK 184 OF SANTA CARMELITA AT VALE LA'QUINTA, UNIT NO. 18 AS SHOWN BY MAP ON FILE IN BOOK 19 PAGE 31 OF MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA k Dated July 24, 1998 STATE OF CALIFORNIA, } COUNTY OF �IIIE iSr�� ss. On f�tVll' it +�� before me L rt<_xt�f Notary Pi blic, personally appeared Personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me' that he/ShOAhey executed the same in his/hag4heir authorized capacity(ies), ,and that by his/her-{t#'refr 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 Oticial seal. Signature —76 MAIL TAX STATEMENTS T William Tribble -80655 Avenue 43, Indio, Ca. 92201. Henry -Griswold, trustee •; '=�• CINDY BURGIN GOMM. x 1180893 'rfr .� t. tx Tapv i/?_':-,CAUFORN1A :61C,E COUNTY •ryCir:'.r, uy:rs:Vil22.2002 .r. a 10- (i his area for 011i6al notary seat) i RC District - P/annina 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 Building & Safety as your correction list. Please attach additional explanations as necessary. APPLICANT.=BBLE CONSTRUCTION' h J PROJECT ` J V. ADDRESS: J 53-445 Rubio LEGAL: LOT9 .,.BLOCK `18 1 UNIT, 18 S.C.'@•V.L.Q. - • C K' D BY: STAN SAS BIN NO: t 3B CASE NO.. 98-20 CHECK DATE: 30 Cly _ 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 , ,r Y N COMMENT/CORRECTION 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 v �(C_-. SS pF, Materials - d}L- SS �pQ Architecture OTHER REQUIREMENTS: 10, yC0 O The zoning code; architectural and landscaping; manuals; anc>r/,Sa signed inspector should • . `.be consulted where. uncertainties arise.=The completed checklist shall be maintained in the Building .& Safety address file. _ _ . :=T' Bud Seogondollor Architect 19175KmaiRd 4n*VaLgy,Ca February 24, 1999 Office of Building and Safety City of LaQuinta Attn: Inspection Department Ref: Residence for Tribble Construction Lot 9, Block 184, book 19 La Quinta Unit 18 Sir: I have examined the loading conditions in the calculations provided by Alpine Engineered Products Inc.for roof trusses to be used upon the above named project. I fine the bearing points and loads used to be in substantial accord with the job requirements. Please be advised that this office assumes no responsibility for the actual calculations, fabrication and/or placement of the trusses at the factory or jobsite. Thankyou for your concern, Trusses Tribble Lot 9