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9811-142 (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 6M) 03 I3 11i90r00 D✓ ate ?' 9- I f 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 ( )„ 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). t F t (); 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 ion 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. n I 111"r«,'1�1U' BUND _ 129"o Y 1-99 (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•- C��ca6e, I shalllforthwith comply with those provisions.;, Il ate: % '� Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made.to the Director of Building and Safety for a .permit subject to the conditions and restrictions set forth on his application. , 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of -such permit, or.cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I -agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the,above-mentioned property for inspection purposes. Signature (Owner/Agent)?1.'�t Date -•).7.4t 'f, 9 tl-#ys . PERMIT BUILDING PERMIT T DATE / � VALUATION �. 3 . �fi LOT ! jD TRACJOB SITE ^'1 ADDRESS 05 AZ �'NIDA>+ R U 1310 APN 774-072-020 �- OWNER CONTRACTOR/DESIGNER/ENGINEER Kirit T t A R+i `f`o 1C3fIs E3 i 11.w.:11f \±it Ai,.l .--N.-, `1''f � 1�7 rl [�/1'�TC J tl lf"Tr�4.t 1 f Jle 1f ire.! f.r.,#i id�A l l.� �♦ Iv '00-653 AVENUE 43 � S"53.AY NUE; 43 1 ill10 CA 92201 1NUIO CA X2201 (760)141-975 r.",.F3.i4 5291 USE OF PERMIT + ' SINClIX FAMILN' I:1GiWF.LUNG. - 81-1) r:% U tl.i NUF DfCXUDE BLOCK WALLS Olt.€'(?aOL. K461 - .DOES t c1lit!tils.l�CikTlUN fa7.+' 'l >SS.RI i�Ut�i l3 �9 o i U3z A'1IJ3.'1.'i 1. 1S'a'IJM CE CI P"` SAIME I?I. At N '1 i°PE. 41AR 0 9 1999 . TRAe'T C0.V1 3TRLFC'1'ICV 1.612.0 rt wt -VORCH/PATIU NS$.00,yT' F �%IT Y Cis?,6r,AtiFlttiitiatJi#i' 4zY,i3fi 5+ 0 LA Qu? Z #, ' .US Y. YAHATIl D COST 01' ',.01T4.Q ,C iZU 4i YM11 :+:f •J �.4,��a � PERMIT FEE SUMMARY CONSTRuC•"('iCi'_N FEL? 101-100.438-00G PLWAN CffECK .FEE 101-r►(31}-439.318 $134.14 171 E DEP 01131T - 101-000-43+9-315 ,���.:)t1 .MUNIANICA•L itrts' 101.000-421.000 $60.00 ErLEC°TRIC.AL FM 10I-000.420-000 $19-3.46 Pi,11JURINO FYI 101-110..419-000 5178,75 STT-ON10NOTIONITE - 1C1ItIDI-22 1.,000 S9.93 CRAVING FEE 101 -WO -423-000 VAND.00 1NN3tASTR1JCI'UR:1 HiE S'4157.77 PRPCIS1: PLAN101-4,tt}(j-4414:14s $1(x±).1.10 40TIA1, �IAI "R1.W�TfON .A, -4q'1 P1..AN c"IiqC;K $1,378 55 7,.1x.55 PREPAID FRES " ?:0,00 1.01.',A1<I.VE!' MI.1' FE3"+•Si i)UENO%V $3,128.5s RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD 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 ' Exhaust Fans O. K. to Wrap F.A.U. Framing 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 " Final � 7 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 t - It Encapsulation Gas Piping 1; Gas Test ,1671 Appliances is Final COMMENTS: Final t Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole 24 Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. 'Smoke Detectors Temp. Use of Power ' Final ;r Utility Notice (Perm) �O r' Building Address G Z til h Owner / C&tyl 0 4 " P.O. BOX 1504 76-495 CALLE TAMPICO . n LA QUINTA, CALIFORNIA 92253 Mailing Address Ro _ b S_r> %9G%P �r- -? City Zip Tel. � S IP inti t %,,� %�,� Co %,/ c. C'r () IZip 9.2d0/ ITel.7,97- State Lic. City 8 Classif.i( SSD Lic. a / �f Arch., Engr., Designer Address / Tel. City Zip State f%,1F 217 90307 Lica C -O a LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000),oI Division 3 of the Business and Professions Code', and my license is in full force and /SIGNATURE I' DATE OWNER -BUILDER DECLARATION Ihereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Bu7 iness 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 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 five hundred dollars ($500). II 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 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 1, 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 contractors) licensed pursuant to the Contractor's License Law.) 17 I am exempt under Sec. B. 8 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 Compe sation Insurance, or a certified copy thereo (Sec. 3800, Labor Code.) Policy No. X/ Company �� �' f�`[i/f7 ie'NS%A7- J�/ n Copy is filed with the 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 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 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 �1RC. �`!�/' S F . IJ /i .J, (/) l ��t•✓I(rf Lender's Address /J X .5'0 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 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 sof this city to enter the above- mentioned property for inspection purposes. Signature of aGPlicant Date Mailing Address City, State, Zip APPLICATION ONLY ILDING: TYPE'CONST. !'} OCC. GRP. '. Number �n, % /C7 /! /�%,/ zi evv. lal Description A/eAl / �✓/`��'wi Iject Description 4 - 072- - S2_0 Sq. Ft. Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. �d r Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY- r (� % Minimum Setback Distances: �' t 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 Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 Date 3/9/99 No. 18431 I CERTIFICATE OF COMPLIANCE APN # 774-072-020 .Jurisdiction La Quinta Owner NameWilliam Tribble No. 53-465 Street Avenida Rubio City La Quinta zip 92253 ,Tract # Lot # Square Footage Type of Development Single Family Residence Comments Permit # Log # Study Area 1612 No. of Units 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. Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Ellen Patino Signature Payment Received Check No Telephone` R 2006245663'} JOTICE: 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 wllect them 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 ,William Tribble 760-342-9825 03/01/1999 12:0.1:28 PM P.1 RECEIVED FOR RECORD AT 8:00 AM DEC 2 3.1998 11 r' irl 0"W d Ifter" Oar". Pamirder Fs" S THIS SPACE FOR RECORDER'S USE ONLY The undersigned Grantor(s) declare(s) that the DOCUMENT TRANSFER to TAX IS: $ 18.15 County $ city I -x— computed on the full value of the interest of property conveyed, or computed on the full value less the value of liens or encumbrances remaining thereon at the time of sale OR transfer is EXEMPT from tax for the following reason: !ipt of which is hereby acknowledged, in of La Quinta State of California, described as: %RMELITA AT VALE LA QUINTA, UNIT NO. 18 AS SHOWN BY MAP F MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA i . e personally appeared -7V.S te -k - - me on the. basis of i(s) whose name(s) t and acknowledged ime in his/herftWr, w#httir signature(s) entity upon behalf of strument. Indic, Ca. 92201 Henry Griswold, - —trustee'- (This area for official notary seall A CINDY BLMGIN COM.M.to # 1180693 -tj?' 'iCAU LQ CCAINry MY CQT-- EVM APA 22,2W2 (This area for official notary seall 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 Building & Safety as your correction list. Please attach additional explanations as necessary. APPLICANT: TRIBBLE CONSTRUCTION PROJECT ADDRESS:. 53-465 Rubio APN: LEGAL: LOT 10_,.BLOCK 184 UNIT 18 S.C. @ V.L.Q. C K' D BY: STAN SAWA BIN NO: 3B CASE N0. 98-21 CHECK DATE: I Ic l 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. 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Case logged and number assigned Verify legal and APN information r � , Consistent with MDG on file (as applicable) MDG filing required (5+ filings since 9/3/98) Consistency with street/surrounding area: Colors v Dk Materialscv, Architecture _ �EVEI�pMENT DEP% OTHER REQUIREMENTS: APPRO GATE 1 . BY — EXHIBITOt The zoning code, architectural and landscaping manuals, and/or assigned inspector should be consulted where uncertainties arise. The completed checklist shall be maintained in the Building & Safety address file.. Bud Seagondollar Architect 19175KmRd Apple Va%?y, Ca February 24, 1999 Office of Building and Safety City of LaQuinta Attn: Inspection Department Ref: Residence for Tribble Construction Lot 10, 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, Respectfully, Bu eaondollar Arc -4033 / g ) ) Trusses Tribble Lot 10 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: R 3 53-465 AVENIDA RU:BIO Type of Construction:. VN Owner of Building: WILLIAM TRIBBLE Building Official Bldg. Permit No.: 9811-142 Land Use Zone: RC Address: 80-655 AVENUE 43 City: INDIO, CA 92201 By: STEVE TRAXEL Date: 10-21-99 POST IN A CONSPICUOUS PLACE