0007-187 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under perialty 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
` 776920' BDattt�r2�
. lkvA�
e 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:
( ) 1, 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) V. .
( ) 1, 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
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 VEMPT Policy No. '% -
(This section need not be completed if the permit valuation is for $100.00 or less).
O 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 Califdrnia, and. agree that if I should become
subject to the workers' compensatio�prouisions of Section 3700 of the Labor
Code, I all fo hwith comply with tF�q§; vlslons.
Date: �,'shApplicant
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. I ,
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
wo'rkJs 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. authorizaLIAPC
tives of this City to enter upon
the above-mentioned property for irposes.
Signature `(Owner/Agent) Date V v
BUILDING PERMIT PERMIT#
DATE W VALUATION LOT ��$7 TRACT
:i S 106 07'1 M
JOB SITE
ADDRESS 54-465 A.WMA RUB1<0
APN
774-234-023
OWNER ,
CONTRACTOR /DESIGNER /EN 1NEER
Y4A6TSSEL p1VqS
co,)ndWORASY H(fb�'�s
56900 J.A-6,kz0N,3T
51370 AVT 41DA.BM1MLTbAS
'CF1 d sIs CA 92274•
L, QUINA - CA. 0,2253
(760)4641 1962 , CMV1 6255
I ISF nF PFRMIT
Gi A i`tiMM'Y` D)WL 1110 w:
.
Sn''? .PT;): IT DOES'[ NOT 113CI..UDE Ftl.,i)CK WALLS OR. PODUSPA,
TRACT CONI)TRUCTION 034.00 SF
�
PORCWPATTO 14.60 m,
GARACTElCARPORT (SV) 10.0ai2o
5 F1'. WOOD FENCE < 200.00 1,F
1~STV"11M CO111'r OF CONS7RUC'f1on
�k'XMIi'FEE
1€ 6,077.00
SUMMARY
CONST RUCTION ft1: 1.019000.418.000. $664.00
PIAN C14ECK FEE 101=t3ilp-<i39-31fi W6.31
MECHANICAL "Z 101.000-421.000 360.DQ
ELECTRICAL FEE 101-000420-000 $11.9.43
PLUMBrHOFEE 10$^OOd,419-000
STRO.NOMOTION FEE -R.ESID 101-000-241-000 $10.61
CIRADING FFX 101.000=423-000 $20.00
DEVFLOPER IMPACT FEE $1,907.00
PRW,ISE PLEA?.i 101-000 -441-345 $100.40
ME DEPOSIT 101x-000_439_318 •$250.Oi1
SUB-1'(YfAL. C0KK..!'R:U010X AND PLAN C117ReX
$3,554.1.0
IMM P -PAID rRS3
00
.'�
' �JCYrAL ^••fit ' '^-'� DVE'
x4250,
RECEIPT
DATE
BY/
C
D E IN
INSPECTOR
- I P
rA
�s
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
3 3p no-
Qj7
'r
Compressor
Insulation
Vents'
Fireplace P.L.
--4=32
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
l C 4�
Drywall - Int. Lath
`(
Final
_
5%
Final
714.14o
POOLS - SPAS
BLOCKWALL
AP ROYALS
steel
Set Backs
Electric Bond
Footings
Main Drain
GG�
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
/
Underground Plbg. Test
/ El(
Final
Gas Piping
`
PLUMBING APPROVALS
Gas Test
Electric Final
Waste LinesHeater
5
Final
Water Piping_10Th4-,0-V-
Plumbing Final
• Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
p - (Z •fJ ®
S %
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPR VALS
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)
a A C
_
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
.47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Date 9/5/00 APN # 774-234-023
No. 20961 Jurisdiction La Quinta.
Owner NameWilliam Russell Rogers Permit # '
No. 54-465 Street Avenida Rubio L.,g #
City La Quinta zip 92253. Study Area
Tract # Lot # Square Footage 1734
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 1,734 or $ 3,554.70
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 CCNalley Independent Bank - Robert
Kellogg Tel-ep`hone,,-
Name on the check
By Dr. Doris Wilson
Superintendent'f
Fee collected /exempted by Ellen Patino
Payment Receivedqr $,54' 70
Check No. 227309
w,
Signature
10TICE: Pursuant of Assembly Bill 31181 (CHAP 549, STATS. 1898) this will serve to notify you that the 9D -day approval period In which you may protes the fees or other payment identified
drove will begin to run from the date on which the building or installation permit for this project is sssued or on which they aro paid to the 01strict(s) or to another public entity authorized to
*Ilett them an 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 waivems.
Embossed Original- Building Dept./Applicant .Copy - Applicant/Receipt Copy - Accounting
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 Safely Department as your
correction list. Please attach additional explanations as necessary.
APPLICANT LA QUINTA PARTNERS/THOMAS BUFFIN
SITE ADDRESS = 54-465 •Avenida Rubio
APN 77.4' _ 234 - 023 BIN NO'.: CASENO:: 2000-293
LEGAL:' LOT BLOCK UNITw S.C.@V.L.Q.
CHECKED BY: Greg Trousdell DATE:
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
Y
N .
COMMENT/CORRECTION
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)
Consistency with street/surrounding area:
Colors
•� Materials
rchitecture
to! a
c c
E _y Z .
C 0 0
a v t0 y
Other Requirements:
/G 2 l/� .
c V
3 v
c
0
v
C
0
U
F.;
L
J
i
AurIT-2000 0202pm From-COf,(MONWEALTH LAND TITLE
RECORDING REQUESTED'BY:
CHICAGO TITLE COMPANY COMPANY
9ASSKC' 207056088
WMUNL5'111REME&D�JE D.
William Phomas Buf fin
P.O. BOX 134
LA QUINTA, CALIFORNIA 92253
+7603413219 T-626 P.002/002 F-624'
AUS
C9dZ �hg-�
. �ro )�
Co'Y
::e racrc�w
GRANT DEED
The undersigned 9rantor(s) declare(s):
Documentary cranster tax is $25.30
•(XXX) Computed on full value of property conveyed, or
( ) Computed on full value lessi liens and encumbrances remaininQ,e.c time of sale.
( ) Unincorporated area: ( ► City of and
POR A VALUABLE CONSIDERATION, receipt of which is nersby acknowledged,
DAVID G. Mc&LROY and SHIRLEY McELROY, husband and wife as community property
hereby GRANT(S) to William Thomas Buffitis an unmarried man
DBA LS Quints Partaers II
`:.
the real property in the City of LA QUINTA, County of Riverside: Scete of California,
described as: _
Loc ii, Bloe 6 c No. 24, Tracc Santa Carmelita at Vale La Quinca, as per map
r ok i9, Page(9) 44-45 inclusive of maps, in the office of the County
Recorder of said County.
MCL I—
Dated AW,, 2000
Scare of
County of S , S
On
before me,
personally aqAeared
(or #-roved to me on
the basis of satisfactory evidence) to be
the person(s) whose name(s) War* subscribed
to the within inacrument and acknowledged to
me that hz74rhr/they executed the same in
Tjj.%1b=.4cheir authorized capacicy(ies), and
that by hI.&Ater/their signature(a) on the
instrument the person(s), or the entity upon
behalf of which the person(s) acted, executed
the instrument.. -
SH @Y mcFh6Y
WITNESS my nd and official a 1. -
signature
MAIL TAX STATEMENTS 3��
/dY�ll?�yyl7 /
!{'7707
,L�,.T,riEJ TO 8E A TFUE AND EXACT
COPY OF THE ORiGINAL
By —
COmmonwftlh LAF,d Tata Eserow
(P)CM IS Fly REAL ION
COMMISSION140.061772 N�T��Puec-(c�o14
' )MMISt'K h EXPIRES FES 12, 2001
-�
Mr �
(This area for official notarial seal)
0
l/l 'd Z -48£6t' 0N'-Vl u"- SHNOU HMOd Wd£ l : l 000Z ' L l ' 2ny
La Quinta. Partners
C/ P O Box 134
La Quinta, CA 92253
August 11, 2000
City of La Quinta
Building and Safety Dept.
Post Office Box 1504
La Quinta, CA 92253
RE: Plan Check for 54-465 Avenida Rubio
To Whom It May Concern:
Please be advised that as owner of the above property, I have ele..ted to employ
Contemporary Homes/Robert Kellogg as my General Contractor, License number 736920.
Accordingly, please remove Lendel Ventures Inc. from the Permit Application and allow
Mr. Kellogg to execute all documents necessary to obtain the permit..
Thank you for your attention.
Sincerely,
La Quinta Partners
rvvven or+vw%r-"w
TROMAS WON & A9900.
61370 AVEN16A. bNMU60 STE. 1
L•A q, 'NTA, GA 92 53
MOUNTAIN
II16 1. ARCHITECTURE
ARCHITECTURE & ENGINEERING
BIG BEAR CIN AIRPORT • SUITE A-1
P0. BOX 6167 • BIG BEAR LAKE, CA 92315
(909) 585-6311
8/10/00
City of La Quinta
Department of Building & Safety
RE: APN 774-234-023
Gentlemen:
This letter is to state that the design of the trusses are in accordance with my design intent. If,
you have any questions, please do not hesitate to call.
Sincere ,
n_
5�C ARC\
,costa, AIA
Architect NO
JOHN F. ACO$TA, ill
A.I.A.
NO. C24055
REN. 4.30.01
JF CA���
CALIF. LICENSE #C24055 • ARIZONA LICENSE #28023 • CALIF. O.E.5. REGISTERED EARTHQUAKE DAMAGE A55E550R #5A1373
Certifica of. O
pancy a
City bf La unto
Q
Bdilding-and Safetk Department ��- OF .
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 iri, comp/lance with. the various ordinances
of the City regulating building. construction or use. For the following;
BUILDING ADDRESS: 54-465 AVENIDA RUBIO
Use Classification: SFD `' Bldg. Permit No.: 0007-187
Occupancy Group: 'R 3 Type'of Construction.: VN Land Use Zone: RC
'Owner of Building: WILLIAM RUSSELL -ROGERS Address: 56900 JACKSON ST.
• City: THERMAL, CA 92274 '
By: • . STEVE TRAXEL
Date: 07-17-01
Building Official -
POST IN A CONSPICUOUS PLACE