0006-210 (SFD)LICENSED CONTRACTOR DECLARATION
1' 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. Class638515 0
f/' Exp. Date
I J�
(j3ate7'7`1-7 Signatureof'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 & Professjonals Code). .
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 BTAT.E RIND Policy No. °2999-4349672
(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 t os Lprovlsior
Aate:--r 1�.!. ;_ Applicant
Warning: Failure to secure Workers' Compensation coverage Is unla[an
shall subject an employer to criminal penalties and civil fines up to1+00,000, in
addition to the cost of compensation, damages as provided for ire ection 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby./made to the DirectorZfBuilcling and Safety
for a permit subject to the conditions and restiions 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 tate laws relating to the building
construction, and hereby aLyfor ze cepresy tatives of this City, to .enter upon
the above mentioned ro e Ins ec I fi _ o ems jp
P P�J? > P
�Signature (Owner/Agent) ”" " '" " '"`Date
�a BUILDING PERMIT PERMIT#
DATE VALUATION LOT -+�•� TRACT r•
,939.20 12 BLK 263
JOB SITE
APN
ADDRESSe°54-74
+ 7%1-"4-024
OWNER
CONTRACTOR / DESIGNER / EN INEER
LSA QUIN T A, PAR"TERS
LDIDEL if EN°t-OW �� -
P.O. BOX 4.50'
78.080 Calle lEsta.do ate 204
LA,'iQU' rrA. CA 92253
J.AQC,7i TA CA. 92253
('760)564-1866 c 'sLO $59
USE OF PERMIT
LKWOU, FAti2111Y 1:1`i'i% TNG
31?I.1-PE,I:.VIT DOES140T INCLUDE BLOCK WALLS OR POOL
TRACT CONSTRUCTION 4445.00 2F
PORCF1tPATIO 49.00 SF
c: 1ARAGEIC.ARPORT (.P) 9,996,00
RS-I'.:MTED COS-.' OF CO N8`MVC11QX
86,939.20
PULMIT FEE &IH04AR'Y'
FEE D01031T 101 Aft -X439.318 • 250.00
CONSTRUCTION Fft 101-000.418-000 $591.00
PLAN CHECK FEE 101.000-459-31.8 $491.70
13fiIi: II NIC..AL FEE 101-000-421-000 $53.50
%FL CTRit".•AL FEE 101-000-420.000 $12171
PL% MBINO FEF: 101-000-419-000
8TR(YRO MOTION FEE - RESIFT 101-000-241-000 %8.69
0".DI1d0 PEE 101-000-423-000 $20.00
DEVELOPER IMPACT FEE s.I,orl,00
PRECISE PL AN 101-000-441-345- $100.00
a
SM-TOTALCOXIS TRUC 110N .d ISM- PLAN CHF, CK
$3,413.12
LMS PRE -PAID TIM
-$250.00
T(Y' AL }bPARWf FEU DIM NOW -
$3,16.3.$2
}}
�
RECEIPT
DATEBY
r+
f� , '�
�
DATE FINALED INSPECTOR
M,
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
ev SV
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
Final
3 z o e/ ':>7
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Final
PLUMBING APPROVALS
Underground Plbg. Test
Gas Piping
Gas Test
a.0
Electric Final
Waste Lines
Heater Final
Water Piping
VI 2AE I QLD
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
pp
Encapsulation
_
Gas Piping
Gas Test
— Z -,p L
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 Q
Utility Notice (Perm) • OST
—'a � 1//
• "
P.O. BOX 1504 APPLICAT N ONLY
Building �78-495 CALLE TAMPICO
Address
LA QUINTA, CALIFORNIA 92253
owner r
Mailing (� s
Address (J. C� a._.+� 4, <( j
'City
L,i4c_J-.)r.s((�1, Iv. Zip
K-3
Contractor
Address T
City Zip Tel.
1-�-t G �, 't•�"f-rte. i r -- • "; r %t�
State Lic. City
& Classif. Lic. # s%
Arch., Engr.,
Designer
Address- Tel.
City Zip State
Lic. # 1
LICENSED CONTRACTOR'S DECLARATION
I hereby affirmjthat I am licensed urider•piovisions,of Chapter 9 (commencing with Section
7000) of Division 3 of the Business grid P,roYession Gode•eand m ,+license is in/f011 force and
effect. �..�..• v • _ $: �..—,_–�.,_ Y ,;.-- l✓J
e,
an NATIMF • -.-. .—» . 1 . neTt
I hereby affirm that I am exempt from the Contractor's Lic rise Law tai the foljowing
reason: (Sec. 7031.5.Busiriess' and Professions Code: Any cif or county which requires a
permit to construct, alterlimpiove, demolish, or repair any str, cture, prior to Its issuance also
requires the applicant for such permit to file a signed state ent that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter commencing with Section 7000) of
Division 3 of the Businiss�and Professions Code, or that. he is exempt therefrom, and the basis
for thealleged exemption. Any violation of Section17031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more thanAve hundred dollars (8500).
(; 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 -I 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 contractor(s) licensed pursuant to the Contractor's License Law.)
Y7 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 Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
r7 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 ($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: d, 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.
a
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 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 :of this city to enter the above-
mentioned property for inspection purposes.
Signature of aQplicant Date
Mailing Address 4,
City, State, Zip
ILDING: TYPE'CONST. OCC.GRP.
'. Number 7;4,2-s4 / • c -al
)al Description `�"�� ' "-'�'t ' 2_ C' 3
Iject Description
Sq. Ft. C �. U No. 1 No. Dw.
Size Stories ( Units
New .IE' Add ❑ Alter ❑ Repair ❑ Demolition ❑
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback fron%Rear Prop. Line
Side Street Setback from Center Line
wSide Setback frorr Property Line
%
FINAL DA INSPECTOR
Issued b Date Permit
Validated jbyy-., % .
validation:
0
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
V
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback fron%Rear Prop. Line
Side Street Setback from Center Line
wSide Setback frorr Property Line
%
FINAL DA INSPECTOR
Issued b Date Permit
Validated jbyy-., % .
validation:
0
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
V
Desert Sands Unified School District
47-.950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760=771-8515
+ CERTIFICATE OF COMPLIANCE
Date 7/17/00 APN # 774-234-024
No. 20727 Jurisdiction La Quinta-
Owner NameLa Quinta Partners, Permit #
No. 54-485 Street Avenida Rubio Log #
City La Quinta Zip '92253 Study Area
Tract # Lot # -12 Square Footage 1405
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 galrages/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 facilityfees imposed pursuant to Government Code 53080 in :he amount q- `, V `}
2.05 X 1,405 or $ 2,886:25 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 Valley Independent Bank / Thomas Buffin
Telephone,
Name ori the check -
By Dr. Doris Wilson'
Superintendent.
' Fee collected /exempted by Sheryl Simmons Payment Received $2,880.25
Check No. 216560
Signature
NOTICE: 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 brother payment identified +`•
above will begin to run from the data on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or tc another public entity authorized to
collect 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 t
a
ti
1
Alun • 12. 2000`, 1 :5OPMa POWER BROKERS
ilC:AUU 11160
RECCRDING REQUESTED BY:...
CHICAGO TITLE COMPANY COM?ANY
9856KC 207055089 PO�PN WIL �'L%RST E �S D,
VILLIAK TUMM BUFFIN -
P.O. Box 1?4
LA QUINTA, CALIFORNIA 92253
raa"cnnr, %No•'t�°4A: pP 1/4
Papa 1 of 2
Recorded in 0ffi,1e1a1�Raeords
County. of :IOlv4ru'id®
Gary 6,"Osa _
GRANT DEEDr-
The undersigned grantor (s) deolare (s) ,—, �8s' r,;_is')
Documentary transfer tax is. $25.30 -�
(XXX) Computed on full value of .prop erty conveYed, or
( ) Computed on full value 'lass Nene 'and encumbronces remaining at 't,ime of esla . SC
{ ) Unincorporated area: ( ) City of and
FOR -A VALUABLE CONSIDERATION, receipt of which is hereby ackno*ledged-
DAVID 0. McRLROY and SHIRLEY McBLROY, husband and wife as community property
hereby GRANT (S) to VILLII+M-THOMAS BUFFIN, an unmarried man •AAs to in undivided 15% intexee.,
and WILLIAM Rs RIL19Y Trustee of the Riley 1990 1rLat as to au >eandivided';
85S intexe8t, as.teaauts iu common
the real property in the City of.LA QUINTA, County of Riverside, State. of California,
described as:
Lot 12, Blo6k-263, Unit No. 24 Tract Santa Carmelite
reaar c n 80a 19, pages) 44-45 inclusive of maps,
Recorder of said County.
Dated April 12, 2000
r�
State of
County of ^�e ) S.S.
on
before me,
personally appeared
(o .proved to me on
the basis of satisfactory evidence) to be
the person(s) whose name(o) ie are subscribed
to the within instrument and acknowledged to
me that Le4e4w/they .executed the same in
h+V�t�their authorized capacity(ie®), and
that by hivf} r/their signature(s) on the
instrument the person(s), or the entity upon
behalf of which the person(e) acted, executed
the instrument.
WITNESS my and official sea
Signature
MAIL TAX S TEME(+!i'S :
SAXE AS AWVE
at Vale La Quinta, as per'map
in the office of the County
OI`Fll•1A�. SF�4L
(:0lt9rihiFi°31f1NN`Q:ti6't�77
MyGd�9A116810NFXPIkZ S'FE918 2401
(This area for official notarial seal)
J
r
RC DISTRICT - PLANNING REVIEW FORM
This form is to be used by CDD staff for review of'gingle family dwellings in the IkC (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 explanations as necessary.
APPLICANT LENDEL VENTURES
SITE ADDRESS 54-�g Avenida Rubio
APIC. 774 _ .234 _ 024BIN NO.:_S^, CASENO.: 2000-245
LEGAL: LOT 12 BLOCK 263 UNIT - S.C.@V.L.Q.
E l
CHECKED BY: Start •Sawa 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
\j
MDG filing required (5 filings since 9/3/98)
Consistency with street/surrounding area.
Colors
Materials
Architecture
\,
v
V
Other Requirements:
A
D�i -f b J1jiSV,&
•
City of La Qu`in
ta
Building and Safely. 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: 54-485 AVEN.1DA. RUB10 . .
Use `Classification: SF.D Bldg. Kermit No.: 0006-210
Occupancy Group:. R 3 .Type of Construction: VN Land Use Zone: RC'
Owner of Building; LA QUINTA PARTNERS Address: P.O. BOX 450
City: -LA QUINTA, CA .92253
By: STEVE TRAXEL .
Date: 03-02-01
Building Official
POST.IN A CONSPICUOUS PLACE
1 �
Wim