0106-009 (SFD)—LICENSED CONTRACTOR DEC.LARATION
I hereby affirm urider pqnalty of perjury,that I am licensed under provisions of
vChapter 9 (commencih4.with'Section 7000) of Division 3 of the Business and
C14 w Professiohals Code, and my License is in full force and effect.
C:) CY) Lic' rise # Lic. Class Exp. Date
LO ok,
LLJ
Z r�, Date Signature of
W W I hereby affirm under penalty of perjury that I am exempt from,the Contractor's,
a- License Law for the following reason:
z 1, as owner.,pf.,.,the,property, or my employees with wages as their sole
com pensation,%wi III �h�`.the work, and the structure.is not intended or offered for
sale (Sec. 7044, 66'§'in ' ess & Professionals Code).
contractors -to construct the l5roject (Sec. 7044, Business' & Professionals
I(.) I am exempt'under Section BiP.61. f6r this reason
LID
Date: Signature of Owner
WORK.ER'S.COMPENSATION DECLARATION
0 1 hereby affirm und * er penalty' of perjury one of the fo ' Ilowing ' 'declarations:
Lo
I have a9d.will maintain a certificate of consent to'self-insure for workers'
LL compensation, as provided for by Section 3700., -of 4he,Labor Code, for the
X UJ
_J performance of the work for which this permit is issued.
I have and will maintain workers'icompensation insurance, as required by
Section �700 of the Labor Code, for the performance of the work for which this
I:L permit is issued. My workers'. compensation insurance carrier & policy no. are:
carrier Policy No.
—
(Thisn°otiomneed not. be, completed if the permit valuation isfor $xOO.0omleou
( ) |' certify that ir'�8mperformance o/the work for °m�mmivponnh��ouod.
I shall not employany person in any manner so as
to become subject to the
Workers' compens . ation laws of California, I 'and agree hahif I shodid)IJecome
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employerto 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 iohereby made tothe Director cvBuilding and Safety
for a permit ouWout to the conditions and, restrictions set forth on his
application.,
1.Each person upvn.wmmmbehalf this application iomade meach person vu
'
whose request and for whose benefit work iaperformed under o,pursuant m
any permit issued aoo',eou|tufthis, app|ioamnagrees to, &shall, indemnify
& hold harm I ess'the'. City of La Quinta, its officers,
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 is�su'a'rce of such .
permit, or cessation �f work for 180 days will, Subject permit to
I certify that I have read this application and ' State that the above information is
correct. I agree to compli with all City, and'State la' s relating to the building
onstruction, and. hereby at0oriz
e reore§fentatives of this City to enter upon
'13 UILDING PERMIT
DATE VALUATION LOT TRACT
ADDRESS
OWNER_,
CONTRACTOR DESIGNER EN61NEER
RANDY &011M.04 BUX3
LEOAVY HOMES'
-411r/50 ADAM, ST #234
78-MSAGUARO ROAD
UINTA :CA 922,53
USE OF PERMIT
TRACT CONX.rRUCTION 3F
POR CHMATIO SP
5 Ilell. WOOD WNC U, 200,00 LF
JUMAIALRY
CONSTRUCTION FEE 101-000-4115-000 $671.00
PLAN CHFICK VE.F. 101-000-439-318 $556.16
ELFWTAUCAL Mg. 101-000-42.0-000 $120.34
MJUBING FFU 101 -WO -419-000 S122,75
ORAPAINO FR 101 -OW -423-000 i2o.00
PRMSP. PLAN 101-000-441-345 1106100
F71Z DEPOSIT 101-000-439-318
1MIS PRE -PAID FM
41.50,00
206f nw, DUE HOW
JUN 2 2-
CM OF LA QUINTA.
.REC4
BY
DATE FINALED
INSPECTOR
4
INSPECTION RECORD
. OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs �1
Forms &Footings �.B `y
��
A�
Underground Ducts
'Ducts
Slab Grade
Return Air
Steel _ _/
Roof Deck �,? .o_�s_r —(�• g(
S7
Combustion Air
Exhaust Fans
O.K. to Wrap/ Louair Q=�o`�
g•7
F.A.U.
Framing_ Gyp.
Compressor
/
Insulation g ,!� /d ( 5� G1i •®/
S7
Vents
Fireplace P.L. 6
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewalh _
Exterior Lath
Drywall - Int. Lath i , , 9 <
t,
Final
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
_
Waste Lines IZI�/�/O��r
8l� C��
-
�
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral _[]_��
Sewer Connection �%l�fld 3� 8 "'W
Q
Pool Cover
Encapsulation
Gas Piping
�� �
,
�%�
Gas Test �/ s
Appliances
Final
COMMENTS:
_
Final /�//Z(/� /
�
rfv UP�z1r�v allelol
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 1
Owner
it
P.O. BOX 1504
Fr, 78-495 CALLE TAMPICO*
lel1 ILA QUINTA, CALIFORNIA 92253
91&u
Mailing
Address
City f :Zip' ! ' .' If '#
M
City lZip I Tel.
State Lic. �y -2-8 o (City
& Classif. �f Lic. ff
Arch., Engr.,
Designer
Address Tel.
City I Zip I State
f' �`CIENSED CONTRACTOR'S DECLARATION
affirm -at I tcensed under provi ons of Chapter 9 (commencing with Section
iviston 3 oytT}A,gusipess and Prpf 6nns`Code�and,my license is In full force and
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 e
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 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 (8500).
l: 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 Contfactor'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 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
doesnot 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.)
1-1 1 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 J
F) Copy is filed with the city. ❑ Certified copy is hereby furnished.
w
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.)
f , 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
L°aws of California.-
Date Owner l' '? A t #,.
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
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 applicant Date -
Mailing Address
City, State, Zip
APPLICATION ONLY
LDING: TYPE'CON/STT. 'DCC. GRP.
Number `"f `'Da '
eDescription
ject Description l ti 4✓ c �i't 1 /C /_ i
ltres r�
Sq. Ft.
Size
New O
No. I No. Dw.
Stories 1 Units
Add O Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
Plan Chk. Dep. `
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing •'
f ?
S.M.I. Y
Grading
Driveway En .
Infrastructur
i
AMOUNT
.1,
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
TOTAL _J . ,�, , ,
ITY OF
REMARKS z` _''"
INANC E j
j {
ZONE11•" r,
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
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 6/22/01 APN # 74-272-002
No. 22160 Jurisdiction La Quinta
Owner NameRandy & Sharon Bills ' Permit # 0106-009
No, 51-540 Street Avenida Rubio Lo; # .
city La Quinta Zip . 92253 Study Aoea
Tract # BLK269U25 Lot # 23 Square Footage 1788
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 tie amount of
2.05 X 1,788 or $ 3,665.40 the property listed above and that'bulding
permits and/or Certificates of Occupancy for this square footage in this proposed project may now ba issued
Fees Paid By cc/EastWest Bank - Legacy Homes I'elephone1A 564_-7820
Name on the check Z.
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by. Juanita Green Payment Received $3,665.40
A-1 Check No. 32-4902340547
Signature
INOTICE: Pursuant of J%Asembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protesr the fees or other payment identified
above will begin to run1from 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
collect them on the OistrictCs)(s) behalf, whichever is earlier.
s `
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
LUNIDEL VENTIVIRCS, INC.
May 30, 2001
Ms. Nickie J. Gormley
City of La Quinta Building Department.
78-495 Calle Tampico
P.O. Box 1504
La Quinta, CA 92253
RE: Sharon Bills .
Dear Nickie:
Please be advised that the following plans have been previously approved for. use in the Cove
area of La Quints by the Planning. Commission. 'Sharon Bills of Malibu Management has my
permission to use the plans only at the following locations:
Plan Malibu -1: 53-590 Avenida Ramirez
Plan Malibu -1:c -54t,"54 -1 -AV
enida,Rubio_-_%
If you have any other questions, please call me at 760/564-1866.
URES, INC.
A.P. Lench,
President
APL:vI
P. O. BOX450 * LA QUINTA *CALIFORNIA * 92253-0450
760/564-1866 * FAX 760/564-2627
'i REGVD FOR PROCESSING .
16ATE)
ASSIGNED TO
RC DISTRICT- PLANNING VIEW FORM (INITIALS)
..This form is to be used by CDD staff for review of single family dwellings in the RC (Cove
Residential) District per Section 9.50.090 of the Zoning Code. Its purpose is to determine:
1.) that the proposed house design does not duplicate the same architectural style of any,
house within 200 feet of the applicant, and/or 2) if there is a need for the applicant to file for
Master Design Guidelines. If the applicant does. need to file a Master Design Guideline, please
transmitted this information to the Building and Safety Department as part of your correction
list. Please attach additional explanations as necessary..
APPLICANT, LEGACY HOMES
SITE ADDRESS��-S�n AyPni da iz„h; o
APN 774._ 272 _ 029 CASE NO.: 2001-485
LEGAL: LOT BLOCK UNIT S.C.@V.L.Q.
CHECK AND APPROVED BY: Michele Rambo DATE: i0 I's DI
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
Verify legal and APN information
Consistent with MDG on file (as
.applicable `
+v
X
� ,6�7-1a)
MDG filing required (5 filings since
9/3/98)
Architectural variety within 200 feet of
the surrounding area:
Colors
Materials
Architectural. design features
9AA
9`SF4
�ql FFG
Other. Requirements.: .
Certificate of Oc
Cupancy
... .....
Cit ofla Quinta
�5
Building and Safety 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 in compliance with the various .ordinances
z of the. City regulating building construction or use. For the following: r
BUILDING ADDRESS: 54-540 AVENIDA RUBIO
Use Classification: SINGLE FAMILY DWELLING Bldg.'Permit No.: 0106-009'
Occupancy Group:_ R-3 Type of Construction: VN Land Use Zone:- SRC
Owner of Building: RANDY & SHARON BILLS Address: 47750 ADAMS ST #238
• City: LA QUINTA CA 92253
t`
- . • ' By: KIRK KIRKLAND
Date: 12-1-9-2001
Building Official.
POST IN A CONSPICUOUS PLACE