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0110-273 (SFD)LICENSED CONTRACTOR DECLARATION f2;'ebm affirm under penalty of perjury that I am licensed under provisions of l'pter'9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License #(C����• 11�y*L99icc.Class J. Exp. /Darytte//yy. A41A 1 VW Gi/11C. r Date f( ` Signature of Contractor i 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),, . l ) I, as 6wear Of tm p'roperty,•'am exclusively 'contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). - ( ) l'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 f eciion 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 IPT Policy No. (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, t shall forthwith comply with those^p •ovisions,. Date: /Z/5101 Applicant '�j�""�MT 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 atv 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 employee§t ' 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 su permit, or cessation of work for 180 days will subject permit to cancellatio I certify that I have read this application and state that the above Information correct. I agree to comply with all City, and. State laws relating to the buildin construction, and hereby authorize representatives of this City to enter upo the ave -mentioned property for inspection purposes. agnature (Owner/Agent) -'-�" Date PERMIT # ` BUILDING PERMIT DATE % VALUATION $I I,, �JAJ4:),� LOT 20 TRACT 11_i•AK 278 1 /5 JOB SITE of,"40 AW.M ID.i RX10 .0 ADDRESS APN F T e 4 - OWNER CONTRACTOR / DESIGNER / EN &NEER ' AANTA& OSA 3JiEVk^"C.O.EW .1iAi i f:f4'i E BUILDERS �'O 73C?� � 13 "� 1 aI39� i�•CikI'Ir�1?sY»'• '11 � . LA Q1:f'�,�` A CIA, 922.53 LA. QLM-n-A C.A. 92253 CMO)'4I.3949 ICra,,f ` 4360 I USE OF PERMIT LM L'mStl :o !l t - Yt'I• M IT . .U16.'S MUT lnu o r 1LOC : JC" L, e`n.ts.A. Olt 1altlit�''ai�.l►��'".�X�I'�'4r1:ti:I•l ' TRACT T CONS'1 RUCTION 2103'tIADD SI POILCHIP TIO 87. W Sri 0A.RA.CII?,1CARPORT 434,000V PMUT ME Rt+'UMMAW11 CONSTRUCTION RUC TION FUM 101-000.41 R-000 V1 ,106.00 PLAIN fCliEtrl:, KF 101 -ON -439-318 $` R7,59 FE11 ?OLk'O= 101-000-4',49-3 18 4=100 MEC•'13ANI.C..A.I. P`t E 103-000.423.000 30 ELECTRICAL HY, 101-Q00-420.000 St x.43 PL13MS:adO "IE 101-000419--000 V13715 OM -ONO MOTION IT2, - MWID 101.000.241.000 �11:ZA 011fi4OI'I40 lit Z 101-000-423-000 iwxEVIsLOPERNPACT FEE �1,90�.fr0 ftt,C F,PL.AN 1,01-000.41-145 . f §U8 _-TOM C',ov�rkY-/� 'now, M71 Pukw ef uxis $3,663.d.3 �.IJi 11 P Z G!, aS 412501DL1 TOTAL PFUMUNTES DUE, INOW c?; . JAN �ffy pjf itAil AT DATEINAL INSPECTOR INSPECTION RECORD -. OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs - —Q Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck 7--d 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 Final i BLOCKWALL AP ROVALS POOLS - SPAS 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 a — p — Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Sewer Connection Pool Cover Encapsulation Gas Piping Gas Test Z L Appliances - Final 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 dT/ Final Utility Notice (Perm) pY COMMENTS: .7j,Vf"PyqW, 117 P.O. BOX 1504 APPLICATION ONLY Building t� 78-495 CALLE TAMPICO Address I 84 o A UC R U PJ 10 LA OUINTA, CALIFORNIA 92253 t) 1 (C " ?•7 3 Owner scivl,1 a `/ Mailing Q ` Address It0f 6 r I� 3 3 S City Zip Tel. Pct i 1 vi Q -P 5 y-1 I Ci 2.2 55- Y(09 - S2 Contractor .4 Mo)Ov� r3� iJens r �NoFf�, 1i33S City Zi -- Tel La(, �s�, 2zss s- 5 State Lic.r City & Classif. ri J y Z— Lic. # Arch., Engr., Designer G , L . S', Address Tel. City( Zip ( State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE 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, 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 live hundred dollars ($500). 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, 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 l I, as owner of the property, am exclusivelycontracting 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.) 1-1 1 am exempt under Sec. B. 8 P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 1 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. 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 (5100) 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 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 withallcity 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 BUILDING: TYPE'CONST. OCC. GRP. A.P. Number 7-7 4 — ) 92 — Q40`-." Legal Description Project Description Sq. Ft.D No. / No. Dw. Size 19G3 Stories Units New Add ❑ Alter ❑ Repair ❑ Demolition ❑ REMARKS ZONE: 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 a U nn O LA UINTA itimated Valuatipn PINA _U 1 PERMIT AMOUNT Plan Chk. Dep. ;>i�`. 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 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 j Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 1/10/02 • APN # 774-292-005 a No. 22815 Jurisdiction, La Quinta owner NameSanta Rosa Development - Permit # No. 54-840 Street Avenida Rubio Log # city La Quinta Zip 92253 Study area ~ Tract ,# Lot # Square Footage 2007 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 gErages/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 2,007 or $ 4,114.35 the property.listed ibove and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now lie issued Fees Paid By CC / l st Bank - Vince D'Ambra T elephone' Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Annette Barlow Pa ment Received $4 114 35 Signature Y Check No. 61302 NOTICE: Pursuant to 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 above 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 b 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 RECORDING REQUESTED BY Old Republic Title Company WHEN RECORDED MAIL TO AND MAIL TAX STATEMENTS TO Santa Rosa Development, Llc 40847 Sandpiper Court Palm Desert, Ca 92260 Attn: Vincent D'Ambra Title Order No. Escrow No. 604576 -LCE DOC " 2001-477734 10/02/2001 08:00n Fee:20.00 Page 1 of 1 Recorded in Official Records County of Riverside Cary L. Oreo Assessor, County Clerk b Recorder I IIIIII IIIIII IIIIII III 111111111111111111111111111111111 M S V PAGE SIZE DA POOR NOGOR SMF MISC. "..P1 W A R L LONG REFUND NCHO E GRANT DEED THE UNDERSIGNED GRANTOR(S) DECLARE(S): DOCUMENTARY TRANSFER TAX is $0.00 CITY TAX is $0.00 (3 computed on the full value of the property conveyed, or C) computed on full value less value of liens or encumbrances remaining at the time of sale, 0 Realty not sold ❑ Unincorporated area 0 City of La Qulnta, and FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, VINCENT J. Dambra, a married man as his sole and separate property hereby GRANT(S) to' SANTA ROSA DEVELOPMENT, LLC the following described real property in the city of La Quinta, County of Riverside, State of California: LOTS 19,E20 AND 21 IN BLOCK 278 OF SANTA CARMELITA AT VALE LA QUINTA, UNIT NO, 25, IN THE CITY OF LA QUINTA, COUNTY OF RIVERSIDE, AS PER MAP RECORDED IN BOOK 19, PAGES 50 AND 51, OF MAPS, IN THE OFFICE OF THE COUNTY RECORDER OF SAID COUNTY. A.P.N. 774-292-004/005 & 006/T'RA:020-015 Dated: July 16, 2001 VI cent J. D...t STATE OF CALIFORNIA COUNTY OF �' t 5) c�e�, - ---)SS- On — U before me, the undersigned Notary Public in and said 7) 0, rson ly appeared or proved to me on the basis of satisfactory evidence) to be the- person(s) whose name(s) isiare subscribed to the within instrument and acknowledged to me that he/she/they executed_ the same in hislherltheir authorized capacity(les), and that by his/her/their signature(s) on the Instrument the person(s), or the entity upon behalf of•which the person(s) acted, executed the Instrument. W 7NE y han and tial seal. OT IGNATURE NOTARY'S NAME (typed or legibly printed), DOD 101 Notary Stamp or Seal 11Pb1► C t311S Cal '-Ihlort# 1270619 Nawy ftft - CdNamla A4yCarmt. Btpies Jul 8, 211 Mail Tax Statements as Directed Above Form provided by OLD REPUBLIC TITLE COMPANY Order AUTO -KC -00007828 Description: 2001.477734 Page 1 of 1 Cogent: N ECEVE 0 C 3 02001 RC DISTRICT - PLANNING REVIEW FORM CITY OFLAQUINTA PLANNING .NNING DEPARTMENT 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 purpo=se 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. i'(.a-sag4sro//PL APPLICANT Santa Rosa Developers SITE ADDRESS 54-840 Avenida Rubio APN 774 - 292 - 005 CASE NO.: LEGAL: LOT *2o CHECK AND APPROVED BY: 2001-578 BLOCK 21"9 UNIT Wally Nesbit ZS S.C.@V.L.Q. DATE: Inform the assigned Building plan checker upon your assignment to thiis 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 4�,�z� Consistent with MDG on file (as applicable MDG filing required (5 filings since 9/3/98) Architectural variety within 200 feet of the surrounding area: Colors Materials Architectural design features Approved Other Requirements: E3 Planning Comm O City Council Communit Dev Initials Case No. 701 ' ibit /laWith Conditions � . sslo.. Depl, affml ...�..,... ....__ ,r._.......... ......_..r _ CITY OF LA QUINTA SUB -CONTRACTOR LIST JOB ADDRESS l ` s��c1 �i�� �?ubi �, (��`11 _ �YP�RMIT NUMBER __ OWNER t 1 >�t `31 vi/�l LL G BUILDER ?o 5► U0- �Ui ��C�/S QIC This form shall be ppsted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to on `:his job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response. Classification .: Contra ctor State Coritractor's License Worke►s Compen§anon Irisurarii a City Business License Company Name Classification License Number Exp. p Carrier Name Policy Number Exp. Date License Number Exp. Date (e.g. A, B. C-8) (xxxxxx) (xx/xx/xx) (e.g. State Fund, CalComp) (Format Varies) (xx/xx/xx) (xxxx) (xx/xx/xz) EARTHWORK IC;1G'l ^;..`i r r. U (Ytls 1 "' �� �t J O !� L � 'L � �v b'� �yC�v►� � ._-- -- ZI _ I o t � � �j C J l $ O � o K C OHICRETE:IC-81. :;> :: U n l�e(Q OJ OS C_ g 7�c� 79 2 3 3110'3 e ``" O 3 zo 101/ OI oK01L ul FRAMING:;(G,=S):: `:?:::: ;:? v1 cu! Wl WLR ST B ' % % %s� SU I 13C o2 eGi �� ��.5�c��i�i [We -1- �nS 1227 /0 3l cel ZZ l 1 d.s-7si -ll /0z MASONRY.IC=291;':`.:;' .:.' ::: PLUMBINciIC.;361;`".".;.'. %q Q GO✓1 Co-' � /�w)Ouf Iuwlb;A L2R _ �- o' Cab }IIG 4l0 6 S,0O lab3S23 12�3i 0.2 1/3i103 STzi`l� t7 c.( S-fq� �,� 2 1 � low - Zoo f T C3 D 12/31 n) //1702 0 2 o,3 j=, �o�f�1 7 014. LATH .:PLASTER jC=351," ` M O �( u e o _,,i taav-s B �`Z � (<� �-2 �l Z $ U' �`J(�e w. l�� . _. nHVAC1C i tat O�j.3 l00 07c),olL6f o l�DRYWALL..(C;9)::: io" 01I� ' <: '; ��oJ 4.1 Vt _ ��Q✓'�1 Ar`c"C 6 22 O O/4 201::> _ `<' <:`<:<:>'s'.: �L8 A L -7o L-38 S7 %'(152 q O9 ELECTRICAL<IC=101;°>.:_::`>;<. �3(u Jl r;�`f� /U 376, I ga %/31"M `�'d 'lt✓�c� 229 .OI—oo/q�rl �. tTt'_ O1 $`� MILS o/ oicASL ROOFING.: .39).;.%::"",.:*:*,:,::,,*.*:,:,.*: ' :> :- p. W iv k lQ �3c to goW 2 as o 2.- 5f*_ 60d Z° -V1 .-no o-/tq 1 , 032 3C o OK SHEET.'METAI IC 31,<:''''. p kQ C ` t, '0-2;0(,2_ O' s pie ✓�d 2 o s - O ( "-C?a07 / I OZ 97 v 63 323 FLOORING:aC-161:; ><;: :.: qVv( S / /J to -I -7 3� lO L1�'II J I��'7� �t�l� y Cl `� 1 11 D/ 23 8 1 INSULATION.(G'2).:::. '?>:✓ei - O./► L "Z 632o'?Z 3C') a l ��2�t1 i3 122pm2$ SEWAGE DISP. (C=421;<'-...'' i4INTING.IC=33)? V'e G (,t- Cf Rv �3f S`3 v (v ZZ CERAMIC;TILE IC-li41.. <.::. um Ile L � J L} (o �j 7? 3o (012-1D3 �-Iz{ (�{ ��� 1 42Mscl 0, 0113/02 01< CABINETS IC=81;. P 145 1=ENCINO.IC3131..>.;:;::`><;. 41�10ei✓1 l,Ovl5 C�Z� o-I�O�S80 I y3 OZ 5 �ILVI 2M&— 200/ 1Z 3/11 OS751 bZ k LANE)3CAPING. (C=271::.':` ; rn 0 q V� 1 "j �i i (� L.� �!o "L2 2 2$ Ip (Y1 } /% Y, oL lL POOL FROM FAX NO. :-7606749842 Mar. "-2 2002 07:56AM P2 CHULES W GARLAND, Architecture, Intedors, Space and Land Planning Structural Calculations 8 March 2002 City of La Quinta Department of. Building and Safety -1784495 Calle Tampico La Quinta, CA 92253 Project: C2 ingle-Kamily-Residence 54-8,40 Avenida RubioC-La-Quiota, California Re, Project Observation To'Whom It May Concern, On'6 March 2002 1 was called to the subject site by the developers, Santa Rosa Development, to make project structural observations prior to them calling for Wrap and framing inspections. At that time: I found the project to be in substantial conformance with the st-ucturai construction documents and I hereby certify that the framing is ready to wrap. Sincerely Charles D. Garland, Arch Yui Velie Way, Suits 5 —. Pahn Desert, CA 92260 c Phone: (760) 340-3528 u Facsimile (760) 303728 CHARLES D. GARLAND C1 199' - Architecture, Interiors, Space and Land Planning Structural Calculations 12 December 2001 ` The City of La Quinta Department of Building and Safety 78-495 Calle Tampico La Quita, CA 92253 3 Project: A Single Family Residence for: Santa Rosa Development 54-840 Avenida Rubio La Quinta, California Regarding: Review of Truss Calculations To Whom it May Concern, I have been provided a copy of the manufactured truss calculations prepared for the noted project by Spates Fabrk cators of Thermal, California. I have reviewed the layout and profiles and have found them to -be in substantial con- formance with the structural design intent of the structural calculations and design of the project. If you have any questions or comments regarding this issue or any other issue please do not hesitate in contacting my firm. Sincerely, Charles D. Garland Architect 74-854 Velie Way, Suite 5 ❑ Palm Desert, CA 92260 ❑ Phone: (760) 340-3528/Facsimile (760) 340-3728 PIC, of �cc upancy-�-: a. Cit of LaQuintay. Building and Safety Department Of mti9�� 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: 54-840 AVENIDA RUBIO Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 01.10-273 Occupancy Group: R-3 Type of Construction': VN Land Use Zone: RC Owner of Building: SANTA ROSA DEVELOPMENT Address: P.O. BOX 11335 City: LA QUINTA, CA 92253 By: RICHARD KIRKLAND y� Date: 05-20-02 Building Official . POST IN A CONSPICUOUS PLACE ` x � m.