0009-161 (SFD)LICENSED CONTRACTOR DECLARATION
t hereby affirm under penalty of periurj/ 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
I On
Date Signature of Contractor�'r
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor',
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
Sala (Ser.. 7n44. Business & Professionals Code).
( ) I, 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 certificatetof 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 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, I shall forthwith comply with thowprovisions.
Date: • d 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 iipRection purposes.
Signature (Owner/Agent) �� �� ''"�-•-----� Date � �F ,
,,BUILDING+ PERMIT PERMIT#
DATE , VALUATION LOT CSCCj�. -Y.RD3 TRACT
(111s: R.t t'4':.' t I 'R..1 19 T.MS
JOB SITE f �•
ADDRESS
API
OWNER
CONTRACTOR/ DESIGNER / EN INFER
40- 847 'SJ.yiNRaITT'M G.•'OU�R f
71--8981-WHWAY y i l'
PAMINCID.i<M-11 CA 92260
LP. QfTWTA CA. :2253
(760)341-$949 CIDT M :4•afO
USE OF PERMIT ::
yy- �,�-+-• ,'y��gy p y yq,ypry
D W.C�ni-r.1.sfJ.YG '
800 Tr'fU''32AOT,00k3 N* rDE F;1bCX $;�td13.i.,i,dila00USPA OIL
DRIVEWAY APPROAC`f!
TRACT CONSTRUCTION .119 `5.00 OF
ir6:3rMPAT,E0 '7'd..00 SP'
t1A"09.lCAR:1'i7WT (W)
ESTAIATED R;:.O,.W CO' COT�f8»"Y c' 3� 1OR
Y
1�:tit✓zi 13 OWYMA Y
t��? dwi°f ti3 C 1 it s Fi?.f I 103 -000.418-Cart; $681.50
PI.A14 C:;iYMI . FEE? 1,01••000-439-316 $50.77
F FM D]W(Mn 1171-000•�39.3113 4250.00
&SCI IAI IC:t L IEE 1 X11 -t)00 -421 -*00 $5150
1ZVO T RICAL PRE 101-tl00-47'CisW
PLAIMB'4. O Ail E, 101-000-419-OOCA �k'�k.a5
-000^:,741.0,130
13'PWOO MOTIUM FFR:, fd,OW IM -000-141-0,130
Oitdla'3kNG FRZ
DYINEWPER IMPACT YZIE 91107-00
ri�4i1,">� IyI.t9S'l 102 •-C10fl-''4.41.-�t�!-S �:;tl!. Utt
C-°g1_E'.'t"LiUC'r(0.,XT
q.UE-11`C+'3',P51'.. AND P+'J,NN Cs` WK
$3,599.42
���D3 PRE'-1alA.Y.�v: AX -13
111
420( ,,00
_S(,Yl-C3.kwf 5'✓Rl' ll.L. J: di�i . -�L+Y 1!. , llo
.. �,kVD
"K,349,42
JAN 0 812001
f401TY (Aa~'••
/U VLAZ ..4k
RECEIPTDAT
,
BY `�F
3
DATE FINALED
INSPECTOR
�}
1 1� :t
' . V
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
, (7
Ducts
Slab Grade
_
Return Air
Steel
Combustion Air
Roof Deck
J,p -p ( r
Exhaust Fans
O.K. to Wrap
�`(p, p `
F.A.U.
Framing
66
Compressor
Insulation
%o1��l
Vents
Fireplace P. L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_ c_
(O { �`�
Final
Final
�o
POOLS - SPAS
BLOCKWALLr A.P ROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
31 a-J�p / .$-�
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
�? �. p(�
Encapsulation
Gas Piping
Gas Test
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
Utility Notice (Perm)
meq_ ��, /C/ s
P.O. BOX 1504 APPLICUION ONLY
Building/ 78-495 CALLE TAMPICO 111
Address �' (� Ave. U QUINTA, CALIFORNIA 92253
Owner
��j
BUILDING: TYPE'CONST. OCC. GRP.
Mailing c-
Address -40S47 S{id,(r I6u✓ acq✓ e3 A.P. Number �7 Q 6? —1 -• Q Q&
C{it�y Cn + Zip 9 a 6
K �(� kf )�„ Ov •• /Legal Description
Contractor Project Description 5,1�1�f�LZ1vB�C%/i1 t.
mo; oup- Bull/�5 C7 O
Address 1.10(W
61-4375 AVi' 4-9fo-6
Cit/��,0 ZIp�Z2t Tel
State Lic. City
& Classif. Sg Lic. # Sq. Ft.No. No. Dw.
Arch., Engr.,
Size �g�s Stories Units
Designer u✓ UPS al f + , New G"' Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address 10 Tel.
35--'37 5 OC44E 0416 Of ,a 2-7 / 4
CityZip State
q2-2 3 Lic. # _
22 2
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 I r Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031:5,13usiness 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 ,PERMIT 'AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or thathe is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
!: 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk.,Bal.
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 Const.
builds or improves thereon and who does such work himself or through his own employees, Mech.
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 Electrical `
of proving that he did not build or improve for the purpose of sale.)
II I, as owner of the property, am exclusively contracting with licensed contractors to con. Plumbing
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 S.M.I,
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
i] I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date owner Infrastructure
WORKERS' COMPENSATION DECLARATION t
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
n Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS v `�
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
1 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, alter making this Certificate of Exemption you should become ZONE: BY:
subject to theWorkers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this'permit shall be deemed revoked.
Front Setback f-om Center Line
Rear Setback fmm Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street,S i6ack;frorq:Center Line
Ihereby affirm that there is a construction lending agency for the performance of the P' ,I t
work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback fr• ri 'Property Line
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
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. Issued by: Date _Permltl•�
I agree to comply with all city and county ordinances and state laws relating to building It
construction, and hereby authorize representatives -of this city to enter the above.
mentioned property for inspection purposes. Validated by:
Signature of applicant —Date—
Mailing
ate Mailing Address Validation:
City, State, Zip ITY 011� 'a �...,A.. , 4
� { �1
«+r lei,J.
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
8
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 1/8/01 APN # 744-292-006
No. 21451 Jurisdiction La Quinta
owner NameSanta Rosa Development Permit #
No. 54-860 Street, Avenida Rubio Log #
city La Quinta -Zip 92253 Study Area
Tract # Lot # Square Footage 1875
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 1,875 or $ 3,843.75 the property listed above and that :)uildirig'
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
.Fees Paid B CC - 1 st Bank - Vince D'Ambra
Y Tgiephone
Name on the check
ti
By Dr. Doris Wilson°
Superintendent
Fee collected /exempted by Annette Barlow Payment Received $3,843.75
Check No. 58007
Signature. (A�
OTICE: 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 pretest the fees or other payment identified
bove 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) v to another public entity authorized to
ollect them on the District('s)(s') behalf, whichever is earlier.
'Cwilector; Attach a copy of county or city plan check application form to district copy for all wau+ers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
FPir,1 FH'.)` NO. ?61,_JE?e49R112 Dec. 20 2000 _ 2 27P!'1 P1
G�1(71i-.'t :5.7 T T.
0 L r F 06:®ioR Fr"e:28. b6
Peg® i of 1 Doc T rax Paid
!ti%t`11i::: Nl: iti'a;i;It;'rlih'•ty Rot:ordad in arficlal,Records
CourAy of Ri-sa--rec(se
Gary L. Orso`
r,M) YA11%\ fd:0011DED MAIL To: A9sessar, , County Clark ' & Reeor&-r
Vincent Damhra-
40$47 Sandpiper Court ^
�'2 m Dmil CA. 5426) r ... I
• M , - A M6_
.. I r' '�.'�'-' � !I ,fit/, ► • .
V .% . ?( 1 � / .��1. i 4 _ I I 'COP) I LNC I .. "r." i 91Ntd
_ ' Lam_.:: ��.___OP
A.P.N.: 774 -29? -004i 005 . b6 'TRA #:Z4fbrder No.: 1E5c.r:iw No.: 2-31661 -
TME UNDERSIGNED GRANTO'R(x) i7Rs:t.ARE(x) 77•IAT rSOCt}MPNTARY T2ANSCER T.4X 1S: COUNTY $62.50
#X l cnaipu:cd on fttil value of gropprm conveyed, or
�...cotaputcd on full valt3;, iu xaska•..o:livtas vr.i:ncumbtaps.scmfl;ttitag at titna of sec,.
- 1 uti=Orporated area; ['X amity of ' :n 25
FOR A VALUABLF CONSInERA.TION, Receipt or wlac.`-: t, i:F;; Iia' act-::ax:4e i:lted,
Harriett Linda Majacic, a Widow
hereby GRANTS) to Vincent ,1. Datnbra. a iviarried iv%an as hix coke and Reparate property
the following described prnpercy in the City of Lan Quinta, County of Riverside State o. California;
Lot 19. 20 and 21 in Block 278 of 6antn Carmeiita at vaie La Quina. Unit Kt). 2s. in the City oh'a a Quints, rmitlty
of Riwer:ide, as per map recorded in Book 19, Page(s) SO and 31, of Maps in the Office of the County Recorder of
said County..
Harriett Linda Mf(ane
Document Data: _Jttiy 12, NW .
OTIA}
On .� before rne. A ?-�� / �tbC1 t=
perscnsllY �PP�� r >�' _
L
(or proved to ane on the bash: o" 51.1risfactn cvMcnuc) to he the ptmLm4) whose ua=,*)& UAdcnbed to the xithin ia$Tl.'mera
rnu aalloV16100 in mo that .IMC execured fie S=e tc IWE9 / aVti pr+md capactt"(t%.)-and Lhst byliar x,gna:ure(SJ ori tale ir.-mill^-lt
the pc.•avn(S3 r the eotiry upon f of w�ich the pers tiftcted. executed rhe :ssauzaaw.
`MTNFiSS my hand as sr• . %
'r!tis area tar official roca:ial sial.
�0d�eeowoes�e4 °�
L. GALLED rOS
COMM. #1227860
e UUTAR ' PUBLIC - CALIFOP.MA
RIVERSIDE COUNTY
Mail Tax Stateinettts to. SAME AS ABOVE o- Address Noted Below
010 FzEPUSIUC TITTLE 00.
RECORDING REQUESTED BY
AND WHEN RECORDED MAIL TO:
Vincent J. Dambra
40847 Sandpiper Court
Palm Desert, Ca. 92260
DOC a 2000-346770
09/05/2000 08:00A Fee:26.00
Page 1 of 1
Recorded in Official Records
County of Riverside
Gary L. Orso
Assessor, County Clerk 8 Recorder
IInIYIIII�IIIII�RIflIIIIRInIIIIAYIIIIIIIV
_ misc.
?
A.P.N.: 774-292-004/ 0051006 TRA#: Q,i
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 Safety- Department as your
correction lista Please attach additional explanations as necessary.
APPLICANT MOJAVA BUILDERS
SITE ADDRESS 54-860 Avenida Rubio
APN 774 292 - 006 BIN NO.: CASE NO.: "2000-363
LEGAL: LOT BLOCK UNIT S.C.@V.L.Q.
CHECKED BY: Stan. Sawa . DATE: J-zl
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
v
.Consistent with MDG on file.(as.applicable
MDG filing required (5 filings since 9/3/98)
Consistency with street/surrounding area:
Colors
Materials
Architecture
Other. Requirements:—
pad rs ��v�
fcv, l� o
t,G6V&
C11"I
11 May 2001
City of La Quinta
Department of Building and Safety
78-495 Calle Tampico
La Quinta, CA 92253
f
CHARLES D: GARLAND,
-�,t .
Architecture, Interiors, Space and Land Planning x �n;:r1�,�.
Structu ral"Calculations
Proj. Single Family Residence for:
Santa Rosa Development
:54.860iRubio
La Quinta; California t
Re. Project Observation
To Whom' it May Concern,
The owner's project superintendent has requested that I visit the project site to observe the general prog-
ress of the construction of the structural portion of the work and t6 11 a framing question that has
arisen in the field. The work, in general, is proceeding well and all aspects of the foundation and rough
framing appear to be in substantial conformance with the structural design intent as exhibited in the con-
struction documents. As to the framing. issue, .detail 5 found on page 2 of 7'is vague and incomplete.
This was a plan check issue as I recall and the concern was to tie together the high and low trusses at
the "Left Elevation" of the building. What was omitted and what I am hereby calling out to be added is a
CS16x60" long nailed from the top plates of the high roof to the low trusses at they joint between high and
low roofs.
4
If you have any further questions regarding, this or any other matter with regarc to the subject project,
please feel free to contact me.�
Architect
35-325 Date Palm Drive, Suite # 151J - Cathedral City, CA 92234 - Phone/Fax: (750) 324— 7146
r
lop
.:
in 2'2,:f2 0 0 9: 46RM ESSW '.
l
h
Earth Syst®rtts
southwest
esrmuaa Donee. CA 9=1 • UM 34&tSW 9
CI'leM Nerve _
Pum MOMS
y
CuenlPhone
CLIENT REPRESENTATIVE SIGNATURE
eaFs•oo:l�aasl .
(700) 345-7315 p.2
FIELD RFlr®OR T
TECHNICIANS SIGNATURE
N2 -9416
SPECIAL INSPECTI-ON.SERVICE'
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE O STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
X." -CPD -)o/
❑ OTHER
JOB LOCATION �•4 —9� p, J► vE.N I A �(to a' o t—a Q u ��
(�'i'
REPORT SEQUENCE NO.
TYPE OF STRUCTURE
3FD
PERMIT NO.
DATE -
411 1
DAY OF WEEK
MATERIAL DESCRIPTION-
119
ARCHITECT '-
INSPECTOR
HRS. CHARGED
•
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERAL.- SUB'
CONTRACTOR OT&U �t,11 �� CONTRACTOR L(N . TL p
g k.nVtAeg-s enoc-
`I ! 8 0 /
bS2P..cpJ 1 /1 GE wt ENT OF $ .A S19" -6H : Tl -E i? E►'F j�
GJ�`YH I �� �6,ec1MQ.N`i"-lSituG- Si�PSoN Ser OX
S Z 7 cl ® TH6 F0y-(-0:,310C- Lo' c-IN't-loNS
S E,h, wesr wpi-k. o ;F 6L- > Q.=,or-N r=46T OF 06 06- 9-oorr-A
k. ® (,0I✓5t- WA-LL4 6 F wAas
C,Lo 5e7r
!�-1 No �5 Qush{Ei) KOD `e3Lowry de -o o PIV,oR- To
6pow srjxEc-TI
D(P I>ATL=- i.z .o z ,
COPY SENT TO CLIENT ❑
CONTINUED ON NEXT PAGE ❑
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE'' SECTIONS OF THE
GOVERNING BUILDING LAWS.
W • ?` IMX4-
SIGNATURE OF REMSTERED INSPECTOR
1 01 -rCZo I1113Z6-`3i
ATE OF REPORT REGISTER NUMRFR
a
Certificate of Occupancy
City of La. Quinta €�
Building and Safety Department OFTM
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: 54-860 AVENIDA RUBIO
Use Classification: SFD Bldg.Permit No.: 0009-161
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC
Owner of Building: SANTA ROSA DEVELOPMENT
Building Official
Address: 40-847 SANDPIPER COURT
City: PALM DESERT, CA 92260
By: STEVE TRAXEL
Date: 10-01-01
POST IN A CONSPICUOUS PLACE