0111-290 (SFD)LICENSED CONTRACTOR DECLARATION.
I 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. Class Exp. Date
4253,81 1101
/Date.`Signature of Contractor
OWNER -BUILDER DECLARAT ON
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).
( ) 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 certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
perfo mance of the work for -which this permit is issued.
W.( 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 ST►.4`:Tk: ME) < Policy No. 1009"M
(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' compensaton provisions -of -Section 3700 of the Labor
Code, I shall.fortthwith-comply with,tho'se provisions. 0-
lDate.ftI -% ';�N�pplicant
Warning: Failure to secure Workers '`ComPensation covers a is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on hil
application.
1. Each person upon whose behalf this application is made & each person at,'
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as -a. result of this application becomes null and voidif.. ,
work is not commenced within 180 days from date of issuance of sucfi
permit, or cessation of work for 180 days will subject permit to cancellatio .
I certify that I have read this application and state that the above information i
correct: I agree to comply with all City, and State laws relating to the buildin
construction, and hereby authorize representatives of this City to enter upo j
the above-mentioned propdhy..for inspection purposes.
t' 9
Signature (Owner/Agent) " ` Date
,?
4 y;
BUILDING PERMIT PERMIT #
Jr
DATE 1 VALUATION LOT 0111-290 TRACT
i j )
t` 'tttt` S1 1 ?1`%6X) 1 3, 14 iiNdFa 7A
JOB SITE
APN
ADDRESS l!,,11�� a p4�+p,-�p�q �1, �7ep�t�q�8 •t�
eJ1.4MAA/ d`9.G'A4d•4Ar6t�A,X'i•eA.7.exaY�.jF.wT..
yes f�r�+x 6�.
/ 73-i.Kay.7`�i26
OWNER
CONTRACTOR/ DESIGNER/ EN INEER
DA VID ljrI.lT.LOR
PACM.0 TRAIYESCONTMUMICIN
1715' 3 ",X`F�'�U',�"J14T
17,119 S MWCIM
S i3CZ*►T'"i7.3 E CA 920%.
S t f'�:.A:NIKME Cdr 92034
C'M)9161-0069 111MIL10. 1955 .
USE OF PERMIT
CIM.. e FJOrt1FLY Y +dlr1�31eF
SM.,P�kp�7�.Agv IT 2�iOi T .[�1CL�ll+lftP E F�yISdr'CAF$.S+t,,, 81..clw'±`LA"fCi4,WAL L4% @•'t. 01, �J'R .
71
j-
5. tl�ES
WWWAY Yb}�1'RV AACH O'Aat,iJRe. D ;S9.A✓Si j'A i'S �%-d.l Ii ) .
TUC:'T CONS RJUC'T'I(X0 1,899,00 SF
%ORCIilIATIO 39.130 SFr
t"� t Ql°.�CiA1 fifi�Ca. 'I' "9Efi4.64 SY
'
T TKE T"SMWARY
CON-STltUCT1014 FEE 101-000-4181, 000 Voa:90
PLAN C^1,I1C M 101-000-439-316 $,11Sn:68
FER, iSl%1''OSIT 101-000-4-39-318 4230.00
Au?.C14bAN1Cti'! 1IZi�' 10141L►L''?-*'i21-000 U6.50
9UCTRICAL FFE '101-000-420-000 $129.03
Pf UmBrorlFfmg $14100
STR.ON 4 MOTION R - 1MIND 101.000.24.1.ON $ l 1-1A
O.>gADJ'N0 P'EZ 101-000.423-000 $20.00
C1WELt7.PM WACT FRE $1,907.00
1 R21DISE Mehld 101-6300-44.1-345 $1nn.d�d
r
9.
,1T.1S4MAL t_'0141�1"1tITMP• A .AND PI..&N C41FICK
$3,663.47
nFr. 18 2001
40REC
M;18AMf 14M ' DATE
DA UJINAL
INSPECTOR
b y
LwiliNIIIIIIII
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION.
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_Underground
Ducts
Forms & Footings
_ j} 7. /`=
�d�
Ducts
Slab Grade
_ `{�
Return Air
Steel
Combustion Air
Roof Deck
5' G
Exhaust Fans
O.K. to Wrap
=
F.A.U.
Framing
r
f
Compressor
Insulation
_ ��—
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
_
3 - 2 (•D Z �� -
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
_
Ovl .. s -q.
Electric Final
Heater Final
Water Piping
�-/'�
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
�2,
Encapsulation
Gas Piping
Gas Test
-G
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_
p2
Utility Notice (Perm) 3F��
.,?3<OL
P.O. BOX 1504
Building78-495 CALLE TAMPICO
Address/<✓®n4 TAl1!e3ti/{Iris- LAQUINTA, CALIFORNIA 92253
Owner ., ,
Mailing
Address��,,.
City Zip Tel.
Contractor" r _. , / P
Address
City
Zip
State Lia
& Classif.
r5'
City
Lic. #
0_3 -e12 , �'
-Size ,4j►
Stories Units
Arch., Engr.,
Estimated Valuation
Rte.. Designer
PERMIT
Address
Tel.
City
Plan Chk. Bal.
Zip
State
Electrical
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) t.of Division 3 of the Business and Professions Code, and my license is in full force and
ellec
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 the alleged 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 ($500).
C -i I, as owner of the property,,,ocrpy,employees with wages as their sole compensation, will
do the work, and the,-structufeiis**not intended or offered for sale. (Sec. 7044, Buisness and
Professions` Code:f,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 irnprovemeMs are not intended or offered for sale. If, however, the building
of improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve f?Vhe`purpiose of sale.)
I"1 I, as owner of the property, am:eXcl"usively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business ands 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.)
17 I 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
``•. (7 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 ($100) valuation
or less.)
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
Laws�of California.
Date Owner
NOTICE TO APPLICANT: IL 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.
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 it work thereunder is suspended for 180 days.
I certify that 1 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
D it - 290
LDING: TYPE'CONST.-•� yet OCC. GRP.
. Number 2,7 9 – /i J o &�
al Description le 7' "� �� �.6� 1, t
Project Description
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
r5'
Sq. F
No. No. Dw.
-Size ,4j►
Stories Units
.New Ad&O Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
f
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
j' A --
Driveway Enc.
LJ
Infrastructure
'FINANCE O -PT
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:
i
5 "
�Y
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
v W,
- - Desert Sands UnifiedSchool District
47 950Dune:Palm's Road:
Notice: La Q1 nta to 92253
Document Cannot Be Duplicated 760-77j-8515,1
.W
CERTIFICATE OF COMPLIANCE.
Date 12/17/01 APN#. :773-083-026
f
No. 22765 Jurisdictiont La Quinta
Owner NameD'ayld ' LMer Permit #
Avenida Ra
No. ,51-460 Street mtrez; : Log #
City La Quinta zip., 92253;,;. '` Study Area
Tract # j Lot # Square: Footage . 1899
Type of Development Single Family Residence No. 'of Units 1
Comments
i
At the present time,' the Desert;'; Sarids Unified: ySchool District does not collect fees,'< on garages/carports, covered
patios/walkways, residential additions under 500:square feet, detached',accessory strtictures 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:
EX-EMP.TION NOT APPLICABLE
This certifies that school facility fees imposed pursuant°fo Government Code _53080 4 in the amount of
2.05 X 1,899 or,$- 3;892:95 `, the•;properly 11
listed:above and that building
permits and/or Certificates of Occupancy for this -square footage in thisproposed projectimay now be issued
Fees Paid By CC - Capital Bank of North County -J.R. " Telephone " 760-805-1251
:Name,on the�check'
By Dr. Doris`Wilson.
Superintendent
Fee collected /exempted by AIinette,,Barlow Payment Received 43,892.95
f Check No. 085325 _
Si nature J
NOTICE: Pursuant of Assembly Bill 3081. (CHAP 549, STATS. 1996):this will serve to notify.youthat the 90 -day approval period in.which you may protest the fees or other payment identified
above will begin to rurrfrom the date on which the building orin_sfallation permit for this project is`sssued or on which they.aie'Paid .to the Districts) or to another public entity.authorized to
collect them on the Distdct('s)(s') behalf; whichever is earlier.%'
Collector: Attach a copy of county or city plan check,apphcation form to district•copy for all waivers.
Embossed Original- Building Dept:/Applicari't Copy 1pplicant1Receipt Copy Accounting
. :.._:.._.::-_._ .......:.....__.... ...... ................ ........ n.1.r.......
RECORDING REQUESTED BY:
N AND.WHEN REQORDED.MAIL-THIS DEED AND,
® UNLESS OTHERWISE SHOWN BELOW,
MAIL TAX STATEMENTS TO:: '� Q fL, n~ i �1?
David Ross Miller `.
1719 .S. Tremont(rjlp•I'�
S. Oceanside, CA 90254
SPACE ABOVE THIS L'INEIF,OR,RECOROER'S USE'
The undersigned grantor(s.) dedare(s):
Glrant:Deetl A.F.N. 773-083-02.6
Documentary transfer tax is $ '
( xx) computed an full value of: property conveyedF or
( )computed on full balue less value of hens arid'encumbrances remaining at.time of sale, ' f
( ) Unincorporated area: ( r) City of '
and.
FOR A VALUABLE CONSIDERATION, receipt of which is`hereby acknowledged, t j.
MARIAN' L. `KNOBEL`
hereby GRANT(S) to . DAVID ROSS MILT ER, 'a•- married man*.as his_ 'sole and :separate property .
9,
the real.property in the City of to .Quinta County of Riverside
State of California,. described as.
Lot 13,& 14 of Block 66 Unit No r `Santa Carmelite at Vale La Quints,
as'per trap recorded in Book Pages mf Maps, Records of Riverside County,
California .
Dated September 26, 2 0 01 signature of: Grantor
Slate of California
County o1
MARIAN'L RN.OBEL
On before me, .
personally aPPears'd - -
MARIAN L KNOBEL .,•
personally known to rpe:(or proved. to me, on the basis ofsatisfactory -
eyidence) to be the,person(s) whose name(s) is/are subscribed oto the
within instrument'and acknowledged to me that aie/she/thay executed _
tha same in his/he.diheir authorized. capaclty(ies),•'..and 'that .by
his/her/their signatures) on the Instrument the person(s), or the entity
upon behalf of which the person(s).acted; executed the instrument:'
WITNESS my,hand and official seal.
Signature
MAIL TAX STATEMENTS"TO - setae -a bav
' I .
Form 3195-4 (s-sa) THIS:FORMFURNISHED BY coM,MdIVWFA.1 TW t enin•Trri c r-MAnn
drfis�
CF
ExtR
B `EWE
.r
a
OCT
RC DISTRICT PLANNING REVIEW FORM CIT(QEj':AaQUINTA
a PC-IANNINUIHPARTMENT
This form is,to be used by CDD staff for`re' view of singleafamily-dwellings.in the RC (Cove'
Residential) .Districtper'<Section 9.50.090 of the Zoning, Code:• Its purpose °is to .determine:
1) that the proposed house' -design. does not.,Ouplicate`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..1f°the applicant'does need':to file a Master_Design Guideline, please
transmitted this information to- the -.Buildirig.'.'and,-Safety Depar'finent as :part of your correction
Fist. Please attach additional explanations as necessary.
.APPLICANT . Pacific Trades
SITE ADDRESS 51-460 Avenida Ramirez-
APN 773 -_G3_3__-096 CASE NO.:,. 2001 575 _
t
LEGAL: LOT 13-14. BLOCK 66 UNIT G ' S.C.@V.L.Q.
CHECK AND APPROVED BY: Wally ;Nesbit 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
-::CQMMENTXORRECTION
Verify legal and APN.information
� �.� � (_ ti �
Consistent with MDG- on file (as
✓�
��c ��- �s
applicable
MDG filing required'(5 'filings since
r/'
z ..
9/3/98)
Architectural variety within 200 feet of .,
the surrounding area:
'
Colors.
?
6y7/1, G -+S c4n c172 (r_� /A9�FS 04(
Materials
„.
F
roved ti Architectural - s• n featu s
anning CornrmissIdh _..=.:._._
i%t66AEk6(6irements:
ommunity Dev. Dept...:.
als
e No.
ibit
ith Ciond4iens
"Certificate of Occupancy
City of La Quinta
��-PepartmentBuil 0 --and- Safety
This Certificate issued pursuant: the, re utrement& of Section T09 of the Ufiiform Building Cod&,
that, at. the am_� ee,,this structum was in coippl1ance With the various ordinances
of the.City regulating. building construction prwse. For. the following.-,*
-,RUILDINGA: DDRESS: ..51-460 AVENIDA RAMIREZ
.,Use "Classifidation: SINGLE FAMILY DWELLING - 'Bldg. Permit No.: 01"1.1-290
Occuoancy':,Group: R.3 Type of Construction: VN Land Use Zone: RC.:..
Owner of .Building: 'DAVI.D'MILLER
Building Official
Address: 1719 S. TREMONT
City: OCEANSIDE,- 'CA .92054
By: RICHARD KIRKLAND
Date: 07-26-02
POST IN A CONSPICUOUS PLACE