0108-057 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
4Chapter'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
Date Signature of 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 & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to -construct the project (Sec. 7044, Business & Professionals
Code).
O I am exempt under Section B&P.C. for this •reason
,,Date �y/'- Gy ` Signature of Owner J/,i.
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 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 those p,ovisions
�FDate:, ` Applicant ,.r -��i
Warning: Failure to secure Workers' Compensation coverage is unlawful and
tshall 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 & eactj'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
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 upo
the above-mentioned property for inspection purposes, 41
WS
lgnature (Owner/Agent)-�`!�'��•,�-�� Y h' Date./ •i
f/ e
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
11LK 3-5 1-15
JOB SITE .
APN
ADDRESS$511,465AV]KINYDA RAW. Aesy
OWNER
CONTRACTOR /DESIGNER /EN INEER
INLIoy V.iIyS
0MVJC/BCSPER
P0 13OX., 6041
LA. (g'.1muX A 9123.E
USE OF PERMIT
Y,,AA�d �yY��• {� x�pu L q �v.Tr
'1'i1'iPxrs� .h S`.J.P.ld.Y.�d• ��� V F.L"ntal� 1G�
d±l"K� • RNPI MIR' 110 PS SSOT INCL UOM �3.�.0+.'.'.�'.:'uv.F LI,, POOL 0R LDS; pi'I AY
APPROACH,
TRACT CONSTRUCTION ?,mmb SF
-
PORCH)PATIO 454.813 SF
0AR13K T C AR.PORT W100 9.F
3 J71'. V100D M4C.2, 300.00 121
?EV2Mn' W2, SUMMARY
CO4FS'.$ RUCTION .RY. 101.000-4113>000 S64CW
PLAN CHECK FU, '101 -OW -439-318 $531,44
RXDDEPOW 101••000439-318 47150100
MPVlA N1.CA,L M 101-000-421-000 $4.6.00
RLW, CWC.C•I L FEJ? 101-000-420-000 S1121,77
1ty,73MI1TNO F1119 101-000-419-000 00.419-000 $113.00
1a"' Di.OWO MOTION Fft • 6tYSID 101-000441.000 $.10.0
C31?A:f.D1140 PEP 's i1$ »K;fltd�,h�3 OBD �ZiLOtD
11WRIP.PER IMPACT RE
Y�
SUB-1`C>'rm, CdMTR C-110,,9 A-11H)1`'LAM Ci 3,i CK
. F'1�1?aP14MFEE
-V30.00. .
NOV 2 9 2001
RECEIPT'S -_
B'f i'
DQTEfFIiyfi�ED
<J SAF(-/\
SP
r
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
O.K. to Wrap
Framing
Insulation
_
/��c//
[CC��
�— / J v .
_ _
_ - O _
G 2,
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
_
_
_ _
_�
�_
_
Fireplace P.L.
Grills
Fireplace T-0.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
°
Exterior Lath
/ .•
Drywall - Int. Lath
Final z _
BLOCKWALL APPROVALS
Final
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
_I
Waste Lines ._7_
Water Piping �2i �
Gas Test
Electric Final
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_ �j
`Z �/�
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
`
Final
COMMENTS:
Final /—
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole 0,2
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.FJ.
Smoke Detectors
Temp. Use of Power
Final—J— �-
Utility Notice (Perm) 1
E16W-1 4—A—&Z., 6• S. %1.7Z
Building r / S
Address
Owner A\
Mailing V
Address (} 0
City / Zij:
0WN6rL
Address
City Zip
State Lic.
& Classif.
7/ 7 ,T lei s 109-
�epf r� I �s
.. 0 0 K90 ,
YYY P.O. BOX 1504 APPLICATION ONLY
78-495 CALLE TAMPICO
I/� /Q j39 f/!L� Z LA oUINTA, CALIFORNIA 92253
1 `s BUILDING: TYPE'CONST. OCC�GRP.
v
A.P. Number
Tel.
Z 7,, S"3 7 7 41 �i 'a,, / Legal Description
Project Description `J /Mi: /e- r M'
67
Tel..
Arcn., tngr., ;q— `
h
Designer J o nJ C A,57111,,
Lic. q Sq. Ft. 151
Size
New O' Add ❑
Address Tel.
o , C6 «:< 30 a `/ 771-3 i �s
City " I • ZipState
a,ao/ Lic.a
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 rile 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 ($500).
!: 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, Buisness and
Professions Code: The Contractoi'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.)
I1 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.)
1-1 1 am exempt under Sec. B. & P.C. for this reason x
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
n 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 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
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 sof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
No. No. Dw.
Stories: Units
Alter ❑ Repair ❑ Demolition ❑
AS - S/- cn ''/4
6VE V, 1fE-Tv
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
-
Plan Chk. Bal
Const.
Mech.
Electrical
Plumbing
S.M.I.
"i
Grading
Driveway Enc.
Infrastructure
t
2 _ t.
L
N.
...
TOTAL I'._,.
I
PT
REMARKS
A0; ,
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:
C
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Desert'SandsUnified&School District
47 950-Diine Palms: Road
Notice: IL Quinti ' CA 92253
Document Cannot Be Duplicated 7.60-771 8515`
CERTIFICATE OF COMPLIANCE
Date 11/29/01 APN# 773-125-020
No. 22719 Jurisdiction ' La Qi inta
Owner Nal. S. 1Vliles Permit #0108-057
No. 51=665 Street Avenida,Ramirez Log #'
city La Quinta Zip 92253 Study Area
Tract# BLK 55 U5 Lot:# . 8 Square Footage° 1.547
Type of Development Single Family.Residence No. of Units 1
Comments
At the presen
t time_ the,: Desert .Sands Unified School District does riot collect fees on aarage's/camorts, 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 frfir paying school feeslat this time due to the following reason:
'EXEMPTION NOT APPLICABLE
This certifies that school.facility fees imposed pursuant to Government Cod e, 53080 in the amount of
2.05 X 1,547 or $ 3,111.35. "the prop..ertyhsted above and that building
permits and/or Certificates 6f Occupancy for this square, footage in this proposed'project may now he issued
Fees Paid By CASH -`Wally-Mileselephone, 760-771-4824
Name'on the check
By Dr. Doris Wilson < .
Superintendent
Fee collected /exe pted by Annette Barlow Payment Received 13,171.3 5
2or
Check No.
Signature
OTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 6"y -approval periodAn which you may protest 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 4o the District(s) or to another public entity authorized to
ollect them ori the District('s)(s') behalf; whichever.is earlier .,
Collectors Attach a copy of county: or city. plan; check application fo to district:copy for all waivers.
t
Embossed Original' Building.Dept./Applicant Copy- Applicant/Receipt Copy -Accounting
RC DISTRICT Pj.LANNJNG REVIEW FORM
This form is to be used,.6V CDD: staff for review ,,6f.single family dwellings in the RC (Cove
Residential) District p6rf$e'ction,9-.-`50.,o90 of 7,the';,Zonihg Code" Jts purpose is to determine:
1 )ro`P-6s6d- hoo'se design does, not'. duplicate e s'a rh
that the r 11 - licate'th .,e�arQhitectural style of any
i
house within 266 feet'l-of thd"applicant "ind/or.2 )`rjf there,is-a.need for the applicant to file for
Master DesignGuidelines. If the appliciiinf does need to file a Master Design Guideline, please
-
transmitted this information to the -Build ing:an Safety Departme'nt--as part of your correction
list. Please attach -additional. . ,explanptions 1iis' necessary.
essary.
APPLICANT WALLYLMLES
SITE ADDRESS -51665Avenida Ramirez
APN 773 125 020
LEGAL: . LOT
CASE NO.: 2001-520
BLOCK UNIT.
S.C.@V.L.Q.
CHECK AND APPROVED, BY: Fred Baker DATE:
Inform the assigned Building, plan checker ppon-.,your assignment to this case. The CDD
'b 'ok ,track assign case numbers.
Executive -Secretary maidtains'a log.. o to, c a
REQUIRED ITEM
Y.
COMMENT/CORRECTION
Verify legal end APN information
consistent with MbO�on file (as
applicable
MDG filing required15 filings since
9/3/98),
A?1ROVED.
CO Mu.,9.NjTy DEVELOPMENT DEP
Architectural variety within 200 feet of
the surrounding area:
Colors
.Materials
Ar&hitectural design features
/B
FX
Fx
DATE t
I�IT
IBIT
CA
E NO.
Other, Requirements:
_ CITY OF LA QUINTA SUB -CONTRACTOR LIST O
JOB ADDRESS �� / �(v s- Avg PERMIT NUMBER OWNER W,4 #0 J &I ZBUILDER O LI) 11-
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Onl ersons appearing on this list or their employees are authorized to work
on this 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 hiiilrfinn nprmit .For Parh annlirnhip trade- all information renuested below must be completed by applicant. "On File" is not an acceptable resaonse.
..: . -
Trade /Classification
Coritractor.
_';;.State.Contractor's License :.
Workers Com ensatiori Insurance
Cit Business License
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xxlxx/xx)
Carrier Name
le.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
Ixx/xx/xx)
License Number
Ixxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C-12) :.
�!�
/vZ
�' ��
v
�% T - — U.cJ�
7,( 6F-3 - 0 0
'
CONCRETE IC 81 ...., ..;:..
-30 -03
FRAMING IC -5)
r 1 I til E CC7 , '� ti C
/�,
�� 'PG G .
�� d
i✓!J %%
s
STRUCT. STEEL (C=511;.:
S TATE' FUND
/ to — �!
9 -3 -02.
a 5 o
MASONRY IC=291.
PLUMBIN(i.IC-361. .:
N NC a 1 C
6
lob 6- ZC�
6 jC o?
, /' 60ti0 LJ-/
206/ /S 3�
y 3%l
0z�4a530
3 0z
LATH .PLASTER IC=35) .
,4L n!T PJE 0. N .
Z6
6 03
r/0U
U)6/` //S6 3S
3CJ 0/.
X530
Ol
DRYWALL (C-91 ::
nf`l'1 nJ E _ N
/!j
16 Z
0 UZ
/�/1�vGtiUtJ7
20 / f S63•S-
F o U/
a:f�0-a530
/ OZ
HVAC (C-201 ,.
L o
S
2 SS
/ Via .
5' T ci .�
a �/ 6 o 00k
0/h/
01-5
ELECTRICAL IC -101. ...
E L6_ 0AJ
G' /1>
1141102,
G, oma► cJ /� //NSE
w C // ` /O� Z,;'.
2k U
/ 9-5
ROOFING (C=39)a .. '> > :
/� n1 T/�cJC /tJ6
til G 6
'0 O Z
,'� % O r>v7<
C 206 S
SHEET METAL (6-43)
FLOORING (C-1.5)
GLAZING ICA 71
15'q110AJ 692 p
,J
-
/
00
0 a 6
1 ' d D/
/3l 03
S AJo .
?C �i� 4 p
O U. 6 0 0
`
26 '
INSULATION (C-2)
SEWAGE DISP. (C-42)InJEt!O
p iJ
1 N�,
e2
6 3 U 2
to 41GS Z 6
�O �)
(6 30 lI
/l l�U�LL 2 /U -9
C. (. 22 6-25y6U
6 3v 0
X32
PAINTING IC -33)
2�Z/�o,,�
— 33
3 Z 330 6
Z� o
s-rA7F FUn!!�
-10598%ab
0
��
fl /l 0
CERAMIC TILE (C-54)
,�/o�/� D Ela
CABINETS (C-6)
a-
FENCING IC -131
_ / 1
r
LANDSCAPING IC -27)
POOL IC -53)
Me
.12
W_
RECORDiNiayt �c�.tL.,c., I �V rw ,.
.1T`r NAT TRLE CA
RECORDING REQUESTED BY:
Fidelity National Title Company
Escrow No. 42865 -CB
Title order No.,33011920
When Recorded Mail Document
and Tax Statement To:
Mr. Wally S. Miles
P.O. Box 604
La Quinta, CA 92253
323678 '
200.1 � 3.
` `07/13/2001`08:`00A Fee:8:00"''' �`•'
Pagel of 1 Doe T Tax Paid
Recorded ,in Official RecordsHry,v
'County 'of Riverside
Gary L. Orso
Assessor, County Clerk 8 Recorder
I
M S U PAGE SIZE DA PCOR NOCOR SMF
MISC.
GRANT DEED
COPY I LONG I REFUND I NCHG I EXAM I
ACE ABOVt I rnw ul.L
H
�� b2c�vlG�
The undersigned grantor(s) declare(s)
Documentary transfer tax is $31.35 M
( X ) computed on full value of property conveyed, or
( ) computed on full value less value of liens or encumbrances remaining at time of sale,
( ] Unincorporated Area City of La Quinta
_ FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Jeffrey Roger Balton, Trustee
under that certain Trust Agreement dated February 4, 1974
1 hereby GRANT(S) to Wally S. Miles, An Unmarried Man
v
the following described real property in the City of La Quinta
(� County of Riverside, State of California:
Lot 8, Block 55 of Santa Carmelita at Vale La Quinta, Unit 5, as per map recorded in Book 18, Page 63 of Maps,
in the Office of the County Recorder of said County.
DATED: June 22, 2001
STATE OF CALIFORNIA
COUNTY OF Lo Nk 9,4'
ON A1,LA Z LO&I before me,
'.r.k GsscK personally appeared
30X'eY o9Zi �>0�0h
personally known to me (or proved to me on the basis
of satisfactory evidence) to be the person(s) whose
name(s) is/are subscribed to the within instrument and
acknowledged to me that he/she/they executed the
same in his/her/their authorized capacity(ies), 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. " t
Witness my h d and fficial s al.
Signature
Jeffrey Roger Balton, Trustee under that certain Trust
Agreement dated February 4, 1974
Y•
Jef o (er Barton, Trustee
RONALD HASSON 3
V NOTARYOPU aC�28�FAII
O LOS ANGELES COCI
COMM. EXP. FEB. ,4
MAIL TAX STATEMENTS AS DIRECTED ABOVE
GRANT DEED
Certificate of Occupancy
City Of La Quinta
B:u#d,�hg,.and Salbty. Deparfinen:t.
This jl7ertiftate.� issqed patsuah"t to- the -req qqireMents'.of Stiction 109 of the Uniform B*,u41qipg.qode,
co'. DIVance with the various
certifying that, time " of )s,,§uahCe,' thii structure was in M ordinances
of i4e, City regulating bw- diqg construction' or use. "For the lolldwing.
BUILDING-AbDRE-8,S: 5.1,=665 AVENIDA RAMIREZ
Use'.Cl,bssif ication: SFD5
Bldg. Permit No';.: 01108��O 7.
Occupancy Group: 133Type of Construction: VN Land Use Zbn'e: RC
Owner of Building: WALLY S. -MILES
-Building- Official
Address: P.P. BOX 604
City: LA OUINTA, CA 9.2253
By: 'GARY SHOWALTER
Date: 5-24-02
POST IN A CONSPICUOUS PLACE
1®