0009-150 (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
595754 '11 C9
o j
)4Qate 4 _% -7-01Signature of Contractors -
OWNER -BUILDER DECLARATAON
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).
() 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
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.
STATE FUND '229-00 WIT 0011090
(This section need not be completed if the permit valuation is for $100.00 or less).
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"corripensation 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 prone ions.
Date: f' S 3. ,A,pplicant / II
CK, 441.
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
fora 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�spection purpo es.
Si nature (Owner/A ent) I f :, /Ia 7 Date
I
PERMIT # ' -
BUDDING PERMIT --- __
DATE )) VALUATION LOT �i0-.t TRACT
JOB SITE I
APN
ADDRESS
` 4-015 A?,WSWA RAMEREZ
e
77,,,11-125-021
OWNER
CONTRACTOR /DESIGNER / EN (NEER
.+��.'C rJu ram, it;°� ;' wiz
PAS CCC}kZV)RIAC'M09 W
2-51951'SiIO1'fT)'.�.6!2�:`�dDOZA
52.,995 ,� � ` 14..14'1 1 ✓ .
ISA QTJ70'+i rA. (JA 9225.3
I -k Qt:F N1A CA, 92253
(760564-3023 CiLO 5537
-
USE OF PERMIT
syDIPUILM`3' Don Tani' lwCrf rum sLC cx wAt.Ls/poor4`,�:Ffl rv. ALY
APPROACH
',P�•Ba.'M, CO'.1 351RUCTEe' N )XI.00 Ss•°
PC)1vfr HPA.`T'It5 58.00 SP
17A13:hCsWUMPO Y 9^180
5 Ff. woor .V.n. ICE Bt .00 LF
r
F,sri ax) coy orF. 6' fom,Al?Wuribm
C€,1307RUCTION YTIF 101-U00-418-000 $6121so
PLAN C.i^Y)�'b IZ110T 101-000-439-1118 $513.45
M.M.4`aNWAIJ REM 101-000-421-000 S6�.Qfl
KIIPC:1'RIC; 1.P&E 101 -000.420 -WO
4ALUNItyM113 FFIE s` 101.000.41 9-000 5 t 1IS."i5
STRONG �AE?Tl(M r ES - RES913 101-000-241-000 19.31
e'sF3AD1190 FESS 101 -000-423-000 MOO
1")V4Z!.€3PM IMPACT FEE g1,at�T�iS)
PRECISE PW4 101-000-441.345 3.too.00
PER D"VOSIT 4150.00
SUR EAL Ce:ai4VMRT.1'Mif?N ME) 111 AN CIMOC
1MM PIU{ -PA ID FIESS
uL� SGt, OU
It"1'.ZF,lki Di1�. NOW
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
MV
., INSPECTION RECORD
OPERATION
4
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set -Backs_
Underground Ducts
Forms & Footings
�I I
.�`'
Ducts
Slab Grade
I
Return Air
Steel ,
Combustion Air
Roof Deck
0 O
Exhaust Fans
O.K. to Wrap
t2;5_ p�
�T
F.A.U.
Framing
12• .(g, 00
Compressor
Insulation
ccD
�-� .
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
ry -ZO
_
QYT
Drywall - Int. Lath
Final
3�!_<a_ O (
S_7
Final
POOLS - SPAS
BLOCKWALL AP ROVALS
steel
Set Backs.
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines�g_Q
0
�T
Heater Final
Water Piping / !l
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
I
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.1.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
'� • • m�—
Building
Address
Owner
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Mailing
Address'`52- !�!CfV �ilJ,%�11 9,0L'>O7-alb
City lZip ITel.
Add
p ITel.
State Lic. I (;fly
& Classif. TS <4- Lic. #
Arch., Engr., i
Designer
Address Tel.
City T - Zip State
Lk �r7.1t,a q7 -L<-� Lic.#
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 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) or
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).
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 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. 11, however, the building
or improvement is soldwithin one year or completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
II
I, as owner of the properly, 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 contractors) 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
F7 Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it 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: Ir, 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 sof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
ILDING: TYPE'CONST
Sq.
New
9
APPLICATION UY
Iv �
OCC. GRP.
Number -7 -12 .-- i 2.S' -=- 15 2 1
J Description LST A !�L, l S._ v .G -S 0 l -A ,R
mt Description �z- i"t. G O
t
CN
r
Ft. No. t No. Dw. , n
T� Stories Units 9w CI Add ❑ Alter ❑ Repair ❑ Demolition ❑ C�
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line v
Side Street Setback from Center Line
Side Setback from Property Line
t
FINAL DATE INSPECTOR POW*,
Issued by: Date Peemiit�
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT
PINK = BUILDING DIVISION
ilk/
If
Aimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
f1 "......
Kt
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 v
Side Street Setback from Center Line
Side Setback from Property Line
t
FINAL DATE INSPECTOR POW*,
Issued by: Date Peemiit�
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT
PINK = BUILDING DIVISION
DesertSands'Unifed School D'i'strict ,
'47-950.1)6ne 'Palms.°Road:
Notice: La, Quinti; CA`92253
-Document Cannot Be -Duplicated. ,'A;,
•r 760 77•:1=8515 a`
CERTIF'ICATE;OF COMPLIANCE
Date 10/31/00.APN # 773=125-021 .
77,
=r
No. 21156 W, Jurisdiction La Quanta
Owner NameAu&st!n& & Eya`Paz : Permit #0009-150
No. 51--685 t Street. Avenida Ramirez Log #
City La Qutrita ;Zip 92253 Study Area
.Tract # BLK55 U5 Lot # 9 , : Square Footage 1501 '
Type of Development •Single "R
le 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 additAons 'under 500 square"feet, detached accessory structures or replacement mobilehomes. It
has been detecminedxthe above;r amed'owner is exempt from.paying school fees'at this timeA a to the following reason:
EXEMPTION NOT APPLICABLE
This certifies_ that's (ihool facility fees.imposed pursuant to Government Code 3080 in the amount of•
2.05 , X ._ 1,501 : or '."$ 3,017.05. -the :propertyaisted above.`and that building
permits and/or Certificates of Occupancy for'thi's square footage in this proposed project may. now be issued
Fees Paid By CC/Dalley Independent Bank /:Augustine Paz'.'. telephone 760=5.64-3023
Name.on the;chi A
By Dr. Doris Wilson ,
Superintendent
Fee collected /e mpted by ` •Annette Barlow:.. ,.-Payment Received. $3;077.05
Check No 227509
Signature
40TICE: Pursuant of Assembly. Bill•3081 (CHAP $49 STATS. 1996) this will senie-to notify you }hat the-90-0ay approval period inwhich you may,ptotest the feesYor other payment identified
above will begin:6,,run fromahe,date.on which tne,tiuilding or installation pennit foi,this pros 's sssued or on whlch'ihey are paid to: the Districts) o,i to another public entity authorized to
:ollect them on the. District('s)(s') behalf; whichever is eadier'. -
Collector: Attach a copy of county or city.. pliii':che& application form to district copy :for all waivers:.
Embossed Original -.Building Dept./Applicant Copy - Applicant/Receipt Copy ,Accounting
Aug -23-2000 09:54am From -COMMONWEALTH LAND TITLE +76034.132.15 T=T22 P.002/002 F -T19
RECORDING R8QU8STND BY,
FIDELITY NATIONAL TITLE COMPANY
10234KC 544669,''
WHEN R$CORDED•, RAIL_ THIS.�DEBD AND,
UNLESS. OTHERWISE. SHOWN Bnow,
DLAIL TAX STATEMENTS :,20 s
SPACE ABOVE THIS LI
FOR RECORDER'S USE
APN 773-125-021
GST DEED '
51 -(0'85 Avg. �a►{�p...�°�.-
The undersigned.grantor(s) declare(s)=
Documentary transfer tax is
(XXX) Computed on full value of property conveyed, or
( ) Computed, on full value less liens and encumbrances remaining at time,oandale.
( ) Unincorporated area: ( ) City of
FOR A VALUABLE.CONSIAERATION,.recei:pt'Of which is hereby`acknovledged,
EUGENE L. TROPE and DAVIDA R. TROPE, as joint tenants,- and LINDA TROPE,
hereby GRANT(,S) 'to
AGUSTIN PAZ AND EVA .PAZ HUSBAND AND WIFE AS.JOINT"'TENANTS
the real property in the City of LA-QUINTA, County of Riverside. State of California,
described as:
Lot 9, Block 55, ❑nit No..S „ Tract Sai,ta.Carmel'ita at Vale LazQuinta, as per map
recorded in Book 18, Page(s) 63 inclusive of'maps,.in the office of the County Recorder
of said County.
Dated August 3, 2000
State of California',
County -of ) S.S. EUGENE L. TROPE
on
before me,
x, 'c;
personally appeared 15AVIDA R. TROPE
personally known.to-me (or proved"to me'.on LINDA TROPE
the basis.,of satisfactory evidence)- to be
the persongs) whose„tiame.(s) is/are s,ubscri_bed
to the within inserument and acknowledged to
me that he/she/they executed the same in
his/her/their authorized capacity(ies), ands...
that by his/her/their signature(s).on the '
instrument the person(s),-or the entity upon _
behalf of which the person.(s) 'ac;L,ed, executed
the instrument.
WITNESS my hand and official seal. i.
Signature (This. area for official notarial seal)
MAIL TAX STATMCROTS TO s 7
I
RC DISTRICT PLANNING REVIEW FORM
This form is to be used by CDD..stafffor 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 bglransmitted to the Building and Safety Department as your
correction list. Please attach additional explanations as necessary,
APPLICANT PAZ CONSTRUCT.IODT/LA:. QUINTA" PARTNERS
SITE ADDRESS: 51-685`.Avenda Ramirez
APN 773 125 -021 BIN NO.: CASE NO.: 2000-31
LEGAL: LOT 9 ✓ BLOCK UNIT �� S.C.@V.L.Q.
CHECKED BY:. Greg Trousdell 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 casenumbers.
REQUIRED ITEM
Y
N
COMMENT/CORRECTION
Compatibility Review
Case logged and number assigned
wF0
.Verify legal and APN information
Consistent with MDG.on file (as.applicable
MDG filing required (5 filings since 9/3/98)
R
F�
Consistency with street/surrounding area:
Colors
Materials.
- _
:~
chitecture
PS�-
�r
Other Requirements:
l
� z
Td
46
BOX 1504 APPLICATION OKAY Y
Building 78495`IoALLE umplco
Address 1 -1 if- pq 1 (2 -17 - LA QUINTA, CALIFORNIA. 92253.
Owner 'Cjt�
BUILDING: TYPE"CONST"—OCC., GRP.
Q6
Mailing..
Address
A.P. Number t!) -2—
City Zip Tel.
Legal Description I.
Z,L 2 -2A-3 I
Contractor . - _. � .. -6
Project Description F,&- L
-JJ1
J r-$. PtIfZ77 --171
Address -
City Zip Tel. Q tS2_?_<y,
State Lic. City
& Classif. :S_1 4_ Lic.# S5. 'Sq., Ft. No'No. Dw.
Stories
Size Units
Arch., Engr.,
Designer tt New Add 0 Alter 0 Repair 0 Demolition 0
Address Tel.
O
bt,—, 15 Q
city. Zip, State (2
Lic. #
LICENSED CONTRACTOR'S DECLARATION
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I am licensedunder "provisions of Chapter 9,(commencing with Section
7000) of Division 3 of the Businessand Professions Code, and my license Is In full force and
effect.
Worker's Compensation insurance, or a certified copy thereof. (Sec. 3 , 800, Labor Code.)
SIGNATURE DATE
OWNER -BUILDER DECLARATION
Estimated Valuatio
I hereby affirm that I am exempt from the Contractors License,Law for the following,
•
reason: (Sec. 7031.5.Susiness end proleisions Cods:> Any' city or county which •raduires a
TOTALS
CERTIFICATE OF EXEMPTION FROM
permit to,construct, after, improve. demolish. Of repair any Structure,' Prior to'Its issuance also
requires the applicant *for such permit lo+rde a signed"statement that he is ficeiised:pursuant to
;PERMIT .
the provisions of the Contractor's License Lew, Chapter 9. (commencing wfth.'Section. 7000) of
subject 16 the Workers' Compensation provisions- of the Labor' Code, you must%, forthwith
Division 3 of the Business and Professions,' Code. or that -he Is exempt therefrom, arid the basis
Any 'OV Siktian 7031.5 by any rote
Dep.
for the. alleged exemption. violationapplicant patron.P,Ian'Chk.
subjectthe applicant toe.Civil penalty of not more than five hundred dollars'($500).
I as owner of the property, or my employees with waigesas their sole compensation;, will
Plan,Chk. Be[.
do ihe work, and
n d the structure is noVintended or offered, for sale. (Sec. 7044, Buisneiss and
Con§t.,
Professions Code: The Contractor's License Caw does -not apply to an owner of propaity who.
builds or knproves thereon and' who does such work:.himself or through his own employees,
'k
Reai Setback from Rear Prop. Line
provided that such improvements ere .anot intended of offered'for sale. 11, however,.the building.Mach.,
or improvement is sold within oneryear of,completion, the owner-builder.;vIll have the burden
•Electrical
I hereby affirm that there is a construction_! ending' y for the performance
agenc the
of proving that he did not build or improve for the purposeof sale:)
11 1, as owner of the property, am exclusively contracting with licensed contractors to com
Plumbing
struct the project. (Sec. 7044, Business, and Professions Code: The Contracloi's License Law
Lender's Name
does not apply to an owner of property who builds 6r improves thereon. and who contracts for
such projects with a contractor($) 000nS ad pursuant to thi Contractor's License Law.)
Lender's Address
.
Grading
1*1 1 am exempt under Sec. -a. & P:C. for this reason
Drivewav End
DateOwnerIn4arstiuc
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. 3 , 800, Labor Code.)
employ any person in any manner so as to become subject to the Workers' Compensation.
Policy No. :__Comp4"
rl Copy is filed with the city. 0,Certified copy is hereby fuinished.
TOTALS
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS'COMPENSATION INSURANCE
•ZONE:
(This section need not be completed H the pet;nft Is4or one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thp work for -which this permit is lssued, 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.. fl; after making -this' Certificate of, Exemption you should become
•ZONE:
BY:
subject 16 the Workers' Compensation provisions- of the Labor' Code, you must%, forthwith
Distances:
comply with such provisions or this permit shall be deemed revoked.
Minimum um Setback
Front Setback from Center Line
'k
Reai Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
"
"of.
gide,Street Setback from Center Line
I hereby affirm that there is a construction_! ending' y for the performance
agenc the
work for which.1his permit is issued. (Sec. 3097, Civil Code.)
Side -Setback from Property Line
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR'
This is a building Dermic when properly filled out, sign" and validated. and is subject to
expiration it work thereunder Wsuspended for 180 days.
I certify that I have read this application and state that the above information Is correct.
Issued by:
Date
I agree to comply with all,'city and county'ordihancds and state laws relating to building
construction, and hereby authorize 'representatives -of this city to' enter the
mentioned property for inspection purposes. •
Validated by:
Signature of applicant Date
MailingAddres
Validation:
City, State, Zip
t 4
WHITE = FINANCE YELLOW = APPLICANT
PINK BUILDING DIVISION