0201-103 (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
D7'23'2j t F) ITIC / /-°T
ate / f I t .J 7'- Signature of Contractor / 'r Z
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).
( ) 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
_ perforrrlince of the work for which this permit is issued.
D (� -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:
'-
Carver Policy No.
STATE 1 U4D 14i6�3i 0!
J (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 anyperson 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 S ction 3700 of the Labor
Code, I stiall forthwith comply with t ose,
��ate: t f `, Applicant—
Warning:
pplicant 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
or 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 inspection purposes.
Signature (Owner/Agent) �i & Date Of��/��
BUILDING PERMIT PERMIT"
DATE /I VALUATION LOT 0201-103 TRACT i
JOB SITE
APN
ADDRESS `CAS AMILDA Nt.kN•i}Cl.A.ti,/: Z
F
773-2,21-02.4
OWNER
CONTRACTOR / DESIGNER / EN INEER
PIC FFA11D SCOTT
PARC HONSS
P 0 13QX 19213
77564 ACOUNTIkY C'1,ATERDYAM, gUfIT, 113
JA CjXlMI A, CAA 92253
PAL", TWEXT CA 92211
(760)408-34,95 t-;1331,41. 21953 ..
USE OF PERMIT
�iT:t?4L,lf 11'�.� :Cr"JIa.,it�Cf
•'
SPL7 - STD. SAVIA FE. PZPMIT OLNt` NCrF INCLUDE ti9.,0 K WALLA
POOL, SIVA OR 1 RIVEW—AN APPROACH
TP.A.0 I' CONSTRUCTION 9,421.00 SF
PORCfu'EIATIi 3 36.60 SP
r
t3A Vk.0FJCAARP0RT 510.00 Sig
••
S lil'. WOOD 1r'723CE i,,F
MISM.LWiAD 013S' OF C:C?.IY;�" 1!.MUfw 110—H
P r` . M.Tr WJ9 SUMMARY
t. ONSTRUCT1014 ME 101-000-418-000 $594.50
'.
I.a4N CHECK IC. FFE 101-000-439-318
ME'CH,f 11CAL M-9 101-000.421-000 160,00
EL -EC:? WC;A],Yfi S 101-000.420.000 $1243.44
PU.lA1f3CNIG FU 101.400-4-19.000 %1101*75
STRONCI Ia♦ OTIOt,! FRE - ItEZf1D '101--(00? 247 -011C► '�.�D
G1TdA DIAO FEF. 101.OW-423-000 R .it6
1:9OMi.b0PFR IMPACT F'L:',
PRECISE PLJJ4 101-000-441-345 MUG,
FERM DRPOSi'I' 101-13t3i3- 3443:YS $��9.60
�,�,
8TJk•'.YVYA 0.0NW;F.'(JCg10)4 AND PLAN C;A1EC'..tC.
ri,4:16D U .
P-TIMMf.1 EYS IDU: _rqo W
�'i;i6017-1
LAN j14� x
WYOFLAQUi6 A /
A E/
BY i
DATE FINAL�ED1J
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
. BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
O
Underground Ducts
Forms & Footings
(
Ducts
Slab Grade
vt
Return Air
Steel
Combustion Air
Roof Deck
- 2_
Exhaust Fans
O.K. to Wrap
C_—
F.A.U.
Framing
C/
Compressor
Insulation
_e2l
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
-
Drywall - Int. Lath
Final —
BLOCKWALL AFtPROVALS
Final
POOLS - SPAS
Steel
Set Backs i
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
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
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
Final O -
Utility Notice (Perm) W49C A&— T
COMMENTS:
Building tr",
Address 4
Tityl 0 "
P.O. BOX 1504
�pp 78-495 CALLE TAMPICO
"NII I)]PrZ—LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address
City Zip - 1
Contractorp` CI
a� t Y vim,
Address�DO ;� Jx
CityI I„ `o k Zlp
Statei.
&..Classit. c
Ardh., Engr.,
Designer r_0 V0 Gt
Address
-2
APPLICATION ONLY
� /
0�
V
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number D -1-14
i
Lof 3 &Jc k- `7 Z
Legal Description
Project Description �Jo_1J 1
City
Lic. # 2- Sq. Ft. No.
Size Sto
Tel.
New Add ❑ Alter ❑
No. Dw.
Units
Repair ❑ Demolition ❑
1)1;
7� Ae�>P " ZtiiL
City I i I IZIp I Lic.t# I
LICENSED CONTRACTOB'IDECLARATION
I hereby affirm-fhat I am licensed u der provisi ns 94hapter 9 (co mg with Section
300) of Divisi9n 3' of the,13 , iness Q'd Profen,®r - od nd my lig se, it full force and
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 or 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 f$500).
I.: I, as oner 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 or completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
I I, as owner of the property, am exclusivelycontractingwith licensed contractors to con.
s rucl the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
doesnot 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.)
0 1 am exempt under Sec. B. & P.C. for this re a on
Date u Owner
r
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
Copy is filed with the city. ❑ 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 ceVane
hat in the Performa ce oft @ work for which this permit is:issued, I shall not
emplo rson in anymine so agto become bje t to the Workers' Compensation
aw1o n.
Date .net
NOTICE TO APPLICANT: If after making Is Cern a of Exemption you should become
subject to ithe 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 1 have read this application and slate that the above information is correct.
I agree to comply with'all city and county ordinances and state laws relating -Jo building
construction, and hereby authorize representatives sof this city to enter :ate above-
mentioned property for inspection purposes.
Signature of a0plicant Date
Mailing Address
City, State, Zip
Estimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
a AMOUNT
I
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
DesertSands�Unifed School„District <;
41-4%,Dune'Palins Road,;
Notice: La QJ -6ita ;CA 92253
Document Cannot Be Duplicated 760-7714.515'
CERTIFICATE OF COMPLIANCE
Date 1/11/02 ” APN#', .773-221-014
No. 22827 Jurisdiction •` La Quinta
owner NameRichard Scott " Permit#0201-103
No. 52-045 Street - Avenida Ramirez . Log #
City La Quinta ••tiip . 92253 Study Area
Tract # BLK 78 Lot #. 3 ,. ' Square''Footage •1;421
Type of Development Single Family Residence No. of Units 1
Comments
At the present time, the Desert Sams Unified. School Ji strict.does :not collect fees' on gazages/cazports, covered
patios/walkways, residential additions urider''S00 square feet, detached accessory structures or replacement mobilehomes: It
has been determined the above-named owner is exempt fromi.paymglschool fees at this time due to the following "reason:
EXEMP-TION INOT"APPLICA'BLE
This certifies that school facility fees imposed pursuant to Government Code 53080 .in the amount of
2.05 X 1,421 or $ 291'05', °' l
,9„ the'property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
Fees Paid By 1st Bank - Dick ScottTelephone._ 760 408-3495
Naine�on:.the check
By Dr. Doris Wilson.
Superintendent
Fee collected /exempted by Paula'Ruiz Payment Received-... $2,913.05
N Check No.'., _04,304
Signature
NOTICE: Pursuant to Assembly Bill 3081 (CHAP 549 STATS�,1996) this Ml mve,to notify,you that the 90-4ay approval pe riod.in,which:you may protest the fees or other payment identified
above will begin to ruri from the date on which',the building(or installation permit for this project is sssued oron which they;are,paid to the'District(s)pYto another public'aritity authorized,to
collect them on the District('s)(s');behalf; whichever, is eadier. '
Collector: Attach' copy of county or city plan check application form to district copy;for all waivers.
Embossed Original-Building Dept./Applicant Copy - Applicarit/Receipt Copy - Accounting
RECORDING REQUESTED BY:
Southland Title Corporation
AND WHEN RECORDED MAIL TO:
RICHARD SCOTT and CLAUDIA SCOTT
PO BOX 1023
LA QUINTA, CA 92253
A.P.N.: 773-221.014.5
Order No.: 21534IS37
Escrow No.: IN21184(C
GRANT DEED 773 - 221 - O14
THE UNDERSIGNED GRANTOR(S) DECLARE(S)
DOCUMENTARY TRANSFER TAX IS $27:50 �2 '�y AVi; �ZAµtQi;Z.
(X) Computed on full value of property conveyed, or
O Computed on full value less value of liens or encumbrances remaining, at time of sale
O Unincorporated area: (X) Cityof La Quinta
FOR A VALUABLE CONSIDERATION, receipt of which Is hereby acknowledged
LEONARD RAYMOND KENNETT,' and MARIE LENORE KENNETT, TRUSTEES of the
Leonard and Marie Kennett eamily Trust,
hereby GRANT(S) to ud 6123194
RICHARD SCOTT and CLAUDIA SCOTT, husband and wife as joint tenants
the following described property, in the County. of Riverside, State of California.
LOT 3 OF BLOCK 78, SANTA CARMELITA AT VALE LA QUINTA, UNIT NO. 10AS PER MAP'RECORDED IN BOOK
18, PAGE 70 OF MAPS, RECORDS OF RIVERSIE COUNTY, CALIFORNIA.
Dated: December 4, 2001
STATE OF CALIFORNIA
COUNTY OF ofat;°° .Q1C�rN:
On. , i%; a6 -D/ before me
a Notary Public In and'for said -County and State„personally
appeared
k Ev,%JAW_B
} SS. LEONARD RAYMOND KENNETT AND
MARIE LENORE KENNETT, TRUSTEES
OF THE LEONAgm.RAYMONDtTRUST
�(ET1F NE'7
By: LEONARD YMOND K NETT,
Trustee
personally known to'' me, (or proved�to me on the. basis of O�ti�?��i�i
satisfactory evidence) to. be the ,person(s) whose, ;name(s) f'' �4
is/ re ubscribed tot within in§trument,and acknowled By: MARIE LENORE,. ENNETT, Trustee.
to that he/she/ ey executed `the ,same in afisZher/ h 'rte
authorized capac les) and -that b.y.'. is/he`. elr
signature(s) on the Instrument the persons)";' or the e y
upon behalf of which the person(s), acted; executed the S. D.' YUNISI<IS
COMM." # 1200541 8
Instrument. Notary Public - Coiifornla 'U
QLOS ANGELES COUNTY m
WITNESS my. hand and official seal. My Commission Expires Nov. 4, 2002
Signature
1 nature of;Nota: (This"Area for Notary Seat only)
MAIL TAX STATEMENTS AS DIRECTED ABOVE
RC DISTRICT - PLANKINO REVIEW -FORM
This f f'sin'gle Jamily-dwellings in the RC (Cove
his orm is to be.used -by CDD staff ' foe review,P,_
Residential) District per Section 9.50`0,90;.6f, the 1oning 'Code. Its purpose is to determine:
1) that the proposed.,ho'u'se. design-. d6e's n*ot'dupli.cate the same architectural style of any
�' applicant to file for
house within -200 feet,bf the '00pIicant,'and-/6*r;'2) jf,ther.the
e is a need for
V; � I
Master Design Guidelines. If the al6plican'"t -does need to file a Miaster Design Guideline, please
transmitted this information to the* Building. - and SafetyDepartrnent as part of your correction
list. Please attach additional. explanation, s as . necessary.
APPLICANT PACIFICHOMES
SITE ADDRESS 52-045 Avenida Ramirez
APN 773 221 014 CASE N.O.:' -2001-5199
LEGAL: 3. BLOCK 78 UM S; C.@V.L.Q.
LOT T,
CHECK AND APPROVED BY: Greg.-Trousdell DATE:
Inform the assigned Building plan e cheek r upon your assignment,to this case. The CDD
K
Executivi Secretary maintains --a log bo, .to track applications -and assign case numbers.
ITEM Y 'N COMMENT/CORRECTION
111. X6�
Verify -legal and APN.inf.ormation
Consistent with MDG on file (as
applicable
ai
MDG filing required (5 filings since
�� /
9/3/98)
.00
I variety within 200 feet.of
Architectural
10tope "
_,000
ding area: N
the surrou ing area:
the surrounding
0\
.100
FY,
Materiii
Architectural design features
Other Requirements:
e(s
17L>
Certificate of Occupancy
City- of La Quinta.
Budding and Safety Departrr►et`
ThisCe
rtificate. issued pursua to the
'requirements of'S
ecifibn 109, of the Uniform 'P0Z1dZ0g
. Cbd6,
certifying that, it the. time, ''of Issuance, thisstructure wasncohipliance with the various
of the, ting.: b construction or' -use. or's'e. F&I -the
WHT
BUILDING ADDRESS:
52-045: AVEN:IDARAMIREZ
Use Classification: SINGLE FAMILY "DWELLING, Bldg. Permit No.: 6204-193
L nd U'-e'Z*one: RC
Occupancy. Group:.. R-3 Type, of Construction: VN ',a S
Ow'ner of Building: RICHARD SCOTT Addee'sis' P.O.. BOX 1023
City: 1A QUINTA-, -SCA .92253
By:' RICHARD KIRKLAND
Date: 05-09=02
Building Official
POST IN A CONSPICUOUS PLACE