0005-162 (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 ir\!ull force and effect.
License # Lic. lass Exp. Date
25381 13 0`// 1/2(
'Date .1!:�17cottO Signature of Contractor C.
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 I 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-irisure 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 ST.ATH FUND Policy No. 1290940=00
(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 man"; er so as to become subject to the
workers' compensation laws of Cal'fornia, and agree that if I should become.
subject to the workers' compensation\Qrovis`ons f Section 3700{of the Labor
,Code, I shall fort with comply with hos rl11.
isions.
Date: 5, Applicant .
Warning: Failure to secure Workers Compen ation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct.] agree to comply with all City, and State laws relating to the building
constAtion, and hereby` �u.thotjize representatives of this City to enter upon
the above-mentioned pro gftK fo Inspection purposes.
Suture Owner/Agent) ent Date4 klw
�§ 9 ( 9 )
� 1(0 BUILDING PERMIT PERMIT#
50
DATE VALUATION LOT Qcxl� i,�2 TRACT
d cr ry
S*6,337,00
JOB SITE
APN
�.Y/��y� .y�
ADDRESS .r9ai-2m x Q RFAL7ryil.V.,z
.773-262-W2
OWNER
CONTRACTOR / DESIGNER / EN INEER
DAA? Nf.UL1"
PACIFIC TRADES CCJ `J'RY1=0114
1719 32 TREMON17
1719 S TR ONT
OCRAWSME CA 92054
S OCE'.A1+?SIDE CA 42054
(760)967.M69 CMN 1955
USE OF PERMIT
(3U FA,MMY DWO'.LWO
S,FD- PMRMIT DOES 140T INCLUDE HLOCX WALL OR POOL.
TRACT CONSTRUCTION I'm. SF
FORCHMATIO ! 0 :00 S?
GAMWCARPO T (sF ' W-3100
S YET. WOOD FLENCE 100.00 LF
lf"S rFMA;l,M7 COS' OF COMS".T1 UCI ION
86.S37.00
PFIMM r' IM SUMMARY
CONSTRUCTION FEE 101.000.418-400 SS$I.00
PLAN CHECK "SE 101-000-4,39-318 $498.26
MECHANICAL FEE 101.000.4:21.000 $60,00
ELII:C:TRICAL 101-000-420-000 $120,63
PL( MBINO FEE 101.000•419.000 $110.75
S7 RONQ MOTION FEE - RFSID 101-000-241 -000 $9.53
O RADRIG I;EF 101-000-423-000 $20.00
1iF'il'1MDPER IMPACT FEE $1,90`?.00
PRECISE PLAN 101-000.441.345 5100.00
FELE DEPOSIT 101-000-439-318 •5350.00
SUB -TOT A.L COM T UCTION AND 13I -W CIO. K
$3,396.27
C' t.J a 7v t � vP.n--FATD FF.R'3
-$250.00
` CITA .rMOM FEES NOW
,146;27
fSDVF
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
rl ��
BOX 1504
Building f >78=495 CALLE TAMPICO
Address �2 ► 2f 4 AWr{ Il_ LA QUINTA, CALIFORNIA 92253
t () KA r u c. -,%L
Mailing
Address
)t Jl.
S/ids.. ZGlpr 2Z."C-q Te
Contractor
Address
City
State Lic. City
& Classif. Lic. N
Arch., Engr.,
Designer
Ad ess Tel.
�� A
Cyty /� Zip'State
(�j C. #L;ra 2'�S Lic. #
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.Businass 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).
f:! 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 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
orimprovement 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.)
II
I, as owner of the property, am exclusively contracting with licensed contractors to con.
struct the project. (Sec. 7044, Business and Professions Code: iThe 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.)
0 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
n 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 (3100) 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
L aws of California.
Date Owner
NOTICE TO APPLICANT., It, 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.
x►
CONSTRUCTION LENDING AGE14CYt
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.) r .�
Lender's Name
> Lender's Address �t
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunderis suspended for 180 days. I
1 certify that I have read this application and state that the above information is correct. (
1 agree to comply with all city and county ordinances and state laws relating to building f
construction, and hereby authorize representatives of this city to enter the above -
A mentioned property for inspection purposes.
Signature of a0plicant Date
Mailing Address
City, State, Zip
WHITE = FINANCE
11LDING: TYPEE;CONST.
-7.P. Number / /���
:gal Description r0� Z/ - T -4-0e Lic e�z U" -if T;� /d
zI
APPI
Project Description
�� GW IVB
Sq. Ft. 3 5No. l No. Dw.
Size Stories Units
New E3-'- Add ❑ Alter ❑ Repair O Demolition O
(L
Estim d Valuation '
PERMIT 11 "
AMOUNT
t
Plan Chk. Dep.
Plan Chk. Bal.
()
Const.
71
Mech.
Electrical
•.r .
Plumbing
S.M.I.
Grading
-
Driveway Enc.
Infrastructure
N
TOTAL
REMARKS
v
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: 7" 'eft l F7 Date Permit
Validated by: j
V17
alida 1t1t ona+`✓I J lyi�
YELLOW = APPLICANT PINK = BUILDING DIVISION
r ,Desert Sand&`Unvfe*d School District``
47-45
WDune Pa1ms,Road.
5
- Notice•
Qumta,'CA 92253 ,
Document Cannot Be Duplicated 760 7.71, 8515 ;
CERTIFICATE dF COMPLIANCE,
bate 5/26/00 - APm# 773-262-002
No. 20.484 t' JurisdIc;t. :La.Quutta
Owner-NameDavid Miller Permit #0005-162
No. 52-580 Street Avenida RamtreZ; k Log #
City La,(?. a %, Zips 92253 ,. Study Area
Tract # Lot' # �� Square Footage =1358
Type of Development Seigle FamilyiResidence` .. 3 f No. of Units 1
Comments r
At the present "time, the Desert. Sands} Unified ,School District, does not collect` fees •.•on garages%earports -covered
patios/walkways, residential- additions: under 5.00, square feet; detadhediaccessory structures�or replacement mobilehomes. ` It
has been determined the abov e; named owner is'exempt from;paying school fees "at this-time dueiio the following reason:
"ILL', 'wry-
- EXEMPTION NOT APPLICABLE '•.
This certifies that school'facility fees imposed "pursuant to Go ernment Code 53080 in the amount of
,. • . 2.05„ X 1,358 or $ 2'9783. 0 :k the pcoperty,listed above and thafbuilding
,£permits and/or Certificates of Occupancy'for th>Is,square footage m this proposed project may'now be issued>
Fees Paid By Check/Capital=Bank of North County M t• Telephone'' 760-967-0069
Name on the.check
By Dr. 'Doris Wilson
Superintendent. '-
;;
Fee, collected /exempted by Mary Ann L ,Bona ' - Payirient'Received.. $2, 783 90,
Check No,`005467
Signature' Yy
i
FNICE"*.,"
Pursuant ofA'sse IyBill3081(CHAP 549 STATSw1996)'thiswillservetonotrfyyouthat the 90-day a proval penodm which yoGmay protestthefees orotherpayment identifietl will begin to run from the'date on Which the building &.installation permitfor his project is sssued or on which they are paid to the Districts)or to another.putilic entity authorized to
t them on the Distric(('s)is') behalf,whichever is eaAiei._� �';1;r�
Collector: Attach a copy of county or city plan check application forM46district copy'M all waivers.
x.
Embossed Original- Building,Dept./Applicant .Copy Applicant/keceipt ",Copy - Accounting
f • S
MAY.12.2000 1:52PM COMMONWEALTH
RECORDING REQUESTED BY:
CHICAGO 'TITLE COMPANY COMPANY
9899KC 207056213
DAM ROSS DSIIJ.BR
1719 G. Tremont
S. Oceanside, CA 92054
NO. 899 P. 4/4
5�2 - 2 go AS- W nk p i Z
GRANT DEED
The undersigned grantor(s) declare(s):
Documentary transfer tax is $17.60
00
(70) Computed on full value of property Conveyed, or
( ) Computed on full value less liens and encumbrances remaining at time of sale.
( ) Unincorporated area: ( ) City of and
FOR A VALUABLE CODISIDBRATION, receipt of which is hereby acknowledged,
JOHN A. KOHLER and CLARA a. KOHLER, husband and wife as joint tenants
hereby GRANT(S) to DAVID ROSS MUM, a married man as iiia sole and separate property
the real property in the City of LA QUINTA, County of Riverside, State of California,
described as:
Lot 21, Block 82, Unit No. 10 „ Tract Santa Carmelita at vale La Quinta, as per map
recorded in aookil8, Page(s) 70 inclusive of maps, in the office of the County Recorder
of said County.
Dated April 27. 2000 -
State of California
County of Riverside } S.S.
On May 5,2000
before me, Kathy R. Piper
, personally appeared
John A. Kohler and Clara G. Kohler
personally known to me (or proved to me on
the basis of satisfactory evidence) to be
the person(s) whose name(s) -Ware subscribed
to the within instrument and acknowledged to
me that -hVtgttf/they executed the same in
his/her/their authorized capacity(ies), and
that by h4eAier/their signature(s) 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 STATEME TO:
SAS AS. ABOVE
KATHY R. PIPER
COMM. 012W49 m
W Nofy Publk GiNamla
RIVERSIDE COUNTY S
14 CMM- exp. March 10, 2004
(This area for official notarial seal)
RC -DIaP-
STRICT PLANNING -REVIEW EPIRM .I
Cp
S
This form is t& -be used by CDD=staff.forreview of: single family. dwellings' in the.. (Cove;Residential)
District, in oider to' determine the applicability -of compatibility issues or need io require the filing of Mast r
Design Guidelines by the"'applicant.It: hall be transmitted`to the Building and Safety Department as your
correction list. Please attach additional:explanations as'necessary. "
APPLICANT DAVID MILLER
SITE ADDRESS 52-280 Ay.enida Ramirez
APN 773- 262 0'02 BIN -NO.: CASE NO.: 2000-226
LEGAL: LOT- 21 BLOCK - 82 UNIT, 10 S.C.@V.L.Q.
CHECKED BY: Greg Tro,usdel,l DATE:
Inform . the assigned Building plan .checker upon .,your assignment .,to this case. The CDD Executive
Secretary maintains a -log bopk to trackapplications�,assign-case numbers.
ORT OF- FIELD COMPACTION TESTS <`.-.
/ 1
OUR RE➢ORT NO.: !, � � �' [i ('�
,
{�
}r
CLIENT:-
COMM : I FI�`fATER:AL
PROJECT:
DATE: ii?/'� i) II 1
2 - 820 ILL
•' r. 3-/.SE.COVRSE
COMPACTIO"I
G - RETWT 01
PERCDlTAGE DOES NOT COMPLY WfTH SPECIFICATIONS. /v
PREVIOUS TEST
STANOAAD CALIBRATION NUMBERS VARIATION. PERCENT,+I• GAUGE ADJUSTMENT Yo VARIATION FROM
NVCLEAR GAUGE INFORMATION ANO 0(�LILY
CALIBRATION
f4:0UNT5 FROM SHEETS LAST USE
E- MOISTURE
(BELOW SPECIFICATIONS ,
. 6 s OTHER
I
GAUGE TYPE: TLAMPBELL I MOIST
JRE:
MOISTURE:
•4tOISTURE:
MOISTLRE:
'
.lAOOEL NO.: 7 } /,� OENSI
•Y:
DENSITY:
DENSITY:
DENSITY:
ROC T OR'INFORMATION
SOIL ID #
VISUAL (CLASSIFICATION
OF SOIL
MAX. DRY DENSITY, PCF
OPTIMUM MOISTURE. %
COMPACTION I
MOIST(
RE
GENERAL LOCATION:
REQUIREMENTS, % (�
i
REQUIR4MENTS,
�`)
TEST
READING
QUOTIE
IT/
SOIL
TEST
ELEVATION
MOISTURE
WET/ORY
PERCENT
COMMENTS
NO
PCF
ID NO.
DEPTH, IN
OF TEST
CONTENT,
DENSITY,
COMPACTION
%
PCF
M-
6L,.
r -D-
L � ' y' ' I �.J'- 1 �
C•' J
rl
�
M-
I.
D-
M -
i
-TECHNICIAN(
COMM : I FI�`fATER:AL
A TESD
'S COMPLY WITH SPECIFICAT10N5
2 - 820 ILL
•' r. 3-/.SE.COVRSE
COMPACTIO"I
G - RETWT 01
PERCDlTAGE DOES NOT COMPLY WfTH SPECIFICATIONS. /v
PREVIOUS TEST
a SUBBASE
0 - MOISTURE
N EXCESS OF SPECIFICATIONS
S - SOIL CEMENT
E- MOISTURE
(BELOW SPECIFICATIONS ,
. 6 s OTHER
I
Certificate of Occupancy
City, o7f-Lq'Q.qinta
Bm,1dih6.;4nd7." Safa De of
Thin Certificate; issued rpursuant o.;the requirements of Section 109 of the Wiform�"Bui/ding ,Coale;
certifying„that, at the time of issuance, #his structure ,was_comp/lance with' the various ordinances.
.,.
of.the` City regu/afing bui/ding,construction`or use.. Forth7.
-
t.. BUIMLDING AIJ:DRESS 52-28 AVENIDA RAIVLIREZ
.UseClassification: SFD Bldg. Permit No.: 0605-162:
Occupancy Group: R.3 Type of Construction: VN Land �Use:�Zone: RC,
Owner of Building: DAVID .MI.LLER,
Building Official
Address: 17fb `S. TREMONT
City: OCEANSIDE,_ 'SCA92054
By: STEVE TRAXEL .
Date: 09-21700
POST IN A CONSPICUOUS PLACE
N) RAISED BOND SEAM AT ;+I2" / +18
WITH CONCRETE GAR, TILE VENEER TO
Z 0 N E
R,E'5lDEN(,,,E
5" BELON ViATERLINE, THREE WATER
EMITTINC7 500NOES TO RUN OFF �
CIRCULATION FRUMP HITH MANUAL SHUT �y
OFF VALVE. I I I 15 r{n ni
(N) STONE STAMP --
CONCRETE AREA
(N) POOL -----
(N) PLANTING ----
AREA
(E) EGRET ------
AREA TO BE DEMO
AND REMOVED
(E) A/C CONDBNCER
TO REMAIN
RC, ZONA
R��IDEN�E
V -01i
SETBACK
(E) MA50NRY KALL
w/ SATE AND AUTO
LATCH TO REMAIN Lu
a
L
O -
(E) GA5 METT ER
TO REMAIN
(E) OONORET
MiVE WAY
TO REMAIN
} a14
ROOM,
6E #J!314!3
43AtiAt3E
C�
O
(F)
*14TRY
10
FITC ieN
(N) MA50NRY BLOCK
WALL~ TO BE N57ALL
Q
51_0ff
5ET5ACK
+ .
10 RtMAtN
VK SYlllf4MNS POM AMA
ICK irm STANK CowftTE
_... (E) MAIN ELEC
-METER PANEL
To REMAIIN
ul
R(,,; ZONE
,�y c;
F,,,,E5l1)E,N6E
%7-- (E) -MASONRY POKEY WALL
and WOOD 1=ENGEiN0
N1 OATE AND AUTO LATCH
TO -REMAIN
(E) WALKKAY
TO REMAJN
(E) SOD
TO REMX'N
(E) 2 TREES
TO REMX)N
®m
EX6TINO SITE PLAN �GP�..E: �/8"=!'-D" 2
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