0001-206 (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
�s �sDi h C9 00130/20(
ate 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).
( ) 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 a 0(F r"i is 1�Llt�F1i Policy No. 2 9•(X3 UNIT W I low
(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�lcompensation laws of California, and agree that if I should become
Subject to the workers' compensation provisions of Section 3700 of the Labor
Zde, I shall forthwith comply with those provisions.
e: Applicant
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
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 .,d 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 puIposes.
;Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT
DATE r' VALUATION 592,987.44) LOT 16 TRACT We
JOB SITE 3Z370A,'1'041)Al2t1M111 .
APN 773-262-07
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
41 .E .ROSS
541 E RDSS
EL CON IRO CA 92243
Ell CbM RIO CA 92243
(7(0)343-9772 011311# 5537
USE OF PERMIT
S1NOL..h kAA9iLY L)WELLINti
SF D -1,kiR ti a UC)I<S NU i F14C1,U1)1'S Bl.t.3C& WALLS URPOOL
1 RAC7 CONSTRUCTION 1,492.00 S[
i30BtrW?A i() vubO 31.
0AKA(j /('A.Rf10RT 463.(1!) SF
5 FT WOOD rENC'Ei 2W.0 LF
M.11M #TEW COST OF CMT,RUC110I
94,"", 7.40
i°ir122MIT �' E' SUMMARY
CcjiO3TRU(!r 1014 FhE 101-000-418-0 (X)
A3 rt �artr• ``t ' •car• ! AA'i nn' c ♦ c..
M L"7#t,itil�. J1L i'i a; �+If �tiiV ^lrl-lrin)
.
At. V 1:L l U t-lit3G-4{) (itJtt l.Hl. yti
PLI,IM.l 4NU FMfi )0f.-!iil0-�19-tJdlil Si I(i.'t5 `
_ j
• t ;
�t•r�tir"�t�t tt:at�vl'it 1N f:►:,a . Rs+xtr� Int_cxx�-2��-nnn �4, �
=- � i
0(:;l; rl�)L't�� i i'� f. , ; t () t •:?010...1: 3�13�"0 $: 0).0303
r ..
PXLC'.l'3EPLAN IOf-(M-441.^345 5)i)11.itt► t.�
J
f`trNi71»"r>(iSt't� i(fi_!�!)^3�1q-'itft _ 's�fl.!'►t7 :..7
�'i
t?i.i(�j'ff"7NrlNORt.AN("'HFC'K
$3,ddR(Ki
LESS PREF-PAID Pri;ti
44M-04
101'All, Nl Rf1 I 1r'V S DUE NOW
51198.06
RECEIPT
DATE
By�`✓� "`
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
'Set Backs
Underground Ducts
Forms & Footings
Slab Grade
s,—
/-
Ducts
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
Framing
5
— od
F.A.U.
Compressor
Insulation
- 3-0 - c-zp c,?F-
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath�--
Drywall - Int. Lath
l/ - — QD
Final
Final
BLOCK
ec
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
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
aD .
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
d S
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole .2-17-0— 5
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) I.
COMMENTS:
.
00(f) I -
P.O. BOX 1504 APPLIC O LY
Building 78-495 CALLE TAMPICO
Address 5 12. a I_ LA QUINTA, CALIFORNIA 92253
Owner
t'.'—' BUILDING: TYPE'CONST. OCC.GRP.-
Mailing
Address _ G G r C t I- A.P. Number
City Zip Tel.
Lin.�� �tZ,L5a f _ e) Legal Description
Contractor Project Descriptionl>
Address
City Zip Tel.
Q
State Lic. City
& Classif. Lic. # Sq. Ft. No.
Arch., Engr., No. Dw.
Size`Z,_ _ Stories Units
'
Designer j t.i1 f New*O Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address TeL
City= -2 -"
State
LA 0j,--rt,,n Lic.#
LICENSED CONTRACTOR'S DECLARATION
I herebyy affirm -that em licensed u der provisions of Chapter 9 (commencing with Section `
7000) of Divisidn 3 of the Business a d Professions Code, and my license is in full force and t` - .►-
effect. ��//7 // /
SIGNATURE �. `DATE jI/ /__. Y -- zwl 1I'% 1 1
1 / OWNER -BUILDER DECLARATION
I hereby affirrrp� that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7081.5,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 (8500).
1: 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
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.)
I'1 I, 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 contractors) licensed pursuant to the Contractor's License Law.)
I'! 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
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 i1 the permit is for one hundred dollars (8100) valuation
or less.)
I certify that in the performance of ihp 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 it work thereunder is suspended for 180 days.
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
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of a0plicant Date
Mailing Address
City, State, Zip
PERMIT I I / AMOUNT
Plan Chk. Dep
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE:Sy.
Minimum Setback Di anC s:
Fr to alkVear
r Line
Setbarop.Line
A Side -81i; tbzck from Center Line
icfailetback from Property Line
FINAL DATE A` IVSPECTOR
Issued by: Date Permit
Validated t
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
rr
Desert Sands Unified School District R
47-950 Dune Palms Road
Notice: La Quiitta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 2/3/00 APN # 773-262-007
No., 19990 Jurisdiction La Quinta
Owner NameAgustin & Eva Paz Permit #
No. 52-370 street Avenida Ramirez
city La Quinta zip 92253
Tract #
Type of Development
Comments
Lot #
Single Family Residence
Log #
Study Area
Square Footage 1492
No. of Units 1
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, 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 from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in .he amount of
1.93 X 1,492 or $ 2,879.56 the property listed above and thattti�ilding,; `,;,
permits and/or Certificates of Occupancy for this square footage in this proposed project may. riow b ' issued '
Fees Paid By CCNalley Independent Bank/Agustin Paz Teiepbonex'160453-977.2
Name on the check tr t
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Mary Ann L. Borja Payment Received $2.879.56
-- Check No: 209635
Signature
NOTICE: Pursuant of Asssfmbly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above 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 to the District(s) or b another public entity authorized to
collect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
JAN.21.2000 i0:44R1 COMMONWEALTH
RECORDING AGREQUESTED,BY:
i
CHICAGO TITLE CCM?ANY COMPANY
99.9472KC 97�57905
WHRL ML D QOId; D'
eco N PLz
and EVA PAZ
LSA 9QUIN A, CALIFORNIA 92253 `
NO. 692- P.2,'3 —
WEI ABOVE THIS LINE ;OR RECORDER'S USE
GRANT D , -c
The undersigned grantor,(s) declare.(s), '
Documentary transfer tax is $c17.60-
(X=) Computed on full value of property conveyed, or
( ) Computed on fu:1 value less liens and enctimbrar:ces remaining at time of ?ale.
! Unircorperated area! ( 1 City of
- - r and
FOR A VALUABLE COISIDERATION, receipt of which is hereby acknowledgs@,
k
R=h C. C014E, TRUST'ZE OF THE RUTH C. COLE LIV=G TRUST DATED DECEMBER 22, 1597
hereby GRANT;S).to s
AGUSTIN PA2 aad RVA PAZ, husband and wife ae.joint tenants
the real property in. the City of LA QUINTA, County of Riverside, State of Gs 1. fcryiz,
described as-
Lct 16, t3iocl: 8a, ilnit Nc• 10,, Tract Santa Carme'lita at Vale La Qu_nta, as per map
recorded ir. Book 18, P&96 (8) 70 'inolueive•-,oF slaps, in the'office of the County Recorder
Of said County.
Dated ,January 6, 2000
State of CaliPorn'a
Coir�ty P RUTY. C. COLE,Oil
be: re me, O �% tdv O c • ���
�a6 peraonal� y appeared
�D ^onna l l sf—*newn—ee-� (or proved to me on
the basis of satisfactory evidence) to be
'the person�whoa' name( iSA"e subscribed
to the w+thin instrument and acknowledged to
me that tat she/prep executed the same in
dii-9tha/herA*Ae-ar authorized cepacity�y
JOnq ,
Com7•(11,lgF
and'
b1' 2�i-Ti her/tke;ir signature 4-@ - on the
a; it6dR+0
"' Nvcry Fib
instrument the perea!S' ;, or the entity, upon
• �. _ Cal ll2�
►�MgelaSGounyjo
behalf BA. which LYie person(•s•� actsd, executed
Mr
rc0"'m•�:�Oec9,?JOr
the instrument..
W�T\'ESS hand and jaf.f'vial 9
Sigra tu—re
,
MAIL TAX STATEMENTS '6: SAME °s A809K
(This area,for of=icidi no=axial seal)
13
This form is to be used by CDD staff for 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 be transmitted to .
list. Please attach additional explanations as necessary.
Building &Safety as your correction*
APPLICANT: PAZ CONSTRUCTION
PROJECT
ADDRESS:
APN:
LEGAL:
CK'D BY:
BIN NO:
52-370 Avenida Ramirez
1L•2 -- O 0
LOT � 7 . BLOCK ..1�� UNIT S.C. @ V.L.Q.
Greg Trousde,ll
CASE NO. 0.0-185 ..CHECK -DATE:
Inform the assigned Building plan checker .upori..y.our..assignment to this case: The CDD
Executive Secretary maintains a log book to track applications and assign case numbers.
The- zoning code, architectural and'landscaping manuals, .and/or assigned -inspector should
be consulted where "uncertainties arise. The completed checklist shall be maintained in the
Building .& Safety address -file.
• r�
..a
.Certifica. to b f Y Occupa-
nc*-
City,of-LaQuinta
Building and Safety Department,�o-
This -Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various- ordinances
of the City regulating building construction or use. For the following:
BUILDING'ADDRESS: 52-370 AVENIDA RAMERIZ
Use Classification: SFD Bldg -Permit No'.: -0001-206 .
Occupancy Group: R 3 Type of Construction: VN = Land Use Zone: RC
s -
Owner of.Building- AGUSTIN & EVA PAZ Address: 541 E. ROSS
City:EL CENTRO, CA - . 92243
By: STEVE TRAM
Date: 05-31-00
Building Official
POST IN A CONSPICUOUS PLACE