9912-155 (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
393754 C9 06),3,X20(
,1 T
, Y
vDa" to ! ' Signature of Contractor ��%����• .��
OWNER -BUILDER DECLARATION
1 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.
"S'2111
91111 I/ew l'.d i11)1. 144f1n
(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' d I mpensation 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"provisions.
,date: a7 � • � ���
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.11 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.
L
Signature (Owner/Agent) -�!/�a� Date 1--
PERMIT #
BUILDING PERMIT,�.x,,
DATE 0110317 $92 Q)97.40 LOT � � TRACT � i-ro T .110
ADDRESS 2-446A �rNIDA10AHREZ JOB SITE
APN 773-262-60
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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Ii1, CEI`r'I'12:U CA 92243
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USE OF PERMIT
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD -
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms &Footings owDucts
Underground Ducts
Slab Grade i
Return Air
Steel
Combustion Air
Roof Deck % 5-7
Exhaust Fans
O.K to Wrap / Z L 00 %
F.A.U.
Compressor
Framing (( - -coo
Insulation -3 �� oo
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath 5/- - 00
Drywall - Int. Lath 00 97-
Final
Final
POOLS - SPAS
BLOCKWALL APPkOVALS
steel
Set Backs -rj%
Electric Bond
Footings
Main Drain
Bond Beam 1,1( eA=q S7
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines _
Water Pipings S
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection -.;;t-
Encapsulation
Gas Piping oe
Gas Test ro-
Appliances
Final
COMMENTS:
r
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring a
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final O
Utility Notice (Perm)
Building
Address S2 d
4
Q
uu�,tc�
P.O. BOX 1504 � �'
78-495 CALLE TAMPICO APPLIC O LY
LA QUINTA, CALIFORNIA 92253
maning
Address
City Zip Tel.
I !_ st v 22 Sl,� _ % 41 ca
Contractor
R&2 CO L -P L O
Address
City lZip
ZkI, a
State Lic. City
& Classif. Set 51 ¢ Lic. #
Arch., Engr.,
Designer LC -"r { X4.1 C u t_VZ4
Address I Tel.
City (Zip (State I
I . i Gin —.. Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I armlicensed under provisions of Chapter 9 (commencing with Section
7000 of Division 3 old e Business and Professions Code, and m license is in full force and
effect. 64
y
SIGNATURE V ) DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness 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 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= 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.)
1 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 contractor(s) licensed pursuant to the Contractor's License Law.)
11 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
F3 Copy is filed with the city. 0 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 (8100) 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: 9, 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 stale 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 -of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number 1'l'N —--
Legal Description L.= 1'� 'Fsl r.� ..s �C'a7, 1, J. as
Project Description Sl a.ni_ I M ^b -e,
_ r ,
Sq. Ft.
Size ��,G( z,
No. No. Dw.
Stories 0 Units
New Ell" Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
�. AMOUNT
Plan Chk. Dep.
q t.21<7 j , O�D
Plan Chk. Bal.
7
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
` '
TOTAL
REMARKS
t. t
t
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback fron Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE. YELLOW = APPLICANT PINK= BUILDING DI ASION
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771=8515
CERTIFICATE OF COMPLIANCE
Date 1/3/00 APN # 773-262-010
No. 19866 Jurisdiction, La Quinta
Owner NameLa Quinta Partners Permit #
No. 52-440 Street Avenida Ramirez La; #
city La Quinta zip 92253 study Area
Tract # Lot # Square Footage 1492
Type of Development Single Family Residence 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 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 the amount of
1.93 X 1,492. or $ 2,879.56 the property listed above and that bc.ilding
permits and/or Certificates of Occupancy for this square footage in this proposed project may now Wissued;
•n
Fees Paid By CCNalley Independent Bank/Augustine Paz Telephone --760-564 33023
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Olivia Aguirre Payment Received $2,379.56
Check No. 209524
Signature f
17
[NOTICE: Pursuant of Assembly 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 orother payment ident Pied
bovewill 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 to another public entity authorized to
ollect 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
Dec. 6. 1999 12:28P:M , POWER BROKERS
fiHCOIiDiNA �Q�°�D I t ,
CHICAGO TITLE COMMA.COMaA[QX
9919416KC 970677 9
mm EXCOxnfi a RM is Dffim AND,
Mwas oTxXMei9 BELOW,
KUL TAX OTATMIMMS To f
WILLIAM THOMAS BVM O
LA QVINTA13CALIFOWIAi 92253
No.f210 P. 4
GRA
��� bIP>2e � 773-96:-010-®
The undersigned grantor (a) declare(a)1.
DocuM®ntary transfer ax is $14.95
(XXX) Co utad on ful value of property conveyed. or
( ) Oily"ad on f ul value leas lien and encumbrances ramsining at time of sale.
( ) unincorporatedarea.- ( } City of , and
FOk A VALMODS CONSIDERATION, receipt of which is hereby acknowledged,
MICHAEL J. SCHALL and` LILLIAN. X. SCRALL, TRUSTEES, A= THEIR SUCCSSSORS' A9 't'RUSTRIS OF
THE SML%LL FAMILY TRUPT, A TRUST .AMURNENT DATED APRIL 29, 2905.:
hereby GRANTS) to
WTLLIAp! THOMAS B=14, a ur M tied than
the real property in the City or LA Q11IIVTA, County of Riverside,LState of".California,
described as ,
Lot'13, block 02, 7ni� No. i0, Tract Santa Carmelite at Vale La into, as per map
recorded in Soot 1e1,,Page(a) 70 inclusive of metes, in the otfic of the. County Recorder
of said County. I _ .
Dated ftcefter s,. 1009
State of California
County of } B.B.
On
before me,
personally appeared
Personally known to m6 for proved to me on
the basis of satisf:aciory evidence) to be
the person(s) whose n" (a) is/are subscribed
to the within instrument and acknowledged to
the that he/ahe/they executed the same in
hie/her/their autheriiedl capaoityy(ies), and
that by his/her%theirIsignatures) on the -
instrument the personte), or the entity upon
behalf of whish the p4rooa(®) acted, executed,
+the .instrument.
MICHAEL J. SMALL, TRUSTER
L=I= K. S , TR78Tag
OOZW889 my hand and official Beal.
i
Signature (This area fo>; offEiCdal notarial `seal)
Man 'TAX STAT>3NT9 T e
0
RC Di ' r.'i - Plann.m.9 ReviewForin..'
This form is to be used by CDD staff for review of single family dwe.11in js in the RC (Cov,e
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. ,
Building &Safety as your _correction list. Please attach additional explanations as necessary.
,APPLICANT: lam- �-�,�-�.� p�2; � �rz.�'• : . .
PROJECT
ADDRESS: 52-440 Avenida Ramirez
APN:. L773-262=010''
- -� .,
13 , BLOCK 82'. , UNIT 10 , S; C. @ V.L.Q. ,
. �. LEGAL: LOT •
CK'D QY: Leslie Mouriquand' �JA -=--^ --"
BIN NO:CASE NO. 99-171 ..CHECK -DA -TE: 7.
Inform the assigned Building plan checker .upbri-your..assignment to this case. The CDD
Executive,Secretary maintains a log book to track applications and' assign case numbers.•
REQUIRED ITEM-
Y. .N, COMMENT/CORRECTION
....,.:,:w:n.. ,:: \,....,...,.,•..4 �.:�:...,........... ... ... .:\:vi: iiii�t�it:„�.�;::`,::•i�"::2��v+:i`ii:Lv.Cn„;:„V;.,?:i:^:•�:iKi�,nKY`in\i..;�`.. n•.. .•; \�`�
:..::...:....... ......:......... ...... . •
B.IL1�:3'.;::5�#EiN.:..�:::::::....................................
Case logged and number assigned
Verify legal and APN information
Consistent with MDG on file las applicable)
.
MDG filing required (5+ filings since 9/3/98)
Consistency -with-street/surrounding area: -
Colors
'
Materials 4
APPROVED BY CBMMUIVfsY DPMPMF
BY DATE
Architecture .
OTHER REQUIREMENTS:
A
EXHIBIT
CASE NO.
The zoning code, architectural and landscaping manuals, and/cr assigned inspector should
be consulted where 'uncertainties arise. The' completed checklist shall 'be maintained in the
Building'& Safety address file.
i
Certificahm.'_'ofoccuancy.,p=�.
toLa C u�ntaCiy.. . , r
Bufilding'..iandDepartment*.
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. comp/iance with .the-various.ordinan'ces
of the City, regulating building construction or use.. For, the--following.
BUILDING ADDRESS: . 52-440-AVENIDA RAMERIZ
Use Classification: SFD - Bldg. Permit No:: 9912-155
'Occupancy Group:- R 3 Type of Construction: VN -` Land Use Zone: RC
Owner of Building: LA-QUINTA PARTNERS Address: 51-370 AVENIDA BERMUDAS
City: LA QUINTA, CA 92253
By:. +STEVE.TRAXEL
Date: 05-18-00
Building Official
POST IN A CONSPICUOUS PLACE