0204-162 (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 in full force and effect.
License # - Lic. Class Exp. Date-
1/3
o�Date '7r Signature of Contractor 3 �+ f P ��,•f�
OWNER -BUILDER DECLARATION f
I hereby affirm under penalty of perjury that I am exempt from the Con'tractor'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).
as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O d 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'
;,/cornpensation, as provided for by Section 3700 of ther 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
Sectiori: 3700 of the, Labor Code, for the performance of the work for which this
permif:i's issued: My'workers' compensation insurance carrier & policy no. are:.
Carrier
STATL1 I17 Policy No.
'(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' compensation laws of California -and agree that if I)should become
subject to the -workers' compensation provisions otf Section 3700 of the Labor
Code, I, shall forthwith comply with those Prov&s&oiiS
Date'? - �y-r, .. Applicant 1 1 n 1/. t R
' t -1 tt l
Warning: Failure to secure Workers�Co pensation coverage &s 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 1,80 days will subject permit to cancellation.
I .certify that I have read this application tion and. state"that the above information is
correct. I agree to comply wjh aq City, and Sttate laws relating to the building
- construction, and= hereby Butor*2'spetepresen atives of this City`to enter upon
the above mentioned prop rty for inction # uurrposes. '
Signature Owner/A ent') - n✓ - Date. 7 11 'n N
BUILDING;. PERMIT PERMIT" `.
DATE VALUATION LOT a TRACT
JOB SITE ADDRESS 5'2 -•iii .l�D..W.a.�,l�ki'Rli��}=Z.
APN 773-29.1^0.2c7
OWNER
CONTRACTOR / DESIGNER / EN &NEER
.
y�uS��Gl!ayyT:9�,3t21������.i,,t}����"jCi���JR4t1�
X' 1..T 1J�,1'n d.,.i J -
yy�%.Y�s�
4,55 460 .�;3A .A.•Yl D!.�... ,
PA1.1a"IMSErRT CA .92261
ImNo ('A, 92201
.(760)347.891' C'x.:L 40: ;
r •.
USE OF PERMIT
FAWLY
SITU .- PERMIT KDOE5 NO tNC.''(,U 9 BLOCK WAZ..;I., d'001. OR•. Mjt: •Kb� AY
;
.,1P�'I�CiACA,'98 CODE, i '
TRACT CONSTRUCTION SY"
y
P0'l2.CkT0VAT10 fi,i(t 00 Sig
t<�% F V
0AMMYCAXPORT SF
OF (.',0KGVRV(Tn#) 1 �
" . 12G,94.80
CCdN5'3`R11'4°i`ION FEE 101-000-418-000
1' LIPIN CHECK mill 101_00"39_918 $604.14
��;UXr�O.�"t'P i�1�C}i3tin4�,�J�:918; •$��tt,t1�
• ,
InI;G fc16;1�f. VER 101 >fy�4a 4aC+C13y,�6
PL21Mi IHO FE : 101.000.419-000 $f;:iz5
OTRONG Hf31'CONFKY,PX3011) 'i 01--000-241.000 %1210
GRADINQ 01
DV1F .0FEH. IMFACT FES
"•
PP:Lr:I:3� �l..,H?�b . 1 t)?-4:3t3�1�i 7-'3�l"� $Tfl3. t10
SUR IC71300 AND PY, AIDY rlralt X-7
��,6��.11.
'{XYrAL k"OMT FEES DUE NOW
��k �+i•t�
r
RECEIPT
DATE
BY
DATE FINALE[?
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms& Footings
,a
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
?-O p
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
_
Compressor
Insulation
_ Gf
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
C ^ G►
Drywall - Int. Lath 1
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
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/
Water Piping
�/
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
/
z yv�p ?i s
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
a
Final
COMMENTS:
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
Utility Notice (Perm)
�I ���, r rr -�' Vii. .r'- +w� .,..w\. �.w.+w' �` �.. r f�., . �r✓--.15f 1� � T _. .""`' } ..-e'`'_`f f� b � �K.G �'�-" y-4 ^'--�`� � ...�
3 � ...� * 4•`f -..,.,•,tea,,, „��+'7--�.�'�—"G— r-.•-- �'r -c� I� +±� ,.� _ _ s..�" ""—r� � �: -• ' / � e/`�
41- P O BOX 1504
Building ^^�� 78-495 CALL
Address 'L&s-/9✓Ca,,�a /CAM«P�_ LAQUINTA, CALI
Mailing r
Address PO �O� 'SS"%
City Zip Tel.
�lr s - �11.bR t '77l-k7b
' K.. 1C•��.n S
UO Qc ILS Od S
inQ ! Z� j 2 Z 7,r
State Lic. I City
& Classif. r Lic. #
Arch., Engr.,- ,'j J� j
Designer viraRS Pi P 2»
AddressZiK t �. Tel.
City
P.Y S , 22 yE✓ Lic.t#
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,Business and Professions Code: Any city or county which "requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to 'lts issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractors 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).
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 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.)
IA 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.) �4
17 I am exempt under Sec. B. & P.C. for this reason w
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,'Gabor Code.)
Policy No. Company ' -''
f] Copy is filed with the city. O Certified copy is hereby furnished
s
CERTIFICATE OF EXEMPTION FROM L
_J 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 .y !
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. r t• - • y
s t i
I CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the i
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. f
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. N,
X
Signature of applicant Date
Mailing Address
City, State, Zip _ _ -♦
E TAMPICO APPLICATION ONLY
FORNIA 92253 02c� - 02
ILDING: TYPE'CONST. OCC. GRP.
-773—.;M-0.27 \`
'. Number
"'�
)al Description 04 'U- G� /"-Y
Iject Description
R ,
Sq. Ft. No. No. Dw.�
Size Stories / Units
Newle Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT ?-AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical f • ;
Plumbing
S.M.I.
r, f.
Grading f j of s I
Driveway Enc. , 1
Infrastructure i -A U +'
TOTAL
}ZONE: ."'� BY:.
Minimum Setback Distances`^ -
z Front Setback frorr Center Line
Rear Setback from Rear Prop. Li e
t Side Street Setbacc from Center Line
Side Setback from Property Line
j,Tri
:_:�Dat'1111 Permit
1 2001
r �.ertM'ff
.r
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
i
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
Date 7/15/02 La Quinta, CA 92253
No. 23371 (760) 771-8515
Owner
Mountain Cove Development
Address
PO Box 3578
City
Palm Desert Zip 92211
Tract #
BLK154
Type
Single Family Residence
Lot # No. Street
Unit 1 8 52685 Avenida Ramirez
Unit 2
Unit 3
Unit 4
Unit 5
Comments CC - 4,034.40
Cash - $177.12
S.F.
1968
Unit 6
Unit 7
Unit 8
Unit 9
Unit 10
BERMUDA DU•N ES r
(10 RANCHO MIRAGE
INDIAN WELLS
PALM DESERTLA ,y
��O INDIO Tyra
APN # 773-291-027
Jurisdiction La Qui nta
Permit # 0204-62
Study Area
No. of Units 1
Lot # No. Street S.F.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/tvalkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that 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 -
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14 X 1,968 S.F. or $4,211.52 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project imay now be issued.
Fees Paid By CC and Cash - Larry Shields Check No. 10900
Name on the check Telephone 760/771-1670
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Crystal Scott
Signature
$4,211.52_ Iso.ao
Payment Recd Over/Under
NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 installationpermit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whi:hever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy -Accounting
OLD REPM TITLE CO.
f RECORDING REQUESTED BY:
AND WHEN RECORDED; MAIL TO:'
MT. COVE DEVELOPMENT INC.
51370 Avenue" Bermudas, Ste. 2
L Q ' CA 92253
a ufnta,
DOC a 2001-240027
04/04/2001 08:00A Fee:26.00
Page 1 of 1 Doc T Tax Paid
Recorded!in Official Records
County of Riverside
Gary L. Orso
Assessor, County Clerk 8 Recorder
M
$
U'
-PAGE
SIZE •"
DA
PCOR
NOCOR
SMF
MISC.
i
"�`^
. COPYs
)w..LONG
REFUNDS
�.NCHG--
. EJ M ,
r ~
.-. r �.
ASSESSOR'S=PARCEL NO:r7.73.291.027 The; undersigned'Grantor(s) declare that the DOCUMENT TRANSFER TAX IS-,
$ 28.60 County. $ City .LEJ
e
le TITLE ORDER NO;: .510999-1 - t r ''xx computed on..the-full value of'the interest -of property conveyed, or
• _computed on the full value less the value of liens or encumbrances remaining thereon
ESCROW NO.: 67771M r at the time of sale!'
• _ . +O
tR transfer is EXEMPT from tax following,
for the reason:
• t �' � GRANT .DEED . . .... -t y.. y ..
FORA VALUABLE CONSIDERATION, receipt of 'which is hereby acknowledged;
STEVE SAMALIN, AN UNMARRIED MAN Y
hereby GRANT(S) to Mt. Cove Developement Inc., a. Nevada` Corporation
q all that. real property situated in the City*of La Quinta County.of Riverside, State of California, described as:
Lots 8 and 9, Block 154 of Santa Carmelita ai Vale La Quinta, Unit No. 16, in the City of La Quinta, County of Riverside, State of California, as per map
recorded in Book 18, Pages 99 and 100, of Maps, in.the office of the County Recorder of said County.
Dated -March 1, 2001
f� f
STATE OF CALIFORNIA,
COUNTY OF RivPrci ria
}
ON March 1, -2001 ,before me . Lanney Mayfield STEVE SAMALIN
- Notary Public,, personally- appeared 4
Steve ,Samalin
personally known to me for proved to me on the basis of satisfactory evidence) to be the person(s) LANNEY HAYFIELD
whose name(s) islare subscribed to the within instrument and acknowledged to me that helshelthey Comm. ' AYFI 0'
executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) an the , _ NOTARY PUBLIC 206870' y
• instrument the person(s), or the entity' upon behalf 'of which the person(s) acted,' executed the
instrument. hs e Riverside County
WITNESS my hand acid offici a ` Ila I My Comm. Expires Jan. 30, 2003
nature 007
STATEMENTS T0:','- (This area for official notary seal)
MT. COVE DEVELOPMENT INC. 51 70 Avenue B as, Ste. 2, La Quinta, CA '92253 -,
=RC DISTRICT - PLANNING REVIEW FORM M
This form is to be used by CDD staff for review of single family dwellings in the RC (Cove
Residential) District per Section 9.50.090,of the Zoning Code. Its ,purpose is to determine: .
1) that the proposed house design does not duplicate the same architectural style of any
house within 200 feet of the applicant,—and/or 2)- if there -is a -need -for the applicant to=file for
Master Design Guidelines. ' If the applicant does need to file a Master Design Guideline, please
transmitted this information to the Building and Safety. Department as part -of your correction
list. Please attach additional explanations as necessary.
APPLICANT W. R. Rogers
SITE ADDRESS 52-685 Avenida Ramirez ;
APN 773 - 291 - 027 CASE NO.: 2001-567
LEGAL: LOT BLOCK 15-4 UNIT S.C.@V.L.Q.
CHECK AND APPROVED BY: Michele Rambo 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 case numbers.
REQUIRED ITEM
Y
N.
COMMENT/CORRECTION
Verify legal and APN.inforrriation
Consistent with MDG on file (as
applicable
�.
MDG filing required (5 filings since
9/3/98)
Architectural variety withini200 feet of
the surrounding area.
.. � ,Colors
Materials
Architectural design. features
aO�E08'1 CD OPZE
EX
y
Other Requirements: `
6� 16—
Bin #
City of La Quints
BLdkffng ar Safery Division
P.O. Box 1SO4, 78.49S Calk Tampico
La Quints, CA 922S3 - (760) 777-7012
Building Permit Application and Track,ng Sheet
Permit #
YProject Address: C. lv Y5— 1 kL
Owncr's Name: Ay, �L/L
A. P. Number:
XAddress:
Legal Description:
XCit.,. ST. Zip: t-,09- aL4- co ---7 e
"Contractor: JW F q-70
('to/) _Se S
ITelephone: --Z2 -7 —/b
Y- 0 7
Address:
K Project Description:
vCity. ST. Zip: -3-;04(6 40LO i
c /4-' 94?zxm//(
�LTelephone: CID
,state Lic. CitvLic. #:
Arch.. Engr.. Designer:
Address:
City. ST, Zip:
Telephone:
. ...........
........ %..::.:
Construction Type: Occupanc%-
State Lic. #:......
Project r% pe (circle one): New Add'n After Repair Dcrno
X
Name of Contact Person: -7— fv
x -
Sq.
Stories:
# Units:
�� Sh -
)Telephone # of Contact Person:' ie-ld:5* V/
XEstirnated Value of Proiect:
APPLICANT: DO NOT WRITE BELOW THIS LINE
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed. ready for corrections
Plan Cbeck Deposit
Truss Calcs.
Called Contact Person
Plan Cbeck Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Niech2mical
Grading plan
2" Review. ready for corrections/issue
Electric al
Subcont2ctor List
Called Contact Person
Plumbiing
Grant Deed
Plans picked up
SAM.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review. ready for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date or permit issue
School Fees
Total Permit Fees
Certificate of.o.ccupanty
City of La Quinta
Building.and Safety Department
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: 52-685 AVENIDA RAMIREZ
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0204-162
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC
Owner of' Building: MOUNTAIN COVE DEVELOPMENT Address: P.O. BOX 3578
City: PALM DESERT, CA 92261
By: STEVE TRAXEL
Date: 12-31-2002
Building Official
POST IN A CONSPICUOUS PLACE
1 �