0207-098 (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
B ` 1.:?, 112
3 / t.1.�, ` F
Date Signature of Contractor
ON-
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 VIA,.TF BUND Policy No. 1247.7134,2
(This section need not be completed if the permit valuation is for $100.00 or less).
() I certify that in the per 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 of Sectio°3700 of the Labor
4Code, I shall forthwith comply with those p ovlslons. A—F
Date: 1- t 1 a�"7.;., 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 applicatiomis 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
t the above-mentioned property for inspection purposes.
Signature (Owner/Agent)— T" • �+ �• a Dat j�`��ry
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE c��
ADDRESS xll~i %�dE�i i � i
APN
77,w4^32,�'fn-015
OWNER
CONTRACTOR / DESIGNER / EN INEER
—
f�{Sy�Y.{��P/9>1AT�:M!,
ta
QOp{I%IADO
P
LA.Q1;TZN:IA CA 92233
Lk CA 92253
,CII 5CA• 4&M IA 19211
USE OF PERMIT
a •)
.
yrn ap ��p Ty y M py�vy�p * y�vp qy �a�t ��rq7 y �*q tp� yy �j 5�g,ry�+�
�1\ 1a! - l /` OMI # 7.PlMSN �, �i4\✓.6rUM 31 4 K yP! ALr' L POOL }., ft iJ.h1tl RIVEWAY.
APPROACH, 08 CODE
TR A,C T COJ' TRUC'1IaN 116010D D O
1*0RC3il7I,re IVO 20.00 Ian'
MRAWL°ARPORT Ox.48 OF
1P'.4ty.%lldM AIM NUMMARY
CGHSTRUCTMIT FFM 10.3: -00 0-416-000 $ 13,00
i>iit'N Cli'FC.2::FEE 101-000-43g34'118't ?, WCn
Psy.I `;
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
gW(//L_.
Return Air
Steel
9k p L
Combustion Air
Roof Deck
Exhaust Fans
F.A.U.
O.K. to Wrap L/e(
Framing
_ e -me—
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
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
Finale
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
�j_//�� _
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
77 -
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole 7 '_.50 Z
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)
RECORDING REQUESTED BY:
`4elity National Title Company.
row No. 44202 -CB.
Title Order No.
When Recorded Mail Document
and Tax Statement To:
Mr. and Mrs. Donald Hamilton
P.O. Box 1281
La Quinta, CA 92253
GRANT DEED SPACE ABOVE THIS LINE FOR RECORDER'S USE
The undersigned grantors) declare(s)
Documentary transfer tax Is $68.20
[ X ) computed on full value of property conveyed, or
[ ) computed on full value less value of liens or encumbrances remaining at time of sale,
L I Unincorporated Area City of La Quinta
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Denise P. Malas, A Married
Woman as Sole and Separate Property and Shandra Pickering, A Single Woman
hereby GRANTIS) to Donald Hamilton and Terry Hamilton, Husband and Wife as Joint Tenants.
the following described real property In the City of La Quinta
County of Riverside, State of California: _
Lots 1 and-27,jBlock 157 of Santa Carmelita at Vale La Quinta; Unit -#16 as per map recorded En Book 18, Page 99
of Maps, In the Office of the County Recorder of said County.
DATED: March 25, 2002
STATE OF CALIFORNI�j.,
COUNTY OF- Lo S • Y-i�1G� e `e
ON —�t- Z -:G L before me,
i M e L PC 51 �j I TZ -4, LA S j r, personally appeared
1 C% S -------------
-persetiaNlf-lrnewrrto- rm (or proved to me on the basis
of satisfactory evidence) to be the person(Q whose
nameare subscribed to the within instrument arid
acknowledged to methat kwQh_j'they executed the
same in i_ /ti=Reir authorized capacity(ies), and that
by AisA& hier signaturew on the Instrument the
person(M', or the entity upon behalf of which the
personW acted, executed the instrument.
Witness my hand and official seal.
Signature
FD -21.3 (Rev 7/96)
Denise P. Melas
Shandra Pickering
JAMS LECK STOLTZFUS JIB.
Commission # 1221597
NOtWy Publib - Calllontlo
Loa A nge" County
W C lmm. 50 rA MaY25, 20M
MAIL TAX STATEMENTS AS DIRECTED ABOVE
GRANT DEED
RC DISTRICT - PLANNING REVIEW FORM
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 y.our correction
list. Please attach additional explanations as necessary.
APPLICANT East Valley Construction
SITE ADDRESS 52-755 Avenida Ramirez
APN 773- 322 - 014 CASE NO.: 2002--6.46 .
LEGAL: . LOT 1.. BLOCK UNIT 16 S.C.@V.L.Q.
CHECK AND APPROVED BY: --Wally Nesbit 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 information
Consistent with,MDG on file (as
applicable
_
MDG filing required (5 filings since
9/3/98)
Architectural variety within 200 feet.of
the surrounding area:
Colors
Materials
Architectural design features
Other mission
C� t Vi
-Community Dev. Dept. 777
Initials —
Case No.
Exhibit
O With Conditions sz-f ok/z6-L 4i
X
%C
7
;
a
Certificate"ofocca' an.c
City of La -Quinta
'...
1, mu"
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: 52-775 AVENIDA RAMIREZ
Use Classification: SFD Bldg. Permit No.: 0207-098
Occupancy Group: 133 Type of Construction: VN Land, Use Zone: RC
Owner of Building: EAST VALLEY CONSTRUCTION Address: 54-880 ALVARADO t
City: LA QUINTA CA 92253
` By: KIRK KIRKLAND
Date: 11-14-02
Building Official
POST IN A CONSPICUOUS PLACE