0006-052 (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
`+10 B % r10131/2t
Date � I Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractorls,=
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 STATE CONI. INS MY Policy No. 13420M.9
(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' compensatio provi ins of Section 3700 of the Labor
Code, I still o hfn/ith comply with th�se prof o,s.
Date: Applicant—
Warning:
pplicant 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. 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
the above-mentioned prope for ingpection purposes.
Signature (Owner/Agent) Date// '
'���'
BUILDING PERMIT PERMIT#
DATE VALUATION LOT2 TRACT
JOB SITE
APN
ADDRESS ._,I.9&5 AVRiNJJ)A %,%IMFZ
OWNER
CONTRACTOR / DESIGNER / EN (NEER
D E:1`TAIiS POST
ATOM'IT-IVRES-1-SOT THWUT DEVVELOPvf10n
77.564 A COUMAY CILUR.DIR 113
77-564 A COUN:i'itY" CWD DSR,
PAIM DESLE r ,CA 92211
4j:M.DESERT CA 92211
(760)408-3495 BUr 6133
USE OF PERMIT
sFJ3 A RMIT DOES 'NOT INCLUDE SL.00K ?Ai',AIA S OR POOJ, s
MCT CONSTRUCTIfYN 1,405.00 SRS
PORE 1ifPATIO 49.00 SP
GARAGE/CARPORT (SFj 91990.00
Es"ro"TM COST OF CONSMUCTION
YIER1lh3f Fn SUMMARY
CONSTRUCTION Ryl 101=000-418.0'00 E5�1:40
PLAN CI�JFXX M,, 101-000-439-318 $491.70
E DEPOSIT 101.040.439-313 4230100
J+6MMANICAL NEP, 101-000.421-000 833.30
MECTR,1C/AL FEE. 101.000-42.0.000
PLUMMIGs FJ, 101-000-419'-000 $123,75
S` P,ONG MOTION MZ - k2MD 101.000-241-000 98.69
ORADIN1 1 FEE 101-000-423-000 $20.00
D>G"I ELOPYR IMPACT FEE $1,907.09
PRZCISE PLAN 101-000-441-345 $100.00
FEE DEPOSIT 101.000-439-318 -9250.00
SM -TOTAL 10ONSTRUC'°TiON AND PL,A14 CSC 1C
$3,413.52
LES.S PRE,-PAMFFXS
4500.00
'1CC iffl:,1I'h'It WJr 11XV DUE NOW
,91.4.52
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
i
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
BW`O4�1
Exhaust Fans
O.K. to Wrap
- ((, - dt9 sF.A.U.
Framing
Compressor
Insulation
CZp- SX
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Apt
Final
Final
eo
POOLS - SPAS
BLOCKWAI
I dppR,OVALS
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
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
- —CPW C37
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) &
ELECTRICAL APPROVALS
Temp. Power Pole Ua
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
P.O. BOX 1504 APPLICATION ON
Buildes
GG tQ� n 78-495 CALLE TAMPICO
Address J tel^ '9V�AVE F-�du 1 r'�GZ� LA QUINTA, CALIFORNIA 92253
Owner Vr—t n ` `_
Mailing '"') �/ 1 U BUILDING: TY-P�E'��COONST. O':C. GRP.
Address t" � C�U I V t� A.P. Number f 1 Q Zn
C ykX4—[Zip Tel}
Legal Description Ln+
CWntragtor ^ n Project Description VY ---w
Addres�� 4-A Co U
State Lic. City i
8 Classif. � %0 5 ( 0 Lic. # 0�1 Sq. iz Ft.
Size
Arch., Engr.,
Designer �/, U New V
14 LL DE21A,
A
id" s P -,\, d. -C n- Q T b�A _IQ 9L
Of
Stae
"t , Vt`) I W1�IZIp ILint# I
LICENSED CONTRACTOR' DECLARATION
I hereby affirrl that I am licensed�under;NNT I, ns of Chapter 9 (commencing ih S ction
7000) of Div's'on 3 of a Businestand Prof e t ns Code and 'cense?s in 11 r e,a d
effect. Y
SIGNATURE 1/ I -DATE'
OWNER -BI ILDER DECLARATION t
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, after, 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 live hundred dollars ($500).
I- 1, 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. It, 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 contractor(s) licensed pursuant to the Contractor's License Law.)
0 1 am exempt under Sec. B. 8 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 if the permit is for one hundred dollars ($100) valuation
or less.)
I certif that in the performance of ing workfor which this Dermit is issued, I shall not
employ" an person in any manner so as to become subject to the Workers' Compensation
Laws of C li ornia.
Date W Owner
NOTICE T • ,APPLICANT: 1!, after making this Certificate o! he
you should become
subject to
the Workers' Compensation provisions of the Labor Code, you must lorthwflh
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,arid .'validated, and is subject to
expiration if work thereunder is suspended for 180 days. .. . -1 " • --
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 -of ;this -city, to enter the above.
mentioned property for inspection purposes. �f -
Signature of applicant - 'Date- ri
Mailing Address
City, State, Zip -
No.
Stories
Add ❑ Alter ❑
No. Dw.
Units
Demolition ❑
Itimated Valuation
P
PERMIT
100 AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
1,
TOTAL
REMARKS
ZONE: BY: "
Minimum Setback Distances:
Front Setback froin Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback frorr Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK= BUILDING DIVISION
e
Notice:
S
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 6/12/00 ,APN # 773-322-023.
No. 20537 - Jurisdiction La Quinta
Owner NameDennis Yost . , Permit # 0006-052
No. 52=985 Street Avenida Ramirez Lo; #
city La Quinta zip 92253 Study Area
Tract # Lot # Square Footage 1405
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 t
2.05 X 1,405 or $ 2,880.25 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now b issued
Fees Paid By CC/Mountain View Fed. Credit Union/Dennis Yost Telephone 760-408-3495
Name on the check
By Dr. Doris Wilson µ
Superintendent
Fee collected /exempted by Mary Ann L. Borja Payment Received " $2'•880.25
Check No. '100790' ,
Signature + r
(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 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 Distdct('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waiv*rs.
Embossed Original- Building. Dept./Applicant Copy'- Applicant/Receipt Copy - Accounting
•
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 t
2.05 X 1,405 or $ 2,880.25 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now b issued
Fees Paid By CC/Mountain View Fed. Credit Union/Dennis Yost Telephone 760-408-3495
Name on the check
By Dr. Doris Wilson µ
Superintendent
Fee collected /exempted by Mary Ann L. Borja Payment Received " $2'•880.25
Check No. '100790' ,
Signature + r
(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 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 Distdct('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waiv*rs.
Embossed Original- Building. Dept./Applicant Copy'- Applicant/Receipt Copy - Accounting
MAY.24.2000 10:23AM COMMONWEALTH
RRCORDING RRQVSBTED BYs
CHICAGO TITLE COMPANY COMPANY
9924XC 207056310
WHEN RECORDED'MAIL TRIS DEED AND,
UNLESS OTRRRWISE.SHOWN BELOW,
MAIL. TAX STATEMENTS TOi.
e
DENNIS YOST
kR •RECORDER' S VSE'"•
. GRANT DEED ABNs 773-322-023-5
The undersigned grantor(s) declare(s):
Documentary transfer tax is
(XXX) 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 CONSIDERATION, receipt of which is hereby acknowledged,
THOMAS AQUINAS COLLEGE
hereby GRANT (S) .to
DENNIS YOST,
the real, property in the City of LA QUINTA, County of Riverside, State of California,
described as:
Lot 13, Block 157, Unit No. 16,, Tract Santa Carmelita at Vale La Quinta, as per map
recorded in Book 18, Page(s) 99 inclusive of maps, in the office of the County Recorder
of said County.
Dated May 24, 2000
.State of California
County of } S.S.
On
before me,
personally appeared
personally known to me (or proved to me on
the basis of satisfactory evidence) to be
the person(s) whose nime(s) is/are subscribed
to the within instrument and acknowledged to
me that he/she/they executed the same in
his/her/their authorized capacity(ies), and
that by his/her/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 STATEMENTS TO:
THOMAS -AQUINAS COLLEGE
BY
,Name/Title
BY
Name/Title
(This area for official notarial seal)
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, in order to determine the applicability of compatibility issues or need to requi`e the filing of Master
Design Guidelines by the applicant. It shall be transmitted to the Building and Safety Department as -your'
correction list. Please attach additional explanations as necessary.
APPLICANT NW SW DEVELOPMENT.
SITE ADDRESS ^ 52-985 Avenida Ramirez•
APN 773-322-023 BIN NO.: CASE NO.: 2300-230
LEGAL: LOT 13 BLOCK 157 UNIT S.C.@V.L.Q.
CHECKED BY: Leslie`,Mouriquand 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
Compatibility Review
Case logged and number assigned
Verify legal and APN information
Consistent with MDG on file (as applicable
MDG filing required (5 filings since 9/3/98)
Consistency with street/surrounding area:
. Colors
'� Materials
,
,
110
✓ I -
Architecture
i .
Other Requirements:
t1pT
A11PROV
ED BY
m
COMM
E
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