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9906-037 (SFD)LICENSED CONTRACTOR DECLARATION l.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 291728 B 0Kf3U21)f ate �.r 1 4 Signature of Contractor 2' 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 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 subj�t to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with those provisions. ate: Zf -; { 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. 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 property for inspection purposes. ;Signature (Owner/Agent) Z y :/. Date BUILDING PERMIT PERMITk!'�� DATE VALUATION $91,(038.70 LOT 3 TRACT HIS 1.131-1 U24 f 'I1 a ADDRESS 53BJP4.5IWUNIDAU11.MIREZi APN 74-121.015 OWNER CONTRACTOR/DESIGNER/ENGINEER LA QIJINiA PARi'N1sRS WILUANI Rf,SSEU, XOQERNs 51.-370 AVEN IDA BERMUDAS 56 900 JACKSON LAQIANFA C;f1 92253 1711FRNIAL CA 922*14 r7fi{I}3n9_1: (I(1 C14,11f 1454 USE OF PERMIT SINGLE .FAMiLif DWE LLiNO ;iii i:► - :I►I%:►21�1I f i�t:iE,3 Ni ! 1 tNr;."i.UDF: i3i.tiCk. +JVAI.i. �2fi %i:�ul.. l:.t?iy-f3A 1. fvf.AN'1lit ELAN. TRACT CC, N s'i'TtT3CTIOM 1,47 S.W it i'uft4;ll)PIXT40 58.0(1 SIS ilAftfl(3iJt;Aiti't.iiCl' r2G3.i.Kr tiF S k" t'. Wool) lru,,N4 1M.0 LF MM11"MATIET) COS"' OF CONSTRUCTIOIN PE#OtNti.C'4 CONyTitt,f -''ION f EX' too -OW -418-000 StAl, .!iir' P1 Amr tivr 'FTF iftl•fX11t-4'39-11f; tif4 if) fi.1XC:i'iiICALFfii SIW_A9 i'T.i1fi TSihii}Ft+, 1f1J.-t3i�414-0i)f) �I3s5t1 g,lVc)N(1 N,1 ►'i1C)W 1 1rfr Rr;_ ;irl 'In14") 241-fti)!i `eta it .1 ! CRAINNO I i 101-6017-•4 3_101DO 320.00 fNNisV;TItU031)10111,*.s1S 225.OW-443-342 szooii.24i I'RfLCISE PLAN 101-M-941-345 E .SAA) 0911, t101 -Wk 4 -W -11A - 2sofri tf ! ' 'ice` � �''•' . St tot4CMA T, CONSTkI.W- t'10N AND PIWN MR -K, 53,508 41 TOTtkL P ERNO.IT F,rF'S -1)1)ENOW 't 1 /1 r RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs .Underground Ducts Forms & Footings let 5, Ducts Slab Grade r Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap p —U — T 1 5 F.A.U. Framing — _ Y Compressor Insulation Ce_ — Qg 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 4eo BLOCKWALL XPFVROVALS POOL_ S -'SPAS steel - Set Backs (f q Electric Bond Footings Main Drain Bond Beam $. _ Approvat to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines / Heater Final Water Piping 7 Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection` :" —Q y Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL AP ROVALS Temp. Power Pole 7 4 -57 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) 7 0,3F COMMENTS: 9Ce B 1 J_uty", �+C,-u j P.O. BOX 1504 5 g {? 78-495 CALLE TAMPICO APPLICATION L Buildin ��// �t i Address fi ¢ r'I V. I16L.2 LA QUINTA, CALIFORNIA 92253 Mailing i/ Address �.��� 4(Jl,,wrr/ ap ✓w;: City Zip Tel. 4 , 0 -'i I 17- x5"3 Slee q _ P4176 G4 fZ:0 0 State Lic. +� �, City & Classif. / a%, / Z et Lic. N Arch., Engr., Designer Address Tel. CityI Zip I State 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 Contractors 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 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). I__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 1, 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') 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 it the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg 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 r Lender's Address 136 This is a building permit when properly filled out, signed and validated, and is su lett o expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information I agree to comply with all city and county ordinances and state laws relating e Ci�lcincp construction, and hereby authorize representatives -of this city to enter the above• mentioned property for inspection purposes. Signature of applicant g1 Mailing Address .!1 City, State, Zip BUILDING: TYPE'CONST. OCC. GRP. A.P. Number Via¢ i 7 .l .. f:) 1 Legal Description Project Description :t Sq. Ft. 07 So No. No. DIN. Size �� r J Stories Units Add ❑ Alter ❑ Repair ❑ Demolition ❑ Wmated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from enter Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line = Side Setback from Froperty Line 60NAL DATE INSPECTOR 1999d by: Date Permit Validated by: � '�i�ti TA WHITE = FINANCE YELLOW = APPLICANT r PINK = BUILDING DIVIS30N e r Desert Sands Unified School District , 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be,Duplicated 760-771-8515; CERTIFICATE OF COMPLIANCE " Date* 6/9/99 APN # t.74-121-015 No. 18871 Jurisdiction La Quinta , Owner NameLa Quinta Partners • ' Permit # No. 53-545, Street Avendia RamiezLo; # City La Quinta zip 92253 Study Area z Tract # BLK232U22 Lot # 3 Square Footage 1,475 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, 1covered . 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 1,475 or $ 2,846.75 the property listed above and tharbu>1'dmg permits and/or Certificates of Occupancy for this square footage in this proposed project may now be-y sued , %✓ { Fees Paid By ccNIB/Tom BuffinT r399 M v Telephone -1200 Name on the check- 1 By Dr. Doris Wilson t,fi • y� � � � ;, moi.."� � ` --_ �' Superintendent�t Fee collected /exempted by Juanita Green Payment Received $2,E47.00 Check No. 195106 Signature NOTICE: Pursuant of As mbly 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 to 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. a , Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt, Copy -. Accounting May .;25. 1999 2:12PM POWER BROKERS —No 1'97 P. 1/2 RECORDING REQUESTED BY; CHICAGO TITLE COMPANY COMPANY 99.8826KC 97056290 *140 MICHAEL SALCITO SPACE ABRE THIS LINE FOR REMER'S U GRANT .DEED r The undersigned grantor(s) -declare(s)t Documentary transfer tax is (](XX) Computed on full value of pprroopperty conveyed, or ( ) coaputed on full valueless liens and encumbrances. remaining at time of sale. ( )' Unincorporated area: f ) City of and FOR A VALUABLE coNSIDBRATION, receipt•of which is .hereby acknowledged, LA QUINTA PARTNERS IT., hereby GRANTS) to MICHAEL SALCITO, the real property in the City of LA QUINTA, County.of Riverside, State of California, described as! Lot 3, Block 232, Unit 22, Tract Santa Carmelita at -Vale La Quint&, as per map recorded in Book 20, Page(s) 24'inclusive of maps, in .the office of the County Recorder of said County. Dated May 19, 1999 State of -California County of on before me, ,.personally appeared personally known to.me- (or proved tolme on the basis of satisfactory evidence) to be the person(s.) whose name(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(iss), and that by his/her/their signatures) on the `instrument the person(s), or the entity upon behalf of which the,pereon(s) acted, executed ,the instrument. WITNESS my hand and official seal. ` Signature MAIL TAX'STATEMENTS TO: LA .QUINTA `PARTNERS TI Name/ 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, applicabitity 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: LA QUINTA PARTNERS LARRY ROGERS SHIELDS PROJECT'53-545 Ramirez ADDRESS: APN: ' 774-121=015 LEGAL: LOT , 'BLOCK, UNIT _ ; S.C. @ V.LQ. CK'D BY: ' Stan Sawa 1 BIN NO:. CASE NO. 99-76 ..CHECK 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. 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'•�+\•..} EM Case logged and number assigned J _ Verify legal and APN information Consistent with MDG. on file (as applicable) MDG filing required (5+ filings since 9/3/98)' Con"sis"tency -with-street/surrounding area:. b Colors Materials Architecture V' ®a ` OTHERREQUIREMENTS: � — 5��C� L( C��C 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, -8; Safety address.'file.