0007-213 (SFD)O 5 M
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I LICENSED CONTRACTOR DECLARATION
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
4253>31 B ; t}i/ 1/2C
Date ? �`� Signature of Contractor
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 STATE MD Policy No. 1280990-00
(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 ofQCalifornia, 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 tholse,� r�ovislons.
Date: � 1 t L» a Applicant t —e .-as �,''� i
Warning: Failure to secure Workers' ComRensation 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 o"'f this City to enter upon
the above-mentioned property for inspection purposes.
gnature (Owner/Agent) A� sl ` """"- " Date(
UILDING PERMIT PERMIT#
DATE-VALUATION.LOT 0007-2113 TRACT
BLKI 10
JOB SITE T
APN
ADDRESS 5:1-71. Avetrl.di3DibH`f[ti%da
773-.14"19
OWNER
CONTRACTOR/DESIGNER/EN (NEER
DAVID ROSS MILLER
PACIFIC *MDES CC51dMUC"'.i IO14
S OCEANS= CA. 92034
(7650)967.0469 - CBIN 195,15
USE OF PERMIT
S.fi GL*g FANMY DWO.LWO
SPD-P12.EMIT DOPZ?RIOT INCLUDE RKOCK:'N►ALI, OM POOL,
TRACT CONSTRUCTION 1.421,00 SF
PORCH/PATIO 36.00 SA'
0ARAGE1CARPORT (Sii) 9,996.00
5 FT. WOOD FENC Z 200.00 LF
ESITMAM) COST OF 4ONS7VCrION'
89133.S.10
TFIM, RER W Yp". v
C 014STRUCTION FL`rL+ 101 *000.418-000 5590D
PLAN CHECK FEE 101.000.439-318 $500.11
MF.C1JA3d CAL, FEE 101.000-421.400 $60.00
91.9C'I'RICA1,, FEE 101-000-4.20-000 $1209.44
PLUMF INO PEE 101.000-419-000 $110,'75
STRONG M011011 FEE - RF SIJ 101-000-241-000 $8.913
f
O ADINQ .WR 101.000.42 400 $20,00
OEVELA'31iER IMPACT FEE $1,907.00
PRE089 PLAN 141.440.441.345 S100.09
YEL DEPOSIT 101-000-439-319 .$750.00
SUS-TC7rAL C°t NSTI1.2UCMION AM PI". C�tiF;{
$3,4:i0.7d
LESS PRE -PAID FFXS
4250,00
r,J
RECEIPT
DATE
BYDATE
FI AL ��
INSPECTOR
INSPECTION RECORD
OPERATION
DATE I
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
1
lzldej
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
1.0 -2 --em
Exhaust Fans
O.K to Wrap
Lp - 3 - pp
F.A.U.
Framing
Insulation
Ag -a - 0e 97
p S
Compressor
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 'a-
BLOCKWALL APPROVALS
POOLS - SPAS
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
c770 S7
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
I
Certificate of Occupancy
City ofta 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: 51-705 AVENIDA BERMUDAS
Use Classification: SFD� Bldg. Permit No.: 0007-213
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC
Owner of Building: DAVID R. MILLER
Building Official
Address: 1719 S. TREMONT
City: OCEANSIDE, CA
By: STEVE TRAXEL
Date: 11-28-00
POST IN A CONSPICUOUS PLACE.
92054
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
Date 8/25/00
No. 20936
Owner NameDavid ROSS Miller
CERTIFICATE OF COMPLIANCE
APN # 773-145-019
Jurisdiction La Quinta
Permit # 0007-213
No. 51-705 Street Avenida Bermudas Log #
City La Quinta Zip 92253 Study Area
Tract # Lot # Square Footage 1421
Type of Development Single Family Residence
Comments
No. of Units 1
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
2.05 X 1,421 or $ 2,913.05 the property listed above and that building .
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
Fees Paid By CC / Capital Bank of North County / David Miller Telephone
Name on the check -
By Dr. Doris Wilson
Superintendent
Fee collected /exe ted by Annette Barlow Payment Received $2,913.05
,�Q, �zil/lq/ � Check No. 077777
Signature
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) 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('sxs') 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
/
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 require 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 PACIFIC TRADES
SITE ADDRESS 51-705 Avenida Bermudas
APN 773 _ 145 _ 019 ' BINNO.: CASE NO.: 2000-278.
LEGAL: LOT 7 BLOCK 110 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
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A
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log
Materials
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Architecture
5 c
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Other Requirements:
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Building s� W-4405
Address
AArAOE &E!5
P.O
t'oft 11_
S
BOX 1504 APPLICATION ONLY
Ab78-495 CALLE TAMPICO
UINTA, G
CALIFORNIA 92253
owner 2
Mailing
•� )'�'
Address
& Classif. *j� 1 Lic. x
Designer
Address
State
Lic. p
under provisidnrrdf Chapter 9 icammencing with Section
and Professions Code, an license Is in full force and
OWNER•IUILDER DECLARATION
1 hereby affirm that m 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, after, improve, demolish. or repair any structure, prior to ,as Issuance alto
requires the applicant for such permit to file a signed statement that he Is licensed pursuant to
Me provisions of the Contractor's License Lew, Chapter 8 (commencing with Section 7000) of
Ornswn 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 appWant for a permit
subjects the applicant to a civil penalty of not more than rive hundred dollars (5500).
17 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. ff, however, the building
or improvement is sold within one year of completion, the owner-bulider. will have the burden
of proving that he did not build or improve for the purpose of sale.)
"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 properly who builds or Improves thereon, and who contracts for
such projects with a contractor(s) licensed Pursuant to the Contractor's License Lew.)
17 1 am exempt under Sec. B. & P.C. for this reason
pate Owner
WORKERS' COMPENSATION DECLARATION
1 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
(1 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 ($100) 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. d, 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 pemat shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby 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
Lenders 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.
1 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.
Signature of adplicent Date
Mailing Address
City, State, Zip
BUILDING: TYPE'CONST. OCC.. GRP. Q
A.P. Number_ — 1 AT7
jr — ®-1
Legal Description CVV
r� tom.
Project Description S • Y �'1 �« --t r� '
Sq. Ft. t t ' No. No. Dw.
Size 'i Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Itimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE a FINANCE YELLOW a APPLICANT PINK a BUILDING DIVISION