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0007-212 (SFD)M 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. Cla s Exp. Date 07Ia ld2Z ate G'Signature of Contractor OWNER -BUILDER DECLARATION I here' 1 --under penalty of perjury that I am exempt from the Contractor's License c. -,,/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 FU13U Policy No. 12$0990-00 (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 of California, and agree that if I should become subject totheworkers' compensitt�on provisions of Section 3700 of the,,Labor �ode, I Ball forthwith comply with those p/rovisibns. a/} ;Gate: Applicant— Warning: pplicant ��Warning: Failure to secure Workers' Comp nsation 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 }he above-mentioned propeity for I spedtion purposes Sinnafjra (()wnar/AnA7Z.�� '^^' f]ata A � ' BUILDING PERMIT PERMIT# OW7-2.12 DATE TRACT ;gLUATION LOT /`• L��`")� M'�4 �3tJ 12 lsIX121 JOB SITE a APN ADDRESS 51-985 .A:VCM14111 Tlenlfuft8 773-184-024 OWNER CONTRACTOR/DESIGNER/EN (NEER DAW0 ROSS MUM PAG LMC 1Vfi )F5 C0NUMUCTION 3 OCLA1`iSiO.9 CA 92054 e760)967.0069 CBI.# 1955 i USE OF PERMIT 917 LE RAWLY DWMZ1 JNG S70-PERMIT1,7OF-S NOT INCLUIDE BLOCK: WA.L,L OR POOL TRACT CONSTRUCTION 1,35 "!.0® Sl? PORCHUPATIO 46.00 SF t: iARA.CtMARPORT (3I) 90,172.40 5 FT. WOOL) FENCE 200.00 1.F ESIT MATEI) COW Off' CONMUMON £38,341.30 CONSTRUCT )ON FZF, 101-000-419-000 $590,00 PL&N CHWX FEE 101-004-4.39-318 $493.61 MECKANICA.L M 101.000.421.000 $53.50 IELWfRICAL FRI?, 101-000-420.000 $122.78 PLUMBING FEE 101.000-419.000 $110.75 STRONG MOTION TME - iiMID 101-000-241-000 $3.$3 C RADINO FEE 101.000.423.000 $20.00 DLrVFI.OPE-R IMPACT FEE $),9v?.00 PRECISE PLAN 101.000.441.345 $100.00 FEE DEPOSIT 101-000-439-318 4350.00 MS -Ta .rAL C0MMUCTZON MI.) PLAN' CTIECK - $3,406.47 I:E3 1? G�pPA1T1 J?9 -$250.00 1'Q IA1a .PKIM 1' MS dills NOW $31 156.47 t{'"� ��+-rte. �•' .1.t3 RECEIPT DATE BY r DAT INALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings , Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap RA.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath v Drywall - Int. Lath Final Final _ oc Ck�� 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 Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp, Power Pole q— 00 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) COMMENTS: t Notice: Document Cannot Be Duplicated Date 8/25/00 No. 20937 Owner NameDavid Ross Miller Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE APN # 773-184-024 Jurisdiction La Quinta Permit # 0007-212 No. 51-985 Street Avenida Bermudas Log # City La Quinta Zip 92253 Study Area Tract # Lot # Square Footage 1397 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 2.05 X 1,397 or $ 2,863.85 the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now t e issued t, Fees Paid By CC / Capital Bank of North County / David Miller Telephone 160-967-0069 Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Annette Barlow Payment Received $2,863.85 Check No. 18865 Signature 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 Districts) or to 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 waivers. Embossed Original- Building DeptJApplicant Copy - Applicant/Receipt Copy - Accounting i RC DISTRICT - PLANNING REVIEW FORM �D This form is to be used b CDD staff for review dwellings in the RC Cove Residential y iew of single family dwe gs ( ) District, in order to determine the applicabilit.= of compatibility issues or need to require the filing of Master Design Guidelines by the applicant. It shall b- transmitted to the Building and Safety Department as your correction list. Please attach additional expl;,,nations as necessary. APPLICANT PACIFIC TRAD"' S SITE ADDRESS 51-985 Aven_.da Bermudas APN 773 _ 184 - 024 gIN NO.: CASE NO.: LEGAL: LOT 12 BLOCK 121 2000-277 UNIT S.C.@V.L.Q. CHECKED BY: Leslie Mour is nand DATE: -� - 0 Inform the gP P Y g assigned Building plan check, -r upon our assignment to this case. The CDD Executive g 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: 0 Colors 4 F m •p V� �, 41c Materials Architecture p 0 •� U a Other Requirements: �� t!'�itrCv P.O. BOX 1504 C�� ,A� 78-495 CALLE TAMPICO Addrdess ` Vim' `Q� N�14� LA OUINTA, CALIFORNIA 92253 Owner Mailing Address - City Zip Tel. Contradtor V(\C\� Address Zip State Lic. I City & Classif. Lic. # Arch., Engr., Designer Address Tel. City`I Zip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION I herebyy, affirm thet I amtll`censed under provisions of Chapter 9 (commencing with Section DOO) of Divislon 3 of the Business and Professions Code, an/d my license is In full force and Ilett. � )� "1. �_J 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 '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 rive hundred dollars ($500). [] 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.) I l 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.) i 7 1 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 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: 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 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. 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. Signature of applicant Date Mailing Address City, State, Zip APPLICATION ONLY BUILDING: TYPE'CONST. OCC. GRP. A.P. Number �T�'' Ij,g Legal Description Project Description Sq. Ft. � No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ XXA�7')Fk LA hiWV Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure r ^— TOTAL - REMARKS 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 = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Certificate of Occupancy 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 ollowing. BUILDING ADDRESS: 51-985 Avenida Bermudas Use Classification: SFD Bldg. Permit No.: Occupancy Group: R3 Type of Construction: VN Land Use Zone: Owner of Building: David Ross Miller "7�&f4,% Building Official Address: 1719 S. Tremont 0007-212 RC City: Oceanside, CA 92054 By: Greg Fox Date: 1-12-2001 POST IN A CONSPICUOUS PLACE