0008-339 (SFD)U'
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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
595734 B1 C9 06130/2(
.,,,Date 14 1 091gnature 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.
( )r 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 FUND Policy No. 219-00 UNIT 0011090.
(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' compensation provisions of Section 700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: � OvAjplicant /I r
Warning: Failure to secure Workers' CompdVirsation coverage is unlawful and
shall subject an employer to criminal penali es and civil fines up to $100,000, in;
addition to the cost of compensation, damages as provided for in Section 3700
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 authgrize rest sentatives of this City to enter upon
the above-mentioned property for inspect on purposes.,
Signature (Owner/Agent) 7 Date"
BUILDING PERMIT PERMIT#
DATE VALUATION LOT -339 TRACT
0911SWOC X3,39:.1,0 7 BLKI03
JOB SITE
APN
ADDRESS 52-415 A.VFJMA 13F1 11IM)AS
`i". -27'5-017
OWNER
CONTRACTOR/DESIGNER/EN (NEER
AL GUSIrrIN & LWA PAZ
PAZ CONSTIZU MON CO
52-995 ,P,''1 NI DAWI DO%A
52-951'5 ,AVF,141_DA Rte. DOZA
LA QulwfA CA 9.253
LA. QLWA Cly 92253
('160>564.3023 'CAW - 5537
USE OF PERMIT
MNGLL FAI�MF DW aL UTO
SFO- PERMIT DO&S NOT INCLUDE 1 LOCk WALL OR POOL.
TRACT CONSTRUCTION 1,421,00 SI?
PORCWPATIO 36.00 SF
0ARAOI+JC.ARPORT (SF) 9,998,00
SIT. WOOD PENCE 200.00 LF
=11AUTi1 D COST OF CCJgSrrRU'C n01q
89,3„IS.10
Mer If r" SUMMARY ,.
CONSTRUCTION FEE 101.000.418.000 $394.50
PLAN CHECK FEE 101-000-439-318 $500.13
'MECHANICAL ng 101.000-421.000 $60,00
ELFCTRICAL FEE 101-000-420-000 $129.44
PLUMBING FEE 101.000.419.000 3110.73
STRONG 1MOTiON FRVX - RES1D 101.000-2.41-000 $8.93
CI1'ADINO FFF 101.000-423-000 $20.00
13LVELOPER.IMPACT FU $1,907.00
PRECISE .# LAN 101.000441-345 $100.00
ftif DXPOSIT 101.000-439-318 3as0.t10
BUD-'Ci)lAl, CIOW RU'C II01`1'.A..ND PLA14 C MCY
$3,430,74
1A9359 PRE -PAID TT_?ES
4250,00
'tY K) MEAL P!.a31,L!'if JrEE ` D4�ET-TOW
RECEIPT
DATE
;`1(��
BY w
,
DATE FI ED
, oa
INSPECTOR
�u
-;o
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
- 00 $
Exhaust Fans
O.K to Wrap
- p0
F.A.U.
Framing
-vo
Compressor
Insulation
!O- OO S
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
-
3ST
Final �0�
BLOCKWALL APPROVALS
Final
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
_
Heater Final
Water Piping�O
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 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:
9 die. A1,4AI�
P.O. BOX 1504 ' APPLICATION ONLY
g 78-495 CALLE TAMPICO
Addrresdins `52 -A IT �� �• Ol iQ to ✓ A ti C LA OUINTA, CALIFORNIA 92253
Address47, %
.
& Classif. 4 4 e ., A- I Lic. M
y..,
Designer L-��Nt� n1S51�,,J•
Address
L� r A.Ah I I LIC.11
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that 1 tun tensed under provisions of Chapter 9 (commencing with Section
7000! of Division 3 of t a and Professl ns Code, and my licenseAp In full force and
Jr zi�ftib
effect.
SIGNATURr DATE
WNER BUILDER DECLARATION
1 hereby affirm that I atexempt from the Contractors License Law for the following
reason; (Sec. 7031.S,Bush ss and Professions Code: Any city of county which requires a
permit to construct, after. Improve, demolish, or repair any structure, prior to ,/tit Issuance also
requires the applicant for such Permit to fib a signed statement (hat 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 Coda. 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 Oro hundred dohn; ($500).
IJ 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. 7011, Buisness and
Professions Code: The Contractor's License Caw does not apply to an owner of property who
guilds or improves thereon and who does such work himself or through his own employees,
provided that such iiprovements aro not Intended or offered for safe. H, however, the building
or improvement Is sold within one year of completion, the owner-bu➢der w/ have the burden
o1 proving that he did not build or improve for the purpose of safe.)
1'I 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
doesnot 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.)
17 I am exempt under Sec. S. 6 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
rl Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed N the permit Is for one hundred dollars ($100) valuation
or less.)
1 certify that m
in the performance of the work.for which this permit is Issued, I shall not
employ any ppearson in any manner ao as to Decome subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT. 9, after making this Certificate of Exampliw you should become
subject to the Workers' Compensation provisions of the Labor Cods, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3087, 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 if work thereunder is suspended for 180 days.
1 certify that 1 have read this application and state that the above information Is correct.
1 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
.DING: TYPE"CONST. OCC. GRP.
Number 'T'S — yl
it Description L oz
pct Description 5 e u 1>; CAt? K 9! Lt T-*
REMARKS
Sq. Ft. No.
Size J d V Stories
No. Dw.
Units
ZON E:
New Lha Add ❑ Alter ❑ Repair ❑ Demolition ❑
Minimum Setback Distances:.,,,
Front Setback from Center Line
Rear Setback from Rear Prop. Line
'
c
Side Setback from Property Line
FINAL DATE
- INSPECTOR
C. +., . , , s ,. I .
Issued by:
Date Permit
Validated by:
Estimated Valuation
Validation:
c r
PERMIT
AMOUNT
Plan Chit. Dep.
—>
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S. M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZON E:
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
C. +., . , , s ,. I .
Issued by:
Date Permit
Validated by:
Validation:
c r
WHiTE : FINANCE YELLOW o APPLICANT PINK ■ BUILDING DIVISION
Notice:
Document Carinot Be Duplicated
Date 9/19/00
No. 21000
Owner NameAugustin & Eva Paz
No. 52-415
City La Quinta
Tract # BLK103
Type of Development
Comments
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
APN # 773-275-017
Jurisdiction La Quinta
street Avenida Bermudas
zip 92253
Lot # 7
Permit #0008-339
Log #
Study Area
Square Footage 1421
Single Family Residence 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 / Valley Independent Bank / Augustin Paz Telephone:�
Name on the check
K
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Annette Barlow
j,
Signature
�y
V
Payment Received $2,913.05
Check No. 227372
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 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.
Embossed Orfgidaf-=
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 LA QUINTA PARTNERS
SITE ADDRESS 52-415. Avenida Bermudas
APN 773 _ 275 _ 017 •BINNO.: ,A CASENO.: 2000-295
LEGAL: LOT 7 BLOCK 103 UNIT I S.-C.@V.L.Q. — --
CHECKED BY: Stan Sawa DATE: �' o
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
v
Verify legal and APN information
11-4
Consistent with MDG on file (as.applicable
MDG filing required (5 filings since 9/3/98)
Consistency with street/surrounding area:
Colors
Materials
Architecture.
Other Requirements:
•
Dk— `12:r 52o 1 l
��✓ X55 {�
I' OO
Certifica'te'
of Occupancy
City of La Quin ta
- . 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.-
BOLDING
ollowing:
BUILDING ADDRESS:
Use Classification: SFD
Occupancy Group: R3
52-415 AVENIDA BERMUDAS
Type of Construction: VN
Owner of Building: AUGUSTIN & EVE PAZ
J
Building Official
Bldg. Permit No.: 0008-339
Land Use Zone: RC
Address: 52-995'AVENIDA MENDOZA
City: LA O.UINTA, CA 92253
By: STEVE TRAXEL
Date: 12-06-00
.POST IN A CONSPICUOUS PLACE
1