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0008-420 (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 C14 U) W Professionals Code, and my License is in full force and effect. O 2D M License # • Lic. Class Exp. Date r--C7LO ^` LLJ 425381 r- Z -/ Da ' te Signature of Contractor � P: C:) OWNER -BUILDER DECLARATION W W r— I hereby affirm under penalty of perjury that l am exempt from the Contractor's ~ W License Law for the following reason: Z_ ( ) 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, Business & Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ( ) Tam exempt under Section B&P.C. for this reason LO N Date Signature of Owner ON a Q WORKER'S COMPENSATION DECLARATION o 2Z I hereby affirm under penalty of perjury one of. -the following declarations: p (.) 1 have and will.mainfain a certificate of consent to self -insure for workers' X LLI compensation, as provided for'by Section 3700 of the Labor Code, for the mJ Q performance of the work for which this permit.is issued. Q C) I have and will maintain workers' compensation insurance, as required by O U Q Section 3700 of the Labor Code, for the performance of the work for which this H permit is issued. My workers' compensation insurance carrier & policy no. are: qt Z Carter Policy'No. aoo O STATS FUND l.�i�i9Q-0i1 J (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 ac iZeJhat if I*'should become subject to the workers' compensation provisions of Section 3700 of the Labor 3 Code, I shall forthwith comply with those�provision_s. Date: 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) Date BUILDING PERMIT PERMIT# DATE VALUATION LOT OW8420 TRACT ; JOB SITE APN ADDRESS 524"5 AVICKMA ]ARTA UDAS OWNER CONTRACTOR/DESIGNER/ENGINEER P.r<1C1��t:''i'.�.A�T;� CCJ�iS'S??��'C'.%4�� •' l�a"�iE'fC �'dZA.U�� E°C;';ri:3'1'CoZ.3'CxiC�?� 1719 S 1PUZ2ON " 1'71.9 a MMOW 3 OCHANP31 R CA 92054 S OC1,'aANomp, CA 92.0S4 MITJ� 1955 USE OF PERMIT r HINGLE 1♦AIMly DW. T.,Yi O SkIV-PP.,PtMIT DOES NOT-dd+df;'1..1.9DE BWC;K 'WALL OX APPROACH .0R1V fFWAY TRACT t:,40Na33TgUCTIOW 1,397.008F PORC111PR&'1IO 13.00 ;;P t��:.�4.OdC�L131�U£ T (i,) ' S..E7 RA1TKdC/. i'•:i✓Dl' ��+019. OF M.oW:i.iS1.R.'9J�.r~'.L.4'�.l'i.'9 3., gY9R.� i�V XaSG�' � ►' i �f: S°J11W A RV CONSTRUCTIO0 #P1s;'~. 101 -M. -D-418.000 560109 Pt.M4 CHECK YOE 101-000-4:39-3,18 $S?O.f . RP:DEPO.IIT '101.000.439.3, 18 -5230.94 A,'f1�t✓t�.��1C:,rT.R..P'�}� 'lei-�ke0-4:28-CJi?m �GQ.At7 9LEC' RICAp.; RE '101.000-420400 %124.04 S'1.YJM13510FEW 101-000-4'19-000 $114111.75 I 'RONO MOTION FU - MID ' 101-000-241-000 $1 1.21 t3RADINO YF% 101-000-423-000 00-4..23-0100 0.00 DEVELOPER IMPACT FEE �1r943'9.0;J PRECISE PLAN - '101--000-441-345 �YJt3.40 SUBC:O.idg IV.`tC"ACYN AZv 1•LW CH=- K $3,618.0 SS PAW MES 4250.00 NOWi RECEIPT DATE / By �' r DA F NAL .INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings Slab Grade Q Underground Ducts Ducts Return Air Steel Combustion Air Roof Deck - (9. O ( Exhaust Fans O.K. to Wrap — ZZ—p( F.A.U. Framing Compressor Insulation — m ( S Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath 5 Final Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I 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 3 p Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G. F.I. Smoke Detectors Temp. Use of Power _ Final Util'dy Notice (Perm) 8 -QLD Building Address Owner PJB: Mailing City Address S� gum T4hf _RLAIKS P.O. BOX 1504 APPLICATION ONLY /n� L 10-495 CALLS TAMPICO QUINTA, CALIFORNIA 92253 s.S V%', k k. %P.. DING: TYPE'CONST.S F OCC. GRP. Number �7 --� 3_ _ - ' � y I Description U-1 ;ct Description S State Lic. City & Classif. 9,C_17 �" 1 Lic. # !q lc� Sq. iz Ft. "'� /� SNo.tories No. s Size Stories Units Designer Address Tel. City IZip I State I Lic. # LICENSED CONTRACTOR'S_ DECLARATION I hereby afJl�m th I a,(i licensed under provisions of Cha ter 9 (commencing with Section 7000) o Drvisi� o th aiLsiness and Professl5fis Code, my license is in full force and effect. �.+.I I A- _ s _ ��/ OWNER -BUILDER DECLARATION I hereby affirm that I m 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 five hundred dollars ($500). I-: 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 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 doesnot 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.) 11 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 (7 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 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 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. 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 a(iplicanl Date Mailing Address City, State, Zip New ❑ Add O Alter O Repair ❑ Demolition ❑ e!> 1-k c!, sl k 4 - It t\(_1 S, �, �c Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. �, �_ �j�' U Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure 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 t FINAL DATE :INSPECTOR Issued by: Date Permit ., s VN Validated by: Validation: _ _ _ VWI `'' WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION 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 52-545 Avenida Bermudas APN 773 _ 305 - 014 BIN NO.: LEGAL: LOT 1 BLOCK 140 CHECKED BY: Greg Trousdell CASE NO.: 2000-301 UNIT 1/ S.C.@V.L.Q. DATE: — 7 — av Inform the assigned Building plan checker upon your assignment to this case. The CDD Executive Secretary maintains a to 'book to track applications and assign case numbers. I eA J2,j Z e D qv' o ri/Mc/Z_ REQUIRED I EM Y N COMMENT/ CTION Compatibility Review Case logged and number assigned Verify legal and APN information zz Consistent with MDG on file (as.applicable9_11c MDG filing required (5 filings since 9/3/98) C LLJ Consistency wit re surrounding area: Colors Materials Architecture w Q z o Other Requirements: � � �� > C° C C1 Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 Date 12/4/00 No. 21279 Owner NameDavid Ross Miller No, 52-545 City La Quinta Tract # Type of Development Comments CERTIFICATE OF COMPLIANCE APN # Jurisdiction La Quinta Street Avenida Bermudas zip 92253 Lot # Single Family Residence 773-305-014 Permit # Log # Study Area Square Footage 1897 ivied cashier's check for $3,841.70 and $47.15 cash. 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 1,897 or $ 3,888.85 the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project mayynow be issued J ..s Fees Paid By CC / Capital Bank of North County / D. Miller Teliephone -"" Name on the check i - By Dr. Doris Wilson Superintendent Fee collec4/exeptedby Annette Barlow Signature Payment Received $3,888.85 Check No. 079260* 40'nCE: 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 peril for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to tilled them on the Distrid('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 Dept./Applicant Copy - Applicant/Receipt Copy - Accounting 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 ADDRESS: 52-545 AVENIDA BERMUDAS Use Classification: SFD Bldg. Permit No.: 0008-420 Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC Owner of Building: PACIFIC TRADES CONSTRUCTION Building O.fficial Address: 1719 S. TREMONT City: S. OCEANSIDE, CA 92054 By: STEVE TRAXEL Date: 03-15-01 POST IN A CONSPICUOUS PLACE