0208-019 (SFD)LICENSED CONTRACTOR DECLARATION
W 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 Cl) Professionals Code, and my License is in full force and -effect.
License # Lic. Class Exp. Date
O co
LO
W 743118 B ca 1� 1/30/2(
Z r- Rate a - Signature of Contractor �� l
6 O ��% I'�T F "4 � � � a .
CIDw i%
J U � OWNER -BUILDER DECLARATION
HLU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z_ ( ) 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).
C'')() I am exempt under Section
u7 B&P.C. for this reason
N Date Signature of Owner
ON
rn
d Q WORKER'S COMPENSATION DECLARATION
o 1 hereby affirm under penalty of perjury one of the following declarations:
LO O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
O -J Q.. performance of the work for which this permit is issued.
00 < 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
rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy Et1111' Policy No.
C)
g(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 manne(,so as to becomesubject to the
workers' compensation laws of Calilfornia,- /nd agree; hat if I should become
subject to the workers' compensati8n provisions of Section `700 of the Labor
3 Code, I shall forthwith comply with those pr Q• visions.
Date: lei- , 0 Z.,,, Applicant�� rf +. V
--Warning:!. Failure to secure Workers' Compensation coverage is unlawful and
✓F 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
44
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 Ouinta, 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 authtorize.l6presentativ rs of this City to enter upon `t
the,above-mentioned property for in pectiori
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- 11:73 1190-01T
Underground Ducts
Forms & Footings
I/T
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
p 3
Exhaust Fans
O.K.to Wrap
F.A.U.
Framinga
Compressor
Insulation
_
O
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
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
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
Gas Piping
Gas Test
SQ 3
Encapsulation
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
Utility Notice (Perm) 57
—If
= M E T R O S C A N PROPERTY PROFILE=
Riverside (CA)
****************************************************************************************
* <<< OWNERSHIP INFORMATION >>>
* *
* Parcel Number :774 065 015 S: T: R: Q:
* Ref Parcel # :000 000 000 Pos Interest:
* Owner Name :Mountain Cove Dev Inc
* CoOwner
* Site Address :*no Site Address*
* Mail Address :51370 Avenida Bermudas La Quinta Ca 92253
* Telephone :Owner: Tenant:
* *
* <<< SALES AND LOAN INFORMATION >>>
* *
* Transferred :07/05/2001 Loan Amount
* Document # :306559 Lender
* Sale Price- :$32,000 Full Loan Type
* Deed Type :Grant Deed Interest Rate
* % Owned :100 Vesting Type
* *
* *
* <<< ASSESSMENT AND TAX INFORMATION >>>
* Land :$32,300 Exempt Type
* Structure Exempt Amount
* Other Tax Rate Area :20-015
* Total :$32,300 Taxes :$382.94
* % Improved
* *
* <<< PROPERTY DESCRIPTION >>>
* *
* Map Grid
* Census :Tract: Block:
* Land Use :R07 Vacant,Residential
* Legal :LOT 4 BLK 204 MB 019/038 SANTA
* :CARMELITA VALE LA QUINTA UNIT 20
* *
* Sub/Plat :Santa Carmelita Vale La Quinta Unit 20
* Book :19 Page:38
* *
* <<< PROPERTY CHARACTERISTICS >>>
* *
* Bedrooms Stories YearBuilt: AgPreserve
* BathFull Units MiscImprv:No
* Bath3Qtr Bldg SgFt: Street :Paved ADDITIONAL
* BathHalf Gar SgFt Waterfrnt:
* Fireplce :No Gar Type Elect Svc:Developed RmAddtns :No
* Cntrl Ht :No Lot Acres:.12 Gas Svc :None RmAddSF
* Cntr1A/C :No Lot SgFt :5,227 WaterSrce:Developed AddGarType
* Pool :No Roof Type: SewerType:None OthrPkng
* *
Information compiled from various sources. Real Estate Solutions makes no representations
or warranties as to the accuracy or completeness ofinformation contained in this report.
C- i
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 per Section 9.50.090 of the Zoning Code. Its purpose is to determine:
1) that the proposed house design does not duplicate the same architectural style of any
house within 200 feet of the applicant, and/or 2) if there is a need for the applicant to file for
Master Design Guidelines. If the applicant does need to file a Master Design Guideline, please
transmitted this information to the Building and Safety Department as part of your correction
list. Please attach additional explanations as necessary.
APPLICANT Mountain Cove Devine
SITE ADDRESS 53-:105 Ave Bermudez
APN,774- 065 - 015 CASE NO.: 002-h74
LEGAL: LOT
4 BLOCK 204 UNIT
CHECK AND APPROVED BY: Martin Magana DATE:
S.C.@V.L.Q.
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
Verify legal and APN information
Consistent with MDG on file (as
applicable
MDG filing required (5 filings since
9/3/98)
Architectural variety within 200 feet of
the surrounding area:
Colors
Materials
Architectural design features
Amdoved
-
hy-
13 PI
0 Ci
Initial
Case
o #
inning Commisslon _
Y Council
.ep
_ KW,
No. 2 -G-7
x 1
Wit
t
� Conditions
Other Requirements:
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 (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that 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
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14 X 1,691 S.F. or $3,618.74 have been paid for 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/Canyon Nati Bank - Larry Shields Check No. 13120
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Monica Guillen $3,618.74 0.00
Payment Recd Over/Under
Signature �yi►
NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the DistrictCs) behalf, whichever is earner.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
�- Certificate of Occupancy
G OF 9► Y p Building & Safety. Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 53-095 AVENIDA BERMUDAS
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0208-019
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC
Owner of Building: MOUNTAIN COVE DEV. INC Address: P.O. BOX 3578
City, ST, ZIP: PALM DESERT, CA 92261
By: STEVE TRAXEL
Date: 08-25-2003
Building Official
POST IN A CONSPICUOUS PLACE