0006-361 (SFD)LICENSED CONTRACTOR DECLARATION
u) I hereby affirm under penalty of perjury that I am licensed under provisions of
I— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C-.4 Professionals Code, and my License is in full force and effect.
C:) ch License # Lic. Class Exp. Date
r- Q u7
r,- W " 291728r--
13 k� t &,-31,x(
O
6 Z r --Date /-4 P Signature of Contractor -
� O O
J U �p 1 OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ CD License Law for the following reason: f
Z_ ( ) I, as owner of the property, or my employees with wages as their sole.
compensation, will do the work, and the structure isnot 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).
co() I am exempt under Section B&P.C. for this reason
N Date Signature of Owner
ON
CL Q WORKER'S COMPENSATION DECLARATION
NT 11 1 hereby affirm under penalty of perjury one of the following declarations:
U*) FQ- 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 _, Q performance of the work'for which this permit is issued.
m Q () ( ) 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 F- permit is issued. My workers' compensation insurance carrier & policy no. are:
It Z Carrier Policy No.
ob D ST.r�TC 1�1i D 229-06 UNIT 0004403
�O
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 agree that if I should become
3 subject to the workers' compensation provisions of Section 3700 of the Labor
de, I shall forthwith,comply with those provisions.
lot
ate:. �, .-s ., -e-` 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
14
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
tl}e'above-mentioned property f_orr',inspection purposes.
Signature (Owner/Agent)'"�-ai *,., ' Date
�;0..0BUILDING PERMIT PERMIT#
DATE VALUATION LOT -361 TRACT
JOB SITEt�
APN
ADDRESS 685 AWJq�a�. DEMM)A U
774-135-021 4• 135-021
OWN()E+yRpg�g�n(
CONTRACTOR / DESIGNER /ENGINEER
y��yyJp� sf�p}yt
�7 d.+`iS4E..iV.LR� kVlt'fi,51R'/h3 .w1-tl 3V L
NW.1L yV��d
IL1?ylRUy7a
PAD, BOX 3578
56900 DAMSON fT
PALM 1r5UZER1' CA 92261
TREaZtAAL CA. 92274
(760)'x99.1200 CBLO 1914
USE OF PERMIT _
MN011. FAA.OLY DWIMIM0
VD -PERMIT D0XS NOT INC;Ll DI& BLOCK WAL1«S OR P0011,
'i
,.{ Lj'it
TRACT C914STRUCTIOII '001,00 OF
,
PORC;1911 ATIO 38.00 SF
["�+
1+c.4 GEIO.ARPOR,T (gF 9,074.84
i VT.'WOOD MC).T 200.09 LF
1
XWMATW> COST OF coxmtranofq
1050—SO
FI J`J FEE stmo&&Ry
CONS` RUCTION FF—T? --101-000.418.000 $02150
PLAN CHECK FE 101-000-439-318 $513.15
MECO KI41C All FEE 101.000.421.000 ` $60.00
_
ELECTRIC;M, PER 101-000-420.000 $c131.:30
P'LUh18ft4G FF.L 101.000.419.000 $11035
STRONG MOTION PEE • R.F.,S317 101-000-'241-000 $9.31
012,AL31NCi FEE 101.000.423.000 $20,00
DFVFAX)J`1:f3'1MPACT 1 $1,907.00
PREC199 PIAN 101-000,441.345 $140100
FEE DEPOSIT 101-000-439.318 42"Wo0
BUD -'W1;ALCONWMIT01014AND PLAITC-11i:CK
$3,464,31
LESS ]~RR -PAID P03S
4250.00
50.00
r, � f �x
OTAL PERA fT r.K,$ ME NOW
S.3,214.
RECEIPT
DATE
BY f
DATE INA ED
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
-(p-
S
F,A.U.
Framing
3-2. - Cp 9
5,7.
Compressor
Insulation
8 3. pfd
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 �/- S7
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
yy -do
S7
Electric Bond
Footings_
Main Drain
Bond Beam
o • Z!i • ch,
S
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
,Q
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
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) Q -
COMMENTS:
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 6/30/00 APN # 774-135-021
No. 20655 Jurisdiction La Quinta
Owner NameStarlight Management Permit #
No. 53-685 street Avenida Bermudas Log #
City La Quinta zip 92253 Study Area
Tract # Lot # Square Footage 1501
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 garageslgarports, covered`
patios/walkways, residential additions under 500 square feet, detached accessory structures or replacei�mobilehomes. It
has been determined the above-named owner is exempt from paying school fees at this time due to the foli-dwing reason:
y'
EXEMPTION NOT APPLICABLE }=
- . I
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
2.05 X 1,501 or $ 3,077.05 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 ccValley Independent Bank/ Larry Shields
Name on the check
By Dr. Doris Wilson
Superintendent
Telephone
Fee collected /exempted by Olivia Aguirre Payment Received $3,077.05
Check No. 216535
Signature
r
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 peril 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 Original- Building DeptJAppIicant Copy - Applicant/Receipt Copy - Accounting
s V
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 W. R. ROGERS
SITE ADDRESS 53-685 Avenida Bermudas
APN 774 - 135 - 021 BINNO.: L�� CASE NO.: 2000-242
LEGAL: LOT BLOCK yp UNIT a?.3 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
1%
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
Materials
Architecture
Other Requirements:
AF
BY
E
CASE
PROVI
HIBIT
NO.
T BY COMMUNITY DEVELOPMENT DEPT
DATE
Coin-imonwealdi !And Title Cor -naw,
728-55 Fred Waring Dr., Suite A5, P -.0m Desert, CA 922b0
Estimated Buyer's Settlement Statement
MUM No..
4
Buyer: Starlight Management, Inc., a Nevaui. Corporation or Nominee
Prooerty: Vacant - APN: '773-304-U'05/*;"I''3-2*0'6-0.'L'i, Lia 9;,253
Escrow Off-irar: Charnn Fikins
Date April 27, 2000 D : EBIT CREDIT
TOTAL CONS 'ON
Deposits 6-y Buyer
PROBATIONS/ADJUSTMENTS
TaxE; APN: 773--W-00.5
Tax(-- k.7n: 77? -.151-011.
ESCRO6 rE", T`TL L CHARGES
Settlement Charge
RECORDING FEES, TRANSFER TAXES
Record Grant Deed
ADDITIONAL CHARGES
Refundable Buffer
RECEIPT DUE FROM BUYER
BUYERS) SIGNAWRE:
Sta0light Management, Inc.
a Nevada Corporation
BY
Name/ T'l t I
BY
Name/ Ti t I e
04/27/00 @13:38:52/SE-`
142.93 05/01/00 07/01/00
6o days @39405 per them
1.51 .15 05/01/00 07/01/00
days @.84083 per them
$32,000.00
500.00
47.64
50.45
248.00
29.00
50.00
31.925.
..0
9
$32,425.09X $32,425.09
Il
Building S -3 «V 8 CJ.
Address p
A
Ownes 1�.{' a ogpT
4
udl'II,iGv
P.O. BOX 1504
nq [�78-495 CALLE TAMPICO
AGf LA QUINTA, CALIFORNIA 92253
Mailing �(� _
Address l �, 5s7g
City\�Zip Tel. 'y "�' « 1140 1 (�
IP•r'711m ��a 7 � Z � � I -� --
City Zip Tel.
T-R,� 9 t-
State Lic. City
& Classif. f, Z Lic. #
Arch., Engr.,
Designer Lekr_-� coQ
pt
Address Tel.
4
City Zip State
LLic.#
--.-LICENSED CONTRACTOR'S DECLARATION
I hereby affirmahat I am licensed under provisions of Chapter g (commencing with Section
7000) of Division 3 dffect of the Business and Professio s.@ode; and my license is in full force and
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Set. 7031. S. Business and Professions Code: Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile 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. IL 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.)
1 11, as owner of the property, am exclusively contracting with licensed contractors to corn
sI,uct 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 wiffra contractor(s) licensed pursuant to the Contractor's License Law.)
1T I am exempt un er ec B. & P.C. for this reason
D to � 1 Owner ,
WORKERS' COMPENSATION DECLARATION
Ihereby 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
r7 Copy is filed with the city. O 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
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
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 applicant Date
Mailing Address
City, State, Zip
(?Aet- �,
APPLICA
.DING: TYPE'CON�}ST. 2 OCC. GRP.
�'}/
Number 1 4 _. (!5'— pZ
Description
Description
s
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 bv:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
I
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New Add ❑
Alter ❑
Repair ❑ Demolition ❑
&A��
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
r/ ' d
r + C% ,
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
r
S.M.I.
Grading
Driveway Enc.
Infrastructure
4
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 bv:
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 ADDRESS:
Use Classification: , SFD
Occupancy Group: R 3
53-685.AVENIDA BERMUDAS
Bldg. Permit No.:. 0006-361
Type of Construction: VN Land Use Zone: RC
Owner of Building: STARLIGHTLIGHT MANAGEMENT
a't_t
Building Official
Address: P.O. BOX 3578
City: PALM DESERT, CA 92261
By: STEVE TRAXEL
Date: 11-29-00
POST IN A CONSPICUOUS PLACE'