0105-298 (SFD)CO
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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 9# y Lic. Class �� Exp. Date
n mxo r
Date , Signature of Contractor
-----OWNER 9U CDER DECLARA ION°
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I hereby affirm under penalty of perjurythat I am exempt from the,Contra`ctor'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 exclusl�ely 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. aye:
Carrier Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with/those provisions..
Date: -7-, Applicant—t `'..rsr• 't tii(;r�q"e�c' w= grit;..
.-•-Warning:^Failure -to'9666"re Workers' Compensation c6ver64, is ufiladul and
shall subject an employer to criminal penalties and civil fines up t_o.,$,100,000,.iri
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 propeity for, inspection purpose$. 7F.N
Signature (Owner/Agent) (/ r Date
_
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BUILDING PERMIT PERMIT# ..•
DATE f VALUATION LOT IQ'1t'� TRACT-
S1 10.1115120 DfX, 240
JOB SITE i y APN
ADDRESS
OWNER CONTRACTOR/DESIGNER/EN (NEER
LKMNIL
c 1� 3 0 AVI?1MA1?i IRWO11AV. OWE 2, .1
1A Q'UN°3'A CA 92253
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USE OF PERMIT
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urmM. w1hT.C6. m, Mo. -
LA QVIVITA CA 92213,3
rv760)564.1866 CSTIN 359
snix'17C211's WkiY mcwtaty-111,0CY, WALLS, POOL Oh' EIRt(:iNA'Y'.APPREXACH.
MASi`F.k' MC:143CQDV.q,. . I
TRACT ^'ONS'f38.1.XT16N 11$46,00 3F
O,li.RAO4M/WWORT 164.00 SP
W.€IND C09'r or c(MYrRucrion :1.10,11630
0O1d4:7'11;UCTJ ON W, 101.000.418-000 $679.00
P1I&N CHECK 11 rll✓ 101-000-439-318 $566.19
M-2 �' " DEP0011 101-000-439-313 -2250.00
'9ZC' IA.TBIT„AIJL,1�Z 101-t<a6(A- 21-Ct10
RTT,Wr 1..1,MCA., PFD,' 101.000-420.00 $1.23,10
/P1.4.tM-HIHO:�?'3';}? 101-000-419-000 $136.00,
3'X'RONG Af OTIOW FER • 11H.11) ]0-000-2414-000 �l1,fi1
OIVYU'.GOPM IMPACT V114%
k' t C'iStp )E`J.41? 10 v -0.1-345 $1Uii.U41 ,w,
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13lXJr 11"C.7;i..i 0 COWC, C71 ' A0.4i1�fJ
4250.00
DUE �
: - ITy OF l!, OUINTA
.FINANCE DEPT
RECEIPT DATET�°n BY DAT FhALECY INSPECTOR
.r
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
�j 7
Underground Ducts
Ducts
_ Q�
S
Slab Grade
Retum Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
_��- p (
��
F.A.U.
i
Framing
_p(
Compressor
Insulation
/(b► '3 �D
��%
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final �— �. v �
�[�Z�
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
1
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
?j' l
S�
Heater Final
Water Piping
p
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_ _
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_57
Encapsulation
Gas Piping
Gas Test
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)i
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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 7/10/01
No. 22235
Owner NameLendel Ventures, Inc.
No, 53-725 Street Avenida Bermudas
City La Quinta
Tract # BLK 240 Lot # 11
APN # 774-135-022
Jurisdiction La Quinta
Permit # 0105-298
Log #
Zip 92253 Study Area
Square Footage 1846
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 1,846 or $ 3,784.30 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may: now beissued
Fees Paid By CC / Valley Independent Bank - Lendel Ventures Telephone -'
Name on the check -
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Annette Barlow
Signature VWQ& (N�
Payment Received $3,784.30
Check No. 247577
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 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 Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
o1 0'5 -25q,6 T4tyl
Building
Address
Owner _
Mailing
Address q .
City Zip
.4 6);.)1 FJrri- -�
Contractor
L!:�&.Jf r (
Address
tom,
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State Lic.
& Classif.
Arch., Engr.,
Designer
4 4Q"
P.O. BOX 1504
78-495 CALLE TAMPICO
M)LN'TA, CALIFORNIA 92253
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APPLICA ONLY j fin^
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BUILDING: TYPE'CONST. OCC. GRP,
A.P. Number —7-7+ - `3<-' IJ ` Z
+l C, Legal Description l� �! F
Project Description.
el_
ity
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Address Tel
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I herebAi
firm that I am licensed .der provisions of Chapter 9 (commencing with Section
7000) ofsion�ot the Busines nd _,r I, ons Code, and y license is in full,force and
effect. L�� r% t se • r C, and
3LGNATURE f b+` DATE
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 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 13 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).
lJ 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.)
t 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
does not 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.)
i7 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
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
Of 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 sof this city to enter the above-
mentioned property for inspection purposes.
Signature of a0plicant Date
Mailing Address
City, State, Zip
Sq. Ft. le No. No. Dw.
Size Stories Units
New f9'" Add ❑ Alter ❑ Repair ❑ Demolition ❑
e Int -A -K E tit ftST� 2.
3tfmateo valuation
PERMIT AMOUNT
Plan Chk. Dep. S 6
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading ini
Driveway Enc.
Infrastructure
CITY Of TA
FINA GE DER
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 DA'
INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
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 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 Lendel Ventures
SITE
ADDRESS
53-725
Avenida
Bermudas
D(
APN
774- 135-
022
CASE NO.:
2001-473
LEGAL: LOT 11
CHECK AND APPROVED BY:
BLOCK 240 ,UNIT S.C.@V.L.Q.
Ik
Michele Rambo e' DATE: 511:z4Q1
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
D(
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
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vEo BY MM�N�Tt D
pPPRO a►A'tE
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gY
A
CASE N0.
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Other Requirements:
I
Certificate of Occupancy
City of La Quinta
building and Safety Department
This Certificate issued pursuant. to the requirements of Section 709 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 followings
BUILDING ADDRESS: 53-725 AVENIDA BERMUDAS
Use Classification: SFD Bldg. Permit No.: 0105-298
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC
Owner of Building: LENDEL VENTURES, INC.
—r&4 -x
Building Official
Address: 51-370 AVENIDA BERMUDAS #2
City: LA QUINTA, CA 92253
By: RICHARD KIRKLAND
Date: 04-18-02
POST IN A CONSPICUOUS PLACE