0212-180 (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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
778780 B 05/:11/2(
Date Signature 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).
Y) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code)y,
() lam exempt under Section , B&P.C. for this reason
Date., -r ` 01 !. '�- 1 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. are:
Carrier FXXMpr Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
ly)l
certify that in the performance of the work for which this permit is issued,
pl hall 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, fl shall forthwith comply with those provsions. '
�i/�
Date: � i Applicant f
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, indem
& hold harmless the City of La Quinta, its officers, agents and employ
2. Any permit issued as a result of this application becomes null and vo
work is not commenced within 180 days from date of issuance of h
permit, or cessation of work for 180 days will subject permit to cancell n.
I certify that I have read this application and state that the above informati n i
correct. I agree to comply with all City, and State laws relating to the bu ding I
construction, and hereby authoriz5�Fepresentatives of this City to enter on
the above-mentioned/property fo 'inspect ion'purposes.
,Signature (Own 0Agent) 'r'•r Date r,
- - BUILIIING.4PERMITPERMIT#
y
02`12-180
DATE VALUATION LOT TRACT
213/2A W: 192
JOB SITE
ADDRESS %'I^.2.��,'�. CAIXE COI
APN
*774-1 H-
1
OWNER
CONTRACTOR / DESIGNER / EN 1NEER
RANDY BILLS
I EGTA ► IY HOMFq
54-865 r`4VM,)A G,MMMOR
4'7'-750 MAM S1'1 EFT #228
LA QU17NT.A CA 92.253
LA QU `rid CA 92.153
(760)W-1820 C;I31'JI 02N3
USE OF PERMIT
2124 S, F. SM. PIMMiT 170IM NOT INCLUDE BIA)CK W.A1,4 P001, OR
DRIVEWAY APPROACH
TRACT CONS"E'RUf".Y1014 X524.00 SF
1;ORCHMA IO, Q23.riiS wE
0A.'42AWCARPORT 50,00 SF
CONSTRUCTION ME s01-000-118.900 MUD
PLAN CHECr, 09-. 101 -OW -419-318 V104.03
FEE VE -POSIT 101.000.439.318 -S350,00
MEZ"ANICAL&E, 101-000-47,1-000 $65.30
Z1.,EC1'FiIC.AL FEE 101-000-420-000 214 11, 8
PLUNIF)INC. MIX 101-000-419-001) $1255.35
Sl'RONG MOTIONFEM - i1 t "'3i? 101-000-2.41.E $16,02
S >rd.Ai7.ING M 101 -000»421? -000 $3.5.00
DEVEI,OPEP IMPA(l .FIEF. 17,405.00
PRF11"ISE PLAN 101-000.4A I -345 '$100.00
8 M-'I'OITA,1', CO 1711R7,11014 AND 1?I�,2 �' CIMM
1=3 PRE-PAIDREW
42MOD
FEB 0
5 10030 L
OF
QU3NTA
F NANC
RECEIPT
ATE
BY
DAyE FIN* D
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
-
Underground Ducts
Forms & Footings
Ducts
Slab Grade
�, —6-15
Return Air
Steel
Combustion Air
Roof Deck_�
O.K. to Wrap
_ ®3
�-��
Exhaust Fans
F.A.U.
Framing
Compressor
Insulation
Fireplace P.L.
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wali insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
—�✓ �
Lam_ Z G f iG
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
4�
Underground Pibg, Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste LinesHeater
I
Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Newer Lateral
Pool Cover
Sewer Connection
_
_ _L� �O
Encapsulation
Gas Piping
"3as 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)
COMMENTS:
CITY OF LA QUINTA SUB -CONTRACTOR LIST
JOB ADDRESS PERMIT NUMBER OWNER BUILDER r Q
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employes are authorized to wo
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
Trade / Classification
Contractor
State Contractor's License
Workers Compensation Insurance
City Business License
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
(C-12)
�r(;
'
0
`
-
0.3EARTHWORK
CONCRETE (C-8)
j +
FRAMING (C-5)
U�`._�• / .`
a
I_J-
/,
V
''
5 ��l'''T
�.i���� �•..f
(� v ��
5 �J,3
STRUCT. STEEL (C-51)
MASONRY (C-29)
s
C"aC -� aG
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J i±l�'r
e" =.i `��.: �' l.�/..11
'�
rn3 �'13
0
0
03
0 -
old
�dj 110 ft a&
09L"' �� /-) i I ,T4t9� 4-11"111 a"
Building
Address / J
Owner '
Aid re;,_5yX
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
MUM /
City - - �ITI /7/� Tel
State Lic. City
& Classif_ Lic. #
Designer Desig
Address I Tel.
City �1 1)�/ ZIp I Lic.t#
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70001
of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE - 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 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
orimprovement 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.)
I1
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.)
1-1 1 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
fl 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
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., ll, 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 aQplicant Date
Mailing Address
City, State, Zip
WHITE = BUILDING DEPARTMENT
APPLICATION ONLY /
BUILDING: TYPE'CONS(T� ) / OCC. RP.
A.P. Number—"
umber �� -I / 1 I O2
Legal Description
Project Description
Sq. Ftsa( SNo.tories
/ No.
Siziz e // Stories Unitss
❑ Alter ❑ Repair ❑ Demolition ❑
Estimated valuation
PERMIT AMOUNT
Plan Chk. Dep. D
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.1.
Grading
Driveway Enc.
Infrastructure
e
1 2002
TOTAL
REMARKS
CITY OF LA Q
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 by:
Validation:
YELLOW = APPLICANT PINK = FINANCE
Oct. 4. 2002 817AM
RECORDING REQUESTED BY:
THE ESCROW SOURCE, INC,.
AND WHEN RECORDED MAIL TO:
AND MAIL TAX STATEMENT TO.
RANDY BILLS, a
Order No. R-21668:3-1
Escrow No. 02 -3568 -SA
Parcel No. 774.111-028
6 P v
GRANT DEED
�s
e��
Cal,"
THE UNDERSIGNED GRANTOR(S) DECLARE(5) THAT DOCUMENTARY TRANSFER TAX IS 50.80 and CITY S
X computed on full value of property conveyed, or
computed on full value less liens or encumbrances remaining at the time of sale.
unincorporated area: X LA QUINTA ' and
FOR A VALUABLE CONSIDERATION, receipt of -Which is hereby acknowledged,
ANITA-II. LU, An Unmarried Woman
hereby GRANTS to LEGACY )HOMES
the following described real property in the County. of RTVERSrWR, State of California:
PARCEL NIUIVMER 774,111.025
t,6 -r 16
LOTS 24l LN BLOCK 1921Dt? UNIT 19 SANTA.CARMLITA AT VALE I.A Q1l'IN xA A5 SHOWN BY MAP ON FR.1-
TN ROOK 19, PAGES 33 & 34 OF MAPS RMIERSID>E COUNTY.
Date October 312002
ANITA K LU
STATE OF CALIFORNIA }
COUNTY OF RIVERSIDE }
On , Before me, the undersigned;, a Notary Public In and -for said County and -State,
personally appeared A649� K. LUof safisfactM e the whose name(s) islare
personally known to me (or proved to tile on the b d acknowledged to me that he/she th }�exe b ed the sapme$in his/herltheir
subscribed to the within instrument and
authorized capacity(ies), and that by his/her/their signature(s) on the Instrument the person(s), or the entity upon behalf o
which the person(s) acted, executed the instrument..
WITNESS my hand and official seal..
Signature
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
Occupancy Group
SINGLE FAMILY DWELLING
77-255 CALLE COLIMA
R-3 Type of Construction: . VN
Owner of Building: RANDY BILLS
Building Official
Bldg. Permit No.:
Land Use Zone:
0212-180
RC
Address: 54-865 A.VENIDA OBREGON
City: LA QUINTA, CA 92253
By: KIRK KIRKLAND
Date: JULY 28, 2003
POST IN A CONSPICUOUS PLACE
ri
V7
X
,VAr&: AAAA Ser ,N 349
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City of La Quinta
Building 81 Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: A
Owner's Name:
A. P. Number:
Address:"
Legal Description: Ltr,Sa?j Z -2
City. ST. Zip: Q) GvLJ-& (�
Contractor: ��
FTelephone:
Address:
XProiect Description:
Cite. ST. Zip: L rti,�
Telephone:
-
State Lic. # : Citv Lic. #:
Arch.. Engr.. Designer:
Address:
City. ST. Zip:
Telephone: -:< r
State Lic. #:
Name of Contact Person: %�[ t�
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: #Stories: �OUs:
Telephone # of Contact Person:
stimated Value of Proiect:
APPLICANT:. DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
3
Item
Amount
Structural Calcs.
Reviewed. ready for corrections
3
Plan Check Deposit
Truss Calcs.
Called Contact Person
(f
Plan Check Balance
Energy Calcs.
Plans picked up
$
Construction
Flood plain plan
Plans resubmitted
'f/!.�
Mechanical
Grading plan
2nd Review. ready fa co
�2(o
Electrical
Plumbing
Subcontactor List
Called Contact Person/ - 96P �
Grant Deed
Plans picked up
5.111.1.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review. ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
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UNAUTHORIZED USE WARNING
REVISIONS BY
----------------------
ADJACENT LOT ±
j SUBJECT PROPERTY
L---------------------- J
,
I
�--� PROPERTY LINE 100.0'
— —......
H.P.
Y i
en
Fcn IN�
I
i- ±37'4r
COVERED i
PATIO ----- i
SEE SHEET #2 FOR
PATIO SLAB SIZE
cj
o i i
o _ '
W
Z I
I--
z
Io
a
O _j CASA SODONAZL Wo Z
LLI
_j
F.F.:l'-O" ABOVE THE CURB I oc
w
PAD: 0'-6" ABOVE CURB MEASURE rG I 0
CENTER OF LOT a@ CALLE COLIMA
Q r
----------------...._......-.--.........�
1 ADJACENT LOT ±
I SUBJECT PROPERTY
I I 12'-0" 581
-0" 30r-0"
L----_•...._..._— _.--,.,........_...•...__._.•..._........._....- —
W I
I w u 0�
3X3
CONC.-
PAD
a.... z
z cnU I
Z
Qo \ �
1 '�I
COVERED
3" HOLE IN WALL PATIO
I \� � IFl
FOR DRAINAGE ROLL -UP GARAGE DOOR
e • .. a ,• - • /
e, � ♦.d :� : .. •� a .. d .0 4'
e �- d d a ...-' SEE SHEET #2 FOR
j PATIO SLAB SIZE
O 0.• 9
i7 ` a. a .e .-O d.ed • - a •
: SIDEWALK
NEW 4' HIGH BROWN d ° 1 a'-Qn e e e ° ♦ �/! ` /
BLOCK WALL
PROPANETANK'`—" d a4 ♦. d°°
d .♦ • °a'. .'a . - vi - c - ee.. 3" HOLE IN WALL
PLANTINGS TO SCREEN 4 d 4 MO FOR DRAINAGE
PROFANE TANK --- _ __ e • d a ° 9 '• ♦ .. " . .—.—.---•—.—.—...—.—.-------.—.—. '-
♦. d G
' 4 - a dZI
•_ a '° ° 'e
WATER METER O • •.• a. d d n
•- •_ '4 v-a - 4
Ili
•
♦e ♦, I
(5) QUEEN PALM cd{ e d
15 GAL_ OR EQUAL Lu �I t ea a I
MIN. 1 112" TRUNK Ull < ,
. , . d ° .•
I / I
318" ROCK PALM SPRINGS GOLD iI
DRIVEWAY APPROACH REQUIRES A DATUM POINT @ GROUND COVERED
SEPARATE PERMIT AND INSPECTION MID -POINT OF LOT
FROM CITY OF LA QUINTA PUBLIC
WORKS DEPARTMENT
77-255 CALLE COLIMA
SITE PLAN
SCALER 8"=1'-0"
Iri
'1
C
THESE DESIGNS ARE THE PROPERTY OF
LENCH DESIGN GROUP. REPRODUCTION
IN ANY FORM WITHOUT WRITTEN CONSENT
IS EXPRESSLY PROHIBITED. UNAUTHORIZED
USE EXTENDS TO ORIGINAL AND MODIFIED
DERIVATIVE PLANS AND IS APPLICABLE TO
INTENTIONALAND UNINTENTIONAL
INFRINGEMENTS.
AVENIDA JUAREZ
13
14
15
16
11
18
19
20
21
22
23 24
12
11
10
9
8
7
6
5
4
3
2
1
P-4
LO
L
N
AVENIDA DIAZ
TABLE OF,
CONTENTS
�I
SHEET
SITEPLAN■■......■..r.........■.........................■..■S-1
FOUNDATION PLAN......................................1
FLOOR. PLAN ..■..■.■..■■.■.a.. ...........
■■s■■........... ■aaer.2
h
ELEVATIONS ..............................................
ELEVATIONS................. e e
r r r+••+ r r+ r s r. r. r e s■■■ ...■a.....
SECTIONS........................................................
ROOFPLAN .....................................................
6
STRUCTURAL & TRUSS
PLAN . ... . . .. . . ■ . ...........7
DETAILS a.■ a•■■■■■ a r■ e■ e■ a e. e s e a a s■■D 1
ELECTRICAUMECHANICAL PLAN.......... / -1
i
e
l
fJ
A.P.N.: 774-111-028
'
ADDRESS: 77-255 CALLF
COLIMA
Af f ?rz4'p'ty
I
LEGAL: LOT #'S 23 & 24, BLOCK # 1925 UNIT # 19
I
• I ,
PlanPlannino ommimmkom.,
City. Councl 1 -
ommunity Dev. Daps,
itis
Case No.
Exhibit
I With Conditions
PLANS PREPARED BY.-
LENDEL VENTURES, INC.
dba
LENCH DES iGN GROUP
A.P. LENCII II
PRESEDENT
DRAWN
A.R./ T.B.
CHECKED
S.L.
DATE
12-09-02
SCALE
1 l8'1-1 P-0ri
JOB NO.
SHEET
S-1
yFC
c
fy,,`