0105-201 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
tjChapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
r
License # Lic. Class .Exp. Date
~
Z-' r— . Date Signature of Contractor,;;" -",'-A' , '
p r'
J U coo OWNER -BUILDER DECLARATION
HLULU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
- 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 , B&P.C. for this reason
O N Date Signature of Owner
0)`
CL z WORKER'S COMPENSATION DECLARATION
C Cc I hereby' affirm under penalty of perjury one of the following declarations:
- H p () 1 have and will maintain a certificate of consent to self -insure for workers'
' X w LL 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 U ( ) I have and will maintain workers' compensation insurance, as required by
O Section 3700 of the Labor Code, for the performance of the work for which this
d rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
,It Z Carrier Policy No.
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,
F' 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 proves onsof Secte6nr3700tof the: Labor
Code,I shall forthwith comply with those provrseons�,`,y,
Dat
e;fc ;('�f",P Appllcarit ", 9�r.•r''�' awr1 , .
Warning: Failure to secure Workers' Compensation coverage_ is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
.IMPORTANT "Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is'performed under or pursuant to
any permit issued:as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, .its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit,. or cessation of work for 180, days will subject permit to cancellation.'
I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property foririspectron purposes. '.
Signature (Owrier/Agent)-4���-- �`�'% �� Date -5 r
BUILDING PERMIT PERMIT#
DATE VALUATION - LOT TRACT
1;102 2;�,�§ � EIJ I TJ2
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR /DESIGNER/ EN (NEER
—L T. RAK
HEAL `„'. x3 . a' .3 EN ERI
L45AN R MAKO 8 ,0 CIA 92440
SA.$ BERNARDWO CA 92A.08
a
USE OF PERMIT
13?17. T)Qba `!d','. r $Y'7MR:9'r*!31bCJC WA=, I Oof., Cbl% L`alEiEWAY
APPROACH. I&.la,:STa:&.HH14-2.t0WA.'TION C
rlOR ATIO
:IMMHR.M+ r W COS.d. OF 6. ria'NW9TWLUCT100
102942a,40
CaNOTRIUCTION, FUM 1,01 -060-4,118-000
01 -00"39v.3 18 4350101
$66,50
St 17,41
myxt k�1�;1'.1�'gP�g.Iy,Cr>�'T}.y�p . 101-0i(��(0-42t 10.00y�0
Wf.3iONO MOT 41.0.1 1; 10-2 41-000
4.
�REC .AN 345 swo.00
t '
pu�NTA
O�A
F Eyp4(F•
CE
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Wy y A�4a v PLAN
OLf.4Y wl.�1Z.r'LY4+.i„C,L�.�.Y .P'►l�iilJ I�.L..H'�}4' ti.:A.�:i."..,A.i.4i.
1 A'c]
iVy��S J:Lik�
�k1.930' FPX31-Pa' M M011
4250,00
p �'qv.1� p q�y''�ry .-p �. ♦7��r sk t,'�,�y�y
- I -r( Yd"JK9P .6.,k;+1R� 2?�• , .iC i.�dr 4 me Vf
yp�y q�9
aa'�41.C. 1'ID
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RECEIPT
DATE
BY (
DAT A E
INSPECTOR
INSPECTION RECOR®
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs ��
Underground Ducts
Forms & Footings
Q
Ducts
Slab Grade
_
!
Return Air
Steel
Combustion Air
Roof Deck
�.I— 1 ..p L Ste'_
Exhaust Fans
O.K. to Wrap
O
F.A.U.
Framing
Z _ ��
Compressor
Insulation 1Z /Z_
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Z
Drywall - Int. Lath
C)
Final
Final�_l'f��
..�T
POOLS - SPAS
BLOCKWAL� AEPROVALS
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
q�f
Heater Final
Water Piping
Ge'D' ✓
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
!�_�p - �� ,�
Encapsulation
Gas Piping
Gas Test
3 a z
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) 6(E4
Bui
Address
Ownerp,'a
Mailing
Address
City
Contractor
Lit
4
P.O. BOX APPLICATION ONLY
TAM G
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
_ rUv
BUILDING: TYPE'CONST. S` OCC. GRP.
A.P. Number
Zip ITeI. r
G.yA' 1_ v'' Or
City Rip . _.ITeI.. -
State Lic. City
& Classif.Ll Lic. #
Arch., Engr.,
Designer
Address Tel.
City IZip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) 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 Contractors License Law for the following
reason: (Sec. 7031.5,8usiness 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 or the Business and Professions Code, or thathe is exempt therefrom, and the basis
for thealleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than rive 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 or 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 contrac(or(s) licensed pursuant to the Contractor's License Law.)
I 7 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
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
1hereby 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 a0plicant Date
Mailing Address
City, State, Zip
WHITE = FINANCE
Description L -o' t'
Project Description
Sq. Ft. �'*
Size
New ❑ Add ❑
1,10
No. Dw.
Units
1 41,611
Alter ❑ Repair ❑ Demolition ❑
C-
>timated Valuation
PERMIT } AMOUNT
Plan Chk. Dep.
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
FINAL D,4
Issued by
Validated
Validatior
YELLOW = APPLICANT
Notice:
Document Cannot Be Duplicated
Date 8/17/01
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
No: 22387 Jurisdiction
Owner NameNeal T. Baker Enterprises
No, 51-825 Street Avenida Juarez
City La Quinta zip 92253
Tract # BL31 U2 Lot # 3
APN# 773-154-015
La Quinta
Permit # 0105-201
Log #
Study Area
Square Footage 1710
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 : 1,710 or $ 3,505.50 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
A
Fees Paid By CCB of A - Rick Webb 'rlephone°~
Name on the check
r y
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Payment Received
Check No
Signature
$3,505.50
2009865336
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) 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 t , 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
I 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
I
WHEN RECORDED MAIL 'r0:
EAL T. BAKER ENTERPRISES, INC
1875 Business Center Dr
0 San Bernardino, Calif 92408
ESCROW NUMBER: 1765–K
ORDER NUMBER:
MAIL TAX STATEMENTSTO:
NEAL+T. BAKER ENTERPRISES, INC
.1875'Business Center Dr
San Bernardino, Calif 92408
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srACE ABOVE I I II'c, LINE FOR 11EGORDER'S USE
p
DOCUMENTARY TRANSFER TAY, $��,
X ... r;nmin�tnrl nn lhn � r.n^irinrgli•q, r�r value of ptow?iI)' on
. (;nnilnrlr••I r,n Ilrn • nn•:Irinrntirnl r,i vnliln lest linuc i)I en!•u�nl•ranr�g
r••n,�i•,in�, nt li•nn t c�ln.
i r ¢u,nn�q,� of U••.:Im v,l ni Aganl rl••i.., mining I�r --Finn Ilnn�r•
I
r
�i GRANT DEER
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
JOHN�'REGINALD MURPHY
r -
1
hereby GRANT(S) to
NEALIT. BAKER ENTERPRISES, INC., A California Corporation
the real property In the City of La QUlrita
County of Riverside
i
AS PER LEGAL DESCRIPTION ATTACHED HERETO AND MADE A PART HEREOF:
I I
Lotr.
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I t,
i
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Dated _Juli► 12,-4988
a 3
STATE OF CALIFORNIA�A�/AGO ; �s-
COUNTY OF i �:l _f
On I ! f i�U� _��� 94 dp(
before me, the undersigned, a /Notary Public
�tIn/and for said State, per-
sonaliy,appeared
, State of California, described as
/JOHN REGIN AI'D MURPHY
G
-- --- — ----- -- — cwwV
OFFICIAL SEAL
?
r ' -,';personally known to me (or proved to me on the basis of satisfactory � ��' �.�BARDARA MCCULLEYr
evidence)�a �•,;�.; C9',�F'f ri!9UC-Ct;LIFORNIA
to be the person whose Warne islare subscribed to the
r)rrlcF IN
withinllnstrument and acknowledged In n,e Ih�l helspPllhPy execulerl V. SAIIUII:GOCQrJt!ry A
i
the sine. i A1r Con�p. Sept. 10, 1990 �
WIT ESS my han;d� and official se I.
71
Signature �Lr✓J��-- �lr In,...,.,., L,, ni i,r „alar„ ,;,.an
FORM NO. GD 400 (1183)
f i MAIL TAX STATEMENIS AS DIRECTED AROVE
t
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t:
LEGAL DFSCRIP'1'ION
.o
c1
�.
PARCEL
I:
Lots 4
and 5 of
Block 29 of Santa Carmelita at Vale La Quinta, Unit 2 as shown by
E,
Map on.file
in
Book 18, Pages 55 and 56 of Maps, Records of Riverside County
!
�I
PARCEL
II:
!
Lot 10
of Block
30 of Santa Carmelita at Vale La Quinta, Unit 2 as shown by map
on file
in Book
18, Pages 55 and 56 of Maps, Records of Riverside County
PARCEL
Ill:
i
Lots.,3.,,
15, 17,
19, 20 and 21 of Block 31 of Santa Carmelita at Vale La Quinta,
Unit 2
as shown
by Map on file in Book 18, Pages 55 and 56 of Maps, Records of
Riverside
County
'
PARCEL
IV:
Lots 20
and 24
of Block 32 of Santa Carmelita at Vale La Quinta, Unit 2 as shown by
Map on
file in
Book 18, Pages 55 and 56 of Maps, Records of Riverside County
PARCEL
V:
Lots 7,
8, 9 and
10 of Block 33 of Santa Carmelita at Vale La Quinta, Unit 2 as shown
by Map
on file
in Book 18, Pages 55 and 56 of Maps, Records of Riverside County
PARCEL'
VI:
Lots 3,
4, 20,
21 and 22 of Block 34 of Santa Carmelita at Vale La Quinta, Unit 2
C,
i
gas shown by Map
County,
on file in Book 18, Pages 55 and 56 of Maps, Records of Riverside
5•
;I
I?EC[= I VFD AUG 0 4 1931
I(
�
LA QUINTA PROPERTY LEGAL DESCRIPTION
PARCEL III
LOTS°3 `15, 17,19, 20 AND 21 OF BLOCK 31 OF SANTA CARMELITA AT VALE LA QUINTA,
UNIT 2 AS SHOWN BY MAP ON FILE IN BOOK 18, PAGES 55 AND 56 OF MAPS, RECORDS OF
RIVERSIDE COUNTY
LOT 3
51825 AVENIDA JUAREZ
PARCEL #773154015-9
LOT 19
51.860 AVENIDA MADERO
PARCEL #773154006-1
LOT 20
51840 AVENIDA MADERO
PARCEL #77315=4005-0
LOT 21
51820 AVENIDA MADERO
PARCEL #773154004-9
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 Neal T. Baker, Ent.
SITE ADDRESS 51-825 Avenida Juarez
APN"��-3 - �� y - 4J)9 CASE NO.: 2001-466
LEGAL:. LOT 3 BLOCK 3/ UNIT 2
CHECK AND APPROVED BY: Wally Nesbit 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
JV.Ovv7o�
Consistent with MDG on file (as
applicable
N�
MDG filing required (5 filings since
9/3/98)
✓
c{ HwsEs
Architectural variety within 200 feet of
the surrounding area:
RECVD FOR PROCESSING /0(
(DATE) Colors
ASSIGNED TO Materials
(INITIALS)
Pvl,vs /zgc,b s/� �o
Architectural design features
'2
Cot4YY iuor 001;0 v^o1�0
✓
✓
Approved Ibv:
O City Council
Community Dev. Dept a
Initials .52L
Case No. RC. 2sr01-Y46
Exhibit
ROMP
June 12, 2001
City of LaQuinta
Dept. of Building & Safety
Re: Baker House
The undersigned Engineer of Record (EOR) has reviewed the truss design criteria for the
above project for conformance with the project requirements. The EOR was not in
responsible charge of the truss design, but does approve the design criteria to which these
components were designed.
.E. 18932
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
51-825 AVENIDA JUAREZ
R-3 Type of Construction: VN
Owner of Building: NEAL T. BAKER ENTERPRISES
Building Official
Bldg. Permit No.: 0105-201
Land Use Zone: RC
Address: 1875 BUSINESS CENTER DRIVE
City: SAN BERNARDINO, CA 92408
By: RICHARD KIRKLAND
Date: 07-15-02
POST IN A CONSPICUOUS PLACE