0010-237 (BLCK)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
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).
( ) I, as owner of the. property, am exclusively 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.
shave and will maintain workers' compensation insurance, as required by
S&HO 3700 of the Labor Code, for the performance of the work for which this
kp ermit.is issued. My workers', compensation insurance carrier & policy no. are:
Carrier Policy No.
VATE FUND 2.29-®4-00Sff3ai
(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 Californla,�an'd agree � that.if I should become
subject to the workers' compensation �provis'ioQs� rSeetion 3700 of the Labor
Code, I shall forthwith comply with thos@� vi.si w!
Date: th.-f Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to crimin al. 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 purs0'dt�to
any permit issued as a result of this applicaton agrees to, & shall;�"inde'mnify
& 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 for inspection,purposes. ,
Signature (Owner/Agent) Datee
BUILDING PERMIT PERMIT#
DATE VALUATION TRACT.
JOB SITE APN
ADDRESS
OWNER CONTRACTOR / DESIGNER / EN (NEER
$ 78.060 C-ALTIZEUTY00.14UPVC, 204'
LA QUINTA CA 9225'
USE OF PERMIT
4 F.P. WALL L 25,vV S,el"
XTrIXAM, D C'OS'H' 0.11' COMM&/M0111 4W.00
tv ��vk�,d, 6S�gbr B'1�LF R'lvl:+ !��°�'JF�•'1'1 �-"SlviJ' c�,'SsT,��
FER-PAIDM-70 $.0100
6xb,
MAL PKER TFEMD0,MKWW
RECEIPT DATE BY'- , r DATE FINALED INSPECTOR
11
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
F.A.U.
Framing
Compressor
Insulation
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
Set Backs
Footings
APPROVALS
Steel
Electric Bond
Main Drain
Bond Beam6e5)
Approval to Cover
Equipment Location
Underground Electric
I'- a
Underground Pibg. Test
Final
(A1�
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
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
. Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
Date 6/28/00
No. 20627
CERTIFICATE OF COMPLIANCE
APN # 773-154-020
Jurisdiction La Quinta
Owner NameLa Quinta Partners Permit #
No. 51-905 Street . Avenida Juarez Log #
City La Quinta zip 92253 Study Area
Tract # Lot # Square Footage 1421
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 1,421 or $ 2,913.05 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 CC - Valley Independent Bank - Pat Magana
Telephone 564-1866
- r
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Ellen Patino Payment Received $x;913,.05
Check No. 216505
Signature 64U
_61
gOTIC E: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90Lday 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
:ollect 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
Building c—
Address
Owner,
Mailing
Address
City
QumCv
P.O. BOX 1504 APPLICATIO
f J 78-495 CALLE TAMPICO N ONLY
Q5 ,r`^ f U q=REZ LA QUINTA, CALIFORNIA 92253
Zip Tel.
-,/ r - . 3 a Q"�
Address,
I�, �i C�
i
State Lic. City
& Classif:.J � { =^� �; ; <. Lic. N + 5�
tngr.,
Designer I_ 4J J
C' 110 C_
Address Tel. �(
City Zip State
1. -AA �YU 1,.a� 1 Z, S Lic. #
LICENSED CONTRACTOR'S,OECLARATION /
I hereby affirm that I am Iicens`ed rider provisions of Chapter 9 (cgmmencing with Section
7000) of Dsion 3jofthe.Businee and;Profesrsions Code; add,myy license is in full force and
effectivi
. - // __ ``_ Z / •A�•'7..✓CJ
OWNER -BUILDER DECLA ATION' f LC
I hereby affirm that I am exempt from the Cont if
License Law for the following
reason: (Sec. 7031.5,Business and Professions Cede: 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 .tor such permit to file a signed statement that he is licensed pursuant to
the provisions of the (Contractor's License Law, Chapter 9"
with Section 7000) of
Division 3 0! the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged e>femption. 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).
1-; 1, 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.)
I'I 1, 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.)
0 1 am exempt under Sec. B. 8 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. 3900, 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
employany 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 if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
1 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 aliplicant Date
Mailing Address
City, State, Zip
�_5
BUILDING: TYPE'CCJONST. / OCC. GRP.
iA.P. Number � t/ 3
,Legal Description
Project Description
Sq. Ft. No. l No. Dw.
Size 4Z.1 Stories Units
New p Add ❑ Alter ❑ Repair ❑
Demolition ❑
ZEAS
Estimated Valuation
PERMIT % 4WAMOUNT
Plan Chk. Dep. C__3 CA -DU
Plan Chk. Bal. v
Const. r t
Mech. ,.4
Electrical
> -
Plumbing
L • t� ,
S.M.I. Y
t r
Grading
Driveway Enc. 71
r1i' ,
Infrastructure
j 1 I t-.•
i
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 by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
12-- 2(`00 1:59PM POWER BROKERS' No <409 P, 2/4
RECCROX10
CHICAGO TITLE COMPANY COMPANT"
10026KC 207056638
w= Rz-c6RD :a aaAh Taxis n�=-ANA
=1988 0TtsRliNX821 SNOW 8XLCP..
XAZL TAX gThT TB:,, y
:99AL°s ABOVE =Z0 L FOR RZCOVWZR'6 V&E
ApDBi 773-154-Oa0
r�A „ "T DEED
The underoigned gramtox(d) dedlare(S)+ '
Documentary transfer tax is P
( Computed nM full value of Pro arty conveyed, or
( Computed on 11 value 1ea0 �,spW .and enounbz'ancea reeflainir,O at time of aa1G,
(
�-Unincorporatsd gran: ( ) Cite o , and
FORA VALUABIA CONS1DzRATI0N, receipt, o� which is hereby acknowledged,
a ;
hereby GRANT (e) to
WILLIAM TfiCMAE B FFIN, AN UNMAtt XM M6 ".
the real property in the City of LA QUINTA, County of Riverside, State of California,
described as:
Lot 6, Block 31, Unit No. 2, Tract Sant Carmelita at Vele La Quinta, as per map recorded
in Book le, Page(m) 55-56 inclusive of ,Uys, in the office of the County Recorder of said
County.
Dated
state of California
county of
on
before me,
per®onally app®, ed
personally known to me (or proved to me n
the basis of satisfactory evidence) to by
the parson(s) Whose ndme(Q) is/are eubac�abed
to the within instrument and acknowledged to
me that he/she/they executed the same i:n4
him/hex/their authori.xad;cspacity(iea), "Find
that by hiA/her/their o gnatur'e (e) on the
instrument the pereoa(a) , or the entity tpon
behalf of which the person(®) acted, 61xe�-uted
the instrument,
WXTNBSS 'my hand and official seal.
Signature
XXL TAX STATE0NTS TO:
(Thim area for official notarial Beal)
0
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 LENDEL VENTURES
SITE ADDRESS 51-905 Avenida Juarez
APN 773 _ 154 _ 020 BIN NO.: CASE NO.: 2000-244
LEGAL: LOT— - 8 BLOCK 31 UNIT S.C.@V.L.Q.
CHECKED BY: Stan Sawa 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
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
V
"v
\_1
Other Requirements:
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