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0006-211 (SFD)LICENSED CONTRACTOR DECLARATION Pihereby 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�it full force and effect. License # Lic.`,�ass Exp. Date 425, s 1 .F3 Vate'A[ � 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. ( ) 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 IiTATE FUND Policy No. _ 12011930.10 (This section need not be comrmpleted if the permit valuation is for $100.00 or less). () I certify that in the perfoance of the work for which this permit is issued, I shall not employ any person iq any manner so as to become subject to the workers' compensation laws of 6alifornia, land agree that if I should become sybject to the workers' compensati provisions. of�S tion 3700 of the Labor Geode, I sh I forth ith comply with thus p�ovisionsr^""} ate: Applicant �h Warning: Failure to secure Workers' Compe * ation coverage is unlawful and shall subjeci an employer to criminal penalties all 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, indemnity & 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 haveread this application and state that the above information is correct. I agree to comply wito all City, and State laws relating to the building construction, and hereby authbrizb+repreielhtatives'of this City to enter upon i/e rpo bove-mentioned propert, for i" spection puses. 3 ature (Owner/Agent) Date " BUILDING PERMIT PERMIT# ,,. DATE VALUATION LOT �� TRACT 06/20i2oc $92,987.40 10 BUICI98 7114 .JOB SITE �.q yA�apn�i�r. . ADDRESS -ah. -c kA.�%ri!.A�F.�°iAw+uAp tz ' k APN .'y 77 --1ti43-022. 0 'OWNER CONTRACTOR/DESIGNER/EN (NEER DAVM ROSS WLtFR iwanc mA s coma 'po now 17 ) 9 P RMA0IV-' 1719 S Td l :%SOA1'T S OCEMSIIFE CA :x.2034 8 OC ANSl`D E,' CA 92054 (760)967-0069 MIA 1 S USE OF PERMIT , Sty' -PF,RM1T DOES NOT 114CLU'DE BLOCK 1,'+lALI S OR POOL TPe.ACT CONSTRUCTION 1.492.09 SF POR.CWPA T IO 90.00 SF (MR—AC3E,/CARPOU (.311) 4,074.811 5 PT. WOOD FENCE 300.00 Lit _ rt MTA!= COST €37f' C01.119f I1'CrA'3:ON n2087.40 P,Fxda ` WE SUMMARY C6NS'1KUCTIUN FEB 101-000-418.000 $608.00 PLAN CHECK FEE 109.-000-439-315 5308.33 MECHANICAL PEE 101.000.421-000 $51.50 FlIECTRICA1. FEE 101.000-420-000 $130.99 PLlFIvIBIE+ O FEE 101-000-419.000 $110.75 STRONG! MOTION Imo, RESID 101.000-241-000 $4.30 GRADING FEE 101.000.421.000 $.20.00 1]L:t EWPER IWACT IEE $1,907,00 PRECISE PLAN 101-000.441-345 $100,Ct� ff -TOTAI. CONSTR17CI1 H AM PLAN A w3,448.06 LESS PRB—PAID sS $00.'080 •�' A9 y' �. L OTAL P;'1 AK"I FEVE$ IgRE 1qO YY � M,448,06 RECEIPT DATE BY DATE FINALED 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 •a./ - CIO Exhaust Fans OX to Wrap . vp F.A.U. Framing - . p097 Compressor Insulation _ / oa-57Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final r - �� BLOCKWALL APPROVALS Final POOLS - SPAS 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 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 Al da 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: �( r.�:Y �• }o.!',;: ,:y--- iv` : � «,;..c i�"'',wR_.?'"i`� '�?�'''lTtlr�''K '�✓✓""'�f�\%n'rv` s-..:,�gr„yc.- 7Gl��t('tl.-'s T�tr•»T T'_"`'i£�'�i i'.i '. `;,;'irr; 4 Rawa I P.O. BOX 1504 .7B-495 CALLE TAMPICO APPLI 10 ONLY Address Building rC p �4 �� Z LA OUINTA, CALIFORNIA 92253 f 1 l City Zip f Tel. State Lic. t City & Classif. - 57�� j Lic. It Arch., Engr., Designer Address Tel. City (Zip ( State I Lic. N LICENSED CONTRACTOR'S DECLARATION I hereby atftrm thiol am -licensed unde,provision%of Chapter 9 (commencing with Section 7000) of D f ion ft1%usiness and,11rdfessions Qode, and my license i;1 to full force and effect. CC _ . � 5 ! t t .11 % 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 Division3 of (he 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 live hundred dollars ($500). .1: 1, as ower 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 1 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 (hereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) I') 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. 3900, Labor Code.) Policy No. Company F1 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.) j 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 , 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 BUILDING: TYPE'CONST. OCC. GRP. A P Number %-7y .. 19 3" U 2 Z Legal Description B�ti: ' Project Description Size t (L jj 1 �. Stories New Add ❑ Alter ❑ Qc�1J7�: Ir.nn �.- -�.vJ No. Dw. Units Repair ❑ Demolition ❑ Itimated^Valuation I Mailing Address AMOUNT City t, Qk0,lies, Qd Zip Contractor Address City Zip f Tel. State Lic. t City & Classif. - 57�� j Lic. It Arch., Engr., Designer Address Tel. City (Zip ( State I Lic. N LICENSED CONTRACTOR'S DECLARATION I hereby atftrm thiol am -licensed unde,provision%of Chapter 9 (commencing with Section 7000) of D f ion ft1%usiness and,11rdfessions Qode, and my license i;1 to full force and effect. CC _ . � 5 ! t t .11 % 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 Division3 of (he 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 live hundred dollars ($500). .1: 1, as ower 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 1 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 (hereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) I') 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. 3900, Labor Code.) Policy No. Company F1 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.) j 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 , 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 BUILDING: TYPE'CONST. OCC. GRP. A P Number %-7y .. 19 3" U 2 Z Legal Description B�ti: ' Project Description Size t (L jj 1 �. Stories New Add ❑ Alter ❑ Qc�1J7�: Ir.nn �.- -�.vJ No. Dw. Units Repair ❑ Demolition ❑ Itimated^Valuation I PERMIT AMOUNT Plan Chk. Dep.` Qd 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 DATE INSPECTOR Issued by: Date Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK =BUILDING DIVISION Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 Date 6/23/00 No. 20613 CERTIFICATE OF COMPLIANCE APN # 774-143-022 Jurisdiction La Quinta Owner NameDavid Ross Miller No. 53-955 Street Avenida Juarez City La Quinta zip 92253 Tract # BLK198U19 . Lot # 10 Permit # 0006-211 Log # Study Area Square Footage 1492 Type of Development Single Family Residence No. of Units 1 Comments 0 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 1,492 or $ 3,058.60 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/Capital Bank of North County/David Miller 'lcelephone 760-967-0069 Name on the check By Dr. Doris Wilson s Superintendent - Fee collected /exempted by Mary Ann L. Borja Payment Received0'W Check No. 18237 Signature NOTICE: Pursuant of Assembly Bill 3W (CHAP 549, STATS. 1996) this will serve to notify ycu that the 90 -day approval period in which you may protest the fees or other payment identified I above will begin to run from the date on which the building or installation permit for this projecl is sssued or on which they are paid to the District(s) or to another public entity authorized to collect them on the Disbict('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 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 PACIFIC TRADES SITE ADDRESS 53-955 Avenida Juarez APN 774 _ 143• - 022 B O CASE NO.: 2000-228 LEGAL: LOT 10 BLOCK 198 UNIT CHECKED BY: Stan Sawa 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 Compatibility Review V 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: Jbo t5ars ye,, co a Certificate of Occupancy City.of La Quintal 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 ollowing.BUILDING ADDRESS: 53-955 AVENIDA JUAREZ Use Classification: SFD Bldg. Permit No.: 0006-211 Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC Owner of Building: DAVID ROSS MILLER b� Building Official Address: 1719 S. TREMONT City: S. OCEANSIDE, CA 92054 By: STEVE TRAXEL Date: 11-09-00 POST IN A CONSPICUOUS PLACE