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9903-084 (SFD)`LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Ghapter.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 8/31100 !pate L Signature of Contractonzl, /f "w" �� ` �' -✓ i 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/t 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 rf WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of p 'rjuPy 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, fo'r the performance of the work for which this permit is issued. ( \)t I have and will maintain workersY compensation, insurance, as required by Sectio3700 of'the`Lalior--Code, for tie)perforrnah a "of -Wel work for which this jpermit'q ISsNig. My workers' compensation insurance carrier & policy no. are: Crier Policy No. ST'ATH .Pf:TIM UNi T' 04104-11,33 (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 a ploy any person in any manner so as to become subject to the workers' cq�pensation laws of California, and agree that if I should become subject to t4 workers' compensatioftrovisions of Section 3700 of the Labor C,odre, I shall forthwith comply with, th se provisions. ate:'?/24,Z % C Applicant ' /ice- /fid >rf a tet. / r 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, 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 permits. 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 epr'Iesentatives of this City to enter upon the above-mentioned property for inspection purposes. Vignatu're (Owner/Agent) =! f - Date e' BUILDING PERMIT PERMIT# �SIi3�3-t1.'3� DATE �� VALUATION S9111.59JO LOT '.; a TRACT3 /2 T3262 U24 ODR SS 260 "EN10 A ,titl�t3+ T APN 774 -233-fitk OWNER CONTRACTOR/ DESIGNER ENGINEER DFE0.N3 SEARCH & 0Lil.:0Wt1,:3-T 'WllLyLN4iySFILL ROt .M' P.O, BOX 399-1200 56-900 :FANCKSON PALM D13S1s'ItT CA. C-42261 "i! RIMAL CA 922174 (760)sq. .200 CR1,#F 5449 USE OF PERMIT SfNOL IS 4 A3WIN >rJfuldRLIANa Sri—) - PURWTDOSS NOT INCL(A)VI BLOCK WALL OR POOL. I, f7wor-o mmLqu 130-M LF 0ARACRiCARPOW _416.00 SIS TP,AC [' C;:ONST..RIX'TION 1,470.00 Nf- E, 'TJMA'.3'E CINST t3.1+ C®iY���'2: UCTI'cOi.l1;. y�7��7yA� p4��y ��' ummRV i 1.1:• J)HP 'SI7' 4250ki) F11.ANCII C'M.,:4'. `1C►a. )(3 -?S n-3F!i $106.7! 'r lot #lOD-�f.l3�Ot3fl $603—sn CONSTRi1O`S'I�,TJ%`1�4`s AMCH1NNAL t-lsG IG1-0til l-iifl0 $47.Uti r3L'EC'1 tti,'AL Fa 103-S30 - 420dW) Pi�t7M:cA4+:tFz tl3t-onn„414.c �t2.11,75 aDMOh.f'" MC_ ION FHE - M3Sf11 101-000-241-M GRAMM M11 101-004-423-000 fiNtl.t7�3 f'*-RAS'I'RUCI'URE FEE 225-000-0 3412 S2442153 PlUi ,`ISSP ATT 01-000-441-345 S1nif.fltt :R4 B -TOTAL C4 MI1—MCF-ION AND PLAIN CHEC?+;. P,:ifi193 USS .i'RYW11AID FUS -$250.00 TOTAL P,hMI%l,!':9` FEES IYU C NW �;5,37:i.±�►:� RECEI T DATE ., /j BYW DATE FINALED INSPECTOR ILI INSPECTION RECORD 1 OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs IUnderground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck (b Y Exhaust Fans O.K. to Wrap F.A.U. Framing _ p - Compressor Insulation - 14 3 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 BLOCKWALL AP ROVALS 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 4= --Z- 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 Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) ?j -�,.� 2,(Q0 ✓6' JfAkEZ. P.O. BOX 1504 APPLICATION ONLY"� Building 78-495 CALLE TAMPICO 1 kGSI/ Address • LA QUINTA, CALIFORNIA 92253 S Owner i)F-Se-2-r PC Mailing Address. P, a 3 G ,100 City Zip Tel. �¢+ 1,0i R . pocolea-r, - Address Cit Zip Tel. fru €�s¢ev4' Zz & t 3'19- /ZOO State Lic. City & Classif. a Lic. # Arch., Engr., Designer Address CityI Zip 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 ProfessI Code, and my license is in full force and effect. r if/, / !✓� GZTU 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 permil 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 (5500). 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.) 1'I 1, as owner of the property, am exclusively contracting with licensed contractors to con- struct the proiect. (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 contractor(s) licensed pursuant to the Contractor's License Law.) J 1 am exempt under Sec. B. 8 P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 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 (E 100) valuation 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. 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 ddress 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 1 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 applican Mailing Address_ City, State, Zip_ BUILDING: TYPE'CONST. OCC. GRP. A.P. Number w %% S `I d / Legal Description' LoT 2g Project Description • Sq. Ft. Size 0 14 New 12 imated L /Ac e 51/,i4! 4 S - co It �'.. No. O Stories Add ❑ Alter ❑ ation PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure No. Dw. Units Repair ❑ Demolition ❑ TOTAL t J. ©C) REMARKS .t 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: MAR 0 q1999 0 ITY OF LIJA C UINTA 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 3/25/99 No. 18496 Owner NameWilliam Rogers CERTIFICATE OF COMPLIANCE APN # 774-233-001 Jurisdiction La Quinta Permit # No. 54260 Street Avenida Juarez Log # City La Quinta zip 92253 Study Area Tract # Lot # Square Footage 1470 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: t► , -' >~ EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount aft rte ! 1. - 1.93' X 1,470 or $'2,837.10 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 ccNal ley Independ. Bank/W. Rogers Telephone 399-1200 Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Adriana Gauto Payment Received $2,837.10 Check No. 183229 Signature IOTICE: 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 bove 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 .,tact 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 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 Building & Safety as your correction list. Please attach additional explanations as necessary. APPLICANT: DESERT RESEARCH. & DEVELOPMENT PROJECT ADDRESS: owl Madrid 774-233-001 _LEGAL: LOT, 24 ,.BLOCK UNIT , S.C. @ V.L.Q. C K' D BY: STAN SAWA BIN NO: SCS CASE NO. 99-45 CHECK 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 O;•tin}i}}:4}}}}}};^:4;•}:b••}}:4}}:{4}}}}:•}}}}}:?^: n...., v....... +............ v:.::::: +•vw:::;; ... ....... v}::.+w:.vw::n:v.v:::;:.+.w::::::::::::::::.v::..... v ... .; ....... v .....: ..: .... ..:: w: •:: }::: }:::::.v•:\^::. v.; •....{{................ n... •.w: ^:.::.:::: ••: n•.v: h{n}}•.};.:•}::::.•.vry;•;•}i;•:^:•}:^:•:•}:?:h:•:: ;r.}. v.:. ..v:G}.....+... . . ... .. .+• .. ....n..n..................v:v,.}::::\:::}::::::::::.v;}::}::::nv}w::.............,..........:..:.........}..........................:. r..:::................v.+•M•^:•:{?v{\}: ..�i �C.ti:'ri: ji;•:v {yy��p,�] ��wp� y�1�{ '{:tin}}}}}};{•}:::::.v::::.v:m.::;;:•}:v::::..:.}:v}:.v T.A��£.F�����iS.iii:Jiiijijiiiiiiiii}:v:}i:{:i:?i\...:...............................................................................v.................::.......r.$.:::.vr......v.:L::{>.{v:Rttti•}:•: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 �l 6 Materials Architecture V_ OTHER REQUIREMENTS: The zoning code, architectural and landscaping manuals, and/or assigned inspector should be consulted where uncertainties arise. The completed checklist shall be maintained in the Building'& Safety address file. ficate of Occap'ancy. Cityof LaQuinta , Building and Safet DepartmentY 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: 54-260 AVENIDA JUAREZ Use Classification: SFD Bldg. Permit No.: 9903-084 Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC Owner of Building: DESERT RESEARCH & DEVELOPMENT Building Official Address: P.O. BOX 399-1200 City: PALM DESERT, CA 92261 By: 8-31-99 Date: STEVE TRAXEL POST IN A CONSPICUOUS PLACE