0006-208 (SFD)LICENSED CONTRACTOR DECLARATION
I -hereby affirm under penalty of perjury that I am licensed under provisions of
6tpter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lid. Class /ExDate
638533c.Ek�
4te&
•DZ ' Signature of Contractory
OWNER -BUILDER DECLARATION �� ft!ff
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason: ,f
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and therstructure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) 1, 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.
"N, / I have and will maintain workers' compensation insurance, as required by
Sectibn 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:
Carver 9TATF FV14D - Policy No. 22999.0009671
(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 California, and agree that if I should become
subject to the workers' compensatef�n provisions of Secti 3700 of the Labor
Code, I hall forthwith comply with Thos „ptC 3,
11�ate:'`� 'r�Applicant ff
Warning: Failure to secure Workers' C6mpensatiOH1C
shall subject an employer to criminal penalties ar( civil
addition to the cost of compensation damages as prov
of the Labor Code, interest and attorney's fees.
Ig ``Js hlawful'and
WP to $100,000"in
for in Section 3706
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,. State aws relating to the building
construction, and hereby authorize representativs of
this City to enter upon
th�atiove mentioned propeit i f jec 'on pb"s��•y-:F
Signature (Owner/Agent) ` - -- _;Z ----Date l 220
4 BUILDING PERMIT PERMIT#
., . �� VALUATION 9,125.S1i LOT 17 TRACT
DATEt. ,.r!�
I�62
JOB SITE -
DRESS
�✓ 1.0 AVF, i. JTU" Z
APN
774-233-0
OWNE �
CONTRACTOR / DESIGNER / EN (NEER
f LA Q1'3 N -TA PA'RT"KM
ulm Vlr'Al°t"ETR U
- O S X50
79.080 Calle T Ando Ste 204
Q UINTA CA 92253
LA Ca11INTA
CA
92253
C160)564-1866
• f
C3
859
USE OF PERMIT
SMI .- !f MiMING
,
SPD -PERMIT DOES NOT INCLUDE 81.Ou1CWALLS OR, 1400L
' r
TRACT CONSTRUCTION 1,4210 9F
PORCKWATTO 33.00 SF
0ARACRICAKPORT (F) 41000,00
9 FT. WOOD FENCE 200.00 L.F
ES'r l'.lm COW 01, CoM'ln€TVrion
CONSTRUCTION YM 101.000 18,=000 S594,50
PLAN CHECK IRE 1G e -003-439-31R
�'1
MECHANICAL FIE 101-000.421.000 x60.00!;
-TSL i►i:'E R1CAL. F f 101-000-420-000, $129.24-
' PIdi1MBINO FIRE: 101-000.419.000
"'
1-T S `�
�{ '
tCRAD1140 FEE 101 wOW-+47J-000 $X00
DEVREA)F R. MIPACT FEE $1,907.00
MWt PLAN 101-000-441-345 $100.00
FEE DEP081T 101.000.439318 4250,00
-TMAL. CONMUM1110K AND Tal M' EI1ECK
$3,421.56
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
1 OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_�
Underground Ducts
Forms & Footings
_ i
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
O' ZtC31
Exhaust Fans
O.K to Wrap
Q7 cA-?
F.A.U.
Framing
d mem
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
�h
Drywall - Int. Lath
�FinalFinal
4A'C
POOLS -SPAS
BLOCKWALLOVALS
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
_ _ 7
Heater Final
Water Piping
��
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
�_� .S7
Encapsulation
Gas Piping
Gas Test
07
� .
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
MZ
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)
P.O. BOX 1504 APPLICATI NLY
Building ,�{ ( 78-495 CALLE TAMPICO
Address '� U ' + vU IQ'E �-(--. UINTA, CALIFORNIA 92253
(_A, C -,):.If (r '7 � �f�l4�t 0_i�C 1c -
Mailing
Address
,City Zip Tel. Q J
tractor
�".y. i fit' t—
f
1 !
ress.,, _
Glty Zip
�/_
,,,. ,,.Z. r�) t t -7—,t4 I 7r '2 w h
State Lic. /
8 Classif. cLJ~ter
Arch., Engr.,
Designer ,i✓" -rz
Address
C. -
City
Lic. # C_ SCI
Tel.
City IZip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION--- -•`
I hereby affirm that I am licensed and provisions•of Chapter 9 (commencing with Section
7000) of Division 3 of,the Business an Professi s-Code�an m license is in full force and
effect. (..L.:..1+1_.x.: i►, rs �r,+r�oi''°'-"g`_� force
a
OWNER -BUILDER DECL'ARATION-",--�'-V • ' /JC'UT ,
I hereby affirm that I am exempt from the Contractor's Licengp-taw, for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city county which regCires-ig;
permit to construct, alter, improve, demolish, or repair any Vu tune, 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, Chapted9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he 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 five hundred dollars ($500).
l: 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 of sale.)
I I 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 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. 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.)
1 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, alter 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 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 a0plicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE•CONST. OCC. GRP.
A.P. Number %-7+
Legal Description `E` /
Project Description
Sq. Ft. 1,1-7- No. No. Dw.
Size Stories Units
New Add ❑ Alter ❑ Repair ❑ Demolition ❑
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
Estimated Valuation
PERMIT
/
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
r
S.M.I.
Grading
Driveway Enc.
Infrastructure
i •�j�'r
t t
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 6/28/00
'No. 20626
CERTIFICATE OF COMPLIANCE
APN #
Jurisdiction La Quinta
Owner NameLa Quinta Partners
No. 54-410 Street Avenida Juarez
city La Quinta zip 92253
Tract #
Type of Development
Comments
Lot #
774-233-008
Permit #
Log #
Study Area
Square Footage 1421
Single Family Residence No. of Units 1
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 CCNalley Independent Bank- Pat Magana Telephone\
Name on the check
wt -
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Ellen Patino Payment Received $2;91,3:05-, ;
Signature
I Check No. 216506
:f
40TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
milect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
.�lif: • 12. 2000 2:OOPM POWER- BROKERS
No' 3409 P • 3i4
A51@OItD�ti 6t$a[TBIB'TSA BYe
CHICAGO TITLE COMPANY COMPANY
9943KC 207056339
r
v �lJ-n�sa
MU P$CORDWIL MAIL THIS OSBD A=t
=L1988 OTEMMSM SHOW H1llraOW1
XAtL TAX BTAT29O M Tom
�c9-� 17
/
M2CHELL8 41CFISTSDT
P.O. SOX 134
LA QDINTA, CA 92253
SP CH AMOVE
1128. = FOR RZOORDxRIS
774-:33-00®•4
GRANT DEEDy19't9'i
The under9igned.grantor(s) declare(s):
nocumentary transfer tax to 012.75
(7t7OC Comguted on ul value of pr erty conveyed, or
( Computed on ul, value 1804 enc and encumbrances
remaining at time of sale.,.
( trniricorporated area: ( ) City of
and
POR A VALEWLE CONS:DBRATSON, receipt of which is hereby
aCknowledgedo
MO=T ST.:DMV6 COLLEGE
_.hereby, GRANT i5) to
T41LLIAM THOMAS SU,FFIN, AN UNMARRIRD MAN
the real property in the City of LA QUINTA, County of
Riverside, State of California,
described as:.
Lot -11, Mack, 262, Unit No. 14, Tract. Santa Carmelite at Vale La Quist&, as per map
recorded in Dock 19, Page(N) 44-43 inCIUMive of Maya, in the office of the County
rtecordex of said County,
Dated June 12, 2000
state of California
County of } B.S.
On*
before me,
personally appeared��
personally known to me (Or proved to me on
the basis of satisfactory evidence) to be
the person(s) whose name(®) is/are subscribed
to the within instrument and acknowlsdgea to
me that he/she/they executed the some in
hie/her/their authorized capacity(ies), and
than by hie/her/their signature(p) on the
instrument the yeroon(a), or the entity upon
behalf of which the persons) acted, executed
the instrument,
WITUSS my hand and official seal.
signature
MAIL TAX BTA V76 To s
MOUNT ST. MARY'S COLLE 04
BY
Name/Title
By
. Name/Title
(This area for official notarial seal)
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
APN 774 - 233 -
LEGAL: LOT . 17
54-410 Avenida Juarez
0 0 8 BIN NO.: CASE NO.: 2000-246
BLOCK 262 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
V
Consistent with MDG on file (as applicable
V
MDG filing required (5 filings since 9/3/98)
Consistency with street/surrounding area:
Colors
Materials
Architecture
V
"NQ
Other Requirements:
+70 S
11
ffCertificate 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: SFD
Occupancy Group: R 3
54-4.10 AVNEIDA JUAREZ
Bldg. Permit No.:. 0006-208
Type of Construction: VN -Land Use Zone: -RC
Owner of .Building: LA QUINTA PARTNERS. Address: P.O. BOX 450
:. 92253
Building Official '
City:- LA QUINTA,
'By: STEVE TRAM
Date: 01-26-01
POST IN A CONSPICUOUS PLACE