0208-219 (SFD)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
8951 10 B Vl)s
Date J-' ignature 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 ,9TAT3':Yj,1HD Policy No. 04400002OZ27
(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' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those/Provisior-YS.
Date: ii s . 9sy .-�j,QPPlicant rig ..z 9" .�✓
..'4p,i,.......,.irf.,,,�v
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 Cityto�enter upon
the above-mentioned propertyforinspection purposes.
Signature (Owner;Agent)
BUILDING PERMIT PERMIT#
DATE VALUATION g t,� �•9��a� �yr,^� LOT " 9 TRACT yY i �f 0y
Ob i.l� , f cfc7.' U 2 i �7LK 2 1
JOB SITE APN
ADDRESSFF�i�Sr"ti J J1�.W , T r'�=��-�SP4
OWNER CONTRACTOR / DESIGNER / EN &NEER
.r1LL.AMMTC;,l4M HOW. BUIMER3,1 C° AU, AMk?RZ�+ LAIA':F,�4�say;MEDI T�.I�:t^:��tS:r;NC
%�.S995 �'1 F D.�.€��'.1;.=1�f(M 76995 �',�,.�%iiV.�.�i.�:�•><...Y c,'.�.NU
P.rtl..W CA 927 11 PAL I i.T9'PPS. i r CA. 922
'(7w),100 -nay'? CPU! 6373
USE OF PERMIT
f'moo S. F. SM.) P8R.M17 ?faES' NOT DACLUM.' t1;,0C- W.A.t,L, POOL OR
DRMC SAY APMACH. 7511, RP—DUtV1) PLAN ChTW Pf✓F, FOR MULIi'l IA
HOUSES S.t?.Mt;1'1 K11.
'3'le.��f:`<` €afJ�+13'T.PaU�:TiO'iri 3,'�'ft.t3f3 �kT.
C.�,RACilwiCA#iPC7P€.".T' 4!4.00 S3
XblsW13WX=_1 Cafe' OF C.041191RIJM1 ,1 K
105, MAD
ryy;yjY, vu s y pyx
XY.`aµa^.i',.�jw.l]�c+r1�'�dtq/��/��L(.�T Rr.LyWp}d�LjV'.AaLt.0.,h'
Cows'I RUC1 Iow lrni
1! (� y�(�
'{�{.g /�f�(��.,f�yQ p�r�[ S6601."
Y 01 "YA00 18-000 :56601."
PLAN CHECK it'M,
101 _000_ 439__31 8 V37.49
M? j EP031T
101-000.1139-318
E
1;01-}d�3(C3y�{D--42ss
y�yilT�{;�C3�af+.Aglg�,fetIK,�A7}�'P
X Lil�C ),F8 AL FRE
p1-000 �}/9�.;3plt1
10 L -000-421 -000 $119M3
T>I. UM- i1NO FEE
101-000-41.0-000 00 W$.`7
S RONO MOTION FU - RESID
101-000-241-0100 51037
C AMD' OtpY
101-000-423-000
VILVEWPERIACT M'
PR 0133 PL
101-,000-441-345 ittU.�+fi
De 5 14:- MS -PAID TWOS
wW0,00
1*10MIX3.1 M.8 WE now
OCT 2 9 2002
CITY OF LAQUINTA
FINANCE DEPT.
RECEIPT
DATE
I. BY
DATf FINAED
INSPEC
INSPECTION RECORD
OPERATION j
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
. BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
f�
Underground Ducts
Forms & Footings
Ducts
Slab Grade
V
Return Air
Steel
Combustion Air
Roof Deck
_
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Insulation
Compressor
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 = `3
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
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
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final 1
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 L2 elK
Final O
Utility Notice (Perm)
COMMENTS:
Comments CC#65507 also used for certificates #23789 and 23790.
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 (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that 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 .
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14 X 1,790 - S.F. or $3,830.60 have been paid for 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/!st Bank - mark Tuvell Check No. 65507
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Monica Guillen
• $3,83Q.60 0.00
Payment Recd Over/Under
,
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the Distdct('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
a4.
RECORDING:REQUESTED BY:
Re/Max Real Estate Consultants/Escrow
Division
AND WHEN RECORDED MAIL TO:
AND MAIL TAX STATEMENT TO:
Order No.
Escrow No. 02 -01436 -DS
Parcel No. 774-263-004
SPACE ABOVE THI
GRANT DEED
THE UNDERSIGNED GRANTOR(S) DECLARE(S) THAT DOCUMENTARY TRANSFER TAX IS $38.50 and CITY $
X computed on full value of property conveyed, or
computed.on full value less liens or encumbrances remaining at the time of sale.
unincorporated area: OR City of La Quinta and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
Natt A. McDougall, Executor of The Estate of Ann McDougall and Nancy M. Leone as tenants in common
hereby GRANTS to All American Home Builders, Inc., a California Corporation
the following described real property in the County of Riverside, State of California:
Lot 21, Block 271'of Santa Carmelita at Vale La Quinta Unit No. 25, as per map. recorded in Book 19, pages 50.and 51 of
Maps, in the office of the County Recorder of said County.
Commonly known as: APN# 774-263-004, La Quinta, CA 92253
Date July 2, 2002
The Estate of Ann McDougall
By: Natt A. McDougall, Trustee
STATE OF CALIFORNIA }
)S.S.
COUNTY OF I
Nancy M. Leone
On before me, the undersigned, a Notary Public in and for said County and State,
personally appeared Natt A. McDougall, and Nancy M. Leone, personally known to me (or proved to me on the basis of
satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to
me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on
the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
WITNESS my hand and official seal.
Signature
NOV 21 '02 13:52 FR - , TO 9-5649975 P.01/0i
dnfornzation
ZBuzld On
•Cansufto • Y
REPORT OF FIELD COMPACTION TESTS
TESTED FOR: MARK TL>'V'EJ+L PROJECT: 54-580 AVENIDA JUAREZ
DATE:
-November 19, 2002
OUR REPORT NO,: 073-20314-2
TEST DATA:
(1) Medium grained silty
sand w/ gravel/cobble/boulders. OPT. MOIST. .
6.0%
l lllr( "TT
'
EB
• ?;, N0.
TEST
DEPTH +ELEVATION
SOIL 10
Nl9MER
—
MAXIM
M�p,gg Q�UA *
DENSITY
WATER
CpNTLNT
WET pRY
DENSITY OEN6n1
PE:RCiNT
COMPACT".SpEQ.
COMMENTS*
9O$ min
2 8"
FG
1
137.5
5.7
134.9 127.6
92.8 1 -
A
2 0"
>;G
1
137.5
5.4
143.8 134.5
67.8 1 -
A
3 011
FG
1
137.5
5.0
132.6 126.3
91.9 1 -
A
—'
1
137.5
3.2
130.9 i26 .8
92.2 1--
A
• r
I_ ..._
...-
r-- ...._
�.
...
TEST LOCATION: Building pad.
West side
North side
Fast sido
South side
NOTES: pEBT►�pM�ORpMEpDTILPO�EIIR�oDn29zt-886ASTMD3017.96-COMIAEATiS .LFITHRIAL 6TESTREUBCOM YVNTHSPOECCCAM
h4pL9SP� dY�WlEaCender tipp��y 5.eBA
E URSE Cpp PRERTRT+TPFg11NFPIEXTI 0T�E3hii IT�gTI N
'i 1 e0N 10 numeer. 6.OTHE E �F:H ®HIOW ECIF(CA�1 pN 0 S
(1) ASTM D1557-00 METHOD A o s
L TEST INSTRUMENT: STANDARD COUNT M: 0;
REMARKS: ADJUSTMENT DATA M: D:
r RespEEdtulf submitted,
TECHNICIAI4: Vinnie De Souza Piolessio»ei Service industries, Inc.
Tiff SE TEST REMTS APPLY ONLY TO THE SPECIFIC LOCA710M NOTEO AND MAY NOT REPnlbeHr ANY OTHER LOCATION¢ OR GLGVATIpRp.
%AWO LNY NOT BE FWAODLPOM EXWT IN FVLL. WWWAw vggw N POWIW" ey pR0/lSSaft SMRVP:E MMIRLFA. dp,
w�eet��j� l-- w'vrw uluWDUFUD, IIIc.. *d -cru Wem "ay, WES L: • P21M LIGUn, GA 98211 • Phono 7E 341-5790 • Fax 786/341.6794
** TOTAL PAGE.01 **
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 at,
building construction or use. For the following;
BUILDING ADDRESS:
Use Classification: SFD
Occupancy Group: R3
54-580 AVENIDA JUAREZ
Bldg. Permit No.:' 0208-219
Type of Construction: VN Land Use Zone: RC
Owner of Building: ALL AMERICAN HOME BUILDERS Address: 76995 FLORIDA AVE
INC
Building Official
City: PALM DESERT CA 92211
By: KIRK KIRKLAND
Date: 2-6-03 1