0011-076 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
H 'Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
i4 LU W Professionals Code, and my License is in full fore and effect.
O � M License # Lic. Classi � Exp, Date
o Z t, Date �; Signature of Contractor.•
CO
0-
i.— C:)OWNER-
BUILDER DECLARATIO
W W,11- I hereby affirm under, penalty of perjury that I am exempt -from the Contractor's
i ~ 0 License Law for the following. reason: •,
Z ( ) 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).
cY) () I am exempt under Section B&P.C. for this reason
N�I
n CDate 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. • r
(�"I'have and will maintain workers' compensation insurance, as required by
Section 370 0 of the Labor Code,fJor the performance of the work for which this
permit.iS issued: My workers' compensation insurance carrier & policy no. are:
Carrier "` Policy No.
(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"I any manner -so as to.becorne subject to the
workers' compensation laws of Californi and agree that if �,shobld. become
subject to.the workers' compensati� pr vision of Section 3700 of tie Labor
Code, shall forthwith comply wit Z.se,' rovi Ion
Date: t Applicant t�JG:
Warning: Failure to secure Workers' C04,ensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code; interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation. ;t
I certify that I have read this application and state that the above information is f'
correct. I agree to comply ,� with all City, and State laws relating to the building
construction, and hereby`authorze representativesof this City to enter upon
the above-mentioned property for�ispection pgposes\ . ,
,•Signature (Owner/Agents 'fitiw?, s. `'z Dated y;
BUILDING PERMIT PERMIT# =':
DATEi VALUATION LOT TRACT
'
z t -7t rte ca.av ew
.JOB SITE ' I
ADD SS
APN
OWNER
CONTRACTOR /DESIGNER / EN INFER
:4 o,f`,mC;''�.titxyn f'"omm'fJcmaw-
pACMIC TRAL)IRS COMPUCY101 '
719 s Tkiq*mom
1719 6 TUM011111
ilk 9205+4
S OC RAMM . OA. 92054
y >�f�Q?Cyi-Ob9 -tip 1555
USE OF PERMIT
7 CYLy`p J" LELg
7r
.
VO • MIMI t' T:PK3:FS',N€`. 110Gt.riM L1!, V.X 1?VrAl:,UP00'dSP.e`)..OR
APNZOACH DRIVEWAY
TRACT CO$ISTFI.IXTION 5-F
PORM'P TIO 36.06 sp
0ARAGWARP. RLT (Si) 0,496,80
5 Ear, WOOD DP` 1110E 200.00 LIV
=AIIE + C0 ff., t }N
1 ARIVA[17Cf2. NiM„ ARY
COfiD;r,°SRUd:'11014 FEE 101-000-41.8-000 $594.S,It
P1,AN C r3.W* ,FEE 101-000-439-318 5300.12
UVIC, MNICALFU*1.101-000.41<000 S60A
abE 31 G'� elf".J 1 PIPM? 101-000-420-000 $120,44
PLUMBING FIE 101.000-419-000 $10173.
STROKU MOT= M - RESID 101-000-241-000 $&.93
0I1 A€?eW0' �f'-� 101-0100-423 000 S20.a,
&9WI,I.,i:DPER 98PACT ;EEG $1g902.OPi
.1
PRV38E, PLAN 10 3.000-441 -.`4 5' $1(14.00
F"le .Esti.?Sf T 1 ti l mOCiC-CD 3 R£ 4250.00
SUB-TO7:AA1,. COXITMIC',WN ,AitTD PlAi CHECK
T`Y'?TALPMW INY,S D 14OW
RECEIPT
DATE
By
DATE FINALED
INSPECTOR
IN
,
Yu
INSPECTION RECORD
#4:
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS.
MECHANICAL APPROVALS
Set Backs
F/1;z
_
Underground Ducts
Forms & Footings
• ov �
S" 7
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
\ (--7 —�(
�J�
Exhaust Fans
O.K. to Wrap
1
F.A.U.
Framing
(_�— p(
57
Compressor
Insulation
10
Vent's
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
l
Drywall - Int. Lath
Final
Final
2- / 3 -o C
57
POOLS - SPAS
BLOCKWALL
APPROVALS
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
�?.��lG�
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
y%
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)
_�..,.-�--c•._,.,-,a v.--•-'n-;--, r•}..,,w.r yr.'�.�,�.•se---w ��.�.�"t,y�ri "', ai;«,j-1,+�.r .iY,r�;,. 1.�`a.,n�v.A�. a,•, .. -i.'� '` f r. �. •''..., F-.. �yb^; _..
P.O. BOX 1504 APPLE-11,0N ONLY
Building ,1� 78-495 CALLE TAMPICO
Address �. SLA QUINTA, CALIFORNIA 92253
Owner
�pJ �� 'WSS,� "`•�"` BUILDING: TYPE•CONST. OCC. GRP.
Mailing �
Address r-„ • R N °`-w%a IV- A.P. Number
City Zip Tel.
1<Legal Description �f g2c1'C`>( ('bbd) 6l-��b�l
Contract o' Project Des ri tion L
ac •� "t'C2R Vk Als Zt Q i w�
Address
J
IT44 Ca Slav 0 (IlIt 2 h
City Zip Tel.
State Lic. City f �`
& Classif. 4q'(.� -jg Lic. # 1 qT, Size t + `�) Stories No.UniDW.
1 Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State r4-5
\ Lic. #
LICENSED CONTRACTOR'S DECLARAT N
I hereby atCrm the I am licensed under provisior{SAf Chapter 9 (commencing with Section '
7000) f Drvis 3 o th Bu's:3�' a� nd Professions Code, and license is in full force and
eflect. �.9»�
SIGNATURE DATE
OWNER-BUILDER DECLARATION Estimated Valuation
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 toconstruct, 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 PERMIT AMOUNT
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 thealleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). — r
I'! I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.
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, Mech.
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 Electrical
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- Plumbing
.. 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 S.M.1.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
0 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
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
f7 Copy is filed with the city: ❑ Certified copy is hereby furnished. -
TOTAL /)
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (8100) valuation
or less.)
I certify that-in the performance of thg workfor 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., d, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you mast forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
R
CONSTRUCTION LENDING AGENCY Side Street Setbacc from Center Line
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.) Side Setback from Property Line
Lender's Name
Lender's Address FINAL DATE INSPECTOR
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. Issued by: Date
I 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. n
mentioned property for inspection purposes. Validated by: (11i�T 2 3 2090
Signature of applicant Date
Mailing Address Validation:
City, State, Zip -A®Y
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Desert Sands Unified -School District
47-950 Dune Palms Road 1�
Notice: La Quinta, CA 92253 f
Document Cannot Be Duplicated s 760-771-8515 ' R
CERTIFICATE OF COMPLIANCE `
Date 1.1/1.7/00 APN # `' 774-134-018
No. 21226 - Jurisdiction La Quintal
•
Owner NamePacific Trades Construction h '
" Permit # ,
No. 53-655 Street • Avenida Navarro y Ling #
r City La Quinta r.' ,zip '92253 Study Area
r
'Tract # Lot # Square Footage A421 4 .}
Type of Development Single Family Residence r' No. of Units • 1`
.4
At the, present time; the'Desert Sands Unified School District does not collect fees on gaiages/carports; covered "
patios/walkways, residential additions under' 500 square feet;` detached accessory structures or replac;;ment mo6ilehomes. 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 b-.filding
permits and/or Certificates of Occupancy for this square footage in this proposed project may now b, issued L'
Fees paid By CC/Capital Bank of North County - David Miller'w Telephone 967 X0069. .
Name on the check
By Dr. Doris Wilson �-
Superintendent .# r
Fee collected /exempted by Ellen Patino Payment Received _ `'C'42, 913-05
Check No. 079075
Signature
FN0111,CE'i,,P,r,si,,nt of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will. serve to notify you that the 9D -day approval period in which you may protest the fees or other payment identified
ewbegntorun from the date on which the building orinstallationpermit for this project is sssued or on which they are paid to the Districts) or toanother public entity authorized to
them on the District('s)(s') behalf, whichever is earlier. r r
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 a Copy -AccountingIrr
,
1
8.��
-`*
RC DISTRICT PLANNING REVIEW FORM
f •
This form is to be used by CDD staff for review of single family dwellings in the R2 (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 Safe", .Department as your
correction list. Please attach additional explanations as necessary. '
APPLICANT PACIFIC TRADES
SITE ADDRESS 53-655 Avenida Navarro
APN -�34 - 134- - Otg NO.: CASE NO.: 2000-334
LEGAL: LOT BLOCK UNIT S.C.@V.L.Q..
CHECKED BY: Fred Baker 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
`DEVELOPMENT
MaterialsY
Architecture
i
C
DEPT
ATELA 11011
E N0.
Other Requirements:
� *6
I
. . .. ..........
... . .... ... ------
W-04-2000 10 09am From-COMWNKALTH WD TITLE +T904133f6 T-381 P.001/001 F-402
ti
RZCO=Z go ARQU29TED BY:
OLD REPUBLIC TITLE COMPACOMPANY
10393KC 507646-13
w= ItSCOU= MAIL, 7HIS ARID AM,
MMESS OTORWIS9 SHOWN BELOW,
MAIL TAX STATXK=TS TO:
'David Ross Miller
1719 S. TREMONT
ocCANSID9, CA 9205.4
dA1bkMt% ISAIrm mu're TIMP WAD areqn""21 IQ RAI
• GRANT DEED
APET• 774.13Q -018•T
The undersigned grarizor(s) declare(s)!.
Dodumentary transfer sixis. $22.00
(XXX) Computed or. Cull `value of property conveyed, or
conpuced on full, value less liens and encuml=ances remairling ac time Of sale.
Unincorporaced 'areat City of and,
pQR A VALUABLE CONSIDERATION, receipt of which is.hereby.acknowledged,
Duane A. Hoffmann and LtsIL6 L. Hoffmann, husband and'wi46 as Joint tenant:$
hereby GRANTS) to
David Ross Miller, a married man as his sole and. separate property
the., real -property. the City of LA QUINTA, County of Riverside, State Of.
described as;
Lot 8*, Block 241, Unit No. 23,, tract Santa Carmelica ac -Vale La. QuLnra, as per map
reccrdecA in Book 20'r Page(s) 25 inclusive Of maps, in the office of the County Recorder
of said County,
Dated Saycambif 20, 2000
state of California
councy of
On
fore ma,
personally -appeared,
.personally known to Me (or proved to M;T. Qn.
the basis of satisfactory evidence) to: ,be
the oerson (a) Ohosa name(a) is%are subscribed
to t=he within instrument and acknowlqdged to
use Chat he/she/they "ecured the 0916&- . 'in
nis/net/their authorized tapacicy(iis), and
that, by has/hair/their eignature(s) on the
instrument the person(a), or the entity upon
behalf of which the person(s) a�cted, executed
the instrument,
W!TNR-S9 my hand and official seal,
Signavire
MAIL TAX STAMM= TO
'd 866'3 ON
Duane A. Hoffmann
Leslie L. Hoffmann
(This. -area for official notarial seal)
100
SO I Q.8;9.* 8 3MOd NV [Z,� 0 1. ON .1
Certificate of Occupancy �, ��
City of La Quinta
Building d Safety-Department an.
This -Certificate Issued pursuant -to the re
quirements of Section 109 of the Uniform Building Code,
.Certifying that, at the .time of issuance, this structure was in compliance with the various ordinance's
of the. City regulating building construction or use. For the'following:
..BUILDING ADDRESS: 53-6.55 AVENIDA NAVARR
0
Use Classification:' SFD Bldg. Permit No.: 0011-076
Occupancy Group: R 3, Type of Construction: VN Land Use Zone: RC
Owner -of Building: PACIFIC TRADES CONSTRUCTION- Address: 1719'S. TREMONT'
City: S. OCEANSIDE, CA -92054
By STEVE TRAXEL
Date: -02-13-01
Building dfficial
POST IN A CONSPICUOUS PLACE
f