0002-098 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed -under provisions of
"34, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
5 M License # Lic. Class Exp. Date
O o39fsi 13 t71:31i1G{
cZ Date �.�-)QN]hature of Contract
Opti / _
J
I.—
OWNER-BUILDER DECLA �T1'ON
W LU 1` I hereby affirm under penalty of perjury that I am exempt from the Contractor's
co 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).
M O I am exempt under Section B&P.C. for this reason
LO
N
Date Signature. of Owner
O a,
d< WORKER'S COMPENSATION DECLARATION
p m
Q I hereby affirm under penalty of perjury one of the following declarations:
Lo H O O 1 have and will, maintain a certificate of consent to self -insure for workers'
X W �= compensation, as provided for by Section 3700 of the Labor Code, for the
m_J Q performance of the work for which this permit.is issued.
Q () () I have and will maintain workers' compensation insurance, as required by
OU Q Section 3700 of the Labor Code, for the performance of the work for which this
Il a Z permit is issued: My workers' compensation insurance carrier & policy no. are:.
00 z Carrier S, A'; E Y-Ti''ND Policy No. I .t^?3^.:ill
t` CY
g (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 rany manner so as to become subject -to-the
workers' compensation laws of California, and agree that if I should becomet-
subject to the workers' compenp�ion provisions of Section 8700 of the Labor
Code f>hal! orthwith. comply YMh those provisions.
Dater ' � ���+ plicant ,�'_ ' : �,/' (. ,(A f�-� �• ^
Warning: Failure to secure Workers' ComLensation 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
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 4eereby authorize representatives-of-thiCity to enter upon
the above-mentiotfed property for inspection•,purposes.
Signature (Owr,/Age` nt) C:.:.,( .'f -'({ Date G'
,_ PERMITJ�x^�1�
BUILDING
.PERMIT `
DP�E VALUATION �� y2,�3 p� LOT )4 TRACT y 'i.`lti�i. "LI it
JOSAADDRITE 54-020 AIV NMA CORT4' Z
APN 774A52 -60A
OWNER
CONTRACTOR I DESIGNERENGINEER
( j i'�P1 f }
T 1 , taNA
l.ii \ 1J I ( , 4�7 .�`11
jI
i,I �iin�i�it`. Lr
PO BOX 134
_3I-540 EISENHOWER DR
L.A QL11r I -A CA. 92'253
1,A. QUI1*E'i.A CA 91253
f7ti0'ISEiII-4iiA4 CIBIlif 226i
USE OF PERMIT
SIiV'Cr3 E: FAMILY DW'E1:1JNG
SFit - PERJW'i' DOCS NOT s%w;'.1.1TUE 13L CK WALLSkPOCq� ( B-':
(tilA.s i'131{ 1
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i�il�i.•i t�'.�tba 1 a�.�,t, t I��t�
k'l-riii,ltrl�rl � tV�y .cll�.ifi) :`tl•
ti F7'. W0(:3D F ENICIE 2J)3.0 LF
l .STIR, I TED CON'f O.F' COINS'l RUIIC'TICNI ti'
9"926.20
lN" f{1�'Ii •1 .�+ !U: �!; :fS�l tb`ii l�'tir'L��'�
F'lt; 1:,lPt.l;ilb` lUl-UUfl-�i.�9-3itt •�24t�.4k3
v�'t�N'i'{'tJJii"f'If-?Td s'F1� t(tf-l6fifl-4lR-Rf?U Se;f►N�(3ft
rl,l0.Td c rr.1�c is >TLu 1 O t �(►rr0--039'-3 i €J s4» i .J9
A3E:1'HANIC:tl1. 1T:L ipl-G13G till U1K) lr�+l.iil�
ELKILIVICAL PEE 101.006 S I2Y,94
u1..t INIAIN16 Flr7: lEi1-000-419-1`100 St 16 is
S'E tt - NC; PAOTI(DN F1117 f;l [I:) 10 _fflo 10
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Ul%V&OVEK 00PAC,I FEL`
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ST1BA—,OIN1.COMS Rift VION` NI;PIAN 04ECK
'"1,J,11210
.d 09'AL PIt;RNIaT i+'la;G S W➢UR+; NOW'
1
RECEIPT
DATE
eV ;r
DAN 'ED
INSPECTOR
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 / Q9
-
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
7 7-47-0 S7
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
— dv57
Final
Final !m as
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 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
Pool Cover
Sewer Connection
pry
Encapsulation
Gas Piping
Gas Test
d dZJ
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
J.
Final
Utility Notice (Perm)
COMMENTS:
4002-OqF)
T4hf 0
409-1-0-c—P.O. BOX 1504 APPLICA N ONLY
L
Building 78-495 CALLE,TAMPICO'
Address 44, OZO u a LA QUINTA, CALIFORNIA 92253
Owner
Mailing
L6 `&-.V Ian r`' BUILDING: TYPE'CONST. OCC. GRP.
Address'? -b r1l�A. A L t~. A.P. Number, l
City Zip Tel.
Z g Legal Description- LOT' 7 A. $L~3?- 2<a 10".- '74 -
Contractor Project Description :!6t "f- L a r,-t,,LA L: j
L,b. 2n
Address
City Zip Tel, 9561 - Z$77, d,
Lr:�. . (—& zz. 5 4L-
S44- 3 o L3 t taJ — 5
State Lic. City
$ Classif. g Lit! Sq. Ft. No. No. Dw.
Arch., Engr., 4.
Size 1 .40Q Stories I Units
Designer L14121 6:.&J New Add D Alter ❑ Repair ❑ Demolition ❑
Address Tel:
P- 0.5 (=-A 4 <o
t cau t IA.rQ1� Cn 1 ftz.s 3 I Lie. p
LICENSED CONTRACTOR'S DECLARATION
I herebiyl affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000pof Division Sof the Buslnla and Professions Code; and my license is In full force=and
effect. J 12 % _ w_ �
OWNEWSUILDER DECLARATION
I hereby affix that I am exempt from the Contractor's License Low for the following
ressom (See. 7081.5,Businesa and Professions Lode: Any city or county which requkes a
permit to construct, aper, improve, demolish, or repair any sticture, prior to •Ifs issuance -.N80
requires the applicant for such permit to 'Ne a signed statement that he in 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 la exempt therefrom, and. the basis
for the alleged exemption. Any vidffilon or Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (5500)..
C 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, Bolrxness and
Professions, Code: The Contractors License Caw does not, apply to an owner of property who
builds or Improves thereon and' who does ,such work himself or through his own orrWkyess,
piovided that such knprovements are. not intended or offered for• site. it; however, the Duildip
or improvement is sold within ode year of completion, the owner-buldar will have the burden
of proving that he did notbuild or Improve for the purpose of sale.)
I'1 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 bwwa or Improves thereon, and who cohfracts for
such projects with a,contraetorfs) /,, .pursuant to the Contractor's Enemas Lew:)
1-I I am exempt under 'Sec. -B. S 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
F]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 pemnk Is for one hundred dollar* (=100) valuation
or less.) .,
I certify Ihaf in the performance of thg work forwhlch this permit is Issued, 1 shall not
employ.any pperson in any manner so as to become subject to the Workers' Compensation
Laws oFCalllornia,
Date Owner
NOTICE TO APPLICANT. it, aper making this Certificate of Exemption you should become
subjects to the Workers' Compensation provisions of the Labor Code; you must forthwith
comply with such provisions or this permif.shall'be deemed revoked.
CONSTRUCTION' LENDING AGENCY
I hereby affirm that therwis 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,
1 certify that 1 have read this application and state that the. above informailon is correct:
I agree to comply withallcity and county ordinances and state laws relating to building
C=C
and hereby authorize representatives -of this city to enter the above•
mentioned propertyJoranspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
PERMIT
Plan Chk. Dep:
Plan Chk: Bal,
Const,
Mech.
Electrical
Plumbing
S.M.I,
Grading
Driveway Enc.
Infrastructure
AMOUNT
I '
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
Notice:
Document Cannot- Be Duplicated'
Date 344%00
No. 20158
Ltl�rs auuuaito u>t>veu. �cuc>'u,i yultrres
47-950 Dune; Palms Road
A!Quitata,'CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
FILE
APN # 774-152-001
Jurisdiction La Quints
Owner NameLa Quints Partners
No. 54-020 Ste. Avenida Cortez .
City La Quinta - zip 92253.
Permit#0002-098
Log #
Study Area
Tract # B2558, U24 = _ w # 24 Square Footage 1465
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 garagestcarports, 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
1.93 X 1,465 ort 2,827.45 the property listed. above' and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issuod:
Fees PaidBy CC&Cash%Union Bank of Califurnina/Robert Kellogg Telephone`'
Name on the check
By Dr. Doris Wilson-
Superintendent
ilsonSuperintendent �
Fee collected /exempted by . Mary Ann L. Borja Payment Received $2,827.45
Check No. See Above
Signature
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) thio "1 nerve tonality you that thetiO4sy approval period in which you may protest the fees or other payment Identified
above will begin to nm from Ste data -on wtdoh the building or installation permit for this pro)eeNs assued or on wMch they are paid to the District(s) or to ano8ier public entity sulhodxed to
collect 5tsm on Bb' Dts WsXW) ba)iaif, wMeltew Is earlier.
Collector. Attacb a copy of county or eity plan check application.form to district copy for all`waivem
Embossed' Original- Building Dept./Applicant Copy - ApplicaWRecapt, Copy - Accounting
Q
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Cettificate 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.: 54-020 AVENIDA CORTEZ
Use Classification: SFD Bldg. Permit No.: 0002-098
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC
Owner of Building: LA O.UINTA PARTNERS' Address:
'row
Building Official
City:
By:
P.O. BOX 134
LA QUINTA, CA 92253
STEVE TRAM
Date: 10-05-00
POST IN A CONSPICUOUS PLACE
t..
JA14.24.2000 10=51AM COMMONIEALTM
smt# PXQMeTRD XV I
CESz000 Tram CawaY MPAMY
9949132= 91057199
W acaw= MA1L UZA 5M
5B CBM
NAIL TI d Tot
WILLIM 721MAS SUFFIh
140.753 P.1/1
�i 794.11ft-00i
GRAM UM 54 020h c012TS-Z
The undereigred gr"tortsJ declare (it) a lWEu►vA
floc M "Iry trmnet tela is
= C" ..-Uted On 1: 1 value of arty con or
Computed osf� 11_value lep0 l�ww and e�i ®0 ��inin6 at time of mal
•• UnincarparatA area: ( T City of
MR A VAL MZ MB,I0SRAT10g, receipt of which is hereby aeknowledged,
ADBSRT K LUM and $YLVIA =MM, husband and Wife ae joint tenants, = CaanwPORAAY
Hoa -
hereby NADiT(S) to
WILLIAX TROMAB au"m AM MWAAIBD MAP DHA La QDnm 9ARTNM U
the real pVgWty in the City of IA QO�i'1'A, County of Riverside4, State of California,.
described "t
T+at 24, slack 9580 VAit No. 901 Tract Banta CW=Iita at Vale Le Quints. as per zap
recorded in Book 19, Page(a) 44.45 iaclusive Of maps, in the office of the County
Recorder of said County.
Dated d8nasry 36, 2400
State of California
County of 1 8.6.
on
before rte. .....�.._.
personally appeared
personally kwva to me for proved to as au
the basis *9 satisfactory evidsrAs) to be
the person(s) whose name(s) is/era subacribed
to the within instrument and acknowledged to
me that he/she/they exacuted'the same in
his/her/their authorized capaaity(iss), anfl
that by his/ur/their signatut6(a) an the
instrument the psrsbnts), or the entity up=
behalf of URLdh the personts) acted, executed
the iasttumaat.
Xss my hand and official goal.
5fguature
WIM Tal[ a'lAT=O tot WifW= IRCMAB am=
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SUVZA MUA=
(This area for official notarial 0011)
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