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9904-135 (SFD)LICENSED CONTRACTOR DECLARATION Tn I hereby affirm under penalty of perjury that I am licensed under provisions of F— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and 04 W Professionals Code, and my License is in full force and effect. O =) co License # Lic. Class Exp. Date W � l2.i3$} 07/31/201 t- Z �at' a ( Signature of Contractor � J �``� �' '�+� co0 J U OWNER -BUILDER DECLARATION W a 1 -hereby affirm under penalty of perjury that I am exempt from the Contractor's U) 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). Cl) () I.am exempt under Section B&P.C. for this reason L N Date Signature of Owner - O rn U Q WORKER'S COMPENSATION DECLARATION ct �` Z cc I hereby affirm under penalty of perjury one of the following declarations: O ; () 1 have and will maintain a certificate of consent to self -insure for workers' LL11LL compensation, as provided for by Section 3700 of the Labor Code, for the Qperformance of the work for which this permit is issued. n Q U ( ) I have and will maintain workers' compensation insurance, as required by j U Q Section 3700 of the Labor Code, for the performance of the work for which this l a)Z permit is issued. My workers' compensation insurance carrier & policy no.. are: _ Carrier Policy No. cc). tii T.A T'Ii 11I,ti}� 17?l`3`jfl C) (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 lawsV California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor 3 C de,•I sha I fcrt�with comply withi host roviSID S. 1te: r 1pplicani: r 1 Warning: Failur to secure Workers' Com sensation 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 City to enter upon the above-mentioned property, for inspection purposes. ` { vSig' nature (Owner/Agent)�Date BUILDING PERMIT PERMIT9y{14-135 DATE VALUATION S91.29LOT 10 TRACT f3-29, w AiODDRESItE S 7.r7'lj�.l<a� f#� �:1�IDA CORTEZ APN 773-152-022 OWNER CONTRACTOR / DESIGNER / ENGINEER PACIFIC 1'II,� D S Cc)N91MUC'1'ION PACI1�IC'i RA)ES C(3Nti17RUCHON .1719.81"FIEA'1.09F 1719 S'T'RI nota S CKCHANSIDF CA 92054 S CUIII.AiNsf DL CA 92054 (76OW67-0069 CST.# 1955 USE OF PERMIT S NOU Fi-W1Lt' D0'4'Ii.f:iNO S1•D - VFnfff 00013, NOT I Cl.UDE BLOCK WALLS OR PO4L f it 712AC T C.0NfM1Z1Ju 10 1 1;175.Tt0 S11 PORCIiJ AT(O 96.00 SF UA.H.A(i1•i,CARPt1RT 46..3.04 S),, t' FF. W4x'iD tiNt:L HOW W L tf;*s'iTi39r ET) (,'OS`!z' CI CON';; kUCT€ON PERMIT I='.rR: SilMMAR CON`'n?UC110N1-HE 1014)0-418-000 Sbf��.5�► Pf.A"N 01-TlZC44 VtT, 1014910.43Q -111A x5119'kl ITE. DEPOSIT 101-000-09.318 4250M Nilte:.i v`fCAL ,h.f%, 1161-600-421-W) di.fil.1 i11.K 1RICAL F1 -..r3 .101. -CM -420-0W Si24. v 111.1 TkIni'140 f: ftY, 71% !;TR ONG' NVO'r.10141 1:1: - RrA."; T` 1.41.000 z1}-000 59113 OHA( Nf klHE i01-000-423,1'100 $20010 iNi,T(JV'fi;WY:'•I•riiWFEE 2254 M!44*�-02 $2,(Axi.26 ss1?1%nN I011 -010 -"l -,14i $iisoW cr 012VOTnt, f"'f_►N8`1 RT .TI0N AND IIIA 1 CSI TI F' $3.561 R,. 1'.KI~ PAID FLUS 4750.00 '1'tA'A14 FSE RM1'1' FKV.44 009 NOW $3,51 on RECEIPT DATE By �`": ✓ DATE FINALED INSPECTOR INSPECTION RECORD 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 Exhaust Fans O.K to Wrap F.A.U. Framing ��� Compressor Insulation _ L— Q S Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wali Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath T Final Final o BLOCKWALL A PROVALS POOLS - SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final 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 '" o Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) !D ELECTRICAL APPROVALS Temp. Power Pole - a — Underground Conduit Rough Wiring Low Voltage Wiring Furfures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) 0 2 S COMMENTS: I-R3� P.O. BOX 1504 APPLICATION ONLY Building V C [ '^�� `� .t 78-495 CALLE TAMPICO Address `V LA QUINTA, CALIFORNIA 92253 Owner Mailing j BUILDING: TYPE'CONST. f 01- GRP. Address t 1 tiM J �„ A.P. Number 2 v ZZ i City Zip Tel. pc\A� StD `, �t'?OE`1 - vvnaraa.�i ��D Address State Lic. city & Classif. 6,ql�3&-1 I Lic. # Arch., Engr., Designer Address Tel. CityI Zip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE 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 permit to construct, atter, 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). C11 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.) I1 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 contractors) licensed pursuant to the Contractor's License Law.) C) 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. 0 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.) I certify that in the performance of thg 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 wfth 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 1. 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. 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. mentioned property for inspection purposes. Signature of a0plicant Date Mailing Address City, State, Zip Legal Description�- Project Description L r Sq. Ft. �t f '1 (•� No. No. Dw. Size 1l 1) Stories Units New ❑ Add O Alter O Repair ❑ Demolition ❑ I T03 -124 Valuation PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS a-625-- AMOUNT 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' a+ Date Permit Validated tkTy Validation. wt�.t`� `s�•��' v`�s 4 WHITE = FINANCE YELLOW = APPLICANT , ` PINK = BUILDING DIVISION - r: Z • 0 Ci —1y OF: I_A r)p IINTA �APR 30 RECD � CUD®sir ct o`��laFn�'iiny Review Form __Il! 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 applicabitity 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: PACIFIC TRADES PROJECT ADDRESS: 51-935 Avenida Cortez 773-152-022 APN: LEGAL: LOT 10 , BLOCK 29-. , UNIT , S.C. @ V.L.Q. CK'D BY: Greg Trousdell BIN NO:. CASE NO. 99-65 CHECK -DATE: Inform the assigned Building plan checker upon your assignment t this case. The CDD Executive Secretary maintains a log book to track applications and assign case numbers. REQUIRED ITEM Y N COMMENT/CORRECTION .....::.+ •: y.: •. as . .. ... :..+ • +.... .... .,� �.,..; ...{: +'••vt•:{: 't'vnW+�..{,YXi:\h?+s..`+}\\2.•.+�y;Q;.\\ti\a:ii{n`:::T\+.jti+'<ii>:v.'j:.;5}''ti''t•':ii+7'2.+.:+.':q�\+•a h?a v��::iV:.+::.•}j}n'k*3tii):}:4+;}i�:i}"i.\,;,:\.',•....•�+••E'\k?naa'aa,4l.'?.aa.�{\>�i vi:`�k\\;: \i :'42Q:•}Yih+y+�+¢•M1.h\.+ \\ kN��nrn::h,+,:.a'4i+n,: +. .. ....... a y...\;\`}oto .+aa, +\� \, :ti^Y' ,:Q+aw•. {: 4 �. }4\ }i\O�a\+�{� i. �` ::A�: sLl?3.ii9Pl?c`IIE['TIcE`c ;'::+. • y 52\:a:Y•S.::i?:%.iiar.:;7:•�:C: {.at++•n: o+:,K :,•�, ii:+,a++.ti.�{,+'^4 ti �.• h2 '�c. vh �a••'4�.}:%ti \\ 4:i .�:Y}�<?1:}+:.:: >f{�},,•1,',+. }:\\Y.•.. 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 Materials Architecture LAQWM N OTHER REQUIREMENTS: V BY OMMUNITY DEVELOPMENT DEPT VMS. The zoning code, architectural and landscaping m'a be consulted where 'uncertainties arise. The, complete6Affibli) li�nll hp -mnilatsiged An the Building '& Safety address file. Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 4/30/99 No. 18655 Owner NamePacific Trades Construction No. 51-935 Street Avenida Cortez APN # 773-152-022 Jurisdiction La Quinta City La Quinta zip 92253 Tract # B29, U2 Lot # 10 Square Footage Type of Development Single Family Residence Comments Permit # Log # Study Area 1,475 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 1.93 X 1,475 or $ 2,846.75 the property listed above and that building: ' permits and/or Certificates of Occupancy for this square footage in this proposed project ma A-6 Fees Paid By CC/Capital Bank of No. County/Pacific Trades Cons Telephone ,; Name on the check a By Dr. Doris Wilson Superintendent t` Fee collected /exempted by Juanita Green Payment Received $2,846.75 Check No. 12971 Signature NOTICE: Pursuant of Asse#ly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from a date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to collect them on the Dislrict('s)(s') behalf, whichever is earlier. Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting 11 rnRPR.14.1999; 1 3:07PVP tOMMONWERLTH 'ORANC-E COAST TITLE CG,-' RECORDING RZOVESTED 9Y, ORANGE COAST TITLE COMPACOMPANY 99,8483KC R-05238-1 mms SRconmp MAIL TSIS DNRD AD1'D, VD=ss OTiiERWIS$ SBCW4 SUM H=j, TAR STATMUMS TOA DAVID ROSS MIb,LER 1719 S. Tremont S. Oceansides.CA 97054 PHA Nu, dull SIU 3SS1N0.872 P. f/1 ul/U1 IJI ozv 1917 GRANT DUD APHs 773=152-021-5/773-15 The undersigned grantor(a) d$%l�%P )I Documentary transfer tax is (XXX) Computed an Pull value of pas•operty conveyed, or ( ) Computed on full value less lxens and encumbrances remaining at time of sale. ( ) Unincorporated area: ( ) City of and FOR A VALUABLE CONSIDUATION, Teceipt of which is hereby acknowledged, JAMES D. HOWARD, M,D., INC., MONEY PURCHASE P'ANSION PLAN Q hereby GRANT(S) to JDAVID ROSS MILLER, A MARRIED MAA AS HIS SOTS AND SEPARATE PROPERTY the real property it the City of LA QUINTA, County of Riverside, State of California, described amt LOTS 9 AND 10 IN BLOCK 29 OP SANTA CARMELITA AT VALE LA QUINTA, UNIT NO. 2, AS PRR MAP RECORDED IN BOOK 18, PAGES 5S-56 OP MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA Dated February 19, 1999 State of Cal.." -Ilk Cou t j S.S. OA befo personally known to me (or proved to me on the basisf satisfactoryevidence) to be ' the person() whose name ) &%-subscribed to the W, hin instrument knd acknowledged to that w executed the Ame in authorigQd capaci ( )r and that byW'sr¢titrlr'ei,ggature( on the instrument the person), r the ntity upon behalf of which the parson) acted, executed the instrument. WITNESS and official se Signature MJ►.I,L TAX STATMOMS TO SAME, AS ABOVE JAMES D. HOWARD, M,D., 1MC- MONEY PURCHASE PENSION PLAN Na Title BY Name/Title ioSHARON COBURN Commisalon 01167021 z Nolgry PulAr - CoOfwn(o g Los Angeles County - Ny comm.0gVlfes Jqn 1,2 (This area for ofi'icial notarial seal)