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r 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
1- 'Professionals Code, and my License is in full force and effect.
License # . Lic. Class Exp. Date
425381 1B
DateMtSignature 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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O 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.
�,1 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 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 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 provisions
Warning: Failure to secure Workers' Compendion coverage is unlawful and
shall subject an employer to criminal penalties andcivil 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 ona 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, indemnifyF
& hold harmless .the City of La Quinta, its officers, agents and employees:
4.2. 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.
Signature (Owner/Agent)L � 1<C� r ' ` *\ Date'-,
V.
4\ • J 3 '
BUILDING PERMIT PERMIT#
' (j7
DATE VALUATION LOTTRACT
.— $91,638.7{1 (�'(' 1. 9 131X
JOB SITE —' APN
_
ADDRESS •.1_915 AVKt-J-I);)A CORi"fL7, '� 73- t�z•�1`�Y1
.
USE OF PERMIT
CONTRACTOR/DESIGNER/ENGINEER
.P Ac,,,iL•nits'vt.a.c
1719 5-.1"etElblvNE'
S OCEANNSWE CA 92054
('760)967-0066) 011.1! 1955
SWC -18 FAtylx.i.`'r' DWELL,TI` O
,5 iD-11i+.lia IT WES MDT NCLUDE t`3J'.00K 1aJALL OR POOL
TItACT CC,N113IRttCTei.N 3,475.00 S1:`
PGRC:IfiPA.1'IO 58.00 SF
UAl.+.AC-1 lC:ftiRPi.; WL' 463MU pit•'
5 F11. WOOD FENCE 200,00,LF
E= I MATED COST 0.UC:'ltZ'STRI Il -7 10 -NI
(II'A Nil T FITXNUNIM ARV
Ct7Id.S^1'RUr f ION PC•:l;
101 -OW -418-000
$6(63.5(6
(11.A.Af C,W-'CK F
((j9-(if)f)-d't4 •
$,Sl4. W
wi7i��t!�'�fts•'iti��y Xt��y�,.�.1^«�>��fs
l U!-,1�1�0q�6'7� ^�992p�t}-(1!{l��tyl
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t �,� "�! V6F' �i•L\7�llLJ
e��c.6��r�i.5�(!?�
.D L.BFl.J9
t �l.t:ilT�sxt• i� C?ti'
1111-�20t1••d i 9=t1i11?
$1'�:3.5tr
�a �6anfcaVICY17TOWf�17 IF_raESr►► Ills-tl0rt-��I»f►fffl
v,rf
GRAD t`t401,4111
I'M.
NWRASf.Fti1CI't✓R.a FT -,8
22.5-C3t`lM04431-342
s ,i►"..216
€ARK_ i8F-P.LAN
$25.(1('3
F141, 0FPOA11r i
10] .-WO-119-MR
47-50,00
RE-11AH.) FE 42500)
IPT . ( DATE,/ BY j'` DATE FINALED JINSPECTOR
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 B - f -
F.A.U.
Framing Y F
Compressor
Insulation Q
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath 2a
Final
Final 1 00
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 —28— 57
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas) QrJ
ELECTRICAL AP ROVALS
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
UH14 Notice (Perm) �y
COMMENTS:
.
.. „. -.. -. r. ^.��.n.-�r. _ , -,�-• r`Y-.rti..,—......-.w...-�t,�,..-4,c;::. ���7y.�,�._.�.j�l...-`+-..�..-r•".'`t.,f"'r.�,S^..-.r'�3.�w-wti�µi^..[`.-'ti.-r .:..:��y��:��=y,,,�- �.�.--.-+�+..
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P.O. BOX 1504 APPLICATION ONLY 0,� S
Building J 78-495 CALLE TAMPICO
Address / 11;�_ILA QUINTA, CALIFORNIA 92253
Owner t
" ci [IQ S S
Address
City
Contra' t�or
���1f t�
Address
City
P0 \ it <t, fL,
'AJ..)
Zip
Zip
BUILDING: TYPE"CONST. OCC. GRP.
A.P. Number -)-)3 1 t 2 ` v> 1 " `a
j—
(�
.,,Legal Description w T I , 1 V
Project Description . r - V`) .
BA1. )Cel rrzC d -0,-R.?
i
Tel. ,
State Ljc.I
" C8 Classif. � � ,
City
Lic. q
Arch., Engr.,
Designer
Address
Tel.
City
Zip
State
Lic. #
y rLICENSED CONTRACTOR'S DECLARATI$'N
I herebUaffir that I am, licenced under provisions of Chapter 9 (com encing with Section
D00) of ivisron cf thkBus(Ress and Profusions Code. and,jnytis nse is in full force and
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
peril to construct, after, 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 thealleged exemption. Any violation of Section 2031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
I-1 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 l 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.)
17 1 am exempt under Sec. B. 6 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.)
I certify that in the performance of thF 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 or Exemption you should become
subject to rhe 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 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 -of this city to enter the above-
mentioned property for inspection purposes.
Signature of a0plicant Date
Mailing Address
City, State, Zip
9�
Sq. Ft.1 U No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter 0 Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.' —�
Plan Chk. Bal. 1
Const.
Mech.
Electrical
Plumbing
S. M.I.
Gradina
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
I Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
4
FINAL DATE IN�S7C- R
a
Issued by: DaePermit 1 it.
Validated by: APR 2 6 1999 *�
Validation: _ �I J
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
CERTIFICATE OF COMPLIANCE
Date 6/4/99
No. 18854
Owner NameDavid Miller
No. 51-915 Street Avenida Cortez
City La Quinta
Tract # BLk 29, u2 Lot # 9
Type of Development Single Family Residence
Comments
APN # 773-152-021
Jurisdiction La Quinta
Permit #9905-197
Log #
zip 92253 Study Area
Square Footage 1475
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:
Add. of Sq. Ft. to New Construction
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 1 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 Pacific Trades Construction
Name on the check
By Dr. Doris�W-I'J.sb11111
Superintendent
Fee collected</Exempted by Julie O'Neil
Signature :`66
Telephone
Payment Received
Check No. 13500'
$2,846.75
NOTICE: Purs of Assembly Bill 30811(CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identifiedbove will beg to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
RC District Plannin+�► Review Form
3g
This form is to be used by CDD staff for review of single family dwellings in the RC (Cove
Residential) District, in order to determine the applicabitity of compatibility issues or need
to require the filing of Master Design Guidelines by the applicant. It shall be transmitted to .
Building & Safety as your correction list. Please attach additional explanations as necessary.
APPLICANT: Pacific Trades
PROJECT
ADDRESS: 51-915• Avenida Cortez
APN: 773-152-021
LEGAL: LOT 9 ,BLOCK 29 _ UNIT , S. C. @ V.L.Q.
QVD BY: Stan Sawa
BIN NO:. CASE N0. 99-63 CHECK -DATE:
Inform the assigned Building plan cFieckef upori your assignment to this case. The CDD
Executive Secretary maintains a log book to track applications and assign case numbers.
REQUIRED ITEM
Y . N COMMENT/CORRECTION
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};?}%}.}A'•:;};!::A\.:.::v.Irv:A:;:.t•\,..:...::..r...::'•.rS?}.y?M}:•}::?1:Yin:!'•}:?!:i:.}• :$::;A� \,}::.}:. ....}qtr%i�''\\\::<�•'nLi:'\\\4 nh�::?:}1�iK?�{nS:;ri:twti:;\�':L•'?;:{ti':`,v}'aa�'a
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Case logged and number assigned
Verify legal and APN information
Consistent with MDG on file las applicable)
MDG filing required (5+ filings since 9/3/98)
Consistency -with-street/surrounding area:.
Colors
Materials
Architecture
v
®a
OTHER REQUIREMENTS:OCII
O�
.The zoning code, architectural and landscaping manuals, and/or assigned inspector should
be consulted where uncertainties arise.. The completed checklist shall be maintained -in the
Building .& Safety address file.
Ac,r,.20. 1999 7:39AM POWER BROKERS
'ORANGE MAu i ► iTLE uL--�
afto=COST TMS COMIAMPANY
99,8483= A-1751381
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DAVID AGES NZIA tR
1719 S. TCM":
s. Oeeanefder aA 97054
No -0116 P. I
-r,-ozoo17 GRAKDE�D - 1 -DT --9 5i -Q15 Corz
The undersioned aator(e) d% (a)I
Docuarenta traniler tax ie convoyed. or
(SUCI ated on full value of prmrty
I i Hain tea
aoan full Value lease, no and euuadtrances remainieg at Cime•aandala.
ated aseaa t )t► of
FOR A VAUUMS �198iA1sMTi01t, receipt of which to hereby aeknowladged,
JAMt39 A. ilO=. , 1t,D., ZNC., mm FaRams pmm:ox PLAN
hereby WAST(S) to
DAVID Ao9S X%ZJAR, A VJMM MVA Af M SOL" A'M 63PMM PRA1BITY
• the real property in the City 09 Lh Qt m*%, Comty of Riverside, State of Ceiiforal.al
described as i
a AND 10 = BL= 19 OP WrA CMMM AAT VALE LA QDAPAI, UNIT No. 1.
\�\l A9 12L 1(AP RECOM D IN soon 281 PANS 66-66 08 Wad tt8Q0 S oP PIVSRSIDB
COIC1Pf'1f, CALIPORNIA
Doted Yebraa:lr Me 1999
state of CalR re
beta=
t
01f
� pe eo�� l appease
personally known to pt! (or proved to to GA.
the hula f 6atasp amral► w}dance). to be
,ubscr�
the psrtoa f 1lhase Sam+ ) fie
to the ri�1► iaatrttmsnt uknavledged to
that �Shs44bW executed the eme in
autbarimed aspaoi (N), and
that by �m mi
iQtiacure { oa the
inotrumat the peraoa�@ f, = the tity upon
behalf of which the p4 =s ) acted, aleaolleed
the inetsumnt.
lggggg fficial se
Signature
Om TAX pwkIMONpB sot AM AS ASM
Jam D. gplowD, m'O., Me.
we itis
I
Same/Title
9HMON COIYRN
CommlsslenYt16�0a1
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ux ArSSIM Courtly
Mvcan�n.a�itet Jen t. y002
('11+is area for official Mterisl eeall
U
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 regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification: SFD
Occupancy Group: R 3
51-915 AVENIDA CORTEZ
Bldg. Permit No.: 9905-197
Type of Construction: VN Land Use Zone: RC
Owner of Building: PACIFIC TRADES CONSTRUCTION
Building Official
Address: