0111-044 (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
774397
Dat Signature of Contractors,
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, a0ld 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.
Se( ) I have and will maintain workers' compensation insurance, as required by
ction 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 STATE FIND Policy No. L06-802-91
(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 Sect'ofi'3700 of the Labor
Code, I shall forthwith comply witli those provisions'. 1
Date - Applicant . r .. 1 - f f ?! .
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 City to enter upon
the above-mentioned property for inspectioq.purposes
., r 1 ,-/,,
Signature (Owner/Agent) •'�^ 'S-� �` �� f� Date/t_/,, �I
r
- -` BUILDING
DATE qq % VALUATION SSqgj 0 LOT 4 TRACT BLK 3 U2
it �/ t •
JOB SITE
SS 41^3 67 CAT-LTEH10,11iD
ADDRESS .
APN
OWNER
CONTRACTOR/DESIGNER/EN &NEER
V,1". Sij:4?��:s:1L iB: , INC".
2 �v0 CY:13C.A.GO AVE BT'3 r,,Y=
"748,18 VVI M? WA'*' IML 12 �
RIVERSIDE M 9.71507
PAL -M DPSE3.6 CA 9, 2255
(760)77 3.3111 C11T20 Z9.4
USE OF PERMIT
-P
Sl .) -1 1" 23.ItdANTRk BA -1. )PUkr,. QT OCA ?JUT INC;iwtli:lE UWCK.'
WAWA POO -1, ORA 0 DRDiEWA't`APPRCIA.fiff
TRACT COMS'TRUCTION !'sonero'-F
:OCIVIpA..I'as�39.00 Ny
OARAGWC.AP;PORT 463,00.11F
_i5'+.0.�XFS7x�.s.3A' i.�Ki:J�i. 0A)+in.`{cJ2Ti S.i.-%iUC714. N
CONSTRUCTION FZE 101-000-41"00 9412.50
PLAN CHECK MEE
MtCHANTCAI, FEE $00.00
0111fx7 101-000-420*000 $131.30
NAYMB INNOT?FXI 10'1.OcM419.000 WOM;
S3'RnmmC3' owl101-000-241-000 3I.3t
C4Txs'DIM0 .T;411tr 101-000-423-000 $20,00
t1Y_-%°7�1,0P1!1i .-IMPACT FFM $1,907.00
PJAEC.ISu. PLAN 10.,,-000-441-345 $100100
i!)?T' D,>;',rt".IM'1 2O)•i0O� 4239-318-3a�n:OQ•
CIITCKx,�4:u�t,3'j
LESS PM8,+1AXD.V11T, 8
nFr 19 200
-V;50,00
{ ay
y �• �r MIS
S '. ..." �.1 Of u��3.RdY.SIr w1` I ��b7�. o
CKYO911,PLAWNTA.
r
�1�'L� �i �i
5YK^a14.p'1
RECEIPT
DATE
BY! �'
DATE FIN ALED
INSPECTOR
J
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE.
INSPECTOR
BUILDING
APPROVALS '
MECHANICAL APPROVALS
Set Backs
—0
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
6 --
Exhaust Fans
O.K. to Wrap
l 02
F.A.U.
Framing
Compressor
Insulation p Z
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall insulation
Condensate Lines
Party Wail Firewall -
Exterior Lath
2
-
Drywall - Int. Lath
2£s p ?—
•
Final -
Final
POOLS - SPAS`
BLOCKWALL
APPROVALS
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 T
Final
Electric
Waste Lines
Water Piping
_
�� 7J
Heater Final
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
Appliances
Final
COMMENTS: ,.
Final
Utility Notice (Gas) ,
ELECTRICAL APPROVALS
Temp. Power Pole
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)
7
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Building
Address ✓ ""�C
Owner
W Q ��2✓ t.`i2�
Mailing
Address 186c)
rty Zip
C�� 99ntractor
Address
City
T4t�p
P.O. BOX 1504 APPLICATION ONLY
78-495 LA QUINTACCALIFORNIA 82253
Avv�r3EJ�; c GlcbcQ PxIvk�,
cc BUILDING: TYP—E''CONST. OCC. GRP.
v�• A.P. Number
T I.
Legal Description Z� • I%� I/� 3
Project Description
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I 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, 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
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 toa civil penalty of not more than five hundred dollars ($500).
I-! 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, Bulsness 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. It, however, the building
or improvement is sold within one year of completion, the ownor-builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
I'
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
doesnot apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
11 1 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
F1 Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
fThiS section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of lhP 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, alter making this Certificate Of Exemption you should become
subject to the 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
ame
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 applicant Date
Mailing Address
City, Stale, Zip
REMARKS
Sq. Ft.
Size 1 YQl
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Rear Setback from Rear Prop. Line
?z'
Side Street Setback from Center Line
fi
Side Setback from Property Line
s
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
t
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
?z'
Side Street Setback from Center Line
fi
Side Setback from Property Line
FINAL DATE
Issued by:_
.Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT
4 -
INSPECTOR
Darnnif
.. r
PINK = BUILDING DIVISIONo
:1: r
rya,
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 12/18/01
No. 22769 Jurisdiction
Owner NameW/R Enteprises
No. 51-316 Street Calle Iloilo
City La Quinta zip 92253
APN # 770-165-002
La Quinta
Permit # 0111-044
Log #
Study Area
Tract # BLK 3 U2 Lot # 23 Square Footage 1501
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 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
2.05 X 1,501 or $ 3,077.05 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 Cash - Ed Whitson Telepho..6 909-779-6000
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Payment Received $3,077.05
Check No. N/A
Signature%(/'vI.CliLL
INOTICE: Pursuant of As mbly 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 I
above w 11 begin to run fr 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 Dis ('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
"1
11/13/2001 14:03 9097794723
oeiv f' o i : nr LAdt-mit I ;!7 AU;
RECORDING RMUF.s1'ED l3Y
American Title Company
AND WHEN RECORDED MAIL TO,
W/R F-Merprises
1860 Chicago Avenue, Ste. G.7
Riverside, CA 92507
A.P.N_: 770-16,;402,0 TRA -7-020
WR ENTERPRISES PAGE 02
7607732819i OCT -26.01 11:51AM; PAGE 111
`Spave Above This Lift fur Recorder's Use Only
No.;'H' —14-40 EscroW No.: 01-1950-sE
GRANT DEED
THE UNDERSIGNED ORANTOW) DECLARE(s) THAT DOCUMENTARY TRANSFER TAX Is: COUNTY 30
J ) wmputed on full value of property conveyed, or
JJJJ Computed on full value less value of Inns or eAcumbfaltM remaining at time of sale,
unincorporated area; ( X ) City of La to , and
FOR A VALUABLE CONSIDERATION, Receipt of which is hereby acknowledged,
Ramona R. Morales, Trustee
of the Morales family Trust
hereby GRANT(S) to W/R Enterprises, a General Partnership attd Allan M. Gold, an unmarried man
the following described property in the City of La Qulnta, County of Riverside $talc of California;
Lot 23 in Block 3, Unlit No. 2 of the Desert Club Tract, as per map recorded in Book 6, Page(s) 2U, of Maps, in the Office
of the County Recorder of said County.
Ramona R. Morales, Trustee
of the Morales Family Trust
Ramona R. Morales, Trustee
Document nate: Wober 8. 2&01
STATE OF CALIFO lA )ss
COUNry Op
On �C-r'e [,ri v R. I before ton,
Personally appeared per
and scally 6lgenown to the (a he/sd to me an Iha basis of U0911a��a)ry CVWClle@) to be the PeMn(s) whoW name(S) is/are subaaribed m rhe within Ig6ttumcnt
a,ai aoknuwh�lged m and that he/shelthay executed the sawn: in hf1/11W(heir autholized capaelty(lrat) and that by his/her/d)elr signJknJ th w the instrument
the peraon(a) or rho entity upon behalf of whh:h the pernon(s) acted, eAewtW doe utstrument.
wtTNess my hand and�io
Signature�,,�/''��
ROSEt1 AWE V MOR= Thla ore, for offfow notarial xcal.
OLD,
~
lNail Tax Statements to; SAME AS ABOVF. or AddrLss Noted llelow
RC DISTRICT - PLANNING REVIEW FORM
This form is to be used by CDD staff for review of single family dwellings in the RC (Cove
Residential) District per Section 9.50.090 of the Zoning Code. Its purpose is to determine:
1) that the proposed house design does not duplicate the same architectural style of any
house within,200 feet of the applicant, and/or 2) if there .is a need for the applicant to file for
Master Design Guidelines. If the applicant does need to file a Master Design Guideline, please
transmitted this information to the Building and Safety Department as part of your correction
list. Please attach additional explanations as necessary.
APPLICANT W/R ENTERPRISES
SITE ADDRESS 51-316 CAlle Iloilo
APN
770- 165
- 002
CASE NO.:
2001-582
LEGAL:
LOT
23
BLOCK 3
UNIT _ 2
CHECK AND APPROVED BY:
Michele Rambo
S.C.@V.L.Q.
DATE: I SDI
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
Verify legal and APN information
Consistent with MDG on file (as
applicable
I
MDG filing required (5 filings since
9/3/98)
Architectural variety within 200 feet of
the surrounding area:
Colors
Materials
-� - Architectural design features
IN�OEQ�
QME
V��g`i C�M pAZE
RO
x.
V
8
CPSE N
x
Other Requirements:
JOHN H A C K E R-& A S SO CIATE S
CONSULTING CIVIL ENGINEERS • SURVEYING
January 14, 2002
City of La Quinta
78-495 Calle Tampico
La Quinta, CA. 92253-1504
ATTN: Building & Safety Department
Re: 51316 Calle Iloilo
Legal Description: Lot 23 Block 3 Desert Club Tract No. 2
Gentlemen
This letter shall serve as a certification stating that the grading of said lot has been done in
accordance with the approved grading plan.
Our office conducted as field inspection of this site and found that the pad elevation was
constructed at 101.9 and the approved elevation for the pad was 101.95. This falls within the
tolerance of standard grading practice.
Sincerely,
r�n 'V
;,42YTO
ti' EP Z
H. Hacker R.C.E. 14614 %0 101 4
Exp 3/31/05 ;y,?'. 3.31-05
CIV 1�
r` F C
JHH/sbg
Xc/file
0
68487 E PALM CANYON DRIVE • SUITE 44 • CATHEDRAL CITY, CA. 92234
(760) 324-0216 FAX (760) 321-5701
ILIEHDGL WIEHUunlu9 OH@,
January 23, 2002
CITY OF LA QUINTA
BUILDING DEPARTMENT
P. O. Box 1504
La Quinta, CA 92253-1504
Re: 51-316 Calle Iloilo, La Quinta
To whom it may concern:
You are hereby authorized to duplicate the approved set of plans including Title 24 and truss
package as required in order to re -issue the.original lost set of permitted plans.
Very truly yours.
LENP VENTURES
.P V nch, II ,
President
APL:ag
Enc. t
-14
i P. O. BOX 450 * LA QUINTA * CALIFORNIA * 92253-0450
760/564-1866 * FAX 760/564-2627
18-495 CALLE TAMPICO
LA QUINTA, CA 92253
(760) 777-7075
APPLICATION
FLOOD PLAIN DEVELOPMENT PERMIT
BUILDING SITE LOCATION
FLOOD ZONE "AD"- DEPTH 1
COMMUNITY- PANEL NUMBER
/
li. � _ l'0 / (O
060709 0005 B
Map Revised: 8/19/1991
APPLICANT INFORMATION SECTION
APPLICANT NAME
�` .
APPLICANT
C'L"e_",L yo Atv-e,
ADDRESS�c�lJ�Slf2�
(MAILING ADDRESS, NOT THE BUILDING SITE)
DAYTIME TELEPHONE NO.
G�'� � 60o
INSTRUCTIONS
1. A Flood Plain Development Permit is required by LOMC Section 8.11.040(A). The Applicant should complete the
Applicant Information portion of this application and submit it to the Engineering Department along with the
required documentation noted hereon at the same time the Precise Grading Plan is submitted to the Building and
Safety Department for plan checking.
2. Documentation required for STEP 1 OF 2 APPROVAL prior to receiving clearance for Building Permit issuance
• Copy of the proposed Precise Grading Plan for review and approval containing all information required by
the checklist shown on the back of this application.
3. Documentation required for STEP 2 OF 2 APPROVAL prior to receiving Flood Plain Development Permit approval.
Note, this approval occurs after forms for the lowest habitable floor are set and before the Building & Safety
Department authorizes foundation construction.
• Submit a completed FEMA "Elevation Certificate" form to the Engineering Department.
• Submit 95% relative density soils compaction certification to the Engineering Department.
STEP 1 OF 2 APPROVAL
STEP 2 OF 2 APPROVAL
The Precise Grading Plan submitted for this application has been
All requirements have been satisfied. This Flood Plain
reviewed and found to contain all data required to satisfy the
Development Permit is approved.
requirements of LQMC 8.11 The proposed dwelling is eligible to
receive a building permit upon satisfying all other Building &
Safety Department requirements.
� d
A THORIZE SIGNA URE D E
La Quinta Engineering D artment
AUTHORIZED SIGNATURE DATE
La Quinta Engineering Department
FILE: Upon Step 2 approval, original goes in "Flood Plain Development Permit" file; copy goes to Applicant
F090 REV -2 7/00
CHECKLIST
FOR
PRECISE GRADING PLANS
IN "AO" FLOOD ZONE
1. Prepare Precise Grading Plan in accordance with Checklist for Precise Plans
and the following additional items. '
2. All elevations shall employ the NGVD-29 convention.
3. Show and label elevation of "High est.A djacen t Grade" next to the building
footprint. This refers to the highest existing natural grade next to the
proposed building prior to constructing the elevated the building pad.
4. Show and label the "Highest Existing Elevation on Lot"
5. Show and label the "Lowest Habitable Finished Floor Elevation". Note,. this
elevation shall be at least ONE FOOT higher than the "Highest Adjacent
Grade" elevation. .
6. The following grading note shall appear on the plan:
All fill material placed under the structure shall be compacted to
ninety-five percent (95%) relative density.
F090A
10199
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