0005-163 (SFD)LICENSED CONTRACTOR DECLARATION
*1 hereky affirm under penalty of perjury that I am licensed under provisions of
�pter 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
+2$3 1 k• 07/31/2(
/Date �i"'Signature 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). t.
( ) I, as owner of the property, am exclusively contracting with licebsed
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.
( ) 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 STATE FUND Policy No. 1280990.00
(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 Californias and agree that if I should become
Abject to the workers' compensation provisions of Section V60 of the�Labor
VI1Code, I shall forthwith comply with those provisio s.
I/ Date: `' � t+. 1 '._ '�
�� Applicant '�'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 f! or,insp� ection purposes.
Jl
Vignature (Owner/Agent) Date , G //1
��;��'�a BUILDING PERMIT PERMITN
DATE VALUATION LOT 00()t' 16'3 TRACT
t89,123M
JOB SITE,'
; ADDRESS i 1 AY=DA vu."co
APN -I-' 3 - (3r f _0
03
;' �
OWNER
CONTRACTOR/DESIGNER/EN (NEER
DAVW MUJIER
PAM, C; TRADES 00R3TItiIG 0kT
1719 3, TREMONT
1719 a 11W.6(ANT
00"SIDE CA 92US4
8 UCEAN'M.DE CA 92054
(760)967.0069 CBLN 1955
USE OF PERMIT
81NG FI FAkZLY DWMIMO
SPV-P iRMIT DOKS NOT YNCLUDE 8J.0CK WALL OR POOL UOT 15
BLOCK 16 flFSFRT CiesJB UNIT alb
TRACT CONSTRUC'T101) 1,421,00 3F
PORCHMA'TIO 33.00 BF,
0A1tA0fJCARPORT (M 91$00.00
3 FT, WOOD FENCE 200.00 LF
il:bi'J!`.ClitU1ixD con of cons trC".f om
89,12JW
PERbPT Fn SUMMARY
CONSTRUCTION FEE 101.000.418.000 $5".50
PLAN CHECK FEE 101-000.439-329 $55.07
MECCHANIC:AL FEE 101 -OW -421-000 $60A00
ZLICTRICAL FM -101-000-420-000 $129.0
PLUb118INC1 li 101.000.419.000 $110'An
GRADINO ME 101-00"23-000 $70.00
DFVEI,OPYI;R IMPACT WE $1,907.110
PRECISE PLAN 101.000-441-345 $100.08
FEE DEPOSIT 101-000-439.318 4250.00
STIB-TOTAL CQNWRiTCTION AND P%,AM0-1?C;'K
$3,421.56
LWS I&PA.ID 1M
4250.00
TOTAL FN I4 !'i` B ]IAT NOW
$3,171X36
1
RECEIPT
DATE
BY/
DATE FINALED
INSPECTOR
l.-
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
S
Ducts
Slab Grade
_
Return Air
Steel
Combustion Air
Roof Deck
-4X7
Exhaust Fans
O.K. to Wrap
3- Qp S1
F.A.U.
Framing
- 6TO
Compressor
Insulation
p —Gid 7
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
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
Heater Final
Water Piping
l9V
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
pts
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) _-
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE 77.3-/3
. #
Date 5/26/00 APN #
No. 20483 Jurisdiction La Quinta
Owner NameDavid Miller Permit #0005-163
51-590 No. Street Avenida Velasco. Log #
City La Quinta Zip 92253 Study•Area
3
Tract # Lot # J16 Square Footage 1421
Type of Development Single Family Residence No. of Units F
Comments
At the present time, the Desert, Sands Unified School District aoes not couect rees on garages/carports, covereu
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 1,421 or $ 2,913.05 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 Check/Capital Bank of North County _ukTelephone 760-967-0069
w.
Name on the check
- -
By Dr. Doris Wilson, �-
`� fyJ,
Superintendent
Fee collected /exempted by • Mary Ann L. Bora _ Payment Received =`$2;913.05
1
Check No. 17921 -
Signature It_
NOTICE: Pursuant otAssemb . dl 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 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 Distdct('s)(s') behalf, whichever is earlier.
Collector:• Attach a copy of county oi• city plan check application form to district copy for all waivers.
+ I -
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
t -
MAY.26.2000 11:52AM•'` COMMONWEALTH NO.464 P'.2i2
TO 5E A TAUS RND 00
RECORDING REQUESTED BY:,, CO
copy OE THE WOOL .
CHICAGO TITLE COMPANY COMPANY
9930KC 207056303' v
ENN . , �E&,"
W116NL O� R g i q N' LA7 EES-COIAERLTH WIND
DAVID ROSS MILLER
1719 S. TREMONT
S. OCEANSIDE, CA 92054 SPACE ABOVE THIS LINE FOR RECORDER'S USE
APN: 773-134-003
GRANT DEED 51-580 Ave .VELQsco
The undersioned grantor(s) declare(s);
Documentary transfer tax is $16.50
(XXX) Computed on full. value of property,conveyed, or
( ) Computed•on full value less liens and encumbrances remaining_at time of Sale.
( ) Unincorporated area: ( )r City of and
FOR A VALUABLE CONSIDERATION,'receipt'of which is hereby acknowledged,
FRITZ�B. BURNS FOUNDATION, A NEVADA NON -STOCK, NONPROFIT,' CHARITABLE -CORPORATION
hereby GRANT(S) to,
DAVID ROSS -MILLER, A MARRIED MAN AS HIS SOLE AND SEPARATE PROPERTY ,
the real, property in the City of LA QUINTA, County of Riverside—State of California,
described as;
Lot,3, Block 51, Unit No. 5 „ Tract Santa Carmelita at Vale La Quinta, as per map
recorded in Book 18,.Page(s) 63 inclusive of maps, in the office of the County Recorder,
of said County.
Dated May 5, 2000
'State of,,California
County of LOS ANGELES } S.S.
on May 18, 2000
before me, L.J. RAWLZNSONr Notary Public
personally appeared.
JOSEPH E. RAWLIN,SQNAnd
W.K. SKINNER
personally known to me (or proved tome on
the basis of satisfactory evidence) to be
the person(E) whdae name(s) Mare subscribed
to the within instrument and acknowledged to
me. that �/they executed the same in
their authorized "capacity(ies), and,
that by bd*XWtheir signature(s) on the
instrument the person(s),-or the entity upon,
behalf of-'iihich the person(s) acted, executed
the instrument
r,,gTTiESS my hand and official seal.
Signature
MAIL TAX STATE ENTS TO:
Y
FRITZ B BURNS FOUNDATION
A.NEVADA NON -STOCK, NONPROFIT CHARITABLE
9
NaWe/Tiltle. Joseph F. Rawlinson,
esident
BY.
411�;IXAIC-�.0m.
Name/ it K. Skinner, Secretary
f �1 A��MI� C�pU1Mr ,
(This area for official notarial seal)
1
1
o
+ �Iiyp
1f •, :tc td'. , if
cc
u ac
-F.40 Quinta,'.-
I N,
OWAA
rt m,
Of
f5uildin a d 'i I S11
n,
r This 'Certificate issued pursuant; tq;lthe_iequirements of Section 1.09 � 6f the Uniform Budding Code,
certifying that, at the time of issuance, ,'this. structure was. in coro/iarice� with the various ordinances
of the City regulating bud/ding.constiuction.or use." For the fo/!®wing: _
BUILDING ADDRESS:',.:_,yr Y '' 51-580 AVENIDA.VELASGO
Bldg.
Use Classification: ' SFD Permit No.. 0005-163
Occupancy'Group: 'R 3 of Construction: VN Land Qse'.Zone: RC
.• ..
Owner of Building: DAVID' MILLER' ,�� ' Address 1719 S. TREMONT
i City: OCEANSIDE, CA .92054
,. ;.. By: STEVE TRAXEL
-7 6 `: Date: 09 ,14=00
•
Al
Building Official
.,+ Y POST IN A CONSPICUOUS PLACE