9907-105 (SFD)' LICENSED CONTRACTOR DECLARATION
=Thereby affirm under penalty of perjury that I am licensed under provisions of
A:hapter 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
67
,pat" e ` Signature of Contractoi'a''�; I
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).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business A. -Prof essiona.1s
Code). =
() I am exempt under Section B&P.C. for this reason w
Date Signature of Owner '
WORKER'S COMPENSATION DECLAII'ATION'
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 Policy No.
1'/t'?•11 f1'Yi"t♦"tai i'�a.t •'pa t.
(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
subjeci to the workers' compensation provisions of Section 3700 of the Labor
tCode, I stall fo hwith comply with ,those provisions.
ate: r f�` Applicant t / t
Warning. Failure to secure WorksCompensation 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.
%Signature (Owner/Agent)�r �t /�.1lir DatefAl � )
' f I
1 1
PERMIT +�i17-�Uti�
BUILDING PERMIT
f
_
DATE 1 VALUATION ..it3.«'int LOT • 'it "' TRACT'
I-% ne?Ile,C,JOBSlfEJ
4ADD ESS OL -.k141 ii'►• V4 ..1..04k i�2'_.i, i.�l,` i
APN ! I.�•rtr:-Ii1JC�
OWNER........
CONTRACTOR/DESIGNER/ENGINEER
' i 'f^1 i.t -•t A i71,�' >t if .•
r.., . Jr•
t A f'�i.` f''t tis 1;' E"{y: �ti11i :ti f `Y: 11.7`'tl'iJ t'T' ;t+
d. ,. ♦ ,, +.ian••. •.ii ,t n.t�t.r.e t•..yr �� � +�
14t1�i�1i1t2W%.}fix
:1-�='•{114.\•iSC•t11„t/fit,/k1t11V,l.A
-M-ZZ1J4%Zi,.iRii
i..111,lt.:it'`+'I?v {.'.A 14.1 11y3
I.,t4_i„tt_1N't'at t.A
cf31,ti i I t,%
USE OF PERMIT
:,,' i • P-43411vii'i' U*OES:�;��.i .iii i.t::i? BJLCtt K WA6, OR. PO,i i„ 't �tN CiiUCK
t• i;i; ��ra�c Ie;;t,t � •� -,.,., f. t ,� it•�t,N; �'lt��f * a:;:�utztvt..�, tJc• :�,�tvtt: l'i;�t� '��•�=t:.
te�aa. gsi..i'Nt .. .,i
1 'i L\i91.•£ 4'•1tv..•1,i�1-!',. f. 14.1/3 t.11+(t.l.l• aL'
•_ tS��i.tit.sr;iC:t\tii':,.13C'i'-►h..�ls! �1
PT. w1iiit)
Y+i WWltif A'C4.'il "IV 11• flit` I`Yl""•lTit'7•f7tdif••'t°illh+ `
a. a,f. A.i i \ X'�i� �,a,. J,s 1 hJJ! y. l..A h,q • i.lNl1. h •.,111
f►'Y ►tip C1114'.
lJSJ.S.�,•JAr
i* IN' •{;f t()f-41tIt)-•%iii-{ttii! sty5.:,5lt
t#.At�t t"l:(Ff"t: t,S%1� 41t{.!h}!}-.lZtt-'il1•C Rt^f2 u7
"T{
k aT •r.s tirira;c +•, ve• £{ti xLit 1'11 f7[�� t•t•. rug
Ik aJ;.�• lar°i2JY•,. i Il. • L:ii l.at 17{II,J r :: ?.)•l :p 11 !•+l
=.�
� },
_a
+•
C. 0-, k 1,2 Ai. FI E1111. }3s)il •)'1i► -0...3t""!
{'!.iiR�1��•f't•.t: i{)-{ii_'£►_/}t")-i)caf! ;1;i3:i.�t:
trs 4.��",
r)N. ri K40110W PT 14 tltV.14ift3 f{ti_{ (10-n2t-f}t)t 10 1;
t;;; L.)iB;t'S ;'''r'; aft: •l.fUli .i<3•f?f1«} �::{! i;n
��S +` R '
7'1<f;t.liaiS9a1./'.IV 14M-a-•Wi-4•.l�
'a
! it IMt
- �•��t11.,����
•�` Ill'• ity}k.i`tff f � -1 �ci.,.a �"7. 1 t � .-�•�,�.i
, A�yt�Vf•ICtx�i�s�tiit.5}ttt+�'ii+'HF S`tiK}%'fMi
...�
Nf la1_•1l•-fi'A1. S-'{ *JS%-1+df'r l'WIN AS!f11-11,AW 014PT'Ic
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
A* INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
11 -Underground
Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
l 2, oa
F.A.U.
Framing—)
— oo
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
y. / —oa
Drywall - Int. Lath
Final
Final OL7 4
BLOCKWALL PP OVALS
POOLS - SPAS
Steel
Set Backs
da 'b7
Electric Bond
Footings
Main Drain
Bond Beam
/_aZ _ �O
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
7-
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
L— 7_ d m %7
Encapsulation
Gas Piping
Gas Test
`
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APP OVALS
Temp. Power Pole 2"!O-0® 5 7
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)
COMMENTS:
• .,-..� -.- v.ix''..i::r;, n,�`:.x+�'^++��i"��7`rJ�'ew�«-...._...._ .^v'l.wr.--.�:.��-�.� Yxer .'7.tn,,,,,,,.-,i`...J�.L.::r-.�';�^""�•-�,+�--r ^ Z..�,�..'...v.i7.•«.rv•..;'jL^.!+-ti...�:-�..-•.wi..-•..-'..T•�:.-+.r-r-.-".:..,.�.,. -.-_�
0�6/0v/ • ,
P.O. BOX 1504 APPLICA O LY -5
Building n, 78-495 CALLE TAMPICO
Address ',J -Y O�SCO LA QUINTA, CALIFORNIA 92253
Owner 1 \
�301 L IL BUILDING: TYPE'CONST. OCC. GRP.
Address
Mailing 5l 1 R .UfAC%A0 .i �,,Qt•y �/��„L�. A.P. Number Qiv5 colo
Cityp Tel.
f ^ Zi �GT put, ! Q \�
Legal Description T IL• !T5
Contrac or Cl
.� IL
State Lic.I City
& Classif. Lic. N
Arch., Engr.,
Designer
Address —Te I.
CityI Zip I State I
Lic. q
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
DATE
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractors 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 to a civil penalty of not more than five hundred dollars ($500).
C-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'1 1, 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 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
Cl 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 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.
Date Owner
NOTICE TO APPLICANT: 11, after 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 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 sof this city to enter the above-
mentioned property for inspection purposes.
Signature of a0plicant —Date—
Mailing
ateMailing Address
City, State, Zip
Description
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
tstimatea valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOT.
REMARKS
AMOUNT
t
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setb ckfl``'�om�3er Line
Side Setback from Propertyll�ifie
FINAL DATE
AwPO"
Issued by:
— Date Permit
0 ^
Validated by:
° [n l w a
vu
Validation:
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
Date 12/28/99
No. 19852
Owner NameJack Clark, Jr.
CERTIFICATE OF COMPLIANCE
APN # 773-265-006
Jurisdiction La Ouinta
No. 52-370 Street Avenida Velasco
City La Quinta zip 92253
Tract #
Lot #
Permit #
Log #
Study Area
Square Footage 1506
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
1.93 X 1,506 or $ 2,906.58 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 CC/Valley Independent Bank/Jack Clark, Jr. Telephone''�-60; 564"35'1-11
w~ -
Name on the check
By Dr. Doris Wilson t r
4
Superintendent
Payment Received
Fee collected /exempted by Olivia Aguirre $2;9ffE:5r8
.-
Check No. 209506
S
Signature 4/n4::
NOTICE: Pursuant ot'Assembly 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 the date on which the building or installation permit for this project is sssued or on which they are paid to the Dishict(s) or to another public entity authorized to
collect them on the Districl('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
Recording Requested Bv,.
'CHICAGO TITLE COMPAwY
• RE=CORDING REQUESTED BY:
CHICAGO.TITLE COMPANY "COMPANY
99.8•i55KC 97056128
WHUNL 0 H R A SwND LOW,D'
LA STTS.:
M $ U PAGE. SIZE !DA! �N-OR
JACK L. CLARK, JR:
54-350 AVENIDA'HERRERA
LA QUINTA, CA 92253
A I R L L - COPY LONG REFUND -NCHG EXAM
U .. vv t 7 WRN: i - �r
64 GRANT DEED
The undersigned grantor(s).declare(s):
Documentary transfer tax is $13.2.0
(XXX) Computed on full value of property'conVeyed, or
( ) Computed on full value less liens and -encumbrances remaining at time of sale.
l ) Unincorporated area: ( ) Citv of and "
FOR A VALUABLE. CONSIDERA'iN20N, .receipt. nf v.hich is hereby acknov:ledged,
MARY KATHRYN HAYHOE, a married woman as her sole and separate property and MARTIN J.
REIMERS, a married man as his sole and separate property as joint tenants
hereby GRANT(S), to
JACK L. CLARK, JR..,.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. 6 . OF B`LQCK 85, O? . •SANTA CAMJELI'j'A..AT 'V $ LA QUINTA, UNIT • NO . 10, AS SHOWN
BY MAP ON FILE IN BOOK 18, PAGE 70 OF MAPS, RECORDS OF RIVERSIDE
COUNTY, CALIFORNIA
Dated April 28, 1999
NQv ad _.
State of Ca4iE r0. rri
County of Lo0.Sh02 } S.S. MARY KATHRY YHOE
On Jur1Q 3,194q .
before me,Q��YdY//�j/�b�l _ C
PAULLA M. JACKSON personally appeared ^^ARTIN J.n, bi RS
MARTIN J. REIMERS.
personally known -to me (or proved to=me on
the basis of Gatisfaccory:ev'idence). to be
the person(s) whose name(s) is,/are subscribed
to the within instrument and acknowledged.to
me that he/she/they executed the same in
his/her/their'authorized_capacity(ies), and.
that by his/her/their signature(.$) on the
instrument the person(s) , or the entity upon...........`..........................................M..JACKSON
behalf of w , i he. erso ,3 PAULLA
h . Ctl t r�(s) acted... executgd :. ..NotaryPublic,- State of Nevada :tj.•i,,,�;t,�-,.' ..h 1,':•1,�.j,.;:::�e+i� ..
the instrument. AppoirI6!'tRec6rdedinWesiioeCounty
g`
No: 9&4349.2 - EXPIRES JULY t, 2000
WITNESS my hand and official seal ,...,...• ..........................
99
Signature (This area for official notarial seal)
MAIL TAX STATEMENTS. TO:
I IIIIII IIIIII II 1999-316464
III IIIII VIII illlll IIIII III VIII IIII IIII 07/15 2of 39 ' 00R
00
0
RC District - Plannino Review Form
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 Iist..'Please attach additional explanations as necessary.
APPLICANT: Jack Clark, Jr.
PROJECT
ADDRESS:
APN:
LEGAL:
CK'D BY:
BIN NO:
52-370 Avenida Velasco
7737265-00.6
LOT' 6 , BLOCK UNIT i o ., S.C. @ V.L.Q.
Leslie Mouriquand
CASE NO. 99-89 CHECK -DATE:
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
.: x;:,:::•>. .'•>x. "C: �,•,.• ' x>'•c: taxi':: tiC;;'.a� w't:;R2?�:\:;�;. •'.�+:0.'�3.\:ti S:A.:�kp' . vbt i 4�4•'`:?:+�`itT:?i:?Fti nvti:�i`v+�? �: h,Y "t:; .: �1•
i��:r,?nt t\ \c
'�.'; ... r'' }>• •. \.wk E \: )••w:ih xa.`.i,;\�.,;)�4;a,ti Q: \.K;h;`.; 4•�'N'Z;C "'•'�"'94'j`'i??<C•�,�`,r:C.�4m
•j'.1 �/�: ]� '• Q' �c: ?.:r�:•�. .•:Y.::\:}.i{?M1:vii)Ci?.:.:.....•.4.?,YF:>{k\?;\..
'V.sfF7.•:17i•�k..:a:�T7ii:�:F.>nv: :.:.'•.. '.F.T�,::> .. •.a.
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.)
q
7'�7 41
Consistency---With-street/surrounding area:.
Colors
Materials
..Architecture
L
a
OTHER REQUIREMENTS:
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.
CITY OF LA QUINTA SUB -CONTRACTOR LIST �1
JOP ADDRESS-' __ _ .. PERMIT NUMBER OWNER_ BUILDER APC -4.
T i orm shall be posted on the job .with the Building Inspection Card at all times iri a conspicuous place.- Only,persons-appearing on this list or their employees are authorized to work '
on this job. Any changes to this list must be approved by the Building -Division prior to commencement of work. Failure to.comply- will result in a stoppage of work and/or the voidance '
f mit • For each applicable trade all information requested below must be completed by applicant. "On_ File" is not an acceptable res • onse. t
o building per
,..,..:...::......,.r.:..........
....... ... :..: ... ,.:�
.Contracts):.:....:...,:........:..... •...........:....
:.::::......:...:
•......:r�::...,:.. 'Conbeclor:s tscense .. ....,.,
..... Siaig .................. ::
:;::.,;:,:.;,;:�...:.;.:• �:::`sNork�ers.Comperi5etioti:�fnsurbnCe.:•.:�':•`; .:..:..;:.::;:;:::;::.:.:::�::
�•:
:::..:.•,�rC ni�ss�lice.n
..., .
:. :...............
•:. ,....
....:•rade. 1. Classrficatlon., :
Company Name
Classification
License Number
Exp. Date
- Carrier Name
Policy Number
Exp. Date
License Number
Ixxxx} '
Exp. Date
Ixzlxx/xx)
le.g. A, 8, C-81
Ixxxxxx)
t+cxlxx/xx)
(e.g. State Fund, CalComp)
{Format Varies)
txxlxx/xx)
EAttTHWDRK`:tC= zE =>
C-oQES Cx a%o o �`
G t
c t ()60!5'
1. 4i�
oL_r(_- � L- ftCi t_c`-
IL
NW C 5 t4 -So 3-ivo
d
�<:.::
.:..........::...:.. :::>:;......,...
CONCRETE:a)C$Y:"`'`.``:':':;
_
2
JI'olp 3 5
{t SD 00�t0
i.-t�fcrs Esatir.�
NW C L4a)t+63
3
f �
FfiAMiNG (C 5�
Ar M-Cpt1��4 vGTtO►S-
C.tO
+ �?g-�ol
Z-29-
N► ��?. c£-fJtVRIf .l l,S..-
'WO -V2493
a'i,�1ir' ?
r
P uwnelNY3�casf
M. O-ALVIN
C_ X
5 4-
Q 31
SrtriTi� l~ut.ID
1090�7,t -,_`tt X
3-1-qq
t3t-'i
-
l ^1S OC
iAtH::LAS7ER;C-35]:`
MA tetAywRll
—7
0
v,�*—-'(t0'=Zto4=�%,�,
% E
A �. �
C2 Cq C
-N-5i
i 31 p
F¢s:Monrr 1�rDEt+►. '�
wN 48- (�3�b-il - 04-
to -b
.
►.� 80
1- -00
ttiv�C ta; Ol t>>
i
�,
C 2c i`
�}-$ 9 fob
31
ia:r`:a IIL"
1� -si CN_�an1� %1 N
l�O�) 2-1_x"'.
O t kM 0 2
`l 9+
_A
7t,4.4 tv
; t Q -
'v..:.. gl.;:
Et ECsIRICAI 1!✓ S di
(i l O.
4-81
���a
Lt Fo2uli! l W p;WA.
W en it �'1 i7 � X
� l � l -(o
.� .
.:;.`;
aoorwc:vc9l
_ ALi
C�
(0 3 iO 39
8'� oU
. -
'10 s,
V1. �siCo
_:
t
w"C �.s 4o s
5
` - s
:...'::::...)..:..r.., .. ..
t�.t rJn evs x
c
g 1
`7'3`7 �
5 3 i -
�- '� Vy N�
Wct tx783'7-74-
►M .0 on�:.ic::z :;; r
M C'1 C3
St^tivAGE<IISP d,2 •.
.'i.,�-sri`.:'.;;.:: 'n>:< `sY:
:PAiFT!NGa�Is2
�1
'
�V�
�V! �U
VIOII I/�
/�
0111 Vim•
;cEnnii ::s
sln,v o a
g
�' W1 8 o
} I o 06-
f
i�
Oo
:FENCINGaCr #: y
N
.::::�� ,�
P rt .'�c:- x<�;.
Ll4ND$CA 11 G ; '2 i•.F ..
C ¢"T
S L 34x1
4 30
. F:
. w G t�1 ';i; Q -3 5
Ar
Certificate -,of Occupan
cy
City of La. Quinta'.
.40W rM
IV-
Building and Safety Department^oti
This Certificate, issued pursuant, to the requirements of Section 109 of the Uniform Bui/ding 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: 52-370 AVENIDA VELASCO
Use Classification: SFD Bldg. Permit No.: 9907-105
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC
Owner of Building: JACK CLARK JR. Address: 51-220 AVENIDA CARRANZA'
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 06-14-00
Building Official r
POST IN A CONSPICUOUS PLACE
I