0101-326 (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
Date'',Y F ! -!' Signature of Contractors
OWNER -BUILDER DECLARATION `
07W&C
I hereby affirm under penalty of perjury that I am exempt from the ContVctor'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 & Professionals
Code).
( ) I am exempt under Section B&P.C. for this reason
bate 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 i. .surance, 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:
Cartier Policy No:
STATE FUND x �f�f�Sd Cot
(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' compen sation,,provisions of rSection 3700 of the Labor
Code, I shall forthwith comply with` thoseQ-rovisions.
bate:77 * ;;'f Applicant f,». •�`� t y-
Fyi�
Warnings Failure to secure Workers' Compensatl�or� 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 forlin.Section 3706 ,.
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building'and Safe►1i_:
for a permit subject to the conditions and restrictions set forth or
application. h
1. Each person upon whose behalf this application is made & each pers n at
whose request and for whose benefit work is performed under or pursua�itl o
any permit issued as a result of this applicaton agrees to, & shall, inder I 111
& hold harmless the City of La Quinta, its officers, agents and amploy eU
2. Any permit issued as a result of this application becomes null and voiFi if
work is not commenced within 180 days from date of issuance of sch
permit, or cessation of work for 180 days will subject permit to cancellati n.
I certify that I have read this application and state that the above information
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 pro erty for inspection purposes. . Z" .
,Signature (Owner/Agent) �I"`�'°��-` Dater
•S y.
PERMIT .#
BUILDING PERMIT .';.
DATE VALUATION' LOT TRACT
131.61 T-71 6
JOB SITE s
APN
ADDRESS .°^2.760 AVRI ` A vii- .a�ARC40
a7� :`�2+�-� -
OWNER
CONTRACTOR/DESIGNER/EN (NEER
DA"M:CLOSS 1k A
PA..Cme rfw)m dWS'.i'f UCTION
17 15) n T.MMONT
17 19 3 MUMMY
S Oce0 ir, GA 92054
8 f 0-FAMDE CA 92054
USE OF PERMIT
MOLEFAMUZINVOLLWO
d-11,1 ,(MI,.
S1FL: & x tV !°,EFAIINI aCl WALL CITY STANW" a PERMIT
D0?43 NOT INCLUDE P001, OR .filli,lVEWA`!f' A}aPROA0,14 (MAZITER. OVA
TRACT CONSTRUCTION 1,391y pill SF
}
POR'C1•iWA TTO 46aco SIF
W:EdMUCrAR''t iRT (90 1k182,40
5 Ff. WSJO.0 FENC1? ly
MOW= COST OF CCS STRI it.�i�ON
1q ,g ty. p y p, �
��l'0M".f�d. A'�.CuTL !D ho"Ry
'
COMBTlitUCTION FEE 1011-000-418-000 090.00
PLAN CNEtr'h" FEE 101-00-439-318 $403.61
lEAE{34A$tllf:ALng 101.000.421.000 W,50
kE,UEC ZIC:AL YZE, 201-000.420-000 $12211/9
PLUMBING FPZ 101-000-419,000 1.a 10,73
3TITIDWO MOTICYN ME& r RESID 102-000-1411-00.0 $8,83
GRAX TAB'Cf MR " �" 1X91.0 23-000 g710M
DF. IC",F,2.0PPIR IMPACT r'1':\i $4,t30t.Uq
_
k�7b1•:C1;11:PLAN ; Z 101-000-441-3-45 1flto,tl0
101-000-439. 3 s R 4230,0
<1At�'Aki3�:"1d>9 A�J.L�''C'LM O, MI :k:
irk x
� 3;�b(i�,� �
JUL 1 LESS ;P2?,IAMED raM
4230.00
CITY OF Lk OUIftIN ,OTAL MMIM. FAWN WE NOW
I�fx z�7
Fltth1KNCE DIP,
RECEIPT
DATEBY
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
I F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final — o
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs J ) S T
(�`�—�
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
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
Final _ O
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)
COMMENTS:
0101, -132-(0
Building
Address ��_ —,;Yoe) i�Gll
Clwnar
J egse See
P.O. BOX 1504 APPLICATIO ONLY P' S
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Mailing
Address /7/9 S -
Citylzi%
Tel.
ON /ffz s1e_Jt+: (#/I, 2 05'(/ 1 '7,6U -`)G7 -d0
Contractor
City
State Lic. City
& Classif. 10 C!2 e), -3 g / Lic. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
t\ I
Lic. #
I hereby affitm that'I am licensed under provisions of Chapter 9 (commencing with Section
7000) of pivisl'gn 3 df �he�Bu3iness and Professions Code, antl my li ense is in full force and
effect. \ {,_ t; \�
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness 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
Division3 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 (8500).
f; 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. It, 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 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
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.)
1-1 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
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 it the permit is for one hundred dollars (E100) 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., If, 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
Ihereby 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 1 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, State, Zip
ILDING: TYPE'CONST. OCC. GRP.
'.Number 79 3— 32(_ —G a /
fat Description �-A
Iject Description/r•
14-
Sq. Ft.
Size
New ❑
so /_fNo. No. Dw.
% Stories Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
itimated Valuation
PERMIT AMOUNT
Plan Chk. Dep. so CIU
Plan Chk. Bal.
Const. 1
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
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 f3,&,N PECTOR
Issued by:dAN Dalte).pUT--- it
Validated by: _ '013
Validation:,
is
s
_ WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
k' Desert Sands.Unified School District
47-950 Dune Palms Road ,
Notice: " r La Quinta, CA 92253, ,-
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 7/16/01 APN # 773-326-001
No. 22259 Jurisdiction La Quinta ,
Owner NameDavid Ross Miller ` ` Permit # 0101-326
No. 52-760 Street Avenida Velasco Log #
city La Quinta `.1`Zip 92253 Study Area
Tract # B 161,U16 Lot # 26 Square Footage 1397
Type of Development Single Family Residence No. of Units 1 ,
Comments
*Received a cashier's check in the amount of $2,86300 and .85 cents.
i�. .
At the present time, the DesertSands 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`
g This certifies that school facility fees imposed pursuant to. Government Code53080in the amount of
�h 2.05 t X 1;397 „or $ 2,863.85 the property listed'above, and that biiildmg
{ ' permits and/oi Certificates of Occupancy for this square footage in this proposed project may rioiv be issud` w
Fees Paid By CC/Capital Bk of North County' J.R., Pacific Trades • Telepl iie 760-967_=0069
- 1.
Name on the check
By Dr. Doris Wilson _ f l _4 z ,
Superintendent -
Fee collected /exempted by Annette Barlow Payment Received $2,863.85
i Check No. 082794
VP w' 4
Signature': .h
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
J00 01 .11:33 FAX 17608049062 CHRONWEALTH" TITLE
0003
RECORDING REQUESTED BY:
AND WHEN RECORDED MAIL THIS DEED AND,
UNLESS OTHERWISE SHOWN BELOW,
MAIL`TAA STATEMENTS TO:
David Ross Miller
1719 S. Tremont
S. Oceanside, CA 90254
SPACE'ABOVE THIS LINETOR RECORDER'S USE
A.P.N. �: •773=326-oo1��snd 0002•" `gyp
Grant Deed
The undersigned grantor(s) declare(S):
�Z 77 0
Documentary transfer tax is $
computed on full Value of pr operty`conveyed, or at time of sale.
rom?;n,ng
V�/�G�
( XW)
( ) computed on full value less value of liens and encumbrances
( ) Unincorporated area: ( ) City of
of which is hereby acknowledged,
FOR A VALUABLE CONSIDERATION, receipt
` MICHELLE EICRSTEDT, a single woman
hereby GRANTS) to DAVID ROSS MILLER, .a married man as his sole aAd separate property
County of Riverside _
"-
the real property in the City of La Quinta.
State of Californla, described as
Lot of Block Unit No. 'Santa Carmelite a:t Vale
La ,Quinta,
orded in Rook Pages qq _ If Maps, Records of Riverside, County,
rec1A"
as per map
California
Signature of Grantor
Dated Jannar 5 ` 200
" State of California
county of ) Ss. Michelle, Eichstedt
On before me,
personally appeared
personally known to me (or proved to me on the basis of satisfactory
name(s) isiare subscribed to the
evidence) to be the persons) whose
instrument and acknowledged to me that he/she/they executed
within
the same in his/her/their author'ixed capacity(ies), and that by
instrument the person(s). or the entity
his/her/their signature(s) on the
upon behalf of which the person(s) acted, executed the instrument.
WITNESS my hand and official seal_ .
Signature m
MAIL TAX STATEMENTS TO,
Y {
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, in order to determine the applicability of compatibility issues or need to require the filing of Master
Design Guidelines by the applicant. It shall be transmitted to the Building and Safety Department as your
correction list. Please attach additional explanations as necessary.
APPLICANT PACIFIC.. TRADES
SITE ADDRESS 52-760 Avenida Velasco
' 2001-391
APN 773- 326 - 0 0`-1 'BIN NO.: CASE NO.. "
LEGAL: LOT 2 6 BLOCK 161 UNIT S.C.@V.L.Q.
CHECKED BY: Greg Trousdell 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
Compatibility Review
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:ed
�C) _ Colors
_ Materials
chitecture
A t
v
b 1p �
Commiss
O
�y G
moms
n ,Dept•. "
►C
E
Se N
N
Wit
�..•!
Gondition
Other Requirements:
WCe.rtificate of Occupancy
Cit of i A Quanta - -
y
'Building Safety Department,�o,Fti
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 fol%wing:
BUILDING ADDRESS: 52-760 AVENIDA VELASCO .
Use Classification: SFD Bldg. Permit No.: 0101-326
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC
Owner of Building: PACIFIC TRADES CONST
Buildirig Official
Address: 1719 S TREMONT
City: S OCEANSIDE CA 92054
By: KIRK KIRKLAND
Date: 11'-21-01
POST IN A CONSPICUOUS PLACE
m..