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9809-268 (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 # LLic� lass Exp. Date f VDate f'Vf Signature of Contractor OWNER -BUILDER DECLARA ION ` I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: 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, 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 Policy No. ;id MM .i'' l7ND t a 0 (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 provisiorls' Section 3700 of the Labor Code, I sh 'I fo v6ate: hwith comply with tthoseYptovislofis: I I` �� Applicant 1 `"" 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. e 1. Each person upon whose behalf this application is made & each person at i 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 staie.that the above information is correct. I agree to comply&th all City' and State laws relating to. the building construction, and hereby authorize representatives of this City to en er upon the above-mentioned property for inspection purposes. 7 , Siat-re ff)wner/Ai ent) + �, �' Date BUILDING PERMIT PERMIT# '-:. DATE IJ VALUATION ,q' . SI5.70I LOT TRACT X160 t tlo JOB SITE� ADDRESS 52 '6rS A.I✓"�1i' U DA �FLA.,NC0 APN 771-;i2; 018 OWNER CONTRACTOR / DESIGNER / ENGINEER DAVID ROSS MR,L.ER PACT IC'i'KND S CON STRU('7rI NT 1719 S TRE.I IONT 1719 S T&Emomr S O(:FANSi,UIr CA, 92054 S (X';EAIUS'IDE CA, 92054 (76019GU069 CEtL.# 1955 USE OF PERMIT Si icf .i `A /til,1r DWELLING ark � ��'It%iTi'�' "DCS�.S 2J()1 tt'uC�t.U�Iv kIl.CiizIk'WAiI. �aR.1�GCrL 9 TRACT CONSTRUCTION 1:252.00 SI: PORCUMA1110 97.00 SI 4; �A[tAGMAttPt,RT 540,00 SF 6 FT. WOOD FENCES 21*100 LF TED CONT OF CONSI7UCI10N 33.186.71) .&STL PMMhr VICE SUNy gIN CON.13,TRU 1CYONFEE I01-000-4184i(,tU $IV)I.50 PL:_AN (-,-K-KX-:, FBF, tf)1-A14 6.439-315 ":87.11 1EClANICAIlt153.50 a ELECTRICAL ' 69 1.01.000- 420-0003/ arGJ. i i PLUI IBING FETE 101-(30". 1940) 3TRONC MOTION ME - RESID 101.000-24.1 d0.1Q $832 G.2r1DNNO r -M 101-=4234VO 570.OfJ 1"tJ RASTRUC'iURCFET, .2.25-000443-342 31,804.42. PRECISEPLAN 10I-000-441-34; $25.00 tm'I !?FMa!'r 101,4))439-318 4250.m S3 T, `fYi A r . c;ON911r3Cf`[(7N AND rif.gly cel rFc A: LESS Ply : M'•itD FEES Pi- - b250.Ot) NOV 091998 MIAL PERMIT FUS D�JV NOW OF LF-,,, 'RECEIPT DATE TBY' DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Jly U Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap _ F.A.U. Framing _ Z— Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Dgwall - Int. Lath17 2 Final Final - - BLOCKWALL APPROVALS POOLS - SPAS 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 // 9 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 Utility Notice (Gas) — C — ELECTRICAL APPROVAL 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: P.O. BOX 1504 Building 78-495 CALLE TAMPICO Address V �, v 1q LA QUINTA, CALIFORNIA 92253 Owner Mailing Address �'� S , �i'Q \ t--, 0 • ,J City Zip Tel. S" . C>c\Pv S. `_�i 1 fit' 1_-) Address State Lic. City & Classif. (� (.(Lic. # «� Arch., Engr., Designer Address Tel. ;ity Zip State Lic. # LICENSED CONT TOWS+ DECLARATION I hereby affirm tAl 1 -am licensed under Drovisionssof`Chapter 9 (commencing with Section 7000) of Div sion of the Business and Professions Cod , and my license is in full force and effect �1 OWNER -BUILDER DECLARATION I hereby affirm that I 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). L; 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.) 1'1 I, as owner of the property, am exclusively contracting with licensed contractors to con. Strutt 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. & 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 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., It, 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. I APPLICATION ONLY ? r BUILDING: TYPE'CONST. y OCC. GRP. A.P. Number 1 3 - 3f? V Legal Description Project Description CONSTRUCTION LENDING AGENCY I,y' -) _ Side Street Setback from Center Line I hereby affirm that there is a construction lending agency for the performance off he work for which this permit is issued. (Sec. 3097, Civil Code.) �fl' �-'� Side Setback from Property Line Lender's Name Lender's Address moi" /IC FINAL DATE INSPECTOR This is a building permit when properly filled out, signed and validated, and6,sub act to expiration if work thereunder is suspended for 180 days. �ry 1 certify that I have read this application and state that the above information is correct. ,, sS P b Date Permit 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. / Vali at d Signature of adplicant Date (W t Mailing Address J alt ation: City, State, Zip l s WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Sq. Ft. O Z Size 0 No. No. Dw. Stories Units New ❑ Add,❑ Alter ❑ Repair ❑ Demolition ❑ 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: Minimum Setback Distances: Fronfl118etback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY I,y' -) _ Side Street Setback from Center Line I hereby affirm that there is a construction lending agency for the performance off he work for which this permit is issued. (Sec. 3097, Civil Code.) �fl' �-'� Side Setback from Property Line Lender's Name Lender's Address moi" /IC FINAL DATE INSPECTOR This is a building permit when properly filled out, signed and validated, and6,sub act to expiration if work thereunder is suspended for 180 days. �ry 1 certify that I have read this application and state that the above information is correct. ,, sS P b Date Permit 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. / Vali at d Signature of adplicant Date (W t Mailing Address J alt ation: City, State, Zip l s WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION 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 Date 11/4/98 APN # 773-325-018 No. 17952 Jurisdiction La Quinta Owner NameDavid Ross Miller" Permit # No. 52-855 Street Ave. Velasco Log # City La Quinta Zip 92253 Study Area Tract # Type of Development Comments lr Lot # Single Family Residence Square Footage 1282 . s . 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: EXEMPTION NOT 'APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.93 X 1,282 or $ 2,474.26 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 Cashier's Check/David Miller Telephodeli 9`67=0069 Name on the check L = 6` By Dr. Doris Wilson Superintendent r Fee collected /exempted by Ellen Patino Payment Received 1 $2, 509.00��1.�7 - Check No \ 056945 1 Signature OTICE: Pursuant of 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 bove 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 ollect 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 OCT.21.1998 .5:41PM COMMONWEALTH RECORDING REQUESTED BY: CHICAGO TITLE COMPANY COMPANY 98,7832KC 87037785-E REQ 5NL R 0W&.D. DAVID ROSS MILLER 1719 S. TREMONT S'. OCEANSIDE, CA 92074 NO.562 P.1i1 SPACE ABOVE THIS LINE -FOR RECORDER'S l GRANT DEED ' The undersigned grantoe(s) declare w.. Documentary transfer tax is (XXX() Computed on full value. of property conveyed, or Cam Property seas liens and enctirgbrances remaining at time of sale, ( ) unincorporated .) City of . �- and FOB A VALUABLE CONSIDERATION, receipt of which .is hereby acknowledged, AT�v •RG and �7A ERG, -husband and wife9 joint .tenants hereby GRANT(S).to f I. DAVID ROSS MILLER RD MAN AS HIS SOLE AND'SEPARATE PROPERTY the real pzopert the City of LA QDINTA, County of Riverside, State of California, r' . LOT 5, BLOCK 160, UNIT NO. 16, SANTA CARMELITA AT, -VALE LA'QUINTA, AS PER MAP RECORDED IN BOOK 18, PAGE 99, OF MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA Dated August 19, 1998 State of. County of C' �Q a� o u:.l�•` On N } S.S• before me, g r 11 1%1, J. A.0 11 N 4N:ts` Q2 personally known to me (ozved to me on the basis of satisfactory evidence) to be the Person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to Tne that he/she/they executed the same in his/her/their authorized capacity(ies), and that. by his/her/their signature s) oil •the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed. the instrument. WITNESS my hand d officio eeal. Signature MAIL TAX STATEMENTS TO: d S �4� 4,1 V NGTkmV L. PUSLIC �FPrI �9�G WAS (This area for official notarial seal) RC. District P/annina 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 _ ..t o '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. AP.PLICANT:' ` PACIFIC TRADES' — DAVID MILLER'" f ' PROJECT . •, - ; , , � � ., • • • • _ � .. :• • •. ADDRESS: 773-325-018 - Avenida Velasco APN: 773-325-018 - LEGAL: LOT -5 .BLOCK 160 , .UNIT ` - , S.C: @ V.L.,Q. CK'D BY: FRID BA=. . BIN N0: 3D CASE NO -. CR .98=15 '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. �'•�r.lp►s#1'r`7A•'kiir kt ■ 7 ••.: aroa•�.wr:far•a•:;;:•:::::.: ........................•::::.::::::::::::::::•::;.::::::;:::::.::::...>:.;::.::•::::::: ... ....... ... .. .. .. ... .Case logged and number assigned Verify .legal and APN information ' �Corisistent with •MDG -on file (as applicable) APP 0V .11-14T DEPT'F MDG: filing required (5+ filings since 9/3%98) ATE Consistency with street/surrounding area: EXHIBIT Nu Colors i f Materials Architecture t : OTHER REQUIREMENTS:': J ; 12 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 1nC r Building°& Safety address _file. _ ;