Loading...
0001-040 (SFD)iLICENSED CONTRACTOR DECLARATION 16 Cy 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 ,425381 t,Date Signature of Contractor', ; r OWNER -BUILDER DECLARATION j 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). r ( ) I, as owner of the property, am exclusively contracting with,licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). . • r ( ) 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-ihsure 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. nr� "i T`to F1r," n.-9M•"f! ,,r .t t i Li t' e, Vt.r 1 r� .(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 Section 3700 of the Labor Code, I shall forthwith comply with those provision`s. pate: _— Applicant '�Y -� �✓ - ' 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 inspection purposes. GS gnature (Owner/Agent), Date .� • • r r BUILDING PERMIT 1 PERMIT# r0ii••0a►tf DATE 1 VALUATION M1 .33-55.10 LOT TRACT IS160;� 6 JOB SITE ADDRESS 52-S95 A1V.EI NIDIA VEL9SCO APN 773-325-021 OWNER CONTRACTOR/DESIGNER/ENGINEER 1)A5 r���,1iOCC A 414100 �, ,!' • \ ,r \ 1J..1 LPlA S,�\IM �)/Ct'�`1�ifr T1I' AQ-A1ZS C.�}A1. _-,UrrirfC).4 F M \ LV l!�!I i4♦ 11♦ , 41,1 7 1719 S '.CRE:A401\r.r 1719 S 'b'IdEMONr S o(IFIANS-11 i CA 92054 S 0C.EANSIDE' CA 92054 i760y)67_(X16Q CMA 1955 USE OF PERMIT SIM31.1i: b'Aj!^ ILI' DW E,f,LiN4 P;RD - PERMIT D(Y S NOT iKUJIM,.B:t,.OM iNA+4S OR POOL MACT CONSMIVUCTJOil' 1,41-1 LA -0 SF PC:ra-te:i PATIO 56.00 SF (JARs14: WCA1tWJX1' 510.00 8E" 5 .FIr. WC") " ) I k+:Ni `f3 .Lir , p e ,I• �e 1� [y XTA.1• Aiixlla i�tA i�Yl rY ld x� M..ify tiEa:i!1?.i.fi�A.9�li �•✓.~�sS. ZY y (�.�* y�`( �,j �A+y,�aA PERM11 FY,P R SNUM1�'RAR CON St`RUC,7fION FEE 1.01.OW-418-000 V5'Ai•50 -K rmF 1-560 t2 A,N C'ia�A f �.fP'n7tArrlta\.e1A. i• j>i (�(�/� -1 /�(�(1 SF„fin w �Yi:.:�-1lfirV � 1.i+, �il�••�E.�'N11\t .G..1V.1'V l i f:�:i.tcil alt, t'i!is $12994 PLUNH3111*3FEE, 10144-419dN.)(? $110.75 'Nn., T �y c. a r :.t SiY2� Ard�.:VVI0N MI iti'-,`ttd) i(1i-t?�.�t31-fN11? k�,93 ; col_ r DING 14.1; 1.01-wo -+.?.3••0100 aid-X11,L0Ai4 2lxfrAke T FE sjl"7-w RKIEA. ISE, PLAN 101-000-441-345 $100.00 1171171 9 yV:kTJ0 tr1° 4250 On S1IR-T1Y1,A f. C. 3N41P I IUr'f(N AND a PLAN (Wta'CK S,it�i20,'7,1 LEISS P"RE-If"Ad ? ITE0 •$2:x0.00 'MfAl,.1}'ERM11' F'.F:VS DUE NOW $1,190.74 RECEIPT DATE BY'I DATE FINALED INSPECTOR OPERATION DATE I INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck 3pO Exhaust Fans O.K to Wrap - _; - F.A.U. Framing _ 1& /1.01 a__7 Compressor Insulation - its 00 Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath V- 17-40 �- 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 li Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Sewer Connection Z Pool Cover Encapsulation Gas Piping Gas Test z 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) p -d P.O. BOX 1504 Building� •� L j 76-495 CALLE TAMPICO Address -5-395 f v V LA OUINTA, CALIFORNIA 92253 Uwnert��\`, •WAS ������.. Mailing y � �J Address �, S . e, J,. V C City Zip Tel. � et mss•• ��_ q Contr for Address City lZip Tel. State Lic. I City f 8 Classif. Q2 � t Lic. q Arch., Engr., Designer Address CityI Zip I State i Lic. N I ( \R LICENSED CONTRACTOR'S DECLARATION I her. bt affir th N am licensed under provisions of Chapter 9 (comme 'ting with Section 7000) o�f Dl,vi io 3 • f tpe Business and=Professions Code, and my lican{e s ulJ�tol!c�6 and effect. ��q'Ct ` —J i K 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 thealleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than live 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 contractorls) 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 1 have a certificate of consent to self -insure, or a certificate of Worker's mpensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy o. Company [ '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: 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 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 a0plicant Date Mailing Address City, State, Zip 006 1 �d 3 Q APPUC O O y 00 BUILDING: TYPE'CONST. _ OCC. GRP. A.P. Number -17 3 - oz I Legal Description lto F ��' Iba uV iiT b ✓ Project Description IF o Sq. Ft. ' j No. No. Dw. Sizes rr Stories Units 701 IFA PERMIT AMOUNT Plan Chk. Dep. -'• BIC), Plan Chk. Bal. Const. ` y Mech. Electrical Plumbing ah j UU S. M. 1. ��� " Grading Driveway Enc. J 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 INSPECTOR Issued by: Date Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Notice: Document Cannot Be Duplicated Date 2/28/00 No. 20073 Owner NameDavid Ross Miller No. 52-895 City La Quinta Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE APN # 773-325-021 Jurisdiction La Quinta Permit # 0001-040' Street Avenida Velasco ti Log # Zip 92253 Study Area Tract # Lot # Square Footage 1421 Type of Development Single Family Residence Comments 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 1,421 or $ 2;742.53 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 Norty County/Don Rogers Telephone ` 760°:�360�- 5.53.8 Name on the checker , L 1� By Dr. Doris Wilson Superintendent1,% Fee collected /exempted by Mary Ann L. Borja Payment Received $2;74.2.53 4. l l Check No. 16982 " Signature W I C / V NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to collect them on the District('s)(s) behalf, whichever is earlier. . Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting G tea. -DEC. 21!1999 11:55AM COMMONWEALTH RRccaDue.' 1tZQft8T$D%,11y a , CHICAGO ;°ITLE COMPANY.- COMPANY 99.9423KC 970577'8 wssat RRcoxaZ - mA L TH19 aRRD AND, MILROU CTUSRW'S2 SHOWS aaLOW, D46RA,IL •TAIL, 9TAT8'MRDi'T9 TO: MICHRLLE..EXCMSTSDT P. 0. SOX 1'34• - nss�won�w .ww• annn�•.w sAn�w GRAM DEE APiit: 773-32S-021-2 �q `5 Ave JEi.A9co Tho undersigned grantor(e)`deaiaretw) Documentary tranafer tact is $14,30- (M) Computed on full value of proerty conveyed, or ( Comptated on full value Is a.liens and encumbrances remaining at time of gal®'. ( Unincorporated area, t ) City of ' and FOR A VALUABLE CONSIDEMT10N, reeeipt:of which is hereby acknowledged, MARY OWEN 13t=, AN UNMARRIED NaAN -hereby GRAXT(S). to DAVID ROSS Mnum, A `4ARRYED MART A3 RIB SOLS AND SETARAMPROPERTY the real property in the City of LA QUJWNTA, CC4Aty of Riverside, -State of California, described Apt Lot 8, Block 160, Unit No.,15, Tract Sdnta Carmeli.ta at vele La Quinta, as per map recorded in Book 19, Pages) 99 inclusive of maps, .in_ the office 'of the County Recordor of said Qoumty, Rated Decenber al, 1999 ;. State of California County of ) S,S.- GARY OWEN SUNK On , before me, " pers.ontally 'appeared j peraonally.known to tie (or proved to -me on the basis of saciefaotory evidanc'e)• to be the Person(s) whose name(@) is/are Subscribed to the within Instrument and acknowledged.to '. me that he/she/they executed the same in his/her/their authorised capacity(ies), and that by his/her/their eignature(A) on 65, instrument the person(s), or trio entity upon behalf of which the person(®) acted, exacuted • the instirument , , WITNESS my hand and official seal`. ' Signature (This area for official notarial seal) MAIL TAR STATEnwTS TO. r �( , 7/V ' d l 198 ON ��j;i��n �1Jlllr�cj f4J71 i � 666� 1'v 080 j4A( m . , . • ;. _ .. ... •. . . • - e���cr��z� - •. READ • RC District -Planning Re Fie W &rm This form is to be used by CDD staff for review of single'fiamily,dwellings.in the RC (Cove . Residential) District, in order to..determine the applicability of comp atibility.issues or -nee - to require the filing of Master, Design Guidelines by the. pplicant. It shall be transmitted to Building & Safety'as your correction list. Please attach additional explanations as necessary. APPLICANT: PACIFIC"TRADES PROJECT ,# . ADDRESS• 52-895:: Avenida Velasco • t , AP.773-325-021 r i r. LOT . 8 BLOCK 160 'r ;UNIT 16 S:C. @ V:L.Q:: LEGAL:. _- - „ CK'D BY. ` Greg Trousdell •CHECK DATE: BIN NO:... 2� {CASE NO. 200_0=178 Inform the assigned Building,; planchecker .uppri:.your_assignment to this case. The CDD Executive Secretary maintains a -log book to track applications and assign case numbers. The. zoning code, architectural and landscapfing manuals, .and/or assigned inspector should be consulted where uncertainties arise. The completed checklist shall be mamtained-in t Building •& Safety address 'file.