0106-012 (SFD)`LICENSEDE'CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing. witWSection 7000) of Division 3 of the Business and
Professionals Code, andimy License is'in full force and effect. -t
License # ' Lic. Class Exp. Date
Dat �� ` Signature of Contractor
P
OWNER -BUILDER
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 stru.~ture 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
d hereby affirm undectpenalty: of perjury one of the following declarations:
() I have and will maintain'a certificate of consent to self -insure for workers'
compensation;'.:as provide&forty.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.
IMMIT
(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' compensate. provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: 'AriDlicaat
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, damag"es 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, anVf@teby.,authonze representatives. of this City to enter upon
the above mentionedgperty for in peefio urposes.
r• ,
'�
Signature (owner/ t'j�.� � -' - /at
e
PERMIT #
BUILDING PERMIT.
DATE / �' �! VALUATION LOT TRACT {,
JOB SITE �� - -
APN -
ADDRESS '
2w910 WMM)A. VW_.1tA99C0
773-326-039
OWNER
CONTRACTOR DE '
RANDY
LEG -14 ("y R(s`IVL'P S
-7750,ADAINO 1ff� '?38
79.555 GUAR -0 ROJ1 D
1A QUWA A 92253
L. Qi TA cA !922i:5
(760)56.4.7820 CSW .
USE OF -PERMIT
S, • Pl&RUI T DOMNM TR4t'LUIkt; BLOCK WALL, POOL OR it?78,'lirrWiAY '
APPROACH. (98` UMS TER .MA.)•JBIJ P1:AH)
TRACT t:ONUTRI.MMON I;M.00 SF
POR.CHIPATIO 46.00 ,"ar
0ARAO �,lt:AaiP(' RT 00) 9,564.60
5 ?T. WOOD M14CL 200.00 LF
00"HOTRUCTION .FEF. 101-000-416.000 $5i1109
PUIN CHIECK Mt, 101-000-439-316 0�56.I6
URC?r4,i<L1.,iTC..+AL V912. 101 -000 -421 -OLIO $62,00
i. CTRtl �Ai. FEE l 01-000.420-000 $120,94
P 13MOD40v M. 1.01 -OW -419.000 $122,75
S CBS.t`:N0 Mi0T1HYN M. , R&STD 101-000-241-000 $,10.89
ORMWO FEE 101.000-42.3.000 $20.00
tl'E'tlt't, op 1mJi%cr Vim $1,907.00
PREMBF, 101-000-441-345 3100100
M,ZDZPOuXT 101-000-439.318 415009
D1.2
PRE -PAID �
4250,00
J U N 1 3 2001 1, PKRbgr FEFS DVEMW
0,320.
CITY OF LA QUINTA
FINANCE DEPT
`
RECEIPT
DATE /v4BY
DATE FINALED
INSPECTOR
i.•
INSPECTION RECORD
` OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings/�
ca
Underground Ducts
Ducts
Slab Grade
'1
Return Air
Steel
1 Combustion Air
Roof Deck
_
e— (
�'
. Exhaust Fans
0. K. to Wrap
O (
T
F.A.U.
Framing
8- 2* at
� C
Compressor
Insulation
49- 3p, p
—j
1 Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
_
Drywall - Int. Lath
FinalI %?/ _o e ( Si Z ,
BLOCKWALL AP'P'ROVALS
Final
POOLS -SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping.
/
t'3 0I
Heater Final
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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole a o
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) t f-- B /
' i.=..+�'*��cy�''=Y^s"��,'1�''='�vFT.-+A'�,��::;y,;;:;,,'`+��4'."-^�.:..a+/v-.'.i.li-�:•t-�r=•�,.�"'w•r:~.r'i`+1'+�.�`%'{�``; "�"�'-.{r:,s�'�r.ji;•
.� c —Q
o�b� t!'�ftiGv
r / P.O. BOX 1504 APPLICATION NLr
Building 5 �. I V VA/ j'� S /'� 78-495 CALLE CALIFORNIAO
Address --// �/ V t / `t h�CJ LA QUINTA, ORNIA 92253
Owner
(ZAW bq #Wau
-tu Mailing BUILDING: TYPE'CONST. OCC. GRP.
Address /-^}(,� � r A.P. Number / 73 3R6 — p "I
' Zip
v 7 r!A/ �by 7�V Legal Description
,Y u__s Project Description
State Lic.City
& Classif. , Lic. #
Designer
Address Tel.
City IZip I State I
Lic. #
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.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
Ihereby 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
mr
peil to construct, after, improve, demolish, or repair any structure, prior to 'Its issuance also
requires the applicant for such permit to rile 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 or 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 live hundred dollars ($500).
E-1 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, 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
0r improvement is sold within one year or completion, the owner -builder will have the burden
o! proving that he did not build or improve for the purpose of sale.)
I II'
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. O 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 ($100) valuation
or less.)
I certify that in the performance of lhp work_.for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: I!, alter making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above.
mentioned property for inspection purposes.
Signature of
Mailing Add
City, State,
Sq. Ft. / (,ter No. No. Dw.
Size i b Stories Units
New O Add O Alter ❑ Repair ❑ Demolition ❑
ESUmatea Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
AMOUNT
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side?—e ba�fr'om�ropef4y-L4Re
FINAL DATE N$PECTOR u
Issued by: Date Perm
Validated by: JU V, AY 1 5 2001
Validation:
CITY OF EA QUINTA
FINANCE DEPT
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
CERTIFICATE OF COMPLIANCE
Date 6/6/01 APN# 773-326-009
No. 22094 Jurisdiction La Quinta
Owner Name Randy & Sharon Bills', Permit # 0106-012
No. 52-910 Street Avenida Velasco Log #
City La Quinta Zip 92253 Study Area
Tract# BLK161U16 Lot# 18 Square Footage 1,788
Type of Development Single Family Residence No. of Units 1
Comments
I,
t
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered
patios/walkways,rsidential additions under .500 square feet, detached accessory structures or replacement mobilehome's.
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
0,1;This;certTies that+school facility fees imposed pursuant to . _ Government Code 53080 in the amount of
2.05 AX. -1,788 or $ 3,665.40 the property listed above and that building
L
permits an&or Certificates of Occupancy for this square footage in this proposed project may now be issued
Fees Paid By CC/ East West Bank - Sharon Bills Telephone 760 564-7820
Name on the check,
By Dr. Doris Wilson
Superintendent �••• - _.
Fee collected /exempted by Paula Ruiz
Signature 1
- r
Payment Received $3,`605,40,
Check No. 2340498
VOTICE: 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
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 Distrlct('sj(s j behalf, whichever -is earlier. fit; r s
Collector: Attach a copy of county or city,&k check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant- Copy - Applicant/Receipt Copy - Accounting
9
SPACE ABOVE THIS LINE FOR RECORDER'S USE
'fie undersigned grerteor(s) d Iere(s): A.P..N.: 7713-326-009
Dot;untettt4ry transfer tax :1s S 2 7 . S 0 City tax $
( X3§ computed oa Rail -value of prop—orty conveyed, or
( ? computed on N)) value less velue of liens or encumbrances remwAing at time of sale,
( ) Unincorporated area: (xx) City ot_-_L, __S3tTIN`TA .and �� is '�` �.;."
FOR VALUABLE CONMI)IcRATION, receipt of which is hereby aeknowle
F,f► L B. HILL AND ALMA B. RILL, l3B� AND 97-6 AS 70111T TENANTS
hereby GRANT'S to
RANDY C. BILLS An SHARON BILLS, HUSBAND AND WIFE AS JOINT TENANT;
the following described rest property in the City of LA QUINTA
County of R -MR SIDE , State of Callfornia
LOT IS OF BLOCK 161 Alt' 'UN7T NO. 16' SANTA CA1 ELITA AT VALE LA
QUIkITA, AS PER MAP RECORDED IN SOO' 18. FOB 99 'OP IAP>;, iIa I'NE
OFFICE of THE COUNTY RECORDER OP SAID COVNT"Y.
DATE: February 26, 2001
SPATE OF CAI. ORNIA )
COUNTY OF
Onbefore tt �J,t�1/�
8"Mitey kwjtrtai rite (or proved to me on the basis of s
tory evidence) to be the p non(s), whose nmm.(a}4st'�'.�"
scribed to within instr>nmgnt aa4 ac led me that
o7ll Y tlzecute4 the sante: bi Ww/, uthoriud
capacftyian�Ute'dl,the
by hisser air ure(s) -on the instru-
nttnt the pens the entity upon bebatf of watch the per.
sons) acted, ez0 instrurnettt,
WITNESS my and official
r••
Signature
/.
Td4-K60
BETTY S. KM""'l
ay
:omm. B 119114 r�
NO"ARY PUILIC • CALIFORNIA �l
Monterey Gaunty
Mr t:omm, ex roe VAY 2,1Qor
(This area for ottic;si notarial seat)
dvvli ti141 1i r4d, rill
i t
RECORDING IEQUESTED BY: '✓
STEWARTTME OF CALWOAMA. INC,
J
WHEN RECORDED MAIL 70:
Dir. and Mrs. Randy C. Bills
47750 Adams Street
'
i
j
La Qua.nta, CA 92253
•
i
ORDERNO.`507176593
ESCROW Y0. 4 0-0-3 0- Bx
SPACE ABOVE THIS LINE FOR RECORDER'S USE
'fie undersigned grerteor(s) d Iere(s): A.P..N.: 7713-326-009
Dot;untettt4ry transfer tax :1s S 2 7 . S 0 City tax $
( X3§ computed oa Rail -value of prop—orty conveyed, or
( ? computed on N)) value less velue of liens or encumbrances remwAing at time of sale,
( ) Unincorporated area: (xx) City ot_-_L, __S3tTIN`TA .and �� is '�` �.;."
FOR VALUABLE CONMI)IcRATION, receipt of which is hereby aeknowle
F,f► L B. HILL AND ALMA B. RILL, l3B� AND 97-6 AS 70111T TENANTS
hereby GRANT'S to
RANDY C. BILLS An SHARON BILLS, HUSBAND AND WIFE AS JOINT TENANT;
the following described rest property in the City of LA QUINTA
County of R -MR SIDE , State of Callfornia
LOT IS OF BLOCK 161 Alt' 'UN7T NO. 16' SANTA CA1 ELITA AT VALE LA
QUIkITA, AS PER MAP RECORDED IN SOO' 18. FOB 99 'OP IAP>;, iIa I'NE
OFFICE of THE COUNTY RECORDER OP SAID COVNT"Y.
DATE: February 26, 2001
SPATE OF CAI. ORNIA )
COUNTY OF
Onbefore tt �J,t�1/�
8"Mitey kwjtrtai rite (or proved to me on the basis of s
tory evidence) to be the p non(s), whose nmm.(a}4st'�'.�"
scribed to within instr>nmgnt aa4 ac led me that
o7ll Y tlzecute4 the sante: bi Ww/, uthoriud
capacftyian�Ute'dl,the
by hisser air ure(s) -on the instru-
nttnt the pens the entity upon bebatf of watch the per.
sons) acted, ez0 instrurnettt,
WITNESS my and official
r••
Signature
/.
Td4-K60
BETTY S. KM""'l
ay
:omm. B 119114 r�
NO"ARY PUILIC • CALIFORNIA �l
Monterey Gaunty
Mr t:omm, ex roe VAY 2,1Qor
(This area for ottic;si notarial seat)
LEGAL DESCROMON
The land-referred to herein to situated in the State of California,
County 01 Riverside, .,described 4a follows;
LOT(S) 18, BLOCK 161 OF UNIT NO. 16, SANTA CARKELITA AT /ALE LA
QU12% A, AS SHOWN BY MAF ON FILE _ IN BOOK 18' PAGE(S) 99 O*F MAP6 ,
'. RECORDS'OF RIVERSIDE COUNTY, CALIFORNIA.
End of•Legal Description
1
! r
l -
a 4
!
} _ Continued on next page
R2- ,
RC DISTRICT - PLANNING REVIEW FOR '
This form is to be used by CDD staff for review of single family dwellings in the RC (Cove
Residential). District per Section 9.50.090 of the Zoning Code. Its purpose is to determine:
1) that the proposed.house design does not duplicate the same architectural style, -of any
house within 200 feet of the applicant, and/or 2).if there is a need for the applicant to file for,
Master Design Guidelines. If the applicant does need to file a Master Design Guideline, please
transmitted this information to the Building and Safety Department as part of your correction
list. Please attach additional explanations, as necessary.
APPLICANT Legacy Homes
` SITE ADDRESS 52-910 Avenida Velasco
APN 773- 326 - 009 CASE NO.: 2001-475
LEGAL: LOT BLOCK, UNIT S.C.@V.L.
�2
. CHECK 9-W& BY: Michele •Rambo DATE.
1
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
Verify legal and APN information
X
Consistent with MDG on file (as'
applicable
�
MDG filing required (5 filings since
9/3/98)
i�L1~•aa�•.
Architectural variety within 200 feet of
the surround ing,,area:
Colors
Materials
Architectural design features
By PRpI,� ,
By
!
• "' C
• s
sy/ear �UN�j�,
M
G' TOFp
T.
Other Requirements:
CITY OF LA QUINTA SUB-CONTRACTOR LIST p�
JOB ADDRESS..., ? -�1 %O_ , _VP G�S� D PERMIT NUMBER OVMER ?iJ� C I lJ(-S � _ 8UWDFR—_ ����4
This f4rr -ANP-.tow, �o �.b jg --- = �-- - ---- - - -
k
;c; this job. Arr cha -- a � ig' a--�° • Only persons appearing on this list or their employees are authcaited to v6,0
1 y rages to this list must be approved by the Building Division p>riwx to commencement of work.. Failure to comply will result in a svoppage of ;vont and/or the Voidance
±,t_t�+ailciinfl permit. For each a icabls trade, aN information re uested below must be completed by applicant. "On File' is not an acceptable reVonse.
r
rrade .. .: .. •... <,.; :•
fir-- ::.::.:;. ,:,.::.; •�;. ,::.::.. �i1i�#�:., '-io�:�si+► �:-;�°',> _�
CoinPWM Name Ghossifi=*01 License Pim bop. !fate earner "acne Policy Number Exp. Onte Lisensa Nand r Exp. Date
(e.g. A. B, C411 (axxxxx► (xx/xx/xxt ie.g. Std:, Fund. CalCemp) (Format Vane) lxxbaJxxt (xxxx) fKxixXixwl
AKS (G: t �► «i � 0- -
- -�1 - 3� lam G 3 i l—la-� i
COPACH E (C.-G) l ` ' t ► `
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5iA!/C7: STtlli•-iG-5t1:"•.<:
2� 3o t b - oc int 1 c ?ol _3 /. - °'o 41
�►rurat L tc sib o -7- c
-75( Z b '1 t -62 c;�t F� tis 3
t+vac tc xoi . u crrry-y-1" kfU� C-Zqq 6N— CLE4 1 D�iJ �t '�.. �=�9 X20$ �7 -v i � � S S/ -4-of
�c-t�►'` -t,, a ct:c �"?'L 77�G— I t� &0� a SS 1 31 oz- 1.,� (on ._ ... WC`1 I 1 G'� 2�3 u If- l k .o
UECTINCAL RaOfiI11G (C39 L
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sof tylETu jVb lem ""t 6'5-� -- lj �?} LS-(F U
FlosoltErlG tt-.151 �
X16 3
- l �clfiwroT //LScc6l T..ir� _ -L_ tai --7.X30, 3fi
slFtnr os til: Nal _ - __ -
PAt!'I NaG (C4311.
__---
ce�c to iE- -- _ --,–= -- -- —_ -- -- - - -- - -- --
I J /r
CA80WTS lC-t$t --- __-_— _..._ — —
— i Ic tc
1 FEAiCi1N[; i�•93i^ l q t i (.t
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>Prsol.Ir•.!,3; - __C�j SCrri2i tSLir�- C/u175C�ir:'C C' -�� — 73 _?7 '__ —_ ��fll�h'yi/t/t /t�S: __. _ �C'.10 ...3' 06
Certificate of Occupancy
City of La Quinta
Building and Safety Department
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 following:
BUILDING ADDRESS: 52-910 AVENIDA VELASCO
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0106-012
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC
Owner of Building: RANDY & SHARON BILLS
Building Official
Address: 47750 ADAMS ST #238
City: LA QUINTA,CA 92253
By: KIRK KIRKLAND
Date: DECEMBER 10, 2001
POST IN A CONSPICUOUS PLACE