0012-243 (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
595754 B) C
Date{- f Signature of,Contractor �° - • • • •v
OWNER' -BUILDER DECLARATION
I hereby affirm under. penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
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 contractigg with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O 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.
( ) 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.
(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 personin any manner so as to become subject to the
workers' compensation laws of California, and agree that if,l should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, 1 shall forthwith comply with those provisions.
Date: f iApplicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition.to the cost'of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
fora permit subject to the conditions and restrictions set. forth.•on his
application.
1. Each person upon whose behalf this application is made & each person, atf
whose request and for whose benefit work is.performed under or pursuant .to
any permit issued as a result of this applicaton agrees to, & shall, -indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued- as a result of this application becomes null and void if
work is not commenced within 180 days.from date of issuance. of such
permit, or,cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
coir ct. I agree to comply with all City, and State laws relating, to the building
nstruction, and hereby authorize representatives of this City to enter upon
the above-mentioned property`,6-Nnspection purposes.
Signature (Owner/Agent) 2! Date
BUILDING PERMIT PERMIT#
ATE VALUATION' LOT {�,>j,w TRACT
E BLK7,17 1
JOB SITE
APN
ADDRESS
X3,125 AVZfW;,), A'V C:0e
7744%54-019
%54-019
OWNER ;.,�
CONTRACTOR / DESIGNER / ENGINEER
PAZ COMMUMMON CIO
52.99' AVVIINMA M�"-i��':tD
52.995 AVWI,i>I+ayt� Ml: OZA '
CA 922S3
Qft2j •3t'J23CI;10 5; 37
USE OF PERMIT
C1LE ITAMUf DWELLWO
311) - P:'.TtA1IT DIVE -3 11C3T INCLUDE, 8,f OCK, WA L!, POp; & SPA, OR
ash,�!•.a't�•.�YAf PROACH. 08' MAST1s1i, ".W"
TRAC'+ CO SMLrC"TION 1,421.00 SiF
PbRCHIPAy O .X00 Ste
0A33.A{9MA PORT C*) 01996,00
5 FSP. WOOD MM11 200.00 I1'
.'v.rCY$.is/.Yl�..Q.1A.�"✓CfivY J. Q,i'''6.�'�iY2rA•E P.!•V 4r0e,3�,�r�M1T.JSV
:limma Iffi as'y
CONS'T'RUCTION ME* 103 -000-41 8-DOO S594.50
PL..fkid' CHECK DEE 101-000439-318 $500.12
2►'Tfi J^i.��T2C�As%.:sTtii 101 m000.421.000 '$60.00
RI.1f,e:TPJ%Al,>� 1d11.fTJG-4 f -fi�J4 Fd .�t4
2'i,l!M8040 FBE ". 101-000,419-000 $110.75
STIvONO MOT)ON FtE • MID 101 -,000.241 -pili}
�1RF,.1�1'I'dC�2;'Tc'T{ 241-p4#Ba42.34t9i1i1 �lll,0it
.
PRECT9E PLAN 10 1 x°006-441- 345 CODA
nsr.>Dm,43srr IO2,kOpO-�b39� 1�3 papa 0.30
_olrOTIAWI C I )X ANI) PLAN 0,101M
1,F,33 PF941AMJIF
' 47:Rii oo--
JAN 0 9 2001..
AT v L, Quiff
RECEIPT
DATE •
.I`
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
i
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
' BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
YJ./r/.
Ducts
Slab Grade
_C
Return Air
Steel
Combustion Air
Roof Deck
C
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
O
Drywall - Int. Lath
Final
POOLS - SPAS
Final f o
BLOCKI"d
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
Water Piping
J
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
O -O/
Encapsulation
Gas Piping
Gas Test
_ of
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)
o�
T4qt 4
I
P.O. BOX 1504 APPLICATIMNLY
Building
78-495 CALLE TAMPICO I
LA QUINTA, CALIFORNIA 92253 p
Address Q .. v.� b, �?+2 V Sr' _.l>..S [., t
Owner
Mailing
Addresstl 16 AJ CC Z A -
City r Zip ZZ Tel.
Ii, A- M Com. 53 S(ot - 2 t2viZ
Contractor
9.Q7_ f a 0 L/a. C�..haJ� Q ntxTN.
Address
Zip
State Lic. L;Ity
& Classif.6 4- Lic. #
Arch., Engr.,
Designer Lt5 �` Q ��atto.►.1
Address Tel.
City P Zi State
l C12 1 61 7 -2 <'2d 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
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 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).
I: 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, Bussness 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 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.)
1'3 1 am exempt under Sec. B. 8 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 (5100) valuation
or less.)
I certify that in the performance of thg 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.
1
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 applicant Date
Mailing Address
City, State, Zip
ILDING: TYPE'CONST. �t OCC. GRP.
'. Number `1 1 4� o 5.4-
)al Description L"OT lea 2- 41
Iject Description U #—A •N- -L
Sq. Ft
Size
New
No. `
2.1 Stories
Add ❑ Alter ❑
No. Dw. `
Units
Repair ❑ Demolition ❑
I -!Srb 0 01, t- Vt t S r>
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep. x
Plan Chk. Bal.
Const. �r
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
ZONE: ,
ABY., e w UN 4%13
Minimum Setback
islailces�.
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
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 _ 1/9/01 APN # 774-054-019
No. 21460 'Jurisdiction La Quinta'
Owner NameAgustin & Eva Paz ' Permit # 0012-243
No, 53-125 Street 'Avenida Velasco Log #
City La Quinta zip 92253 Study Area
Tract # •BLK217U21 Lot # 6 Square Footage 1421 '
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
2:05 X 1,421 or $ 2,913.05 the property listed above and that building-
-
permits and/or Certificates of Occupancy for this square footage in this proposed, project may 6W be issued {-
Fees Paid By CC - Valley Independent Bank - Agustin,Paz Telephone 760-564-3023,,
Name on the check
a
By Dr. Doris Wilson-
Superintendent
ilsonSuperintendent
%�.
y Fee collected /exempted by Annette Barlow Payment Received $2,913.05
Check No. 235164
Signature
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them on the District('s)(s') behalf, whichever is earlier. -
Collector: Attach a copy of county or city plan check aj*lication form to district copy for all waivers.
EmWssed Original- Building Dept./Applicant Copy.- Ap�licant/Receipt .Copy -'Accounting.
• 1
Nov=4Z�2444 46:81 pm
From -COMMONWEALTH LAND TITLE
RECORRZ G RSQ929TED RY; ,
COMMONNK"TH LAND.TITLR.COMPANY
SAMPLE
IdPiBN RROORDAb ,"TL TNZ9 DSD AND,
unto$ W=XRWZ3!t SHOWN ULOW,
3lAIL.T�IX 97ATzkzwT TO:
41ILLIAM THOMAS BOFFIN
774-084-019-1
R
+tsoa4iaz(6
U
T -ads V001/001' P-062
em xnnim THT3'.1_T" ADQ IIB['ClY %T,;,, wee
ASK- 774-0 4 Qyg.1
�s GRANT DEED
tr,-, .tuildersigned granzor.(s) declare(s)
DOGuu.`.'�cary transfer .Coit is �, ..• ;
mon full value o!?�5bs'ty conveyed, or
C 1�CompUred on�.#'t`i w oaiue tee lions and encumbrances remaining at rime.ot sale,
•(. ) Dnincorporatekaree.. ( ? City of and
FOR A VALUABLE"CONSIDERATION, receipt of which is hereby acknowledged,.
FREDERICK D. SAUNDERS ana UT'TS Vi HA 402"S, CO -TRUSTEES. OF TRE REVOCA13LE LIVING tRUIT,
F6k PRBDBRICK D. ?SAUNDERS AND BST°TE P. SALTOIDFRS DATED OCTOBER 22, 1491
hereby 4RANT(S).to
WILLIAM THOMAS- BUFFIN, Ali UNMARRIED. MAN
.the real property in the City of LA QUINTA, County of Riverside, Siace of California,
described as:
LCL 6, Block 217,. Unit No. 21, Tract Santa Carmelita at Yale La Quinza, as per map
recorded in Book 20, Page(s) 22 inclusive of maps, in the office of the County Recorder
of said County.
Dated •,movenber Z, 1000
State of CalLggrnia
County -of } S.S.
On
.�belore me,
personally appeared
personally known to me .tor proved to me on
the basis of satisfactory evidence) to be
tne• pt-rsonW whose name(s) is/are subscribed
to the wlthin 3netrument and acknowledged to
me that tlo/plie/they' esxeeuted the same .in
his/her/their authorised capacitylieal, and
that by tris/tier/their signatures) on the
instriument the persons) or the enzity upon
bahalf.of which the person(s) anted, executed
the instrument.
WITNESS my hand and Official seal.
Signature.
1,SAIT. TI►X "STAT S TO:
FREDCRICK D. SAUNDERS; CO-TROgTER
BETTS P. SAUNA8R8, CO -TR TRE
f
(This area for offs-eiai notarial seal)
S8331C88 dRN NV89 6 001lc' 'C "A0N
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 PAZ CONSTRUCTION..
SITE ADDRESS 53-125 Avenida Velasco
APN 774 - 054 - 019 BIN NO.: -2 a-
LEGAL: LOT 6 BLOCK 217
CASENO.: 2000-378
r
UNIT 21 S.C.@V.L.Q.
CHECKED BY: Fred Baker 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
j
Verify legal and APN information
O j
Consistent with MDG on file (as.applicable
S51011
MDG filing required (5 filings'since 9/3/98)
to
0 m ep
Consistency with street/surrounding area:
j Colors
/
/` Materials
�- `Architecture
� G
O G�
\�\\-
G
o
imp
— \44).
Seon
.
y
Other Requirements:
Certificate --of Occupanc
Y.
CitaY, of Lin
Q_
- Building. and Sa''fetyDepartment-.. -of.
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: 53-125 AVENIDA VELASCO
Y,
Use Classification: SFD Bldg. Permit .No.: 0012-243
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC,
Owner of Building: - AGUSTIN & EVA PAZ Address: 52-995 AVENIDA MENDOZA
- City: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 05-23-01
Building Official
POST IN A CONSPICUOUS PLACE