0004-332 (SFD)LICENSED CONTACTOR DECLARATION
I hereby affirm under penalty of pe ury that I am licensed under provisions of
Chapter 9 (commencing with Sect, n 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 Signature of Contractor
OWNER -BUILDER DECLARATION
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).
( ) 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. fog this reason
Date 'X?.91,�.ike4 Signature of Ownere
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 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 provisions.
Date: Applicant—
Warning:
pplicant 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. f
Signature (Owner/Agent) �- -r'' Date �f•�'r'
BUILDING PERMIT PERMIT#
DA'F@/1 f VALUATION LOT -332 TRACT -
5
✓-
JOB SITE '
APN "
ADDRESS 53-670AVIMA MMACO
774-125-W?
OWNER
CONTRACTOR/DESIGNER/EN INFER
GARY \ADRIMA EVERSON
C3iKiT1*TF:RiT3LHi DER
52630 AV n-WAMRRBR ►
52630 AVENMAIM2IM
FSA QU1NTA CA 92253
LAQU1NTA CA 92253
(160)564-6515 'CM -
USE OF PERMIT
Md'I.,E 1rAi1 XY DWEU1NG
SMPF.l2MI f DOES NOT MCLUDR BLOCK WALL OR POOL
TRACT CONSTRUCTION ?,256.00 9F
FORCH1PAT10 40.00 SF
04MOE CARPORT (AF) IZ837.60
6 FTP WALL 3&.00 L!'
]ESI IAM C'OUX OF CONSTRUCTION
1361648.1.5
IRTWT FU SUNY
MECHMICAL FF. 101-000.421-000 �b0.00
Q
ELECT K1CA L FEE 101-000,420-000 $154.96
P
-'
PLUMA1NO FEES 101.000.419.000 $139.50
1
STROAICs MOT1014 FEE - RF,SID 101 -000 -241 -OOT? 313-.39
� ' • --
ORADING FRF 101.000.623-000it
DLr VPLO PER IMPACT P
j
PRECI09 PLAN 101.000.441-345 SODA
. ! ► -!.
FEi? D POSIT 101-000-439..318 •$350.00
r
PL A14 CHECK FFZ 101-000-439-318 $499,35
1
�,.•, T Y% .i
C014STRUfCTIO14 FEE 101.,000-418-000 $769.00
MM-I)CMEAL CONST`RUC1710H AND PL AR CIWAX
$3,6611.80
LESS PRE -PAM FEES
• 250,00
I. 'AL -MVM C FEES ME BOW
.,r
$3,41320
RECEIPT
DATE
BY% 7ATE
FINALED
INSPECTOR
V
f 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
p - y- o0
Exhaust Fans
O.K. to Wrap
4:510
F.A.U.
Framing
Compressor
Insulation
00
s Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall firewall
Exterior Lath
_,Drywall = Int. Lath
Final
Final OL
BLOCKWALL APPkOVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
L exedPlumbing
Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_ pp
Encapsulation
Gas Piping
Gas Test
�(
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final / O
Utility Notice (Perm)
COMMENTS:
-
f
T46 tyl 4
// // P.O. BOX
Building /� �v �Vto j%�t I! lk?f o LA QUINTA78-495 CCALI
ALLE
Address ls/
Mailing
Address
V
Zip Tel.
1504 AP CA I ONLY
TAMPICO
CALIF 92253
LDING: TYPE''CONST. - CC. GRP.
.Number 7 / L� A2 � ��% �/
al Description a --/-7,l A//� 2 2 9 'ter
to Po F R f3L) I L DE K (Project Description
Address -57A - G 3 0_,d E rz R 6- #a. A. • ._ I
.r
City . L.1 0 I N74 (Zip
State Lic.I City
& Classif. Lic. If
Arch., Engr., �}
Designer 6�.6 6 RY / f D A r1 S
Address A D C)� 0 t j E Tel 174 6 55 A
City ` � ^f TA Zip 7) a 53 State
(_ Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affi!T,thatf am licensed under provisions of Chapter 9 (commencing witrvSection
7000) of Dif Sion.o).rthe Business and Professions Code, and my license is in fulldorce and
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5%siness 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 (5500).
I-] 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, as owner of the property, am exclusively contracting with licensed contractors to con-
If.
on-
s rust 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.)
I I I 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
f7 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: 11, 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 it work thereunder is suspended for 180 days.
1 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
ateMailing Address
City, State, Zip
Sq. Ft. No. / No. Dw.
Size ,a,,'JS'0 Stories ! Units
NewWo Add ❑ Alter ❑ Repair ❑ Demolition ❑
stimated Valuation
PERMIT 3 dQ AMOUNT
M1
Plan Chk. Dep.
Plan Chk. Bal.
Const.
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 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 7/27/00 APN # 774=125-007
No. .20783 Jurisdiction La Quinta ,
Owner NameGary & Adriana Everson ,;F - Permit #
No. 53-670 Street Avenida Velasco Log #
city La Quinta zip 92253 Study Area
Tract # - Lot # Square Footage .2256 '
Type of Development Single Family Residence No. of Units
Comments
Y
s�
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 theabove-namedowner 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 '2,256 .. or $ 4,624.80 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 CC/Bank of America - Adrian 'telephone 1 564-0515.
Name on the check
• "' . r •:.i3 � `si ` ' .ter By Dr. Doris Wilson %`' : + ` ` •�
Superintendent
Fee collected /exempted by • ,Elleh Patino Payment Received $4;624:80,:1
k'/ Check No. 401243562 --
Signature
• r
OT10E: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
)ove will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
3Ilect them on the District('s)(s') behalf, whichever is earlier. <
Collector: Attach a copy of county or city plan check application form`to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy -Accounting
I LLJ 7U7J41 J 100 Y. UUZ
-r' H
U11 REPUBLIC TLE CO.'
%tCORuiNG RLOuES1EO By: 141510
3 AND VA IEN MECOALUD. MAIL To..' , ✓`'
P AID fl6CElYEp r
Gary EvPrsou Doc.trS.11erTr-oar . AT8Of1q� ac ECoAo
52630 Avankla I•I6rrera LACK ! �.
is OuinlA. CA 92253 RiCo_ fleclueT '
APR -2 tggg ,
II_
' R.rtv,)n In er1tiYR Rrwo�! 1 , ' -)
N. I
Rucardur
ASSC$:OR j PARCC•L NO: 774.125-0D7,�nu7 ;v,uE rcR 46cmata3
Tl� Od0-l7►S The °1ge15j8ned Giartlor(s)
TO I.E OROdoClure Illul ole DOCUMENT tRANSFER
L•n N0.• 110636.16 TAX p -
S 27.10 CounlY
$ city
ESCNOW No., 4867 -DS =xco"Guled on the full Jatue of lne Interest of progeny conveyed, or
CDr'►Aatad on me fuu value tas9 utlJ value of liens or encumbf3nces I �'
~GRANT DEED raliaining Iboreon at qly dmo of Gaon, , r
�dR iu,slerls EXEMPT from tax rOf, 100gwing reason: f
FOR A VALLIASLE CON O A
S! rRATION, tpeelpt of WfUCh isltarebyacknOvAedggd, •'
Anly J. StorzlM, 3•J;f» g)o woman -' 1
heroby GRANTS) to Ga
ry Everson and AArfana Evursan� htaaDand and eiFc na Jolnr cunaticlr
alI Ihal real propCQy Situated in the City of La Qulnla Counly OIRIvorSlde. Slane of Coldornia, dPscripud as. ` N
t.
�Lorc 7 and a InQ1jiIof Santa CarmeOla 'at Vab La Out nla, UAIf A22 s l;
maps, Room of Riverside County. Cartrornia. per Rlap4aC&UL!d in 80ok 20, page 24 of I
t
Daird February G. 11106
STATE OF CALIFORNIA, ' An I ^
COIJNTT OF yw kN4 ��1
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pCraenYh tcrvl.,n Iw Ir! IW .• C'
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0DCfWn�IYvInramCi�)IS/�SuniL/IOeU +n trW ru.n m:IrWn `r� 4•- ••i .:U `
aunorrotJgpd le rnt mJr +Iv3Aenhor erauxe,l IAo cW,. Inaul►ma y \ :A; ,� .. �g acpK��
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Int Person v or alw ' and lhol M' hall"Arm"' c 1-W- '
a 1118 vnhi Y1 Yry On Ub +nitlYlc11t + r.�-+^+, 1'"'�1 • JJ��
Int fUlf n or y open benalf et Allen III, Wn�l M.d, excorbd -.. '•• -•,� •• r
(nd rMlrurtleM' -
WInaES$ my oncvl I 8
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MAIL TAXSTATE NTS 70:
Gary Everson`- 52630 Avenioa Herrero, La t3umW. CA 83))3 (Tmn u,aa lot on:✓,t nmary foal)
r-+ I
Order: AUTO -KC -00036196 Description:, 1999.141510 Page / of 1 Comment:
I
RC DISTRICT --PLANNING REVIEW FORM. •lf:
F A ..
This form is to be'used b CDD staff for review of si'n le-famil dwellin sin 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 r`GARY - EVERSON
SITE ADDRESS ..537670 Avenida Velasco • - _
APN 774' 125 = 007 BIN NO.:: J��+ ' CASE�NO.: 2000=279 '
LEGAL: LOT 7 . & g BLOCK 228 f . UNIT 22 S..C.@V.L.Q.
CHECKED BY: Greg 'Trousdel l " DATE:
c' Inform the assigned Building plan checker upon your assignment to this''.case. • The CDD Executive
LL.� f .
' Secretary maintains alog-bookto track applicatioris'and assign case numbers.
:REQUIRED ITEM, .: -
Y';N
,. COMMENT/CORRECTION ..
Compatibility Review
Use logged and number assigned.'
/
4. • ; • '' 'i
r
Verify legal and APN information
-
Consisteint'with•MDG on file (as.applicable
ity OUhC{I'
v - -
MDG'filing required (5 filings since 9/3/98)
Consistency with street/surroundiiig area:
E
bit _.._:.�:. ....�..:,.. ;; _.
i h onditions ;...,_,._:.. ....�.....�:
x .%�. Colors
Materials
r
! -a �.
°
Architecture
Other Requirements: f = ''
' .:.fie
� 'a
� � : • � •� . M`,
C.ertificate of Occupancy
City of La'Quinta
Building and Safety Department. OFti
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: 53-670 AVENIDA VELASCO
Use Classification: SFD Bldg. Permit No.: 0004-332
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC
Owner of Building: GARY/ADRIANA EVERSON Address: 52-630 AVENIDA HERRERA
City: LA QUINTA, CA' 92253,
By: STEVE TRAXEL-
+l Date:. 06-21701
Building Official
POST IN A CONSPICUOUS PLACE