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9912-080 (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 U'+W1 r I ©-ate I � 27, Osignature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors 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 offerdd,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. 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: Carver Policy No. ,0r T A' iT1.Ti�.'1� . 154Z,, 66.1-99 (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 all comply with those provisions. 6Date: %' l fo9-OCGApplicant ' a+� �� 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 thea . ove-mentioned property for inspections purposes. 6Signature (Owner/Agent) Date L!a _&v . - . BUILDING PERMIT DATE VALUATION :�Ac� % 9fi r�5 LOT JOB SITE ADDRESS 54-062 AVENiDA V,v< LASCO OWNER PERMIT J1 .� TRACT APN CONTRACTOR/DESIGNER/ENGINEER 1&0" V,rIL.1,1AM TR71:B1,E 80-653 AVENUE 43 80-635A'V NCTR 43 ' l.NDIO CA 92201 INDIO cA, 922ol (7((1)3:17-9755 CRY, 529 USE OF PERMIT SINGLE FAIv1iI. i' Di+JELL NG SPD •- MtMiT DOES NOT INCLU E, BLOCK WALL OR 1100% 'ELIAC T 05143)1'T UC710IN 1,5 75.00 3T 110RCIapxTio 247.00 SF GA1dAUEYC ARPU.'KT 472.00 Sir 5 FT. WOOD FENCII W).00 11,117. fS'f 111MA +". ED'._`0S ' 011F 99,75 t.30 PERMIT liir'.R -S+:TA011ARV Fi k.; DEPOSIT 101 -WO -439-318 •B'��.t� fiY�Nfi'1"JJ110T!0N FEF 101-0011-418-000 z:.tt1 PLAa4 CHECK FEE, 101.000--n.29-318 g 10 ;i�iECHAN(CA), fL 101-ti00-4i1-u0G S47.lni URC RICAt, FEE 101 -ON -42,0-000 R1,t1K4l3.i33Q Fi F ifYY-4t(1c►•419-0f1�e Ql(>1 �5 Z0%.1C'f IMI0N I 7 - RE- S,O 101-i1,i' 0-241 G.€ MI ING FEE loi-000-423-tom 520.0 f DEVELOPER IMPACT ME %1,907.4)0 PRiC,0 11R, PT, AN 1011 -OM, .4A) - Ad, 1100.00 Si1);-T0TAf.C;O�NSTRUr- ON ANY?Pf,ANC;1�FY7 ESS PRE-PA1D FT,ES -�2Sl1.00 TOTAL t'I<+;RN11!' .MEEN .Oft, NOW I !U,741.00 RECEIPT I DATE I BY INSPECTOR /' INSPECTION RECORD - OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings GAJ JCC Underground Ducts Ducts Slab Grade _ _Q�QD 3 ( Return Air Steel Combustion Air Roof Deck 3– Exhaust Fans O.K to Wrap 3—L– ov F.A.U. Framing Y-10 --e Compressor Insulation – Z! – ca Cjs" _ Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath 00 lqi _ Final5 A �j 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 Plumbing Final Water Piping 7`/ Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral / Pool Cover Sewer Connection _l� G� Encapsulation Gas Piping Gas Test —i Appliances Final COMMENTS: 1 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) 17 Building Address Owner 1J, -//,- C? /-X Mailing Address city —Al Contractor 40 - Address 2?0 city, State Lic. & Classif. 6_57SIX Arch., Engr., Designer -Address City BOX 1504 78495 CALLE TAMPICO' APPLIC 0 PHLY LA QUINTA, CALIFORNIA �, 92253., 20I BUILDING: TYPE`CONST. OCC, GRIP 3 4 7 Number 7 7 3 Tel - Legal Description—,4_67 # zP4 Project Description Tel s -s City NO'. Dw.' Stories Units New,O Add 0 Alter 0 Repan ,d Demolition 0 Tel. State Lic. # LICENSED CONTRACTORS DECLARATION affirmthat I am licensed under provisions of Chapter 9 (commencing with Section A9 M-1 lvisrion toliaJon; 301 the Business and Pro my license is In full tome and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec. 7031.5,8ushess-and Professions Cub: Any cly or counly which requires a Penni to construct, after. kniptove, demolish. or repair any structure, prior to -ft issuance also requires itte applicant for such permit to So astatement that he Is licensed pursuard to PERMIT AMOUNT, the provisions of the Contractor's License Law,=Ier 9 (torrxrlenckp wtA Se Wan 7000) of Division 3 of the Business and Professions Coda or that. he 6 exempt therefrom, and me Deaf tar the Any Section 7031.5 by '&V for Plan Chk. Dep. afted exemption. violabort of spplicant a pormir su4wfs the appkant to a ch* penally of not more than five hundred dollars ($500). Plan Chk. Bal. C-1 1. as owner of the property, or my employ with wages as their sale compensation, will do the work, and the structure Is not Intended Or offered for sale. (Sec. 7044, Buisness and Const. Professions Code: The Contractor's License Lew does not apply to an owner of prop" who builds at irnproves thereon and who does such work himself or throupit his own employees, Mach.' - provided that such improvements are not intended or offered for sale. it. however, Me building or Improvement is said within one year of compledort. the ownerbuWa.r will have Me burden Electrical of proving that he did not bu#d or Improve for the purpwo of safe.) 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Low does not apply to an owner of property who bukis or improves thereon, and who contracts for S.M.I. such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading 1-1 1 am exempt under Sec. B. 6 P.C. for this reason Driveway Eric. Date -Owner Infrastructure WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers Co7Tu4l InsuXce, or a certifisO c ��f. ;Pn. 3800. Labor code.) TT Policy No. 6 Vompany n Copy Is filed with the city. 0 Certified copy is hereby fumished. TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS 1QW WORKERV COMPENSATION INSURANCE a lialL-19-9 (Tits Section need not be completed If the Pam* Is for one hundred dollars (5100) valuation or less.) I certify that in the performance of thp work. for which this permit is Issued, I shall not employ any In any manner so as to become subject to the Workers' Compensation I'll's a lFersnion 0 & WVJ DateOwner NOTICE TO APPLICANT. ff, after m&ttV this Certificate of Exemption you dwild became ZONE.' BY: Subject to the workers' Compensation Provisions of the Labor Coo, you must "wiM comply with such provisions or this Pam*email be deemed revoked. Minimum Setback Distances: —Front Setback from Centerline Rear Setback from Rear Pitip. Line CONSTRUCTION LENDING AGENCY..'Side 1 hereby that there Is's Street Setback from Center Lini performance affirm construction lending agency for the performanof the work for ch this permit is issued. (Sec. 3097, C" Code.) Side Setback from Property Line Lenders Nam \Lenders Address This Is a building � permit when properly filled out signed and validated, and Is subject to FINAL DATE —INSPECTOR t expiration I work thereunder is suspended for 180 days. I certify that I have read this application and state that the above Information Is correct. Issued by: DatePe rmit — 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 properly for inspection purposes. Validated by: Signature of ailplicant Date4 Mailing Address Validation: v P City, State, Zip WHITE = FINANCE YELLOW = APPLICANf-!:" PINK w BUILDING DIVISION Desert aanus Unineu acnuui District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 r CERTIFICATE OF COMPLIANCE Date . 1/24/00 APN # 774-215=004 No. 19944 Y Jurisdiction La Quinta Owner NameWilliam Tribble Permit # No. Street SEE BELOW Log # City Indio Zip 92201 Study Area Tract # Lot # Square Footage 3150, Type of Development Single Family Residence ' K No. of Units 2 Comments 1) 51-300 Avenida Hueneme @ 1,575 sq. ft. 2) 54-062 Avenida Velasco @ 1,575 sq. ft. A i w r 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 3,150 or $ 6,079.50 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/Prime Bank/William Tribble Telephone 760-347-9755 Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by. Mary Ann L. Bora Payment Received $6,079.50 Check No. 2196 & 2197 Signature F 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 - ove will begin to run from the date on which the building or installation permit for this protect is sssued or on which they are paid to the District(s) or to another public entity authorized to llect 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 12/29/99 WED 17:52 FAX 909 889 7632CONTRACTORS FINANCIAL Q002 11003 ` RECORDING AMUS M BY: AND WHEN RECORDED, MWL TO: r William Tribble 80555 Avenue 49 Indio, CA 92201 • - ZMM SPACE FGTa FMICOPOM UM ONLY ' AMEMOri'SPARCFINO,: 714-215-004 The undersfgner!Grantor(s)declare(s)thetthe DOCUMENT TRANSFER TAX IS: TITLE ORDER NO,: E 14 , 3 0 County = city ESCROW NO.: 19277-004 Computed on the full value of the interest of property conveyed, or — computed on the full value lose the value of liens or encumbrances GRANT DEED mmainlrq thereon at the time of Sale OR tninsfer Is EXEMPT from tox for the,fbllowing reeson: FOR A VALUABLE CONSIDERATION, mcelpt of which Is hereby acknowledged, IE Mieaki hereby GRANT(S) to William Tribble, a widower all that real property stunted In the . City of .La Quints County of 'Riverside , Srate.of California, described as: LOT 4 19 BLOM 281, OF' UNIT NO.26 OF .THE SANTA CARMELITA AT VALE LA QUINTA, AS PER MAP RXCORDBD IN BOOK 2o, pA+GE .5a •OF DAPS RECORDS IN TSS OFff rCB OF TSE COUNTY RECOMOR OF SAID . coulTPY DatedOctober 22, 1999 � O _ STATE OF CALIFORNIA, } ZE Mieaki COUNTY OF r e- > 8L On cy u 1 g 4 Wit, before me a Q=r e - z , NotaryPublic, personally appeared Personally kmmn to me (or proved to me on the basis of 203110 tory eMence) to be the perm whose named 881NDA� 10/04.subscribetl to the within Instrument &W acknowledged Co wnu*0 t So me that ?Wshe/da y aamuted the same In %oar/tltek a.fatotr IIIc Gat6amla authorized capaaityo&4 and that by %W/hsr�alr signet mN) onoCCU* 9.� on the instrument the personK or the entity upon b®halt of 1�Ca�ni e+I which the person(y.a W, executed the Instrument. WITNESS my hand end dal ssa4 Signature ` MAIL TAX STATEMENTS TO: - rn�aroaror�eHe'm.naarye�n' SAM AS ASOVE- Af ORM ont, ST4TE a ZP ..A' ; :+ r. �'0- b . • .: R D� r� - Plan-0-Ing-Re view Eb rm. Nva SAF . 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 issuesaor need to require the filing of Master' Design Guidelines by the applicant. It shall be transmitted to Building &.Safety as you r,correctiori list. Please attach additional explanations as, necessary. • APPLICANT' TRT.RRLF CQN9,TRUCTTQN' PROJECT ADDRESS' Avenida. Velasco •. API' -774-215-00.4 - - LEGAL: LOT 4 , BLOCK UNIT , S.C: @ V.L.Q. , `CK'D BY: Stan Sawa • ' BIN NO: . CASE N0. 99=161_ - CHECKrDATE: Inform- the assigned Building plan checker .up6n..your_assignment to this case. The .CDD Executive Secretary maintains a log book to tracks applications and assign case numbers. 'TheToning code, architectural and landscaping manuals, and/c r assigned inspector should. j be consulted where- uncertainties arise. The' completed checklist, shall .be Tmaintained in the Building & Safety address file. re y� Certificate.of'06cupanc Y City of La Quinta Building and Safety Department :_ av 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 bui/ding construction or use. For the following - BUILDING ADDRESS: 54-062 AVENIDA VELASCO Use Classification: SFD Bldg. Permit No.:. 9912-080 Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC Owner of Building: WILLIAM TRIBBLE - . Address: _ 80=655 AVENUE 43 City: INDIO, CA 92201, By: STEVE TRAXEL ' o Date: 09-21-00 Building Official