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0112-171 (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 &5 IRS F11 � � U£�u�i.1121 Date �'%* Signature of Contractor '..:1 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 tfie property, am exclusively contracting with licensed contractors to construct the 'project (Sec. 7044, Business & Professionals Code). O I am exempt under Section B&PSC. for—this reason�� Date -2 w_ L -Signature-of-Own2��^. y`-�2��'' -�� ---•° WORKER'S COMPENSATION DECL/� ATION 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 STATE COMP Policy No. ` 014m-oI (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 Calif ornia,.and.agree that if.4 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply wi h those provisions >�u Date:' 'T Z-0 ;a> Applicant r .00;, 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 p"roperty for inspection purposescr % Signature (Owner/Agent);✓" `�-% -� �- Dated BUILDING PERMIT PERMIT# DATE VALUATION LOT TRACT BLYK 29 JOB SITE APN ADDRESS OWNER CONTRACTOR/DESIGNER/EN (NEER P:f°e,TWP ' F,'V,A 19 W=311 Wl ' P -ATA -Mi 9'MrAN S i E,'81QN' 73 `C. 1,O. BOX 621 P,O, DOX 621 ru"M MIX CA $01 ;i1WZfZ81DF CA �5U1 (760>39%,141.4. '_TKA CIA USE OF PERMIT, � �y� 7 ��q� LVJiIr!• .a.� 6R!•�,nl.eldV G / :St°i3 F I�vI�119%i I�OIu.S YdCJT' Ii�4t A�YiIJI Iii.00iC 9+iA1i', P001, OR iRB.V`',R+`s"._. TRAM CONSTRUCTION 2,116, An 'B.F F'i)RC.WPA` IO 101.00 :TF (IARA(L CA R..PORT 497,410 3 S fe'. WOOD FENCE 1011, 00 LF k� l F= 6 UhVd&RY P%�N CFIIs;Ct� i�ISE 1 Ql •CO©�4I��3I g �diI7,.G� ME IIP., OSIT 1fl4'QOC-�t3 '31 4350.00 MECHANIG"M= 101-000-421-000 05.30 ,ELECTRICAL M 101-000-420-000 $132.30 PL[i»IrtO KE 101-000-419-000 S143,25 _.x.9=0140 MOT'IO14 $12.69 GR AFS K0 FRE $20.00 DEVE PER IMPACT FEE, $1,9(act0 PRECISE PL" 1(31•-{100.441.345 KI00,00 ,. 1'iXTSTICIATIOW FEE. 101.,000-423-000 $744.00 S 1►.e M @ -TOTAL, jiAE 3'ITtU6M09+"�JdT3t�7y�'i.:f3,Igtry'L1����9+7=� $3,7212. r, f, ! ��{{,� ��� MAR 2 ®f��lLA6d� 'I . �'�.�T FM 1k� AYIS NOW W $3.462; 55 RECEIPT DATE BY (,f DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs zUnderground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap Framing d p F.A.U. Compressor Insulation -o Z Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wail Insulation Condensate Lines Party Wail Firewall Exterior Lath (a Drywall - Int. Lath .a?i Final _ Final 4W, �_o BLOCKWALL APPROVALS _ steel POOLS - SPAS 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 �� Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection - Q L Encapsulation Gas Piping Gas Test . / . oZ Appliances Final 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) J COMMENTS: Building 77--r /jaC' Address L J T4hf 4". P.O. BOX 1504 APPLICATION ONLY 78 4q5 CALLE TAMPICO SI°N/4-,�Idf* Ct LIFORNIA 92253 Owner PAULOE-ru" e v, 4N, I S Mailing Address P O 8 k, 61 a City Zip Tel. Gl'aq i 1Zt 9 � ��� --'7 �D ContracJpr _ VA-" A-"4 E�11� 0 164&1 S AddrNO City Zi�Tel. Oy �1/• aso / 78'D State Lic. City rr & Classif. 6 � �[ Lic. # Arch., Engr., ^ �l Designer AdPress Tel. 'yU 71 a 1C1 �a-1 788 -6 280 City Zi State RV, baso � Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 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. r 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 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 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 five hundred dollars (8500). C1 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 orimprovement 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 I 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.) 11 1 am exempt under Sec. B. S P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to sell -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company F1 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 io the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: If, atter 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 informatigfi' 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 3UILDING: TYPE'CONST. OCC. GRP. a.P. Number - 73 !sA - o a6 -- 3 _egal Description L.CJT 0 A -T' L 'e -0G a 9 Droject Description r&—p. '01. 1 Sq. Ft. Size New,*& Add ❑ PERMIT Plan Chk. Dep. Plan Chk. Bal. ('const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS No. (1) ONC- No. Dw.�� Stories Units Alter ❑ Repair ❑ Demolition ❑ 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 Ill RECORDING REQUESTED BY: . 'fidelity National Title Company Escrow No. 43246-CB - Title Order No: 33025207 When Recorded Mail Document and Tax Statement To: . Mr. Paulden Evans P.O. Box 621 .Riverside, CA 92502 �APN:'77 -15 - - -- ; SPACE ABOVE THIS LINE FOR RECORDER'S USE - __.._�.. The undersigned grantor(s) declare(s) Documentary transfer tax is $78.10 ( X ) computed on full value of property conveyed, or [ ) computed on full value less value of liens or encumbrances remaining at time of sale, [ ) Unincorporated Area City of La Quinta FOR A VALUABLE CONSIDERATION, receipt of which is. hereby acknowledged, Chris C.'Theis and Leslie A. Roney-Theis, Husband and Wife as Joint Tenants . (hereby-GRANT(S) to"-'Pau[den Evans-Design Center; Inc.,^a`California-Corporation,' the following described real property in the City of La Quinta County'of Riverside, State of California: Lot 24, Block 29 of Santa Carmelite at Vale La Quinta, Unit #2, as per map recorded in Book 18, Pages 55 and 56 of Maps, in the Office, of the County Recorder of said County: DATED: September 25, 2001 STATE OF CALIFORNIA a COUNTY OF (%f., ON Oc-7-6>%,2 Z zc� t before me, hris C. Theis �I /icG4 =� personally appeared '/� /?L.,L e �; _ ; -tel c S 6- Leslie A. Roney- heis personally known to me (ofpTrnred-to-m-e-orrthU17asis' of-satisfaGwy-evidence) to be the person s)-whose nam s is/ r&subscribed to the within instrument and - acknowledged to me that hefshe executed the same in hisNje�r/thauthorized capacity lesj; and that by bis/Het eir' signature(j: on the instrument the person(�s), or the. entity upon behalf of which the ANN BROWN person j;acted, executed the instrument. Commiss;on 1287809 z urg r Notary Pu rc --- Carifomio Ventwo County r Witness my hand and official seal: rgyC EEsJon )52005 Signature MAIL TAX STATEMENTS AS DIRECTED ABOVE FD -213 (Rev 7/96) GRANT DEED 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 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 - PAULDEN EVANS SITE ADDRESS 77-125 Calle Sinaloa APN 773 _ 152 _ 026 CASE NO.: LEGAL: LOT 24 CHECK AND APPROVED BY: 2001-593 BLOCK: 297 UNIT _ Wally Nesbit DATE: S.C.@V.L.Q. 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 Consistent with MDG on file (as applicable / MDG filing required (5 filings since 9/3/98) Architectural variety within 200 feet of the surrounding area: Colors Materials Architectural design features 7. c� cam / D 6 � 14.42 ;-v �,iy r�;,4, 4 -0,1,f -s LX Ot ofttiMnts: 0 Planning CoMMI110*0 a'City Council XCommu 00% peps z116Zo tnitlals Case No. „c a -.422.. SWAS avw I 77�9 X-7. '1J;th Cenditiens —rIAIIr1 r,ul/171 In fotion 7 - Build On ERR orb, oiUig • Cm►sW�i7g . tear REPORT OF FIELD COMPACTION TESTS 'PRULDEM SVA PZ �,� TESTED FOR: PROJE 77->p pLLE SZNAhOA' .__._..._ CORONEL CONSTRUCTION LA QUX TA. CA; DO 80X389 : I LA QUXNTA, CA 97253 07 -. t2 DATE: Building pad. ............. April 10, 2002 West _-� _ OUR REPORT NO.: 073-20096-2 East side TEST DATA: (1) MQdium grained Silty sand• OPT. MOIST side ' TEST NQ I TEST DEPTH ELEVATION SOIL IO ! NUMBER MAANUM LAS DRY, r WATER i WET 'PERCENT ISpec, Spec OMeAgNTS' 9 I DENSITY CONTENT I DcNanY i DENSITY COMPACTION . 0� Min i1 I 8" FG1 1 117.0 i 7.3 i 218.8. 110.7 94.6 i1 - A i i-- — .._.._._....1.... _._. _. ........ ..._... ._.... ... ' 2 SII FG I 1 i 1 117.0 ; 8.9 120-6 110.7 99.6 i 11 - A j..:.- ....i... all _. _....i. _._..._! 1 117_.0_...._�. 8.1i 116 2 107,5 91.9 Il - A 4 _ 8" FG .. lY 1 117.0 7.3 ; 115.8 i 207.9 ; 92.2 :'1 - A TEST LOCATION: .i _..._._I .. Building pad. ............. West side 12 East side �3 i South side !4 North side i NOTES: TESTS PERFORMED PER ASTM 02022.98 4 AS't'tu 03017-98 *COMMENTS: 1. fill MATERIAL OENSITIR SHgWN: Lbs. per cubic toot PtTVt CONTENT: P rr�gnt of dry we' f L` P RCEN� �MPAGT1Qf1: ft oq rtYBxilin d a: COURSE anslty aI on sample uklieatl2 Wry S. ESMeEM son ID nuwt; . 6, HE * (1) ASTM D-1557, Procedure A A. TEST RESULTS COMPLY "" SPECIFICATIONS Bl PF"C1 9LCIOMPACO N DOES NOT COMPLY Ee. . vMwTISuPREECFICATt RSCA TIONS 710N5 I ml"I INSTRUMENT: STANDARD COUNT . M: D: REMARKS: ADJUSTMENT DATA M: D: Respectfully submitts.i, TECHNICIAN; Paul Hoersting Professional Professional Service TKEZIE TEST RESULTS APPLY OKLY TO1ht "ECIINIC. LooanOM NOTED ANO MAY NOT ReMaENT ANY OTVIER LOCATIOna OR ELEVATIONa. RSPORTS MAY NOT. K gSPRVDUCED. t)Q=0V %N FVIL.. WITNCGT WRITTEN PERIAEBICN ay PROFEMONAL WRVICE 1IMMMES. M. Para,eisstitF Protse10nal Servide Industries, Inc, • 42-240 Green Way, Suite 0 • Palm Desert, CA 92211 • Phone 760!341-5790 • Fax 760/341.6704 ** TOTAL PAGE.01 ** 31. Certificate. -of Occupancy o4�� `fig City of La Quinta Building and Safety Department�°A.o,,.ar°_ .This Certificate issued pursuant: to the requirements of Secdoh 1,09 of the Uniform Building Code, certifying that, at the -time• of issuance; thisstructure was in compliance with the various ordinances of'the Cit' regulating building construction or use. For the following: City BUILDING ADDRESS: 77-125 CALLE.SINALOA Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: '0112-171 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC Owner of Building: PAULDEN EVANSDESIGN INC. Building Official. Address: P.O.. BOX 621 City: RIVERSIDE, CA 92501 By: RICHARD KIRKLAND Date:. 06-20-02 POST IN'A CONSPICUOUS PLACE