0012-054 (SFD)LICENSED CONTRACTOR DECLARATION
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
781834
V 4,;rWz
Date"a `^'° Signature of Contractor x
OWNER -BUILDER DECLARATIONd�pf:Y;�: ft
I hereby affirm under penalty of perjury that I am exempt.from the Co t actor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages ! s 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. 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,.insuranc3 carrier & policy no. are:
Carrier Policy No.
tl�°i t
(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,4so as to become subject to the
workers' compensation laws of California, and agree that .if I shoUld' 6e_ccome Nj
subject to the workers'. compensation provisions ofS,&&action 3700 of the Labor
Code, I shall forthwith comply with those prov�.S Ions:L�+;�
Date: I •" f` Applicant
s .'P�;4�.x'iFir�...tR �: � 7'0.•" t'""
Warning: Failure to secure Workers:,'Cotnp` nsation'coverage is h' wful-atad
shall subject an employer to criminal penalties and civil fines u o $100,000, in
addition to the cost of compensatipn, damages as provide or in Section_ 3706
of the Labor Code, interest and attorney's fees. ;.
IMPORTANT Application is hereby made to the Dire or 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 a&
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, indem ify`A
& hold harmless the City of La Quinta, its officers, agents and employbets'�,
2. Any permit issued as a result of this application becomes null rvQ�iitf
work is not commenced within 180 days from date of issuancq o c
permit, or cessation of work for 180 days will subject permit.to cancellation._
1. certify that I have read this application and state that the abovelinformation is
correct. I agree to comply with all City, and State laws relating46,the building
construction, and hereby authorize,.representatives of this Citytoeriter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent): -- f � Date,'. 't
,r y.
\B?UILDING PERMIT PERMIT#
DATE j, ! VALUATION LOT 0012^054 _ TRACT
�'r
JOB'SITE
APN
ADDRESS
iW 7Q -.W AVE TUJUNGA
MM -011
OWNER
CONTRACTOR/DESIGNER/EN INFER
iaIBI.3 PAla'IW� �! &UP
PIRP.U�a` .W" INC
POBOX450, :
PODOX517
I,&QuiRrA CA 92253
1fi1,Qla'1�"rA Clv, 92253
•
��i3�80�r;�4'�;1 C:1rsi� P:��'i
USE OF PERMIT
SFD n PEP. IT S OES NOT iViClrUDE RLOCK 3§ ALL.,'P001, &SPA OR.
,DnI 3'FWAY A&PRtiACK
TRACT CONSTRUCTION 2663.00 S
F'DE2CHMATIO, 7340 9
Ct.:i MOMCARPORT (810 13,994:80
ESUMAT1: ED COW off` CO.i�' MUCI`V.D.R
159. 1990
••��yy ��jj ��,,�• LL gg;;��; app
,FEK�.6.`/.'LLT FJ�ICE SiJ15.81MMY.
CID'"MUMON FU 101-000-438-000 $849,50
Pr:,,A14 CHH. FAX 101-000-439e.318 0%-64
FEE DEPOSIT 101-000-439-318 • 250,00
Ff,,EtvTR im, IER 101-000-420-000
STRONG MOTI N FRE - R281D 101-000-241-000 �asr
GRA1'►&1lNif "X oh 101-000-1;23-000 $els:il l
OE'1,10PER I CI' MF S1,94'7.OD
mpmnsp. PLAN 101-000^441-345 �lOttOtl
2� 1- RtT8-11WALC�. NSTRUIM10 M•�xayYPrP.yta�a=���
$3,q4CC�6.09p�
,t�V, q�l�ry�cq
3 LdC l�vtV d-L4.G"'.M"Qf4[.� J"'9FZ .
�`�•brJi,00
Y17!
RECEIPT
DAT -/�
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION'
DATE
INSPECTOR
=' BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
7
Underground Ducts
Forms & Footings_
_ _ _� !
���-
Ducts
Slab Grade
Return Air
Steel
Combustion Air ;I
Roof Deck
_ _
Exhaust Fans i
O.K. to Wrap
Framing
%'•f!a Cif'
g=� —
7
S
F.A.U.
Compressor
Insulation
3 —v
s r
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
Drywall - Int. Lath
8=
"
Final
Final
POOLS - SPAS
BLOCK WALL/APPROVALS
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
/
c_ter
(
Heater Final
Water Piping
a%I'%/ O/
.i
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster iE
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation 1
Gas Piping
Gas Test
Appliances
Final ;
COMMENTS:
Final
Utility
Utility Notice
1l -Y ,�� •
II
(Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
(`tt
Rough Wiring
d
Low Voltage Wiring
�
Fixtures
�+
Main Service
Sub Panels
_
;E
Exterior Receptacles
G.F1
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
ld.�jfy�,/
S
P.O. BOX 1504 APPLICATION ONLY
Building�,� 78-495 CALLE TAMPICO
Address -7A -�S � ��. / /Au A -,,49A. LA OUINTA, CALIFORNIA 92253
=--7-r ` ''&)`'"'f -W I "' 1/ / BUILDING: TYPE'CONST. OCC. GRP.
Mailing
Address �xi Y 4k--0 A.P. Number ��U . CiE��
City Zip Tel.
�, ` Legal Description
Co tractor /" Project Description
Address
State ME City
& Classi" Lic. #
Arch., Engr"
Designer LJGr15����
Address Tel.
City A C�Zip State
.I4 ILIkJ n C» 7_f ' Lic. #
l_
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 ($500).
I7 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 himselfor 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 or 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 proiect. (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.)
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.)
Icertify 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: 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.
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 applicant Date
Mailing Address
City, State, Zip
Sq. Ft. No. }} No. DIN.
Size ,A Stories f Units
New V Add ❑ Alter ❑ Repair ❑ Demolition ❑
PERMIT AMOUNT
t,
Plan Chk. Dep. 41 WSQ • UQ
Plan Chk. Bal. t1
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure NOV 2 0 2000
i.
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
" �t�cot'dint kequeaf�d By
CHICAGO.TITLE COMPANY
^ :RECORDING REQUESTED BY:
CHICAGO'TITLE COMPANY COMPANY
10220KC207057127
WHl1NLMA oO IRREMENST�EOOND
'
Brauckmann, Inc.
P.O. BOX . 517
LA QUINTA, CALIFORNIA 92253
uvc ss 2000-381907
09/28/2000 08:00A Fee:6.00
Page 1 of 1 Doc T Tax Paid
Recorded in Official Records
County of Riverside
Gary L. Orso
Assessor, County Clerk & Recorder
GRANT DEED / / V - U71- U 1 U
oao -- 0►4:. 0
The undersigned grantors) declare (s)
Documentary transfer tax is $68.20
(XXX) Computed on-full.value of property conveyed, or.
( ) Competed on . ful l value less liens and ;7incumbra.nces remaining at time of sale.
( ) Unincorporated area:,( ) City of and
FOR A VALUABLE. ;CONS ID;RATION receipt of which is hereby acknowledged,
SAMUEL CASTRO and PETRA CASTRO, AS TRUSTEES OF THE SAMUEL CASTRO FAMILY TRUST DATED JUNE
3, 1983
hereby GRANT(S) to BRAUCKMANN INC., a California Corporation 1
—78-580 Av.TvJ'v>�FrPt.
the real property in the City of LA QUINTA, County of Riverside, State of California,
described -as :
azse'e 0"b -TAP .T
Lot"Y 18, Unit No. 5,, as` -per map recorded in Book 211 Page(s).,61762..
inclusive of maps, in the office of the County Recorder of said County.
Dated July '28, 2000
State of California
County of S.S.
On / o
before me
personally ap eared.
personally known to me (or proved to me on
the basis of satisfactory evidence) to be
the person(s) whose name(s) is/are subscribed
to the within instrument and acknowledged to
me that he/she/they executed the same in
his/her/their-authorized capacity(ies), and.
that by his/her/their signature(s) on.the
instrument the person(s),or the entity upon
behalf of -which the person(s) acted; executed
the instrument.
WITNESS Fury hand and official seal.
Signature
MAIL. TAX STA MENTS TO: -
same as above
SAMUEL CAST O, TRUSTEE
P TRA CASTRO, TRUSTEE:
JANNA ROBERT5Commission # 1150494zVldd.
Notary Public - Califomia
Riverside County
My Comm. Bpes Aug 19, 2001
(This area for official notarial seal)
I�IV
-A
L
NCHG
EXAM
GRANT DEED / / V - U71- U 1 U
oao -- 0►4:. 0
The undersigned grantors) declare (s)
Documentary transfer tax is $68.20
(XXX) Computed on-full.value of property conveyed, or.
( ) Competed on . ful l value less liens and ;7incumbra.nces remaining at time of sale.
( ) Unincorporated area:,( ) City of and
FOR A VALUABLE. ;CONS ID;RATION receipt of which is hereby acknowledged,
SAMUEL CASTRO and PETRA CASTRO, AS TRUSTEES OF THE SAMUEL CASTRO FAMILY TRUST DATED JUNE
3, 1983
hereby GRANT(S) to BRAUCKMANN INC., a California Corporation 1
—78-580 Av.TvJ'v>�FrPt.
the real property in the City of LA QUINTA, County of Riverside, State of California,
described -as :
azse'e 0"b -TAP .T
Lot"Y 18, Unit No. 5,, as` -per map recorded in Book 211 Page(s).,61762..
inclusive of maps, in the office of the County Recorder of said County.
Dated July '28, 2000
State of California
County of S.S.
On / o
before me
personally ap eared.
personally known to me (or proved to me on
the basis of satisfactory evidence) to be
the person(s) whose name(s) is/are subscribed
to the within instrument and acknowledged to
me that he/she/they executed the same in
his/her/their-authorized capacity(ies), and.
that by his/her/their signature(s) on.the
instrument the person(s),or the entity upon
behalf of -which the person(s) acted; executed
the instrument.
WITNESS Fury hand and official seal.
Signature
MAIL. TAX STA MENTS TO: -
same as above
SAMUEL CAST O, TRUSTEE
P TRA CASTRO, TRUSTEE:
JANNA ROBERT5Commission # 1150494zVldd.
Notary Public - Califomia
Riverside County
My Comm. Bpes Aug 19, 2001
(This area for official notarial seal)
440
CJ �ry
MAR 2 .0 2002 • 78-495 CALLE TAMPICO
- LA QUINTA, CA 92253
C� p (760) 777-7075
'boP PUBLIC WS
APPLICATION' ,
• A. � l 1 t 1 w. •� r ' • 1 f•
: 'i.: • wti. • i
FLOOD PLAIN DEVELOPMIEi.NT" P_ ERMIT
-BUILDING SITELOCATION
FLOOD ZONE "AO" - DEPTH 1
& f .,c
COil MMUNITY- PANEL NUMBER
060709 0005, B
i 9
Map. Revised: 8/19/1991
APPLICANT INFORMATION SECTION
. = APPLICANT NAMEi-
APPLICANT
i4PPLICANTy
ADDRESS
(MAILING ADDRESS, NOT THE BUILDING SITE)
-
DAYTIME TELEPHONE NO.
o)
INSTRUCTIONS
1. A Flood Plain Development Permit is required by LQMC Section 8.11.040(A). The Applicant should complete the
Applicant Information portion of this application and submit it. to the Engineering Department along with the
required documentation noted hereon at the,same time the Precise Grading Plan is submitted to the Building and.
Safety Department for plan checking.
2. Documentation required for STEP 1 OF 2 APPROVAL prior to receiving clearance for. Building Permit issuance
• Copy of the proposed Precise Grading Plan for review_ and approval containing all information required by
the checklist shown on the back of this application.
3. Documentation required for STEP 2 OF 2 APPROVAL prior to receiving Flood Plain Development Permit approval.
Note, this approval occurs after forms for the lowest habitable floor are set and before the Building & Safety
Department authorizes foundation construction.
!� Submit a completed FEMA "Elevation Certificate" form to the Engineering Department..
• Submit 95% relative density soils compaction certification to the Engineering Department.
STEP 1 OF'2 APPROVAL
STEP 2 OF 2 APPROVAL
The Precise Grading Plan submitted for this application has been
All requirements have been satisfied. This Flood Plain
reviewed and found to contain all data, required to satisfy the
Development Permit is approved.
requirements of LQMC 8.11 The proposed dwelling is eligible to
receive a building permit upon satisfying all other Building &
Safety Department requirements.
AUTHORIZED AGNAYURE DAT'
La Quinta Engineering D artment
AUTHORIZED SIGNATUREDATE
La Quinta Engineering Department
neo. upon aiep z approval, onglnal goes In -r(ooa vlam Uevelopment Permit" file; copy goes to Applicant
PLAN NUUE
µ PCN;=C.�.O.t�
FOBOREV•2 Please use this Plan C eclS k Number C
r on all Correspondence while plans 1�joo
are In plan check
a
CHECKLIST
FOR
PRECISE GRADING PLANS
IN "AO" FLOOD ZONE
1. Prepare Precise Grading Plan in accordance with Checklist for Precise Plans
and the following,additional items.
2. All elevations shall employ the NGVD-29 convention.
3. Show, and label elevation of "Highest Adjacent Grade" next to the building
footprint. This refers to the highest existing natural grade next to the
proposed building prior to constructing the elevated the building pad. .
4. Show and label the "Highest Existing Elevation on Lot"
5. Show and label the "Lowest Habitable Finished Floor Elevation". Note,this
elevation shall be at least ONE FOOT higher than the "Highest Adjacent
Grade" elevation. .
6. The following grading note shall appear on the plan:
All fill material placed under the structure shall be compacted to
ninety-five percent (95%) relative density.
F080A 10/88
is 9NiU�J MO3HJ 1A M
#voq) i'401e s u gn!'6ni"
Lr^i 5'€3; si a 1a?^ UP^Q1:91°c9:.1 I!t3 r0
[%,q flu 3'a
FLOOD PLAIN DEVELOPMENT' PERMIT
BU.I.LDING SITE LQCATION
FOOD ZONE "AO- - DEPTH 1
i,( AI &4—
COMMUNITY= PANEL NUMBER
060709'0005 B
J
D
oT
Map Revised 8/19/1991
' APPLICANT INFORMATION SECTION
APPLICANT NAMEi
AR W*1f1 * le O e�✓� VP,N r.
APPLICANT.
all. �px yJ`a
' ADDRESS''
(MAILING, ADORE SS NOT THE 'BUILDING SITE)
/ _ A ��/j/�J• G� q .
DAYTIME TELEPHONE:NO,•
S/�/� Lf.�✓G/� S �'��� + '
INSTRUCTIONS
1. A :Flood Plain Development.Permit is requiied by LQMC Section 8.11.040(A). 'The Applicant should. -complete the
Applicant Information p''oftion-of .this application and submit it to.the:Engineering.Department along with the
v required documentation noted hereon at the same time the ,Precise :Gtading Plan:is ubmitted to the Building and
Safety.Department-for plan checking.
2. Documentation required for STEP 1 OF 2 APPROVAL prior to receiving clearance for Building Permit issuance
• Copy of the proposed 'Precise Grading Plan for review and approval containing all information required by
the checklist shown on the back of this application.
3. Documentation required for STEP 2 OF 2 APPROVAL prior to'receiving Flood PlainDevelopmentPermit approval.
Note, this approval occurs after forms for the lowest habitable floor are set and before the Building & Safety
Department authorizes foundation construction. `
• Submit a completed FEMA "Elevation Certificate" form to the Engineering Department.
• Submit 95% relative density soils compaction certification to the Engineering Department.
STEP 1 OF 2 APPROVAL
STEP -2 OF 2 APPROVAL
The Precise. Grading Plan submitted for this application has been
All requirements have been satisfied. This Flood Plain
reviewed and found to contain all data required to satisfy the
Development Permit is approved.
requirements of LQMC 8.11 The proposed dwelling is eligible to
receive -a building permit upon satisfying all other Building &
Safety Department -requirements.
UTHORIZED SIGNAT RE DATE
La Quinta Engineering Dep merit
AUTHORIZED SIGNATURE DATE,
La Quinta Engineering Department
. PN �«N 4 appluvev, wnyniai yues ui nova riain vevelopment rermlt me; copy goes to Applicant
F090 REV -2
7/00
CHECKLIST
FOR
PRECISE GRADING PLANS
IN "AO" FLOOD ZONE
1. Prepare Precise Grading Plan in accordance with Checklist for Precise Plans
and the following additional items.
2. All elevations shall employ the. NGVD-29 convention.
i
3. Show and label elevation of "Highest Adjacent Grade" next to the building
footprint. This refers to the highest existing natural,grade next to the
proposed building prior to constructing the elevated the building pad.
4. Show and label the "Highest Existing Elevation on Lot"
5. Show and label the "Lowest Habitable Finished Floor Elevation". Note, this
elevation shall be at least ONE FOOT higher than .the "Highest Adjacent
Grade" elevation..,
6. The following grading note shall appear on the plan:
o
All fill material placed under the structure shall be compacted to
ninety-five percent (95%) relative density.
F090A 10/99
s y
Mfg J ccupancy
�ertricate ®
City ofla Quintzi
Buldn and Safet Departrrmen%.olti
g Y
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Build,
ing Code, '
certifying that, at the time of issuance, this structure was hi comp/lance with the various ordinances
of theCityregulating building construction or'use.. For the following.,'
BUILDINGxADDRESS: 78-580 AVE TUJUNGA ;,.
Use Classification:.' SINGLE FAMILY DWELLING - Bldg. Permit No.: 0012-054
'Occupancy Group: 13-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: LBH PARTNERSHIP + . ` Address: P.O.' BOX 450 -
City: LAQUINTA;CA.92253
By: GARY HARTMAN
r
- Date: 11-26-01
- Building Official - s
POST IN A CONSPICUOUS PLACE