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0111-107 (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 ` "c 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'i" 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 r Date, ,A- 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 an&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 h;)''1 certify that in the performance of the work for which this permit is issued, all 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. r Applicant --.:.ti..,_k".,., 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. IMPORrtANT 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. f 1. Each person ;upon whose behalf this application -is made & each persori_ 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 suLl permit, or cessation of work for 180, days will subject permit to cancellatiVlb.' yr: I certify that I have read this application and state that the above information correct. I agree to comply with all City, and State laws relating.to:the build construction, and hereby authorize representative's of this 'Cityt to.°;enter u . the above-mentioned property for inspection purposes. -'u ' ,.p /,Signature (Owner/Agent) 'Dat'eq'�X /{` ' ^• PERMIT # BUILDING PERMIT DATE ( VALUATION LOT °' TRACT q 24 ?f`D sVa JOB SITE APN .. ADDRESS 71, 710 911 ' MA VVCI.NGA OWNER - ` "`" CONTRACTOR / DESIGNER / EN (NEER " 61,0112.1;f PARKS CsynUM. B'CT11-IM, 53-745 AVM.gt)AiMDEI C O 1.A QYTS1TEA CA 92253 USE OF PERMIT Di;NRWAY.APPROACH, r TRIACT CON ST32i1L,1` OW 456100 8F PC R.Ck'ly'l?'.ATIO _ 116. Oct $17 A#;ACI iC tidE�C�Bt1' 702,100 V E5MWO'D C01',Tf OF CONIT .1 )�t`59.80 PARA: Ir " M 913MMARY C:CiN;1'}'1t'UCTIOAi FEE 101.000-4•16-000 $818.00 :MAN CHECK FEEaA FEE 1)Is`PfART 101.000-:99.518 42.,00 lvY1.YCHANIC A.t, rEf I01-k1iAf!-.42i.-OE1L� 10 .btk Fl.,WK1CA1, lr", 101 -GOO -420-000 P@..11?eB1140KPIV 101-0004,19-000 $iSO.30 ST RUn O i OTIC,)'N - s - 13 > la 101,000-241.000 G gAtliI1di1.1% '101-000-42. �-,Citi 0 MAO MITI -TOTAL ART) P➢:..t1K C 'f'tC $3,857.18 _ ._..•; ..... _, __ _ WENT, F111R11WFLOM DUE vik,o 7,18 s. 4 r JAS 7 »t F AQUI A} t f� : :^<< BY, "m DATE FI ALED INSPECTOR �A� e. -_tel INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs M AA Underground Ducts Forms & Footings , Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap O F.A.U. Framing G Compressor Insulation p Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final OZ POOLS - SPAS BLOCKWAL A PROVALS 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 Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection /I �` Encapsulation Gas Piping or Gas Test 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 _ Z Final Utility Notice (Perm) ..-.C",r'T b,TjY•4�i•��.Ty�.�4yirSy,;Si mL•�^?y+�t.�riri.;'Ot�.}��i='%����j�iA'+v '4T`���'�r .�•, x�.�a•7rr6' .' '�QA7���i�Y.;��r �Y�`I M'^,_° TA AV IN1 � � P.O. BOX 1504 �/ (�j f � T 78-495 CALLE TAMPICO APPLICATION ONLY Address / %rl // �`�r�N�`J! `t LA QUINTA, CALIFORNIA 92253 oil l ��7 Owner t 3 O BUILDING: TYPE'CONST. % OCC. GRP.Z Mailing Address r A.P. Number City Zip Tel. ,;a (� r .�, (� "'J 7 j �? a 5 4 �f, j Legal Description D �~ � V Contractor Project Description —< F. 0 I��� Address State Lic.I City & Classif. Lic. # Arch., Engr., Designer Address Tel. City IZip I State 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 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 ($500). 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. 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.) .. 1 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 confractor(s) licensed pursuant to the Contractor's License Law.) ' f7 1 am exempt under Sec. B. & P:C.'for this reason Date owner WORKERS' COMPENSATION DECLARATION Ihereby 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. ❑ 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 thF 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 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 sof this city to enter the above- mentioned property for inspection purposes. Signature of aGPlican Mailing Address_ City, State, Zip_ Sq. Ft.�.'•No. / No. Dw. Size 2 5 d Stories Units New 0" Add ❑ Alter ❑ Repair ❑ Demolition ❑ NI 1 6C<f' ,Ir� /)e- (j'( f,, S _' S- /v/L) itimated Valuation PERMIT AMOUNT Plan Chk. Dep. 72 Plan Chk. Bal. Const. Mech. t Electrical i PIUM9 S.M. 111111 Gra Drive y nc. infras rucLI EQ131 ✓' r— ra 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 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 followingreason: EXEMPTION: NOT APPLICABLE This certifies that school facility fees, imposed, pursuant to Government Code 53080 in:the amount of 2.05 X 2,458 or $ :5;038.90 'the property listed above and that building permits and/or Certificates of Occupancy for this square footage in'this proposed project may nowbe issued Fees Paid, By OC / Wells Fargo & Co. -,Brian Devlin Telephone, "760-535-0907-,, Name on the check ' By Dr. Doris Wilson Superintendent f Fee,co&cted /exempted by Annette Barlow Payment'Received $5;038.90 SignatureJ�J��� w Check No. 0737703105 NOTICE: Pursuant to 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 Oistrid(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 �, EC7_7'2001 11:42 7ii077111i�1 Fred Sands Desert t �Realt #0370 P.00.2/003, . :—tts z 0=0 IL r , +Tive�ii . i:. •,�� :` ��. !N!Y/3Mt tla;MA Paw -COO - INLAND e;MPIRL OIViSION Pana f .r 2 0" T Tax hid illaCORDSIIG RRtQ1Jg41s:D !3Y - Raoordsd !n Off ielol Row& County of R3aara1de • tlartl L. OpoA AND WWW RBCOR920 MAIL TQ Aa1trlaaar , t7aunty C lark i Rtroorti.. Globe A. P%*s 53745 Avenida' Madero La Quetta, CA S?,2,i3 A it l Om► Lp10 - Aln,�o wG0 �� A.P.N.: 77002-012 TRA A: PLtyO t c?, . Order NO.: 3302SU9 ftMW No.: .16963 -LE 'GRANT DEED THPU"M=NM0PAW0l[p) DEGLAREM THAT DOCUAIRWASLY TRAMPM TAXIS: LOUMT324 ] tutew ted on Rill value of property Coat+eyed, or ]j oy0trlp o I CvaY mbranm remaialioS at time of sde, , and FOR A' VALUABLE CONSIDERATION, Receipt of Which IS hereby acknowledged, Dat>ala G. Ga tna hereby GRANT(S) to Gtaria A. parks, a Married Woman as her Sole =a Separate Property. the following described propt:rty in the City of La Qulnta, County of Riverside State of California; r , Sea Rxbibtt "A" attached hereto and made a part hereof, Deaait G. [iatdetar Dmmtnt Ante: -Svwtt:tnbet 29, 2001 STATB OF COUNTY ORAL OS ANGELES )33 On OCTOBER 1242001 before me, CLATRX RNEAIRE patoaally appmw DMS C . CARD20:R , peraeoallr WOW to ftte (ot prayed to fit on the bats of aarlsfadeoty evidenoo) to be the perton(a) whmae maw(aLlam sub m"Od to dt wim imo•umem and vcbw WZvd to me flat hehhe/they executed ft iet/tDNr authorized apadq(les) and ftt by blslbernTxfr tlpummM w ftirotrutr m the persons) or theanti upon— Nitat which rzs) acted, ted the iesazresrnt. WTTNM my hurl I tot• Si;�weia . r Thi aft* W official 110129W "It CLAIRE SHERIFFAM. y COMM, 01281444 a TART PLfif11C - CAufOitn 1 wottan tRaeaDee tazoo+ y Mail Tax State=nts to. SAME AS ABOVE Or Addren Noted Below OXdex: Mot-00Qa6mRypA7, ntome•ri»tin..- ?nni cpncni no.-- , „a 1 -s,nnwwnw, + O 699' ON Z L: £ L LO L L/Z L ss-M17M IS 0:) 39NVNO Taff 4. .ate 78-495 CALLE TAMPICO LA QUINTAi CA 92253 (760) 777-7075 r APPLICATION' RE""ElIVED j JAN 0.2 2002 KS FLOOD PLAIN DEVELOPMENT PERMIT . �UILDING SITE LOCATION 7.i0 �,/� FLOOD ZONE "AO'.- DEPTH 1 COMMUNITY- PANEL J 7Yc`C'f— OPSr'Yr� �uis- (/, �7 NUMBER* 060709 0005 B Ao-r 2 � /J` q� �, Y� 7 [' ^ Q G7 V-0 f a Map Revised: 8119/1991 APPLICANT INFORMATION SECTION - - APPLICANT NAME APPLICANT 3 3 7 J' , 4 v e. 1�4d"e r ;✓ ADDRESS (MAILING ADDRESS, NOT THE BUILDING SITE) 2 a, ,/ . , a ` 49 C% oZ S J DAYTIME TELEPHONE NO. O 0 INSTRUCTIONS r. 1. A Flood Plain Development Permit is required by LOW 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 & ent requirements. ;Sa4fetyepa D SI NA URE DATE La Qui Engineering epartment AUTHORIZED SIGNATURE DATE. La Quinta Engineering Department -W ­ym41 yens m r-wou riain ueveippment r-ermlt-- Tue; copy goes to Applicant FOBO. REV -2 7100. G `1. L f F/1� CSP $a° � A1v,-e1aZ,-k,IODER—Z y JOB ADDRESS Z f 7 (D � � Jn ERM T NCITYOUMBER�UINTA 5UB WONR RACTO LIST � �� Q � BUIL This form shall be posted on the job with he Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employee are authorized to work on this job. Any changes to this list must be approved by the Building Division prior. to commencement of work. Failure to comply will result in *a stoppage of work and/or the voidance of building Dermit. For each aDDlicable trade. all information requested helnw must hp rmmnleteri by nnnlirnnt "On Pilo" is nr%t mn nrrnn*nklI —e--nea Trade / Classification Contractor State Contractor's License Workers Compensation Insurance City Business License Company Name Classification (e.g. A, B, C-81 License Number (xxxxxx) Exp: Date Carrier Name Ixx/xx/xx) le.g. State Fund, CalComp) Policy Number (Format Varies) Exp. Date License Number (xx/xx/xx) (xxxx) Exp. Date Ixx/xx/xx) EARTHWORK (C-'12) v ,, C -Z2 5-1 116 3044 000A -1 Z1 CONCRETE (C-8) (� 6-3 1 7 3 l 7' v -►,4 0e, 4.2 FRAMING IC -5) . `' -7 ��0 b v 6 I *':Z 2 D STRUCT. STEEL (C-51) r J _ , MASONRY (C-29) 6 �',� ., Q1149-60 102 926 2 S . PLUMBINO•IC-36) ,. Y s iP 0' b116 13 6 13 LATH, PLASTER IC -3511 Pic - C—A -0' `6 7/-5 10 ✓ fJ 3 FCJ l (a C�' 0:242 69 / DRYWALL (C-9) fl � �� CSuS J c� 3 9a 5 3 B• ..� I d G O - !9 9371,7 1 HVAC IC -201 GiVS A7O 4G ffl 3 0-1-0579 ELECTRICAL.(C-10) ROOFING IC-391RICE e—v,-�-�' C 9� D eT L4T�fuAID 06 II Q 30 Z as5oAopoo/.54 Iof e3 SHEET METAL (C-43) / i , / ✓ i FLOORING IC -151 �,3?94 GLAZING (C-17) (70 (o ✓ D + O)G 7 6 qle 116 a INSULATION (C-21 7T ra S e �- O 6 V✓ i eZo p D SEWAGE SEWAGE DISP. (C-42) S �,' -�2- `� 73(0��� Z- (o,3Or 0-3 �& �. n�-' ( f -0 3 3 OZ , PAINTING IC -33) CERAMIC TILE (C-54) Lo� i CABINETS IC -el. G 5 7 v do -2-7 000 Togo =0 6 4 FENCING. IC -131' . u/ LANDSCAPING (C-27) 19cel -2, IC -53) © C S S6 /� e ✓ --tPOOL 0 v -Gi7 - -- . D 06 mi- ALo u--• 0/ 23 j tea.f l u, cit 10: `'I_)0, utbt`lCAI [A rv!u. tf" ;pr�1. ;is a r i �?•?a;r'I a.g ti"'.i_ cm 1P b1;tiur v cif- m'.Yr at- 78 711' ; v or-i',d ,TuiQr111 L!i;.1 U.- I-Ia���:_ u.��lt�1�"!�1�'I��'��� l?ill:$ .�P`� �ir:t tf.i fl?'',�� k1��='c.1.lf c, -I �3.f ;'l: attqi prqtzaJi l;r?ct tl! tfliti; t�! l�ji:,r:t rl opo OF T1 � 78-495 CALLE TAMPICO" LA,GIUINTA, CALIFORNIA 92253 ^ TELEPHONE (760) 777-7012 FAX (760) 777-7011 - OWNER/BUILDER INFORMATION Dear Property Owner: ' An application -for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. • For your protection you should be aware that as "Owner/ Builder" you,are the responsible party of record on such a permit. Building permits are not required to be signed by property owners uitless`they are,personally performing their ` own work. If your work'is being performed by someone other than yourself, ,you,, may, protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the City or County. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan `to subcontract, you should'be aware of the following information for your'benefit and protection: If you employ or otherwise.engage any persons other than your immediate family, and the work (including materials and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the State and Federal Government as an employer -and you are subject to several obligations 'including State and Federal income tax withholding,, federal social security taxes, worker's a compensation insurance, disability insurance costs and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with resp&c to worker's compensation insurance. For more specific information about your obligations. under Federal Law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Adminstration). For more specific information about your obligations'under Stitt Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. ' If the structure is intended for sale, property owners who are not licensed contractors are.allowed to perform their work personally or through. their own employees, without a'licensed contractor or subcontractor, only under limited conditions. t A•frequent,practice of unlicensed"persons professing to be contractors is to secure an "Owner/ Builder':.' building permit,' erroneously, implying_ than the property" owner is providing his, or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing 'their own work . personally. Information abcut'licensed'contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N -Street, Sacramento, California 95814. , Please complete and return the enclosed owner -builder verification form so that we can confirm'that you are aware,of these matters. The building permit will not be issued until the verification ii returned.• „ Very truly yours, CITY OF LA QUINTA DEPT. OF BUILDING AND SAFETY + 78-495 Calle Tampico La Quinta, CA 92253 (760) .777-7012 FAX 760) 777-701 OWNER'S SIGNATU /DATE PROPERTY ADDRESS- PERMIT DDRESSPERMIT NUMBER(s) - *b2 Certifica fOccu T to o t Cit of La uinta Q . Building and. Safety Department �� 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 o46@of of 45 q'ggWating building' construction or use: For the foffowing: BUILDING ADDRESS::- 78-710-AVENIDA TUJUNGA ' Use Classification: • SINGLE,FAMILY DWELLING Bldg..Permit;No. 011-1-107 Occupancy'.Group: R-3 Type of Construction: VN -Land Use Zone: RL. Owner of Building: GLORIA'PARKS- . Address: 53-745 AVENIDA MADERO _ City: 'LA QUINTA;• CA 92253 By: RICHARD KIRKL•AND ' Jb' Date: 06-25-02 Building Official POST IN A CONSPICUOUS PLACE