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9811-036 (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 �Stt7di3 i213 u9s i at" e t - 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 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,I have and will maintain workers' compensation insurance, as required by S C lion 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,6 the workers' compensation provisions of Section 3700 of the Labor Coyle I shall forthwith comply with ihose provisions.' Xte:0eo r Applicant t I 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 prope rty for inspection purposes. $ig' nature (Owner/Agent) + ' r� .'' Date t • I• F"' PERMIT #- BUILDING PERMIT 9_�, DATE l VALUATION " �w311,967." LOT ;� TRACT 19470-2 2 - I., C4Q I I JOB SITE I ADDRESS,' -79-4-82 9-402 '. ll,�.r.K1rj(; .,R"K � 1JJLN1 APN f 769462,0022 L� 1 OWNER CONTRACTOR/DESIGNER/ENGINEER h'.i l :V[CK ENW11 HUD M:n.:.n V C0 NNWAN IES i 5727 S .1.'t�'1 S A V 8 H125 73768L1RREA S,"1'R. F'f �i' 1.tiA OKE 74105 PALM DRSf.;1 ' CA 92260 (70773-52135 MA 2523 USE OFPERMIT SINGLEAMIL2 JYIfG FAMILY 81.0 - i'. O.i3#,.<:)trst:. WALLS Ori POOL. CO*LIANC! ; i+vi lit it,T L .1 tT.1EFCA a S'1'XFH L ANS, IAt%;I.VE)INt3 'ME PNDANORI� ED SRECWS ALT O!<' .1973 (16 U.S.C. 031; .TF '341Q.) .W APPLICADI.I 15 }LEQUI[RED. /r1 Yl1�j•{4,\♦n1.11NTn9?/W 1�C frr"� i„l!� { �ftVS 1,.V1Vp ttCUi.. CI\JtV S,NJ;r.U7 Y l' Frt�Ftc'iFii?AiIO I,00.00 5, 41{1R r�i ttslC AStt't Jit I' I o_Iw o 5}.; ESTIVIUATED COW; OF. CGINSTURK-,'TION 5 1111167 110 CONII IIRUC'fT1:W FtE 101-000.41it-000 PT AWrt-1Ff-K V1 T, 1f}I-Iltii�l3+�-;1elfi $i F;•#I9 �j 1TI: f3C)�r 41'1` ,101.000-X139-318 -$1, 4t) WlsiOlAt+f3.CAL FEE 101AW-421-OW isLE(Tt'1tiCAt, :FEE '101 -#JIM -420-000 5332.81 P1.( lklAtw(F PF.F. 10 t -)M-k 119-131 } S297 Vf S:rrT"!_0140Iti 0Tf0N1 CC —RES10 101-M-241-000 $51.20 GRAO1'tvIO, VEL J[01(. dL00-=123.000 I�!�17%t��aIfR.fi�..'TLkRI';.I'E 2.25-M-443-3422.25-M-443-342/}}iP�-443-342 S6>00.0kt PR q(-,1 .,iv n1, AN 10 t 4011-441 -��1► ���c � ART IN PUMLIL PLACT'.� - TWSsr 701 Oi>o-255 aoa $1.029.32 SUE (X,) .tS'1'RU r, TION ANIt.KAN CEi)•CK. V 4,712.74 LESS RI-3-NUID:tFtU.S -sf,wo.00 °t't7'I'tAL. !?iF;RMIX FEES DUE t1f0W $113, r D.2.24 RECEIPT DATE BY DATE FINA IN P e OR INSPECTION RECORD OPERATION T 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 Exhaust Fans OX to Wrap - g57 F.A.U. Framing _ (9 _ p Compressor Insulation _ Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath p - Drywall - Int. Lath 119 - IF ( / fi15 (P 6Z — Final Final BLOCKWALL'APkOVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground PI . Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines A-tHeater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test �vp Appliances Final Final Utility Notice (Gas) OO ELECTRICAL APPROVAL Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring" Fixtures Main Service Sub Panels Exterior Receptacles G. F.1. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) 41 1 CO MENTS: "a" aA . 0%/P o��— -� �[ Ale 149$7 fit. A/10 "' 6 -79' 482 P.O. BOX 1504 Building78,, 95 C�LLE,TAMPICOAPPLICATION ONLY Addres✓wif 7gZ6�1�,- Q� N .,� LIFORNIA 92253 Owner /%JA„ //� a6 MailingGI`! BUILDING: TYPE'CONST. OCC. GRP. Address 72 J LGwl5 Ata IN IZ'57- A.P. Number CitYTVL.SA Zip ITel. r. •6� 1', �-7 Idr5 17/9 _ r,2 _ 1D Legal Description (� / Contractor �r r Project Description !\Yti/!fo 16il Address' �ti 4/Te State Lic. City & Classif. 5�6740 Lic. a Sq. Ft. No. No. Dw. Arch., Engr:, Size Stories Units �)q Designer 9 y' New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ ,Address, Ire CA - '7 -76,1 l_ / 1 -SZ�S A�� Jae - 3 C'ity tat '12�Lic. E�Q / f� 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 Estimated Valuation 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, after, 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 PERMIT AMOUNT 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 Plan Chk. Dep. opo subjects the applicant to a_civil penalty of not more than five hundred dollars ($500). i l: I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 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, Mech. 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 Electrical of proving that he did not build or improve for the purpose of sale.) I'1 I, 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 Law doesnot apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) i 7 1 am exempt under Sec. B. & P.C. for this reason Grading Driveway Enc. Date Owner Infrastructure 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.) y Policy No. Company n Copy is filed with the city. O Certified copy is hereby furnished. TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS t WORKERS' COMPENSATION INSURANCE (This section need not be completed it the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg work. for which this permit is issued, I shall not employ any person fn 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 ZONE: w+ BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. Front Setback from CSI ter Line Rear Setback fro, rr>1�a�r�prop. Line CONSTRUCTION LENDING AGENCY Side Street tf ifroddm' Center Line 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.) Side Setbac fro�vPropPxi�W0.➢ne Lender's Name Lender's Address `,-. This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE YIV4ECTOR expiration if work thereunder is suspended for 180 days. �i I certify that I have read this application and state that the above information is correct. Issued by: Date 0L, Cpermit 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. Validated by: Signature of applicant Date r J Mailing Address Validation: City, State, Zip f 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 1/7/99 APN # 769-162-002 No. 18216 Jurisdiction La Quinta Owner NameMilt McKenzie Permit # No. 78-482 Street Talking Rock Turn Log # City La Quinta t Zip 92253 Study Area Tract # Lot # Square Footage 5,935 Type of Development Single Family Residence No. of Units 1 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 following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.93 X 5,935 or $ 11,454.55 the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed projec`tkmay rioW-66-issued Fees Paid By CCPD National Bank/Fedderly Company n �+ Telephpine . 773-52.05 Name on the check By Dr. Doris Wilson Superintendent 40, _> Fee collected /exempted by . Juanita Green Payment Received $11,454.55 Check No. 74382 Signature ,/ NOTICE: Pursuant of As mbly 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 fr 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 Dislrict('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 141.8/1998 10:05 6193255608 KRISTI W. HANSON PAGE 02 FROM : FEDDERLY COMPPVIES "12-09--1996 1.4:02 PFUNE NO. : 760 773 0875 911fb249106 cbpm&e . ] ne . 0bw No. 2093422 A $screw No, MiD31, . Lm No. • ftIDIrft►Al0 wHZN RECD try py . TWWW TW Ift- 6 tees. 7e=aoste 5727 300tH twie age=* lily. CO. pevordw lux", 0s 741054119 Dec. 14 13'=; 0-:25A,j M2 098030 AT 0:00 Alin MAR 17 1998 M== t�ssatea► MML S TO: SVM" 0+ee ells 900 6or KWDCW- DOCUMONAAY TRANSFBR TAX S - —Ca0VAM"the enameled" acvww-oP MPonr OR SAME AS ADQVJ gpmpned on tba o"sidemion or value less lids or atcuR+bFinas gat time of Sam Tlra Uaduir.e OesuNor ' S atwe of DWvw or Apo data w inia0 Lax -firm Nome TRA-,- D�fO ORANT DUD P011 A VAl3J�:Li CONSt�IwTioN, reotiot of'WWA is bwaby edwwmdpa TOADr"1 N OL UB ASSOQAM LLC., a OduMa IBtoted SAft soaiDaY h0rab1QRANiil) to NUtea A. NWAM14 40d Aseto D. ReMestle, Trvvt:eva of the DLtltolt D. McKa sle Re.oeasla Cruet AOraammt Qated SeDteal►es E. t9l3 od tall "we* ih ds Chy of Le 40hus ��++Y �� 8asq oarCetllbf+tl� daQibed a , im 32 Tine! 2470.2 (Ses Fuwbk -A- MtachW pwoo) DW4& r b taaeT 2$, -1904 1 . . wwa�q a or�eAe� whwe atlitas(t►�a � etre wphbt vid d ll�s.daM d to saz *M hv*% trsy moowl aha etwa iti wtOoslyd s jlie� til no by Air 1r `letllldf tIM6 epdtp shoe bttat♦fof rime" =94 mmante� . WIT'N88S M NAND APO Off ICAL spm 1lgmtw�e LLC' J IF v fiS' nil r P 1DEIVT aveuesa�,t,�e�. o�w.•er.� • ��s0e wvrAea.—aat+w�. w.tio.ew.w •ar cow%as.t�22.QI0e (Ties Wee (br of cid +basdai $al) 1&;18/1998 10:05 6193255608 KRISTI W. HANSON FROM FEDDEILY COMPANIES PHONE ND. 760 773 0875 12-49-1246 14:03 5193249108 CsQ�c, frac. • i I EMBIT "A" PAGE 03 Dsc:. 14 1?3= 09:(�27AM Pz _.. --_.F.(42 _._...._� .98030 Lac �2 of Tran No. ? 70.2. 83 NIM mV on file in book 266 pcs 57 thfW* (4 of nom Roar& of RiMwgo Cmmw, Camaro& iIOS DSM I$ MADE Am ACCLMO StJB wr TO THE FOL1Aw1NG: 1) Piomk. ir4um tew "me am Uw 1wtuttL 2) All tett of roo4 ittclttnitta without lietittitift dw certain Declaration of COW"M. Cot>ftm sM Re nehons and Reseruatians of EWwMents for the Trt Mdit Cowmwxsfty, meotdw as Gti:autlatt No. 262677 of Oifteial records of RiCAM*- Cguhlyda. wlt" is incorpoTaeA 6y teferance herein as if fully t1t;4 f0!!d1 bm6t tted iffy ontesndomts atrfttppftearittrttary deelmdons thereto (the "Dwialdg t1"} The Dsdwaiea inch der. In w"w otlwr mefta. certain arehiteeorrat 6h4emm gw"Im trod mbimons which will apply to the car rtmtion of a taidenoo oa *A aba" deurr"d to / Wr7artifcato of Oc' cupanCy .� ... 0 0 Citof La' uinta V 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:. + , 78-482 ,TALKING ROCK TURN . Use- Classification: SFD Bldg. Permit No.: 9811-036 ~ Occupancy Group: R 3 Type. of Construction: VN Land Use Zone: RL Owner of Building: 'MILT McKENZIE " Address: 5727 S. LEWIS' AVE. #125 City:. TULSA,. OK74105 By, STEVE TRAXEL Date: 05-22-00 - } Building Official POST IN A CONSPICUOUS PLACE JON TANDY A Op OV ' 7630 Medjool Ave. SUz R J. �R Palm Desert,-' CA 92211 L®�llj+ F�0 Office (760) 772-7192 INSPECTIONFax (760) 772-7193 Fax (760) 776-3338 REGISTERED INSPECTOR'S WEEKLY REPORT TYPE OF INSPECTION PERFORMED ❑ REINFORCED CONCRETE D STRUCT. STEEL ASSEMBLY ❑ ❑ POST TENSIONED CONCRETE_ ❑ ASPHALT ❑ OTHER ❑ REINFORCED MASONRY ❑ FIREPROOFING- IREPROOFING'JOB JOBLOCATION- -, REPORT SEQUENCE NO. TYPE OFSTC1 �\�t� ^ - PE'RNf1T"P70. ,K` 1��/!�G DgTE � -IDAv J7CTOR OF WEEK MATERIAL DESCRIPTION ARCHITECT 3 + HRS. CHARGED f ENGINEER ASSISTANTS HRS. CHARGED - INSPECTION r GENERAL - - SUB _�`'Q'� DATE CONTRACTOR CONTRACTOR ��� `�C1��YgL { 1;L � �! , (� p L A. c.J b f _ �_.Q_d a oT w �W Q Ro-J Wu".,t- COPY SENT TO CLIENT ❑ CONTINUED ON NEXT PAGE ❑ PAGE OF s CERTIFICATION OF COMPLIANCE 8W..r.RF_HeVsir.F-RTLF_Y.i-.T:HAMWI W.A:VPX.INSprr-T— fil T(1 LLLLia.GC.T nc—.— - _ ----- _ tIEC"?aEif °'tit?+EE i