0106-010 (SFD)�) LICENSED CONTRACTOR DECLARATION
t l(,nereby' 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 -L cense is in full force:and effect.
License # Lic. Class Exp. Date
a r.
Date--igrtaturQ of Con{ractoWr`'-
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjurythat 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).
( )'l, as owner •of the property, am exclusivelycontracting With licensed.
contractors to construct the project (Sea 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:
,Carrier Policy No.
EXSMPT
=(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
I's to the• workers' compensation provisions of Section 3700 of the Labor
Code,'I shal1,forth�with cooply with �th��,p ovisions.
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $1.00,000, 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 cf such
permit, or cessation of: work for 180 lays will subject permit to cancellation.
I certify that I have read this application i
Correct. I agree to comply with all City, is
construction, and hereby authorize reprt
the above-mentioned property,foA iin. pect
Signature (Owner/Agent)
^. i.•"" -.,� ,Tc.s•;
d state that the above information is
J State laws relating to the building
entatives. of. this ,City to enter upon
n' urpo�ses ✓ '` j
.Date
��'`•BUILDING PERMIT PERMITJt
DATE { ,, . //VALUATION " ' LOT IIfY,�icF W M TRACT !
JOB SITE
ADDRESS
APN
�(/
OWNER.
CONTRACTOR/DESIGNER/ENGINEER. - - -;
U-555 SAGUARO ROS
IAQU1' TA CA 92233
F,AQ-ow' CA 97,253
(760)504-7820 cmvt
USE OF PERMIT
a PERMIT 1301 tNOIT INCLUDE BLOCK tPJ;t1 LL, .POOL OR DRAFEWAY
b'ROACHr (RV MASTER f?y}!+fs BU PLA -H)
PORCHIPATILry O.Cti; SP
c MU.03+CARPOR'T (OUPN)
3 `. `NOOD ?LrNcfl 200.00 LF
.e
a>0MAUCTION F M, 101.000-418-000 5071.00
KI&W Chlac, ` ME 101-000-439-318 $536.16
my-CH"ICA4.ME 101.0 00,42,1-000 �tS3,e3
t
f?VINCT..WWA1,$120.84
PLUMBING FFIL? 9122115
GRAMM.R 101-000-42.3-000
O ZrWPE1N, IMPACT FEE
PIRFIANOEMAN IK)l�d1 Bid �x avat. i
FLf r .f WP4'$SiT
t .:.�-- -- --- T$'OM AYM PLAN CHEM
. .. Soar '- i '.: JUM E dtEN6 'L•P.1�.�r NOW
}yy
DUE
prep ry{� r. 1A
A7o7r�6'b°ei�Y
MY OF LA WNTA
RECEIPT B
DATE FINALED
INSPECTOR
`* .
'T_
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_7
5
Underground Ducts
Forms & Footings
GG _ Q
Ducts
Slab Grade
�'�-I
Return Air
Steel
Combustion Air
Roof Deck8
��- O C
'j?
Exhaust Fans
O.K.toWrap
8 AD -CDI
5T
F.A.U.
Framing',j
Compressor
Insulation
_3(. o t
S?
Vents
Fireplace.L.
Grills
Fireplace;T.O.
Fans & Controls
Party WalUnsulation
Condensate Lines
Party WallFirewall
Exterior Lath
Drywall - lht. Lath
Final
Final
��� j��
S
POOLS -SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines-�-$-
`
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
sp O (
gT
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL
APPROVALS
Temp. Power Pole
% - �O - p (
g'•�
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)
(p •Zs �p
a�D6.D�
Building
dSI / I (
Buil ng
4
P.O. BOX
78-495 CALLE TAM TAMPICO
LA QUINTA, CALIFORNIA 92253
vwn70,m 1. lI ? &J 0 1
Mailisng
Addreskk// � DAM_„
A
Cit.,y ZipG
Tel.
. lA t�NCY - oa `3
ZipCJ4 J; d Tel. 77) 01-7
State Lic. City
& Classif. 2, go I Lic. #
Designer
Address Tel.
City f (Zip (State I
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.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
1 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)•
1: 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 contractor(s) licensed pursuant to the Contractor's License Law.)
I1 I am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 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
F) Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
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 in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, alter 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 1 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
APPLICAT N ONLY (\
BUILDING: TYPE'CONST. /�'�%/��..,, OCCC.` GGR�P.
A.P. Number 7�-3 t,/6'� 60
Description
Project Description-
5
escription
. 5/= ;6 e -K f"
WHITE = FINANCE YELLOW = APPLICANT
CITY OF LA p IU ryiA
FINANCE DEPT
PINK = BUILDING DIVISION
Sq. Ft./� C�
Size r b
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
71
PERMIT
AMOUNT
Plan Chk. Dep.
Q'
Plan Chk. Bal:
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
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 PECTOR
Issued by: D
Validated by:
m'N 2001
Validation:
WHITE = FINANCE YELLOW = APPLICANT
CITY OF LA p IU ryiA
FINANCE DEPT
PINK = BUILDING DIVISION
` "Desert Sands Unified School District ' -
r .< 47-950 Dune Palms Road` -
• Notice: La ,Quinta, CA 92253
-Document Cannot Be'Duplicated,. t 760-771-8515
~
'CERTIFICATE OF OF COMPLIANCE
11 Date 6/22/01 APN # 773-063-006 .
No. 22159 Jurisdiction La Quinta ;
Owner NameRandy & Sharon Bills Permit # 0106-010
No. 51-140 Street ;i Avenida Vallejo Log #
• E City La'Quinta zip 92253 Study Area
Tract # BLK71 U9 Lot # `17 Square Footage
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 bn 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
2.05 ; X 1,788 or $ 3,665.40 the property listed above and that'ouilding '
permits and/or Certificates of Occupancy for this square footage in this proposed project may no be issued
Fees Paid By cc/EastWest-Barik!r Legacy Homes' ' Telephone 5:64-7820
. Name on the check
By Dr. Doris Wilson a.;r;�`t`4�1 ` • Y
Superintendent
Fee collected /exempted by .Juanita Green Payment Received
Check No. 32-4902340545
Signature
{
F
TICE: Pursuant of mbly Bill 30a1 (CHAP 549, STATS. 1998) this will serve to Notify you that the 90 day approval period in which yoq may protest the fees or other payment identifiedve will begin to run the date on which the building or installation permit for this project is sssuedor on which they are paid to the District(s) or to another. public entity authorized to
ect them on the Dis ('s)(s') behalf, whichever is earlier. y
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 ,
4-tiarQl `:iOPv 15: 39 FAY 7 ti U' SyM WIZ
- • AAA ��� t. - r }' � .�� �- f .IL"�
�,' ' 64EC l�®*51Eidt1E8YE0 8P, �' . moo c0 aesis—asTAGG ,f
4 9iNALD BEAMAN' - �aiee�apag
'Attaflioy At Law ReeorAad btt 111,10461 41saoreo
�..
wwQtir of A1MN0iio
_ IVY
.o�aeri WdSaADiio MAIL 'T AoavOa®fe *AmyC➢„„InIo,99ro "AlIoeorior,'. t
iNf �i{�f, �in. _ •Y l It i� 'Ca 1 atm Moran !d arta
2M atAle mum -Ahw
QUITCLAIM DREG
Th® Sued+ 4�w�ra�d +�olid�ahof N&
OW A NTARY T6A'EPIR TAX NONE 9vt
ThIg Is bi Iid glfi GfW ft flmnot ra�aaae nothing In 141WO. R ATT 1 tB1 t: LWJ
ti FOR Nb c, ONSllt EPATIQN, hdEt�bERT WI. EICHEN &,� IRF 61CHEN, hii30�ad
and wft. as wrnmutt#ty'p1 �tyi.•dr� t+iafaby a�mlb3a, rdtsSsd, Wd 9®f**r oftitm to
' t NAD Elchll$W, at his Soba 4 OVOMW pa' WW, ball of thdif 0'ft 00. WKII Imf0st '+
and to-tubo: I<n laa "s d®scrlb�,mw pPq* ti ki to qty of Le &lure cow► bit
Alvefolde. State of 6al6fetrit�.;` tBS"9 1Mt1;
LW 111. Wook 71 of a 06=0% of Vats Le Quinia, Unit 9 as pow t1jap
rsacWad to Back 18. Psi 80 atmops. fewds of Rnroatids bounty,
r ` •Vbttud: July ��t ?%MO' - * `, - - .
T OWN
M t A �w.r•�•wmwv y - -
a' , v
_ Y
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) it'there is a need.for the applicaHt 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 additionalexplanations as necessary. t '^
APPLICANT Legacy Homes O��SS\NG . �pPSEI N:
SITE ADDRESS"° .: 51-140 Avenida17
APN 773 _ 063 _ 006 CASE NO.: 9OQ-471
LEGAL: - LOT BLOCK UNIT' S.C.@V.L.Q.
} Michele Rambo
CHECK AND APPROVED BY: DATE:
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
,X
Consistent with MDG on file (as5u.bv
njuLdd � G
J�kur
applicable
MDG filing required (5 filings since
X
No. f 4L&ate• Will 6u
9/3/98)
'Architectural variety within 200 feet of
the surrounding' area:
Q�
X •
N�Ci 5
Colors
v
Materials
F
QRo
Architectural design featuresVA
Other Requirements:
C of Odcupancy,..
Cit -of LafQunta y1�
AN
Buildingand,Safe!y Department
This, Certificate issued pursuant to the requirements 'of Section 1.09 of the Uniform Building Code,
certifying that, at the,time of issuance; ,this'structure was in compliance with the various ordinances
of the City regu/sting building, construction or use. For the following -
BUILDING ADDRESS: ' 512140• AVENIDA VALLEJO
., Use Classification: - SFD Bldg: Permit No.: 0106-0.10
Occupancy Group: R 3 Type of, Construction: `` ' VN Land Use Zone:. 'RC
Owner of Building: -,RANDY & SHARON BILLS! Address: 47-750'ADAMS ST #238 ,
' City: LA QUINTAL, CA 92253
r , By: STEVE TRAXEL `.
- Date:- 11-01-01 -
Building Official a
POST- INA CONSPICUOUS PLACE