9911-120 (SFD)LICENSED'CONTRACTOR DECLARATION,. - '-
I,hereby affirm under;penalty'of.perjgiy,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: isJn.full force and effect. '
License # -Lic. Class Exp: Date
.Date Signature 6f,-.Contractor� 4
OWNER-BUILDERDECLARATION '
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�pr'operty, or my employees with wages as 11 their.sole
compensation, will do the work, and the structure is not..intended or offered for
sale (Sec. 7044, Business ,& Professionals Code);
( ya
'I, as. owner of the••property; am -exclusively contracting with licensed
contractors .to• construct the - project (Sec. 7044, Business` & 'Professionals
Code
( am tempt•under Section B&P.0 ,.'for this reason
of a5 to l� :–" % i Signature of Ownerti__-l�/ ��s •+''�)/
WORKER'S COMPENSATIONDECL'ARATION '
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:
(This section need not be completed if thepermit valuatiori is for.$100; 00 or less):
2 1 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 toIthe workers' compensation provisions, of Sebtion'3700 of the Labor
Code shall forthwith comply with those'provisions: , 1
{ f 1. - r e' r>s a -f /`� Ill f
p�e: Applicant
Warning Failure to secure Workers 'Compensation coverage, is unlawful and
shall subfect`anemployer to criminal penalties' and'civii'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, attomey'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. i #' n>r
1. Each person. upon whose'behalf thisAapplication is made & each person at
Whose request and for whose benefit work is pertormed under or pursuant to
any permit, issued as.a result of this applicaton.agrees to,'& shall, indemnify
& hold harmless the City, of La Ouinta, 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'subjeot permit to'cancellation.
I.°certify that I have read this application'and state that the above information•is
correct.,t 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 property for inspection purposes
f i nature (Owner/Agent) bc` %� ���Date �f J
PERMT 19,114 to
p
BUILDINGPERMIT=
.
DATE'EI ' EVALUATION Y�1 . � {3 •� L0 . LOT, - '�. `a TRACT
11'
:.
JOB SITE' ` 1-1sf8OD . VEM D.c�` '�k�l'�� EJO
APN I'�a 125-017
ADDRESS
OWNER b
-
CONTRACTOR/DESIGNERd ENGINEER
w
;h!117Y :;QI11 t vt fit d.,
�3 11' t1�3 ti31-MIR . .
4,��^>y.i4i,l1S�$$-�Fi�'4.Y:?N .��` 5C1�. i:•�:9,�d'a. '
.. '
PALM DENE'RT CA'_Or11 I
t C Lft
s
USE OF PERMIT
:eiP:Cibp4 1'1AAlL 93►JV:I e.�f�S>
. t
Sri)- PERMIT NN(W dlC1UiaEd.iJCK.6i3$X.id.i�CJ1.:Fl.ANO n'
-POR :fC.�tY-�.��i �'. .l r'ti7 �e fW�r»i
PLAN ip4,';FF
4
i'�cst4�..S: ,vt/is l,S"muci,*Ci % Apr°uu�.vi�v. i/r
PORCHAIATIO 40.0 $F
+;> wda tic c<AE►. 1 444-00 :sir
5 M 'WOOD 20.00 'd.F
.F»"WIE
}
"M MED C*03,71 OFICUNSI-TRU
pnzo
Am
C'0N.'`" };RiIC' T'10Nt .6 101-00-41&ON) $v7i
1'1:MC)W<'C:ft Ffy" t01.-QW439-uIt, ic
MEC" 1<V"tiiS'.;'AL IM . a •..r . li3-� Qtd(�-�4ti ,C�Oe� f):tl .
. r .0 rxrn
P-L{UA ' fl�Sf�IFEI
I RONO.>v )TION FEE, REMID i!)) 0£30- ; B -.(Am
�€)�'+1),.rt:e'.:?i IOM
yC•�R�t1�1')T�;iy�t+T?7' �' �
pI'�4'A�74�..IT"Lw56 JAYlT'���v7 ���,B� JV'1 ,.��'
• 4�;
E� irtrbSEz: +i r!'tq' lQ3),ditldN-441-34.5 t3li.41ca
°a:
.Ate'P C$d';31AILIC AA S . ROW 701-UWT5.".+�3N 5Zf3a25,
`�:
tFJO.t1 3.13:1 (;W,.439. �,1t+ns(i.tEef
;
-C KS � k? 3 LN? Z 'Z.,,A i s y)i'�;CK
. $•.Aad+xyll.i,' J'.V,J,Y`,y%✓i71Y)Vv -
..Ac.T7�n�.1�
�
� .,. V
RECEIPT
DATE
BY 1
D
INSPECTOR
g t;
-4
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
X
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Roof Deck
O.K. to Wrap 7
` �� I
Combustion Air
Exhaust Fans
`• F.A.U.
Framing�
Insulation
�(o - G� 21>7
�;�- coo 3?
Compressor
Vents
Fireplace P.L.
Grills
,Fj,M Lace T.O. C
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
%ls'
'
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
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
Water Piping
G '
7
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
—
j Encapsulation
Gas Piping
Gas Test
Appliances
i Final
COMMENTS:
I
c
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole 9 7
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final _ /3 , 0
Utility Notice (Perm)
.-..�.•..ryv�—•.- _� _._-.�•----,.-+►-w•.-'�{rw..\...w:..-.:la'`.�.-R..nM�•,r..+'La.•�!'.;:"+.•-=�'-.-..r...:.a""'l+�^`.t,�l'.(y� `-'T"'- r.• TL CA% 5 G C � � l)�L D � r.� (A 4j
• �IGGI'IAiiV Tei`r sTAA F r Fa9l
P.O. BOX 1504 APPLICATION ONLY
Building 78-495 CALLE TAMPICO
Address *t 51-560 Avg ✓A upio LA QUINTA, CALIFORNIA 92253
'5f4il7_(V A(LG.
Address lvA5W11i/6i� �! A I''3 4
City
lZip ITO.,
Address
State Lic.I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address I Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
t.
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effec
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'fts 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 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).
C-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.)
II 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
doesnot apply to an owner or property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
I'] I 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. ❑ 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 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, after making this Certificate or 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 ievoked. I
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, CIO Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it 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 a0plicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE'CONST. OCC. GRP..
A.P. Number 7-7—�) ( —7;;L ` oo-7
Legal Description Lcn 180 SLtL (aO Y LnJI IT 5 ,
Project Description c>' r 1-3
5/a M F 45 Z I - IS
A'S RA- I eE 7—
Sq. Ft.
Size +�(��
No. No. Dw.
Stories Units
N Add ❑
Iter ❑ Re a2irD7emolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Z • no
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 INSPECTOR
Issued by: Date Permit
Validated b'y:!
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Desert Sands.Unifed School District
47-950 Dune Palans Road
Notice: f - La Quinta, CA 92253.
Document Cannot Be Duplicated" 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 11/19/99 APN # 773-125-017
No. 19634 Jurisdiction : La Quinta
Owner NameRandy 8i Sharon Bills Permit # 9911-120
No. 51-880' 'Street, Avenida Vallejo ,Log #
City' La Quinta j zip 92253 Study Area
Tract # B60, U5 Lot # 18 Square Footage • 1788
_
Type of Development Single Family Residence No: of Units 1.
Comments
At the present time, the Desert Sands Unified School District does, not collect tees 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 530807'x. .. in the amount of
+ 1.93 X 1,788' or $ 3,450.84 the property listed above'and thai building
>" • .
permits and/or Certificates of Occupancy for this square footage in this proposed project -may now be issued. t
`� cj m
Fees Paid By cc/Prime Bank/Escrow Funding - Sharon Bills", Telephne 833-25770 ;
Name on the check r ` 3'
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita. Green Payment Received $3,450.84
Check No. 2021 .
Signature
FNncE,i Pursuant of As mbty Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the tees or other payment identified
wll begin to run f the date on which the building orinstaliation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
them on the District('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
NOV-12-99 I'1' = 13, FROM = FORES I TE ' ESCROW INC." 619 773 9289 �}' ' +' PAGE ''2/2
s RECORDING PSSQUES17M BY '` '; ,' . , '' •'
is ANDWHEN MCORDED MAIM. TO
RANDY C. 'BILLS - t� rn � a♦�€ i►�sa c�testsei t�v aF '
SHARON S. BILIS a, TNestcp adnsitdgd
r. TORMTE Ytl Im �G
42585 Devonshire. Street r '
-Palm Desert, CA 92211 ev . c
ell
Spacti Above This Line Por Recorder's Use Only
A:P.lvt: T73-�72-007 TRA #: 02Q016 Order No.: R-1801231 Escrow No.: 2-29229.
THE UNDERSIGNED GRANTOR(g) DEC LARE(s).THAT DOCUMENT ARYTRANSFER TAX Is: COUNTY $15.40
( X j computed on full value of property conveyed, or s: ,
(• computed on full'value less value of liens or encumbrances remaining. at time of sale, ,
( unincorporated area; t[,X ]City'of 'La 0airita , and,,
FOR A'VALUABLE CONSIDERATION.;Receipt'of which, is hereby acknowledged,` 4'
AWRAM M. ATTIE, a Married Man .
hereby GRANT(S) to RANDY C." BILLS AND SHARON S. • BILLS,- HUSBAND ,AND ''WIFV AS TENANTS IN ' w
COMMON, t
the following described property, in the City of La Quints, County,of Riverside State of California; s
Lot 18 in Block 60 of Santa Caratelita Vale La Quinta Unit 5, as shown by map, on file in Book 18, Page(s) 63 "of
Maps, Records of Riverside County. i
• - - M //lam' � _ , i �, - ,.
AKRAr
�. . ATTIB
-
Document Date: October. 14a 1999' -
STATE OF CAWRN1A �, k AS _
COUNTY OFddl'l.Q
t
on 02�nhor l Sit% Lqc 4 before me.cr �Le. e
personally appcaud ,,(M • c
(or proved to tnc on the basis of satisfactory evid=S) to be the perso whose nvaeV is1�E aubsoribed to the within instrument
` and acisnowlcdged m tnc chat hels executed the same Ir mauthorized ac aitid that I
MIC ity by his t t tater sign turO/ on thc' rostru=m
• "the petsoc�Sf or the entity upon bch of which the per5ptl� acted. executed the iasWrttent. , -
WETNESS my hand nd official seal. ` t
Signa re
_ a This area for official nomrW seal-
Mail Tax Statements to:, 'SAME AS ABOVE.or Address Notedelo' w"
R I i ri - r
,.
+used b� CDD staff foi�review of;sin'gle'Ffamily-dwellings in the RC (Cove 4
This,form is'to be y, .� ,
Residential) District, in order to determine the applicability-of"compatibility issues or need
'to, require the filing of, Master Design Guidelines, -by the -applicant. It shall be+transmitted to
-. Building &,Safety as yourtcorrectiori list. Please attach additional explanations as necessary.
APPLICANT*' RANDY & SHARON BILLS �, M
,.
PROJECT
ADDRESS: 51-880 Avenida Vallejo
-773-172-007 f ,i
LEGAL: LOT_ 18 -!BLOCK f 60 ,UNIT 'IS.C., @,•V.L Q'.
Fred Baker
'CK'D BY: ,: 4
CASE N0 99-'149 -..CHECK"DATE' a �.
BIN' N0:
Inform .the assigned Building plan checker•.upon.•.yourrassignrnent to this�.case. The 'CDD .:
Executive Secretary maintains' a log book lto,track-applications and assign case numbers.
The �zonirig code, architectural and landscaping manuals;, and/or assigned inspector should
be consulted where;uncertainties arise. The completed checklist shall -be maintained in the
Building Safety addressfile'.. :r ,�
r
CITY OF LA QUINTA SUB -CONTRACTOR LIST
J O`6'ADDRESS____—PERMIT NUMBER _ _ OWNER__ _ BUILDER—_ _
7hi-s. htr!n p9Stgj 9wA11P 14h with the BuiLdiIIg.lII iBection Card atalllJrnas iiLa consaicuop"lace. Only persons appearing on this list or their employees are authorized to work
oil 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 permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
Trade I clessificetlan Contractor Stete'Conuector•s Licensa Workers Com ensallon Insurance City Buslness r
Company Name Classification License Number Exp. Date Carrier Name Policy Number Exp. Date License NumberDate
-__ (e.g. A. B, C-8) lxxxxxx) Ixxixx/xx) (e.g. Sta.; Fund, CalComp) • Format Varlesl Ixxlxx/xx) fxxxx) /xx)EARTHWORK IC -121 //IA C'gM_7Y�fT-1dW L3 (7^d 301 _ of az `L t -fid X994 /oo �
CONCRETE (C-8) r r 'r
FRAMING IC -51 RDU eUF�&,6VXt.CTi'c 97 7 '"31-00 D U 1 1O 711-00 582 3 2 00 i
STRUCT.'STEEL (C-51). '
SHEET METAL (C�3)
FLOORING (C-16) O wvj X12
QLAZING IC7.1711 .;
MASONRY IC•2D11
r3
Z2
a f,
ctOC*M T W-5-
1-1160
iii 7 re
30-01
PLUMBING (C-36) TpFrAN Pu0n&
C--
FENCING IC -131
-0r
`'P3T2; 4AJO ZZCiCIG64/d��'/
I'Oo
p0/
-I-OD
�o t �L
LATH. PLASTER IG361:r,,-67
�' ?)s��)l�/�
�— 2�Q3
F�
511cO.Qd
DRYWAIlIC-91G/
---3 97
s-a.�v
3
MVAC IC -20)
_ Z�
'/-
LSA
- �p
70
�i1Li�WN
_dp
2 7
—
II 2 00'
I�'I •_
ELECTRICAL IC -101 11- <cLCr r
C - /O
-: �Xxd rtf T 1W oPe LSAS..._--
ROOFING IC39! : / 1�
1 i71 P'!192T" ��� C - 3q U'77 .� 7 � '� t �4/On1 )AA_ n.n41i� IdG 160Q 6,1.,1. 4-D/ do 432 _ 10k 00___
li-3066
A rid
SHEET METAL (C�3)
FLOORING (C-16) O wvj X12
QLAZING IC7.1711 .;
(1l.ATtON IC -Y1
INS / L i
._-
SE AGE-DISP. IC -42j1%. '
`
TING IC 331 j*::*( OQt,)ZR--
CABINETS Ic-a)
FENCING IC -131
LAANDSCAf' G IC -271' VI ST7rY
li-3066
A rid
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i1
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_ \ -
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Or
Certificate: of.cuanc
Oc , p
.
Cityof La Quanta
Y
Building and Safety Departth6nt° r
OF '
This Certificate issued pursuantto .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:
r BUILDING ADDRESS: _ 51--880 AVENIDA VALLEJO
Use Classification: SFDr - Bldg. Permit No.:.t 9911-120 x
Occupancy Group: R 3 Type "of Construction: _-VN Land. Use Zone: RC
p. Owner of Building: . RANDY & SHARON' BILLS 'Address:.. 42-335 WASHINGTON ST. SUITE#F-376
City: ''PALM DESERT, CA 92211
By: STEVE TRAXEL
F Date: 05-19-00' `
Building Official, u
POST IN A CONSPICUOUS .PLACE '~