0107-319 (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
iDateq",.2h- fd Signature of Cohtracto'
OWNER -BUILDER DECLARATION ,r
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.1:7044, Business & Professionals Code).
( ) I, as owner'.ofthe 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 insurance carrier & policy no. are:
Carrier Policy No.
STATE FUND
,(This section need not be completed if'the permitvaluation 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 to the workers' compensation provisions of Section 3700 of the Labor
Code I shall forthwith comply with hos provisions 'S
Datel- ^'! - 41 Applicant—
Warning:
pplicant 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 t
any permit -issued as a result of this applicaton agrees to, & shall, indemnifyf.�
& 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 voidl, '
.work is not commenced within 180 days from date of issuance of sued
permit, or cessation of work for 180 days will subject permit to cancellati un.
I certify that I have read this application and state that the above info,'rmatio' is
correct. I agree to comply with all City, and State laws relating to:,ftle buil
construction, and hereby authorize jepresentatives of this City tolent,r upon
the above-mentioned property -f r inspection pgrp�ses.'•
Signature (Owner,/.Agent)-• 'R✓°f� - I Dat f�
BUILDING PERMIT PERMT#
VALUATION LOT TRACT
DATE .. Qr� /'
r.
JOB SITE ! 1
APN
ADDRESS .
,
Xi -M) AVJFM. DA VAUX10
774-05"W
OWNER
CONTRACTOR/DESIGNER/EN INEER_ -_
yr
EAy� � �r�w A j y y � �p p� �yq'��p y y��r� �}•�� f
Tr V[91.e111 `.'W-GV13'��.111+.16.'V.C'i�
Y r (�, � q �yy,�. yy � * p,p d (ry
�.•ti' rAUXY < ONSMkI( ON'
54880 ATL. ALVAffW)0
14880 AVL' ALVAIW>6
LA OWNTA, NTA, CA 922.33
LA.01YAk fA CA 92253
MW -4844 (MLO 1961
USE OF PERMIT
AwyC1' Fjw>ty lyww l wo
5P'IJ•I?iS Md'l F tdC'K.d;Cl ktt7� �7�'i O.i�fdfSld.1'' t� 4aP��tOA(:4. eiCt i.J� a'
WN- RY&Ns';'WICATPWO 17 ALU60 LY 5'GARDEN VIALI ORC°O, MAS: eR
1IH;A.''tullVf01;`° 918 COI3Ti'.S
TRACT C(M'Ef OTTOW 3,QUO OF
�
Ciha"tf�C9��lCf.IRPORT 457.00 S
_
6 F. WAO., 2201,00 IX
�'`yYMIAMED C:09r OF C.ONISIMUC,'T'10V
107;3M.30
q,�•y'g /}yrs. Y�� (��^(�/�y�,�'�
�.�"riF.1WAU.A .LS ,L+a� t76J1,Y8;}A.9FG�Y.
CON TYRUCT100 M. 101 -WO-41 - $753.00
PLAN CH=.* IFEE 101-00"39-31£8
FEE .E7.KIPOW 101-000-439-318 S Slso l
P@EC1:kAAi7>;;AI,FEE 1.01.1000-421-000
WIAC T.R11CA3., FEK 101.000.420.0010 $116,60
1
PlIU i B] NO ,':L1 101 -000,419 -WO O $131.23
5 TT-c.0HO MOTTaN FER , REM . 101 -000.7,41-OW ;10106
ORM3111140 FEE ] 4$-tAt?G-dt� 4-t181i3. ��b.00
TyWRLOPER IMP.A,ft FES" �1oSl ,fti1
FIRC'.t:`13M VI.A)d 101-000-44.1-;345 $100.00
I
3D -WW, MI. Z'lMC71014 AMD Pl,," C°k�_i�.1C.
i Till Z?l:^RFA io'an
r�x547.00.
i
T�.
SEP
2 b 2001
t
CITY OF LAI, -Q lttr ; e.
.
j1..
RECEIPT
DATE 1,
BY v
T F D 2 -
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
" INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
S�
Underground Ducts
Forms & Footings
-O:
Ducts
Grade
Fk�_3Slab
Return Air
Steel
Combustion Air
Roof Deck
O.K. to Wrap
L/—!
�_
Exhaust Fans
F.A.U.
(��(
Framing
InsulationZ
J y /%d
I f —L61
/L�
Compressor
Vents
Fireplace P.L.
Y
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
�—
a _
POOLS -SPAS,
BLOCKWALL APPROVALS
steel
Set Backs
6Q — (- O
Electric Bond
Footings
Main Drain
Bond Beam
=�1�(
Approval to Cover
�40n,
/�+�/d j
g�-
Equipment Location
Underground Electric
Underground Plbg. Test
Final
F
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
/ Z 3
�,
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer.Lateral
Pool Cover
Sewer Connection
(p- Z3 .d�
S %
Encapsulation
Gas Piping
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
Final
Utility Notice (Perm)
Vg �•- ,,„v,�,g.= =�.s ,'r. �'�,"`q�"�"�`'"'.�'d y'� K''`'��"'fl�� ". ,,,, _ �.,Y. , . �-..,...�r��''`� . r � f a'�Sf5i� "�raR' �d
BOX 1504 c�
APPLICATION ONLY
_ 78-495 CALLE TAMPICO
I Addrdess f. '� /UPJ ' 1 Q LA QUINTA, CALIFORNIA 92253
Mailing
Address ` G r/�4� ,W
City Zip Tel. /
ntractor
`/ c,7_ �
dress
9
//(')'V./t,:F./
Statei� /�
& Classt-
if. ' /�
Arch., Engr.,'
Designer O
Tel.
BUILDING: TYPE'CONST. OCC. GRP.
7
A.P. Number / 7�— a5 -3 -oaf -
Legal
oafLegal Description 4EI i ZiaISL 119
Project Description
Lic. V i •% �7 % Sq. Ft.
Address �_ I Tel.
CityI Zip I State I
Lic. q
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 andel/ Prot ions Cod/eej,,An`d-my license is in full force,and
effect. ' .✓' • 1!/
SIGNATURE - DATE
OWNER -BUILDER DECLARATION
Ihereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8usiness 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 applicanQo�,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).
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, Bulsness and't
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.)
I'I 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.)
17 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
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
f7 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, atter 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
No. No. Dw.
Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
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 a BUILDING DIVISION
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.=�-
Plan Chk. Bal.
Const.
Mecti:
Electrical
Plumbing
S.M.I.
Grading ;f
Driveway Eric.// — �
If If
Infrastructure((,f !
1
UuL rfull
` W _/VU/
11 i~/! 1
TOTAL
` -�•C utpr
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 a 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 9/26/,01 APN # 774-053-005
No. 22537 Jurisdiction 'La Quinta -
Owner NameEast Valley Construction Permit #9 107-3 19
No, 53-100" Street Avenida,Vallejo Log # -
City La Quinta zip 92253 Study Area
Tract # 9LK218 Lot # 20. Square Footage 1687
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
2.05- X 1,687 or $ 3,458.35 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
Fees Paid By CC/Terry. Hamilton Telephone: 564-4844
Name on the check
By Dr. Doris Wilson
Superintendent -
Fee collected /exempted by Juanita Green Payment Received$3,458".35
Check No. 61103
Signature
NOTICE: Pursuant ssembly 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 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 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
r
JUL. -30' Q1 ON ON 12:59 FIDELITY NAT TITLE
RECORDING REQUESTED BYc'
Fidelity National Title Company
Faueraw NO. 42978-C9
TWO order Wo.
When Recorded Man Document
and Tax Statement To:
Mr= and Mrs; Donald G. Hamilton
P.O. pox 1281
La Quints, CA 92263
The undersigned grantorls) declamis) ,
Documentary transfer tact is 468.30 "
X I computed an full value of property conveyed,. cr
I I computed On full value less value of liens or encumbrances remaining at time of sale,
1 I Unincorporated Area City of Lo Cuintas
FOR A VALUABLE CONSIDERATION, receipt of which Is hereby acknowiedged, William L. Smith and Betty Ann
Smith, Trustees of The 1M11lam L. Smith and Betty Ann Srrilth d/d/t 7.21-99 4
hereby GRANTiS) to Qonald 0. Hamilton and Terry J. Hamifton, Husband and Wife as Joint Tenants
the follovAng described real property in the City of La Quint@
County of Riverside, State of Californla:
Lots 19 and 20, Block 218 of Sarft Carmalita at Vale Le Qunita, Unit #21, ats'par,map-recorded In 866k 20, Page
22 of Maps, In the Office of the County Recorder of said County.
DATED: July 24, 2001 ,
STATE OF CALIFORNIA - William L. Smith and Betty Ann Smith, Trusters of'
COUNTY OF The Wlliiam L. Smith and Bom Ann Smith d/d/t
ON before r4, 7-21.99
personally aapeared
By.
William L. Smith, Trusts@
personally known to me for proved to me an the basis
of astlsfectory evidence) to be the personae) whose By:
naeneW i9/are aubscritted to the wlihin instrument and Betty Ann Srnith,.Trustee
acknowledged to' me, that he/she/they executed the
some In his/herAheir authorized caPaclty(los), and that -
by his/her/their eianaturele) on the Instrument the
person($), or the entity upon behalf of which the
Person(s) aated, executed the Instrument. -
Witless my hand and official seat.
Signature
_ MAIL TAX 8TATSMENTS AS DIRECTED ABOVE
PO -213 (Rev 7/98) GiLCNt" DxED 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) if there is' a need for the applicant 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 additional explanations as necessary.
APPLICANT
SITE ADDRESS
East Valley Construction
53-100 Avenida Vallejo
AP 774 - . 053 - 005 CASE NO.: 2001-524'„ Nye
LEGAL: LOT 20 BLOCK 218 UNIT S.C.@V.L.Q.
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
M.ME RECTION
Verify legal and APN. information
00
Consistent with MDG on f a�n%
applicable 4 P •� Go
e
to
MDG filing required (5 filingWIN
a
998 \n 3 No.
/ / ) e
°
,Olt
cor
Ar itectural variety within 20—d��''
o VAr�,P�- � r.S,T, As .
1�� 5lc�N �►'S "���.. ,
th urrounding area:
ors
ials
lea
U
chitec ural desi nres�e,.�s�
FOther Requirements:
� eRC, o 1, 5zs
1 "
JAMES C. ORLAND — CIVIL ENGINEER
1011 MANHATTAN BEACH BOULEVARD
MANHATIANBEACH, CA 90266
(310) 545-8808 FAX (310) 545-8035
January 10, 2002
City of La Quinta
Department of Building and Safety
78495 Calle Tampico_
La Quinta, CA 92253
Subject: Structural Observation
Project: Durango Office Building, 51-105 Avenida Villa, La Quinta
Gentlemen:
Bob Randolph working under my direct supervision performed Structural Observations at
the site December 22, 2001 and January 9, 2002. Attached is a copy of the field notes.
All noted deficiencies are minor. The structure as built complies with my structural
design requirements.
Please feel free to call if you have any questions.
Sincerely yours, p��OCESpRN9l`�y
9� Z
L m
LU No. C22024
J mes C. Orland*—. Civil Engineer E`p' Sept30, zoos
T9l CIV1L
err FOF,CACIE�
J
p L -+, .
r�.My�''
'
SUPERIOR40,
INSTRUCTIONS":*:;,..:
v:.gANDARD SERIES •
r w law f1Mpww
PIP! AID,0M : REV. AOS 2M
r Mr -3 i. v:/Ti7V
BBFI36 w' 8CF136
Tus Pr►sta Aftn ffonual Will enable YOU to Ootain a seEO. BtAdertt eAd
dependable irtst won of your fhplece *vw. Please read an0 under
' sran0 ttusse irstractlorta before b"" Our Ir .
. .i Do not dw or modlly tds ftreptaoe or "S �under arty
dry Any mon of este 2W of the flM*M tom,
'1 inciU4inO bat scot S"tw to ttte *Wm. chimney wwwD arta
acbepwb% MW Vold ills vti mtv. NOnparw eDp ov* of tldewwm
an0 coved msuft in an urke end potIMOV dar►F= bvbhdm
IMPMA11t TO ASSM FFAM AUVMW OF OM OMM
pWALL THIS Fm/M M A WJW M KUW fODt><iCH'
USi4iSl' SAMS AS VECESSAtet! AT SM ANDMI 90r=.
Rou teFl< a Ttas MA(rt K IF GRRiM POOMm' .
i
1
RETAIN SSE I S U WH t No. esz•totC=
t�oo
FOR FUTURE REFEREN ,
' 4
cd WU?_tb:ot 0002 TZ 1100 ON Xd.'. 140213
Certificate -of Occupancy
City of La QuintaTo
�4 �
Building' and SafetyDepartment �°EMOFm °`sem
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: 53-100 AVENIDA VALLEJO
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3, U-1 Type of Construction: VN
Owner of Building: EAST VALLEY CONSTRUCTION
Building Official
Bldg. Permit No.: 0107-319
Land Use Zone: RC
Address:
54-880 AVENIDA ALVARADO
City:
LA QUINTA CA 92253
By:
KIRK KIRKLAND
Date:
FEBRUARY 5, 2002
POST IN A CONSPICUOUS PLACE