0107-318 (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 # 7� y�Lic. Class j3 Exp. Date !a t
Date'
4-T��Signature of Contractor`•d�'
".. . �- •~4 OWNER -BUILDER DECLARATIONyy
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). h
( ) 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 Cude, for the
pe ormance 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 124"13-99
(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 to the workers' compensation provisions of.Section' 3700 of the Labor
;Code, I shall forthwith comply withAbose provisions. + s(
iDate =:1%- -?/.^ 2.3 !^ t 3 Applicant
~-~Warnings Failure tc, secure %R Fkers'' ompensation 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 foi h 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 U
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 i
work is not commenced within 130 days from date of issuance of suc .
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 i.
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to Anter uppri
the above-mentioned property for ihspection purp s es.
j Signature (Owner/Agent)-r'� L. Lmy� Daftl_
-2a/k'-1
BUILDING PERMIT . PERMIT#
DATE dt VALUATION LOT TRACT
JOB SITE
APN
ADDRESS acy q Y6� py g ���y� .,t A— y' t'4i1
` .74.Q.4�,c�T. 1t�i/1�ii� DA '1%[tfi...C.aRal7'i..
9 w *fLv1 ri�fr
J7tWI•••1�s.7na^l.M
OWNER
CONTRACTOR/DESIGNER/EN (NEER
E"N'ALIY CONOTRUCUON
.ASsVALLEY COM;MUC."I10W
5Y"'C[N�EALPdRpeO
54880 AYGnpyV/AyDO
LR QL IWTA CA 92.253
a.,A QUTNTA VIA 9.7253
(d�U��•41�+� � .. C.t�I.�r Z1
USE OF PERMIT
3FWI20 I.Ar COM00 T Z"IT.AINMUS' (,'VJ L i b'Y.A.1.UO 4* 5' [7tmnsm
WAL1_•-Ot'100MORS INOT VOCUMMOL OR l: RFVW,, :AY.AMOACH. WASTER
H&MILITON-118 COWS
c.. -k
L �°C��`isi c at��t�tr la 11637.00 OF
GLA.RAilW. RPORT 457.09 SP
6 FT, WALL 1120.00 top
5111T. WWI 60.011 LF
U-2 D C09f Cad Cdi4,r� fRtrC."H8. V
1(mgm.-m
PLAN CHS FE 01 000439-318 $134.18
WWI T RPOS1?' 101--OW-439-318 •$-750m
ACP,C14ANI1;'AL. FEE 101-000-421-000 $60,40
It l..!': TR.11:0�i?.,1q.3? 101-000-4:70641t3tY $116.0
P9,,UMMO 101.000.419-000 8131,'5
:'sTP.M10 MOTION .FrP, • RMID 101.000-'41-f $10.06
ORAD N¢31?; 10 $70.011
AZV11'.3..' )PZR.1MPACT FEE $3.,50'3'.011
PUICISF PLA 101-000.441.345 $1110.00
Ct51d�a!'1tLi�,`d'1L3t�f1 P 101-000.418-000
i
�1 E
1XSE VRPAID FXS
SEP 2 61001 IXYfAL FEMW AWKS DUR NOW
CITY OF LA Q INTA
FINANCE DOPY.
RECEIPT
DATE% ^e
BY
DAT AI_Ejb
INSPECTOR
INSPECTION RECORD - 1.
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
_
!CJ O
��
Underground Ducts
Ducts
Slab Grade
-Z -/d
��
Return Air
Steel
`
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
0
F.A.U.
Framing
0
-
Compressor
Insulation
_ _ G
Vents
Fireplace P.L.
/
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
I Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
_ _ ---
/nno-
\
Final
FinalM%
POOLS - SPAS
BLOCKWAI A PROVALS
Steel
Set Backs
p- - O (
5'Z
Electric Bond
Footings
j� jlsf
Main Drain
Bond Beaml�
(�
i�
Approval to Cover
A4
Equipment Location
Underground Electric
Underground Plbg. Test
Final
i
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
_ _ _
S
Heater Final
Water Piping
�� 23�a
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
�� /23 �(
�'�f
Pool Cover
Encapsulation
Gas eiping
Gas Test
Appliances
Final
COMMENTS:.
Final
Utility Notice (Gas)
ELECTRICAIZ APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
//•(�
Exterior Receptacles
_
G. F.I.
Smoke Detectors
-f
Temp. Use of Power
Final
Z%�__
Utility Notice (Perm)
P.O. BOX 1504
Building 78-495 CALLE TAMPICO
Address �` �, — ! 2 01LA QUINTA, CALIFORNIA 92253
Mailing
Address / (j 8) ux �
City / Zip Tel.
Contra/cttoF _
Address
City Zip .� , Tel.
State Lic. I/ City
& Classif. 34, 2 U 5M Lic. #0/99/
Arch., Engr.,
Designer /� %t 6•
Address Tel.
City IZip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed undprovisof Chapter 9 (commencing with Section
7000) of Division 3 of the Busing§s areril Professions ions Code,''an`d my license is in fug -force and
effect. i- �•% �f/r`/•r<./ ACil
SIGNATURE C 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 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 (5500).
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.)
1 II'
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 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.)
1-1 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. O 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 (5100) valuation
or less.)
Icertify 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.
Date Owner
NOTICE TO APPLICANT: It, atter making this Certificate of Exemption you should become
th
subject to e 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
T-h�'s 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 a0plicant Date
Mailing Address
City, State, Zip
G
APPLICATION ONLY
BUILDING: TYPE -CONST. OCC. GRP.
A.P. Number / / 77L/ 5
+ 03-696
Legal Description (, T f locilC
Project Description
Sq. Ft. No. No. Dw.
Size 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: v Date Permit
Validated by:
Validation:
it
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Estimated Valuation
PERMIT
AMOUNT
,D
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical 1°
/c
Plumbing
�1 1 ,
S.M.I.
Ili III
Grading
Jr I I I!yt)
Driveway Enc.
h. I JUL L b NUI
Infrastructure
LI I y Ur Ln ;•
C D'
IF ill
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: v Date Permit
Validated by:
Validation:
it
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 9/26/01 APN # 774-053-006
No. 22538 'Jurisdiction La Quinta
owner NameEast Valley Construction Permit # 0107-318
No. 53-120 Street Avenida Vallejo Log #
City La Quinta Zip 92253 Study Area
Tract # BLK218 Lot # 19 : Square Footage 1687
Type of Development Single Family Residence No: of Units 1
Comments
'
4
, T
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 icil 'phone .?:564 4844
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Payment Received $3,458.35
y
Check No., 61106
Signature
F
TICE: Pursuant 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
ove wilbeginto 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
lect 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
t
v'L. •�}0' 01 OWN) 1 :59 F-IDELITy NAT 'TI.TLE tEl 1"Dig -;'9=0394 P 00?
RECORDING REQUESTED far:
• Fidelity National Title Company
Eaorow No. 42978-C6 '
Title order NO.
l
Whsn Recordad Man Document
and Tax Statement To:
Mr, and Mrs. Donald G. Hamilton
' P.O. Bok 1`289 . r
La Quints, CA 92251.4
GRA ��E� SPACE ABOVE THIS UNIZ FOR b R'8 use
Y •. _ '
The undersignad grarrtor(a) daciarelsl
Documentary transrfer'tax is $68,30 t
IX l COMPuted on fol value of property conveyed, or
( l computed on full value lobe value of liens or encumbrances remaining at time of sela, �
C 1 Uninoorporatad Area City of LG Quints
FORA VALUABLE CONEIIDERATIOW, receipt of which Is hereby aeknoeuledged, • William L, Smith and Betty Ann-
Smith, Trustees of The Williams L. Smith and Betty Ann Smith d/dlt 7.21.99
hereby GRANTISI to Donald G. Harrillton and Terry J. Hamihon, Husband and Wife as Joint Tenants 4
the following described teat property In the City of La Quints ~�
County of Riverside, State of California: -
Lots 18 and 20, Block 218 of Santa Carmelita at Vale La Ounita. Unit 021, as per map rocordad In Book 20, Page
22 of Maps', In the Office of the County Recorder of sold County.
DATED: July 24, 2001 : s.
STATE OF CALIFORNIA• William L. Smith and B r
'COUNTY OF etty Ann Smith,. Trustees of
The Wiliam L. SmIrM and Betty Ann Smith did/t'-
�N before me, 7-21.89
. personally appeared .
Wflilam L. Smith, Trustee
Dersonailly known to me (or proved to me on the basis
Of aanlsfaetory evidence) to be the personis) whose By:
narne(a) is/are eubscrib W to the whAn instrument and Betty Ann Smith, Trustee
acknowledged to me that he/aheAhey executed the
some In his/herAhe(r authorized capacity(ies), ano that
by hislhar/their slanature#e) en the Instrurraent the -
peraon(s), 0 the entity ,upon bOaifof which the
person(o) acted, executed the Inst-rument,
Witness My. hand and'official Goal.
Slanature
MAIL TAX STATEMENTS AS DIRECTED ABOVE r
PO-213 (Rev 7/3b1 GRANT DEED
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 Fast Valley Construction
SITE ADDRESS 53-120 Avenida Vallejo. n
�q
APN 774 -
LEGAL: LOT
053 - 006 CASE NO.: 2001-525
19 BLOCK 218 UNIT
CHECK AND APPROVED BY: a O_A ,D
Inform the assigned Building plan checker upon your assignm t to this: case. The CDD
Executive Secretary maintains a log book to track application and assign case numbers.
REQUIRED ITEM
Y N
COMMENT/CORRECTION
Verify legal and APN.information
Consistent with MDG on file (as,
applicable
MDG filing required (5 filings since
9/3/98)
Architectural variety within 200 eet of
the surrounding area: toi
4
Materiafs�
�1
Architectural design features
131 to
n9
m o
m
b
4
ee 140
DN /
'
Other Requirements:
" - . • .. .: Iii%,!'` '
INSTALLATION
010PIORO
INSTRUCTIONS
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OrCe.rtificateof Occupancy
City of La Quinta
Building and Safety Department OF.°
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: .
f
BUILDING ADDRESS': 53-120 AVENIDA VALLEJO
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0107-318
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC
Owner of Building: EAST VALLEY CONSTRUCTION
wr-,�� /4--w . - --
Building Official
Address: 54-880 AVENIDA ALVARADO
City: LA QUINTA, CA 92253
By: KIRK KIRKLAND
Date: JANUARY 11, 2002
POST IN A CONSPICUOUS PLACE
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