0003-159 (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
14-1
�D� � 19 Signature of Contractor
.,OWNER -BUILDER DECLARATION
x
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. k
(�),l 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:
CarrierG� vu
�1tq Policy No. ""29-00
t 00a'11483
(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 with those provisions..
=date: f .10� 6 Applicant—`
�i:�l-c�`r.
1
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 property for'inspection purposes.
4
�S g lure (Owner/Agent)~; N� - -- - -m'" Date
BUILDING PERMIT PERMIT#
OtDIB3-x.59
DATE o m ,�ooVALUATION $89.1 M.80 LOT 7 TRACT B1..,UM
JOB SITE �}
ADDRESS r-SFf3 P1i',t�l,lljl Vi�i,L�+.t4➢
APN
/ /�4 �9.�6-E➢.�
OWNER
CONTRACTOR/DESIGNER/ENGINEER
rnIlii V0. TA
AAO LV0.TA 41 Ii 14{ % ,P\Gor, AIH: 1 Ll I%_,
tTr9't i tAM1tr 04IQQL'( r 'D.ne--cpV
VV GLt I., Llivl G\V.l),3L ..tL J.\.✓x./1..4 A!
PO BOX 35 78
.56900 J:ACKS01v S'1
PALM D:ESERf CA 92261
-zH1RIO..AL CA 92274
f7t`+1i�399-121113 CK -if 1954
IJSE'OF PERMIT
SINGLE FAML Y DWEi.,LM
Sr,D- PERNHT DUC-8 NOT INCLUDE BLOCK WALL OR POOL
TVt-01" CON 21-1 RUC 1111,1` 1,421.00 `S..l`
PORCM)Ai iO 33.00 SP
(3,K?At3EICAkZP01 309.00 SFF,
5 F 1`. 'WOOD FENCE MO.JO LF
i IAs ED WST OF
PERMIT FEVSUMMFAW
CQNS4'R.UUf1:0N1E.E 101.000-4i"00
PTIAN ,{i�t��Ny1(17i
f ia-11t13M
. 4B?Bc1i.-ry?rMiS;
IIVI IMVIMi —?, p10li1--0�10i)0
.9'ih/,EiV
Us✓ RiCAL FEE. 101-000-420- 00
PLUA110ING F'HE 101 -OW -419-000 $11.O.ii
GRAt)rW1 -M, ? 101 -0130 -423 -ON) +n.rx►
1?f31./is'4,L1PM. MPAC7 FrIE
P'l-WC18E PLAN i0l-M-441-345 $ftrA.VtI
FEE DEPOSIT 1t}l—tli30—Q39w:318 -$250.(x1
C1 ffl-'( rAl, CONS 1111- (l j`jON ,AND _P?!AN CHEC,-11.)
� lg d.�CC�IStt_n(5�
Y
"d'MAL P)$;lt2;IMT J+E'<E3 i3l)E NOW
RECEIPT
DATE
BY
\B+.171: "
DATE FINALED
INSPECTOR
4.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR +
BUILDING
Set Backs
Forms & Footings
APPROVALS
(al-�_
MECHANICAL AP_ PROVALS'
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Oi-/O- ICAO <X_
Exhaust Fans
O.K. to Wrap
y_ ay_00
F.A.U.
Framing
Compressor
Insulation
-017- Oa
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
- o <4,t -
Drywall - Int. Lath
_ 2 _ CO
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Y -/S- 00
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
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
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)
Building a
Address
Owner
'STA j20C- W1
Mailing
Address P,v, (30i
City
Cc"
tr"a'ctor
bU . V . fly
P.O. BOX 1504 APPLIC 5
E 78-495 CALLE TAMPICO
y(l L LE,70 LA QUINTA, CALIFORNIA 92253
Zip_ ITel.
- 001'Z
City Zip Tel.
�fi4fvwuo I q-22-144 49q, I zo
State Lic. City
& Classif. 2 1 1 —^� 7� Lic. #
Arch., Engr., f
Designer tzic.0 fir. a
Address Tel.
P. 0-00X 45_0 .lu� 1 GG
City Zip State
�A Ui a 2Z �j ",J" Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I,ram licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3„ofrfrhhe:B'usipF"�eyss/aDd Prof�essi'ons Code, and my license is in full force and
effect.% _"" �'�f�"• e""i�"""
SIGNATURE • DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 703 1.5,
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 rhealleged 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, 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.)
I 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.)
1-1 1 am exempt under Sec. B. & P.C. for this reason
Date Owner �• `
WORKERS' COMPENSATION DECLARATION i
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
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 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 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
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
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.
1 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
LDING: TYPE'CONST. OCC. GRP.
. Number '7'l 4 - 019 Z - of R
Legal Description
Project Description
Sq. Ft.' Ala
Size
No. No. Dw.
Stories Units
New Add ❑
Alter ❑ Repair ❑
Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
% y
v P,
Const.
Mech.
Electrical
Plumbing
S.M.I. !
�/
Grading
Driveway Enc.
Infrastructure
„ TOTAL
REMARKS
i
1r t
.-ZONE: BY:
Minimum Set tiack-Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Seback from Center Line '
Side Setback from Property Line
FINAL DATE ` INSPECTOR
Issued by:—Date Permit
Validated by:
Validatio
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Date 3/20/00
No. 20185 Jurisdiction
Owner NameStarlight Management Inc.
No. 54-385 Street Avenida Vallejo
APN # 774-082-019
La Quinta
Permit # 0003-159
Log #
City La Quinta zip 92253. Study Area '
Tract # BLK224 Lot # 7 Square Footage 1421
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 1,421 or $ 2,742.53 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 CCNalley Independent Bank/LarryShields Tele'phn o`ne `I7
60=345-0012
Name on the check
By Dr. Doris Wilson
Superintendent T� '
Fee collected /exempted by Mary Ann L. Borja Payment Received 1.y f 2,7 153
Check.No. 209774 '
Signature
v v
NOTICE: Pursuant of 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
above will begin to 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
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 DeptJApplicant Copy - Applicant/Receipt Copy - Accounting
Company can issue a Standard Policy of Title Insurance Ownersform, i-th'Iiabi1ity of
$321000.00, on real property in City"of La Quinta, County of Riverside, State of California viz:
Commonlyknown as; Vacant-Lots: APN: 774-082-019/020, La Quinta, California 92253 .
A� Lots 7 and 8 of Block 224 at Santa Carmel`ita .at Vale La Quinta,'Unit #21,
as per map recorded.in Book 20, Page 22 of maps, in the office-of the County
Recorder of said County.
Except any reservations of record of minerals, oil, gas, water, carbons.and:hydrocarbons.
Showing title vested in:
t Starlight.Management, Inc., a Nevada Corporation or Nominee
Free from encumbrance except:
A.- .Current,general and special taxes for the fiscal year in which this escrow closes; and
taxes.for the ensuing year,-if any, a lien not yet due or payable.
B. The lien of supplemental taxes, if any, assessed pursuant to the provisions' of Chapter
• 3.5 (commencing with Section 75) of the Revenue and Taxation Code of the 'State of
California. •k
C. - Special improvement assessments, if any.
D. Easements, rights; rights of.way, covenants, conditions, restrictions and reservations of
record.
CSeller Buyer
by
OP
10AR OtseAfT4
RC DISTRICT -PLANNING REVIEW FORM 1 RtVU
co
a
This form is to be used by CDD staff for review of single family dwellings in the RC (Cove�Res_idential)
District, in order to determine the applicability of compatibility issues or need to require the filing of M'asterr
Design Guidelines by the applicant. It shall be transmitted to the Building and Safety Department as your
correction list. Please attach additional explanations as necessary.
APPLICANT W. R. ROGERS
SITE ADDRESS ' 5 Avenida Vallejo `
APN 774 082 - 019 BIN NO.: 36 CASE NO.: 2000-202
LEGAL: LOT BLOCK Z2 UNIT S.C.@V.L.Q.
CHECKED BY: Greg Trousd > l DATE:
a
Inform the assigned Building plan checker upon your assignment to this case. The C ec tiv
Secretary maintains a log book to track applications and assign case numbers. z
REQUIRED ITEM
Y
N'
C0MMENT/C0RRE5r
Compatibility Review
Uj
a
Case logged and number assigned
Verify. legal and APN information.
Consistent with MDG on file (as applicable
4J
MDG filing required (5 filings since 9/3/98)
• o. m
a _ C„
•
Consistency with street/surrounding area:
Colors
�• Materials
Architecture
Q m W U
Other Requirements:
G �Airty
3.
�1
*Cerftticatoo fOccupanT f
c
a� •c
Ci
tof LaQuinta.
.Building and Safety Departments
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: 53-385 AVENIDA• VALLEJO
Use..Classification: SFD Bldg. Permit No.: 0003-159 LL
Occupancy Group: R 3 Type of Construction: VN Land Use Zone:' RC
Owner of Building: STARLIGHT MANAGEMENT INC Address: P.O. BOX 3578
City: PALM DESERT, CA 92261
By: •-.STEVE TRAXEL _
Date: 06-09-00
Building Official x
POST IN A CONSPICUOUS PLACE