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0106-131 (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 Date •-' -'/";/ Signature of Contractor - OWNER -BUILDER DECLA ATIONj 'N 1; I hereby affirm under penalty of perjury that I am exempt from the ContrIctor'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). . ( ) 1, 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 hefeby 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. ran F1yu13 1��91#931-01 (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 S lion 3700 of the Labor Code, I shall forthwith comply with those`provts s. t Date: -2- .;; f Applicant iY Warning: Failure to secure Workers' Compensation ccJerage is unlawful and shall subject an employer to criminal penaltiesSand civil fines up to $90,000, in addition to the cost of compensation, damages as,provided for in Section 3706 of the Labor Code, interest and attorney's fees. a. 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 & sac n at Whose request and for whose benefit work is performed under or s ;any permit issued as a result of this applicaton agrees to, & shall ify & hold harmless the City of La Quinta, its officers, agents and loy es. 2. Any permit issued as a result of this application becomes null vo d if work is not commenced within 180 days from date of issuan a of s ch permit, or cessation of work for 180 days will subject permit to c ncellat on. 1 certify that I have read this application and state that the above inf rmation is L • correct. I agree to comply with all City, and State laws relating tote building '. construction, and herebyyauthorize representatives of this City to,egter upon the above-mentioned props y.for inspec4ornpurposes. i, I . 9`T ` N Signature (Owner/Agent) � Uate"' ..BUILDING PERMIT - PERMT# DATE/ J� VALUATION LOT 0106 -1131 TRACT JOB SITE APN ADDRESS OWNER CONTRACTOR / DESIGNER / EN (NEER y 1719 0 JaMU NT 3 719 V TRYEMONT 0 t;3UMM)DE CA 412054• V 010EANMYS CA 92054 (160)967-0069. CS3%k 1955 USE OF PERMIT S1?E) P 6rY5u!'f 00173 NOT INCLUDE 13I.�%L .QC i�3.Af i:, POOLOR1)d2fVL'Ihf it,Pl RO, CH (KAOT.F 8. PLAN 90 NA4) TRACT CONSTRUCTION 3,409,00 wXl Q%3"(.A0F11C,AFtP0RT 519.00 SF Ff. WOOD VENCID 200,00 L ` �y�y.�yq�,�(�yq�y"".fif�.'d�11,��.d'�:d�a'v'9`�1:4f` ��^^^�y;,��yj;)��yqp'�'•��++yp} Fra flu, MWIC .!° .1'.�Na '�4 �4,7x1�'.r19D im b CONSTRUCTION ME 101-000-418.000 $590,00 N1HC11A:NIC.AL F=' 101-000.421-000 $53,511. ELZICTRICAJ, iIZY 101-000420-000 $129.30 PLUMB 14{0 FEr 103 -000-419-000 $10173. MOTION !SEE . ,RESH) 101-000-241-000 $3.84 CIVIL4DEN0 Owl 101-000-423.000 $20fio DEVE1A)PI3d IMPACT FRE sl,90'7.00 PRECISE P A14 101.000-441-345 $100,00 FEL DEPOSIT 101-000-439-318 .250.00 ,.. 9 ` _. TAS:. C` 01UT3 IX -H!. ON AND 1~!i. AX (.::Hr-) 53,41430 A,�«3a� .�':�1•,: �ATlJ F�' s� �+,`ku:�J Ca. O(1 L -_ 2 2001 iTY OF LA OUINTA FINANCE DEPT , n ^ RECEIPT DATE / BY DATE I SPECTOR :eINSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts - Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final _ Final �G� 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 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 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) Q% �Q• 17 CITY OF LA QUINTS I BUILDING & SAFETY DEPARTMENT. 1 77.,7-7012 INSPECTION REQUEST LINE 777-7153 owner DAVID MILLER r�rr I A�F4 ontractor PAC I permit Number 0106-131 POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES` JOB ADDRESS 54-240 AVENIDA VALLEJO SFD - PERMIT DOES NOT INCLUDE BLOCK WALL, POOL OR DRIVEWAY APPROACH. 1 'DATE INSP. I TYPE OF INSPECTION _ FOUNDATION & SETBAC' FOOTINGSTEEL Si l MAIN GROUND SYSTEM GROUND PLUMBING I PRE-GUNITE DO NOT POUR UUn�.n .wA 10 LAAC I i JOISTS & GIRDERS j ELECTRICAL GROUNDWORK DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC i ROUGH PLUMBING ROUGH GAS & GAS TEST — - i HEATING' T A/C •rte FINEPLh�JG,�_, ROOF " v BOND BEAM _ O.K. TO WRAP - GROUT ❑ 4' ❑ 8' FRAMING INSULATION ' PRE -ROOF - i COVER'NO WORK UNTIL ABOVE IJAS. BEEN SIGNED DRYWALL INTERIOR POOL FENCES GATE SEWER SEPTIC TANI ELECTRICAL PLUMBING FINAL GAS TEST HEATING - A/C HOUSE NUMBERS JOB COMPLETED TEMP POWER - o _ .. .........� n.n_UT Tn Building f Address / Owner Mailing df Address i 7 ser < f421 rii a •� T� `.'rQo__& Id c -p P.O. BOX 1504 APPLICATION ONLY / 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 CityZip Tel. Contractor , . , Address ,� f City Zip Tel State Lic. City & Classif. f�f�/� 1 Lic. # G� " Arch., Engr., Designer . Address Tel. CityI Zip I State Lic. # \ LICENSED `CONTRACTOR'S DECLARATION I I hereby affirm that amlicensed 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. \_ '� 1_1� SIGNATURE E .% �. `� C N V DATE .OWNER -BUILDER dECLARATION I hereby affirm that I am exempt from the dontractor'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 oner of the property, or my employees with wages as their sole compensation, will do the wowrk, 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.) 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'COMPENSATIONINSURANCE (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 Certificateof 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. 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 UILDING: TYPE'CONST. OCC. GRP. .P. Number -7 %V 7 / --' - 0/2- egal Description Z,. 1 / � /,41- 2 5/, roject Description %1:::� 2 Sq, Ft.: No. No. Dw. size Stories Units New/ Add ❑ Alter ❑ Repair ❑ Demolition ❑ REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Estimated Valuation Side Setback from Property Line PERMIT AMOUNT n :i Plan Chk. Dep. Issued by: Plan Chk. Bal. Validated by: Const. Mech. Electric - - It Plumbiqq n I+� S.M.I. Gradin Drivew nc. Inf rasti ucture :F i i� ouiNr ry 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 by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Desert Sands Unified SchooMistrict " 47-950 Dune Palms Road Notice:' La Quinta, CA 92253 Document'Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 7/2/01 APN # 774-213-012 No. 22200 .. Jurisdiction La Quinta i Owner NameDavid Ross Miller Permit#0106-131 No. 54-240 Street Avenida Vallejo Log # City La Quinta zip 92253 Study Area Tract # B283U26 Lot # 13 Square Footage 1409 Type of Development Single Family Residence No. of Units 1 Comments . i J 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 1,409 or $ 2,888.45 the property listed above and thatbuilding , permits and/or Certificates of Occupancy for this square footage in this proposed project may ndw be issued Fees Paid By CC / Mission Oaks National Bank - J.R. Rodriguez Telephone 760-967-0069 Name on the check B Dr. Doris Wilson' By .. r Superintendent Fee collected /exempted by Annette Barlow Payment Received $2,888.45 �L�/� W �`'' • '. Check No. 10580 Signature NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified ' above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to tolled them on the District('s)(s') behalf, whichever is earlier. Collector: -Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accountirig y l , 01/0001 10':25 FAX 17608049.662 CWWONWEALTH TITLE 0002 RECORDING REQUESTED BY: AND WHEN RECORDED MAIL THIS DEED AND, UNLESS OTHERWISE SHOWN BELOW, MAIL TAX STATEMENTS TO; William Thomais Buffin Power Brokers 8.0: Box 134 La Quinta, CA 92253 SPACE ABOVE THIS LINE FOR RECORDER'S USE The undersigned grantor(s) declare(s)- Grant Deed ARX. 774-213-012 Documentary transfer tax is S ( %y) computed on full value of property conveyed, or ( %--)computed on full value less value of liens and encumbrances remaining at time of sale. ( ) Unincorporated area: ( ) City of FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Lorenzo & Rachel Arraz hereby GRANT($) to David Ross Miller, a Married 'Man as his sole and separate property the real property in the City of La Quinta State of California, described as Coimty of Riverside , and Lot1` 3_of Block 283 _ Unit No, Santa Carmelita at Vale La Quanta, as per -map recorded in Book Pages tof Maps, Records of Riverside County, California Dated June 6, 2001 State of California ) Signature of Grantor County of ) SS. On before me, Lorenzo & Rachel Arraz personally appeared Lorenzo & Rache rra personally known to me (or proved to me'on the basis of satisfactory evidence) to be the parsons) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorited capacity(ies), and that by - Ns/her/their signature(s) on'the Instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal Signature MAIL TAX STATEMENTS T0, tee, r....., e.9,,. . .- - r 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 PACIFIC. TRADES SITE ADDRESS - 54-240 Avenida Vallejo APN . 774 - 213 - 012 CASE NO.: 20.01-509 LEGAL: LOT 13 V BLOCK 283 ✓ UNIT S.C.@V.L.Q. CHECK AND APPROVED BY: Greg Trousdell DATE: Inform the assigned Building plan checker upon your assignment to this case. The CDD Executive Secre�tart' maintains a log boo to track applicattiio s and assign case numbers. REQU ED ITEM Y N I COMMENT/COR ON Verify legal and APN information .1000 ., Consistent with MDG on file (as Qi applicable MDG filing required (5 filings since t t0111\ / 9/3/98) OP . G Architectural variety within 200 feet the surrounding area: _all olors C ,th O C 6 cS C.1 p mix at rials Architectural design features Other. Requirements: ,F l� c /J- 7 U \GC . (p/T"C' / 1 V Certificate of Occupancy City of. La Quinta Building and Safety Department 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: 54-240 AVENIDA VALLEJO Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0106-1.31 Occupancy Group: R-3, U-1 Type of Construction: VN Land Use Zone: RC y Owner of Building: DAVID ROSS MILLER Address: 1719 S TREMONT City: OCEANSIDE CA 92054 _rW_&_t Building Official -By: KIRK( KIRKLAND Date: JANUARY 18 2002 POST IN A CONSPICUOUS PLACE H