0202-263 (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
Z,
/Date- Signature of Contractor
OWNER -BUILDER DECLARATION
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. QI 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 K 41) 157&5$' -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 totthe workers' compensation p ovisions of S ction 700 of the Labor
Code ^t all fortfiyvith comply with t'os p sons.
Date:. Applicant t
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 peison 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 employ °s..
2. Any permit issued as a result of this application becomes null and vol` t—
work is not commenced within 180 days from date of issuance of -UM
permit, or cessation of work for 180 days will subject permit to canceiQio
I certify that I have read this application and state that the above inform ti i
correct. I agree to comply with all City, and State laws relating to the baildin
construction, and hereby authorize representatives, of this City to enter, upon
the above-mentioned property f • r i spection purposes.
(Owner/ASignaie ' Date
�.t
BUILDING PERMIT PERMIT#
DATE% ` VALUATION LOT 0202.-263 TRACT
7 ! "' SO—W 19 WX .412
JOB SITE
APN -
ADDRESS
-gift{) AWNWA, V&LIXY0
.774-= -005
OWNER
CONTRACTOR/DESIGNER/EN (NEER
Q�3� . TKr?ARWERZ
TW`010 10 ROW
CA 9.22S3
P.t9,L. A DF2"-'r CA 92,211.
295;
USE OF PERMIT
SED - PERMIT DDIM NOT Y'd>yCL UI)L H.iOCK. WA1,4 POOG OR, DRIVKWAY
APPROACH. MASTER RAI -98 CO In
TRACT CONSTRUCTIOV 1.501.60 3#
P+ORCHIPATIO 58.00 S
(;9�°,iLA.4'3W,AVORT 463.00 U
51+`T. ,W001)1aENC& 200.00 LF
XSIM"TED COUr OF :;0V,4YrA'UC1T0,K
CONSTRUCTI(W FEE 103 -000-41 0013 $6121s0
PL AIM CHFICIS: FEE 101.000-439-316 S15t3.as
MECH NICAI, FF3 101P000.421-000 5b1 40
b+;1.F4TRICALNFlt 101-0 00-420-000 S.13130
I"LUMBM10 F29 101-00041D.000 2110.7-5,
STRt, NO ?AOTION FER • R&1I) 101.000-1041-000 $9.31
ORADI G FIDE 1 {11=000-42-3-1100 520,00
Y)EVZ.10PER]U :ACT?PE $1,007.00
IyR "ISE PLAN 10s--000-441-345 SY00.fId4
Tett DEPOSIT SIT 101-00"39-518 „�zSt1.00
A
IMS PRE-PAMM.81
-$25U0
9 TOTAL 1;XRM_' s5DUEI �.�41
z
TB 2 r
o
f YOFL1AQUII'1���'
RECEIPT
DATE^ r
BY'._,..r..--�-"
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
-.;4
Ducts41
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
.02--
Exhaust Fans
0. K. to Wrap
–o Z
F.A.U.
Framing
_ m o y
Compressor
Insulation
-0 Z
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 ov
BLOCKWALL A PROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
-�� * ��
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Gas Piping
l p►2. j�
Encapsulation
Gas Test
Z,
Appliances
Final
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) Z • Q . o Zr
COMMENTS:
4 4 "
P.O. BOX 1504
Address
Buildingi`,%a 1 ` �0 76-495 CALLE CALIFORNIATAMPIO
AddresU' l'F/ � /'iiJC. ifi�K.l; [J � QUINTA, ORNIA 92253
Mailing?v}
Address
City Tel.
�•
Address
City Zip
Jrarc Lw / 7
& Classif. �' Lic. #
n
Designer
Address
City LD IZip IState
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I am licensed and 6r90isions of h� ter 9 (Comma
nth"e Busigess andot6,iyns�C e, and my license
OWNER -BUILDER DECLARATION
I hereby affirm that 1 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 rile 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 thathe 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 rive hundred dollars (S500).
C] 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
Prolessions Code: The Contractor's License Law does not apply to an owner or 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 11, 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.)
1-7 1 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.)
PNo. Company
Ii
7 Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed pit 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, alter 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 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 aQplicant Date
Mailing Address
City, State, Zip
yr
APPLICATION ONLY
LDING: TYPE'CONST. OCC. GRP.
. Number V+ W --!A
�Qtno _
al Description L67 -♦L67-1 `1f / -A— eze 3.
inrt tlncrrintinn N�. S � 11 -
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
sq. Ft. '
Size
No.
Stories
i No. Dw.
1 Units
New Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
tAA s
Plumbingf�e.���_j
S.M.I.
Grading
o-.4 aq`fllo AAr
Driveway Enc.
Infrastructure
CrTYONF,L
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
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 •2/26/02 I APN #. 774-302-005 .
No. 22991 Jurisdiction La Quinta
owner NameLa Quinta Partners Permit # 0202-263
No. 54860 Street Avenida Vallejo Log #
City. La Quinta zip, 92253 Study Area
Tract # BLK312 Lot # 19 Square Footage 1501
Type of Development Single Family Residence No. of Units
Comments
Construction of new single family dwelling of 1501 sq. ft.
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
2.14 X 1,501 or $ 3,212.14 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 1 st Bank/Dick Scott Telephone '760/408-3495 .
Name on the check
By Dr. Doris Wilson ;
,r
Superintendent
Fee collected h C /exempted Crystal Scott Payment Received. '
P Y • rY Y 33,212.14
Check No', -'61381
Signature ) ;
r
F
TICE: Pursuant to Assembly Bill 8081 (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 will begnto run from the date on which the building or installation permit for this project is sssued or on which they are paid to the Districts) or to another public entity authorized tolect them on the District('s)(s') behalf, whichever is earlier. - y
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�
.s................ . .. ... .... n rinn. rrnr a—.r r..r rr r. �' '{ , 'i... �.....................r...........r. .. ....
RECO DING REQUESTED BY;
AND WMEN RPtORPED MAIL THIS Dill 00 ANd,
iUNLE.S.5 OTHERWISE SHOWN BELOW,
'
MAIL .TAX $TAT6ME1`!T$ 70(_
LA . QU,INTA PARTNERS'
P.O. BOX 134... .:
LA QUINTA, `CA 192253'
.
6
� � •c? � v�' VAc�.Ej�
$PACFe ADCVe'THIS LINE FAR RFl bROER's use
The undersigned grantor(s) declare(s): Grant.D"d A. P. N. . °�`Y4 —.102-005
Documentary Irdn3far tax la g
I,
compu►sd'ori full value of prop conveyed, or
( ) aompuW on tull value Iasa.valya of Ileus and aneumbronosa:ramelnihp tat Ilme of Be*
( ) Unincorporated area, . ( j City of
_ and -
FOR A VALIIABkL? CONSId�RATIQN; recalp! of w1ilGh,ja fiefdoy
aoknowledged,
RUiiEN .GRIJALVO
hereby GRANTS) to LA QUI.NTA PARTNERS
the �t�l property In the City. of . La Quint.a '
County of )ti •lersid e r
Stite bf Nlitcmle, described as
Lot 1 Q of Block 31.2 Unit No.
� �; Santa. Carmel�t:a s.t Vale .La Quinka,
ars pvir map recorded .3n BQ.ok a Pe.ges .
�f Maps, Records og Riveraid.a County,
D�c asau�zv 21 204.x.._ . '
$Igriatura of Grantor ' '
Iste of:Catilomla } '
CountY Ar ) S9...
On _— _be6�ro rre,.
RUBEN GRIJALVO
-XCIBEN GRTJALV@
_.
psrvnsIiy.known tome (O proved forma on tie liasll;of s� Oiisfacctory
^. _
av!dencs) to be the person($) whose nat7l0($) !e/Ara 5Lbacrited.la the
within Instniment and aoOowtadoad to ma that.he/shaAh®y exeeuted
the same In hia/h odlhelr author x0d capnGity(ie'a);..ar,d that by
1118/hrNthelr-slpneture(e) on Che lnsirment Iha,pen4n(e),'or the artily
upon bohglr of which the pereon(e) acted, exnculed thednalrvntent '.
WITN@9S my hand and 010141 Seal.
SlOnatwA
• MAIL TAX STATRARNTS T0, �,
RC DISTRICT - PLANNING REVIEW FORM'
ECEIVE
FEB — 5 2001
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 additiorial explanations as necessary. pcA—s f2,0-5- ---9
APPLICANT PACIFIC TRADES
SITE ADDRESS 54-860 Avenida Vallejo
APN 774 - 302 - 005
LEGAL: LOT 19
CASE NO.: 2002-618
BLOCK 302 UNIT
S.C.@V.L.Q.
CHECK AND APPROVED BY: Wally Nesbit DATE:
Inform the assigned Building plan checker upon your assignment to this case. The CDD
Executive Secr.etary•`maintains a log book to track applications 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 feet.of
the surrounding area:
F
Colors
Materials
Architectural design features
2cat
&-5c,,�s ro �f 7v
S'J�C/Z.Jv•�„✓�
LX
Other Requiby.,
D Planning Commisslon
❑ City Council
Qommunit Dev. Dept.
Initials
Case No. /ec OZ -&t 6
Fxhibit
ate
eso
.,..�....
�..,
0 With Conditions
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:
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Const
IIOwner of Building:. LA QUINTA PARTNERS
..1—d04n
Building Official
54-860 AVENIDA VALLEJO
Bldg. Permit No.: 0202-263
;tion: VN Land Use Zone: RC
Address: P.O. BOX 134
City: LA QUINTA, CA 92253
By: RICHARD KIRKLAND
Date: 07-09-02
POST IN A CONSPICUOUS PLACE