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9604-121 (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 1U0i313 E3 C- 12 �r �fi I 1196 Date ��'�Signature of Contractor/�• 6( -� r 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. ( ) 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 8l'iVI FUN17 Policy No. 1 I2t I9_96j (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:provlslons. ) �~ ate: //.. Warning: Failure to secure Works' 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 nulland 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 j ,,Signature (Owner/Agent) ��F Date %. 7. - 1; PERMIT # CONTROL # 21 BUILDING PERMIT 9604- 3534 DATE i :. VALUATION $123,80.1.10 LOT .. 9 TRACTy . CLU15 JOB SITE 7S-. 7i-N.i1)A LA F'ONI)A- APN '7116.,)_132,.0,17 ADDRESS OWNER CONTRACTOR/ DESIGNER / ENGINEER t 1T til t L: E tiYr�t2 iraN t .lac"`rION cCC.NSTRUK ION 310.11 NAk Rl BE LLA V[S'CA. - - 66909 9AN BRC NO: SAN )> fAN CA IS"1 CA 07253 DES.E:':RY HfYTSP10,N'Q CA92240 - t`6i.9)25i,.p�39 CfiL.tl i?0 USE OF PERMIT ,#' RMTf 'iNCi,Cft'ES Pk'sitiLA1#a #`FA WALL 8 AS 8130VtN`QN 5 I.Tri PLAN, 59( 01, T E RMITTO 8133 BT A; tiAnIE17A'1't'0'. °TItAO'r Cc3NS f.'fttlC"E'ION 1.845.00 SF P01trCH'PAVO 280.00 SF t;ARals�ai ft tlTtT�e)R"r 441.001 SF 4 .FT. WALT, 4f4)A0 LF WIMA'. ED cosi or cf1wr.nC'T'1m 123.801..1.0 rryx:aN�t�"'fi fC,rintJ d if?T-00-418v{)!Nj PLANK C1 JECK FIN i>� � �OSi•,i;,',9-31.x' ��2�. � �� —�� &i[8Cfl#X 1#CA1.. I -TI s 1011 OWQI-Uf1C1 $41.00 L- � FL#rer'!�'1tiCA'#;, ►�#:� .. 101�1E3-f1s°r�--C2t)Gt gta�.�J � rrt:i:YMA1f� O FIF , : • ±-0I>.(>0if 10-000 314'C. NCO MO 11110-N 111,9;1 t2:E gw lD1 00044'(-wo L ' �#T.t1fiJL!`�'11F�„ •. ,l�1 tiGt)N��-t>C�i �7�C1ii: c� il+£f'6::A.`lYltf "1`tr E l�l?E 22_5!000-443 342 „ 48 .61 aC v PREC38t. PLAN • T;01 -0D0-441445 =50) xNRT IN T'U0 TC P1.A.{:ky5 - RES3 8F 1: '1k:�'�'AL �;ti.N4"'!') i4' .t�aN AND PLAIN CHECK. 1,2;13.6 T S& PREPAID 1-1-3ES -$250M TOTAJ4.11ERMIT FEES DIT, NOW $3,96167 RECEIPT _ DATE BY DATE FINALED INSPECTOR INSPECTION 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 &G Exhaust Fans O.K to Wrap F.A.U. Framing L Compressor Insulation Vents ' Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath 44 Z4 �41 Drywall - IM. Lath Final Final BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Q Approval to Cover Am Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines / Neater 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 Final`70vS�. Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: Building Address 1J TA uGGu 2 y P.O. Box 1504 -APPLICATION ONLY -- 78-105 CALLE ESTADO ��. LA QUINTA, CALIFORNIA 92253 VWIICt Mailing Address City Zip Tel _ Contractor Address City lZip I Tel BUILDING: TYPE CONST. OCC. GRP. A.P. Number 76' / 3- ---o 1-7 Legal Description (C,/ 7 %/Cr< 5 Rojo -c 21 ;,,K/ Project Description State Lic. City & Classif. Lic. # Sq. Ft. Estimated Valuation //,!�—� r PERMIT Size, Arch.; Engc - , Designer _ New Address Tel. CityI Zip I State Lic. # 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 and Professions Code, and my license is in full force and effect. SIGNATURE 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 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 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.) 17 1 am exempt under Sec. B. 8 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 ❑ Copy is filed with the city. O Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSU RANCE (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 the work for which this aermit 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 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 BUILDING DIVISION /t�; 7` ci No. / No. Dw. I Stories ! Units 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 Side Setback from Property�Line n FINAL DA' Issued by: Validated Validation: Estimated Valuation //,!�—� r PERMIT AMOUNT ' Plan Chk. Dep. ZS b, DU Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL f Z -� . Ou 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 n FINAL DA' Issued by: Validated Validation: CONSTRUCTION ESTIMATE 1ST FL. SO. FT. $ 2ND FL. SO. FT. @ POR. SO. FT. ({i GAR. SO. FT. @ CARP. S0. FT. @ WALL SO. FT. @ SO. FT. @ ESTIMATED CONSTRUCTION VALUATION $ NO. ELECTRICAL FEES UNITS MOBILEHOME SVC. POWER OUTLET NO. PLUMBING FEES YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation COLL. AREA FLOOR DRAIN ROUGH PLUMB. 'MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER FORMS VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) ROCK STORAGE APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL HEATING (FINAL) FURNACE UNIT WALL FLOOR SUSPENDED REINF. STEEL LAUNDRY TRAY TEMP. POLE AIR HANDLING UNIT CFM KITCHEN SINK WATER HEATER ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET BOND BEAM COMPRESSOR HP POLE, TEM/PERM LAVATORY =$ HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER FRAMING BOILER B.T.U. SO. FT. fig+ c BATH TUB SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SU. FT. RESID @ IIA c SEWAGE DISPOSAL SO.FT.GAR @ ?/ac HOUSE SEWER FIREPLACE GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING R AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL I VK'b WUNA I UPIrWI tII IALJ GARDEN WALL FINAL Desert Sands Unified School District Notice:' 82-879 Highway 111 Indio, CA 92201 Document Cannot Be Duplicated 619-775-3500 CERTIFICATE OF COMPLIANCE Date 5/22/96 APN # 769-132-017 No.' 14501 Jurisdiction La Quinta Owner Name George Deverian . l -a -%n Dim No. 78-520 Street Avenida City La Quinta zip 92253 Tract # Type of Development Comments F_ Lot # Single Family Residence Permit # Log # Study Area 116 Square Footage 1845 No. of Units 1 ., 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 1.84 X 1,845 or $ 3,394.80 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/Bank of the Desert/George Deverian Telephone Name on the check By Dolores A. Ballesteros Superintendent Fee collected /exempted by Pauline Pearson 7L WIN. -i_1 f r r !! \ r Payment Received $3,394.80 Check No. 16358 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 i Notice: Document Cannot Be Duplicated Date 5/22/96 No. 14501 Owner Name George Deverian No. 78-520 City La Quinta Desert Sands Unified School District 82-879 Highway 111 Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE Street Avenida La Fonda Tract # Lot # Type of Development Single Family Residence Comments APN # 769-132-017 Jurisdiction La Quinta Permit # Log # Zip 92253 Study Area 116 Square Footage 1845 No. of Units 1 Originally the address was entered incorrectly as'18520 Avenida Marbella Vista. Corrected on 6/25/96. 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 1.84 x 1,845 . or $3,394.80 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/Bank of the Desert/George Deverian Telephone Name on the check By Dolores A. Ballesteros' . Superintendent Fee collected /exempted by Pauline Pearson Payment Received '" $3,394.80 Check No. 16358 Signature , b A n. oaQQ ,) A 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 July 1B., 1996 City of'La QuintaBuilding-.Department 78495 Calle Tampico La'Quinta, California 92253 Attn: `Mark Re: The Deveria i Residence Custom Home.. Changes to'the Construction Documents: Dear Mark, Please attach this letter with the following change's to the City of La Quint's approved set of Construction Documents: 1'. Deleteahe. number 4: rebar reinforcing in:the garage concreteslab shown on "GARAGE FLOOR PLAN KEY NOTES" note number one, sheet 5.. 2, Change the<depth of the 12° wide footing around the house from 18" below grade to 17 below, grade, shown on detail #-7, sheet S-3. - 3. Delete one of the number 4. rebars in the 12" wide footing aroundthe,house, shown on .detail number 7, sheet S-3. If.there are, any questions or commentsplease,,call me at (714) 361.-5618 Sincere) , eoZrt L i n n a u s Robert Linnaust Associates 158 West Avenida Alessandro San Clemente, California 92672 Phone: 71:4/ 361=5618 FAX: 714f494-6181 Certificate of Occupancy City.of La Quinta Building i and Safety Department This Certificate issued pursuant to the requirements of Section 109 -of tfte 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 ollowing. BUILDING ADDRESS: 78-520 AVENIDA LA FONDA Use Classification-: * SINGLE FAMILY DWELLING Bldg. Permit No.: 9604-121 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL Owner of Building: GEORGE DEVERIAN Building Official Address: City: By:. DANIEL P. CRAWFORD JR. Date: DECEMBER 12, 1996 POST INA CONSPICUOUS PLACE