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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 -
638535. B
I •C <I0*
pate Signature of Contractor
OWNER -BUILDER
r
A •V-
I hereby affirm under penalty of perjury that I arft exempt from the Contract6P's
License Law for the following reason: j
( ) 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 DECL=ARATION
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 STATE FUND Policy No. - '
(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 r
subject to the workers' compensatio provisions of Secs(on 3700 -of the Labor
q Code, I sh/SII forthwith comply with tho a pro�ui
ante: "�' `�Applicant -- ---�
t
Warning: Failure to secure Workers' Compensation coverage is unlaI�TdL�
shall subject an employer to criminal penalties and civil fines up to 1,0,000, In
addition to the cost of compensation; damages as provided for j 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 .representat' es of this City to enter upon
the above-mentioned property for inspection pgrposes.
Sig ature (Owner/Agent) �te
Liz
4-/ 6 a a BUILDING PERMIT PERMIT#
DATE VALUATION LOT 3912-150 TRACT
BLK 49134'
JOB SITE/
APN
ADDU SS
51-297 AWMDA DIA7,
773-043-034
OWNER
CONTRACTOR/DESIGNER/ENGINEER
LA Q•CiIMA PAR`MRS
LEND1 L V NTURES
51370 AVB BERMUDAS
_
54-090 AVMA y'tT T .A i--,
LAQUINfA CA 92253
LE.QUINTP, CA -'92253',
(760)564-1866 CB.L*' 1;59;
L.E24CH i9L�t5lAt f9KcJUi° ��
USE OF PERMIT
8WGLB FANS[LY D1Fi'k,1.� 1N0
PO B6X 450
SE'D . PERMIT DOLS NOT INCLUDZ BLOCK WALLS OR POOL �•� ,.. , i
TRACT CONSTRUCTION 3,006,00 SF
PORCH/PATIO 263.00 SF
C AIARAMICARPORT 70.00 SF
ELATED COSf OF COMM11C'I'101V
881 84.50
1'Tt'.iOirA"t FEE S`17111i141Et y
C014STRUCTION FEE 101-000-418.000 39200
PLAN CHECK FEE 101-000.439-318 - M,Ig
..CHANIC�.L FEE 101-000.431.000 $92.00
LECTIZICAL FEE 101-000-420-000 $189,67
111"PELUMBINO FEF1 101.000-419-000 $161.25
5TRONOMOTION FEE -PMID 101-000-241-000 $13.14
OIRADING Ir -R 101.000-423.000 $20.00
DZS/EI-?PFR IMPACT FLEE $4907.00
PRECISE PUN 101.000-441-345 $100,00
FEE DEPOSIT 101-000-439-318 4250.00
81'TB-TCYtAL CONSS'RIMMON AND PLAN CHkG'T:.
$4,187.74
LES PRE -PAID FEES
-$250.00
TOT AL PERV- 9f F ERS DCS, NOW
$3;` . 7,74
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
ISC�
evor.—A
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
f
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
• Q
Exhaust Fans
O.K to Wrap
_ v7
F.A.U.
Framing
_
Compressor
Insulation
p �v(
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 o
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
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
Water Pipings
_ _�J
S /
Heater Final
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
Aa57
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 D
Utility Notice (Perm)
COMMENTS:
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: SFD
Occupancy Group: R 3
51-297 AVENIDA DIAZ
Type of Construction
Owner -of Building: LA QUINTA PARTNERS
—1- * &004 %
Building Official
Bldg. Permit .No.: 9912-150
VN Land Use Zone: RC
Address:
By: STEVE TRAXEL
Date: 10-25-01
POST IN A CONSPICUOUS PLACE
. t.
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, in order to determine the applicability of compatibility issues or need to require the filing of Master
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.
�� v�-4r-�" rr --
APPLICANT �1yy\aVl 'CGt in -6vV1 � �-eV.0 e/J (Giyl l/
SITE ADDRESS S ( 2q 1 C1rv'& D !q2'
APN 113 - 0 4 3 - 03 4 BIN NO.:
CASE NO.: y � -1 !.3
LEGAL: LOT BLOCK UNIT S.C.@V.L.Q.
CHECKED BY: �� DATE: cO
Inform the assigned Building plan checker upon your assignment to this case. The CDD Executive
Secretary maintains a log book to track applications and assign case numbers.
REQUIRED ITEM
Y
N
COMMENT/CORRECTION
Compatibility Review
v�
Case logged and number assigned
Verify legal and APN information
\
Consistent with MDG on file (as applicable
IN,
MDG filing required (5 filings since 9/3/98) .
Consistency with street/surrounding area:
Colors
Materials
Architecture
l
-,
Other Requirements:
S�nn�i 31 (s1V
Building
ggI2-150
T4`v1 4
P.O. BOX 1504 APPLIC O Y
78-495 CALLE TAMPICO
97 , i X; #, LA QUINTA, CALIFORNIA 92253
Owner
Ln
Mailing c.
Address i O ,��
City Zip Tel c+
66
Contractor
Address,
City � Zip Z « `.� Tel.
� V
State Lic. City
& Classif. L, G,> ` Lic. #
Arch., Engr., ,
Designer
Address Tel.
�ty1. ZIp777 t Lic.t#
7 LICENSED CONTRACTOR'S DECLARATION
I herebyraffirm that I am licensed under provisions of,Chapter 9 (commencing with Section
7000) of Division 3 of jhe Bu�,s'r�ess and Professions Code and my license is in full force and
effect. L A Lo 1 �-- V :Lit [�� � I f.4�
SIGNATURE + DATE
0', fNER-BUILDER DECLARATION '
I hereby affirm that 1 am Axempt 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
Me provisions of the Contractor's License Law, Chapter 9 (commenc4 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 tb 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, ancifthe structure is not intended or offered for sale. (Sec. 7044, Buisness and
Prolessions Coye": 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.)
II
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 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. 3900, Labor Code.)
Policy No. Company
(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 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, atter 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 applicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE'CONST. �f OCC. GRP.
A.P. Number
Legal Description �+ taf.e.:. l— 4 q
Project Description V si Q-.
1P -C. t.9 -4 ✓x IL-'I-T,r11 (._
Sq. Ft./ No. ( No. Dw.
Size " X_X' c Stories Units
New 47� Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
WHITE = FINANCE YELLOW = A
PERMIT ` AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
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
PPLICANT
INSPECTOR
Issued by:
Date��
Validated by:
Validation:
or
PINK = BUILDING DI�ISIDN°
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 4/10/00
No. 20264 Jurisdiction
Owner NameLa Quinta Partners
No. 51-297 Street Avenida Diaz
City La Quinta zip 92253
APN # 773-043-034
La Quinta
Permit #9912-150
Log #
Study Area
Tract # BLK 49 U4 Lot # 5/6 Square Footage 3006
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
2.05 X 3,006 or $ 6,162.30 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/Patty Magana
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by
Signature
Telephone
Y
Mary Ann L. Boda Payment Received '%'.:,$6,l62.30
Check No. 216233
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1988) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment IdentHied
above will begin to run from the date on which the building or lnsta0ation 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 Dlstrict('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
NW, 8.1999 10: S6AM , COMC1 NWEALTH
=CORDING 280t1SBTBD Syr
CHICAGO TITLE COMPANY COMPANY
99.9134KC 97057070
MEN #OCORDSD NA11i TXXS DMW AND,
mmmes OTu mmax S8oWN SB cm,
VAiL TAY STATMXT6 'i'0 r
HAL BRASU", Tnotee
GRMa
'!5-1//V"e 0, a. --2—
NO. 406 . P.3/3
■Oda -034
The undersigned grantor(s) declare(s)r
Documentary transfer tax is $96.16
(Xxx CoMputed on full value of Irplerty conveyed, or
( Computed on full value les 1 one and encumbrances remaining at time of sale.
( Unincorporated areal ( ) City of
and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
BYRON L. TURNER and JOYCE S. '1MMIL, husband and wife as community property
hereby GPJW(®) to RMLD N. BUSMs Ttnstae of the Harold R. Braour* Family Tzgmat dated
April 3, 1998
the real property in the City of LA Qt7INTA, County of Riverside, State of California,
described as:
Lot (a) 8 and 6, Block 49, Uftit No. 4, Tract Santa Carmelite at Vale Le Quint&, as per
may recorded in Book IS, Page(®) 62 inclusive of maps, in the office of the County
Recorder of said County,
Dated October 20, 1999
State of Califon is AA ��'�
country or .fl :'!!�. W�1hL I ) S.S.
on �Gi• 9.t// IV
before me,, l j'-�gt
, personally appeared
Gr1 !�UL
(,NneL
i , 4.9-C
_
personally kaOWnJt0 me (or proved to me on
the basis of satisfactory evidencs) to be
the person(o) whose name(s) War* subscribed
to uhe within instrument and acknowledged to
me tha: he/she/they executed the same in
his/her/their authorized capacity(ies), and.
that by him/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 handamend &K ficial Seal,
Signature t ,'`��\
MAIL TAX STATMOMT9 TOr SAME AS ABOVE
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(Th18 area.far official notarial seal)
S83NO89 83MOd NV89:6 OOOZ 11'JQW
APR- 3-00 MON 12:12 PM I.ENCH DESIGN moo« FAX N0. 760 564 2627
04/03/2000 13:40 7148560706
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