0007-210 (SFD)LICENSED CONTRACTOR DECLARATION
U) hereby affirm under penalty of perjury that I am licensed under provisions of
1L6-
,"Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
L - Professionals Code, and my License is in full force and effect.
O =) ch License # Lic. Class p Exp. Date
oZ r- Date F ' Signature of Contractor
�O�
J U C OWNER -BUILDER DECLARATION
HUJ rl- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z ( ) 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).
ce)() I am exempt under Section , B&P.C. for this reason
N Date Signature of Owner
ON
rn
CL Q WORKER'S COMPENSATION DECLARATION
C) CC I hereby affirm under penalty of perjury one of the following declarations:
- FZ O () 1 have and will maintain a certificate of consent to self -insure for workers'
X w �= compensation, as provided for by Section 3700 of the Labor Code, for the
Om � Q performance of the work for which this permit is issued.
Q U (.,) I have and will maintain workers' compensation insurance, as required by
OU
Q Section 3700 of the Labor Code, for the performance of the work for which this
CL:LO H permit is issued. My workers' compensation insurance carrier & policy no. are:
Nt Z Carrier Policy No.
co D STATE: FUND 1280990.00
�O
J
(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 ofNCalifornia, and agree that if I should become
1 subject to the workers' compensation provisions of Section, 3700 of. the Labor
e�•i7 Code, I shall forthwith comply wit ,those p' ovisions.
Date: 25 ? 10 Applicant
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
I 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, indemnity
& 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,vauthorize representatives of, this City to enter upon
the above-mentioned property for inspection purposes. \
Signature (Owner/Agent)�� `��'^�) Date
PERMIT PERMIT#
DAT � LOT ` TRACT
' /;7LUATIONILDING
BLOCK
fit 32
JOB SITE
APN
ADDRESS . AvFmliiq T)IrAL•
773 1;x54)15
OWNER
CONTRACTOR / DESIGNER / EN (NEER
DAVID K Alit{ UR
PAMIC TRADES t ONS'S'RUCrION
9 0C'FANS1DE CA 92054 -t
(760)967-00€9 cmE ff 19ms
{
USE OF PERMIT
SDIGIZ FAlttl7L' YD IFLL O
SI?D- NER.MIT DDS NOT INCLUDE BLOCK WkLL U.Z POO),
TR.AC I CONSTRUCTION 1,421.00 8F
PORC1.1/PA'T10 36.00 SF
MIACIF.�CA.RPMf (31) 9,096,00
5 F'I'. WOOD INCE 200,00 LF
T DWYEDD CO.Vf OF CONb'TIZIIC TON
89,335.10
P1±'R11 U 1~TR $!%Muia RY
CONSTRUC" 1'lON FEL 101-900.418'000 S5900
PLAN CHUCK FEE 101-000-439-319 $500.12
MECHANICAL FEE 101 -000-4ZI -000 $60.00
ELECTRICAL FEE 101.000-420-000 $139.44
PLUM81NO VEE 101-000.419.000 $11 a,7s
STRONOYAOrIONIFEE,-RFSID 101-000-244-000 $3.93
ORADMA RE 101.000-423.000 $20.90
IDZti EL,OPZR 1MPAC'f FEE $1,907.00
PREC18E PLM 101.000.441.345 $100.40
FEE DEPOSIT 101-000-439=318 4150100
SID33-'1`tYt AL CONSTR 'i TfON AND PLAN GIM, CK
$;3,430,74
LESS P72E�PA7D M., S
-$250.00
TOTAL P1L` 21l� 11' MES DUI;+. NOW
53,180.74
RECEIPT
DATE f B t;
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
_
Underground Ducts
Ducts
Slab Grade
�•�
Return Air
Steel
G��l
Combustion Air
Roof Deck
O.K to Wrap
60
/----t9a
✓/!�
,00
Exhaust Fans
F.A.U.
l�
l
Framing
�%
Compressor
Insulation
_�• �a
aj
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
_
Exterior Lath
Drywall - Int. Lath
Final
FinalPOOLS-SPAS
BLOCKWALL APPROVALS
Steel
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
/_ _
S'
Heater Final
Water Piping/(7
Plumbing Final
Plumbing Top Out
G
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
s/ (7 _zw�v
S%
Encapsulation
Gas Piping
Gas Test
/—
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
! 7-49
cr7'
Underground Conduit
v
Rough Wiring
Low Voltage Wiring
Fi)dures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
/
Temp. Use of Power
Final
7 'r)
Utility Notice (Perm)
660 -A .
4 ade'a I
P.O. BOX 1504 pppLICA O LY
Building —2� R L �� 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
Owne7
BUILDING: TYPE'CONST. OCC. GRP.
Mailing `
Address �� A.P. Number
Legal Description
Contractor Project Description
V A,
Address
-
p
State Lic. (� I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City IZip I State
#
LICENSED CONTRACTOR'S DECLARATION
I herebyy affirm t at I,am,Qcensed under provisions of Chapter 9 (commencing with Section
000) o DrvR on bf tR@ business and Prof"essions Code and my license is in full force and
ifect. S
0 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 (8500).
I: I, as ownerof 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 wfll have the burden
of proving that he did not build or improve for the purpose of sale.)
I l 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 contractors) 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
Ihereby 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
n Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100) valuation
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.
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.
t 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 aQpticant Date
Mailing Address
City, State, Zip
Sq. Ft. t �` `
Size f \
New ❑ Add ❑
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
No. No. Dw.
Stories Units
Alter ❑ Repair ❑ Demolition ❑
AMOUNT
s
f r
--
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
NSPECTOR
Issued by: Date Permit
Validated bv:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Date 8/7/00
No. 20847
Owner NameDavid R. Miller
No. 51-825
City La Quinta
Tract #
'Type of Development
Comments
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Street Avenida Diaz
Lot #
Single Family Residence
APN # 773-155-015
Jurisdiction La Ouinta
zip 92253
Permit #
Log #
Study Area
Square Footage 1421
No. of Units
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 1 in the amount of
2.05 X 1,421 or $ 2,913.05 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/Capital Bank of North County -David Miller
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Ellen Patino Payment Received
Telephone x•
s
r,
$2,913.05
Check No. 18649
Signature
IOTICE: 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
bove 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
ollect 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 - Accounting
JUL.24.2000 10:54AM COMMONWEALTH
RECORDINQa REQUUTED BY: "1
CHICAGO TITLE COMPANY COMPANY
10EE0NN97KC 207056828
UNL L�AREN'1'SDLOWD ,
DAVID ROSS MILLER
GRANT DEED
NO. 707 P.1/1
&V-41111:5V]:1S�IrIi : r
Wlhtlsm*ffrl I - —
The undersigned grantor(s) declare(s):
Documentary transfer tax is $22,00
(XXX) Computed on full value of property conveyed, or
( ) computed on full value less liens and encumbrances remaining at time of sale.
( ) Unincorporated area: ( ) City of , and
POR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
WILLIAM R. RIL8Y, TRUSTEE OP THE WILLIAM R. RILEY 1990 TRUST
hereby GRANT(S) to
DAVID ROSS MILLER, �k MARRIEA MAN AS HIS SOLE AND SEPARATE PROPERTY
the real property in the City of LA QUINTA, County of Riverside, State of California,
described as;
Lot 3, Block 32,'Unit No. 2 „ Tract Santa Carmelita at Vale La Quinta, as per map
recorded in Book 18, Page(s) 55-56 inclusive of maps, in the office of the County
Recorder of said County,
Dated June 27, 2000
State of Cal' rni
County of ers�de } S.S.
.on July 14, 7000
before me, $e7y,V Collier,
, personally appeared
T.T'ill ism }R]1W1z_ Trurtae
/j ziz-L�' &Z&Z 14
LIAM R. RILEY, TRt7ST$E
personally known to me (or proved to me on
the basis of satisfactory evidence) to beItc
KELLY COLLIER �
the person (s) whose name (,x-) is/ subscribed COMMA 1 23420
to the within instrument and acknowledged to TARY PUBLIC-CALIFORNIAG)
RIVERSIDE COUNTY
me that he/ehef-they executed the same in MM. EXP, JUNE -6, 2003
1-;is/her7LcMr authorized capacity(ires), and
that by his/herftheir. signature() on the
instrument the perscn(s�, or the entity upon
behalf of which the person(,e) acted, executed
the instrument] /'1
wiTNESS my ha' d lmd off-kadial seal.
Signa ureS A l (This area for official notarial seal)
MAIL TAX EME T0: SatesA$ ABOVE
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.
APPLICANT PACIFIC TRADES
SITE ADDRESS .51-825 Avenida Diaz
APN 773 - 155 - 015 BIN NO.:
LEGAL: LOT 3 BLOCK 32
CASE NO.: 2000-262
UNIT S.C.@V.L.Q
CHECKED BY: gta�S�wa DATE:
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
Case logged and number assigned
Verify legal and APN information
Consistent with MDG on file (as applicable
v
MDG filing required (5 filings since 9/3/98)
Consistency with street/surrounding area:
Colors
Materials
Architecture
V
Other Requirements:
O�i -�f ldy�l/1L i>r,
,
Certificate of Occupancy
o
City. of La. Quinta 4, �
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: 51-825 AVENIDA DIAZ
Use Classification: SFD Bldg. Permit No.: 0007-210
Occupancy Group: R 3 Type of.. Construction: VN Land Use Zone: RC
Owner of Building: DAVID R. MILLER
Building Official
Address:
By: STEVE TRAXEL
Date: 11-.15-00
POST IN A CONSPICUOUS PLACE