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0108-315 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of CFiapter 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 3.95754 mil C`•.9 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. ,• 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. SMATE, :4t7,'?I!?D 229-90 UNIT 4%r 1000 (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` provisions. ! ,dDate:,_ + Applicant Warning: Failure to secure Workers' Co pensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application Js hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth o his application. 1. Each person upon whose behalf this application is made & each peison at whose request and for whose benefit work is performed under or pursuari}�to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees: 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter.upon the above-mentioned property for -inspection purposes. Signature (Owner/Age_nt):, Date,. 1 BUILDING PERMIT PERMIT# DATE VALUATION LOT TRACT 9g a♦ �7 /1 y n Y r� 9 aTl• i•..� c, i f [iY�l. '! 3. ! 17 JOB SITE .�M1- k. APN ADDRESS 5 1, AWNWA DIM, 773461-4V7 OWNER CONTRACTOR/DESIGNER/EN (NEER ,A,E`rUMIN &L,VA PAZ P.A.Z CONSMA"PrION Co LA. QUINTA CA 92253 (760)564-3023' CUP 5531 r USE OF PERMIT Q!�3 1'1i1i,L?�C 3 S'6e 1 b LCkT 15, �.%'T911. Ni.P:OK:IM Gi•'AN i (1, F& I'UMIT s30i?.„$ RIOT 1INWI,1 E BLOCK WALLA P001AMA OR. DWEWAY APPROACH T CT CONSTRUCTION 1,646.00 30 GARA.6i?1'CA10,bRT SF 5 FT. WOODMCM 200.00 ,t,.r c'?0NSI'I~+.UCTION FITS 101.000-418-000 $681150 PI.&W CHI= F49 101-000.439-119 $183.(33 FE90TE'POSIT 101--M30-439.318 42501"1 • M I.T.f:.'H.018K..,i�. , FI?',S 101-000-421-000 $54.00 FlI.rl?i:Y'Rli`l<..L FEZ #t 3101-000-420-000 $123,19 M.UW.Hf14G JIM'. .. 1011-000-4i9_000 $118.011i 35T.f+`ONG.'<?Y1.€;+2°0,H PEs:- RVIND 101.000.241-000 911.13 f3RADMU1t ES 1 w --000-42 3- cloo $20.00 DEVELOPER IMP.A.C: P FEE � 31,t3(12,�f7 P �Ci k; pI,A 101-00CI-4.49.-313 $1©it.t30 cO.MME.C110 ANI7PLAN'C ECIC. .$3,591.04' ..%9 Pn—PAW FU0 .$25o.00 (� OCT 15 2001 1 ,-8 YDI,' SOW MAI- yM 37 $3,534594 CITY OF LA QUINTA FINANCE OF -FT. RECEIPT DATE /f BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings �` Slab Grade Underground Ducts Ducts Return Air _�D'd' Steel Roof Deck f01!�� O.K. to Wrap II/�Z_� FramingJ' /a O / �� Combustion Air Exhaust Fans F.A.U. Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath J /I Final Final POOLS - 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 Water Piping `�- r �- �� S7 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` Appliances -1 Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole C✓ 7 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 - ---� .r"q yM.',' id. V .. 7f3-4 5 CALLS TAMPICO APPLICATION ONLY 1# Add",Sl- 9�o A vC D % A Z LA OUINTA, CALIFORNIA 92253 ' J9 iIJ � &VA 1 -),Az Address City Zip Tel. f City ZipI State I Lic. # LICENSED CONTRA TOR'S DECLARATION 1 hereby affirm that I atn,licensed under Or isfons of Chapter g (commencing with Section 7000) of Division 3 of the Business and Prof Bions Code, and my license is in full force and effect. , I -•,.� 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, atter, improve, demolish, or repair any structure. prior to'tts 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 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 (f500). I,' 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 of improvement jS 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.) C) 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 r7 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 th@ work for which this permit is issued, I shall not employ any �ergon in any manner so as to become subject to the Workers' Compensation Laws of Cali amnia. Date Owner NOTICE TO APPLICANT.- ff, after making this Certificate of Exemption you should become subject 10 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 sof this city to enter the above- mentioned property for inspection purposes. Signature of alfplicant Date Mailing Address City, State, Zip 3 JILDING: TYPE'CONST. OCC. GRP. op P. Number -77 3- l W ^ 00 )gal Description L p -t / 174.UC 1 33 L) ;J I _ ;Z oject Description .S / �, �� U O Sq. Ft. No. No. Ow. Size % -✓t) S ( Stories Units New`,d Add ❑ Alter ❑ Repair O Demolition ❑ TC / Z 1 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 INSPECTOR Issued by: Validated by: lirl I Validation: AU CITY OF LA QUINTA WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION rAZ �1 pU�`TILUC r 1 U fJ L"t 'J Address 4 City Zip Tel. State Lic. City ! ✓£ Classif. � ,- 5 S Lic. # J r 7 !: Arch., Engr., Designer I E !JC H ht - t -Address Address Tel. City ZipI State I Lic. # LICENSED CONTRA TOR'S DECLARATION 1 hereby affirm that I atn,licensed under Or isfons of Chapter g (commencing with Section 7000) of Division 3 of the Business and Prof Bions Code, and my license is in full force and effect. , I -•,.� 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, atter, improve, demolish, or repair any structure. prior to'tts 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 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 (f500). I,' 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 of improvement jS 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.) C) 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 r7 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 th@ work for which this permit is issued, I shall not employ any �ergon in any manner so as to become subject to the Workers' Compensation Laws of Cali amnia. Date Owner NOTICE TO APPLICANT.- ff, after making this Certificate of Exemption you should become subject 10 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 sof this city to enter the above- mentioned property for inspection purposes. Signature of alfplicant Date Mailing Address City, State, Zip 3 JILDING: TYPE'CONST. OCC. GRP. op P. Number -77 3- l W ^ 00 )gal Description L p -t / 174.UC 1 33 L) ;J I _ ;Z oject Description .S / �, �� U O Sq. Ft. No. No. Ow. Size % -✓t) S ( Stories Units New`,d Add ❑ Alter ❑ Repair O Demolition ❑ TC / Z 1 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 INSPECTOR Issued by: Validated by: lirl I Validation: AU CITY OF LA QUINTA WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Desert Sands Unified School District 47-950 Dune Palms Road . Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 Date 10/15/01 No. 22582 Owner NameAgustin & Eva Paz CERTIFICATE OF COMPLIANCE APN# 773-161-007 Jurisdiction La Quinta No. 51-950 Street Avenida Diaz City La Quinta Zip 92253 Permit # 0108-315 Log # Study Area Tract # BLK 33, U2 Lot # 15 Square Footage 1846 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 1,846 or $ 3,784.30 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 CC / Valley Independent Bank - Agustin Paz _ Telephone Name on the check - } Y . By Dr. Doris Wilson Superintendent Fee collected /exemp ed by Annette Barlow Signature Payment Received Check No L�+ ` $3,784.30 255414 40TICE: 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 rbove 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 - Accounting V v:30 FAX 17608049062 4G REQUESTED BY: ND ZiEN RECORDED MAIL THIS GEED AND, UNLESS OTHERWISE SHOWN BELOW, MAIL TAX STATEMENTS TO: Mr= & Mrs. Agustin Paz COMMONWEALTH TITLE 16 003 SPACE ABOVE THIS LINE FOR RECORDER'S USE The undersigned grentor(s) declare(s): Grant Deed A.P.N. 773-161-009 Documentary transfer tax is $ ( X-jr) 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 and FOR VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, SOUZA, JOHN F. hereby GRANT(S) to AGUSTIN PAZ and EVA PAZ, husband and wide as joint tenants the real property in the City of La Quinta State of California, described as , County of Riverside Lot 15: if Block 33 Unit No. , .Santa. Carmelita at Vale La Quinta, as per map recorded in Book Pages of Maps, records of Riverside County., California Dated . July 31, 2001 _.� Signature of Grantor State of California ), County of ) SS. — -- SOUZ.A, JOHN F. On before me, ,personally appeared --- SOUZA, JOHN F. personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) 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. authorized capacity(ies), and that by. hls/herkheir signature(e) on the instrument the person(s), or the entity upon behalf of which the persvn(s) acted, executed the instrument. " WITNESS my hand and official seal. Signature I MAIL TAX STATEMENTS TO, came as above i i Form 31954 (s-9 I THIS FORM FURNISHED BY COMMONWEALTH LAND TITLE COMPANY! 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 -2-GO-feet of the -applicant; an-d/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 PAZ CONSTRUCTION SITE ADDRESS 51-950 Avenida Diaz i3o AP 773 - 161 - CASE NO.: 2001-545 LEGAL: LOT 15 BLOCK 33 CHECK AND APPROVED BY: Greg Trousdell UNIT 2 DATE: S.C.@V.L.Q. Inform the assigned Building plan checker upon your assignment to this case. The CDD xecutive Secretary maintains a log book to track applications an assign as n mbers. ,�� _�- REQUIRED ITEM Y N COMMENT/CORRECTION Verify legal and APN. information des Consistent with MDG on file (as applicable MDG filing required (5 filings since 9/3/98) G Architectural variety within 200 fe t 54 Q�' e the. surrounding area: OQ`��r Oki 7. o pC 5 Materia�� TiFwArchilecLl11sign features Other Requirements: V` t� S Lq 41 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 51-950 AVENIDA DIAZ Type of Construction: VN Owner of Building: AGUSTIN & EVA PAZ —r b' -L Building Official Bldg. Permit No.: 0108-315 Land Use Zone: RC Address: By: RICHARD KIRKLAND Date: 03-20-02 POST IN A CONSPICUOUS PLACE