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LICENSED CONTRACTOR DECLARATION
1 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
?rofessionals Code, and my License is in full force and effect.
y License # Lic. Class Exp. Date
29172 B 0.11126i
pate Signature of Contractor77 .' "- • =�
.t 77
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:
'(, ) [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) - ssued. My workers' compensation insurance carrier & policy no. are:
CarrierPolicy 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
subject'to the workers' compensation provisionsof Section 3700 of the Labor
Code, I shall forthwith comply with those provisions:.
Date� Applicant_ ..� 9fr. _�✓�
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 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 representatives of this City to enter upon
the above-mentioned property for
inspection purposes.
$Ig ature (Owner/Agent)'-^' X ' a� Date �'✓� • '� ��
BUILDING PERMIT PERMIT"X124
DATE VALUATION 591,294,10 LOT 6 TRACT 11166. -UI 7
ADDRESS .rYTr�'iS AVE'�NiIt DIAL AZ
APN 773481-019
OWNER
CONTRACTOR / DESIGNER / ENGINEER
f.A QUIN'LA. 3?.A ll�l3'n S
WILL IMM RUSSELL RIOCTER.S
51220 AVENIDA CA.RRA.hf.7. A
56-900 JACKSON
LA QUfiV' A CA. 92253
THERMAL CA 9�L74
(160)399-1200 C:111,7N, 5449
USE OF PERMIT
SINO IMAM LY WELL3NG
Sr, D - PER&-fffT 00ES NOT tAiC::UA)II, L1LOCK WALLS OR POUL. (xm
TRAC CONSTR CTION 1.4 r5.00 Sr•
PORG11,%�AM 96.00 S.i:
ifd ftAtviFrOtli¢k?UiZ`I' ' 463A.Ki SF
4'f+'1'. 190013 FfsfiVCE 100,00 .LF
ESTIAMAUM MST Ole CLaNSUR. JCTIGN
91,294.111)
f'.It:R1m,T 1iC,U;9f(siify,AR°k'
raOi�TS�IRFR;'f`fi5 f r�F'g 1f.11 -OW -418.000 S60150
P1 -AN F93 1f14�ii30r43a:3;ts� $�ca4.7�a
17,1 DJ's'OS#'i' 1(Bl -fJ00. i3 -31 4250.00
-
1.1XC,C'f`1bC,`AL FEE 101-000-420-000
I�f;fit4fE fN(" ai+f; i(!I_000-4,19-f' , f S12A.75
.ly[,..CiN61Iti" rIONFrM-RFISUD 1/0�l-0010-241"0'��o
@px/,..13,,
�c RA.1.?f. O i',fW, 100-tf00 423.000 .D4l1.00
9FiFKAS`.t'RUC11i1LI W F EE 2,25-0W-443-;342 52,006,26
Pfd,r:C,'IS'i� f?t.ati?J IOf-n(H)-4rt1-345 $'1m00
I� a
Sl,ti� `rY.�`1'c11,: C;t�1+i41!Ii1C'�'i'i'f��i .+�i�ll"► l�.i�tA:�� 4:!•3.Ff;Io:
�3a�l..Lt1
LX,SS FRE -PAID FEES
.$250:00
1
D '3:MAL
131` PUMlbti`:ti FUES DUE NOW
S3,31`I:Lix
APR 2 3 1999
n
RECEIPT b `"�
DATE V
BY S
DATE FINALED
INSPECTOR
I.
3
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings (
Ducts
Slab Grade za
Return Air
Steel
Combustion Air
Roof Deck -Z -
Exhaust Fans
O.K to Wrap -y(_ S
F.A.U.
Framing
Compressor
Insulation y
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath - ( - cj F
Drywall - Int. Lath - - T_.
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
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 si
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Piaster
Sewer Lateral
Pool Cover
Sewer Connection S
Encapsulation
Gas Piping
Gas Test d
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole Z� _
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)
COMMENTS:
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. BOX
Building -` `I/1 r 78-495 CALLE TAM TAMPICO
Address �/A Z LA QUINTA, CALIFORNIA 92253
kAPPLICAT NLY
15NO3
L. Av ► is ?01 r 4 N -r- I
Mailing J /1
Address 4' / -A-10 A V I N. G. C.a, a. Z A
BUILDING: TYPE•CONST. OCC. GRP.
A.P. Number 17 3 7 -AP/ 0 14 to
/ + /
Legal Description L O -r (y QLack 1 tO b
Project Description PLAN IT t
/ t
VN I '�" 11
City /�'�
La QV f fJ 4t
Zip
~1 1. Z S 73
Tel.
S y~ 8 y �0
Contractor ( O%E j,. M5 .
Address
-
`!��dl`F_LDG
City
Zip Tef.
NV IV
5,6611
State Lic. City
& Classif. 3 7 0 yy (3 Lic. # 9 .0 �'
Sq. Ft.No. No. Dw.
Size Iw 7 5�' Stories Units
Arch., Engr.,
Designer
New ❑ Add ❑ Alter ❑ Repair ❑
Demolition Cl
Address
Tel.
City
Zip
State
Lic. #
NSED CON;PACTOR'S DECLARATION
e&d and T pr:0pS10 ,j�_qpter 9 (commencing with Section
1 hereby aff4to:?of
LeBusin
7000) of�ss and �,d s ode, and my licensi In I I Ion,"
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
permil 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 rive hundred dollars ($500).
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 will have the burden
of proving that he did not build or improve for the purpose of sale.)
Estimated Valuation
PERMIT AMOUNT
t/
Plan Chk. Dep. O ✓�^
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
I 1 I, asowner 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.)
tl I am exempt under Sec. B. & P.C. for this reason
S.M.1.
Grading
Driveway Enc.
Date ownerInfiaS,tfu
lure
'
WORKERS' COMPENSATION DECLARATION
i hereby affirm that I have a certificate of consent to self -insure, or a certificate oM
Worker's Compensation Insurance, or a certifi h eof ( y sec. 00, L or ode.)
Policy NO. -Company CompanyDir-�p
Copy is filed with the city. ❑ Certified copy is hereby furnished.
10 lqqq
TAT,QL�-,
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
)� R�EWIi4RKS-� e 6 V(
(This section need not be completed if the permit is for one hundred dollars (5100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
y
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.
ZONE: BY:
Minimum Setback Distances: '
Front Setback -from Center Line
Rear Setback from Rear Prop. Line
' CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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.)
'•
Side Setback from Property Line
ame
Lender's Name-
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Lender's
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 lawsrelating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of adplicant Date
Mailing Address
Validation:
City, State, Zip
APPLICANT �;, PINK= BUILDING
WHITE = FINANCE ^. YELLOW =
Notice:
Document Cannot Be Duplicated
Date 4/22/99
No. 18618
Owner NameLa Quinta Partners
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
No. 52-625 Street Avenida Diaz
City La Quinta
Tract # B166, U17 Lot # 6
Type of Development Single Family Residence
Comments
APN # 773-281-019
Jurisdiction La Quinta
Permit #
Log #
Zip 92253 Study Area
Square Footage 1,475
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 th'e.'amount of
1.93 X 1,475 or $ 2,846.75 the property listed above and- J'iat banding v `
permits and/or Certificates of Occupancy for this square footage in this proposed project iris y_now-iie issued
Fees Paid By CCNalley Independent Bank/Michelle Eichstedt Telephone
Name on the check 'r
By Dr. Doris Wilson ='
Superintendent
Fee collected /exempted by Juanita Green Payment Received $2,846.75
Check No. 183348
Signature
NOTICE: Pursuant of Assbly 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 identifiedabove will begin to run fro 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
collect them on the Dislrict('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
e
MA CITY OFZ
� 1?�
R 16 RECD . �..� �►
t R
RC District - P�ann A&LReWe,w-Tia n
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
Building & Safety as your correction list. Please attach additional explanations as necessary.
APPLICANT: CATES CONSTRUCTION
PROJECT
ADDRESS: Avenida Diaz 1C
APN:
773-281-019
LEGAL: LOT'—,.BLOCK ,.BLOCK 166. UNIT 17 , S.C. @ V.L.Q.
C K' D BY: GREG TROUSDELL
BIN NO: See Bldg. staff CASE NO. 99-49 CHECK 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 I N
COMMENT/CORRECTION
Case logged and number assigned
Verify legal and APN information
Consistent with MDG on file. las applicable)
MDG filing required (5 + filings since 9/3/98)
i
Consistency'wit
IColors
Materials
Architecture C'
i
OTHER REQUIREMENTS:
The.zoning code, architectural and landscaping manuals, and/or assigned inspector should
be consulted where uncertainties arise. The completed checklist shall be maintained in the
Building .& Safety address file.
3'I
T ti Feb -03-00 03:24pm From-COWNWEALTH
RECORDING REQUESTED BY:
CHICAGO TITLE COMPANY COMPANY
98.7993KC 87009840
Wi1LM0L%RRAAAV0 r'
DAVID ROSS MILLER
+6103413215 T -T11 P.01/01 F-624
GRANT DEET)
The undersigned grantor(s) declare(q)o
Documentary transfer tax is $13.20,
(XXX) Computed on full value of property conveyed, or
( ) Computed on full value less, liens and encumbrances remainsng at cime of sale.
( ) Unincorporated area: ( ) City of , and
FOR A VALUABLE CONSIDERATION, receipt of Which is hereby acknowledged,
LOYOLA MARYMOUNT UNIVERSITY
hereby GRANT(S) to
TRUDY SHFRMADT. A MARWEED WOM&N
the real property in the Cicy of LA QUINTA. Councy of Riverside, State of California,
described as:
LOT 6, BLOCK 166. UNIT NO. 17, SANTA CARMRLITA AT VALE LA QUINTA, AS
PER MAP RECORDED IN ROOK 19, PAGE 19-20. OF MAPS. RECORDS OF RIVERSIDE
COUNTY, CALIFORNIA
Dated October 11, 1998
State of California
County of S ) S.S.
on
before me,
--- personally appeared
personally known to me (OT Pv
to be
•the persongQ whose name$KQ sr subscribed
to chs witriin instrument ano acknowledged to
that skejtp-executed the same in
. / authorized capacicy(.P< , and
chat by 0/hez�rsignatureA on the
instrument the person A , or the entity upon
behalf of which the person X acted, executed
the instrument.
WITNESS my hand fnd official s 1
Signature
MMI. TAX STATEMENTS
LOYOLA MARYMOUNT UNIVERSITY
s.
SI E, TITLE
Joh . Oester Vice -President fox
sys and rinnarp
SIQNA £. TITY.E
f
(This area for official notarial seal)
,
s
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: 52-625 AVENIDA DIAZ
Use Classification: SFD Bldg. Permit No.: 9903-126
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC
Owner of Building: LA QUINTA PARTNERS
Building Official.
Address:
By: STEVE TRAXEL
Date: 9-30-99
POST IN A CONSPICUOUS PLACE