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0002-097 (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 395754 9C9 ii6�'3i}i'z�it Date Signature of Contractor Y ^+ • • _4 OWNER -BUILDER DECLARATION i 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. ( 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. (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 Sgction 3700 of the Labor Code, I shall forthwith comply with those -provisions. J Date: R! �i� Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to .the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnity & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit,. or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owrer/Agent) P_1J 1 1 Date BUILDING PERMIT PERMIT(NA)2-0�J1 DATE 4)VI ()/Z0 f1 VALUATION Sii %1811.'10 LOTI TRACT 11M 1)11$ JOB ADDRESS 5.3-405 t��l�'�FIDA )i AZ APN 774 -IMI -01.3 OWNER CONTRACTOR / DESIGNER / ENGINEER T e%v r trr,� n %r"MrCR[ , v l %4%1 A" i.f Z%A%.A 1'1- J 0A'`,FrfNR.TCr0TTI'✓1'fC'f'i�i•I-'�l A IiA. w\Ji,ti a alVy �. I.�.rtY v PO BOX 134 341 E ROSS LA, QU1N FA Ck� >s42253 U C.ENIRO. CA 92243 (760)353-977.2 CMA 5537 USE OF PERMIT NOLE, PANEL Y' DWELL NG S00 - t ERMtT':DOES NOT INCLUDE BLOM WALB OR PC, 6_t (LI QUA MX -2 J1tAti Pir1l.) 1,409.00 of 01ARf#f&'CARPOItT 50.0 COP 3 FT. W001) FENC`IE 200,0U LF ,a �.'.: y:s► :ii �� ae. ea a'.i.� i 0n3 a°.. a°t � �+ gg ��Agyy��k7 (K1N31-H.UU1'1( N.045, 101.000-41.9-000 $590.00 Of, A'hVlf- M,( %, FFA _10110-41;104-311 R Y1011 l �r�,1��.{�iu4ar'rii., .�ti itis •V,)�^`i.�c�.j •iri)v d'�J,.�. �ii T. ''1�1'E 11 1T�L �1��-I,�JV��1��-1 �1 �129.2U 1J1.t)A1l3J:N4) 1ZHf, 101-000-4I9..000 $t1rt.75 S1rye0>.0 kll"'roN Rl F f t3J-(i01D-?414M r;•t2A.t?iN%.f"lsa"; 10 $20.00 DU rfo,01,01IN1iJA':J'PEL $1,907.w 1+i EUR,49PLA.N 101-000-441-315 �1UA.t1s► : : t+F.r 1)f%i�(i�i'f' 101-(3tN.l_q;3q.4iR art^51'T OL1 � � �. _T►.3-*M sof,l' (1Nk t C" T Ni IST) KAN 041CK3,4.14,it) ESS PIRE .-PAID FEES' 4250.GKI RECEIPT DATEBY DATE FINALED INSPECTOR �1r / / n / 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 3 L31 Exhaust Fans O.K. to Wrap V Qty F.A.U. Framing Insulation �i _ C �` Compressor Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath / f 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 Heater Final Water Piping ?j 2 db Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Ov Encapsulation Gas Piping Gas Test Ba Appliances Final Final Utility Notice. (Gas) ELECTRICAL APPROVALS Temp. Power Pole r _ p 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) Q _ COMMENTS: b 0002 - ai7 Building Address - Owner 2 �- P.O. BOX 1504 APPLIC O400 76-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 -A5 %_ra. r r "``T'" " BUILDING: TYPE'CONST. OCC. GRP. Mailing Address P. O G,0K %34- A.P. Number City Zip Tel. 1,N t,�ttv'rr, C_� a"LZ-53 Legal Description 1 _rsr -�kcx-�- li R U14 ct" (S� Contractor Project Description S%&Jg,b,.5 tars L-4 "0,4 L - e w, own-miesnS Address - AV a- , NAAgigir City Zip Tel. t_ti 4"�tatrti �# �{Zz-S3 ��o �- 2�1Z '-� — 5 -0 0 -z State Lic. City & Classif. S q -5, 4 T:!> Lic. # Sq. Ft. No. No. Dw. Size 140,1 Stories Units Arch., Engr., Designer Un- C-4 Q6St1�0 New Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. mna, 450 City Zip State ou ."'r4, (> I -Tvm-3 Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am If ensed under provisions of Chapter 9 (commencing with Section 7000) of DivJ'si n 3 the B iness Professions Code, license of and and my is in full force and effect. l 7-'I Z00 GNATU DATE OWNER -BUILDER DECLARATION Estimated Valuation I hereq 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 PERMIT AMOUNT 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 Section 7031.5 'any for Plan Chk. Dep. for the alleged exemption. Any violation of by applicant a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). Plan Chk. Bal. C', 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 Const. Professions Code: The Contractor's License Lew does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, Mech. provided that such improvements are not intended or offered for sale. It, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden Electrical 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- Plumbing struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law builds improves thereon, for S.M.I. does not apply to an owner of property who or and who contracts such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading 1-1 1 am exempt under Sec. B. & P.C. for this reason Driveway Enc. Date Owner Infrastructure WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 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 n Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS 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 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 ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 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.) Side Setback from Property Line Lender's Name Lender's Address FINAL DATE INSPECTOR 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 1 have read this application and state that the above information is correct. Issued by: Date Permit 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. Validated by: Signature of a0plicant Date Mailing Address Validation: City, State, Zip WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Notice: Document Cannot Be Duplicated Date 2/14/00 No. 20022 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. 53-005 Street Avenida Diaz City La Quinta APN # 774-041-013 Jurisdiction La Quetta zip 92253 Permit # 0002-097 Log # Study Area Tract # B178, U18 Lot # 1 Square Footage 1409 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 1.93 X 1,409 or $ 2,719.37 the property listed above and that building , permits and/or Certificates of Occupancy for this square footage in this proposed project may now be rs9ued �' C Fees Paid By CCNalley Independent Bank/Agustin Paz Teleph'o : Name on the check By Dr. Doris Wilson i f Superintendent Fee collected /exempted by Mary Ann L. Borja Payment Received $2,719.37 IQ. Check No. 209652 Signature NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 9D -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to collect them on the District('$)($') 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 -t. MA -2 JAN.25.20N0 10:31AM COMMONWEALTH NO.796 P:lil noomme ANGMTRD By, CHICA00 TITU COMPANY COMPANY 9343KC 707055174 WNWA RXCOWND ULIL T=2 D= ANBD. Vnccs 0TRITKOs BROW NXLOVI K= TAX STATEM UM TO i WILLIAM THO AS SUFFIN BRA= ADWR 7=8 LZUR *OR UL'O#a naz AFlQe �9?d=OfI�033� GRAW n= The undersigned grantor tr) declare (s) : Documentaxy transfer tax is Computed on full value of propperty conveyed, or Computed on full value leas Bens and'snZumbrances remaining at time of sale. Uninaorporated areas ( ) City of and FOA A VALMUS CW.91f3ftA!fXW, receipt of which is hereby acknowledged, MICHAEL J. PAMIZZQ, hereby GRANT(s) to WILLIAM THOMAS BUFFIN, AN tJiRAPMED MAN DSA LA QUII+Yt'A PARTNERS II the real property in the City of U QUINTA, County of Rivereids, State of California, described as:' Lot 1, Block 179, Unit No. go, Tract Santa Carmelita at vale La Quinta, as per map recorded in Book 39, P49e(8) 30-31 inclusive of maps, in the office of the County Recorder of Said County. Dated caauary ]e, 9000 State of California County of j S.B. on before me, personally appeared personally known to me (or proved to me on the basis of satisfactory evidence) to be the peroonts) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/sbe/they executed the same in his/her/their authorieed capacity(ise), and that by his/hex/their Aignature(e) an the " instrument the person(e), or the entity upon .' behalf of Which the person(s) acted, executed- the instrument. WITNESS my hand and official seal. signature MAID TAX STATENBI $ TO: WMUX TROmRs liwrzv 9 'd W6'ON MiC�i, J. PRg'f�►t�ifb (This area for official notarial Baal) S0089 00d Nd9£:01 OOOZ '9Z'Uef ✓I �� J'. '�Il.i;� CIS C''' LA RC DISTRICT - PLANNING REYIEWTORM / FEB 0 REC'p This form is to be used by CDD staff for review of single family dwellings in the RC (Cove Residential)�Sr j � 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 LA QUINTA PARTNERS SITE ADDRESS 53-005 Avenida Diaz APN 774 - 041 - . 013 BIN NO.: SASE NO. LEGAL: LOT 1 BLOCK 178 UNIT 18 S.C.@V.L.Q. CHECKED BY: Greg Trousdell 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 MDG filing required (5 filings since 9/3/98) Consistencyfi ty4th street/surrounding area: Colors �N0, Materials G\�N��G Architecture LPA i Z DES 11 m Other Requiremen 0 �pZE PQQag4t 8y 0.