0001-079 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Xhapter 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
tasuso� a 1 fr�/Uiioc
,/ateSignature 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 ;TI ;?'a'iY%diZ Policy No. 15.1`664-Z'
(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.
Ate: 3 -�3�L-�s✓lApplicant
itD
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.
Sgnature (Owner/Agent) - ��Date�wfy-j
BUILDING PERMIT PERMIT#
4116t111-079
DATE/^ VALUATION S11.(1,91- LOT 1 TRACT
'd/ rf
vO
✓
JOB SITE
ADD R SS 33-4ZOkY�V17!I 0A.DLA
APN 774-072-008
OWNER
CONTRACTOR/DESIGNER/ENGINEER
itSTltYJtrirA,!oQr3T'Tf'"ru'%KTfln 'i\T(�
�..1 II.Y'aI1%_ 1►1.J4.V :.d.,,lVV.
`'r'6>i0ni11(`IiA�CT`t{Trf'1'fl�Rrri1 tRTL`
t.uua)...�.d1,Ia'U.! V�..AIVt'aU..V.el.l�+b..,
80-655 A NU 43
&)-635 Ai 1Y igU.E 4_1
1N1:)10 CA. 91601
IND1.0 CA 92201
('760)347.9755 112113LI 5791
USE OF PERMIT
SINO.,
SFD - F-MvilT DGES NOT .1N LUD13 BLOCK- WaA•LU OR POOL
I-'rvN.C'r C O NSTItUCrION 1,a3 1..00 :'s1'
-
PirRO V13Ei.1 0 liloo SF
•.�
4 }WkAOWCAR1'0.fiT WA.09 tit''
,
5 FT. WOOD P-ENCE 240.00 .LFF
.
�•z}�.p, A yam, ei'li.�i.t L1�1tLi d4 L i'COSTFCpNS yvMNI
PF CONS
•.
110,917.30.
YACRIMT FEE8U1Cz-U1!
C• ONSTRt"fC71C 4 VEX 101 -000 -418 -WO $678.04
PT.Ary C,FTFr,A FVIR 101-Oft(11,-439-3 US
N. (17711 (A Ia11 U FZIi "101-000421-000
iik.laC,1 d0ALFi47E iui•000-4 0-000 Si f.i2
f• 1JJ.tMb1N(J FEX, 101 -OW -419-000
91RC)1' OA,f()Tt()N.FF-;RfNIP �01-W-7dI-Q%V $11 of#
^..
1, i40
, 71RCi,0.00
r, aw :
DEVERLOPER1NIPi,CTkF1iii $I,107.t81
, _•
••• ' ✓t••
Pft' ;ISFPLAN 101-000-441-345
i
ART UN PT 191J(,- P1..r1(71;S 12i?afT 7(14-l��)-7
' F�f•`C)3XT 101-000.439-318 -$250.00
may,
SUR -IMM, CONSTM �'110N AND P:-•�N C,1-Si•;�''j.'
$3,025,74
ESS PTU -PAI FEES
41250.00
TOTAL P1?'.�dMIii FEES IS(J'F i1`f; W
$3.37$:/4
RECEIPT
DATE
BY
DATE FINALEDINSPECTOR
e. POP
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
Exhaust Fans
O.K. to Wrap
n
F.A.U.
Framing-7-4-990-57Compressor
Insulation
? yo —Z?l� '!
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
7 ' — CAP
Drywall - Int. Lath
./ 400
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
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
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
Utility Notice (Perm)
COMMENTS:
Notice:
Document Cannot Be Duplicated
Date 2/2/00
No. 19983
Owner NameWilliam Tribble
No. 53-420
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 # 774-072-008
Jurisdiction La Ouinta
zip 92253
Square Footage
Permit #
Log # WT1781
Study Area
1781
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 the amount of
1.93 X 1,781 or $ 3,437.33 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/Prime Bank/William Tribble, Jr.
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Mary Ann L. Borja
Signature
Telephone .
Payment Received $3,437.33
Check No. 2194
NOTICE: 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
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('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
Took -or7�
Q
Cv� � �5 P.O. BOX TAM APPL I ONLY
Building [� n 1 78-495 CALLE TAMPICO
Address 53 7�o fIUe,. d o LA QUINTA, CALIFORNIA 92253
Owner/ ) ,
L✓t r ~1 art -4 /C BUILDING: TYPE•CONST.1/le
OCC. GRP.
Mailing � [
Address ?0 -65S thAf• '/ j A.P. Number / 7
7 oz.2 - 0 0 f?
City Zip Tel. � CJ % /6
T,,,�I,•U �'�(f � Legal Description
Contractor/r Project Description
//'t J✓lP C OtirTo,.,,s ,_To,.,,C a .
Address �
5Am c an -471 T
City Zip Tely:jAN 18'2900State Lic. a '*IV•& Classif. �j St�Q 0� # S� 9 / Sq. Ft. No. J !! No. Dw.
Size / �� Stories / Units
Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.-
' l t+
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am'llcensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Pr� fessions Code, and my license is in full force and
effect.` ��_6W
SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.S,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
for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit Plan Chk. Dep. r
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
t-_' I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.
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, Mech.
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 Electrical
of proving that he did not build or improve for the purpose of sale.)
I1
1, 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
does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.1.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
1-1 I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's CUennsat n�gsurance, or a certified_ ,py thereoy���800, Labor Code.)
Policy No. ��.•77 7i Company 6Y� f
(7 Copy is filed with the city. O 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 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, 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
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
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 I 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 applicant Date
Mailing Address Validation:
City, State, Zip
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
r -
b
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 .
Building & Safety as your correction list. Please attach additional explanations as necessary.
APPLICANT: TRIBBLE CONSTRUCTION
PROJECT
ADDRESS: 53-420 Avenida Diaz
APN:. 774-072-008
LEGAL: LOT' 16 , BLOCK., UNIT . S.C. @ V.L.Q.'
CVD BY: Fred Baker
BIN NO:. CASE NO, 2000-183 CHECK -DATE:
Inform- the assigned Building plan checker .upoh..y.our..assignment to this case. The CDD
Executive Secretary maintains a log book to track applications and. assign case numbers.
REOUIRED ITEM • Y
N I
COMMENT/CORRECTION
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ti\.\..{:�
[Case logged and number assigned
Verify legal and APN information V
Consistent with MDG on file (as applicable)
MDG filing required (5+ filings since 9/3/98)
Consistericy •with-street/sur ounding area',
Colors
Materials
.Architecture .
v
�6
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.
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
ollowing.
BUILDING ADDRESS: 53-420 AVENIDA DIAZ
Use Classification:. SFD Bldg. Permit No.: 0001-079
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC
Owner of Building: TRIBBLE CONSTRUCTION CO. INC Address: 80-655 AVENUE 43
Building Official
City: INDIO, CA 92201
By: STEVE TRAM
Date: 10-12-00
POST IN A CONSPICUOUS PLACE