0001-078 (SFD)O M
LO
WV-
6ZI�
O' 0I— CD
www
►— a
U)
Z
CO
Lr)
N
ON
_0 <
a a Z
Lo H 0
0 J J
m<3
tl
Lo,
H
I'll Z
r O
` J
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
65pi803 13 I 1 6610i
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, 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:
Carver SPolicy No.
SMAT 11A,'1� 1.` f 2fi t-29
(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;,Vhall forthwith comply with those provisions.
Date: Applicant a �`.2�.•' `"150./
V -
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 (Owner/Agent) f' X1- Date
BUILDING PERMIT PERMI103('14)78
DATE'{ �% ySI`� i/ VALUATION _.11(9.;09,70 LOT 1 �. TRACT BLK1841 U18
JOB SITE ADDRESS '5SS - 160 Ad WDA Mul
APN 774-0/.2-6,16
OWNER
CONTRACTOR /j DESIGNER ENGINEER
Ai
{�
ni tJ 1 A'L\lJ4,k i.-14
80-655 AVENUE; Ria
80-655 AVE.. Ln. 43
INDto CA 92201
3:tJD[0 CA 92201
Q64j347-9755 C'8L# 5291
USE OF PERMIT
SINGLE FA(+2ii.Y DWELLING
SrT<) - PL -R vtlT DaiS NO iN LADE BLOOM t} AL LS; M A4C I
'x Ei: iC i^'OINTSAll.UC 101'1 1, 1C)1.VV sr.
PO%CI4rPA71O 198.00 Sl
(3AidA AYC;ARP01U.' 474.00 CF
5 FT. WOOD I EN E 20.00 LF
EST 1AOMX5 ED COST OF COINISTgill'C."1710IN
I1 1.99"10
PERM -IT FE -40, SUi%f-MARY
C ONST12t1L. fKYN Fist: 101-000-418-000 5678,0
PCIAN 1(13 -()Oil-X139-119 8564.29
NZ1AN.'iCAL xIPTRE 101-0004'..1-000 $50.00
LL,t C,X1U0AL F.f-j 1011400420-M $141.32
PLUM110ING .N M.L: 101-(1(1()••419-000 S116.75
,MOW(l Mc,TKYN FrF, - fi,F,S!-1) 101 -000 -M. -MO 1%t 1.02
C` 1ADUNIC rEE 101-000-Q3-000 $20.001
Ltis'V'r OPER IMPACT F U, $!,907.06
P1t_ C .I.SF, ki.AN 10.1-000-441-345 5100.00
Ali' fT!}2i 113)..,1;1'f',AC"1?C?55-Ono $rS 50
-
EL MPO.SIT 101-()00439-313 -$250.00
�• `
•
A
`
'
9
SUB-`1KY-M, CONS1"RUCITON ND PLAN CHECK
, •$3,fZ3.t�3s
LESS PPLE-PAID FEES
t�-x..$250.00
'.e€Y1*AL i?I~;I3`MIT li+EMS' DUE NOW
RECEIPT
RECEIPT
r�T�
DATE
BY �' (
DATE FINALED
INSPECTOR
l
\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
—
Exhaust Fans
O.K. to Wrap
<Ile
F.A.U.
Framing
Compressor
Insulation
.. —da
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
• tw
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
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
COMMENTS:
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)
` 0001 -07-6 -18
�GG�tiCt/
P.O. BOX 1504
Building /�/
78-495 CALLE TAMPICO APPLICATI� ONLY
Address 5-3 — 70 40 LA QUINTA, CALIFORNIA 92253
Owner cc
I—).// `T /`� /r' � BUILDING: TYPE'CONST..Jft
OCC. GRP.
Mailing
A.P. Number
Legal Description .4 D /
uontracior, Project Description
Address
City lZip Tel.
State Lic.I City
r
& Classif. / o an 7 Lic. #
Arch., Engr.,
Designer
Address Tel.
City IZip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of t e Business and Pro essions Code, and my license is in full force and
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
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, 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
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.)
1'I 1, 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.)
i7 I 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 sell -insure, or a certificate of
Worker's Compensation Insurance, or a certifie.d�gpy thereof. (Sec. 800, Labor Code.)
Policy No. ✓��� ash 'Company -S' , r FU .,
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 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
subject to 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
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.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it 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 applicant Date
Mailing Address
City, State, Zip
Sq. Ft. No.
Size Stories
New ❑ Add ❑ Alter ❑ rFiepair ❑
stimated Valuation
PERMIT AMOUNT
Plan Chk. Dep. 25p'
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: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
6
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 2/2/00
No. 19985
Owner NameWilliam Tribble
No. 53-460 Street Avenida Diaz
City La Quinta
Tract # Lot #
APN # 774-072-010
Jurisdiction La Quinta
Permit #
Log # WT1781
Zip 92253 Study Area
Square Footage 1781
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 1,781 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. Telephone -,;-
Name on the check S. r '`
By Dr. Doris Wilson
Superintendent f
r�
Fee collected /exempted by Mary Ann L. Borja Payment Received $3,437.33
i
Check No. 2198
Signature
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 Distdct('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
12/29/99 WED 17:51 FAX 909 889 7632 CONTRACTORS FINANCIAL -Q001
...nuc 9 002
RECORDING REQUESTED BY:
AND WHEN RECORDED, MAIL TO:
William Tribble
60655 Avenue 43
Indio, CA 92201
TW SP^" RA FMORME" use ONLY
ASSESSMIS PARCEL NO.! The undersigned Grantor(s) dedam(s) that the DOCUMENT TRANSFER
TAX IS: .
TITLEORDERNO.: 92022209 S 57-75 County
City
ESCROW NO.: 19362-004 XX computed on the full value of the interest of property conveyed, or
— computed on the full value less the value of liens or encumbrances
GRANT DEED remalNng thereon at the time of sale
-- OR transfer Is EXEMPT from tax for the following reason:
FOR A VALUABLE CONSIDERATION, receipt of which Is hereby acknowledged,
Henry C. Griswold as Trusme cf the FAmwy G1dow ad ;ivftig 'fit established pxreuem to that certain doctrimt
maitled "Declaration of Trust" dated Jane 19, 1995, and ewxxited by Hetny C. Griswold as Tttcstor and Thotee
hereby GRANT(S) to
WILLIAM TRIBBLE, A WIDOWER
all that real property aftuated In the City of La Quinta
County of Riverside , state of California, described as:
LOTS 14,15 4 16 IN BLOCK 164 OF SANTA CARMELITA AT VALE LA, QUINTA, UNIT No -Is AS SHOWN
BY MAP ON FILE IN HOOK 19, PAGES 31 OF MAPS% RECORDS OF RIVERSTME COtTIM, CALIFORNIA
Dared December 20, 1999
} t"Henry
STATE OF CALIF
Griswold, a ee
r
SIA. 'r
COUNTY OF t
On 21- f qAM{ , before In. Ana
V Notary Public, personally appeared
,men r.,.:risl�yol
personally known to me (or proved to me on the basis of
satisfactory evidence) to be the persons) whose name(i)
is/are subscribed to the within Instrument and acknowledged
CtNDV 9URt91N
to me that he/shsfthey executed the same in hls/h*their.
by his/hejUvelr
0
COMM. otter
NoraRYPu
authorized capacity(les), and that slgnature(s)
RrvERSyDE 00lJ�fiY
DEQQL�rTy
"�rOa"""�� °f
on the instrument the person(s), or the entity upon behalf of
which the persons) act eoce�t.
d the Instrument
WITNESS my hand
A'761,04d-
Signature �*&zelram�M2—
Rn�ae4malAadn�mry�9
MAIL TAX STATEMENTS T
SAME AS ABOVB-
AWROS
crrf. ErATI s UP
F
-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. issue's -6r need
to require the filing of Master Design Guidelines by the applicant. It shall be transmitted to
Building & Safety as your correctiori list. Please attach additional explanations as necessary.
APPLICANT: . .TRIBBLE CONSTRUCTION
PROJECT
ADDRESS: 53-460 Avenida Diaz
APN: 774-072-010.
LEGAL: LOT • 14 , BLOCK , UNIT S.C. @ V.L.Q.
CVD BY: Fred Baker
BIN NO:. CASE NO.2000-182 ..CHECK-DA.TE:
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.
' REOUIRED ITEM
Y.
N
COMMENT/CORRECTION
;'J:\.:}hC�:���4i>i$.GCi::����i:•: \�..�a;\,,:i�•'?��•:2:4�•;' r\ntiv::.va. •: y6:{.CCili`l:Jive'.\'.. •.:f �\\.... .. �a-\-•
'\`:C:is{\: *1.1- :: V{{: Gi:\ \ `.�`v\ \{\{a:r:a>� J^.t:.a\}}:. \a:?:{ e ta{ `•A\C.:'S
{\{.. }. �.......:.......... .. a::•\{env.\\Q:�4+.{•i;}\�4•.\•:i{n\y{�{\\{��nw•� C\ �yh`\'K�.n�:
;fi:;cti\•�ti{>•ti{C `.: \•�: �c�\y"�^.a:\is��::\Ca:.n`:..vC:i..`.•:.`::\\.{'\{.\<X^.,:\c..y?{';+f:\.\::•n:y.i`i:
i\ ...:. ....��...•rv.4vin�av a' '.q�a�.a..:.n.{a.�.�i. v.Ji•\�ia:4\.:.:a`5.:..�•..vL\..
A. t14;P;A,i3:t17;s
�.w�::
w.• L.�`:'r:{{�'\:. \•.n �a J.:f..:ti{.lana
.a a:.. iU`{ar�hN`\�.i',.fn•.ti�$]`r �.`a \
.:�\.: ti{j:�i t•^\{ \
[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)
Consistency 'with'street/sur{ounding area:.
Colors
Materials
--Architecture .
OTHER REQUIREMENTS:
4V C
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.
204.4.
BAZUA ROOFING
CAL LIC # 628223 DATE:
P.O. BOX 1078
MECCA, CA 92254 WORK ORDER NO.
(760)397-3200
BILL T0: PHONE:
rZ
CUST:
JOB:
JOB ADDRESS
DESCRIPTION OF WORK START DATE
MATERIAL WARRANTY LABOR GUARANTEE
$50.00 FEE ON ALL RETURNED OR CANCELLED CHECKS.
10%lFEE ON ALL CANCELLED ORDERS.
C� /
TOTAL AMOUNT DUE
AMOUNT PAID. DOWN
TOTAL BALANCE DUE
NOT RESPONSIBLE FOR WIND OR INTERIOR
Thank You
I REQUEST THE ABOVE
WORK TO BE DONE.
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:
Use Classification: SFD
53-460 AVENIDA DIAZ
Occupancy Group: R 3 Type of Construction:
Owner of Building: TRIBBLE CONSTRUCTION CO. INC
Building Official
VN
Bldg. Permit No.: 0001-078
Land Use Zone: RC
Address: 80-655 AVENUE 43
City: INDIO, CA 92201
By: STEVE TRAM
Date: 10-12-00
POST IN A CONSPICUOUS PLACE