9912-164 (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
2911-729 i� � �, O!31/204
Date. � Signature of.Contractoc •
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason: . •
( ) 1, 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.
(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.povi'sions.
Date: �9d�` Applicant..,-i'w
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,insp ce tion purposes.
f i
Signature- (Owner/Ageni)�F Date
PERMIT #
BUILDING PERMIT "12464
DATE VALUATION S'g*,''A 10 LOT t.w TRACT RL IV'U18
JOB SITE ADDRESS f f 53•-495 bgL���'.�:�t A II .kE il�d APN In"),71-023
OWNERCONTRACTORDESIGNER ENGINEER
SvrA1U-"r.1'�AN%rEN,11DTfrrNC `pLIAlk i W(SSE li'R./1"
0,FitS
PO BOX 3578 3690: JAChSCU &V
VALM DESx°kl' . CA !42261 THERMAL CA 9123
I USE OF PERMIT
1.h OUE FA_)4itLz D1+U 'Li..it'V0,
Pofry-PkaKW1 DGES' NOT .;N LIDS BLOCK WALL OR Pk -.)O -L
MAM'MRST RUCTION 1,409.00 SF
iiARr01Y%7,A;WIe;:)l2"):' 519AW) EN
RECEIPTDATE I BY DATE FINALED I INSPECTOR
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RECEIPTDATE I BY DATE FINALED I INSPECTOR
tj
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
p
Underground Ducts
Ducts
Slab Grade
_
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
f DO s►?
F.A.U.
FramingZ
Z�
Compressor
Insulation
Ua $
Vents
Fireplace P.L.
_7(
Grills
Fireplace T.O.
Fans-& Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior lath
Drywall - Int. Lath
_
Final
Final
C¢
POOLS - SPAS
BLOCKWAI I APPROVALS
Steel
Set Backs
Electric Bond
Footings
Bond Beam; �� •�
I /
i�Et s�
Main Drain
Approval to Cover
f
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
����/�� ��
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection—(f-pv
S %
Encapsulation
Gas Piping
Gas Test
- Z
Appliances
Final
COMMENTS:
Final _
Utility Notice (Gas)ue
ELECTRICAL APPROVALS
Temp. Power Pole s-tw
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)
Building S 2)-49 S,
Address
Owner
ST#�R�fG►aT M
Mailing
Address f..0. 3S-79
City lZip
Contractor
Address
P.O. BOX 1504
(C c r— C, -L t w:>78.495 CALLE TAMPICO
a l 2 LA QUINTA, CALIFORNIA 92253
1 9 Z_2A6 t 1345 -ov k-2—
City IZIp 1T399 -
T
T39Q - t ZO o
'�tE2M0
State Lic. City
G
& Classif. �, -1 2 8 Lic. #
Arch., Engr.,
Designer
Address Tel.
City IZip I State
Lic. #
1( LICENSED CONTRACTOR'S DECLARATION
I hereby affirm the am licensed under provisions of Chapter 9 (commencing with Section
7000) of Divisiorf,3:o t e Business and Professions Code, and my license is in full force and
effectV�s
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 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 thathe is exempt therefrom, and the basis
for thealleged 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 f$500).
I-: 1, 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.)
I 1 I, 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
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 -
n 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 (E100) 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, alter 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
1hereby 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 1 have read this application and state that the above information is correct.
1 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 applicant Date
Mailing Address
City, State, Zip
t ' 11 �, �
1
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number _77-1 ^ 61 - QZ 3
Legal Description LCa" (Z- 'BLY— i 9)3 ' n)VTA 61) 01 ALrTA
Description
Sq. Ft. No. No. Dw. t
Size Stories Units
New'g Add O Alter O Repair O Demolition 0
itimated Valuation
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
;t
FINAL DATE—INS
Issued by: Date
Validated by: BEG 15 1999
Validation:
'ITT 0r LA QUINT
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
t
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 12/27/99 APN # 774-071-023
No. 19831 Jurisdiction La Ouinta
Owner NameStarlight Management
No, 53-495 Street Avenida Diaz
City La Quinta
Tract #
Type of Development
Comments
Lot #
Single Family Residence
Permit #
Log #
Zip 92253 Study Area
Square Footage 1409
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 1,409 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�issudd"
Fees Paid By CCNalley Independent Bank/LarryShields Tel�p`hone
Name on the check
By Dr. Doris Wilson -
Superintendent '� r
Fee collected /exempted by Olivia Aguirre Payment Received $2,719.37
Check No. 209494
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('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
DEC.15.1999 11:53AM'
RECORDING REQUESTED BiY:
CHICAGO TITLE COMPANY
99.9348KC 970574499
COMMONWEALTH
WH�qAMA�L TAR���ITS WOWND.
STARLIGHT MANAGEMENT,' INC .
P.O. Box 134
C/O POWER BROKERS
LA QUINTA, CA 92253
GRANT DEED
NO.583 P.1!1
THIS LINE FOR RECO
APN: 774-071-02Y
53-495 q✓E D(A2.
'S USE
The undersigned grantor (s ) declare(s):
Documentary transfer aX is $16.50
(XXX) Computed on fulvalue of property conveyed, or
( ) Computed on ful value less liens and encumbrances remaining at time of sale.
( ) Unincorporated area: ( ) City of 0 and .
FOR A VALUABLE CONSIDURATION, receipt of which is hereby acknowledged,
I '
WILLIAM THOMAS BUFFIR, AN UNMARRIED MAN DBA LA QUINTA PARTNERS IT
hereby GRANT(S) to
STARLIGHT MMAGEMENT,;INC., A NEVADA CORPORATION
the real property in Che City of LA QUINTA, County of Riverside, State of California,
described as:
LOT 12 OF BLOCK 183 OF SANTA CARMELITA AT VALE LA QUINTA, UNIT NO. 18 AS SHOWN
BY MAP ON FILE IN BOOK 19, -PAGE 30 OF MAPS, RECORDS OF RIVERSIpE
COUNTY, CALIFORNIA
Dated November 3. 1999
State of California
County of Riverside ; } S.S.
On November 3, 1999
before me, Selly Collier
i, personally appeared
William Thomas Buffin
personally known to m'e (or proved to me on
the basis of satisfactory evidence) to be
the person(s) whose names) is/are subscribed
to the within instrumLnt and acknowledged to
me that he/she/they ekecuted the same in'
his/her/their uthoriked capacity(ies), -and
that by hie/he their signature(s) on the
instrument theerson;s), or the entity upon
behalf ofwhic �he e sons) acted, executed
the instrument 1
flalal Be
Signa re N.
MAIL T T MAN S *• Seam AS ABOVE
WILLIAM THL� BUFFIN
DBA LA QU PARTNERS II
",,, , KELLY COLLIER �
V COMM. t 1229426
Q - NOTARyFURLIC•CALIFORNIAQ
RWERSIDE COUNTY ��
1 COMM• �Jlp. JUN.E8. 2009
(This area for official notarial seal)
r
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: W. R. Rogers
PROJECT
ADDRESS:
APN:
LEGAL:.
CK'D BY:
53-495 Avenida Diaz
774-071-023
LOT' 12 , BLOCK 183 , UNIT , S.C. @ V.L.Q.
Stan Sawa
BIN NO:. CASE NO. 99-169 ..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 I
�nn
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)
Co nsistehcy-with -street/surrounding .area:_
Colors
Materials
.Architecture .
V
�►
v
OTHER REOUIREMENTS:'
p0011pc a Y -<)VN -_a
Y's 4
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 ADDRESS:
Use Classification: SFD
Occupancy Group: R 3
53-495 AVENIDA DIAZ
Bldg. Permit No.: 9912-164
Type of Construction: VN Land Use Zone: RC
Owner of Building: STARLIGHT MANGEMENT INC.
Building Official
Address:
P.O. BOX 3578
City:
PALM DESERT,
By:
STEVE TRAXEL
Date:
06-14-00
POST IN A CONSPICUOUS PLACE
CA 92261