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0106-049 (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 i� �,, Exp. Date X595 ,54 � 131 C9 f�' i6��lDl�S, ate I ,a a "' 110(Si1nature of Contrac%'rr OWNER -BUILDER 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 exclusivelycontracting 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: K 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 perf'brmance of the work for which this permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier Policy No. UH i T 00 110.00 (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 17. .1 subject to the workers' compensation provisions of Sectio 3700 of the Labor Code„I shall orthwith �� omply with provisions. Oat'( -2 cIAlpplicantt 9 t 7W! $ 0. ,- t. 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, damfges 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 Quints, 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.' / ps gnature (Owner/Agent) . � i Date BUILDING PERMIT PERMIT# DATE VALUATION LOT oio&w TRACT Y; JOB SITE APN ADDRESS 2-W.A�`.. DYAZ 774-20143R & OWNER CONTRACTOR /DESIGNER / EN (NEER PAZ CONSTRUCTION CO • PAZ COMr7fid;'. MION CO 52.996 6?►'t%i MA INWOOLN 52.995 AMTDA)NMSD07A 1wkQ13mA CA 92253 LAQUTWTA CA 92253 (760),564-3023 ("Mi f. 35:37 USE OF PERMIT XX MALA VAWa- ENO 5PD—w.i'Mq 1g0T M%LUDE POOL,, BIAXX WALLS OR DIUV WAY a'SePtPMA64 (93 B1 MASTER) '7'FiACT CONST RUCTION 1,492,00 "uF lxORI.t;,WA>,ATIO 9100 SF 0Ak1A<MCARPORT (3,.11 9,017M.80 p'r. WOOD Yxy; = 200J.k LF A--�►7h OF &/WJ.RSY.�ffiL4lbr.VAW.LI' i7,&Yr'"'�31d7V �gq 7A�y,�yTr �1�'g'p yp,��{ �Wn+i�AAy��.�]!1+��17D .C� R!rJ4R.G.F'.�,P, L'r� C14.7d7:'1.J%AaW.�+`� 71 C`O?ZQ''4l`�C;f:'b'IO f ITWO 101-000-0,16.000 2608A Pi..R..l+t C:HW°1C RZ 101-00110-430-318 $SID8.53 M'W3aANW.f L FER 101.000.421-000 SUM. RL?4” TRtf'IAL.IME 101 00(x- 20-000 $f30.9 P1eUM33iHOME 1131^060-414"t10:1 STRONO MO'iIOX Mt o RMLO 101-000-241-000 M40HO 101.000-4��i3;f��tt �4,OCt IMPACT "IF, IzREC1U4.. PLPI 1111 1 441.34 r JUL J �� 1 1 !� Z001 S't.. B-'t'OTA[I x:;07 r I C'l W AhM PT.MS CHECK Cs_1y�!��y�y^��fj�--�,i�`�( /,fir ■1 yy. 11 r ` 4 •bCNr�.L3�N 9Js .t '^�.�� 111 FII�Vhl1'(,E �U�hIA RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs_ �_ ( c57 Underground Ducts Forms & Footings q�_ _(70 Ducts Slab Grade / vv Return Air Steel� Combustion Air Roof Deck [ (Q —� Exhaust Fans O.K. to Wrap 7 F.A.U. Framing -_� J, —Q( S% Compressor Insulation ��/p SZ Vents Fireplace P.L. L Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath ' Final Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set -Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines _ _ _ 5% Heater Final Water Piping -G' d Plumbing Final Plumbing Top Out _g Equipment Enclosure Shower Pans O.K. for Finish Piaster Sewer Lateral Pool Cover Sewer Connection -O( S7 Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) �'$`.' i'.Y;,1�,„;g,YL�t�ni�FK"YY^Y!'tY":iwg!•;' ��'`�s0'/',T`1;�M1C7'9""'yxz-�s"�,"'r'"A""r�,,r"l�,'�r�'4X°�'^; (9l 06 P.O. BOX 1504 APPLICATION ONLY Building 78-495 CALLE TAMPICO ddress A - ? 7 L7 i t _ LA QUINTA, CALIFORNIA 92253 Owner Mailing I Address City ]Zip ITel. Address City [Zip State Lic. City C & Classif.1595 -) -s� Lic. # J Arch., Engr., Designer L Address Tel. CityI Zip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION 1 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 *hat. 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 live hundred dollars ($500). I: 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 wo•k 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 I I, as owner of the property, am exclusivelycontracting 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.) 1-1 1 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 ( 1 Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed it 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 cut, 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 slate 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 BUILDING: TYPE'CONST. A.P. Number �) :� j, -- Z ---,[ Legal Description k A- Project Description `1kge (a OCC. GRP. 0 1 I I_Q i a/ 7 �� J 2 'R>Lr) .r+ Sq. Ft.V �� No. Size Stories No. Dw. Units New Add ❑ Alter ❑ Repair ❑ Demolition ❑ / 2 '4' l -r IC V ss Estimated Valuation PERMIT AMOUNT �1 Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical - Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS i tt Iv/ j1 y r ZONE: 7 Minimum Setbatkin CUU llnt Setb�1�mCent"erLine fr Setba ..Li eide Stre�enter Line Side Setback from Pr Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION 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 7/11/01 No. 22242 Owner NamePaz Construction Co. No. 54-220 Street Avenida Diaz city La Quinta Tract # BLK 255 Lot # 14 Type of Development Single Family Residence Comments APN # 774-201-011 Jurisdiction La Quinta Permit # 0106-049 Log # zip 92253 Study Area Square Footage 1492 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 2.05 X 1,492 or $ 3,058.60 the property listed above and that building , �J permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued r Fees Paid By CCNalley Independent/Kathirine Lozano -Paz Const Telephone= Name on the check .. By Dr. Doris Wilson Superintendent Fee collectj/exepted by Annette Barlow Signature Payment Received $3,058.60 Check No. 247582 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 ;01/09/01 10:25 FAX 17608049062 RECORDING REQUESTED BY; . AND WHEN RECORDED MAIL THIS DEED AND, UNLESS OTHERWISE SHOWN BELOW, MAIL TAX STATEMENTS TO; William Thomals Buf f in Power Brokers B.O. Box 134 La Quinca, CA 92253 CWI1fONi4EALTH TITLE 0002 SPACE ABOVE THIS LINE FOR RECORDER'S USE The undersigned grantor(s) declare(s): Grath Deed A.P.N. 774-201-011 Documentary transfer tax is $ ( �y) computed on full value of property conveyed, or ( x) computed on full value less value of liens and encumbrances remaining at time of sale. ( ) Unincorporated area; ( ) City of FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, GOLDEN EQUITY hereby GRANT(S) to WILLIAM THOMAS BUFFIN the real property in the City of La Quinta County of Riverside State of Califomia, described as Lot 14 of Block 255 Unit No, Santa Carmelite at Quinta, as per map recorded in Book Pages of Maps, Records County, California Dated May 21_, 2001 State of California County of _)SS. On before me, personally appeared Gorden Equity personally known 1c,me (or proved to me on the Oasis of satisfactory evidence) to be the parson(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that halshelthey executed the same in his/her/their authorized capacity(ies), and that by his/herllheir signature(s) on the Instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. Signature MAIL TAX STATEMENTS TO, ---s ae—se a`araz;� Signature of Granic GOLDEN EQUITY _ , and 'ale La of River , ide 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 per Section 9.50.090 of the Zoning Code. Its purpose is to determine: 1) that the proposed house design does not duplicate the same architectural style of any house within 200 feet of the applicant, and/or 2) if there is a'need for the applicant to file for Master Design Guidelines. If the applicant does need to file a Master Design Guideline, please transmitted this information to the Building and Safety Department as part of your correction list. Please attach additional explanations as necessary. APPLICANT PAZ CONSTRUCTION SITE ADDRESS 54-220 Avenida Diaz APN 774 _ 201 _ , 011 CASE NO.: 2001-500 LEGAL: LOT 14 BLOCK 255 UNIT S.C.@V.L.Q. CHECK AND APPROVED BY: Fred. Baker 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 Verify legal and APN information Consistent with MDG on file (as applicable APPROVED BY OM UNITY DEVELOPMENT DEP MDG filing required (5 filings since 9/3/98) EXHIBIT Architectural variety within 200 feet of the surrounding area: Colors Materials Architectural design features CASE NO. Other Requirements: 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: 54-220 AVENIDA DIAZ Use Classification: SFD Bldg. Permit No.: - 0106-049 Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC Owner of Building: PAZ CONSTRUCTION" CO Address: 52-995 AVENIDA MENDOZA City: LA QUINTA CA 92253 By: KIRK KIRKLAND Date: 11-21-01 Building Official POST IN A CONSPICUOUS PLACE