0208-013 (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
782.124 11IM, j 0881f2i
Date ?� f Signature of Contractor �r= f /� y' - +
t V
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 $1,rAyp F,>yPlY� 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, fIrshall forthwith comply with hose prgvisions:'1r
bate: k' r Applicant y%t/ ✓I'llfY
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefitzwork is, performed under or pursuant to
any permit issued' as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property f r inspection purposes.
8
Signature (Owner/Agent) •� '/` .•�`<*°"' Date` f
...
BUILDING PERMIT PERMIT #
DATE r, % VALUATION �9 � .� LOT TRACT RLL 276 25
JOB S1 I E
ADDRESS 54-MSAV'NJIDa�Y;DW&
APN 7*74-.2W4)19
OWNER
CONTRACTOR // DESIGNER/EN (NEER
.
LlyyKSC01f
GA1H-1C rRK)WS
P.O. BOX 1.023
77304 A, COUN7.RR f C.'LUi DRiVE, S-UfYE 113
iAQUI T, A, VA 92253
P.ALW a� �t1' CA 92211
(760)408-3495 CB.&O 293:
USE OF PERMIT
C�'.1.S PA . '
SIS=.Pd?l�.NIT i'?G$.r' a NOT INCLU11 ? BLOCK `c7>f'PJ.143111000L DIZ DRIVEWAY
°)'1+�ACIi't;.°0i4iurTRUMON V
�gAP,�t��filOC.eA.�k�Ca1�'j' '. 4ti:3.lDff 9F
.
EVEMATED CONT OF CGJI S-MIMMON
9,14 MAO
C 009111TRU C T I ON FU 101-000.418.000 W11510
PLAN FEZ' 101-000.439,309
FRED ?OSIT 101.000-439.318 MMA
MECoRAN"ctal 11IFF, t 01 �=421.050 $5, 30
MlarRIM. FEE, 101 -OM-420-WO %I H.00
PLU241511401PBE 101 _000-419-000 $12235
O T )3.t:AN � 1 is".OD'1O:' RE - 31•.' ID 3,01-000.M.000 $9,17
OPADINO F '101-000-423-000 $13.03
DEWIX)FIRP, IMPACT 149 Q1,4000
~
tiST-*r(' 'A
J °� 1a . :
0,921.99
t
U
?iJNO9Y
�i';+j� 1.99
,
CIN
NCEDEP'T
RECEIPT
DATE
Y�
D E FINA
LZ
INSPECTOR
�j
L—L
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
d�G • �/
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
L7- 4 -
Compressor
Insulation
(>>
Vents
Fireplace P.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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
�J
Heater Final
Water Piping
_
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection/L�
li
Pool Cover
Encapsulation
Gas Piping
_
Gas Test
_
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) l601
ELECTRICAL APPROVALS
Temp. Power Pole - 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)
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 (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that 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
Education Code Section 17620 and Government Code 65995 Et Seq..
in the amount of $2.14 X 1,521 S.F. or $3,254.94 have been paid for 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 1 st Bank - Dick Scott Check No. 63037
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Crystal Scott $3,254.94:-
Payment Recd Over/Under
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the DistrictCs) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
Pte-fi m add- • .�r4- 8 85 gvc - '-3i'09 z
_...__ ...._...... f
01/09/01 10:28 FAX 17008049062 COMUONttEALTH T:TLE 09
RECORDING REQUEST -5-0 BY:
AND t'VHZN RECORDED MAILTHIS DEED AND,
UNLESS OTXERWSE SHOWN BELOW,
-MAIL TAX STATEMENTS TO:
RICHARD SCOTT
SPACE ASOV9 THIS LINE FOR RECORDER S USp
The undersigned granlor(s)declare(a): Grant DAed A•P,N.774 266-01 9
Documentary Iranafer )8x is $
( X4 computed on full value o, proparty conveyed, or
( ) computed on.rull value lens value of Ilens and encumbrances remaining al time of sale,
( ) Uninco.rpere;ed area: ( ) City of and
FOR A VALUABLE CONSIDERATION, recelpt of w•iIch is hereby acknowledged,
JOHN & XELLY ALLCHIN
hereby GRANT(S) to RICHARD SCOTT a married man as his sole. and separate property
the real property In the City of La Quini~a County0f Riversida
State cf California, dearrioad as
Lot; 8 bf Block _2L7 i Jnit No, �, Santa Cartnali.a at Vale La
Quints, as pat nap recorded in Book Pages of Maps, racordo of
%varside County, California
Doled _ _ Jun
State V0411(ernla )
County of ) SS.
On berora me,
,personalty appeared
JOHN & KELLY ALLCHIN
personally known to me (or proved to me on the basis of sa.vviaclorry
evidence) to ba the pare»(a) whose name(s) Islsrs subecfted to Me
w4h:n lnsbumunl and acknowiadged to ms that he/she/they exeeuler
the sena in nts/he.10olr aulholized cspeelty,'iaa), ant ihel by
:�relherltneir alanature(s) on the instrument the porson(s), ar th6 antlty
upon bensllaf which the barscn(a) aCsd, maculed the Inatrumenl.
'MTNEES my hand and otncJat seat,
Signelu►e
MAIL TAX STATEMENTS TO,
l/l 'd l/_0"ON
Signature of Grantor
JOHN & KELLY ALLCHIN
AW'q NH I7.: I 1 7.1`107 /? - hrir
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 housing 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 transmit
this information to.the Building and Safety Department as part of your correction list. Please
attach additional explanations as necessary.
APPLICANT:
SITE ADDRESS:
APN 774 - 266
Dick Scott
LEGAL: LOT 8
54-885 Ave Diaz
- 019 CASE NO.: 2002-691
BLOCK 266 UNIT 25 S.C.@V.L.Q.
CHECK AND APPROVED BY: Martin Magana 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)
MDG filing required (5 filings
since 9/3/98)
Architectural variety within 200
feet of the surrounding area:
Architectural design features-
Approved ey: - eso
43 Ci .y Council ----
mmu i y Oev. Dept.
Other Requirements:
Initials ZaaZ-0 9I
Case N^
Exhibit ----
Certificate of Occupancy
City of LaQuinta
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: 54-885 AVENIDA DIAZ
Use Classification: r SFD Bldg. Permit No.: 0208-013
Occupancy Group: R3 Type of Construction: VN Land -Use Zone: RC
Owner of Building: DICK SCOTT Address: 77564 COUNTRY CLUB DRIVE
City: PALM DESERT CA 92211
By: KIRK KIRKLAND
!! d� Date: 2-18-03
OF.
Building Official
POST IN A CONSPICUOUS PLACE