0105-238, 0112-099 (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 Di\,lsion 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lie. Class. Exp. Date `c
N�
7� 1.1 � •,///��•' f��{ f1S4� 112'
Date ��f _ Signature of Contractor.,'{-' .0f�
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&RC. 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 A policy no. are:
Carrier Policy No.
IOCN1�tP7'
,(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 shill fog6with comply with thodpta!Siogs;,,.>/ .
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT. Application is -hereby made to the Director.of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made& each person at
Whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a "result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that .1 have read rthis application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon,
the above-mentioned property foV9,,e (on''urposes.%Signature.(Qwner/Agent),�`' Dated -'✓r`
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
7
. W-07
JOB SITE
APN
ADDRESS
77,583 CALIX 7.1'ORAFMO
771.222-01.2
OWNER
CONTRACTOR / DESIGNER / EN (NEER
Wle.W1~'`i?OM, DFZI,:P-T COVE, DEV, LLC
CON t.Y M014I)MON MY:i"EMS INC
PO BOX 6513
P. O, BOY 62$
LA (,?YwrA CA 92,253
LA Q WA -CA. 92, 253
(760 !"71-3593 C.°mo 38:40
USE OF PERMIT
ON(n EV FAMILY T-)VMAJNG
SM - PERMIT MYS NOT INCLoURr, ?3Lt?t:iZ;'BV•ls5"3./F`ODUSSRA. OR
BWSWAY APPROACH, '1%PLAN CHECK FRE APP1.119D MR MULTIPL.F
163: uAwx, of SAmE PLAwTlf n
TRACT C0143TRUCTION 1,591,0 SU
lPZ3RCI•UPATIG 92.00 8F
(1AM409 550100 Sar
VOT.tV1:A' ) COST OF +L;'OXVJC1xUCITOY
T''EUMI'1; r, iffy 90MMARY
(OONSTRUC`I`ION FRE '001-000-418-000 Tfi3UD
FRE DEPOSIT 101-000-439-a19 •pso.00
MI?C'&I.Rt<AflCALiri~I? $60,00
E -L.%'/` TRICAI, PXIX
9'I,iIMBT140 NSE 101-000-419-000 $I36.Ot1
STRONG NOTION FEF r RESID 101-000-24.1-000,
ORAD 9 Y99 101-000-423-000 >e10.0d
DE"+7 ELC►PYR, IMPACT 9'F'E $1,30 vo
PRECISE PLAN 1.01-000.441-343 811061.00
PLAN +;"HMIC ftga 101-000-•4.39 -31 fI V1175-
Li fiQ`I' -., ITC*Ytvrl A14 PLAN I'�%3:i�,OX
$3,39's.78
Jf t IS PRX-PATl.7NIM9
42 500)
M DIT. NEW
3 1 11001
t
-iNTA J 4
ECEIPT I'IiVAI e*T9PT 4 LOY
DATE FINALED
INSPECTOR
• q;.
H SPEC ISM RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
SULMNG
APPROVALS
MECHAMCAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
/
Ducts
Slab Grade
I�
Return Air
Steel
Combustion Air
Roof Deck
S
Exhaust Fans
O.K. to Wrap?
_
-j
F.A.U.
Framing
/ S
Compressor
Insulation
S
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
_
Exterior Lath
j
Drywall - Int. Lath
p'
* __ '
Final
Fnal
POOLE -SPAS
o L OCKWALL
APPROVALS
steel
Set Backs
Electnc Bondy
Footings
Main Drain V
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
L�'LNJG�RC�8�1�
Gas Test
Waste Lines
l��� !
K
Electric Fina!
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
f _
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
C/NTS:
Final
Utility Notice (Gas)
ELECTMCAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F. 1.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
-O S'
N. X7,35
nt°s- S s
7� �
Iding L CYT
-7
)V� �) 4
P.O. BOX 1504
r 78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
APPLICATION ONLY
4f 4 16 &-y'
4 O -&—y. `' 0 BUILDING: TYPE"CONST. OCC. GRP.
0, AbFl\f A.P.,Number " �.22 �'��^L — L`-1,4;
Dna Cr
ZI
Project Description
n ZIVA353 16,
State Lic.b 710h/ City
& Classif. (p Lic. #
J I Lic. #
DECLARATION
I hereby affirm that I am exempt from the 0pntfactor s License Law for the following
reason:. (Sec. 7031.5,Buseess and Professions Comae: Any efty or county which regiibes a
perp* to construct; alter, Improve, damollsh. or repair any structure, prior to •Its Issuance also
requires Me applicant for such permit to file a signed statement that he /s licensed pursuant to
the Provisions ol'rhe Contracrorti License Lew, Chapter g (commencing with Section_7000) of
Division 3 of the. Business and Professions Code, or that
he is exempt therefrom; and the basis
for the aaeged exeinplion. Any violation of section los 1. ti by 'any applMant for a pemdt
subjects tris applicant ro a eivll penally ol.nnt more than
five
hundred dollare, (1500).
C I, as owner of the property; or my,employees with wages as.their sole companeation, will
do the work; "and the structure Is not intended or offered'for sale. (Sec. 7011, Bulenesa and
Professions. Code: The Conlinctor's. ucerise Law does not apply to an owner or property who
builds or approves thereon and who does such work hUnself or through hie own enwicyoes,
provided that such improvements. are not intended or oNeied for sale. It. However,. the bugdxrg
or .improvement is sold vithin'.one year of compleflon, the owner -builder wal have the burden
of proving that he didnot build or improve for.the purpose ofselej
F1 I,.as owner of the,propogy,am exclusively contracting with. licensed contractors to con-
struct the .project! (Sec. 7044,. Bualness and Pro/ess/ons Code: The Contractor's License Law
does not apply to an owner of property 'who buMs or Improves; thereon, and *ho contracts kir
such projects with wcontrwtorls) licensed pursuant to the Contractor's License Le)
1:11 am exempt under Sec. -B.,& P.C. for this reason
Data Owner
WORKERS' COMPENSATION DECLARATION
f her affirm That 1 have a certificate of consent to sell -Insure; or a certificate of
Wo. rs Compensation Insurance, or a:certifled copy thereof..fSec. 3800,.Labor Code:)
Policy No. Company
n Copy is,fifed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be. completed If the permit la for one hundred dollars (s100) valuation
or less.)
I certify lhat)n the performance of thp work -for which this ,permit is issued, I shall not
employ any parson 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 or Exemption you sho0id become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with.such.provisions. or this Permit shag be doomed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that,thete is a construction lending agency for the performance of the
work forwhich this permit is issued. (Sec.. 3087, Civil Code:)
Lender's Name
Lender's Address
This is,abuilding 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 cityand county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property forinspect,on purposes.
Signature of adplicant Date
Mailing Address
City, State, Zip
Sq: Ft. No. No. Dw.
Size Stories Units
New ❑ Add D Alter ❑ Repair ❑ Demolition ❑
PERMIT
Plan Chk. Dep.
Plan Chk. Bal,
Const.
Mech.
Electrical
S.M.
Enc.
TOTAL
ZONE: BYi
Minimum Setback Distances:
Front Setback.from Center•Line
Rear -Setback ff . Line
Side Street Se rom;Cent Line
Side Setback f qjv L'
FINAL DA
Issued by
Validated
il I CITY OF L-A
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 COWL 4,NCE
Date:i1 5/31/0.1'-:., APN# 773-222-012.
No. 22071 Jurisdiction La Quinta
owner NameJack McKenzie Desert Cove Dev., LLC Permit#0105-238
No. 77-585 Street Calle Durango
City La Quinta zip 92253
Tract:# V IO Lot#. 1 Square Footage
Type of Development Single Family, Residence
Comments
Cashier's Check for the amount of $6,523.10.
Log-#
Study Area
1,591
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 ,1,591 or $ 3,261.55 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed,projectmaynow be issued
Fees, Paid By CC/ PFF Bank & Trust Mark Roe Telephone
r ame on the c ec
By Dn Doris Wilson ,
Superintendent
Fee collected /exempted by Paula Ruiz
Signature
Payment Received $3,261.55
Check No. 520999825
40TICE: Pursuant of Assembly Bill 3081 (CHAP 549,,STATS. 1998) 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 thepare paid to the District(s) or to another public entity authorized to
:ollectthem on the District('s)(s') behalf,; whichever is earlier. .
Collector: Attach- a copyof county or city plan check application form to district copy for all waivers.
Embossed Original= Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
{
MAY.21.2001 a 8:56AM
.1G RFQUWIM BY
A R%cmmzpAAM Tot
'A.14000ZIE
a ]jjjj Cowbell
0 T IV St
n L .L a. CA. 94510
q_P.N.: 773M2,412-6 TRAP
CDS
NO. 495
�ecdrmPAr.J, 3-30-ot
gpaee Above 7bb Live for peooider'f Uio Qoty
X004693 psciaw NO.: 16431dS
P.2/4
��c►ccv r,aNL1� GRANT DEED
T +_ 5 93.00
TMP. UNDBRWNSD GRarMIt(a) DECLUtE(o) THAT ppCtli►11 UAltY'Y'RANSP6R'l'AX t6� COUNZ Y ..
X ] jc t ted on full v"!Pf qty pveyw� O txsi rcmainmg: at cfiaaa of sole,
ocaputed on toll valpe lisp value-of'liaos ..
°iP I City of BZW . sad
FOR A VAir,UAIiLF CONSIDP.,IZATION, l pt,Of WbICll b hereby WWwlodged,
CHARLeES, J. MAGUM) 84 Uumwded Nm and DOROM GAYB TAYLOR, an U»wnsrrictl Woman as Jaunt
Tenants
hereby GtRAN' s) to Som lld. MCKSN.i>P, a Married. Meta
the (0Mowing daacribed pmpetty in the City of LA QUINA, County of ltivmwe State of Califorpia;
LOT i, BLOCK 77 OF SA,NT!► CARMELTTA AT YALE LA QLtIIyTA�
UNiI' NO. 10, AS WK sY ANAP ON
Fu,F IN BOOK 19 PAGE 70 OF MAK RECORDS'OF JIVERSIDB COUlr1'Y� CAi.> YiRNI�►
Docunsent Dam: Ln 2001
STATE OP CA1.11�..._. .
courrrlt OF r�9. d t ,
pamoeaity Ilia C
persvaplly tow to me of proved to toe on fors Buis o
erA wlts) mwlWged 10 ttb tlmc ' ° " div a.me i
the por. ate maty upon bAWt of which 40pereon(R)
wrrNRSS taYANO atm ORl
t
CoS11qW4
NaitsN' �
Nb►�'tR'-�®� �
tie ns tk�'�o�ro � on �e ira�m�t
a�emackkvtln) and tbac by hiN,Wet,4, * +Lp"cg).
eeecytted the imsOuaIPP.
Ulf Am for am4W eotmbi heal.
Ma Tax Stats os to: :SAME AS ABOVE or Addrm NOW below
to
N lL
CY
Ouch
W
o Z f`
0' C
HCID
Wa
N
Z
0
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.
Licelise # Lic. Class„ - - — Exp. Date;
•'f�S21 flrw J3 f:it��``-iJa3/;3 ),��C
A %
Date' - �'. fr Signature of Contractor----
..-P,
ontractor
OWNER -BUILDER DECLARATION
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.
.l(kl. 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
hit is issued. Myy workers' compensation insurance carrier. & policy no. are:
HATE COMP Policy No. 76�8:l"
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in theTerformance of the work for which this permit is issued,
I shall not employ any person'Nin any manner so as to become subject to the
workers' compensation laws o,?Xalifomia, and agree that if I. should.become
subject to the workers' co p1 ation provisions of Section 37.00'of the Labor
Code, I shall fort) oth com lly with those provisiorfS'rl
,/Code,
}' .f�'!`.� APplicant•-
Warning: Failure to secure Workers' Co ensation 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 aW'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;pukpo§es.
Signature (Owner/Agent)
BUILDING PERMIT PERMIT#
DATE ,;4,q4afolr VALUATION . LOT TRACT
JOB SITE 7.7„.,�.�ir: _L��,f i1ME ►L: APN
ADDRESS
OWNER CONTRACTOR / DESIGNER / EN (NEER
f:iRROC+v'.rCaVFY?'>Wk;LOPMI~W.,'i.TC FAU DE --41 AN.SD11,93113W:I.N'C'.
7&••401 y,:g3:I��I•q`WAY 1 I1, UITK. F'Z ,7 P.i+y.,l J?t�X 621 'p 9250
LA-QUD
TA CA
ERSME
i 1t0;f3 ^1t19^a (.'.:taiX, 6246
USE OF PERMIT
E1S'1,'€M 17D C09r 001 f.'.O.RMUCTIO.N 0.(X)
PERMIT FRE WA1MdRy
1IDPL1iMEN7A,LPJ,MMITIME M400,42.3.000 $4.ia
JAN U 9 2002
%M-WfAL ('01+1S".i"FtUCrlOR,h?J:1 V). A (A HeM $4.stl
J. EM F'3KiB-J'.A'ID T M $0..00
OTAL rEMUFAMS DUE StlCadtl 94.50
1
RECEIPT DAT BV �� DATE FINAL �D INSPECT
�•/a� o z
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Retum Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali 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
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)
ELECT=aAL 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) - Q "
/V"—
Cl. if OF LA QUINTA
c�oFn BUILDING 4, SAFETY DEPARTMENT
777-7012
INSP_ECTION REQUEST LINE,
777-71.53
Owner
DESERT COVE DEVELOPMENT, LLC
Contractor PAULDEN EVANS DESIGN INC.
Pemnit,Number 0112-099
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 77-585 CALLE DURANGO
SUPPLEMENTAL PERMIT TO REFLECT CHANGE
OF CON -TRACTOR (ORIG. PERMIT # 0105-238)
TYPE OF INSPECTION DATE INSP.
FOUNDATION 8 SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM_
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIG
CONCRETE SLAB
JOISTS 8 GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIG
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS 8 GAS TEST
HEATING It VENT - A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
`. FRAMING
INSULATION
�. PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
.mss DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE 8 GATE
FINALS
ELECTRICAL 77T 6 ci_
PLUMBING
FINAL GAS TEST
� Trurn 1'ffl\11/CO I � \ I
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: 77-585 CALLE DURANGO
Use Classification: SFD Bldg, Permit No.: 0112-099
Occupancy Group: R-3, U-1 Type of Construction: VN
Land Use Zone: RC
Owner of Building! DESERT COVE DEV. LLC Address: 78-401 HIGHWAY 111, STE F2
Building Official
City: LA QUINTA CA 92253
By: KIRK KIRKLAND
Date: 2/21/2002
POST IN A CONSPICUOUS PLACE