0105-039 (SFD)+ LICENSED CONTRACTOR DECLARATION ,
41 Neby 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
Pyrofessionals Code, and my License.is in full force and effect.
License # Lic. Class Exp: Date
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).
P%Q I, as owne'r.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.0-•for this reason
llDate/`� > % �*'e Signature of Ownerez. f Y rr�
` . • 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:
Cairier , , Policy No.
(This section need not becompleted 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 o the workers' compensation provisions of:Section 3700 of the Labor
Cpde;:l shall forthwith comply with'those provisions
Vllate.�-,�, y >�r- Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject ani 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,i his f
application.
r 1. Each person upon whose behalf this application is made & each petson'at f
whose request and for whose benefit work isoperformed under or pursuarj)fto
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 gay
work.is not commenced within 180 days from date of issuance of such °T
permit, or cessation of work for 180 days will subject permit to cancellation"+
9
I certify that I have read this application and state that the above information is
correct. l.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.
aF Signature (Owner/Agent) D.atw"•12r�
' BUILDING' PERMIT PERMTIJ
DATE VALUATION :. LOT« TRACT
TR 7,190
JOB SIT
APN
ADDRESS
M)- JAN MISNOTWARDR, 0
-00.
OWNER '
CONTRACTOR / DESIGNER / EN INFER
USE OF PERMIT
t��••a+� y�e 1�yEty�7 ♦e��t�+3 q Tt,�Par *9 �+, 1'y /yds.* garpt t r^ tJ�,1� /^�R f�q,�rn yi�reyA co
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.,4.fj7'Rt. A0114. f
TiRACTOONSTRUCT1014 SF
.- is`i:f'r'#�lA'i ff7 ` �i0.tt0 SF
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C;0+:1:3`�`� RUC�'#O'2s A'1 E 0 WA -000.43 S-005
Vi,.3Mf;aHECK VVIE
V RE DEPOSIT. 101-000-439.318 »;w;dioloo
PUt804%+i12C-ALPEP AGI-C)�?Ci��1�CC2S� �9d.€tSf
f'R3 EC 17ICAL RX 101.000-420.000 314;1. 11
f?�,cs>< r312�6 101-0001.4.19400 8153. e3
,2x'f"R07r O MOTION HER -1 ESM 10 1 t,000 -'Z4 1-000
ORAD'I'MCFEV, iti-003;A23-00: � U,fif2
IMS Y1R% w-1 a. FH
4250.00.
IMM1.1bliNIM, YXIES 103% NOW
Lr 1 s 2001 {
l.A "'
WY Of=FM
CF1F�aTtSl t ,
At
RECEIPT=
DAT.E��
BY
DAT LED
INSPECTOR
li
wt .,
F .. s.
INSPECTION RECORD
r, OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
'BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
7
Underground Ducts
Forms & Footings
Slab Grade
_ ,S
��+1
Ducts
Return Air
Steel
Roof Deck
O.K. to Wrap
B/
Combustion Air
Exhaust Fans
F.A.U.
Framing
_�
('a _lg v/
Compressor
Insulation
/j
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
Drywall - Int. Lath
®%—`// •—D y
Final
2—
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
Water Piping
_ 1
1I r�"
Heater Final
Plumbing Final
Plumbing Top Out
,� _
Equipment Enclosure
Shower Pans
l=� _S
O.K. for Finish Plaster
Sewer,Lateral
/
Pool Cover
Sewer Connection
.. d S7
Encapsulation
Gas Piping
Q
Gas Test="
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)/
. ELECTRICAL APPROVALS
Temp. Power Pole
7
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)
QT1, a
BOX 1504
,f� I 78-495 CALLLE TAMPICO APPLICATION ONLY
AddrBuildes9 ''-1 IlaV �jA,Q/ , LA QUINTA, CALIFORNIA 92253
Owner -
� Gc
Mailing -A i
Address
r 01ZipCQ'a.a. 6 ITeI3 T3-Z?42 I
Contractor
City lZip
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
3`i!o
City Zip State
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 the Business and Professions Code, and my license is in full force and
effect.
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 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 ($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 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 contractor(s) licensed pursuant to the Contractor's License Law.)
0 1 am exempt under Sec. B. & P.C. for this reason
C�
.DING: TYPE'COONSyT. �G?CC.. G'�R/P..
Number ( /- ��r fL�1 Ole —Z,
I Description +Z- • a 2_/ 90
roject Description
Sq. Ft.'7 No. No. Dw.
Size G ... (. Stories Units
New Add Wt Alter ❑ Repair ❑ Demolition ❑
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing .
S.M.I.
Grading I"1 I
Date Owner InfraSti
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.
TOTAL
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: It, 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
Ihereby 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 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
Mailing Add
City, Slate,
REMAF
AMOUNT
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
Desert Sands Unified School District} r
47-950 Dune Palms Road k
Notice: La Quints, CA 92253
Document Cannot Be Duplicated, 760-771-8515
CERTIFICATE OF COMPLIANCE '
-
Date 8/23/01 L "APN # 649-080-003
No. "22408 Jurisdiction La Quints
. Owner NameNicholas Panzarin ' Permit # 0105=039
A)..
No. 80-145 street Westward Ho )(gig # `
,
City La Quinta T Zip 92253 ' ' Study Area
• Tract #'. TR 2190 ? Lot # 42 Square Footage 2502 ,
-Type of Development Single Family Residence No. of units 1
fi.
At the' present time, the Desert Sands Unified School District does .not collect fees on garages/carports, covered
patio's/walkways„ residential additions under 500 squarefeet, 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 fcllowing reason:
EXEMPTION NOT APPLICABLE • '
This certifies that school facility'fees imposed,pursuant to Government Code 53080 in th.-, amount of
` 2.05 = X 2,502 r t or $ 5,129.10. the property listed above and that Guiding
' ;-tet..• .y
permits and/or-Cerhficates.of Occupancy for this square footage in this proposed project mayznow be issued }
Fees Paid By, CC /Valley Independent Bank - Nicholas Panzarini o e'phone760 343,2762 `
Name on the check
- By Dr, Doris Wilson
Superintendent
^V
Fee collected /exempted by -,',Annette Barlow Payment Received`$5,129.10,-
Check No. 251280
Signature
NOTICE: 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 t-te 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 Dietrict(s) or to soother public entity authorized to
collect them on the District('s)(s) behalf, whichever is earlier.y
Collector: Attach a copy of county or city plan check application form to district copy for all waivers. R
Embossed Original= Building Dept./Applicant Copy - Apphcant/Receipt Copy - Accounting ,'
t
J
RECORDING REQUESTED BY
DOC a 2001-142111
04/05/2001 08:00A Fee:6.00
AND WHEN RECORDED MAIL THIS DEED AND, UNLESSPage 1 of 1
OTHERWISE SHOWN BELOW, MAIL TAX STATEMENTS TO: Recorded In Official Records '
r County of Riverside
NAME NICHOLAS PAUL PANZARINI SRT Glary L. Orso
STREET / Assessor, County Clerk 8 Recorder
ADDRESS 81-1y4�s8 PECOS PLACE
CITY STATE INDIV, CA 92201 I
LIP J
M U PAGE SIZE DA POOR NOCOR SMF MISO.. '
Title Order No. Escrow No.
77W
COPY LONG REFUND NCHG EXAM I�I�
i�,OZP DOCUMENTARY TRANSFER TAX $—O— ND CONSIDE ION
GRANT DEED,"` 0 computed on full value of property conveje , or
❑ computed on full value less liens and —GIFT—
encumbrances remaining at time of sale.
The Undersigned Grantees.
SIGNATURE OF DEc AR NT OR AGENT DETERMINING TAx =IRM NAME K
FOR VALUABLE CONSIDERATION, receipt of which is acknowledged, I (We), RICHARD JAMES LOPEZ AND
MISHAUN .F. HAWKINS, (NAME or GR.vronlan
grant to NICHOLAS PAUL PANZARINI SR, A MARRIED MAN AS HIS SOLE AND 'SEPARATE PROPERTY.
(144W OF GRAWMI -
all that real property situated in the City of LA QUTNTA 4or in an unincorporated area of) ,
RIVERSIDE County, State of CALIFORNIA. , described as -follows (insert legal description):
LOT 42, TRACT 2190, AS PER MAP RECORDED IN BOOK 41,,PAGE (s) 55 THROUGH 57 INCLUSIVE OF
MAPS, IN THE OFFICE OF THE COUNTY RECORDER OF SAID COUNTY.
• LETICIA NAVARRO
COMM. #1290034
NOTARY PUBLIC - CALIFORNIA
RNERSIDE COUNTY
My Comm. Exp. Feb. 7, 2005
'Assessor's parcel No. 649-080-003
Executed on MARCH 12 2001 , at CALIFORNIA
STATE OF CALIFORNIA
L L v
COUNTY OF RIVERSIDE M F. S
OnMARCH 12, 2 -before me, LETICIA.. NAVARRO 4'D NOTARY PUBLIC
personally appeared
RICHARD JAMES LOPEZ�AM �MISHAm Om AUNARY �F.I HAWKTNG SIGHT THUMBPRINT (Optional)
personally known to me (or proved to me on the basis of satlsfactory:e idence) to be the erson(s) whose
name(s) is4F_rOubscribed to thewithin instrument and acknowledged t me that he/she ieylexecuted the
same in his/her/140 authorized capacity(ies), and that by his/her
signature(s) on the instrument the
person(s), or the entity upon behalf of which the person( "
st e t
WITNESS my hand and official seal. LEI ICIA NAVARRO
`�
CC�h,-M, #1290034
NOTAil'r PUBLIC/- CALIFORNIA
jY •"• • '
Q: c - ASIDE COUNTY
My Coma Exp. Feb. 7, 2005
ISwrutvR[1!
(SEAII
MAIL TAX STATEMENT TO: NICHOLAS PAUL PANZARINI
SR. `
81-148 PECOS PLACE, INDIO, CA 92201
eefore you use this form, fill In all blanks, and make whatever changes ere appropriate and necessary to your particular transaction. Consult
a lawyer if you doubt the form's fitness for your purpose and use. Wolcotts makes no representation or warranty, express or implied,
respect to the merchantability or fitness of this form for an Intended use or purpose.
with
WOLCOTTS FORM 778 - rev. 7-99
111111111111111111111111111
GRANT DEED - (price class 3A)
c 1999 WOLCOTTS FORMS, INC.
i 67775 39778 9
W ,
Q
m
s ,
6
0
,CAPACITY CLAIMED BY SIGNER(S)
-10 O CORPO ATES)
OFFICERS
(TITLES)
10 PARTNER(S) O LIMITED
O GENERAL
10 ATTORNEY IN FACT
0 TRUSTEE(S)
i0 GUARDIAN/CONSERVATOR
0 OTHER
SIGNER IS REPRESENTING:
,(NAME OF PERSON(S) OR ENTITY(IES)):
YO UNG 'ENGINEERING SERVICES
'
`. • Engineering Architecture•Surveying•Bui1ding & Safety:Services
3 "
Letter 1of Transmittal _
To: City of La Quinta -Date: 7/6/01
Project: PC # 0105-039 (2° check)
80-145 Westward Ho Dr.
Attn: Greg Butler. W.O.:
Tel No.: Tract No.:
We are forwarding: By Messenger By Mail X Your Pickup
No, of Copies ; Description:
1 Plans (I" submittal)
1 Plans (2°d submittal)•
1 Structural calculations (1't submittal)
r '
1 Structural calculations "(2°d submittal) ... -
1 Truss calculations
t
Comments: ' Greg A—All structural comments have been addresses with the
exception of the missing drag trusses in the truss manufacturers layout and a letter
of acceptance from the Engineer of Record.
This Material Sent for:
Your Files X Per Your Request
Your Review Approval
. Checking At the request of:
Other
y By: John W. Thompson i
Phone # 760-342-9214 ;
47-159 Youngs Lane, Indio, CA 92201 (760) 342-9214
Bronz Young -
CITY OF LA QUINTA SUB -CONTRACTOR LIST
�Je2AI&tlfdJOB ADDRESS
,—'I.5 PERMIT NUMBERn(05- a?d OWNERFl N zfl R '/ i BUILDER
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building hermit. For each annlicahip traria all infnrmatinn ronunetnri hnl^....., + tie L,.,..1 1... ., c . un_ c1_n :_
Trade?<Classlfication
Contractor
State Contractor's License
Workers Compensation Insurance
City Business License
Company Name
Classification
(e.g. A, B, C -el
License NumOar,
(xxxxxx)6
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CelComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
Ixxx 1%�
Exp. Date
Ixx/xx/xx)
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