0012-244 (SFD)LICENSED CONTRACTOR DECLARATION
I hareby 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
,, wg 1
1 Y 9JR*T 3 b ✓f d%�
DateSignature of Contractor
r' OWNER -BUILDER DECLARATION
I hereby;affirmunder 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).
( ) 1;'as owner of the' property, am exclusively contracting with licensed
COntraMors�, to wir strut She project (Sec. 7044, Business & Professionals
Code).
O I am exempt'under Section B&P.C. for this reason
Date _ Signature of,,Owner
r WORKER'S COMPENSATION DECLARATION
I hereby affirmunder 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'Lahor.Code, for the performance of the.work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
STATE FUND 2d V'UMM
(This section need, not be completed if the permit valuation is for $100.00 or less).
(v�) I certify.that in the performance of the work for which this permit is issued,
I shall not'dmploy 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 provisions. �.
Date .`APPlicant f .
- Warning: Failure to secure Workers ✓Compensatiooverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
additionlo 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 permitsubject 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 -61111 City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property.'forinspection purposes. .
;,Signature (Owner/Agent)'1' " �- 1 i ,9 r"'►T Date
BUILDING PERMITPERMTIJ
DATE [� VALUATION LOT
.TRACT
j
JOB SITE I
APN
ADDRESS
AVENIDA WMA
7 74-134-0(0
OWNER CONTRACTOR/DESIGNER/EN INEER
WUM.M.S AOA a ORAN WMIIAM ELr .�R j:)a JJ
IMt W 25214D J'TRT011121'• 1224 W. 2452ND 11111Thmr
TAUBM (73 IT (JA 907 20 14ATMOR (XIT
CA
90710
USE
�O{�F4PERMIT
SMP pURM11'r-D0=v'R¢' T MCLUDE, H;L,C:aC.KW,,fi.L,f.;, POOL 9,`,SP:A. OR
I'#t.#�64'�'•(:'i)1�s�i9ti�l�`C1�7R3 !��`b'i8,�6 �F
,
6 VT. WOOD FENCE 200,00 IS
C:iARAM 431.00 Y+
AZYMC TF.D COST a0l SuW+AYix}Z�yAY.ucrlo
X.S.4, 1(r)SFx9✓iJ
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_
INSTRUCTION. FEM, 101-000-418-000 .5o
,
P L.A M C kf ft= FER, 101-000-09-318 $520. _34
VVY. MOW 101.000-h:931 P 42.5014ti
IJ
ler91ykX.*flA1NJ(11A.L -t(i,t00 $41. OD
g1 p0�9i� (a;gLD,g0--x,-21
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PLL PA1313v0 Inv, -C.( -41 -1000
STIR0100 MOTION W,- RgSi 1-01-0004A 1 -000. W1.94
F� ...
t1a�1+Fs114a PSME.. 101 -.006-423-610
iaEVEWI.i-',M IMPACT FEM
f �,..i.
PRECISE, PLAN 10 »000-441-34
C r'F
` 1o1 -IL AL C OMMM 7a�':-10W.A ' M n.L-147 t ywl=
$3,620.92
LEW PRE—PAID FEW 3
425049
RECEIPT
DATE ,l ' `
BY
DATE INA D
INSPECTOR
f r)')_
�i
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
j BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs _ _
Forms & Footings _ _ _�,?�� I
Slab Grade
_
s
Underground Ducts
Ducts
Return Air
Steel
Roof Deck
Combustion Air
Exhaust Fans
O.K. to Wrap(0=5
S'r�
F.A.U.
Compressor
Framing O ( g -Z- ,
Insulation
�--� �_�p
Si-
Vents
-
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
Final
r
'''-1-��?j-1�-�
(�
Final
PooLs
-SPAS
BLOCKWALL
`
APPROVALS
Steel
Set Backs
Footings
����/p�
g�
Electric Bond
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
'
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
_
�2 - (3 - �!
�7
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection 7%3/Q
Gas Piping
Gas Test
3-2 p (
47-
�j,! (
40
Pool Cover
Encapsulation
Appliances
Final
COMMENTS:
I/��
,
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole _ 7
Underground Conduit -
Rough Wiring
Low Voftage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
53 ' SAO P.O. BOX 1504
Buildin ` % 78-495 CALLE TAMPICO APP:IC 1 ONLY
Address All1�i'1r ��. I /,�,AQUINTA, CALIFORNIA 92253
Mailing
Address
City Zip Tel.
4A eW,9z7 ie�->)?,_f-?;
Contractor
/V n'.A
Address --:)
))City Zi , Tel. / n
G� of 07P �E
State UC. City
& Classif, h !� Lic. N
Arch., Engr.,
Designer 0 /A of
Address I Tel.
• LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
s° d
7000) of Division 3 of the BusinesProfessions Code, and my license is in full force and
effect. A iN-1
SIGNATURE • �L/ " ! DATE
OWNER -BUILDER DECLARATION
Imphereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, atter, irove, 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.)
F1 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.)
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
17 Copy is filed with the city. O 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 ($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 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 a0plicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE'CONST. OCC. G P.
A.P. Number_ -7%h -►moi' - 605 ✓
Legal Description Lar St. -IL 291k, 00m 23
Project Description_ / 1A --s
Jr.Jr., __#.1M
ZONE:
BY:
Minimum Setback
Sq. Ft.
Size 2 , 6 6 n
No. No. Dw.
Stories ! Units
/
New , Add ❑
Alter ❑ Repair ❑
Demolition ❑
Side Street Setback from Center Line
Side Setback prom Property Line
FINAL DATE
INSPECTOR
Issued by:
Dam Permit
Validated by:
Validation:
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
,,j
-2,1
Const.
Mech.
Electrical
Plumbing
S.M.I.
«•,
tw , P
Grading
t: ,
Driveway Enc.
Infrastructure
vs
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 prom Property Line
FINAL DATE
INSPECTOR
Issued by:
Dam Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Desert Sands Unified School District
47-950 Dune Palms Road 4
Notice:,La Quinta CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 12/21/00 AMP" " 774-134-003
f -No. 21395 Jurisdiction La Quinta ' _ Y
Owner NameWilliam Elemer Doran , " Permit #0012-244
No. 53-560 street Avenida Villa - ,,,Loa
Log #
City"La Quinta zip 92253 Stucy
Area .
Tract #.$LK241U23 Lot# ;22Squ'are Footage 19f:0
-Type of Development Single Family Residence - _ s No. of Units 1
i
y•
At the present time, the . Desert -Sands Unified .School District does not collect fees orb garages/carports, covered
patios/walkways, residential additions under 500 square feet, detached accessory structures or reolacemenf mobilehomes. It "
has been determined the above-named owner is exempt from paying school fees at this time due to the following reason:'
•' 1 i EXEMPTION NOT APPLICABLE ;
This certifies that school facility fees.imposed pursuant to Government Code 53080 in'the amount of
2.05 X ' 1,980,' or $ 4,059.00 ~ the property listed above and teat,b ildmg -
permits and/or Certificates of Occupancy. for this square footage in this proposed project may now be issued' , x
Fees Paid By CASH Bill Doran r% 'L
a Telephone' 310=534 3313 .
r v..
Name on the check
ByDr. Doris Wilson, _; f,' • .
Superintendent
Fee collected/exempted by ' Annette Barlow Payment -Received $4,059.00
(_ Check No. .N/A F
Signature
NOTICE: Pursuant of Assembly Bill 3081i(CHAP 549,'STATS. 1996) this.will serve to notify you that the 90 -day approval period in which you ma; protest the fees or other payment identified
above will begin to run from the date on which thebuilding or installation permit for this project is sssued or on which they are,paid to the Districtf ) 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
FlDEI rri tq,%�1 TITLE 00 9 DOC . U 1999-532038
12/07/1999 08:00A Fee:6.'00
RECORDING REQUESTED BY:�/D
'� Page 1 of 1 Doc T Tax Paid
-,-idelity National Title Company S 3` Recorded in Official Records
Escrow No. 41158-CBt County of Riverside
Title Order No-,S,31T� Gary L. Orso
Assessor, County,Clerk &.Recorder
When
n Recorded Mail Document
and. Tax Statement To:
Mr. William Doran s u
• La Quinta, 6
A 92253' �- .. � � � I :•-_- � ,
. LA R CDo� LONG REFUND NCHG - f
-
A /4-1,34-00 =1`,' 774-134-002-1 & 7 7 4 -13 4- SPACE ABOVE THIS LINE FOR RECOER'_SU SE
G RDT DEED
The undersigned grantor(s) declare(s)
Documentary transfer tax is $54.45 �.
[ X:. I computed on full value of property conveyed, or •+ ISG
[ ] computed on full value less value of liens or encumbrances, remaining at time cf sale, ,
[ ] Unincorporated Area City of La Quinta ,
FOR A VALUABLE CONSIDERATION, receipt of which is hereby•acknowledged,` 'Robert C. Greenwood and Adeline
K. Greenwood, Husband and'Wife
hereby. GRANT(S) to Doran Revocable. Trust dated Dec. 28, 1998, William E. Doran & .Verna 7.
H. Doran, Trustees
the followi ed real property in the City of La Quinta
Cou of Riverside, S e of California:
)L s 22, 23, and 24 of B ck 241 of Santa Carmelita at.Vale La Quinta, as per map recorded in Book 20,•page 25 of
aPYtp, e-9 the County Recorder of said County.
DATED: November 11, 1999
STATE OF CALIFORNIA ,
COUNTY 0a.
ON oy i 9> 1 `1� �1 before me, Robert.C. Greenwood
personally appeared
c C.. U✓cc ,.,/ooh nn 1 �• . , / _. : - J
+�_tlinz k. 4rctrv�/�.�Gi Adeline K. Green ood
personally known tome (or proved -to me on the basis
of satisfactory evidence) to be the person(s) whose
name(s) is/are subscribed to the within instrument and
acknowledged to- me that he/she/they executed the 7ERI J. HILL
same in his/her/their authorized capacity(ies), and that Commission # n. c0759
by his/her/their signature(s) on the instrument the Z Notory public - Cal�omia
person(s), or the entity upon beralf of which :the Son Diego Courty
person(s) acted, execute the instr ment. MY COMM- ExPirM Aug122000 r
Witness my h and of i ial seal. ,' y
Signature
MAIL TAX STATEMENTS AS DIRECTED ABOVE
FD -213 (Rev 7/96) GRANT DEED -
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 the Building and Safety Department as your
correction list. Please attach additional explanations as necessary.
APPLICANT
SITE ADDRESS S" 3 - SZ o 14 --S . I//L tea.
APN IT y - 003 BIN -NO.:. CASE NO.: 00 - 3
LEGAL: LOT Z 2 BLOCK Z 5'r UNIT 23 S.C.@V.L.Q.
CHECKED BY: 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
Compatibility Review
Case logged and number assigned
Verify legal and APN information
Consistent with MDG on file (as.applicable
MDG filing required (5 filings since 9/3/98)
ya
Consistency with street/surrounding area:
w. Colors
Materials
Architecture .
vac. c,�-.mss �. •-.��aF
OK
co..�e-ezc�vs
�-p c�...s�s�-z,�Tw�rai
s ✓fl2JwrVp�NG mss'0 Planning
2 v4-ei mow. sa,� -city
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Fq
\ Exhibit
With Conditions_._._.....,.
ate o
f ccupancy,rtific,, -
Ce
City of La, Quin ta,.
,.4�.���
Building. and Safety Department of
This -Certificate issued pursuant to the requirements of Section 109 of the Uniform Building- Code,
certifying that, at the time of issuance, 4his structure was. in compliance with the various ordinances
of the City regulating building construction or use. For the following: }
BUILDING ADDRESS: 53-560 AVENIDA VILLA
Use Classification: -SINGLE FAMILY DWELLING Bldg. Permit No.: 0012-244
Occupancy Group: R-3 Type of. Construction: VN Land Use Zone: RC
Owner of Building: WILLIAM DORAN Address: 1224 W. 252"d STREET
._ .
City:- HARBOR -CITY, CA 90710
By:, RICHARD KIRKLAND
Date: 07-08-02
Building Official.
- POST IN A CONSPICUOUS PLACE