0010-276 (SFD)LICENSED CONTRACTOR DECLARATION'`,
I hdreby affirm under penalty of perjury that I am .licensed 'under provisions of
'Chapter 9 (commencing with Section 7�000)'of Division 3 of the Business and
Professionals Code, and my License is ih-full force and'effect
,License # Lic. Class. � E�r Date
� y �� Iib ' ���� ��•--3',,,��r��ib��d��i°
Date °. Slgnatureof.Contractor `" ,✓
OWNER -BUILDER DECLARATION} < pry
I hereby affirm under penalty of perjury that^I am exempt from the Co ractor's
License Law for the following reason: F� n f
( ) I, as"owner of the property, or my employees. with wages as their -,961e
compensation, will do the work, and the structure is not Intended or offered for
sale (Sec 70.44, Business & Professionals Code). !�
( i) . I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code):_
O I am exempt under Section B&P.C. for this reason,
Date Signature of :Owner• '
WORKER'S COMPENSATION DECLARATION',
1 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:
`y Carver .. Policy No.
(This section need not -be completed if the permit valuation is for $100.00 or less):
O 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 pro visions 'of Section 3700 of the Labor
Code, I shall forthwith comply with thoseprovlsl ns.
Date: `,¢ -..�a Applicant w*r.•
d1r c. .
Warning: Failure to secure Workers fCompensati_on coyerdge� awful and
shall subject an employer to criminal penalties and civil fines:d'p 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,Diirrector 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;it'
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 Quirita, 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,, represent tives of this City to enter upon
the above-mentioned property lfo r insspe ctio6,�jyg rtes_ x ', f•,r / /j!
��t� few r7'
Date`" `
Si nature (Owner/A —M' `
` - SU,ILDING. PERMIT PFRMITk
DATE • •`;'VALUATION LOT ,0,276 TRACT, •
.4 •p� ..^7 ..
i /1 R c1 1 ry y (/"e T
.�ti�`69 !•J�F;/!(�� :AAi7 .:!iCJi t .1f7..G 2 1. I�'�.��
JOB SITEI ?'
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN INFER
Cdr* i fi
1,30WEL V 4, WC C.
i aa�, t:82 7iC.it1! 'CA 922 x 3
LA t?•U3NTA. ? Cry, 92253
(160W.0€ 66 ' C".E V 4359
USE OF PERMIT
SFD�P�.�'>`1 IT GDOM"1vC3'r U40AM
TRACT C:C31i«P>!MIC°Ttc' N 4.7521E10 SIP
GARA.WCAPPORT 010 1£t 21.At0 ^
4OOd3 rlg�i+iG 10.00 LF
r
TED C`OUT 03r C 0111 11RI 9C -N
107,507 d�S
�•WIMM
ff pp rim
FJ11���w1�li7�.Y��7 ��i1�'dtt.#tRli6ltL�. `
mm
011)NIST"iFtUC`t'Ity>Dd RIE, 101-.0 0.43 S -OW s l.so
1yiaKN f",fFECK I-1101 :i01-000-439-318
3VIEf":H ANIS°ha, FER 101.00n-421•0.°90 $62,00
��aF?.t:'A"144C.°,1�.1..","�.� "i�11-•tiOt2-�i�;C�•l7OC+ �°42a.f1tS
FLU M8rN0 k OT, EO34)OO.r19-000 $11635
M J }YyL2C13wtr10 #5�96��'1�gsyTONI rife ik.FS$i� 101-000-M-000 10::iv .
4yq.yf1n
• 0A Gti1?INR0 FR8, 6 Q 1. u•t1i�47a•*78�p�"a;3:A� &�.Q«�
101.000.4lµ`:345 �4U6�.00
��;�•O�,�C5�1`T' � � �Ox-Ofb1:9��t��-59.� ��"��11.SiSi
S�
PAID'��'>
- t 1,05 PRE-PALD
&250.00
NQV 0 200Q '%ocl d DRi' F9181];U ' 1%0W
"ITTVi LA
. .
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
g g . , f. • '4 ,} rip ��p�'°a�i''%f P .� �„ �, � `h
INSPECTION RECORD -
OPERATION j
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs '
Forms & Footings _ _ _�_( �j� G`
Slab Grade 1'
Underground Ducts
Ducts
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U. "
Framing
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
BLOCKWALL A" PROVALS
Final
POOLS - SPAS
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 f. (?i.0 Vii,
Heater Final
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)
- 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 Notice (Perm) "
,,gra d� . ?(.a
Building
Address ip f I
Owne
Mailing
- Address
0
4C. v
Zip Tel. _
Address
- - r . 4-4�.i.�ii�.�
4P.O. BOX 1504
78-495 CALLE TAMPICO __.,APPLICATI NLY
LA QUINTA, CALIFORNIA 92253'
0
Ufk;T�\ F;,x-2 :;; V-ZT1-r
BUILDING. TYPEC/OUNSI. U%, .GRP.
A.P. Number %/ / !s4- - cx-.)
6 6�= Legal Description f - �� T� LA -)C- � F'
Project Descriptio ��"C-
State Lie City
& Class if �� Lic. #
Arch., Engr., \C�+ '� j
Designer J q /�.� J-Z1�
Addre s Tel r A/
pity Zip State
2 C "j 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 I am exempt from the Contractors License Law for the following
reason: (Sec. 703 1.5.
Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior wits 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, 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
orbimprovement is sold within one year of completion, the owner -builder will have the burden
of Aroving that he did not build or improve for the purpose of sale.)
F ltl' as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. fSec. 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 contractorfs) licensed pursuant to the Contractor's License Law.) -
i 7 1 am exempt under Sec. S. 8 P.C. for this reason
Date Owner v
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.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (5100) 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. s
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 applicant Date
Mailing Address
City, State, Zip
WHITE = FINANCE YELLOW = APPLICANT PINK: = BUILDING DIVISION
Sq. Ft. I -
Size
No. / No. Dw.
Stories Units
New,d Add ❑
Alter ❑ Repair ❑ Demolition ❑
I
+0 . 6
o
r
Estimated Valuation
PERMIT
' AMOUNT
Plan Chk. Dep.
Z S e) — c5a
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
infrastructure
TOTAL
REMARKS
S
ZONE: ..BY -
B -
Minimum
Minimum Setback Dis
Tint Setback from Center.Line
Rear Setback from Rear Prop. Line
Si ie Street Setback from Center Line
Si ie Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK: = BUILDING DIVISION
r. Desert Sands Unified School District - z
47-950 Dune. Pahns 16ad E
;Notice:' La,Quinta, CA 92253
Document• Cannot Be Duplicated 760-771-8515~ f
4
CERTIFICATE OF COMPLIANCE:
` Date 11%3/00 APN # 774-134-006
Z.
. No. - 21169 Jurisdiction La Quints
Owner NameLeonard Lam r ' :Permit #0010-276
No. 53-610 "Street Avenida Villa :, Log#
.- City La-Quinta Zip 92253 Study Area' ,
Tract # BLK241 U23 Lot # 19 Square Foots 1752,
Type of Development Single FamilyResidence. h No. of Units 1
At the present time, ,the' Desert Sands, Unified School District does not collect fees, on garages/carports, covered
patios/walkways,'residentiai additions under 500 square feet, detached accessory struc.ures 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
r 2.05' " X 1,752 or $ 3,591.60 the property listed move and that building `
pPermits and/or Certificates of Occupancy for this square footage in this proposed .project may now ie issued
_
Fees Paid. By CC / Guaranty Federal Bank / Leonard Lam ; Telephone 760-564-1866
.� -
Name on the check
�t Yr
By Dr. Doris Wilson
'Superintendent •,:�r
Fee collected /exempted by K Annette Barlow Payment Received $3,591.60
s • . �V� .,per-�_ .Check No, - 1713107 •
Signature
ti
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) this will serve to notify you that the 90 -day approval pedod'ir which you may protest the feas 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 pais -.to the District(s) or to another public entity authorized to ,
collect them on the District('s)(s') behalf, whichever is earlier. ti '
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
A , ,
y COC N 2000-367338
09/19/2000 µ08:00A Fee:9.,09
Pape 1 of 2 Doc T Tax Paid
RECORDING REQUESTED BY „Recorded in Official Records
County of Riverside
-'' Gary, L . Orso
AND WHEN RECORDED MAEL TO: Assessor, County Clark b Recorder
Leonard Lam
111 Chelsea Circle
Palm Desert, CA 92260 - —
Mg U PACE SIP CA PCM NOCOR SMF h=
A R L Gw wrx REFUNn NCNO DW
A.P.N.: 774-134-006-6 TRA #: ��.� Order No.: Escrow No.: 583961
GRANT DEED
THE UNDERSIGNED GRANTOR(s) DECLARE(s) THAT DOCUMENTARY TRANSFER TAF IS: COUNTY 19.80 y
( ] computed on full value of property conveyed, or
[ ..] computed on full value less value of liens or encumbrances remaining at -ime of sale,
[ ] unincorporated area; [ ] Cityof LaOuinta,and
FOR A VALUABLE CONSIDERATION, Receipt of which is hereby acknowledged,
Thomas Erdosi and Sidne Erdosi, Trustees of the Erdosi Family Trust, and Harold Wellington and Barbara L.
Wellington, Trustees of the 1991 Wellington Family Trust.
hereby GRANT(S) to Leonard Lam 'a single man
the following described property in the City of La Quints: County of Riverside State of California;
�I,ocIG UPIr2S
Lot 19 and 9M 241 of Santa Carmelita of Trail , in the City of. La Quinta, County of Riverside, as per map
recorded in Book 20, Page(s)'25, of Miscellaneous Maps, in the Office of the County Recorder of said County.
mss osi, Trus Harold Wellingbn, Trustee
4Erosi. Trustee Barbara L. Wellington, Trustee
Document Date: August 14, 2000
STATE OF CAL )SS .
COUNTY F )
De.. D before me,
personall ap red _ ...
personally (mown to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instruz=
and acknowledged to me that be/she/they executed the same in his/her/their authorized capacity(ies , and that by his/her/their signature(s) . on the instrumem
the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument.
WITNESS official
Signa'
i • This area for official notarial seal. .
• BRADLEY ERDOSO ;
V COMM. 01263189
NOTARY PUBur cAuFORNIA Q
SAN DIEGO COUNTY 0
` COMM. EXP. FE9.11, 20041 ,
Mail Tax Statements to: SAME AS ABOVE or .address Noted Below
f
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 LENDEL VENTURES
SITE ADDRESS 53 -610 -Avenida Villa'
APN 774 _ 13.4 -_ 006 .'BIN NO.: CASE NO.: 2000-327
LEGAL: LOT 19 BLOCK 241 'UNIT Z 3 • ' S.C.@V.L.-Q.
w
k , -
CHECKED. BY: Wally Nesbit DATE:l�
Inform,, the assigned Building plan checker upon your',assigninent to viis case: The CDD Executive
Secretarymaintains a log book to track. appl,ications- and assign case numbers.
REQUIRED ITEM
Y
N
COMMENT/CORRECTION
Compatibility Review
Case logged and number assigned
�'""s'°` A.�a�
l�iz r�rno•S cw
Verify legal and APN information
X
" Pr O&rli^WC&I LAM /2`iS�05vC�
Consistent with MDG on file (as.applicable,
MDG filing required (5 filings since 9/3/98)
Consistency with street/surrounding area:
Col or$
Materials
Architecture
x
w : �,.. S�,y,�,••
X
��z2� C - c' ,�_�. L� gas
Other Requirements: Mo�� `vw 7-:,
NWS ft/t � %�'�-ic..•� �r�f �,�ES
wI . i S✓✓'iti rr�-� of rc5iru c n� .� Sy
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,l CITY OF LA QUINTA SUB -CONTRACTOR LIST 2AIJ
JOB ADDRESS 573 �� ��.V� V , � PERMIT NUMBER li OWNER LZDIV/—lam BUILDER
This form 'shall'66 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-1cha* nges 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 permit... For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable' response. -
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