0007-254 (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 o9the Business'and
Professionals 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).
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
I hereby affirm under penalty ofperjury one. of the -following declarations:
O I haveand 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 Policy No.
STATS M4D 1542490 -99 .
(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 shallnot..employ any person in any manner so as to become subject to the
workers'.compensailon-laws;.of California, and a�gte' a that if•I should become
-subject to the workers' compensation provisions,of Section 3700 of the Labor
-''Code, I shall fortpwith comply with those''provisionsf T, ---
.0IrApplicant��f�
Warning:, to secure Workers' Comptensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
additionto 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. ,.._ Ds.. .'.
1:.Each peeson'upon whose behalf this application is made & each person I
whose.request and forwhose benefit work is performed under or pursua t� oc�
any permit issued as a result of this applicaton agrees to, & shall, inclam,
& hold harmless the .City of La Quinta, its' officers agents -and employees.
2. Any permit issued as a result of this application becomes nNTnv(('
work is not'commenced within180 days from date .of'issuance of, such
permit, or cessation of work for 180. days -will subject; permit to cancellation.'.
_ �1
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 authoirrize representatives.of this City to enter upon
the above-mentioned property for,inspection purposes
,(' i
Signature (Owner/Agent) �`� =9f Date
BUILDING PERMIT PERMIT"
DATE \, -VALUATION LOT -Z TRACT
t 11:110,127.151
JOB SITE r
ADDRESS `. 53-81.0 AVY-MA V1.UA
APN
:774-174-W3
OWNER " <„
CONTRACTOR / DESIGNER / EN (NEER
MME i lE 1?'10MFs
B & til CON104MIJanox '
74.041 MCaIli°d�11'-111 s ; '
51�����%NT?JDAJUARI-.�
.PALM. MSM CA. M260
ISA QUINTA CA 92253 Y
(�65?Z3?-4'1 C 5941.
E;
USE OF PERMIT ^'a
SWO- J 1,17L•1dVlM D V"f •.. ��JMG .'
t
Y,
SIPD-PIrJd. I lr DO&S INCIT INCLUD111 rBLOCX W.AL1,P OR. POOL � �t
TI3AA T Ir0 N3TP.UCT10N f 1,785,000%
PORCI-YPATIO '` IdS.t0.5i
QV) ryy 9 ..
GARAGEfCAVORS QV) it1,13s.20
A�
5 Fr. WOOD FENCE ^ +.. "600:OD 1.•1'
1
:i~91TWAJUD COST OF CONMLrSwT10Al,':
110,72710
k''k�. fil `: Eil Si�i�9.MAR
.xh
CCDM RUCTION FFY 161.000.418-05)0 +5 Yi1.00
PLAN CHICFC E $362:79
,MEC41ANICAL FEE :1.0-000-421-000
..
LI.&MR.IC:A.L 1+7L► 1011-�i!<'fl-420-i?R!3 '. ffi1z1.33
' 1w[imTsil o PS9• 1014100«419-M $12935
STRCY140 MOTION FE9 - RESID 101-000-241-000 ffi31.D7
O ADING FEE 3 til. -000.423-000 Saw
DEVZL 3PER IMPACT FEE 11
PRL"C.ISFPLAN. } 1i3'i�Q004I'd�45 �JOO.,itp
FEIr DEPOSYr 101-000-439-318.
� '14
q ML CONS"TRUMON AND P1.AW'-C`
t "...
$3,590.93
LooL&3S;1 R-E-PECK;.Mk*.
-$armoo
N
TOML`PMMH 1v �ES IM, ffOW
[RECT!7k
.DATE
ir
BY:
DATE FINALED
INSPECTOR
11T.%
j,
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
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
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PIN. 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
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 (Perm)
COMMENTS:
a
�!'��. a�I[7>�i6�•�'++,�xr+�r►ri��r• rsf'�"rlFi�'rr°a"^-Z"''t "tz'T>f"'"".
Cgilicoq —P.O. BOX 1504 APPLICA ION ONLY
in78-495 CALLE TAMPICO
Address'" LA QUINTA, CALIFORNIA 92253 Q--�
Owner
Mailing /� '
Address" / 4 ZX//
f/fL-rt
Contractor
Address �t
—y � A
State Lic.
& Classif:
Arch., Eng
-Designer
Ad?gL
O J1
City
4'
I herebv aff
iira' 4
Zip Tel. 86 ^ 33
yL �v
4f e� i�►�l
F(v A c- V -u Ar Z
Zip„tel J z Tel,-pg 11
J/
city
Lic. q
��l� (`%t+�/,✓�JL` �/L (” Tel.
State { /L
Lic. #
LICENSED CONTRACTOR'S DECLARATION
m that I am licensed under provisions of Chapter 9 (commencing with Section
of 3 of the Businessland ProfessionsCo e, and my license is in fu)1 arfd
OWNER -BUILDER DECLARATION
I hereby affirm that I 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 (8500).
l: 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 comptetlon, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
( 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 contractors) licensed pursuant to the Contractor's License Law.)
I 7 I am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION 1 i
l :. J.
y: -1 hereDy`affirm that I have a certificate^of consent to'§elf-insure, 'dr 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. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROMR -
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 thg 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
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.
1 agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives sof this city to enter the above•
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
.DING: TYPE'CONST. C. GRP.
Number_-�7T"
'I Description
f t Desc•rlptiori S/�/G2G- r�✓1 /� �/ /•!y�`IL�
1 1
Sq.•Ft" I No. No. Dw.
Size Stories Units —�
Nemi pL` ` Aiid/ ❑• ' ' AlteA0 - Repair O _Demolition
1 i
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
"S.M.11.
Grading
Driveway Enc.
Infrastructure
1!
WIT,
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 from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
1•,
Desert Sands Unified -School District
47-950 Dune Palms Road
Notice: 3 La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515 '
CERTIFICATE OF COMPLIANCE
Date 1/22/01 APN # 774-174-003
No. 21543 Jurisdiction 'La Quinta
Estate Homes LLC
Owner Name Permit # 0007-254,
No. 53-810 2, Street Avenida Villa Log#
City La Quints Zip 9225Y Study Area
Tract # Lot # Square Footage. 1785
Type of Development ' Single Family Residence y t No. of Units 1
Comments
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
J This certifies that school facility fees imposed pursuant,to , Government Code 53080 in the amount of
2.05 X 1,785 or $ 3,659.25 the property listed above and thatbuihding��°f ,
,Permits and/or Certificates of Occupancy for this square footage to this proposed project maYn..owbe issued
Fees Paid B CC - Canyon National Bank - Crre' Shannon
Y9 Telephone 760-837-5478`
Name on the check
By Dr. Doris Wilson r�
Superintendent
Fee collected /exempted by Annette Barlow Payment Received $3,677.10 `
Check No. 05386
Signature
OTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
bove 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 District(s) or to another public entity authorized to
Dllect 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
' NGE COAST U LE W
RECORDING REQUESTED BY:
DOC p .2 0 0 0— 2 5 2 3 9 5
06/29/2000 08:00A Fee:6.00
angio Page l of 1 Doe T Tax Paid
Recorded in Official Records
County of Riverside
Gary L: Orso
Assessor, County Clerk 8 Recorder
WHEN RECORDED MAIL TO: II
IIIIII
IIII I
Estates Homes LLC
IIIIII
(IIIIII
IIIIII
IIIIII
(IIII
(IIIIII
IIII
74041 Hwy 111-
-Palm Desert.Ca.92260"
_SPACE
-rRi)''Oo7l�(iTJ�/ G R A N T
M;
$
u
PAGE
SIZE
DA
PCOR
NOCOR
SMF
.1 ;C.
LA
R
L
COPY
LONG
REFUND
NCHG
EXAM
The undersigned Grantor (sj declare(s): Documentary transfer tax is $ 16.50
ASSESSOR'S PARCEL NO.: 774 174 003(X) computed on full value of property conveyed, or
TITLE ORDER NO.: 186540-1 ( ) computed on the full valueless liens or
ESCROW NO.: 206306RW encumbrances remaining at the time of sale
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged:,
HOWARD A. JOHNSON. AND CONNIE W. JOHNSON, TRUSTEES OF THE JOHNSON, LIVING TRUST
DATED NOVEMBER 5, 1996
hereby. GRANT(S) to ESTATES HOMES, LLC, a California Limited Liability Co an
mP Y
The following real property in the LA QUINTA, Riverside County, State of California:
described as: Lot 22 of Tract SANTA CARMELITA'AT VALE ,' as shown by Map on file in
Book 20, Page(s) 25, in'the.Office of the County.Reco Orr of Rive ide County.
Date: May.1, 2000
STATE OF, -CA IFOR,�N�"IA ) /�
COUNTY OF 1,1(1=/16 /UE "
On �'._ f _UU . before me, �he undersigned,
P sonally an eared -_44-e!
C NNIE W. JOHNSON, TRUSTEE
QAJ
personally known 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 instrument
and acknowledged to me that he/she/they executed the
same in his/her/their authorized capacity(ies), and
that by his/her/their signatures) on the instrument
the person(s), or the entity upon.,behalf'of which the
person(s) acted, executed the instrument:;.`
Witness,(y ha d 'and Zfcial ;seal:
��:Signatu / )
> ANN CRQUDY
Commission # 12&489331
Notary Public - CalifoT,io zz
Riverside County
y MY Comm. EV -4 -es Jun 20.2004.
(This area for official notarial seal)
MAIL TAX STATEMENTS TO: C/O ESTATES REALTY, 74041 HWY 111, PALM DESERT CA, 92211
iJ
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 B & M -CONSTRUCTION
SITE ADDRESS Avenida Villa
f
- s -
APN '774 _ 174 _ .003 BIN NO.: `CASENO:: 2000-282
LEGAL: ' LOT BLOCK4. UNIT S.C.@V.L.Q.
Leslie Mouriquand i
CHECKED BY:. • • !. r DATE: � -/ --c 0 •
- w
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
4
j
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)
Consistency with street/surroun' ding area:, ''
•,
ty
Colors
t a
a m
Materials
E o g
V:� v
, 'c C
Architecture'
> c > E Z D.
Other Requirements:
Q t = ° -a -0 —
00=yWa