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0108-333 (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'of the Business and P.Sotes57onals Code, and my License is in full force and effect. - .License # Lic. Class Exp. Date Jf 110. 114 Date 4k, 2r. , `F Signature, of Contractor ✓�C;y� 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 strbcture,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). () I am exempt under Section B&P.C. for this ;reason Date Signature of Owner c 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: Carrier Policy No.. STAT''. MND 229-01 1 NYr 0004403 ' (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 shall forthwith comply with those p rovl� ns. :.e� F .' Applicant _ 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:ismad rgat"-" whose request and for whose benefit work is performed un r pursu any permit issued as a result of this applicaton agrees to,' In emnlfy & hold harmless the City of La Quints, its officers, agents emRI es. 1 2. Any permit issued as a result of this application becom n - II a d I J work is not commenced within 180 days from date tof i u nce of such permit, or cessation of work for 180 days will subject perm t to LA I certify that I have read this application and state that the ab ve in formWJWAfl,'iCE correct: I agree to comply with all City, and State laws relati o e uilding construction, and hereby authorize representatives of this'City to enter upon the above-mentioned property for inspection purposes. . Date ,Signature (Owner/Agent): BUILDING PERMIT PERMIT# ,DATE VALUATION d y pq LOT._ TRACT y q JOB SITE APN ADDRESS OWNER - CONTRACTOR/DESIGNER/EN INEER I- Tue. dmCZLES .I>iINN COWA3:tii'a' . WMLIAM RUSULL ROGIMS i A 92261 '1'�1 RMAL CA 922"%x€ -760)399- uoo CWX 1934 USE OF PERMIT - S'l D 4 .Ti1ASTIM NNVAVOa 'LOT V, f4LK. 111. PFF'MIT DOCS NOT INCLUDE ;ti3E,e`KM ��'.�R.1% %'3OM PA 011,T)M'WAYAPPROACH TRACT CONST RUC11OV, SP QA,P,AQ$0J6;.fs.'+2.i?43i2.a 1 x.,611? Me UTDA'AU'D COST OF CON110THUCIAM 'k E iNUT FEW S17MA.RY CCY14.'Tf V(,!r1€N FEE 101-1100,4'18-000 �391a�30 PI.A` w Cilfatlx FFE 107-000-439-318 "M L)UP001T 101 -000 -439 -MR 4230,00 144=1.1AHICALME 101-000-421-000 $513.50 1'f8 SI C 3tiS,'AL "RE 1,01.000-420!,000 510.1.2 PLIDWID1140 FEE 101-000-419-000 $112.00 :3'1`id:OM MG?TION PER -• RISID 101-000,4A1-000 U.G }�1 01TAUNDI NO MIZ W-000-423.000 U0.00 DEVID-W1:'12. rMPAC T FRE $1,407.00 €� iif�11S1=:;f'IaA7 101-1100-441-341 $100.00 SD*B- L3 AL COX M.) , �T.d'-MON AND PL.4V �'`„E•:��.t."X, 14.03 M. -PAID FEND 2001 yy,�++ MpR PER ur MRS MY, RECEIPTDATE �� BY D� �' �Dt�INSPECTOR -- _ $3,:381.c1 4250.00 o,3 11P I INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings_ lA <<� Underground Ducts Ducts Slab Grade �0 Return Air Steel _ _ _ Roof Deck !D 26(d O.K. to Wrap J/ S�O! Framing _ C.� -40 L S� T, Combustion Air Exhaust Fans F.A.U. Compressor Insulation Fireplace P.L. / ( Vents Grills Fireplace T.O. Fans & Controls Party Wall Insulation Conddnsate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath l J Final _Q2li�- Final POOLS - SPAS BLOCKWA ,L /SaPPROVALS 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 _ �� L 6� vZ Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection p ^�"r Encapsulation Encapsulation Gas Piping Gas Test _ �(uJ/02- Appliances Final , COMMENTS: " Final Utility Notice (Gas) 6 �. /LAPPROVALS ELECTRIC Temp. Power Pole !(mob 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) ... .. ,�, w ...� - 3vl•,trr�• ++1psj�'yY'' rx.uw. �."�.._..,s,,,-�gv1't u s7e- . �_ t,, '•`' . b .�s� . Y,..^'.�T P.O. BOX 1504 APPLICATION ONLY // /' 78-495 CALLE TAMPICO , �IJ tress .-57- �,l f� o x I/r f/!-1 LA QUINTA, CALIFORNIA 92253 der Address -�,s . ( r /, .I. City Zip Te l. f� Contractor I ff , �Gw.L Address ity lZip State Lic.City & Classif. l-7 Lic. # Arch., Engr., / Designer lPi�f'I VNt�sivL.. ?61 9UA 1'l � — / b 00 City Zip. State ).) S 3 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 Contractor's 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 to'lts issuance also requires the applicant for such permit to rile 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 !or thealleged 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). 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 or sale.) I 1 I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the proiect. (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 r 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 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 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 LDING. TYPE CONST. OCC. GRP. .Number t/E% Gly al Description ject Description t f ' • I t Sq. Ft. , r Size l New;p No. it No. Dw. Stories t Units Add ❑ Alter ❑ Repair ❑ Demolition ❑ c " u o" Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. CITY OF LA QUINTA FINANCE DEPT. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure �f 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 P*operty Line FINAL DATE INSPECTOR Issued by: Date Validated by: Validation: rmit AUG 3 0 2001 CITY OF LA QUINTA FINANCE DEPT. WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION f r ,, Notice: Document Cannot Be Duplicated Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE Date 9/21/01 - -APN # 7.3-144-001 No. ' 22523 Jurisdiction La Quinta Owner NameThe Charles Robin Company Permit #0108-333 No. 51-510 Street Avenida Villa Log # City La Quinta zip 92253 Study Area Tract # BLK 111 Lot # 35 Square Footage 1412 Type of Development Single Family Residence 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 This certifies that school facility fees imposed pursuant to Government Code 53080 ' in the amount of 2.05. X 1,412 or $ 2,894.60 the property listed above and that building r permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued Fees Paid By CC / Bank of America - Rose Shafer Telephone ,70-339-1200 Name on the check By Dr. Doris Wilson v Superintendent. ; Fee collected /exempted by Annette Barlow Payment Received $2,894.60 . ` - Check No, 2009608704 „ Signature NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the Distdct(s) or to another public entity authorized to collect them on the District('s)(s') behalf, whichever is earlier. Collector: *Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting. , Rug 21 01 10:1.6a Judy Vaussie An-ZI-01 DO:Q4as Prm-OLD REPUBLIC TITLE (760)564-3316 TIOTT321II T-029 P.02/02 F-2ZT age M game—Mmses BeCO)pegrtttolet)mty wrtsntiw w:wN *«•�.� ap t s► , M ► fi• /rte f1EPU8LtC;ME CO, f �...•..o r• «...a, w.•i Apo wwA¢0�10M.MAIL eo 1raVw�. crew„ aim: � aw«•r TNI t'f1AkLF, � k�nUC I'/r,1'ASl• ��• w•+:t KII.fY.t`:r.Unt t+k. ter• • I .. ns 1t�4 4 ..a.oatwu_. The WduKWW tdenta(♦) Wo-re(s) M10 low OCCWINT TRANSM eecYlsaaticttKd TAX t$: 7RA V. 0?.o0/fi ..:.t 0rt01nar : 1 t _ Ca++dr / Cer x� Co an INV 0VVOWof"ANVIp♦t0POPUIVYcunvRw-ZVA Como"onft M """Unto tueatlim0enclofflo %ft GRANY DEED °"aEAMPT•w t• I'll WOk*,Mw%lVaWn . FOR A VAUJABLe CQNSIpEAATt0N. famot of W Vh is Bne v wk—Asogod• l � i11::.1AM 1'ktNBLL. :• I:104�t:Y xIK/ At•LjltAliL :1':.sc F-' Vtt.t.JAN 7VINM1.1% N1 1RMLPNtYY IMZI twvbp GAMT1$1 to! Trot CwF1116 PCP)N C0101'Ar11!. A CALIMMA -04"AL PAR'M:kSN7Y septpe8ppropollTmthf City or to pu11RA OCAM Of NI.•cpluV SIVA oceftllw•r>e h LIU: S). W 2i 0> NLoer. Iii In (ANT& C#"Xl-:TA A: VM -L lA.(rJltllA. LT:1T pt't:. :: Al; t9tk . awy ZIP, /•RSYS •" • hitt. eq o/ Raps. YnTmo! 01f ►!!•RPY•14R r.'r,+7x;'7 OipeO June :1100 ._ —.._ . _...._� /Cs;�de�� Lam• STATE OFCALWOL16A.t M,LL,AM "SO= C04NTT OF Ri+ZrNd• p q , N c" .'-w ,I. 0.. bdwomB.. Sys�ttea �,1�w.a.,a !♦:stir• At�ito��01� �illlas ir+llDic Attear=� a 1We■I'7+AC r - i7 14 to f 01080110 wm t b Ap�lww 111e 101100111/11wjw gig to an ow tr 411111e10W IMP M� 6119111 �? 9• wth tl>tlele llttllr M W-cnl et ttltecrfldMe Wind ss my s Alwl•1rtr+wrrt MOL TAX stTAtJ id ANe A8 Atiblle• ��•,� os • 1 a O!sder: w07040-00001969 Description: 2000.226156 pa"I o�'1`` t: 4 r P. 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 per Section 9.50.090 of the Zoning Code. Its purpose is to determine: 1) that the -proposed house design does not duplicate the same architectural style of any house within202-feet of the applicant,—and/or-2)-if-there is -a -need -for -the -applicant to -file for Master Design Guidelines. If the applicant does need to file a Master Desig;-1 Guideline, please transmitted this information to the Building and Safety Department as part: of your correction list. Please attach additional explanations as necessary. APPLICANT THE CHARLES ROBIN COMPANY' SITE`ADDRESS 51-510 Avenida Villa A•PN 773 - 144 -0 01 CASE NO.: 2001-546 LEGAL: LOT 24 BLOCK 111 UN Z S.C.@V.L.Q. CHECK AND APPROVED BY: Greg Trousdell DATE: Inform the assigned Building plan checker upon .your assignment to this case. The CDD Executive Secretary maintains a log book to rack applications and asst n case numbers. REQUIRED ITEM Y �d N COMMENT/CORRE TION Verify legal and APN.information e Consistent with MDG on file (as applicable MDG filing required (5 filings since n � 9/3/98) ed G° Arch' ectural variety within 200 fee Pa `y G th surrounding are4: 0 ► i'� �� Colo ``ass ,0 '600 s Materials Architectural design Other Requirements: cv -- G. 6y% 9XZ61�( r. (Certificatedf Occupancy City of La Quinta Building and Safety Department OFn 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 ADDRESS: 51-510 AVENIDA VILLA Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0108-333 Occupancy Group: R-3, U-1 Type of Construction: VN Land Use Zone: RC Owner of Building: THE CHARLES ROBIN COMPANY Building Official Address: P.O. BOX 3578 City: PALM DESERT CA 92261 By. KIRK KIRKLAND Date: 01/08/2002 POST IN A CONSPICUOUS PLACE f