0104-102 (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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
wDa aP��Gif`,. J 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).
( ) I, 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
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
() I have avid 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
Se�c`ti In 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. •
1"ATE i,G 224-01 UNIT DDCW483
(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 provisions-
Date:,;..v'r 41 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 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 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.
Signature (Owner/Agent) _� f— - ---'Date
' BUILDING PERMIT PERMIT#
DATE VALUATION LOT ��-t,:, TRACT
JOB SITE I APN
ADDRESS
OWNER I CONTRACTOR / DESIGNER /
1 -370 AM 41DAWINIM YD -V.
5690O.T.ACT-OXON ST
1A QMNIA CA 9225.4 nma"L
(16q)399-1-40 CIBIA 1954
USE OF PERMIT
47SE'!f'.I.LX'F!?1Fsf LY...d1NJ�4r{.t�}�re0
S,VL) 00gSNaf J.NCJJX.()Z 13LOC,,.r. W.R4..T.h)00". Ar C)P
01WEW Y APPROACH. N',iA31 PR 3-t
T"WT C0113TRUCTION 1,421.00 8,F
PORCHOPKr}0 36.ttf11 Sy
tS:dRICA-R TOR5)19%, f
r-T.'1A3`�;tpr.13+'I qu 200.4(9 LF
Y.91U.11NEW MIN OF CCUK13-121TC-InON
-
MUM n12 94—Tmawlty
APR 12 2001
CON13"TR.U(i WN, FF
101..000^4184,100
4i +f.e0
PLAN CHECK ala
"101-000-439-318
• VA0 0.922
WX
101 -CM -421.000
W
!lX1,3?rCp,`�rr"p�pSyJAL. Pyite
$299
P1111
a101-000-420-000 /p�yy
sy'[�yr�t.Ca2pf O i�J�p FEE •' .'�iE.SID
101 1 wt�af,p00
-�i?t�rza�-,2p
L'YMN
O .4,T.�%1.5 G. .K21
PS �4p
101 ^t+'MI-42 fi r ✓00
00
D3:' BLC�b'EP, I, a8�+i�C T FRE
$1,90
PENC''•dHIM
$C0)� 10),000-441-345,
$100
$10
s;��.�;srpyyPIAN SIT
101-000-A39-318
AA.44
11.75
$$,v3
A0
7, 00
0100
0.00
LES0 PPM -PADD Fi;,23
RAlIMRMT KK95DUN NOW
DATE FINALED
INSPECTOR
$3,410,74
4250,00
APR 12 2001
RECEIPT CITY OF LA 0 �' f/�
6!
J ,
AA.44
11.75
$$,v3
A0
7, 00
0100
0.00
LES0 PPM -PADD Fi;,23
RAlIMRMT KK95DUN NOW
DATE FINALED
INSPECTOR
$3,410,74
4250,00
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
Set Backs
Forms & Footings
Slab Grade
Shower Pans
Steel
Sewer Connection
Gas Piping
Roof Deck
Gas Test
O.K. to Wrap
Framing
Insulation
Fireplace P.L.
�_s=
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
�Q . ! f •7
Drywall - Int. Lath
L _ /'7-,- 4) f
%
Final 17,11
BLOCKWALL APPROVALS
Set Backs
Footings
Bond Beam
PLUMBING
APPROVALS
Waste Lines
Water Piping
Plumbing Top Out��
Shower Pans
Sewer Lateral
Sewer Connection
Gas Piping
( /
Gas Test
I Final
ELECTRICAL
Power Pole
round Conduit
Low Voltage Wirii
Fixtures
Main Service
Sub Panels
'Exterior Receptac
G.F.I.
Smoke Detectors
Temp. Use of Poi
Final
Utility Notice (Per
Mt•M
'ALS
'OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
Condensate Lines
Steel
Electric Bond .
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Gas Piping
Gas Test
Electric Final
Heater Final .
Plumbing Final
Equipment Enclosure
O.K. for Finish Plaster
Pool Cover
Final
COMMENTS:
POOLS. - SPAS
• P.O. BOX 1504
�. APPLICATION ONL
Building 78-495 CALLE TAMPICO
Address e11 1Ar-C LA QUINTA, CALIFORNIA 92253
Owner ' 520 AV • V k t 1A
Mailing Q BUI
Address �) . 370 PV- QEQMWA � A•P
City Zip �.c(zZITel.
III - ILI O Leg
Zip
State Lic. City
& Classif. 2 q ,,.' Z Lic. #
Arch., Engr., `
Designer (o
Address .51,3-70 Tel.
CityC� Zip State
1 � 9 ell 'Z ; 3 Lic. # Gu/"
LICENSED CONTRACTOR'S DECLARATION
1 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
k 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 ($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 (hereon 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.)
II
I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the proiecI. (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.)
1'71 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
i'1 Copy is filed with the city. 0 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 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: IL 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 a0plicant Date
Mailing Address
City, State, Zip
LDING: TYPE•CONST. OCC. GRP.
. Number ? 7 3 - 14 U. OUZ.
Project Description
Sq. Ft. No. + No. Dw.
Size Stories Units
New% Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep. O) (� ci
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I. _
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
•�i
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setbacl!)r bl-r operty Line
FINAL DATE
Issued by:—
Validated by
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING
2
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 4/12/01 APN# 773-144-002
No. 21883 Jurisdiction La Ouinta
Owner NameCharles Robbin CO .
No. 51-520 Street Avenida Villa
city La Quinta Zip 92253
Perm* #
Log e
Study Area
Tract # Lot # Square Footage 1421
Type of Development Single Family Residence Nc. of Units 1
Comments
At the 'present time, the Desert Sands Unified School District does not collect fees on garagis/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 folbwing reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
2.05 X 1,421 or $ 2,913.05 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
Fees Paid By CC Canyon Bank - Larry Telephone 7Et0-399-1200
Name on the check
By Dr. Doris Wilson r,
Superintendent
Fee collected /exempted by Arlene Garcia Payment Received $2,939.20 tt
Check No. 06377
Signature
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notity you that the 90 -day approval period in which you may protest the bes or other payment identified I
above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy -Accounting
t - .
QOI�RT STEM"'
RECORDING wouestED gy.
Af+iD WHEN RBCOApED. KVL TO:
THE CHARLES ROBIN COMPANY
38951 KILIMANJARO DR.
PAL11 DESERT, CA 92211
FAX NO. Feb. 06 2001 07:141`1`1 1-'i
ASSESSOR -S pAACEL NQ.: 773-144-0016,002
TITLE OADER No.: 503154 -13
6SCAOWNO,; 19777-004 —
GRANT DEED
Lk�cc;rf-- 3 z: S1- 52a
Trus SPACE r.C+ a•s use Ony
The undersigned Grantors) declare$that the 1?pCUAAENT T
TAX IS: ( RANSFEq
s 2 County $ _
xX_ computed on the full value of the interest Of roe City
computed On the full value Less the value of liens encumnees
remaining thereon at the time Of salla
-- Op transfer Is EXEMPT from tax fpr the following r.!,.
FOR A VALUABLE CONSIDERATION, receipt Ot which is hereby acknowledged,
WILLIAM TRIBBLE, A WIDOWER {WHO ACQUIRED TITLE AS WILLIAM TRIBBLE
AN UNMARRIED MAN
hereby GRANTS) to
THE CHARLES ROBIN COMPANY, A CALIFORNIA GENERAL, pAR21BRS�p
all that real property situated In the City of LA QViNTA
County Of Riverside , State Of California desc 0:
LOT 23; LOT 24 OF BLOCK 111 IN SANTA CARMELITA AT
BOOK 18, PAGES 79 AND 80 OF MAPS, RECORDS OF #VVIR 'J;k QUINTA, UNIT 240 (S) 12 AS pgR
Dated_- June 12, 2000
STATE,bga.:. }
Suzett;4 y �.
NOUry Public. personally a4pe
AG
whose
ink t(<Ck;
d same to � � ' '
.M by his/h�t/ingtr sig
t lfRl! ti}. ar the entity upon
executed the instru
`--.�is
!/
LIAM TRIBBLE
311%r .:!' A',AR1E ATYIM
`°w .' Co:rrss:7n s ! tA5lS3 i
W. Y ru�., - C -Ci ferule
�..�,....-:C-c1Z7OD
MAILTAX STATEMENt$T0- frhiswea9moftroo.rou.-f a"
SANTE AS ABOVE 0'
-
cm, sa�r� a 2w
RC DISTRICT - PLANNING REVIEW FORD[
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. RECVD FOR PROCESSING �z � o 1
(DATE)
APPLICANT Rogers
ASSIGNED M
SITE ADDRESS TIALS)
51-,520• Avenida Villa
APN 773 _ 144 _ 002-BINNO.: CASE NO.:- 2001--437 ,
-LEGAL: LOT 23 BLOCK l ill UNIT 1l2 S.C.@V.L.Q.
CHECKED BY: Wally Nesbit 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
C141WL-F5 1D1?1'1V Gam,
Consistent with MDG on file -(as.applicable
MDG filing required (5 filings since 9/,3/98)
Consistency with street/surrounding area:
Colors .
6
1 �
Materials
Architecture
t
•
w u s r,? -0
LX
-
Other Requirements: ,
Approved bv: no. ;
O Planning Commission,.
O. City Council
ItMommunitv Dev. Dept.
Case No.
Exhibit
With Conditions 04
I�
0
Certificate*
City Quintaof La
Bui/ding'and Safety Department '0
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: 51-520 AVENIDA VILLA
Use Classification: • SFD Bldg. Permit No.: 0104-102
Occupancy Group: R3 Type of. Construction: VN Land Use Zone: "RC
Owner of Building: CHARLES ROBIN CO Address: 51-370 AVENIDA BERMUDAS
7 o
City: LA QUINTA, .CA 92253
By: STEVE TRAXEL
Date: 07-18-01
POST IN A CONSPICUOUS PLACE y
I.