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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I ari 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. CI {ss Exp. Date
5, 04�f ?la3i2t
Dater i Signature of Contractor • � f
OWNER -BUILDER DECLARATION rf`
I hereby affirm under 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).
( ) 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'S
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.
(V,, 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 STA,E,�.l�UN Policy No. 1415 5-01
(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 thowprovisiS.
Date: /eApplicant 'k4'4' 'f s^
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. t
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 b�ilding _.o
construction, and hereby authorize representatives of this City to enteq upon t
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) ,!rte Date .�� r p
BUILDING PERMIT ,PERMIT#
DATE VALUATION LOT 011.11-260 TRACT
$921M.20 24 RLK 52 S17155
JOB SITE
APN
ADDRESS
1-510 AV"M DA Hl+.k�RMA
773 -13:3 -MI
OWNER
CONTRACTOR / DESIGNER / EN INFER
VALLUM MIZAS
-0, TORUS CONSMUC71011
81 _90 .AV13152
81-900 AM- i E 52,030
33d .1Ci CA ±42201
NWO CA. 92201
(76O�Y1 rp-x648 CTSIX 101
USE OF PERMIT
'03NOL
dt�i3�11O�i;2MIT l.t'tlr.5 NOT Y�1F�pL��f+1}7l.(��1&�p�*EigI.�7C CAC �'A1,1;x, P1501., SPA OR
DRIVEWAY iya'Y4d'0.] �S d.C"!'�74t/.�•XCCIAJ�fy(�,L R YS-2
'11t�t�4.f�.+�pp.��/COpp�'igq13�'RUCTIOX 1,��3p.11�� ;DIY
P EZh..r71IPA IO 243.00 NC
G.R RAO&C. Pc'?F8,".T 9p
lr"!.'WOOD POMP; 200.00 L?
ES"tllillA TM coyr oF ct.7lYmuenort
9w.92.6.20
FERA0.71 VAX subim"Ry $I
CCR3iRUCTION 'EI"t 101.000.418-000 $G05 00
PLAN 0-1 UX FRE 161-000-.;+t351.11 & $311.34
MECHA3+t9C&L Y99 101.000.421.,000 50100
M,t:C' RICA1, P't�£? 1.03�t'tS�ta-�12G?-CiL'Q $129.44
101-000-419.000 $1.1.6.75
TP 1,0111 M1:37`ION VER ID 101 ••000-4'1-000
OKADIH >vt t f51-r�C319<4 3,000 $ 0. 0
f;7E'MOPER. MPACT P'E'E $3,�i0'7.Do
PREXIM119 SHUN 101.000-441.345 $100.03
war.. DEPOSIT 101-000-4-39-318 •�a�o-t�tl
f
,
3,7041 ```-P.fali FM3
-=450. 00
__'•� 1 - - IX3'rAL PE1e` T IMES DUE NOW
IN 3 0 2001
RECEIPT - a•
D&EU
ABY
DTE FI ICED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs/
Forms & Footings
Z 7_ %a.
(
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Roof Deck
f/�j_d� �i
Combustion Air
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
InsulationG
�l�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
ez—
Drywall - Int. Lath
Final
Final
= -�- _ Q 2� r� _ —
POOLS - SPAS
BLOC KWALL APA R OVALS
steel
Set Backs
Electric Bond
Footings
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
_
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
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 (Perm)
WJ
0k��
Building
Address
Owner
2, u0 sq�
&49w(v
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Mailing
Address r� j -�j ig a A V C. `j 2 -
City
, v O; 1) Zip 22 v 1
Contractor
Address
CityZip 1_2Zv Tel
_N\",
772 Z r X
State Ljc. ! v City
&Classif. v ! O Lic. #
Arch., Engr.,
Designer
Address Tel
Cit Zi State
yL �(• p Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I,. am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3.6f'th8 Busin ss and Pr6fessions Code, and my license is In full force and
OleGty
5IGNATURk
DATE
4aNN�ii•BUILDER DECLARATION
I hereby affirm that I a 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__1 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.)
I I 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
doesnot 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.)
i] I 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
f7 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 (S100) 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
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 it 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
APPLICATION ONLY
ILDING: TYPE'CONST. S l' R OCC. GRP.
'. Number 7 7.3 - /5 s +V r
lal Description
l to l z /; Uc S".z Sc. Gt,�fS-
roject Description
Sq. Ft. No.
Size /y�Z Stories
New$ Add ❑ Alter ❑
imated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure yy
11
�1
t
�I
TOTAL
REMARKS
No. Dw.
Units
Repair ❑
Demolition O
AMOUNT
Chi 11 ti.F
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
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 11/21/01
No. 22702
Owner NameMr. Bill Doran
No. 51-510 Street Avenida Herrera
APN# 773-133-001
Jurisdiction La Quinta
City La Quinta zip 92253
Tract # Lot # Square Footage
Type of Development Single Family:Residence
Comments
Permit #
Log #
Study Area
1492
No. of Units 1
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 1,492 or $ 3,058.60 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 CASH - Frank Orduno Telephone
Name on the check
By Dr. Doris Wilson
Superintendent r
Fee collected /exempted by Annette Barlow
Signature
Payment Received $3,058.60
Check No.
IOTICE: 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
ollect 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
Ix
RECORDING REQUESTED BY:
00ALITY TITLE COMPANY o r: ccc
p p c »
WHEN RECORDED MAIL TO:
C
WILLIAM E. DORAN, TRUSTEE
524 Via Almar lit 11 ,
Palos Verdes Estates, CA 90274 c
_SPACE ABOVE THIS LINE FOR RECORDER'S USE
GRANT DE ED
The undersigned Grantor(s) declare(s): Documentary transfer tax is $ 16.50
ASSESSOR'S -PARCEL No.: 773-133-001(X) computed on full value of property conveyed, or
TITLE R_
_ORDE'N_O.: 62210 -LP _( ) computed on the full value less leins or
ESCROW NO.: 2385-D encumbrances remaining at the time of sale
FOR�A;VALUABLE CONSIDERATION, receipt of which is hereby,acknowledged:
JOHN C. DODD" AN UNMARRIED MAN
;.,
j.hereby' GRANT(S) to WILLIAM E. DORAN and VERNA H. DORAN, TRUSTEES OF THE DORAN FAMILY
TRUST DATED SEPTEMBER 10, 1981.
The following real property in the City of La Quinta, Riverside County, State of
California:
described. as: LOT 24,, BLOCK 52, SANTA CARMELITA AT VALE LA QUINTA, UNIT NO. 5 , AS
SHOWN BY MAP ON FILE IN BOOR 18, PAGE 63, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA.
Date:. October 5, 1994 c 4,14
'JO H-C:yDODD-
STATE._OF CALIFORNIA )
` COUNTY OF Los Angele' )
on 10-7-94 before me, Pearl -E. Noble
personally
.appeared John C. Dodd---.-.-.
-pe (or proved to me on the basis
:.,;of•satisfactory evidence) to be the persons) whose
name(s)-is/aie subscribed to the within instrument
and acknowledged to me that he/she�they executed the
same'in his/he!r _`_'= authorized capacity(ies), and
that by his/ham signature(s) on the instrument
the persons) or the entity upon behalf of which•the
person(s) acted, executed the instrument.
Witness my 'hand and official seal.
Signature
qpmyPEARL E. NOBLE
COMM. f 9861'0
N_,Skc- orry PubCoffomioLOS ANGELES COUNTY
Comm. Exoes FEB 28,1997
Name.(typed or printed) (This area for official notarial seal)
;� MAIL TAX STATEMENTS TO: Lot 24, Blk. 52, Unit 5, La Quints, CA 92253
RC DISTRICT - PLANNING REVIEW FOR SEP -
CITY OF LAQUINTA _
This form is to be used by CDD staff for review of single family dwellin�jsPfl�fl
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 within -200 -feet of-tho-applicant;-an-d/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 Design Guideline, please
transmitted this information to the Building and Safety Department as part of your correction
list. Please attach additional explanations as necessary. jp4A-S Atc.b '?Ao
APPLICANT A.O. TORRES
SITE ADDRESS 51-510 Avenida Herrera.
APN 773 133 -001
LEGAL: LOT
II�1ia o]5
BLOCK
2001-549
CHECK AND APPROVED BY: Wally Nesbit
UNIT
DATE:
S.C.@V. L. Q.
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
Verify legal and APN. information
CK
Consistent with MDG on file las
applicable
MDG filing required (5 filings since
9/3/98)
Architectural variety within 200 feet of
the surrounding area:
Colors
Materials
ro
ed by: HiQ
Commissloa �,,...�,,,.,,,,�,
Architectural design features
Planning
City
ounce
Other Requirements:
1 -Corr
itials
munity Dev. DepL
r.......,.,.,w
Cse
h
Q.
E
chibit
O
With
GGndi• OnG
O4
s CITY,
IT ;,0F'LA QUINTA
BUILDING & SAFETY DEPARTMENT
of 777-7012 '
,- `-;'a .l.:IN_SPECTION REQUEST LINE
- 777-7153
I
Owner
WILLIAM DORAN
Contractor A.O. TORRES CONSTRUCTIO
Permit Number 0111-260
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 51-510 AVENIDA HERRERA
SFD/ PERMIT DOES NOT INCLUDE BLOCK
WALLS, POOL, SPA OR DRIVEWAY
APPROACH/MASTER YS -2
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB 1 _ 7
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRle- - ___
z, ROUGH PLUM91NG
ROUGH GAS GAS TEST - j
HEATING & VEN
FIREPLACE
ROOF -
BOND BEAM
I O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING — �• 7�L ,�f
INSULATION
PRE -ROOF
f`
I COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH l 12
POOL PRE PLASTER
POOL FENCE & GATE i
$EWER SEPTIC TANK 14 -
FINALS
ELECTRICAL -
PLUMBING
I FINAL GAS TEST - G%
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
G=
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
Certificate of Occupancy
City of La Quinta
Building and Safety Department
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 HERRERA
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3, U-1 Type of Construction: VN
Owner of Building: WILLIAM DORAN
Tom. #`-�7
Building
Official
Bldg. Permit No.: 0111-260
Land Use Zone: RC
Address: 81-900 AVE 52
City: INDIO, CA 92201
By: KIRK KIRKLAND
Date: MAY 16, 2002
POST IN A CONSPICUOUS PLACE