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0001-037 (SFD)69 LICENSED CONTRACTOR DECLARATION �f I hereby„affirm under penalty of perjury that I am licensed under provisions of Ch'ajftr b -(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 J '', . "1 .6 \-I— 01/31f "0f 2-6 c ,[,Datet Signature of Contractor' OWNER -BUILDER DECLARATI • N 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&RC. 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 and will maintain a certificate of consent to self -insure for workers' compensation, I as provided for by Section 3700 of the Labor Code, for the performancelof the wor0or'which this permit is issued. ( g 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: Cartier ry ` "ADPolicy No. 13 T 1 14130990-991 (This section need not be compl'e'ted 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 iri any manner so as to become subject to'the workefs' compensation laws of, California, and agree that if I should become subject to the workers' compensation provisions of Section 3700Zof the Labor Code, I shal� farthwith comply with those prl vlsi ”-- ,Pate: ? �` 11U Applicant ' C,�,"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. 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 correcV/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, inspectpurposes. _ ,� Signature (Owner/Agent) \ Dated_ BUILDING PERMIT PERMIT# t9i90i-1937 DATE'VALUATION r��;�r� () LOT TRACT ,r1 a� ADDRESS -JOB SITE " ►.1-645 A.Ar 1I1lA i�i✓.iQ➢t3Uii11A APN - OWNER CONTRACTOR / DESIGNER / ENGINEERS DAV.11) ROSS t"'ll x'k PAC11FIC "ARADI S f„ ONSTRUCIMN a OCEANSIDE CA. 42054 i 7o)967o"(A C431/ft 1955 USE OF PERMIT t Site: i;. RA.I�iILI .t�vdLi.iNu SM - ,931w MI T D065 NOT 1NC,'i.UDE DJ tick WALL OR :! OOL (3 1 T1ZACT C0N31l:.tXM, %331 1,42;.00 SF 1'ORCHN'AT10 3t5.(fti SF , GAtRA.(.i'E/l:;ARFOR T f 510k S • ' 5 F -r. WOOD T.TXCE N040 Lig it i v STi A IED COX, 01' I% . PERNUT FEE S-UN7rIvIARY. C0N9rRIJ0'10N M' 101-000-418-000 P!I, Nt 0-W— CI{ .M; S5 12 ;4 r. I r"I: KANI, C ./1I 1 ..01 < 1 ' 1.c Y •000 Mll Olt; 1~f, CTRICAL F a.1f1i:'OGO�gill-t}C.�� i!'G`l.Ad I''1.tyfA!tlitAlc3FbT If) x(30-4.19d3t}(i $110.75 RINCYNG'�,�►1-1TION rr.,. _ a:„i ? ?()1-littf} Z4.4-I?tJp $ ", G1LA,,L)T.NO17E�r tO1• (irX23-0t3sa $X00 D111:'1ff PE:livif?ACTFL,R PRIXNS-E PLAN 101-000--441-345 S1f�i.wkt t:,<Ry; t �s~'► r34!•T 10140t11}43c!_31? .SGSfr !tf# SUM :Ja'M, CONi�. RL1C'1'if`fY :5.NDT'MAN �[''�1):C`K L:L' SS TPRE, 't: AID F'.£1 S FU ,�250.W, `i'CB'1'A1; DU NO 53. Q."1+✓1 RECEIPT DATE BY ? DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings i Ducts Slab -Grade Return Air Steel Combustion Air Roof Deck a_�—�� 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 AP OVALS 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 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection S7 Encapsulation Gas Piping Gas Test •'17 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) �j COMMENTS: Q00 Building° r d L-- •, y T4tyl 4uucv '4 P.O. BOX 1504 APPLI 1 LY 78-495 CALLE TAMPICO / (� D} A QUINTA, CALIFORNIA 92253 S06 '. \\ Mailing Address City Zip Tel. ( CQAtv->ii uC gzIM ' V"(NC71.F\ Address Sp Zip State Lic. City & Classif- �tt'i y5g ` t Lic. q 1Q Arch., Engr., Designer Address Tel. City IZip I State I Lic. q LICENSED CONTRACTOR'S DECLARATION I hereby a term ih I am tcensed under provisions of hapter 9 (commencing with Section D00) of Divs1Qn� the �usi a s�� r` >;'sions Cod and my license is in full force and ffect. } OWNER -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 or sale.) I 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 contractor(s) licensed pursuant to the Contractor's License Law.) 17 1 am exempt under Sec. B. 8 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 1`7 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 ($100) valuation or less.) I certify that in the performance, ormance, of t 1 workforwhich,this perrpit is issued, I shall not employ any person in any me net sb as to become subject't9 the W rkers' Compensation Laws of California. Date NOTICE TO APPLICANT: If, atter ma ng this Certificate o! 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 sof this city to enter the above. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip LDING: TYPE'CONST. OCC. GRP. Number 1 3 ' -3 a r+ al Description �� lio ject Description 5. T r Sq. Ft. 1 Size r New ❑ No. No. Dw. Stories Units Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. 2 Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure AN 0 263,0 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 Notice: Document Cannot Be Duplicated Date 1/28/00 No. 19975 Owner NameDavid Ross Miller No. 51-645 City La Quinta Tract # Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE Street Avenida Herrera Lot # APN # 773-132-018 Jurisdiction La Quinta Permit # 0001-037 Log # Zip 92253 Study Area Square Footage 1421 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: This certifies that school facility fees imposed pursuant to in the amount of X 1,421 or $ 0.00 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 B CC/Ca ital Bank Of North Count /David Miller Name on the check By Dr. Doris Wilson - Superintendent Fee collected /exempted by Mary Ann L. Bona Payment Received V',742.53, , Check No. 16633 Signature NOTICE: 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 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 DEC.21.1999 11:56AM _COMMONWEALTH RZOORDIWO ARQU39TO 8Xl • CHICAGO TITLE COMPANY COMPANY 99,9463KC 99057866 oov)-oa9 NO. 799 P.3/3 WHEN ARCOSW= XhIL VXZS TIRED AIM, G' MM88 "OTHRAOPISS =OWN DI&ON1 M41L TAX STATEN TOc DAVID ROSS MILLER 1719 S. TREMONT S. OCEANSIDE, CA 92054 e8RAC9 ABOVE THIS &INS POR RRCObtDgrg USE GRANT DEI � ApIVe 993•132-028.4 - 5t- 695 The undersigned grantor(a) declare(9), Documentary transfer tax is $17.05 (XXX) Computed on full value of property conveyed, or ( ) Computed on full value less liens and encumbrances remaining at time of @ale. ( ) Unincorporated area; ( ) City Of and ?OR A VALUABLE GONSIDERA'TION, receipt of which is hereby acknowledged, HORACR M. WHITE and RVEI,YN M, WHITE, AS TRUSTORS AND TRUSTEES OP THR WHITE FAMILY TRUST DATED MARCH 9, 1990 AND AMENDED NOVEMBER 9, 1998 hereby GRANT(S) to DAVID ROSS MIT42R, A MARRIED MAN AS HIS SOLE AND SEPARATE PROPERTY the real property in the City Of Lk OUTNTA, County of Riverside, State of California, described aa: LOT 6, BLOCK 33, UNIT140. 5, SANTA CARMLLITA AT VALE LA QUIYTA, AS PER MAP RECORDED IN BOOK 18, PAGE 63 OP MAPS, RECORDS OP RIVER8I08 COMI'T'Y, CALIFORNIA , Dated December E0, 1999 State of California County of } S.S. On before me, personally appeared personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose same(®) Ware subscribed to the within instrumoint and acknowledged to me that he/eche/they executed the same in hie/her/thair authorized capacity(ies), and that by his/her/their oignAture(s) on the instrument. the person(a), or the entity upon behalf of wh4ch the person(s) acted, executed the instrument. WITNESS my hand and pffi.cial goal, Signature Xh= TAX STATEMENTS TOa y/I 'd 11931IqN MORACS M. NHITE, TRUSTEE EVSLYN R. WHITE, TRUSTEE (This area for Official notarial seal) 9 �h�,iCN� �Jf�ud WdbU• i � `t6h � l�� "1� far - RC District rlann' na► •Review grin 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 Building & Safety as your correctiori list. "Please attach additional explanations as necessary. APPLICANT: PACIFIC TRADES $,�. PROJECT ADDRESS: 51-645 Avenida Herrera APN: 773-132-018 LEGAL: LOT' f; BLOCK 53: , UNIT S - , S. C. @ V.L.Q. C•K'D BY: Greg Trousdell BIN NO:. ��. CASE NO. 2000-177 ..CHECK -DATE: Inform -the assigned Building plan checker upoh..your.assignment to this case. The CDD Executive Secretary maintains a log book to track applications and assign case numbers. E__ REOUIRED ITEM Y . N COMMENT/CORRECTION ;Y:ai: v: a•`i!%!! `. � ♦ v \C •. •::r: !:'i:k:4�"`vY i:♦2},! �! � i ":t }!}::!.<!y!: •.. �;...\........� ;\,.'\!•tM`!`!.`:\^i!�:i:+�n:;'>tAti:!:t:':��.!},`t::•X?4:=?C't�!!y}C�::tZ\•n...'\\\, c::.:5:t•: a \Z :....::. .. ��'. �\��.'t: `. \,. n.. n.t., \�♦ :Za Case logged and number assigned Verify legal and APN information Consistent with MDG on file las applicable) MDG filing required 1l5+ filings since 9/3/98) Cbnsisteney •with-Witharea: Colors Materials . Architecture . vG0 P y �1 OTHER REOUIREMENTS:' The zoning code, architectural and landscaping manuals, and/or assigned inspector should be consulted where uncertainties arise. The completed checklist shall be maintained -in the Building '& Safety address *file. D CU rA • 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: Use Classification: Occupancy Group: SFD 51-645 AVENIDA HERRERA 'R 3 Type of Construction: VN Owner of Building: DAVID ROSS MILLER Building Official Bldg. Permit No.: 0001-037 Land Use Zone: RC Address: 1719 S. TREMONT City: S. OCEANSIDE, CA 92054 By: STEVE TRAXEL Date: 06-29-00 POST IN A CONSPICUOUS PLACE