9907-061 (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
634981
Signature of Contra"
OWNER -BUILDER DECLAkiA11)ON
I hereby affirm. under penalty of perjurythat 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 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.
r `� e-�7".'e�Y H q f G'. ..t1 f ♦tWYM. ,� �yy •
L!e.(�a./'):iF.4 IL\J1F3,4,+.�:i f.d Y.i. �!'8 Yl`�.�'a 4141'Ii�f��i✓:.,
(This,section need not be completed if the,permit valuationis 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 l should become
subject to the workers' compel do provisions"of Section'3700 of�the'Labor
Cod , I shall for 'th comply t ,thos rovisions—...^-�--
�Dat��•_. f 1 Applicant
Warning: Failure to secure Workers' Comp ns5i6n 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 l 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 prope, y_fpr inspe tion purposes.,'
Signature 4(0wger--gent);f.•.f ✓ Date
BUILDING PERMIT PERMIT#
DATE (W V199 VALUATION $ LOT 9 TRACT .y
JOB
4Q! RESS 5),..700 E�VEIN�I�M ��4�LRER
PN ��,�-��t1S'YA.0
OWNER
CONTRACTOR / DESIGNER / ENGINEER.
e t
y,,: -c. ��a►ax�trha11u. PIR.rcr,t;,.>�
CORiiu7ICON��",i.x y.VN,
51-.370AVVN1r.).1'i13111kMDA$
.EISENHOWER E)R_
L A.4?LF(N'f.IV C;_A, W!253
LA Q(_i!N`2'A CA 97253
(760564A604 C 'M .#r 2263
USE OF PERMIT
a.3ivCrl..E I'A,CV1.10° 1LAWik'i.d.,1N4r
my wFt..Nuz Aitom WAIL op. i.r(`'L&
Y'+n r.rw .e n.. rrw�•
eActLVu rri"a .4,3SLAn r•
'S.it.�kt..t 'LVAV:9.t 8 .t�J '141'Wit'
['r?ftt`E�UiE'�►'i'i:Ci 3.1.l.04'i :il� .
tot'�i♦�tae,;i�`„„'t'�,4�ts3Z't'" �1kif).tifid :3f�
5 VT. WOCA) FENCE 2(00 LF
PE"AXJ.Fl1ri.'ii. FE, 4?. 03 TJ A07I.'lAR.Y
i`.t,IN?:37`.tC4,1(,'VIOIvl.i?d^;
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2Y.1.4:.1-. .x%�`tiL �.tY.R. i'>�1]LAl.i'�t�"'f.a�.1'tiU�� .D�«-•.YV'
.
'!'lZoi'r4l�$�Lf 101 -0W -420 -+-:►CLQ 5126.63
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s
r:it iPd4i iltt"r'i"3C)fi) F jrt� >$ErR3i") !>%4-dKH1.�,�¢'I-i.K13,�:1
t .
.125.600,iW1..?,,j.A $9,876.0
`PJkK 8..E PLAN l E�1 f?�3i➢ lt�,t8-�i�? �fi �'st�
- . y
Ci t f '6) !?(St t°i` � 0l • i?Q4)-. L➢ i, 4456),fin
;vi,. IM,y r AL (X1NYM ''7'i0N A NI PY,,A��.1qq�, CHECK
't;3-112 csfl
L SS
.. fJWS AL R' E.EYlY AT Jk?V3;.fe�` f..77C?.'Ng-➢'v>I
RECEIPT
DATE
BY ��
.r
DA�E I A E „ �,
L/(YI'%VI1.
INSPECTOR
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
d • Z(o
Exhaust Fans
O.K. to Wrap
�/�
F.A.U.
Framing
% q r ,
Compressor
Insulation
(.1 - Zz - Q 7
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
/ - Z -
Drywall - Int. Lath
/- LQ - Q .57
Final
Final
POOLS - SPAS
BLOCKWALL
_
APP OVALS
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
y Qdv
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) 4
ELECTRICAL A ROVALS
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)((r
i
P.O. BOX 1504Buildin
78-495 CALLE TAMPICO APPLICA O Y
Address V %"7dc /4(1l LA QUINTA, CALIFORNIA 92253
Owner
Mailing `
Address
City Zip 5,;—
Tel.
4A i�/ rot el4�1� J+ IS -
Contractor
IV . a . �u GFir�
Address -
�'L
City Zip
Tel.
7WACA 101
9 t?,?- izo
State Lic.
City
& Classif.
Lic. #
Arch., Engr.,
Designer
Address
Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 a licensed under provisions of Chapter 9 (commencing with Section
effect.
of Division 3 0 J e'Buslne ,s and Professions Code, and mx license is in full force and
effect. l��g�
SIGNATURE 7 DATE
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, atter, 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'] 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.)
II
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.)
1-1 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
n Copy is filed with the city. O 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: 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 aQplicant Date
Mailing Address
City, State, Zip
ILDING: TYPE'CONST. OCC. GRP. ~
r. Number
tai Description 5-1
eject Description Z67'
Sq. Ft. No. No. Dw.
Size Stories % Units
New Add ❑ Alter ❑ Repair ❑ Demolition ❑
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL bA
REMARKS
JUN2;9
ZONE: l Ty
Minimum Setback Distances:
Front Setback from Center Ljne'N7',
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 8/12/99
No. 19170
Owner NameLa Quinta Partners
APN # 773-133-010
Jurisdiction La Quinta
No, 51-700 Street Avenida Herrera
City La Quinta zip 92253
Tract # BLK 52 U17 Lot # 15
Type of Development Single Family Residence
Comments
Permit #
Log #
Study Area
Square Footage 1,358
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
1.93 X 1,358 or $ 2,620.94 the property listed above and that tuilding z
permits and/or Certificates of Occupancy for this square footage in this proposed project may.how be ivssued
Fees Paid By ccNIB/Thomas Buffin Tele fihohc
Name on the check
µ
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Payment Received $2,620.94
/l Check No. 195290
Signature
NOTICE: Pursuant of A#bmbly 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 f m 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
JUN.23.1999 3:57PM COMMONWEALTH
ANCORD2W R8p036TBD BY2
BENEFIT LAND TITLE COMPACOMPANY
99.864exi 5992314-40
WAM PiCOADIM MAS& TRt8 REED ANO,
mman8 Onmlxf8E AM= BELOW,
K%ZL TAX aTAT010=8 TOc
WILLIAM THOMAS DUPPIN
P.O. BOX 134
LA QUINTA, CA 92253
NO. 638 P.4/6
GRAM D= APYi 773 -133 -010 -9/773 -ft -
The undersigned grantor(s) dsclare(e);
Documentary transfer tax is $27.6o
(XZK) Computed on full value of profarty conveyed, or
( } Computed on full value lees 1ens and encumbrances remaining at time of sale.
{ ) Unincorporated area: ( ) City of , and
POR A VALUMLR COATSIDERATION, receipt of which is hereby acknowledged,
NO= DBVSLOPMUT, INC „ A CALIFORNIA CORPORATION
hereby GRANT(S) to
WXLLIAM THOMAS RUFFIN, AN U0=22D MAW DBA LA QVINTA BARTNSRS
the real property in the City of LAQUIWTA, County of Riverside, State of California,
described as&
�y Lot 1S of Block 52, Unit No. 5, Tract Santa CarMelita at Yale La Quinta, as per map
recorded in Book 18. Page(s) 63 inclusive of maps, in the office of the County Recorder
of said County.
and Lot 4, Block 171, Unit 17, Santa Carmelita at'Vale La Quint&, as par
map recorded in Book 19, page 18.20 o= maps, records of Abvereide Comty,
Datadasefte 93, tipp
State of California
County of } 9.8.
on
before me,
personally appeared
psraonally known to me (or proved to me on
the banjo of e0�tiafactoxy evidence) to be
the person(s) whose name(a) is/are subscribed
to the within instrument and acknowledged to
me that he/she/they executed the same in
his/her/their authorized capacity(ies), and
that by hie/her/their signature(s) on the
instrument the person(e), or the entity upon
behalf of which the persons) acted, executed
the instrument.
WITNESS my hand and official goal.
Signature
!Sats+ TAX STATMMTS TO i
t A 60££*0N
WORLD DMLOpM$t0'T, INC,
A CALIFORNIA CORPORATION
BY
Warne/Title
BY
Name/Title
(This area fpr official notarial seal)
,
SMOH d3MOd NVW L 6661 1Z, SAP
W I a 64 r fOft-
. coal��T+o►.�5 �Pj .
RC District - P/annina Review For"
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 correction list. Please attach additional explanations as necessary.
APPLICANT: W. R. Rogers
PROJECT
ADDRESS: 51-700 Avenida Herrera
APN: 773-133-01.0
LEGAL: LOT' 15 , BLOCK 52. , UNIT 5 , S.C. @ V.L.Q.
CK'D BY: Fred Baker
BIN NO:. CASE NO. 99-84 ..CHECK 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
:.;•t•:::::+'.::`f +cC:2rz t• ':. :\: ?:t`.:iC�C'"'..;C.{ \'*T\i;tici2.;, :...:: ••:.,45P.t XV..:' �.'.<•t:' ' \; ...\:M1 r ...,.: • �.. •:;...:�. v:.: \. .
`0.£:3:�w ����... •.\�'.'�;\ t; \10\?c.�n.�$.: `C3a ••:.•`C"vr,}:'':•;,:•:t•,�L`•� \,2, 'S �#y°•v+.: `:+'2<<v'`C:?"tC'"��� \�`'C\.e'�`a S
�f�'>�:\\ �k, '�£:'•>�.'o. \; .>,. \,',^ka a
ti i. .: n: i {�: ': '\: C�... j:�p�. j ,4�wihi'�':••k:::\\ n 2•:i �� :: \:. k:. Mn �' ::'•:;; �i, 'C •. it:.+E }: 4:n:
L��.���I�!F���\ �:..:.n\}}.:Y?ti?..v}:>.\iA\i:•:•: n. •..:ti :\.0,.?:.:'�i:G4\::.:C....k:�\.ilnQYC>.:vv.L.x.Ci:.\�:\�}k.:.:\\..h,`,T;..:\T.... .
Case logged and number assigned
Verify legal and APN information
Consistent with MDG on file las applicable)
N"y DqL PMENT D EPT
filing required.15+ filings since 9/3/98)
_
UATEiMDG
Cbhi iste'ricy with-street/surrounding area:.
Colors
Materials
Architecture
ASE. No.
d
OTHER REQUIREMENTS:
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.
June 24, 1998
Mr. Daniel Crawford - Inspector
City of La Quinta
Department of Building and Safety
78-495 Calle Tampico
La Quinta, California 92253
STRUCTURALENGJNEERING CONSULTANT
54625 AVENIDA BERMUDAS. LA QUINTA CALIFORNIA 92253
760 -WA- 84PHONE V 760.771.36D6FAX* WISH@CWIA.COM
Regarding: CVHC Plan 320 and 420 - Truss Calculations — Group 7 (Typical all La Quinta Projects)
Dear Daniel:
I have reviewed the truss calculations from Imperial Roof Truss which is to be used for the roof construction of the 3 bedroom and 4
bedroom homes in La Quinta. The truss calculations labeled "320 Plan" are for the 3 bedroom plan that is associated to the "96-051"
job number listed in the lower right corner of the architectural plans. The "420 Plan" truss calculations correspond to the "96-052" 4
bedroom drawings.
I have reviewed the truss -calculations to confirm the capacity of all design loads -drags and bottom -chord loaded -girder trusses. I have
found each to be in compliance with the intentions of the structural design. I have also verified that the roof dead loads used in the
design of the trusses exceed the design loads on the structural calculations. The truss calculations are more conservative and therefore
acceptable.
The Truss calculations will be used the self-help La Quinta Project - Groups 4, 5, 6, 7, 8 and 9. Each group will use the same plans as
those mentioned above that these truss calculations conform to. I have provided a separate letter referenced above for each group.
These are intended to simply the City's records and allow a separate approval for each block of homes. Coachella Valley Housing
Coalition can provide the addresses for each lot in each of the groups listed
Please contact we at your earliest convenience if you should have any questions or additional requirements.
Sincerel
De "s S. Wish PE
Structural Engineering Consultant
.... C�crvfL
`1°�hCl v Cts.
STRUCTURAL ENGINEERING FOR -CUSTOM HOMES • REMODEL - COMMERCIAL - LIGHT INDUSTRIAL -SEISMIC RETROFIT & REPAIR • UNREINFORCED MASONRY • RETAINING WALLS & FOUNDATION • REPORTS:
a
DAMAGE ASSESSMENT • NEW ROOF -INSURANCE CLAIM -DENNIS S. WISH P.E. HAS BEEN A MEMBER OF THE STRUCTURAL ENGINEERS ASSOCIATION OF SOUTHERN CALIFORNIA SINCE 1983
pity of lea 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:
51-700 AVENIDA HERRERA
SFD Bldg. Permit No.: 9907-061
R 3 Type of Construction: VN Land Use Zone: RC
Owner of Building: LA QUINTA PARTNERS Address: 51-370 AVENIDA BERMUDAS
City: LA QUINTA,CA 92253
By: STEVE TRAXEL
Building Official
Date: JANUARY 14, 2000
POST IN A CONSPICUOUS PLACE
Y