0004-077 (SFD)LICENSED CONTRACTOR DECLARATION
I.hereby>affirm,wncler penalty of perjury that I am licensed under provisions of
H; Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
�� : �:- Professionals Code, and my License is in full force and effect.
ow License # Lic. Class Exp. Date
(� ln," _
o Z
/Date— Signature of Contractor A IZ 115Z^'"
CD
J U
c:, OWNER -BUILDER DECLARATION
WW I hereby affirm under penalty of perjury that I am exempt from the Coktractor's
License Law for the following reason:
Z ( ) 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). j
( ) I, as owner of the property, am exclusively contracting with`�licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
C0 () I am exempt under Section , B&P.C. for this reason
O N Date Signature of Owner
rn
WORKER'S COMPENSATION DECLARATION
C:) 2 Cr I hereby affirm under penalty of perjury one of the following declarations:
F- 0 () 1 have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
O _ Q performance of the work for which this permit is issued.
m Q C) ( ) I have and will maintain workers' compensation insurance, as required by
O � Q Section 3700 of the Labor Code, for the performance of the work for which this
Ii rn F— permit is issued. My workers' compensation insurance carrier & policy no. are:
? Z Carrier Policy No.
w5)
C) 1
J
(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; 6f•.Section 3700 of the Labor
Vbode, I shall forthwith comply with those provisions.
Date: '52 r_�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 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
th/bove-mentioned property for inspection;purposes.
Signature (Owner/Agent) Date
- ° BUILDING PERMIT PERMIT#
DATE VALUATION LOT OMI -077 TRACT .
szt�at,3c�.l�u 2 :l�I�6t1�'3
JOB SITE
ADDRESS s1-7" .AVEMI>A HFRPFT:A
APN
773-R?2<d/0
OWNER
CONTRACTOR/DESIGNER/EN INEER
WALLY S. MaM
ow1•TEFtfI ummz
PO 33035 604
LA t<LWIA CA 922522
i } CB19
USE OF PERMIT
M (AY FAMMY DWE3 WO
P3
SFD , PP.RMI T DOES NOT INCLUDE BLOCK WALL OR POOL
TRACT CONSTRUCTION 11526.00 31;
PORCWPATIO- t 439.00 9F
'
CtARAOIFJOARPORT $46.00 S1'
5 I1'i': WOOD PENCE 00.00 LF
F .'M AUED COST OF CONFIRi7U.00N
10)"Wao
PMWV FfM 9UMMA:RY
C014S`1'RUCTION _",E 103.000.418.000 5646.50
PLAN CHECK FEE 101-000-430-318 $539,35
MEC A"HICAL FEE 101.000.4421-000 $60,00
1-LF.,CTRICAL ;VEL? 101.000-420•-000 $133m
I
PL.UMBTN5# FEE 101.000.419.000 $116.7-
. 110 MOTION "%- R SID 101--000-24-1-000, $10.14,
ORADING 1& 101.000.423.000 $20.00
DLYELCIPER IMPACT FBI: $1,907.00
PRECIS E PWN 101.000.441.345 E100.00
ART IN PUBLIC PLACES - RF SIL 701-000-255-000 $3.43
FEE DEPOSIT 101-000.439.318 52s-0,00
SUB-41OTAL C0NSTRUTC'1'1OAi AND PLAN CMMIC
$3,537.53
LT M_ -PAM FSM
•$250.00
70'1'4%. PT'nIM. MkS DUE .N0W
$3;2,57,&3
1
1
RECEIPT
DATE
,�Y%�
DATE FINALED
INSPECTOR
e
5
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
7.,Z 7. O
Exhaust Fans
O.K. to .Wrap
/���� :57
F.A.U.
Framing
s�3p 6 '57
Compressor
Insulation
=oZ -- O t
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
Drywall - Int. Lath
"Q'(
Final
Final D T
BLOCKWALL APPROVALS
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
Water Piping
_ _/J
i S /
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
o -C —S:7
Encapsulation
Gas Piping
Gas Test
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) •—O 1 !9
COMMENTS:
Building
Address
Owner
S► -7$5 AJE AmeoLA P.O. BOX 1504 A PLICATION ONLY
78-495 CALLE TAMPICO
L" R G LA QUINTA, CALIFORNIA 92253
L
Mailing P /'
Address v a p
City, I Zip
el.
G A
e� r,
-
1 9 2 Z. s3,
�
Contractor
Sq. Ft. /
Size
%
No. Dw.
Units I
Newt-- Add ❑
Alter ❑
Repair ❑ Demolition ❑
Address
r CO
f "
City
Zip9Z�
Tel.
State Lic.
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
City
& Classif.
Estimated Valuation
Lic. #
Arch., Engr.,
PERMIT
jZ�w
Designer
Plan Chk. Dep.
Address
Tel.
City IZip I State I
Lic. If
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Cha t�r 9 (commencing with Section
70X0) of Divisi 3 of the au�mess and ProfessionAs Cdr nd my license is in full force and
effect. ��l�l%..i,�+li7
SIGNATU� C�0y �� 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, 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).
1: 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, 8uisness 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. It, 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 t I, as owner of the properly, 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.)
tl 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
CI 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 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 sof 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- 17 aC - co/c
at Description Let GO
ject Description . 5 •
15Aw
g 45
52-t;2.5- eAt4+ lm,
Sq. Ft. /
Size
No. f
Stories I
No. Dw.
Units I
Newt-- Add ❑
Alter ❑
Repair ❑ Demolition ❑
TOTAL
REMARKS
f "
c r
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
Estimated Valuation
PERMIT
jZ�w
AMOUNT
�..
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
f "
c r
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 5/3/00
No. 20386 Jurisdiction
Owner NameWally S. Miles
No. 51-785 Street Avenida Herrera
City La Quinta zip 92253
APN # 773-171-005
La Quinta
Permit #0004-077
Log #
Study Area
Tract # BLK155U16 Lot # 6 Square Footage 1526
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 1,526 or $ 3,128.30 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/Inland Community Bank/Wally S. Miles
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by
Signature
Name on the check
Mary Ann L. Boda
d /1
Payment Received
Telep4one'
$3,128.30 -
Check No. 023643
NOTICE: Pursuant of Assemblg'91ti 3091 (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 permitfor this project is sssued or on which they are paid to the District(s) or to another public entity authorised to
collect them on the Oistrict('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.
WHEN RECORDED MAIL TO
AND MAIL TAX STATEN04TS TO
NAME Richard G. Crockett
ADDRESS P.O. Box 1440
CITY La Quinta, CA 92253
STATE & ZIP
GRANT.DEED
. I Am Na 773-172-0144
THE UNDERSIGNED GRANTOR(s) DECLARE(s)
DOCUMENTARY TRANSFER TAX is i CITY TAX S
cmVutedonfkAva%eofpvpeqcmveyeeLor computed on fifi value less value of iers or encifr&anoes rerrwMk at tined sale,
Unincorporated area: City of LA QUINTA, and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
WALLACE S. MILES, AN UNMARRIED MAN
hereby GRANT(s) to
WALLACE S. MILES, AN UNMARRIED MAN AS TO 1/2 INTEREST AND RICHARD G. CROCKETT, AN UNMARRIED
MAN AS TO 1/2 INTEREST AS TENANTS IN COMMON
the following described real properly in the County of Riverside
Stale of California:
Lot 2, Block 60 of Santa Carmelita at Vale La Quinta Unit No. 5, Tract, County of Riversied State of
Califomia, As per map recorded in book 18, Page 63 of Miscellaneous maps, in the office of the
county recorder of said county 773-172-014-4
Dated
STATE OF CALIFOMM
COUNTY OF /</ Y2/'S / Gee } S.S.
On Af 1'1 .21 'Et o2 oo D before me, 640
(here InseWnwne and We of the otticw), personally appeared a // a o
WALLACE S. MILES
personally larown to me (or proved to me on the bass of satisfactory evidence) to be the wtwse names) subscribed to the vi thin instrument
and acknowkoged to me that hefslfl�ltpi a ec tAed the same in hisljre *dr aWwomeed capacit w4,, and that by ftW7pW sigmWreo on the instrument
the pmorgpf, or the entity upon behalf of which the prior adK emarbed the irdmawt
WITNESS my hand and official seal.
Signature
...._
r 'dC323k6 ;Z� MICHELLE RAMOS t
QomtfsiM # 12463 l
NOW Pubfk • Cd to Tdo
Ri w*b courrhf
M►oomm.6�eaosic2a�OD
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, in order to determine the applicability of f 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.
APPLICANT WALLY MILES
SITE ADDRESS 51-785 Avenida Herrera
APN 773 - 172- 014 BINNO.: CASE NO.: 2000-207
LEGAL: LOT 2 BLOCK 60 UNIT 5 S.C.@V.L.Q.
CHECKED BY: Stan Sawa 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
Consistent with MDG on file (as applicable
MDG filing required (5 filings since 9/3/98)
Consistency with street/surrounding area:
Colors
Materials
Architecture
�.
Other Requirements:
U -e'
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: 51-785 AVENIDA HERRERA
Use Classification: SFD Bldg. Permit No.: 0004-077
Occupancy Group:' R 3 Type of Construction: VN Land Use Zone: - RC
Owner of Building: WALLY S. MILES
Building Official
Address:
P.O. BOX 604
City:
LA QUINTA, CA 92253
By:
STEVE TRAXEL
Date:
08-28-01
POST IN A CONSPICUOUS PLACE
CITY OF LA O111.1IQt4 SUR-COt4TRACTOR LIST
JOB ADDRESS- PERMIT PERMIT NUMBER OWNER- BUILDER
This form shall be posted on the job with the Building Insoection•Car at all times in a conspicuous n ce. O rsons appearing on this list or their employees are authorized to work
p
on this job. Any changes to this list must be approved by the Building Division prior to commencement of w6,nc. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
Trade' / Classification Contractor State Coinractor's Ucensa Woikers Coin ensafton lrsurence.': F, Cit Business License
Company Name Classification License Number Exp. Date Carrier Name Policy Number Exp. Date License Number Exp. Date
(e.g. A, B. C-81 (xxxxxxl (xxlxxlxxl (e.g. State Fund, CalCompl (Format Varies) Ixxlxx/xxl lxxxx) (xxlxx/xxl
tJ1RTHWORK IC=121 I I U.A2� r— r C-/7 -7/ Z., /k.tn.GU -7 o- 0 V •An A*'?.'7 I -V -cin
CONCRETE(C-B)O
A o1U�S U cT
8
7
3-31-2co1
CL-Aecaooa NAT -1.. ►NITS
o2KR�0985
2-9-00
5964
12-14-00
FRAMING W-6)
iUC
• 6
G
S3
3 as
Mi NRY (C-291
PLUMBING IC -36)
/� D �4, c /i3
733 %S'
!3/zap
e Nmv
,!' o $"
212AX
LATH; PLASTER (c•351
7
3/ at
c/
so
96
/.2 •/ • - b
DRYWALL (C-8)
ee A�T
73 3'757
311 Z,b
Cl .4% 5
ddk ovoe
�G
12 4 Lid
WA4.� 1C-201
► C O
' z0
S2 z - S
1.31.00
G 1 N EM T
/ ' 2 �o
G /S-�
p
ELECTRICAL IC -101
A wlm a
40 L 2551
1-31
1-18--o
"OFING.IC-391
D4& pffr Koo F/ •
C• '
'73 2S'
2.280/
VA T� f;4AJ
004 206'7,5-.39-
I - -&d
5'9
:$HEFT METAL IC43)
FLOORING ICA 51
.S - 6 AJ C A Q T
C ./,5-
6800 2
! / -30 ri
S r.9
7 -/ - o
o
Jv • I -
BLAZING' 1C 17r - : ..
d suu roH tC-21
14
- 2
LL32 072-
- 'u e/
LiprM
TcZ a 12 Z 00 2S
3o•ov
032 /
z,5' u
410,fXL5C&w—"
733,5-7
3-31..►or
t►ifTtNo.1c
C A
C -33
32,33o62-29-01
52rZ F
O l
/b -/-6d
> ,l.s
CERAMIC TILE.IC-541
a /,yam D
CABINETS IC'M
f jip Q
.ANDSCAPM IC -271:;•
Al Coe 4EW
C '/3 127ya 9.0— 1-3-3/
`1
cee
4-0a X-3 X/-/2-00
>b