The URL can be used to link to this page

0002-428 (SFD)FE LICENSED CONTRACTOR DECLARATION c 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 Fmfessionals Code, and my License is in full force and effect. i "tic''anse * Lic. Class Exp.. Date Date 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: j ( ) I, as owner of the property, or my employees with wages as their1sole compensation, will do the work, and the structure is not intended or offereb for Sale (Sec. 7044, Business & Professionals Code). 71 ( ) 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 SectionB&P.0 for -t is reason D�aie 1-11 , , t ., 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. (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: 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. 1 Sigpature (Owner/Agent) 62Date � I i D �' O UBUILDING PERMIT PERMITk , 0002-42E3 DATE VALUATION LOT TRACT 595,27 �0 JOB SITE APN ADDRESS 52-=5 AVI.1'MA UKFJZFRA 7•1113-223-022 OWNER CONTRACTOR / DESIGNER / ENGINEER I R:CCHAM LOPF2, OVftM2 BU.ILDEi2 52-025 AVEIMAHERRM , 52-025 AVKIMAHIEKRRERA LAQURdTA CA 92253 LAQUINTA CA 92253 {' (760)775.7123 CB11 USE OF PERMIT MWGLL1r 1::AMfLY DVM C1 SYD IOLF 6' ,91.00IC t+NN.ALL - PERMIT DOES NOT INCLUDE POOL. ,t TRACT CONSTRUCTION 1,343,00 OF PORCH/PATIO 36.00 SF (3ARAGPJCARPORT 431.00 OF 6 FT. WALL 10.00 LF 5 P'i', WOOD F•EidCR 125.00 LF EIS TM G`US'C OF CONIVMU'MON 95,2730 PE'i AUT Y1W. 3171 ARY CONSTRUCTION FEE 101.000.415.000 $621.50 PLAN CHECK FEE 101-000-439-315 $518.76 MECHANICAL FEE 101.000.421.000 $33,30 ;:1=TRIC.A,L F'SE. 101-0011-420-000 $127M PLUMB DIG FEE 101.000.419.000 V 103 STRONG MOTION FEE •IMI) 101-000-241-000 $9.53 GR.ADFRO FEY, 101.000.423.000 $20.00 DEVELOPER IMPACT FE -9 $1,907.00 PRECISE PLAN 101-000-441-345 $100,00 ".9 DEPOSIT 101-000.439-318 •$xSO.C>0 SUB -TOTAL CORMTWICT.TTON fiND PL HCl;: $3,414.34 L,..RSS PRIs-£?1L'll'1EE9 -`,250,00 TOTAL T'_ET2A 1<YF-IFS DUE NOW 0,224-34 RECEIPT DATE BY % DATE FINALED INSPECTOR ` INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING Set Backs APPROVALS d MECHANICAL APPROVALS Underground Ducts Forms & Footings Ducts Slab Grade _ Return Air Steel Combustion Air Roof Deck BB rj Exhaust Fans O.K to Wrap 69<2 F.A.U. Framing Compressor Insulation . ga 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 oZ b� BLOCKWALL A PROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Water Piping �_ / �/ i Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection -Cv 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 O l Utility Notice (Perm) L., D COMMENTS: 6Fx�2 -1_6 P.O. BOX 15047. APPS 1. Building d 1 ,�j _r, �n l- 78-495 CALLE TAMPICO Address lS2—d� ' `ye:WbA 1'E�.�x l OUINTA, CALIFORNIA 92253 Mailing �q) ftcos f�L Address City IZIp%2^ ` ITeI� I I tit, %) � J _ Cont ip State LiaI City & Classif. Lic. # Arch., Engr. „r Designer �� f %j J _ N I 07b Aririrpss I Tell. 11Stae A bm IZfp 2,w 1 1 Lic.t# I LICENSED CONTRACTOR'S DECLARATION I 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. r `SIGNATURE 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 or thealleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars ($500). IJ I, as oner 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 orimprovement 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 II' as owner of the property, am exclusively contracting with licensed contractors to con- struct the proiect. (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.) 11 1 am exempt under Sec. B. R 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 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: 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, CivilCode.) 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 Mailing Add City, State, BUILDING: TYYPE'CONST. OCC. GRP. A.P. Number `1S--2,23—ala. Legal Description Description Sq. Ft.' S A:+No. j No. Dw Size Stories t Units Add ❑ Alter ❑ Repair ❑ Demolition ❑ on PERMIT AMOUNT Plan Chk. Dep. `: S0 ' Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure 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 Issued by: - Validated by: Validation: INSPECTOR WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Permit Desert Sands Unified School District 47-950 Mune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 4/11I00 No. 20276 Owner NameRichard Lopez No. 52-025 Street Avenida Lopez Jurisdiction APN # 773-223-012 Permit # Log # City La Quinta zip 92253 Study Area Tract # Lot # Square Footage 1548 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/waikways, 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 1,548 or $ 3,173.40 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 Richard Lopez - CASH. Telephone , Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Ellen Patina Payment Received. $3,173.40'` ` / Check No. CASH. Signature�&� �it—�J JOTICE: Pursuant of Assembly Bill 3081 (ORNP 599, STATS. 1996) this will serve to nopfy you that the 9May approval period in which you may protest the fees or other payment Identified hbove 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 ofcounty or city plan cheep application form to "6trict copy for a n waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting RECORDING REQUESTED BY: ..,S-TNWAR'1'TITLE OF CALIFORNIA, INC. WHEN RECORDED MAIL TO: RICHARD J. LOPEZ 81148 PECOS PLACE INDIO, CA 92201 ORDER NO. 507-162350 ESCROW NO. 30130 -BK - -/2 C'-_ o a, C-) D / 7 DOC a 1999-512377 11/19/1999 08:00A Fee:9.00 Page 1 of 2 Doc T Tax Paid Recorded in Official Records County of Riverside Gary L. Orso Assessor, County Clerk 8 Recorder I iII I III IIIII II I I II I The undersigned grantor(s) declare(s): A.P.N.: 773-223-012 Documentary transfer tax is $ 15.40 City tax $ ( XX) computed on full value of property conveyed, or ( ) computed on full value less value of liens or encumbrances remaining at time of sale. ( ) Unincorporated area: (XX) City of LA QUINTA , and FOR VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, KEVIN KNICKERBOCKER AND PAUL ZIMMERMAN, TRUSTEES OF THE ERICA RINALDY TRUST AGREEMENT ESTABLISHED JUNE 15, 1981 hereby GRANTS to RICHARD J. LOPEZ AND 'MISHAUN F. HAWKINS, HUSBAND AND WIFE AS JOINT -TENANTS the following described real property in the City of LA QUINTA County of RIVERSIDE , State of CA LOT 1 OF BLOCK 76 OF SANTA CARMELITA UNIT #10 AT VALE LA QUINTA AS SHOWN BON MAP ON FILE IN BOOK 18 AT PAGE 70 OF MAPS IN THE OFFICE OF THE COUNTY RECORDER OF RIVERSIDE COUNTY, CALIFORNIA. DATE: November 02, 1999 STATE OF CALIFORNIA } } COUNTY OF ss. �► 0 } On -liIC7before me ft6 � )Af � �/vtaV-"Cnw. v` \ ' C_ personally appeared e'� "1/V D.Y CG�Q personally known to me (or proved to me on the basis of satisfac- tory evidence) to be the person(s), whose name(s) is/are sub- scribed 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 his/her/their signature(s) on the instru- ment the person(s) or the entity upon behalf of which the per- sons) acted, executed the instrument. WITNESS =ffici, se Signature ERICAljfl T ALD RUST 7 ESTABLISHE J 15, 1981 BY: I' C r 10 BY: L, KEV KNIfICERBOaXER. TRUSTEE rA!% 110:::D (This area for official notarial seal) MAIL TAX STATEMENTS AS DIRECTED ABOVE M s U PAGE SME DA PCOR -MOR SMF MISC. A I R L COPY LONG REFUND NCNG GRANT DEED I The undersigned grantor(s) declare(s): A.P.N.: 773-223-012 Documentary transfer tax is $ 15.40 City tax $ ( XX) computed on full value of property conveyed, or ( ) computed on full value less value of liens or encumbrances remaining at time of sale. ( ) Unincorporated area: (XX) City of LA QUINTA , and FOR VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, KEVIN KNICKERBOCKER AND PAUL ZIMMERMAN, TRUSTEES OF THE ERICA RINALDY TRUST AGREEMENT ESTABLISHED JUNE 15, 1981 hereby GRANTS to RICHARD J. LOPEZ AND 'MISHAUN F. HAWKINS, HUSBAND AND WIFE AS JOINT -TENANTS the following described real property in the City of LA QUINTA County of RIVERSIDE , State of CA LOT 1 OF BLOCK 76 OF SANTA CARMELITA UNIT #10 AT VALE LA QUINTA AS SHOWN BON MAP ON FILE IN BOOK 18 AT PAGE 70 OF MAPS IN THE OFFICE OF THE COUNTY RECORDER OF RIVERSIDE COUNTY, CALIFORNIA. DATE: November 02, 1999 STATE OF CALIFORNIA } } COUNTY OF ss. �► 0 } On -liIC7before me ft6 � )Af � �/vtaV-"Cnw. v` \ ' C_ personally appeared e'� "1/V D.Y CG�Q personally known to me (or proved to me on the basis of satisfac- tory evidence) to be the person(s), whose name(s) is/are sub- scribed 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 his/her/their signature(s) on the instru- ment the person(s) or the entity upon behalf of which the per- sons) acted, executed the instrument. WITNESS =ffici, se Signature ERICAljfl T ALD RUST 7 ESTABLISHE J 15, 1981 BY: I' C r 10 BY: L, KEV KNIfICERBOaXER. TRUSTEE rA!% 110:::D (This area for official notarial seal) MAIL TAX STATEMENTS AS DIRECTED ABOVE CALIFORMA ALL-PURPOSE ACKNOWLEDGMENT State ofI All 1*7 County of �/�,,/ �� On ��' 17 ! Q � before me, A !�/ � 5kaz , Date /J Name and Title of Officer (e.g., 'Jane Doe, Notary Public") personally appeared ANDREA SM cammlssim f 113MI Loa Angeles County My Corm. E4*es Apt 30, 211MI Names) of Signer(s) ❑ ersonally known to me roved to me on the basis of satisfactory evidence to be the person(s) whose name(s) 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 his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. Signature of Notary Public OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: Document Date: .99 % Number of Pages: a✓ Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: /.7'U1 Z J%W MW ❑ Individual ❑ Corporate Officer Title(s): ❑ Partner — ❑ Limited ❑ General ❑/Attorney -in -Fact ?I Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: RIGHT THUMBPRINT OF SIGNER Signer's Name: i Individual Corporate Officer Title(s): Partner — ❑ Limited ❑ General Attorney -in -Fact Trustee Guardian or Conservator Other: Signer Is Representing: RIGHT THUMBPRINT OF SIGNER r� 1009 Niptional Notary Association • 8236 Remmet Ave., P.O. Box 7184 • Canoga Park, CA 91309-7184 Prod. No. 5907 Reorder. Call Toll -Free 1.800-876.6827 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 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 Richard Lopez SITE ADDRESS 52-025 Avenida Herrera APN 773 - 223'- 012 BIN N.O.: CASE NO.: 2000-197 LEGAL: LOT BLOCK UNIT S.C.@V.L.Q. CHECKED BY: Stan Sawa DATE: `v 7.oD-f--> 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 �r Case logged and number assigned Verify legal and APN information i 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: �� '{b 1-s'su & rJ � DO i OWNER/BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as "Owner/ Builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the City or County. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the State and Federal Government as an employer,and you are subject to several obligations including State and Federal income tax withholding, federal social security taxes, worker's compensation insurance, disability insurance costs and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N. Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, CITY OF LA QUINTA DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico La Quinta, CA 92253 (760) 777-7012 777-7011, OWNER'S SIGNATURE/DATE _5 04vtn"Ji4 ('-PROPERTY ADDRESS 2 -- PERMIT NUMBER(s)