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9802-006, 9806-187 (SFD)H N U) W r�0U.) ' W 6Z� co O O H(0 J W W ,I— a U) Z ce) LO N ON U M Q CL LO - CE 0 LL 0 W J C0 < O � 0) q11- Z_ ab 5 r` C) Q J 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 # Li Class Exp. Date f -#NOate � Signature of Contractor OWNER -BUILDER DECLAR TION 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&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. (,4 1 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. . Ive'k'�.1 tr. "' _gr GOlr�4I9 (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' compensatiprovlsions.'of Section 3700 of the Labor Code, Ls ,(the comply with o ,pry visions. `ODate: _� . 1G J Applicant i t"r 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. } - r1. 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 Jany permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmlesssthe City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if jwork 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 toenter upon the:above-mentioned property for Inspection purposes. ,Signature (Owner/Agent) "'%C�laik - ^- —Date J L BUILDING PERMIT PERMIT# °DNTR°`" yx0�^11fid, DATEVALUATION���A!{����� LOT a Il TRACT 1S V ADDRESS JOB SITY r 5*L36I1 1WEANWAURRU1C. KA IOWNER APN . 773-164-063 / DESIGNER / ENGINEER 1JAWD ROSS MILL ER , PAC'ITICTRADU% ' LA QIJI I A CA Si225 fh 1,' ? 54.02 7 : CKM 01,80 U'SE OF PERMIT 13F» S['I;, PF.fi1 IT 00tr5 NOT 1IN"CZCi3"H,,BLOCK WALL`S 011 POOL'. MAC i COtid`a"17�.UCT[ON is l l.ti ii�'11%C r1Q1RCI _PXrl.0 (3ARAf"rir CARPO► 506.00 SF 6 FT. WOOIXIFFNCE LIF 1!+;';TMILV0,11D COST OF CONI STRift-'HON, C'Os�fST.`RlfCTIClNH`! i0I-fiW-418-000 S594.�10 K,AN fP1x0,, : YF M-000-439-318 00.433--31.8 1499.5: - €VIL'�i-lAiilflr".r�d.'�`:it�; 10.1.^f.)00-II^✓1-©0{1 ,xi5`:,,`'+{t av-1,IMAL. FM, tol-600-420-000 PLI M:I31NG FM 1.01-000-419.000 $12L.9) tiT110?vr:�sr�e1�1� F1 - !Ol-0011-241-01 1 •� .90 01tAOINC FIX I01-000423-000 ��ttT Ct(1 1NS"82PYS1`R(X` 1J_REFFX. 22-5-W0443-342 S043,17 f?3:.t CISs)N ft. AN 101:4)00-441-315 Fr1..t+.N CHECK J 7 1014)004ii -3318 �25Cf.faEf SUB-T01ML CONINIR:UM'ION Mn_ PI. AN CR CK 1 RECEIPT _ DATE e89,620.491 S � W `95 PtJ fAl, it'Eil MIT 1s PEN IDU 1k+, NOW DATE FINALED INSPECTOR INSPECTION RECORD i OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APP OVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck J( Exhaust Fans O.K & F.A.U. Framing - $/ X Compressor Insula on __�_� Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath %gym. g Final Final POOLS - SPAS BLOCKWALL APPROVAILS 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 Q _ / Pool Cover Sewer Connection 7 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 c Final Utility Notice (Perm) S2 — Sao Avc% / (tP-'eEZAP.O.44" Building 78-495 CALLE TAMPICO Address's 1 ``� vi dl r fC SLA OUINTA, CALIFORNIA 92253 \� t` ,, `7 Uh ,, ti—\.-,. Mailing Address 1-\ \cl City JJ Zip d • C ", % , C 'r � I\ -, p State Lic. I city & Classif. V, 1�\'�Ir Lic. # GC S Arch., Engr., Designer Address Tel. City I Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm thanI amlicensed under provisions of Chapter 9 (commencing with Section 7000) of Divisiory3I the Business and Professions Code, and my license is in full force and effect. t , 1 I it .-r V _.. J 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). F21 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 1 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 contractol(s) licensed pursuant to the Contractor's License Law.) i? 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION Ihereby 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 it the permit is for one hundred dollars ($100) 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 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 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 sof this city to enter the above- mentioned property for inspection purposes. Signature of a0plicant Date Mailing Address City, State, Zip 9502- -oo(O APPLICATION ONLY BUILDING: TYPE'CONST. OCC. GRP. A.P. Number Legal Description Project Description t~� . ✓\ WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Sq. Ft. Size T U No. No. Dw. Stories Units New ❑ Add O Alter ❑ Repair ❑ Demolition ❑ t a Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. fA—) Plan Chk. Bal. j{ Const. Mech. Electrical Plumbing S.M.I. r jAN Grading Driveway Enc. Infrastructure OF LN&A Q%X U11 NTA f �l TOTAL j `, ✓ r ,�V 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 Desert Sands Unified School District Notice: 82-879 Highway 111 Document Cannot Be Duplicated Indio, CA 92201619-775-3500 CERTIFICATE OF COMPLIANCE Date 3/6/98 No. 16697 Jurisdiction Owner NameDavid Ross Miller No. 52-300 Street Avenida Herrera City La Quinta Zip 92253 Tract # Lot # Type of Development Single Family Residence Comments APN # 773-264-003 La Quinta Permit # Log # Study Area Square Footage 1410 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 J _ This certifies that school facility fees imposed pursuant to Government Code 53080 in the,amount of 1.93 X 1,410 or $ 2,721.30 the property listed above and that btiiiding y permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued ;r Fees Paid By CC/Capital Bank of North County/David Miller Telephone : Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Rosita Jones Payment Received $2,721.30 Check No. 052365 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 dale 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 FEB.20.1998 5:15PM COMMONWEALTH RECORDING REQUESTED BY: OLD RELIC TITLE COMPACOMPANY 98.7124KC 105544-13 X1,1 ]?AVID ROSS MMOM 1719 S. Tremont S. Oceanside, CA 92054 SPACE ABOVE GRAM DEED NO. 039 P.2/4 IS LINE FOR N: 773-264- � 2 — 300 0 Avr 1 ce.Qi2A The undersigned grantors) declare(a): Documentary transfer tax is $11.00 (XXX) Computed on full value of property conveyed, or ( ) Computed on full value less liens and encumbrances remaining at time of sale. ( ) Unincorporated area: ( ) City of and FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, GLEN TITAN, TRUSTEE OF THE ALBERT L. SHORE 3.997 TRUST DATED 5/28/97 hereby GRANT(S) to DAA ROSS WLY&R, a married man as his sole and separate property the real property in the City of LA QUINTA, County of Riverside, State of California, described as: r LOT 20, BLOCK B4, SANTA CARMELITA AT VALE LA QUINTA, UNIT NO. 10, AS PER MAP RECORDED IN BOOK 18 PAGE 70 OF MAPS, RECORDS OF RIVERSIDE COMM, CALIFORNIA Dated January 22, 1998 State of California County of On before me, personally ap ared personally known to me (or p ved to me on the basis of satisfactozy videnee) to be the person(s) whose na (s) is/axe subscribed Co the within inst�ru nt and acknowledged to me that he/she/th executed the same in his/her/their horized capacity(ies), and that by his/ r/their signature(s) on the instrument he person(s), or the entity upon behalf o which the person(s) acted, executed the in rument. W17ESS my hand and official seal. Signature MAIL TAX STATEMENTS TO: SAME As ABovB zk: i�- GLEN TITAN, TRUSTEE OF THE ALBERT L. SHORE 1997 TRUST DATED . 5/28/97 I (This area for official notarial seal) M 0 I NI �r- r Cu � 28 L -0 _ 38'-0n DAVID MILLER 51445 AVENITA RAMIRE2 LA GUINTA INVOICE 5387/5396 4/12 2/12 PITCH' 2x4 TOP CHORD TILE ROOF TYPE 9TY Description Detail GEO1 I TA SO 231771 REPAIR A-327278 IGEO2 i TA SD 231775 REPAIR R-327278 GE03 i SC TR SO LA 231778 REPAIR R-327277 SCISSOR FURRING G£01 I GE 231776 REPAIR R-327278 101 2 TA 231768 REPAIR R-327278 T02 B. SC TR LA 231778 REPAIR R-327277 SCISSOR FURRING T04 1 SC TR SO LA 231778 REPAIR R-327277 SCISSOR FURRING T05. 6 SC TR LA 23078 REPAIR R-327277 SCISSOR FURRING T05A 7 TR 231775 j REPAIR R-327278 T06 i SC TR LR 231778 REPAIR R-327277 SCISSOR FURRING j Abbreviations E: Gable End I R: Level Return C: Scissor D: Stud R: Truss TRUCTURAL TRUSS, INC. CERTIFIED INSPECTION CLIS ICBO #AA -513 IN STRICT ACCORDANCE WITH UBC 25-17 PREFABRICATED 13 APA, 1998 ccpyrfsht tel compuVas Inc. U) (V U) W ouch Q u7 ' W C:) Z 0 o H W w r1_ I— a U) Z co LO N ON U_ °) � Z Lo r � 0 XW�= mUU O 0)Z � Z_ ob Z) �O J 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 2 ts© B 6,_0196 /Date t� z'' I r� Signature of ContractorC• OWNER -BUILDER DECLARATION 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&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. (K) 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. STKM FUND 2Z9-96 0010419 (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 fotthwith comply wit those pro`yisions. Applicant %;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 correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representativesof this City to enter upon the above-mentioned property for inspection purposes. t /Signature (Owner/Agent) ' Date � iZ �� V BUILDING PERMIT PERMIT# CONTROL# / DATEbVALUATION LOT 9506-.1 S7 TRACT 3 // „ $4,.561.20 4 71951 JOB SITE APN ADDRESS 52-308 AVVg1DA iIERRERA 773-264-003 OWNER CONTRACTOR / DESIGNER / ENGINEER DAVID ROSS MILLER PACIFIC'I RADES 1719 S TR.EMONT P.O. BOX 722 S OCEANSIDE CA 92054 LA QUINTA CA 92253 (619)%4-0673 CBL4 4180 USE OF PERMIT � rcr SUPPLLNENTA'L 1 O PERMIT #9802-r06, 'fNCREASING i� VING AREA BY ' 34 SQPARE P. BT. TRACT I' CONI STRUC'VION 83.00 SF y . .Lt -ST IMATED LOST OF CONSTRUCTION PERMIT FEE SiTMhURY SUB -TOT -AL CONSTRUCTION AND PLAN CwCk . $t).00 LESS PkE-PAID C' E ES $11.0:1 TOTAL. PERMIT FEES DUE NOW $0.00 RECEIPT DATE BY DATE FINALED 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 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 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 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 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 i Final ' Utility Notice (Perm) COMMENTS: Notice: Document Cannot Be Duplicated Date 6/23/98 No. 17218 Owner NameDavid Ross Miller Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE No. 52-300 Street Avenida Herrera City La Quinta Tract # Lot # APN # 773-264-003 Jurisdiction La Quinta zip 92253 Permit # Log # Study Area Square Footage 84 Type of Development Residential Addition No. of Units 1 Comments Supplemental to permit #9802-006, increase living area by 84 sq. ft. 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: Residential Addition 500 Sq Feet or Less EXEMPT This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 0.00 X 84 or $ 0.00 the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project iriay now•be'issued Fees Paid By Pacific Trades I~� T'elephona 564-027 {-, Name on the check = '� By Dr. Doris Wilson ? N` Superintendent ;, i C Fee collected /exempted by Juanita Green Exempt $0.00 Check No. N/A Signature NOTICE: Pursuant of sembly 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 ru om 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 D rict('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