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0202-266 (SFD)U) H N •� iW �v O LLJZ CO C)" c0 W W Ha Z LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of s 3.Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. ch License # Lic. Class Exp. Date 42 3€1 k3 f !?7 . /V WC 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: ( ) 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 �,f �:j 'Signature of Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of • perjury one of the following declarations: ( ) I have andtwill 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: Carver Policy No. STATE ,FUND (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 Sectjon 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 $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1:. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with'all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection'purposes. Signature (Owner/ en '" " --�^� Date r'! �• BUILDING PERMIT PERMIT # DATE VALUATION LOT 02,(Y_#_-2," TRACT JOB SITE ADDRESS. ' APN 52-795 AVF,,=A HM SMA 773-234-015 OWNER CONTRACTOR /DESIGNER / EN INEER :PA0:.' IC ` RACES PAC.'Ir''IC T. AMES CCMM RZI'C11O14 17 ),� S TitE, MON'.E` 4,719 3 TiRY240-M S OCEMYIDE Cil 9$:1354 S Oif.1"EANUff )EI CA 92054 (760)967-0069 C 19 1955 ; USE OF PERMIT SWOLLE E,t 24M.N DWELLINGZ. ' SF13 • t�N1�..Im+1fT' L9i.�1f'»� YdC72' 3`t1+w}..�30� F3F.t�i:IC'i�''elS Y.� }�4�4'?R, f,�K t313.Ti1'l�U�ol. APPROACH, 93 MAS T F.F. "SAN FIL IM 1'1 ACT CONSTRUCTION t`[� A� 30 2902 }fit; RCHIPA'P O 109.00 SP 0A13,AGEIC.A.13P41t1' a40.0r) .1rr° CITY 'WOOD FlA4Uil�IiA LAQUI Fr. 1^.['NCE \ 200.00 LI FAN 1 W'.i WATiL D COFf OF C,'dr1NG:1C Ui Y°.C011 PMM@'I'MM 611MUARr' ... C'QIs1.`311' UC' ION 1T12 lfil ^OC1�• 1 ^{6UZ9 5 9� e0 PLAN CHWK 1Z%? 1171-000.439.3231 MECHANICAL li,U 101-000-421-000 LEC:f'RICAL.RiL 101-00" 20-000 $106.07 P1.:6i1►4'RT.. G IEE 101.000-419^ $110,79 5TRO'NO MOTICYN RKE, a P io 101-000-241-000 $9,'77 ORA1` IRO V R 101.0100.423.0013 920.00 DMI -OP _R IMPACT "M $j,90.00 PR�.,OSE PIAN 101.-000»1141-345 MOM 0'8:>a MPOSI'i 101.000-4:39.31$ •$�9t3,00 .81JR-TOTIAL l'v`G? i`1 UC 110H AND Tr'T.AM (ML—CR, $'1,380.25 J TarAa1.e:e?ur:li!In'.v, ,;'DX NC,Si1t' v, RECEIPT DATE r+ BY D E FIN LED INSPEC g� INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Retum Air Steel Combustion Air Roof Deck & . 0 1i Exhaust Fans O.K. to Wrap — epi 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 �( ZZ U2� 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 ��// �i.� �'� `�l\(+' Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Sewer Connection �$' <3� s% Pool Cover Encapsulation Gas Piping Gas Test 22 . 02f_ 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 _ , O Final Utility Notice (Perm) COMMENTS: S Z S .+� ��2�41111111, P.O. BOX 1504 Building 78-495 CALLE TAMPICO APPLICATION ONLY Address . _ LA QUINTA, CALIFORNIA 92253 ��.3 2y — 0 ~�� 5 BUILDING: TYPE'CONST.iV OCC. GRP. Mailing Address �- � 2 A.P. Number [' 7 J p A r Legal Description Project Description � � � •' r � Ci Zi ITEII. j Contractor—r plicz 6a Ifs d(e� Address f.al 7� CAM", — 914� O City Zip Tel. G6r /f(,rL it State Lic. & Classif. .. r) 38. City r' Lic. # ! 9Sq. Ft. I. No. No. Dw. I 11W Grading Size ; Stories Units Arch., Engr., Driveway Enc. // Designer T��B / New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. 1r*j��,c,•-ti 1 D D2 i.404 City Zip State Lic. # 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. 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 for 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 five hundred dollars ($500). 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, Bulsness 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 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 properly who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law.) 17 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 it the permit is for one hundred dollars ($100) valuation or less.) Icertify 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., 11, 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, 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 applicant —Date— Mailing ateMailing Address City, State, Zip I '700 S78 9410 S Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. , Plan Chkr Bal. Const. Mech. Electrical ,. Plumbing S.M.I. I 11W Grading I r:Ct�) 0 n- MU '—� Driveway Enc. Infrastructure 1r*j��,c,•-ti 1 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 4/30/02 No. 23180 Owner NamePacific Trades No. 52795 city La Quinta Tract # BLK159 P Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253• 760-771-8515 CERTIFICATE OF COMPLIANCE APN# 773-234-015 Jurisdiction La Quinta Permit # 0202-266 Street Avenida Herrera Log # Zip 92253 Study Area Lot # 2 Square Footage 1382 Type of Development Single Family Residence No. of Units 1 Comments Single Family Dwelling 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 2.14 X 1,382 or $ 1,957.48 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 Capital Bank of North County - Brent Garcia Telephone Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Crystal Scott Signature Payment Received $2;957.48 Check No. 087576 OTICE: Pursuant to 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 bove 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 Dllect them on the Distrid(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 - 6 2002 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 per Section 9.50.090 of the Zoning Code. Its purpose is to determine: 1) that the proposed house design does not duplicate the same architectural style of any house within 200 feet of the applicant, and/or 2) if there is a need for the applicant to file for Master Design Guidelines. If the applicant does need to file a Master Design Guideline, please transmitted this information to the Building and Safety Department as part of your correction list. Please attach additional explanations as necessary. /%hr's ✓ S z l (o APPLICANT PACIFIC TRADES�Q°5-U_o'� SITE ADDRESS APN LEGAL: 52-795 Avenida Herrera 773 - 324 - 015 CASE NO.: 2002-620 LOT X Z BLOCK 159 UNIT 169 S.C.@V.L.Q. CHECK AND APPROVED BY: Wally Nesbit DATE: 2- Z Il &1_1z 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 Verify legal and APN information v� �^'�✓s'�� Consistent with MDG on file (as applicable MDG filing required (5 filings since 9/3/98) Architectural variety within 200 feet.of the surrounding area: Colors Materials eatures Architectural design features- VvtN ccllob( 2 27 02 i�S f Ctrl iSii✓r c s�r� SG h`fr►£ Approved Other Requirements: (3 Planning Commission 0 City Council ommunity Dev. Initials Case No. Coe- 4, Exhibit 13 With Conditions Dept. &D .__.._.,. ._. ..._.............. M m to a® RECORDING REQUESTED BY: RM AND WHEN RECORDED MAIL -rHI$ DEED AND, K� UNLESS OTHERWISE SHOWN BELOW, MAIL TAX STATEMENTS TO: David Ross Miller 1719 S, Tremont S. Oceanside, CA 90254 SPACE ABOVE THIS LINE FOR RECORDER'S USE 0 N The undersigned grantor(s) declare(s): Grant Deed A, P• N. 773-324-014/015 Documentary transfer tax Is $ ( ;;a) computed on full value of property conveyed, or ( ) computed on full value less value of liens and encumbrances remaining at lime of sale, ( ) Unincorporated area: ( ) City of and FOR A VALUABLE CONSIDERATION, receipt of which Is hereby acknowledged, ROBERTA HERLIHY hereby GRANT(S) to DAVID ROSS MILLER, a married man as his 'sole and separate property the real property in the Ci(y of La Quince State of Califomia, described as , County of Riverside Lot 1 & 2 of Block _ 159 Unit No, Santa Carmelita at Vale La Quinta, as per -tap recorded -in Book Pages If Maps, Records of Riverside County, California Dated_ January -23,'2002' Slate of California ) County of ) S.S. On before me, . ,personally appeared ROBERTA HERLIHY personally known to me (or proved to me on the basis of satisfactory. evidence) to be the person(s) whose nane(s) Is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in histherrlheir authorized capachy(tes), and that by hlslher/their signature(s) on- the Instrument the pemon(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. Sic�nat�re MAIL TAX STATEMENTS T0, I I Signature of Grantor ROBERTA HERLIHY W N '~ N L) Z 3 z N 2 o a LU y Y w cn ( N Q CC 4 uj CD FE_CO^ O Fo GC N a W L U Z U CL a 0 a O Id LO O O c ai y ' O Z Ln U U : Q G� C1 U N ~ Z O O Nei O a pw w'+ V F- LU y ,y O moomm LL m cn C Q cn a C� C7 INC 44"Olt co tat o c 0 _co co V ;ice a1 U aca W 0 c v C Z) 0 O