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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
q %� a
.51;57.x4
t
Date � 1 "(° " �'� , Signature of Contractor
OWNER -BUILDER DECLA7ATION
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.
s� I have and will maintain workers' compensation insurance, as required by
Secti6n 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.
STATE IaUND 2210-oCt 01417 0011090
(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' compensatio9fprovisions of Seqlion 3700 of the Labor
Code, I shall forthwith comply with Ithose, provisions.
Date: i ' tU Applicants
ry 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 if�or inspection purposnes.
Signature.•-(Owner/Agerit)"f e" Date 4
-UILDING. PERMIT PERMT#
ATE f / /. C* yALUATION LOT�6? TRACT I/
' if .31'4_ I D 1 3
JOB SITE
APN
ADDRESS
?-SKS t�.''if:NfDA XMIRR 3ZA.
i 3�-�.32-2i23
OWNER
CONTRACTOR/DESIGNER/EN (NEER
ACYUMM VAZ
PAI, >r:Z4MMI1:TC1` 011 co
5MRS AYEWDAVN"re.+�?^�C?
2-995 A-.VENJDA=07A
,1,,kQ)U.1 rXA CA 92253
Y.,AQ1_l N A CA 92253
(760)564-3023 MIX 55317
USE OF PERMIT
4q130 -..AMASYER -Sk PER141T 100ES 140T INCLUDE, WX)CK WA.L2.`.�,
L
NOV 0 6 20M L
TRACT (11.0.1-11RUCITION 1,421.00 SF
CITY OFLAQUINTA '
Pr_1RC} /Pt.`, I0 36.30 sly
FINANCE U -PT.
_ _ -- = ;
( 1R A��:tI�l�'.�41i.T'G�M, 510,00 Off'
5.V11. '4F1'OOD 111ENCE 200.00 1.,F
ESIMATIM COST Oft 4:'C?MMxJC,".!.[<ON
YNOfff r, RE SUMMARY
CaNT1T UCTION M? 101-00 0-418-000
F'i.AN CREC;ft FEE 101-00-439-318 �rSVC. I Z
VIRCHA1'.41CA1.1 FRIK '101-000-421.000 $69.00
L:.Pr, 0?JCA$1-' YFF, 101-.000-420-000 $129.44
PLUMBING Mr. 101-000-419-000
Sit .gON,U MOTION Pari, < RESIT 101-000-241-000
C4FS.&DINGI €TIM, '101-000-423-000
DEVELOI-�11.?,P, IMPACT FEE
9°R,,W,IVPLM+ 101-000-443 -345 SINAD
&M -TOTAL C':'f NITM 1'CTIONI'ARD;Ni:.M'C53a?,t"i:
$3,4:3034
LUS PR tFIAM FERS
$0100
7l MAL V*Wff `i'I` T.0 DUX NOW
",430.73
RECEIPT
DATE / I� �' /
By �� "
c'' 3,`�`
DA F D
INSPECTOR
M
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
%2_s_ / �Q�j�
Exhaust Fans
O.K, to Wrap
Framing
J Z/
F.A.U.
Compressor
Insulation
y 7
Vents
Fireplace P.L.
Y
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
_
Exterior Lath
—z:::
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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
2 - 7 '_-i
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
Final. •:'
/'2 �7 �s�
Utility Notice (Perm)
��
wm�%w 7 11-11' _7W
P.O. BOX 1504 APPLICATION ONLY
Building 78-495 CALLE TAMPICO
Address •` I!r-00<n. LAQUINTA,CALIFORNIA/�33
Owner _?
'LJ BUILDING: TYPE'CONST. OCC. GRP.
Mailing
Address 'S7 C �L9 �s J Cl oZ A.P. Number
City Zip Tel.
Legal Description 7c7 �_
Contractor Project Description
ty Zip Tel.
!J" h !-t
State Lic. I City
& Classif.�� S -� g- Lic. #
Arch., Engr.,
Designer L��-�-
Address Tel.
CityI Zip I State I
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 thathe 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).
f: 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 no 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.)
1 1 I, as owner of the property, am exclusively contracting with licensed contractors to con•
slruCI 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 contractors) licensed pursuant to the Contractor's License Law.)
1-7 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
Ihereby affirm that there is a construction lending agency for the performance of the t
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 slate 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 applicant Date
Mailing Address
City, State, Zip
WHITE = FINANCE
Sq. Ft. �A No. No. Dw.
Size 14 2 Stories 1 Units '
New 6K Add ❑ Alter ❑ Repair ❑ Demolition ❑
stimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. i
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Set back-frarriZen ter Line
FINAL
Issued
Validal
Validai
Prop. Line
i Center Line
frty Line
R
YELLOW = APPLICANT
PINK = BUILDING DIVISION
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: 52-965 AVENIDA HERRERA
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0109-244
Occupancy Group: R-3 Type of Construction: VN
Land Use Zone: RC
Owner of Building: AGUSTIN PAZ Address: 52-685 AVE. VELASCO
City: LA QUINTA , CA., 92253
Building Official
By: RICHARD KIRKLAND
Date: 2/7/02
POST IN A CONSPICUOUS PLACE
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
Date 11/6/01
No. 22647
Owner NameAQustin Paz
No. 52-965
City La Quinta
CERTIFICATE OF COMPLIANCE
Street Avenida Herrera
7 73-3z,y' o,>-
APN #
Jurisdiction La Ouinta
Permit # 0109-244
Log #
Zip 92253 Study Area
Tract # BLK i3 151 Lot # 1.1 Square Footage 1421
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 1,421 or $ 2,913.05 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may n6w be issued
Fees Paid By CC / Valley Independent Bank - Agustin Paz Telephone
Name on the check
By Dr. Doris Wilson _.
Superintendent
Fee collected /exe pted by Annette Barlow
,^
Signature
Payment Received $2,913.05
Check No. 255462
IOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) this will serve to notify you that the 904ay 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
ollect them on the DistrictCs)(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
RECORDING REQUESTED SY:
AND WHEN RECORDED MA:i THIS DEED AND,
UULESS OTHER'NJOESSHOWN BELOW,
MAIL TAX 6TATEMENTS TO:
Mry b Mrs. Agustin Paz
SPACE ABOVE THIS LINE FOR RECORDER'S USI;
Grant Deed A.P.N, 773-324-02.4
The undersigned prentor(s) declare(s):
Documentary transfer tope is $
( xjj computed on full value of property aonvoyad. or
{ ) computed on full value less value of lions and encumbrances -emainimo at Citta of sale.
} Unincorporated area: ( ) City of_,,, _ , and
FOR A VALUABLE CONSIDERATION, recelpt of which is hereby acknowledged,
K & S BUILDERS ':INC.
"tareby GRANTS) to AGUSTIN PAZ and EVA PAZ, husbar.•.d and wi.dt as joint tenants
the real property i{t the City of La Quinta
Slate of Calirorhla, described as
, County of Riverside
Lot 1 bf Block 159 Unit NO, Swata Carmelite, at Vale. La
Quint:a, as per map recorded in BooX'.—. Paps of Mapor -records of
Riverside Courtly, ' California
Dater- September 5. 2001
swte of Ceivornla )
County of )SS.
On pefore me,
pereeneq a 6Ared
—"—�—'& S BUILDER C _
personalty known to me (or proved to me on the basis of iatiefectoty
ovIdence) to be the pemon(s) whoa$ Aa Mo(s) Is/are s0scrfbed io the
within Instrumail anq acknowledged to rte that he/she/they executed
the same In hie/herAhelr authorized capsoity(iea), and that by
his/her/their signalure('a) or.. the Insirvmenl the person(t), or the entity
upon behalf of which the person(s) acted, executed the Instrument,
WITNESS my hand and ot'flctAJ Seal,
Slpnature
MAIL TAX STATEMENTS TO, �_s eb,:asse
I 'd 1ZLI'V'0N
Stgnsture or Grontor
rK^& S BUILDERS INC, ~.
CJTACi;8 8311-1,0'j 'N'V87:II i 0 0 Z 1y 'aaS
y4'x s ._...... �
'`.e— _,,,�,� ,:e.�, .._:,;,;,ani'
S2— CIbS 1�-�/Le CCoa,��
Logo S
I I
RC DISTRICT - PLANNING REVIEW FORM jl
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.
APPLICANT PAZ CONSTRUCTION
SITE ADDRESS 52-965 Avenida Herrera
APN 773 - 132 - 023 CASE NO.: 2001-550
LEGAL: LOT 11 BLOCK 53 UNIT -_ S.C.@V.L.Q.
Michele Rambo O
CHECK AND APPROVED BY: 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
Verify legal and APN. information
X
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:VON
Colors
Materials
Architectural design features
O
QRO��O
0y�`j`\sp O
4
GP .
Other Requirements: