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0109-186 (SFD)U) H N to W O �CY) W oZ� CZD0� ww� I— 0- U) Z n LO N ON 0 rn Q_ Q Z Lo acc 0 0 J J mVU O � IQ- Iq Z_ os 5 t` CY R L 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 Dater ' '� �'Slgnature of Contractor -...........»--...,......«.. 1, � �! V011VNER=BUILDER-DECL-A'RATION tip...% 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 underlSection , 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. ( ) 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 $100.00 or less). ( ) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if.l should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall ,fo hwith comply with those q�ovi Ions. »''1 Dater, Date ' y Applicant t- \ Warning: Failure to secure Workers Comp'ensatio coverages{s unlawful and shall subject an employer to criminal penalties and 6lvil fines up i$ $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 4nd Safety for a permit subject to the conditions and restrictions set forth on his application. 1.1" 1. Each person upon whose behalf this application is made & each person a, whose request and for whose benefit work is performed under or pursuant t any permit issued as a result of this applicaton agrees to, & shall, indemnif & 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 i work is not commenced within 1,80 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 authorizer representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature, (Owne"r/Agent)+Date,._ 1:1 ` BUILDING PERMIT PERMIT# DATE�rVV)ALUATION LOT D1W_1&j TRACT X,! i"lusvj ,i� . 2`• JOB SITE ADDRESS 71 . �,' TP -M) AHE'RIMA 7x3-0&3-018 OWNER CONTRACTOR/ DESIGNER / EN INFER DAVO ia<..MR&1""T+ ;1'ACUIC' Ira CON313MUCTiCiN 1719 S. ITRIbiUZ3'T' 1 1719 0 °TfiEMONT t7� M. E. CA 92054 "1 0L:Wx317 E CA 92054 (7m)967.,0069 ci% t` 1955 USE OF PERMIT Sin) - MA�"J'VR SAN RE"PY17..I OTO. PERMIT DOPPS 00T igdCLi11a ALOCK WA1.4F. 4 POOU' PA OR DWRINA.; APPROACH, TRACT =14STRUC 71014 I1382.00 S;? ORC°iIMA370 10a.00 Ek' .. 040.&OWCAIRPOV 46%00 SP 5 Irr, WO13 D VE3dCE 200.(* 11F ENTWA'.i1'D Coln OF C:OPS'�°.iiUC"`17.0N 87,19':5o) C014311RUC'TION FES 103.000-1181-M) SW,50 PLAN CEiY'rK "X 1011-000-4.39-318 W6.7i mWaNkII(Mil PER 141.000-421-4100 533,50 °'22X71'RFC;AL FEE 101-000.420-000 $106.07 )51;UMST41C P'1IE 101.000.419.000 5110.115 STROMMV11 ON ME - RF31P 101-000-241-000 Sam 011W. IMC FRE to DP.V'P1X)PER JMPA,(',T FEE $1,907. DO 11WSFIX PLAN 101 »$1t3L-441.345 5100.00 SM.-. C0149'1�'t3C'S.Old ,1"�N1.0 3?�..AM CTC 1C: ffOCt22 "n':3so. 25 2001 ms PPX_PAMFKM v,v0 CITY OF LA QUINTA TOTAL F' 1I,1' lirl E'S DW,' NOW camamC'- TDEPT RECEIPT DATE f BY 10/ .� 1 IF DATE FINALED INSPECTOR -? J �.. I INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings ? f.O Underground Ducts Ducts Slab Grade _ i Return Air Steel Combustion Air Roof Deck/�� 3 -'O jg�' Exhaust Fans O.K. to Wrap F.A.U. Framing Insulation _ til' /?� Compressor 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 POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Ptbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines _ _ 5'� Heater Final Water Piping �L(p- �� Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection L —off 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 `Final /—'f 02-- Utility Notice (Perm) - ZZ _ 2. 11I1MIiIrWM 1. P.O. BOX 1504 APPLICATION ONLY Building 78-495 CALLE TAMPICO Address Rte" J 3 > > - /z.i . %/f_' d/1/ / />�- LA OUINTA, CALIFORNIA 92253 Owner \ O �W 4,11111 Mailing Address 17 j, City ZipJ Tel. Contractor Address City Zip Tel. State Lic. & Classif.f� City Lic. # ,s- t,` Arch., Engr., Designer Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am Ilcensed under provisions of Chapter 9 (commencing with Section 7000) of Divisioh 3 of the Business and, \Professions Code, and my license is in full f7e and effect. ! ` -• .C`�% ,/ SIGNATURE '� r'-jr DATE OWNERBUILDER DECLARATION I hereby affirm that I am tixempt,fiom the Qontractors License Law for the following reason: (Sec. 7031.5,Business' and Pr67essions-•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). I,' 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: rhe 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 property, 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.) 1-1 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. 0 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 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 Address City, State, Zip LDING. TYPE CONST. OCC. GRP. . Number ? ? of I!" 1-':-0) �— 61 / al Description 2,- / 7 r ai �"� 7 7 -, Project Description SciFtJ 1 No. No. Dw. Size'` ,1/� Stories Units New,- Add O Alter ❑ Repair ❑ Demolition O Valuation PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS x 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 10/22/01 No. 22601 Owner NameDavid R. Miller No. 53-385 Street Avenida Herrera City La,Quinta Tract # BLK 225 Lot # 7 APN # 774-083-018 Jurisdiction La Quinta Permit # 0109-186 Log # zip 92253 Study Area Square Footage 1382 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 1,382 or $ 2,833.10 the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project maynow be issued Fees Paid By CC / Capital Bank of North County -JR. Rodriguez Telephone. r- Name on the check By Dr. Doris Wilson Superintendent Fee collected /exe pted by Annette Barlow Signature Payment Received $2,833.10 Check No. 084398 JOTICE: 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 ibove 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 Distdct('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 r 01/12/01 14:90 FAX 17608049062 ■ RECORDING REQUESTED BY: AND WHEN RECORDED MAIL THIS DEED AND, UNLESS OTHERWISE SHOWN BELOW, MAIL TAX STATEMENTS TO: David Ross Miller 1719 S. Tremont S. Oceanside, CA 90254 i¢ COMMONWEALTH TITLE _......._..:....... _... _...� 603 SPACE ABOVE THIS LINE FOR RECORDER'S USE The undersigned grantor(s)declare(s): Grant Deed A.P.N. 774-083-018 Documentary transfer tax is $ computed on full value of property conveyed, or ( ) computed on full value less value of liens and encumbrances remaining at time of sale, ( ) Unincorporated area: ( ) City of and FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, BILL RILEY hereby GRANT(S) to DAVID ROSS MILLER, a marz-ied man as his 'sole and separate property the real property in the City of La Quinr-a State of California, described as Lot 7 of Block 225 as per map recorded in Book California Dated September 4, 2001 state of California County of On before me, ,personally appeared BILL RILEY 55. County of Riverside Unit No. , Santa Carmelite. at Vale La Quinta, Pages mf Maps, Records of Riverside County, personally known to me (or proved 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 hls/her/their signature(s) on the Instrument the person(s), or the entity upon behalf of which the person(s) aclad, executed the instrument. WITNESS my hand and official seal. Signature MAIL TAX STATEMENTS TO, _ same a s a�Ave Signature of Grantor BILL RILEY Form 3195-4 (6-94) i THIS FORM FURNISHED BY COMMONWEALTH LAND TITLE COMPANY RC DISTRICT - PLANNING REVIEW FORM SEP - 20gj CITY OF LAQUINTA This form is to be used by CDD staff for review of single family dwellings n Rb*IR1Qd159pyA�TMENT 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. ///0 APPLICANT PACIFIC TRADES SITE ADDRESS APN 774 - 083 - LEGAL: LOT 7 53-385 Avenida Herrera G= 018 CASE NO.: 2001-547 BLOCK 225 UNIT S.C.@V.L.Q. CHECK AND APPROVED BY: wally Nesbit DATE: 9 Z/O / 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 sir is &5�4 Consistent with MDG on file (as applicable MDG filing required (5 filings since C2 ,C-/uiL 9/3/98) Architectural variety within 200 feet of v" the surrounding area: Colors US Si ••� �CAiL D:9i ��91rGi Materials Architectural design features Other Requirements: Planning City Commission - Tom munity Dev. Dept. =0 se o.l?L L91 .._. �._...._.. Eibit f1l ith Conditions c r s ,�,,, Certificate of Occupancy City of La Quinta Building and Safety Department J �14W OF 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: Use Classification: SFD Occupancy Group: R-3 53-385 AVENIDA HERRERA Bldg. Permit No.: 0109-186 Type of Construction: VN Land Use Zone: RC Owner of Building: DAVID R. MILLER Building Official Address: 1719 S. TREMONT City: OCEANSIDE, CA 92054 By: RICHARD KIRKLAND Date: 03-14-02 POST IN A CONSPICUOUS PLACE