0206-155 (SFD)!y 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
C4 to Professionals Code, and my License is in full force and effect.
jLicense # Lic. Class Exp. Date
w 0789540 11311 3
6 Z r- 1 Date Signature of Contractor
J
I. -
to
OWNER -BUILDER DECLARATION
HWa I hereby affirm under penalty of perjury that I am exempt from the Contractor's
C License Law for the following reason:
Z ( ) 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).
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
N Date Signature of Owner
ON
t — Q WORKER'S COMPENSATION DECLARATION
p X I hereby affirm under penalty of perjury one of .the following declarations:
Lo FQ- 0 () 1 have and will maintain a certificate of consent to self -insure for workers'
XW compensation, as provitled for by Section 3700 of the Labor Code, for the
Oto _J Q performance of the work for which this permit is issued.
Q () (,)/I have and will maintain workers' compensation insurance, as required by
Q U Section 3700 of the Labor Code, for the performance of the work for which this
Il LO HQ permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Canierf,,sjTS lgyWD Policy No.
co f1 gpD00?:,t?227
0
g (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 shoul become
3 subject to the.workers' compensation provisions of Section 370 f the•Labor
Code,%I'shall forthwith comply with those°protions. ,
Date:Y
Applicant—
Warning:
pplicant Warning: Failure to secure Workers' mpensation coverage s 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. y
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/Agent) Date �! A
BUILDING PERMIT PERMIT#
02 -06 -INS
DATE LOT TRACT PL 23!3 U22
VALUATION $9%703.70
1 .24
JOB SITE
ADDRESS S3 7 D At 'flF7 ML e til
APN
774 l6� I�1.
OWNER
CONTRACTOR/DESIGNER/ENGINEER
AIL VaR' CAN •TYt" ME BUM) tMW UIC�d,111��
T�A�i' ��L��a? I�i'3i S Dlat�;� INC
76995FLORIDA,Ayk-2=
76993 ELDRIDA A'M,r'�AM
PIKU6 0&MIT CA' 92211
PALM.CA//'44((5���;1�M��211��•
(760).L�lid°��S27I7 CMIN - 6M5
i
USE OF PERMIT
aT.1itlOAeG1,`,f•-i[7RLi.e=2F O7'lE aL:190
r -
;r.tyll: LOT 211, POOLSPA
felt'�rlL3ilL dA. ,A FI€. �G�;f :' siirii tti'CC� itS F IF' Fi �ltst3 �9 �.£' :[: tort
U.A.C: §304. YOPZ SL"OU14'W/0 MUgt'!'.
:t PACT COMMUC'1It7A1
k1ki f /f>:��II?d 141.00 Sir
?
t'SARA+:tFX.!►PUPORT
ESIMMY.D (110117f OF C0108111RUCTION
"1 98303.70
PK9.iT :9" IT& 81" 1P
CONSTRUCTION RX 101.000.418.000 $0101,00
�nLAN i:tlOZIC rep, *539,93
fTIE T*PI"e.T 101 -4 00-43M I8 4760100
taiqqf�`VVgif•..�iyrryt�;L Iy {� 1. �E?/i��dA
.
ry21ry-�iy8ry3C�t ��5�p��0•.
Ri�C TTryIC—A..1.I ,1 t�dAy ! "'l!V��"W641aViiM1l JI A�,e�Q
1?1..UMBINCI r if 2�Qf311 i9 -0(t4 $ISfi;.f1G
STRt'3 M MO'.iiON HE - LL ID 10..1 -0 00-24 37
ORAD -MG M 101 •-000-423-000 $15.00
DEVELOPOft IMPACT FEE $007100
PH,F ,*.1 el; PL,A1%1 101-.000-441-345 $199.00
INVE£i'I'.IOATIOIN FER ?01-0%)-4V-(=
SIIfk311I IL C.`'OM i.T.i R AIM PI.,1`19 CIW,' o.
$40311.37
X11::;33 r :RE -PAID v:W
4250.00
• U
JUL11 70��
CITY OF LAQUINTA
FINANCEDEPT:
RECEIPT
DATIE
BY
1
DA FINA ED
16
EC O
INSPA1-1
V.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
_�/L_
_ Q —
Ducts
Slab Grade
,� /L�
Return Air
Steel
Combustion Air
Roof Deck
- Q
Exhaust Fans
O.K. to Wrap
O Z_
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
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
7 fid- O _
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Suver Connection
7 v, V djf.G
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 G' _
UU14 Notice (Perm) r j
COMMENTS:
Building �-my 4lo if /T V r
Address
Owner
P.O. BOX 1504 A PLICATION 0146
78-495 CALLE TAMPICO
,XJZ LA QUINTA, CALIFORNIA 92253 D b —ISIS'
Mailing
Address'y2- %7 3 5' t1J -res uGro,v :T F �1
City Zip Tel.
Contractor
Address
City jZip j T
State Lic. I City
& Classif. % l c/ .�— tf 6 Lic. #
Arch., Engr., ✓
Designer L y
Address Tel.
City I Zip I 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.
51GNgTURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors 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 bf Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (8500).
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: 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 (hat such iirrprovements are not intended or offered for sate. 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 contractor(s) licensed pursuant to the Contractor's License Law.)
it I 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
r7 Copy is filed with the city. ❑ 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., It, 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 io enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number %'7 y 'de
Legal Description L ° % V PJL�<' Z 3! V►t 1T ZZ
Project Description P D
Size t Z� Stories
New ❑ Add ❑ Alter ❑
No. Dw.
Units
Repair ❑ Demolition ❑
itimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
1141 If -L 0 fuul
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
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
Date 7/11/02 La Quinta, CA 92253
No. 23364 (760) 771-8515
Owner
All American Home Builiders Inc
Address
53760 Avenida Herrera
City
La Quinta Zip 92253
Tract #
BLK238U22
Type
Single Family Residence
Lot # No. Street
Unit 1 24 53760 Avenida Herrera
Unit 2
Unit 3
Unit 4
Unit 5
APN #
Jurisdiction
Permit #
Study Area
No. of Units
S.F. Lot # No.
1628 Unit 6
Unit 7
Unit 8
Unit 9
Unit 10
4C-v�iFzsc�o
o
Q BERMUDA DUNES r
C/) RANCHO MIRAGE
�i INDIAN WELLS
PALM DESERT
c}% LA QUINTA 4�'
��O
IN y�
774-164-001
La Quinta
0206-155
1
Comments Payment by: 1st Bank - CC64541 - $3337.60 and 1st Bank M040777 - $146.52
Street S.F.
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 (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that 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
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14 X 1,628 S.F. or $3,483.92 have been paid for 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. See Above - Mark Tuvell Check No. see above
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Crystal Scott $3,483.9.2 $0.00
Payment Recd . Over/Under
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
!G 4�EQUESTED BY:
Y itcal Estatc Consultants/Escrow
Division
AND WHEN RECORDED MAIL TO:
AND MAIL TAX STATEMENT TO:
All American Home Builders
76995 Florida Avenue
Palm Desert, CA, 92211
Order No. 524779
Escrow No. 01 -00708 -DS_
Parcel No. ,774-164-001
ISPACEI ABOVE THIS
GFZ INT DEED
THE UNDERSIGNED GRANTOR(S) DECLARE(S) THAT DOC
X computed on full value of property conveyed, or
computed on full value less liens or encumbrance
unincorporated area: OR City of La
FOR A VALUABLE CONSIDERATION, receipt of which
Evangeline Waldrip and Aileen Spann, as Co -Trustees of
hereby GRANTS to All American Home Builders, Inc., a
the following described real property in the County of Rive
Lot 24, Block 238 per Riverside County Assessors Parcel
22 on file in Book 20, page 24 of Maps Records of Rivers
Date 10/26/2001
Laura M. Bellocchi 1991 Family Trust
By: Evangeline Waldrip, Trustee By:
STATE OF CALIFORNIA }
)S.S.
COUNTY OF }
ARY TRANSFER TAX IS $34.10 and CITY. $
rem6ining at the time of sale.
)uinta and
iy acknowledged,
ra M. Bellocchi 1991 Family Trust, UDT April 8,1991.
iia Corporation
State of California:
4-164-001, of Santa Carmelita Vale La Quinta Tract Unit
unty.
Spann, Trustee
On before me, the undersigned, a Notary Public in and for said County and State,
personally appeared Evangeline Waldrip and Aileen Spann 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 au horiz6d capacity(ies), and that by his/her/their signature(s) on
the instrument the person(s), or the entity upon behalf of v fhich 16 person(s) acted, executed the instrument.
WITNESS my hand and official seal.
Signature
CHARLES D. GARLAND
CIM Architecture, Interiors, Space and Land Planning
Structural Calculations
3 May 2002
REVISED: 11 June 2002
The City of La Quinta
Department of Building and Safety
78-495 Calle Tampico
La Quinta, CA 92253
Project: A Custom Residence for:
All American Home Builders
53-760 Avenida Herrera
La Quinta, California
Regarding: Truss Calculations
To Whom it May Concern,
I have been supplied with truss calculations prepared by Spates Fabricators of Thermal, California for the
project noted above. Upon review of the calculations, the applied air conditioning- equipment loads and in
light of the structural design documents I find them to be in substantial conformance with the structural de-
sign intent as documented in the structural calculations prepared by my firm for the noted project.
If you have any questions or comments regarding these issues or any other issue please do not hesitate
in contacting my firm.
Sincerely,
No. 91199 c
l o 03
tA� XP. DATE
Charles D. Garland 4
Architect FOF CAL%
74-854 Velie Way, Suite 5 ❑ Palm Desert, CA 92260 ❑ Phone: (760) 340-3528 ❑ Facsimile: (760) 340.3728
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:
53-760 AVENIDA HERRERA
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction
Bldg. Permit No.:
VN Land Use Zone:
0206 -155 -
RC
Owner of Building: ALL AMERICAN HOME BUILDERS Address: 76-995 FLORIDA AVENUE
City: PALM DESERT, CA 92211
y By: KIRK KIRKLAND
Building Official
Date: OCTOBER 16, 2002
• Y
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