0009-060 (SFD)m
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LICENSED CONTRACTOR DECLARATION
I heieby 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
'^)
%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 Signature of Owner .
I,
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.
(,N),, 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.
iTATIF, FUND 22 .009671
(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 forthwith comply with those provisions. -
die: 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 herebyy��,uthorize representatives of this City to enter upon
the above-mentioned property for inspection purposes...
/Signature (Owner/Agent) date l�
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
i
JOB SITE ! W
APN
ADDRESS
4.460 ,m TDA , =R
'774-2.14-M
OWNER
CONTRACTOR / DESIGNER / ENGINEER
S C1cam'SY,I A CA 92054
1d Q%Tarm CA 92253
(760).564-1866 CB1.10 859
USE OrF�PERMIT
J
?MV Y 1lis:io •r.�J�lTsr�.M'� A�AAA.iYni
S7+i! • f7l�, IT' .00ES NOT 11tlE;.f U 71; 8L0C X' 17y.Ai.:U1rC�Sll..l�7�:1 l' K AY
APi'11O1i,CO
TRACT CONSTRUCTION 001.00 UP
i�CYIiCfI M`ll'1C1 39.00 91�
CI.Fa,1!'at;Si�lO+P►i�I'OI3T ��1� �,Cs�T4.�U.
.
5 ?T. WOOL) FENC I 7,00.00 1Y
Y COST Orl �'Od�'�v"!'.� I C°`,CtGN,
93 l o
77 77LLYYyy��,,pp//��((�� 'Yy�y, r� ♦ pXS"�1fa�1
d:�.Ca14.S O*' TJ�.lLF i TiMMAR
VO1�FSTRUC:°1'1OA71'. R 101 -000 -418 -WO O 56.12130
'PLAN C;IIW.K FEE 101-Gf:3U'439-318 $513.45
MI RCHAVA ° lFFE 101•,13530.421.000 $60.00
F'JAMTRICAL. FTZ 101.000-420-0W $131,30
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PLUMBINO 1 ,I✓ ] 01 -000-4119-0 00 8110179
o
V1TO:NOMOTION 0'24.,•, VMS) 101-000.241-000
ORAWN0 RM 101 _0530--4213-000 U0100
l;, lF?ErELt:1YE,iE' ]1'dlRACT FEKE $1,907.00
PRRMSE Pl kta 10.1-000.441.-345 $100.06
V
PE :1:3"EPO91`f 1(3! • 000-439-319 / .112150.00
C7
M16 -TUM, COMM. C�C`I CG1�F,L.f1i:i LAM r—MA-.1:
$3,464.:31
�.�YR3�.:i�.�.d.1�»if'.�%1�1�.�'�-.�.:
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.f OYJ,StiL S..k:r'�L:.1 . 1'-F:s:N &e�'UE HO
RECEIPT
DATE
BY /' )
DATE FINALED
INSPECTOR
k� .
.7,.', �.��
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_
57
Underground Ducts
Fors & Footings
Ducts
Slab Grade
-
Return Air
Steel
Combustion Air
Roof Deck
!(- - 6O
�7%
Exhaust Fans
O.K. to Wrap
/'?)O d0
:%
F.A.U.
Framing
l2, -!C04_
g%
Compressor
Insulation
I Z -(o-00
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
S7
Drywall - Int. Lath
Finalof
�/0
5�
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs V ��
(O —(L- OD
$ T
Electric Bond
Footings
�O%l7�Oo
Main Drain
Bond Beam
S7
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
2_ Q
�t
5'
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_ _
_�j
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
O — L 3-00
s'7
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Per). _-q",pip �
S
6-boI—off
Building
Address
u�lttcv
P.O. BOX 1504
78-495 CALLE TAMPICO
L C1-
L25eMl QUINTA, CALIFORNIA 92253
Owner—
k
Mailing
Address �%'
City Zip Tel.
Contractor
Address
City Zip. Tel„ ._
l� C"i +fit --7 -7 C ?j -, L4 r '
State Lic. City
& Classif. Lic. #
Arch., Engr., 4
Designerti.X-t(
Address- - Tel
City Zip, State Jr
'-7 -7 2 Lic. # C
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 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 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).
I: I, as oner 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 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.)
1*1 1 am exempt under Sec. B. 8 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. ❑ 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.
Dale 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
V V
� Id � �24
APPLICATION ONLY
.DING: TYPE'CONST. OCC. GRP.
Number -rr? � ' '2 1 T - UU �'Sr
I Description l �� r I �" - L. 2_.�Zi
mt Description 11/E-VJ Sr x--,6teE 77 *1 f z-`7"
�C'axG.
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
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ,5< Add ❑
Alter ❑
Repair ❑ Demolition ❑
14
Estimated Valuation
PERMIT
I AMOUNT
Plan Chk. Dep.
>C) r .C,
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
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
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 10/5/00
No. 21052
Owner NamePacific Trades Construction
No. 54-160
City La Quinta
Tract #
Street Avenida Herrera
Lot #
Jurisdiction
APN # 774-214-008
Permit #
Log #
Zip 92253 Study Area
Square Footage 1501
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 1,501 or $ 3,077.05 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 - D. Miller Telephone
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Ellen Patino Payment Received
Check No
Signature CrJ )
$3,077.b5
19309
40TICE: 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
rbove 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
JUL.25.2000 2:49PM COMMONWEALTH
RECMINO REQUESTED BY:
CRICA00 T M 9 COMPANY COMPANY
10200KC 207067108
W"��
DAVID ROSS MILLER
1719 9. TRI■ ONT
S. OCIANSIDN, CA W34
GRAW DEED
itio.7e0 P.sii
Is4 - l (110 4,✓, [%e aegvA
IS LINE FOR REC/4-214-006
O DER'
The undersigned grantor(s) dealate(S):
Documentazry transf r ax is ¢19;28
(XXX Computed on full value of property conveyed or
( ) Computed on full value la a llene 4nd encumbrances remaining at time of sale.
( ) Unincorporated area; { S City of and
FOR,"A VALUABLE CONSWERATICN, reosipt of which is hereby acknowledged,
THOMAS AQUINAS COLLNGS,
hereby (3AANT (S) to .
DAVID ROSS MILLXR, A MARRIED MAN AS HIS SOLS AND SEPARATE PROPERTY
the real property in the City of LA QU=NTA, County of Riveroide, State of California,
described ea:
Lot 17, shock 282, Unit No. 26 „ pact Santa Caxmelits at Vale La Quints, as per map
recorded in Book zoo Pags(s) 50 inclusive of maps, in the office of the County Recorder
Of said County,
Dated July 25, 2000
State of California
County of
On
before me,
personally appeared
r
personally known to me (or proved to me an
the basis of oatiSfactory evidenCS) Co be
the person(s) whose name(a) ie/are subscribed
to the within InStrument and aCknowiedged to
me. that he/she/they executed the same in
hie/her/their authorized capacity(iea),,and
that by him/her/their sipnature(s) on the
instrument the"Berson(s),.or the entity upon
behalf of which the pvreon(s) Gated, executed'
the instrument.
WITWESS my hand and oftieial eesl.
Signature
MAIL TAX STATEMENTS TO:
01
THOMAS AQVINAS cozy AGrk
BY
Name/Title
BY_
Name/Title
I
(This area for official notarial seal)
S83;IC89 83hh03 NVVV:/ 0002 '9 d9S
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, in order to determine the applicability of compatibility issues or need to require the filing of Master
Design Guidelines by the applicant. It shall be transmitted to the Building and Safety Department as your
correction list. Please attach additional explanations as necessary.
APPLICANT LENDEL VENTURES
SITE ADDRESS 54-160 Avenida Herrera
APN 774 _ 214 - 008 BINNO.: D CASE NO.: 2000-310
LEGAL: LOT 17 BLOCK 282 UNIT S.C.@V.L.Q
CHECKED BY: Fred Baker 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
Compatibility Review
Case logged and number assigned
Verify legal and APN information
Consistent with MDG on file (as.applicable
MDG filing required (5 filings since 9/3/98)
Consistency with street/surrounding area:
Colors
Materials
Architecture
Ar,
R
ROVEO 8Y CO MUNITY DEV 0
ATE
IBIT
Other Requirements:
s
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 comp/iance ,with the various ordinances
of the City regulating building construction or _use. For the following.
BUILDING ADDRESS:
Use Classification: SFD
Occupancy Group: R 3
54-160 AVENIDA HERRERA
Bldg. Permit No.: 0009-060
Type of Construction: VN Land Use Zone: RC
Owner of Building: PACIFIC TRADES CONSTRUCTION
�d%
Building Official
Address: 1719 S. TREMONT
City: S. OCEANSIDE, CA 92054
By: STEVE TRAXEL
Date: 02-19-01
POST IN A CONSPICUOUS PLACE
Him