0106-165 (SFD)LICENSED PONTRACTOR DECLARATION
I hereby affirm under penalty of perjury -that I am licensed under provisions of
rR5
.pttN.e,' (commencing with Section 7000) of Division � of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class- Exp. Date
13 1,12f,
Datet) � �f F � Signature of Contracto�r��64r� �•'ri+�ti`;�'�e�1�&�
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,"Ito 6 nstruct the project (Sec. 7044, Business & Professionals
Code). 17
( ) I am exempt under Section B&P.C. for this reason
Date I Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one'of the following declarations:
() I haveeand will maintain a certificate of consent to self -insure for workers'
compensatepn as provided for by Section 3700 of the Labor Code, for the
performande 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.
k;,l4,EMPT
(This section need not be completed if the permit valuation is for $100.00 or less).
(y) 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 sh II forthwith comply with!those,pro Isions.
Date: F a :' Applicant\...kw�< "t, . 9i s^r� a 'y�l I... � a
s
Waning: 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 setforth 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/Agent)�`���4ltila ik�»DateF"+
BUILDING PERMIT PERMIT#
DATE / / .;VALUATION LOT ()106.-165 TRACT
U24 Al 0,11A A
JOB SITE Eti
APN
ADDRESS
521-90 E RfM.[6X.ti,.IS Yal3.i.'(Sw
(YVYiA"��YiVC7
OWNER
CONTRACTOR/DESIGNER/EN (NEER
MAV J & %r W. A IR0XA.
CAL, ri:CH ifL+."�'.�;!'.•t)PM1_--b 1' C010"ORAI i0w
75352 1'111531'�?')OW DI
'
DWIAN W&IS CA. 92210
(760)773-93-74 01DIN 0919
USE OF PERMIT
&W UILS F-Amn"t DWELLING
vyly�pC�l9:r. O
i�jY�yC b'VALi,�.`ri�pl3.C�3^Jflyi�li�C1gZ36�IVF”�fyLYg7�d:A�:jV�'^.,r1-;�1qr�1+?��'yL'3:�A�.C�1��,,7'i:�,1'��f PI,,(IpA1%;C9
yM1+f'T
Z% IT14..C''i1A, �`ELJICri;IAL &TV fA'� E M1'!Y{ %, FNCIAGFDNO THE R rl'dl�f�d`YCIERX0
CUSTOM CG'NSTF,i,UCT10E 4 01'QO v
��I�c�It�.4�.'r.�� • l,lf�,fii0 ��
CMAWCA!'wl''z;JRT 014.00 OF
'1'�,tLIr COW OF C:C.kfi9` 9UC1r1(yff
4,'24,1910X0
gRISV.
C'ON0 TRUNCT3ON PT, L
1 LAW CHECK FE �i�`y�-�a'p�GpEp?-�3°�-?3£� �tl,hCr3.f��?►
d'W, lis"PEPOSI!` 101r.O �° �:ii•.4 ..$},,fJOtf,��
IMEC:H A.*NIaAL tirlX 10 1 000-X3:21-000 $196.00
ELECTRICAL FRE 3,0, ° OQb-420.000 VV6.52
PLW03n4o FRE, 101-000-419-000 $266.00
efP,0 Q'h4C5 ` 0W FE% - 9011D 101-00044.14= $42,49
0}R.FiDlFiU RZ 101-000-423-000 $20.00
LREV9LOPER IMPACT W -Le $1,907,00
�Sb2.U9
,ART Ild PUBLIC Pl.ACRM - WWIE 2'70-000-445-000111=51
` � " �Ai���1:3'C'4SiJ�d llid��r 1:'I,A�' C3•�G�1:C
f6�.,�'32.
YAR -PATIO 1'1� MIS
]DI
-$1,00aoo
FLEP0 5 2001 YfAL P-MMEE'S VUR NOW
CITY OF LA QUINTA
FINANCE DEPT. �\
RECEIPT
DfS,E'
BY
DATE FINALED
INSPECTOR
e
INSPECTION RECORD
Z OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
/j�--
iJ
Underground Ducts
Forms & Footingsj-���`
•�
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
_
L��7 Q
�
Exhaust Fans
O.K. to Wrap
] y 02--
F.A.U.
Framingy
Compressor
Insulation
Vents'
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lathy=
jB= O L
Jv
fF--
D�rywal-lam- Int. Lath
ca—
L
Fl-
Final
FinalS'ZO
�2_ (�
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
Waste Lines
_
D�3/D/
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
/�/3/� ST
Encapsulation
Gas Piping
Gas Test
7
Appliances
Final
COMMENTS:
FinalG
/3,e��j�r`.' [/3 �oZ (, N_
Utility Notice (Gas) V2
s -J 1,1 C
ELECTRICAL
APPROVALS
► A° `
Temp. Power Pole
�^ a/ ('L� fZL�r
.Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
77. -1
Smoke Detectors
Temp. Use of Power
Final
Utility Nbtioe
-
]IRIA,
w
B u i 1 5 9
Address
P.O. BOX 1504 APPLICATION ONLY
78-495 CALLE TAMPICO
2aC LA QUINTA, CALIFORNIA 92253 o/n6 -/6�
Mailing
Address
City Zip Tel.
Contractor
State Lic.
& Classif.
Arch., Engr.,
Designer
Address
Zip Tel.
CC 7 '7_t ,o 1 `7 `% "Z
NN 0 // I Lic. #
Tel.
CityI Zip I State
Lic. #
LICENSED CONTRA11 CTOR'S DECLARATION
I herebyy afT�tm that I am licensed under provisions of Chapter 9 (commencing with Section
000) of Divisfoq 3 of the Business and Professions Code, and my license is in full force and
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).
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 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-
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.)
17 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. 3900, Labor Code.)
Policy No. Company
r7 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 if 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
employany 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 I
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
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is corre
I agree to comply with all city and county ordinances and state laws relating to build
construction, and hereby authorize representatives sof this city to enter the abo
mentioned property for inspection purposes.
Signature of applicant —Date—
Mailing
ateMailing Address
City, State, Zip
BUILDING: TYPE•CONST. i- OCC. GRP.
A.P. Number 17 O U 0 n n (1
Legal Description 7 L A C T
Project Description t rl C . L.
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
� IISide Setlpe f om Property Line
jed by:
JUbyl 4
CITY OF LA OUIN
FINANCE DEPT
INSPECTOR
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Sq. Ft. L1• C' No.
Size L tJ A iaL 4 _ Stories ,
No. Dw.
Units
New/ Add 0 Alter O
Repair 0 Demolition 0
f
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
�X j
Plan Chk. Bal.
r
Const.
F
Mech.
`s
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
� IISide Setlpe f om Property Line
jed by:
JUbyl 4
CITY OF LA OUIN
FINANCE DEPT
INSPECTOR
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 9/5/01
No. 22441
Owner NameMr. & Mrs. Matt Rocca
No. 52-905, Street Latrobe Lane
City La Quinta
APN # 774-340-006
Jurisdiction La Quinta
Permit #
Log #
zip 92253 Study Area
Tract # Lot # Square Footage 5021
Type of Development. Single Family Residence No. of Units 1
Comments
with guest house.
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 5,021 or $ 10,293.05 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 / Wells Fargo Bank - Lori Hatzopoulos Telephone
Name on the check'
By Dr. Doris Wilson
Superintendent
Fee collected /exem ed by Annette Barlow Payment Received $10,293.05
Check No. 7377003228
Signature7:i
IOTICE: 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
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 District('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
RECORDING REQUESTED BY:
Fidelity National Title Company
Earrow No, 3099 -CAH
Title order No. c� v( Sr0
When Recorded Mail Document
and Tax Statement To:
Mr. & Mrs. Matt J. Rocca
DOC N 2000-036660
01/31/2000 09:00A Fae:9.00
Pegs 1 of 2 Doc T Tax Paid
Recorded in Official Records
County of Riverside
Gary L. Orso
Assessor, County Clark 6 Recorder
.�_.__ ... i 111111 llllll llllll IIII IIII Illlf 1111111 III IIIII IIII IIII _.
• M 3 U I AAoE I aaE I vA PCCR NocOR MP wac_
A R L COPY Lana WVM I WHO V'm
GRANT DEED
The undersigned grantors) declares)
Documentary transfer tax is 9423.50 T
[ X I computed on •furf'vatue of property corweyed, orSIP -
[ I computed on full value less value of liens or encumbrances remaining at time of sale,
[ I Unincorporated Area City of Le Quinta
FOR A VALUABLE CONSIDERATION, receipt of which Is hereby acknowledged, TRADITION CLUB ASSOCIATES,
a Delaware Limited Liability Company
hereby GRANT(S) to MA-t.t J. Rocca, Trustee of The Matt J. Rovacable gust Dated September 6, 1990
as to an undivided 50% interest add Kimberly A. Rocca, Trustee of the Kimberly A. Rocca
Revocable Trust Dated March 27, 1996 as to an undivided 50% interest, as tenants in common
the following described real property In the City of La Quinta
County of Riverside, State of California:
COMPLETE LEGAL DESCRIPTION ATTACHED HERETO AND MADE A PART HEREOF MARKED EXHIBIT "A"
DATED: January 21, 2000
STATE OF CALIFORNIA r-
COUNTY OF 1!C
ON� -V
--before me,
ex ri/&66@NonalIy appeared
personally known to me (or pie -,ad to me-sR-th&basla
) to be the person* whose
name(O Is/ere subscribed to the within instrument and
acknowledged to me that he/•ebeA executed the
same in hisA mm4#wW authorized capacity(4e), and that
by his/4ep/Oweia- signature4e) on the instrument the
person(s), or the entity upon behalf of which the
person(•e) acted, executed the instrument.
Witness mMhaand official 1.
Signature
07
TRA/ei
B SSO I ES, a Delaware
L ty any
David Chapman L.¢uc�1
CHRLONA J. DOM
Contrnwon # 11274W
NotaY iftmiic , cadslg nft
Rlverwo Counly
1@WC=TMl5ph3&F9b2IX2W1
MAIL TAX STATEMENTS AS DIREC'T'ED ABOVE
FD -213 (Rev 7/96) GRANT DEED
RUG 15 2001 8:30RM CRL -TECH DEVELOPMENT CORP 760 773 4723 p.2
I—
E)MBfT "A.,
'LOT 6 OE'I`M,(;TWO. 2886'7,1N. TIM' . Y. GFIA:SU: tA�, r�-SUM .ay.
AP ON FILE IN BO.OK.276 _R S:&9 3t OUGH 79; `t:LbS
MAPOFMAPS,
RE�COkDS..OF RIVMSV)E.COUNTY, •.C.A ORNI-k.
7m CONVtY CE IS MADE AND ACOEyJTD AND SAID PRINERTY IS
HERF-gy'NIADE SUBJECT TO THOSE .CERTAIN COQ E . +, . I"f S.; :CO1aTDfi i0Ns
AM R£STRICTIONS -.CONTAIN-ED;.1PI :; .T . T CLARATION*.
RESTRICTIONS RECOROED:JLA.X,25; I9-9AS NSTRUA&NT;NO 26 77-
R�I JRA .Ai GUST f5; i93 hS : STRL T`€T N�3. 17�i }Ni3`MOIDIFIM
MAR�T.4 :}?, :1999. AS:,NS,T.,RU #EI T,NO.-Y-4162:19`AM:0F'01 LAL .RECORDS OF
RI RSB3E UAIT AL .' "°i F- BY TfUS".R UNCE ARE HER y"
.INCQRP ATED. ANV"* €D .A PART WMflF AS TI�4`E7rtH FULLY ,SET
FORTH[ MRM
..... .....:
�� f41J31C�68A8:89R
a
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:
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Cons
Owner of Building: MATTJ & KIM A ROCCA
Building Official
52-905 LATROBE LANE
Bldg. Permit No.: 0106- 165
Const V -N Land Use Zone: R/C
Address: 55305 SHOAL CRK
City: LA QUINTA CA. 92253
By: KIRK KIRKLAND
Date: 08/20/02
POST IN A CONSPICUOUS PLACE