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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
1558..8x13 B
Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under p-inalty 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.
( )„ I have and will maintain workers' compensation insurance, as required by
Sa ion 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:
Cartier Policy No.
ErFA E.FUNW, 1192664.09
(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 shallnot 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.
Dater 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 186 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 ielating to the building
construction, and hereby authorize representatives of this City to enter upon
the above=mentioned property for inspection purposes.
Sig ature (Owner/Agent) `";'"�" Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
E.C3€3 BUKI.49 Z114
JOB SITE
APN
ADDRESS
M -405 F1MMM ER DIMS.
; MWI-€ 7.0
OWNER
CONTRACTOR / DESIGNER / ENGINEER
90.655 A.3!2 -TUR 43
80-65-.% A, _E F 43
WD10 CA 92201
M10 CP. 92201
Q60)347.9755 CBL-# 5291
USE OF PERMIT
-
3.110 & 130 VX 5° BUD= 1t%G>LI., PX2 CITY ST.A.Affl.ARD.:PERMIT D0FIS'
NOT INCIAID r P001ASPA OR DRIVEWAY ASIPROAC H,
r1A!n
F``-9 ® 2 2@!;1
t1 C./ �n Yf t��}7 t/� i .1f�9 {
TRACT
•i !'lAA,/Mn b'.+pC C)s�yia�yd+.3LYJCT1014 .f � i/lY11000 S{
FC3RC1iIPA110 96.00 eS,f•
�� aU
0ARAM,IC.tARr-0R.'i' (81" 9,24)0.40
& FT. WAU, 130.0iD LF
F9.1,10J15.77.11D C4D T.C' OF COMMUC:°D01'4
II0.01,yS3.C3d7
AA +u%�d 1Al1y � RE 3 C11 a,M-421 -OM $60100
El:.frC T .£{1{;&L FIM 1,01 -(WO -420,000 $141.32
PLUMB= FEE, 101,-000.419.000 $116,%+
S'.i'RS N13MOTION PRE r }',.cI MD 101-000-x"41-0+00 $J1.09
C31;ADI,s0 VOR 101.,000-423.000 $20.00
PRj><.OR K. -MM 101-000.441®s45 $160.00
ART M PUBUC PLACES - :lid' 11701-000-2.55-1000 $37.29
PEE DEPOM 101.000.439. 1'8 424100
113-1ti.14 a] U* MtE 101-000-439-318 $440.70
?e.�["]`�I. S.��aTA.LJ' .�.Vltl �s R'l .W`✓rA4JJ.`E .A��yy lyyl��dit��+.��ijFMOXy
$},�.gq3'i/2ry.//95y
1M
��yy�
J.a1.�4f11.9 d-.L�.USIP�' ID L`3!ntw,L�Y
42 50.00
",4'Cif't#L NOW
$3,252,13
RECEIPT
DATE IBY/
DATE FINALED
INSPECTOR
r_< J��
.1
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
l��� jj —O /j
Exhaust Fans
O.K. to Wrap
t�-a.��0
e%�!
�7 •
F.A.U.
Framing
�-_� d/
Compressor
Insulation
Vents
Fireplace P.L.
`
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lues
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
_ I
� � �1 13!
Final
ll
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 rw" r !ROVtw_
Gas Test
Electric Final
Waste Lines
/ _
?/(`0 l
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
[
I
Equipment Enclosure
Shower Pans
_
t
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
�1�1C�..O
_
5 7
Encapsulation
Gas Piping
ff
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
Utility Notice (Perm)
Notice:
Document Cannot Be Duplicated
Date 1/26/01
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
No. 21571 Jurisdiction
Owner NameWilliam Tribble
No, 51-405 Street Eisenhower Drive
City La Quinta zip 92253
APN # 773-091-020
La Quinta
Permit #0101-240
Log #
Study Area
Tract # BLK139U14 Lot # 8 Square Footage 1781
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 1,781 or $ 3,651.05 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 OC - Wells Fargo & Co. - Willaim Tribble Telephone
Name on the check r -
By Dr. Doris Wilson
Superintendent
Fee collected /exe ted by Annette Barlow Payment Received $3,651.05
Check No. 0503003978
Signature
VOTICE: 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
above 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
}
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. ,-Z
APPLICANT Tribble -Construction___ _k
SITE ADDRESS 51-40.5 Eisenhower Drive
APN 773 - 091 _ 020 BINNO.: CASE NO.: 2000-374
LEGAL: . LOT 8 BLOCK UNIT S.C.@V.L.Q.
CHECKED BY: wally Nesbit DATE: /Z /2t3/90
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
r/
Verify legal and APN information
JU4*v1000V, -+ rruOr,�
Consistent with MDG on file (as.applicable
z/
MDG filing required (5 filings since 9/3/98)
Consistency with street/surrounding area:
Colors
Ot.�L oni3c-� :sit .�S
C VM C Aj,�t 4mt-f1 4kh--0 7V Materials
in f /g/ -s5 L154 , vy*L A -r- y
Architecture
No T G¢CI.Ep oLrr
Gs
2, v�/LcFfc�w.�f2dYriv ar
A r
ved
so #
j Commission
p Pl
O Ci
Cmmunity
Initials
ase
annin
y Colincil
No.
D v Dept i2 bo
Exhibit
With Conditions
4 RECORDING REQUESTED BY
"JR4 5b4849 /ESC#600487-LA
APN 773-091-020-9 •'KA O�-O ' 0/
WHEN RECORDED MAIL TO
r William Tribble —'
Name 80655 Avenue 43
Addreess Indio, CA 92201
City
State
Zip
DOC a 2000-372595
09/22/2000 08:00A Fee:9.00
Page 1 of 2 Doc T Tax Paid
Recorded in Official Records
County of Riverside
Gary L. Orso
Assessor, County, Clerk & Recorder
IIIIIIIIIIIIIIIII
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I LONG
REFUND
NCHG
EXAM
Grant Deed
The undersigned grantor(s) declare(s):
Documentary transfer tax is $ 19.25
........................................
( X) 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: ( Y City of L A .
........................................................
( ) Realty not sold.
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
John W. Huff and Donna Huff, husband and wife, as Joint Tenants
hereby GRANT(S) to William Tribble, an unmarried man
that property in RIVERSIDE County, State of California, described as: LOT 8 ;IN BLOCK
139 OF SANTA CARMELITA AT VALE LA QUINI'A, UNIT #14, AS PER MAP RECORDED IN BOOK
18, PAGE(S) 82 - 83, OF MAPS OF RECORD, IN THE OFFICE OF THE COUNTY RECORDER OF
SAID COUNTY.
Mail Tax Statements to Grantee at address above
Date
June 15, 2000
STATE O
COUNTY OF t
On "\km � . oqoo'a before me, the
undersigned, WT�Ktary Public in and for said State, personally appeared
Jahn W Htaff and Donna. Duff
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 his/her/their signature(s) on
the instrument the person(s), or the entity upon behalf of which the person(s)
acted, executed the instrument. ,
WITNESS -=y hand and ofdciAl seal_ ,.
FrGIS-140 8/94
(typed or printed) yy„
. AZLj__"o4
Donna Huff
OFFICIAL SEAL
BILLIE HALL
NOTAF+Y PUBLIG-OREGM
COMMISSION [NO. 324344
iNIM :;'^lON EXPIRES JUNE 14, 2003 '
MAIL TAX STATEMENTS AS DIRECTED ABOVE
OI
(This area for official notarial seal)
4.. S
--C 2 Of (2
9
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: SFD
Occupancy Group: R 3
51-405 EISENHOWER DRIVE
Type of Construction: VN
Owner of Building: WILLIAM TRIBBLE
Building Official
Bldg. Permit No.: 0101-240
Land Use Zone: RC
Address: 80-655 AVENUE 43
City: INDIO, CA 92201
By: STEVE TRAXEL
Date: 08-31-01
POST IN A CONSPICUOUS PLACE