0101-241 (SFD)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
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 (S:ic. 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.
f(;) 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:
Cartier Policy No.
BUTS MAM
(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.
Date: `f' ,t Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT "Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date 7
r'
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0101-24.1 TRACT
FLK1.79 U14
JOB SITE
APN
ADDRESS
°5:d-•'�a"�`5�kk"..t��f��.t:�W'@R13J�'1�!E
773-091- YAJ,
OWNER
CONTRACTOR /DESIGNER / EN (NEER
U A M TK S.8LE
TRM13 E COMST'RUC110N CO., WC.
60.6551IMN 7E 43
Wli-655 AVE,11WE 43
11;1' XO CA 92201
INDIO CAb 92201
P69)347.Y155 0-57.1t, 5291
USE OF PERMIT
'31rD & 13g LF X 9 81,OCK WALL PER CITY STANOA D P?Rt IT f iO"i
f3C1R` 1kdCrit<UOE P004PPA €2 T JI iYt'L�A;tLy #l'PPROA(ri�, �'r '1..At3
k`'€0, i *EDU CTI0A101d ISvtJANCZ? OF SAME X+1 XH TYPIte
TWT 111A110D O FIB
0 2 2001
0i11"c.W1df_'lallaa0RT (SF) ;;,310.00
9 Yee, WAU 130,00 LF
e
RY
YF.ka1T 110AMARY
PLAA 0JEC K is 101-M-439-318 g 1IX05
WE .0.9'90313' 101-0.00-4.39-:318 4250.0ID
ME.CHAWICAL IFEE. 1,01 -000-421 -000 MI."
9Y,1rCTPJ.f<''AJ,$VISA 1X31-0004'0-000 $1XM
Mm"'DING F. 101:,0991.419-Ud, 01 $124,00
S71'1�Cy1 d MOTION 1 ?L: • AHSID 1 31...Ca4)fl••:WI-000 X10.:7
6UDT1,i F�'�' _()00
DEV LOP1 R IMPACT i F �1,oitY Bl1
1'RIX1081'.3:,AX 101-000-441-345 00.441-345 $100,00
C0149TRUCT10141 PEE 101-004-4,8-000 $+5.11,00
t1IM-`I'MA`d.., C00MUC1ION MD FLAK C51EC K
$3,146.66
US$ M -PAID FBES
4250.00
RECEIPT
DATE
BYoA
Dpi INALE ,0
r`/ 2U
INSPECTOR
INSPECTION RECORD
y OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set BacksUnderground
Ducts
Forms & Footings
d'j
�C �
�_7
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
J=�Z Q
�J%
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
--g Ci�
�'j `,
Compressor
Insulation
s=� ��
�!
l
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final8f
3%1�7
Final
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
Electric Final
Waste Lines
//�� 4
t� 'f
S�
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
-//e
rj�
Pool Cover
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
vG2
-
5�
Utility Notice (Perm)
Z
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 1/26/01
No. 21572
Owner NameWilliam Tribble
No. 51-425 Street Eisenhower Drive
APN #
Jurisdiction La Quinta
773-091-021
Permit # 0101-241
Log #
City La Quinta zip 92253 Study Area
Tract # BLK139U14 Lot # 9 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 puilding.
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 ;T lephontz'-
Name on the check
By Dr. Doris Wilson
i
Superintendent
Fee collected /Lpted Annette Barlow Payment Received $3,651.05
Check No. 0503003979
Signatur
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
9bove 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
:oIlect 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
ORDER /Esc#600488-LCE
APN 773-091-026-0
WHEN RECORDED MAIL TO
r- William Tribble —1
Name 80655 AVenUe 43
Street
Address Indio, CA 92201
City
S
U
State
SIZE
DA
ZIP
NOCOR
SMF
MISC.
L.
J
DOC a 2000-372744
09/22/2000 08:00A Fee:29.00
Pape 1 of 2 Doc T Tax Paid
Recorded in Official Records
County of Riverside
Gary L. Orso
Assessor, County Clerk 8 Recorder
1111111111111111111111111111111111111111111111111111111
.M
S
U
PAGE
SIZE
DA
PCOR
NOCOR
SMF
MISC.
AM
A
R
I L
COPY
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 encumbralices remaining at time of sale.
( ) Unincorporated area:f?< ) City ofLCL .............Dal..✓-'................................................................I...........
( ) 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 9 IN BLOCK
139 OF SANTA CARMELITA AT VALE LA QUINTA, UNIT #14, AS PER MAP RECORDED IN BOOK
18, PAGES) 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, 20(
no .4r el)
STATE OF CZZKMMIAC9
COUNTY OF Ot-
or, JUNE 15, 2000 before me, the
undersi ned a Notary Public in and for said State, personally appeared
JOH F1'. HUFF AND DONNA HUFF
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 my haad and official a 1.
Signature _
Name
(typed or. printed)
FTGLS-140 8/94
Donna' Ruf f
OFFICIAL SEAL
�'� BILLIE HALL
NOTARY PUBLIC -OREGON
COMMISSION NO.324344
MY ,RES JUNE 14, 2003
MAIL TAX STATEMENTS AS DIRECTED ABOVE
(This area for official notarial seal)
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 Tribble Construction
SITE ADDRESS 51-425 Eisenhower Drive
APN 773 - 091 _ 021 BIN NO.: CASENO.: 2000-375
LEGAL: LOT 9 BLOCK UNIT S.C.@V.L.Q.
CHECKED BY: wally Nesbit DATE: iz �a grz
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
,/
N/A
Case logged and number assigned
Verify legal and APN information
oi^ ^41? 61 SI bo -'ts Jorr�.�t70NN^ /t(JpF
Consistent with MDG on file (as.applicable
MDG filing required (5 filings since 9/3/98)
,/
0"1 Icier£
Consistency with street/surrounding area:
/V011 S Colors
Materials
Architecture
?
Ivor eA-i-v£o aw r
,/
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[].City
Initials
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ad by,sa
Plan
Com
ping Commission
vuneil
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Ln+uurt
With Conditions
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I
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
51-425 EISENHOWER DRIVE
Type of Construction: VN
Owner of Building: WILLIAM TRIBBLE.
Building Official
Bldg. Permit No.: 0101-241
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