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0101-242 (SFD)
LICENSED CONTRACTOR DECLARATION T 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 4558303 n Date ' ' -4 • 2) Signature of Contractor 4-• r 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 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My wurkers' compensation insurance carrier & policy no. are: Carrier Policy No. (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: 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. I 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--!• BUILDING PERMIT PERMIT# DATE VALUATION LOT TRACT t41 3.3 10 ]BILK] 39 Ul4 JOB SITE APN • ' ADDRESS M OWEM DEM _4A SENH 1173_09144M OWNER CONTRACTOR / DESIGNER / EN INEER 'r`3't�l'�m C;t:imf.VVtis"c'1. oy Co., 80••'65:5 ,NVENUE 4.3 430-65:5 AVENUE 43 W.D10 CiA 92201 IRMO CA 02201 (760)3,d1-.9755 C'13110 5291 ` USE OF PERMIT. SMIi' FAVI eY I V'l.kiLMIG S1'i.) 0. IYJ LFA .7f,, 5' Ila CK WA.LL.AS PXTZ CITY STANDARD-PEPLIVIT WKS NOT MC"L1SM F"i.31:°i.LdSPA OR MMEWA.Y' APPROACH, 7%153. AN C118C,K ME 1 EDUC )'1014 ON ISSUANCE OF SAME PLAN TYPE. FIL78 0 2 2001 TRACT CONSTRUCTION 1.7aim 3F ✓ T � ' �� �4ARAOWC,Ai?.}�7RT (Sf) 9,311J.00 r 5 FT, WHAM 1.30,00 ly 1 K �s .'.irD cltosf OW t'01�11�":1.��. U1709 1(M;32 AW i�//rye�y� ��u�•g,,rr1�� �1gy��':�.A PERM '!f'.DkX S'1JUA'�! IA'AR'� 1'LA?1 ME=IM 103-000.439-318 $11IMI PUP, rilffICISIT 101-000-43 -318 42$0.00 M'ECIMN3CAL WE 1014M,421-000 ,5,50 aCn;ra.PLIF F`I��t1+��113}Y•tI§ 1�1r,3 1431 �'t�t)43-�'! �<Ct�JO 31:1`i,Ctp SS'iry'I;p':!?�y1+10 �5gf3'I�/'1�CFhi ,", Z? d RESiD fit p0yyt-00/0-24y1-(0}}r00 p$fyf9l.'/��7 1140 i)ZVI?I*W 'E111MPACT F ;' $1,907m lFm." ss p1dol 101-000447-345 316010D C0` STRUCT 014 Fi.s. 1©1 Ur3Q-�1.1�3 BUtD �fi7i.d40 SU.I' -11arAL COMYi:-rurMTON -AAND Pi" �°.�•�.t4tr� X71 � i �•�.�a�1 .:l't.'L.f'2L FE8.•e.MU SLYKES D't!L`.NiiiY'Y M2 91. ,66 RECEIPT DATE C BY3 a "1A /A DATE FINALED INSPECTOR I 1 s-.�t`� R INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings _ _ � 7 Underground Ducts Ducts Slab Grade Return Air Steel Combustion Air Roof Deck -6 / 57 Exhaust Fans O.K. to Wrap S/- yi --cTt 'S7 F.A.U. Framing O 9'7 Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath _ C Drywall - Int. Lath Final Final POOLS - SPAS BLOT WALL 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 Water Piping / lcy// cS e_:S Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection y/Y-m / J7 Encapsulation Gas Piping 5% 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 1,4- Final Utility Notice /1 Zn96-If (Perm) Notice: Document Cannot Be Duplicated Date 1/26/01 No. 21573 Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE APN # 773-091-022 Jurisdiction La Quinta Owner NameWilliam Tribble No. 51-445 Street Eisenhower Drive City La Quinta zip 92253 Tract # BLK139U14 Lot # 10 Type of Development Single Family Residence Comments Permit #0101-242 Log # Study Area Square Footage 1781 No. of Units 1 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 ptoject may now b� issued ' Fees Paid By OC - Wells Fargo & Co. - Willaim Tribble ' T>ele hod6 Name on the check By Dr. Doris Wilson Superintendent Fee collected /exemp ed by Annette Barlow Payment Received $3,651.05 Check No. 0503003980 Signature �•0 K� 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 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 collect them on the Districtf 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 U00RDtUAE3i [jLE M ORDER# 504851 /Esc#600489-LCE APN�3-091-022-1 WHEN RECORDED MAIL TO r William Tribble Name 80655 Avenue 43 Street Address Indio, CA 92201 Address City State Zip 1. J The undersigned grantor(s) declare(s): DOC a 2000-372743 09/22/2000 08:00A Fee:29.00 Page 1 of 2 Doe T Tax Paid Recorded in Official Records County of Riverside Gary L. Orso Assessor, County Clerk 8 Recorder I IIIIII IIIIII IIII IIIIIII III II III 1111111 III illll'llll IIII M I $ I U PAGE SIZE DA PCOR NOCOR SMF MISC. l A R L I COPY I LONG I REFUND I NCHG I EXAM Grant Deed V Documentary transfer taxis $ 19.25 ........................................ ( X) computed on full value of property con0 veyed, or ( ) computed on full value less value of liens and cumbranc remaining at time of sale. AM ( )Unincorporated area: () City of . . ............................................................................................................. ( ) 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 10 IN BLOCK 139 OF SANTA CARMELITA.AT VALE LA QUINTA, UNIT #14, AS PER MAP RECORDED IN BOOK 18, PACE (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 OF COUNTY\O'F4 U (. On VvL Lo 00 before me, the undersigned, a Nof4y Public in and for said State, personally appeared JOHN W. 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 %hand and offici al. Signature Name i1S (typed or printed) -140 &94 - Donna Huff �)o OFFICIAL SEAL I BILLIE HALL NOTARY PUBLIC -OREGON COMMISSION NO. 324344 MY COMMISSION EXPIRES JUNE 14, 2003 MAIL TAX STATEMENTS AS DIRECTED ABOVE (This area for official notarial seal) _ _,_ 1. 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 51-445 Eisenhower Drive APN 773 - 091 _ 022 BIN NO.: CASE NO.: 2000-376 LEGAL: LOT 10 BLOCK UNIT S.C.@V.L.Q. CHECKED BY: Wally Nesbit DATE: Z fZ 8% 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 VZ Verify legal and APN information r/ °"'''''¢S usrfo "5 Consistent with MDG on file (as.applicable MDG filing required (5 filings since 9/3/98) oN t=ic.0 Consistency with street/surrounding area: yoS- Nis Colors Materials Architecture �j Vol- cm&Eo cru T .4o°Q� �T�'� �or•s•sr�,�.r ,..r�rf C/T'`r Gvia6 tiNgS Ce�NO�noNS i V. � cOtiPirn1344- 60"ILS- 2. Vf,¢iF7 d7 Alftitrvr 0 L�l rov d b • t Planning Commission City Council �~ Community ev. ep ials Exhibit With Conditions