0104-030 (SFD)H
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F • 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. DateetYfr R
ate - r Signature of Contractor
OWNER -BUILDER DECLAF ATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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.
�( j1 I have and will maintain workers' compensation insurance, as required by
So;-, on 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.
cP� 1;;TAPU 229.0 UNIT' W) M90
(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 Sec on 3700 of the Labor
Code, I shall forthwith comply with those e�roy' inions.
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 Buil
for a permit subject to the conditions and restrictions s
on hisn
application.
►�
1. Each person upon whose behalf this application is made &
p rson at
whose request and for whose benefit work is performed unde
pu uant to
any permit issued as a result of this applicaton agrees to, &
11, in emr*PR
& hold harmless the City of La Quinta, its officers, agents
em loyees.
2. Any permit issued as a result of this application becomes
ull an void if
work is not commenced within 180 days from date of is S
ance a su Ty
permit, or cessation of work for 180 days will subject permit
o cancellation. FIN
I certify that I have read this application and state that the above In orma Ion 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
thh/e6ove-mentioned property forinspection pur oses.
gnature (Owner/Agent) II ; .f Date
BUILDING PERMIT PERMIT#
DATE VALUATIONLOT TRACT
S�
JOB SITE
APN
ADDRESS 39 1-M IMAM 9MOX" .DRIVE
77,34,75-004
OWNER
CONTRACTOR / DESIGNER / EN INFER
i .Pn Ct'JMT'RUC T109 CLIN
PAZ £,`0MMCTC;'itON CO
52-5195 MMIDA:WDOZ,
52-M. d4 ?A •NUS ZA.
LA+ '(3ItT.M. ':A 92253
LA QUIN'1.A CA 9225:
(760)564-30n r'S.tX 5537
USE OF PERMIT
SM, - IMMIT VM NOT [14CL#)DE Sf.ZOK' �1°1ALIJPMA. PA OR.
,r���i��.��� Y;.�1Z.T�':AY' - lt•1 h�r�� k Rl`� 9;T .
7'h.11tCT C:ORSTRUC"` ION 1,02,00 OF
PORGktlt? A T,10 90.00 ZIP
t'TATtA E/CA1Q.POTt.'T ) 9,014.80
$ Vt. WOOD M11,NCa 200.00 L
.P.MulAIM) CONT M? C-OWYMUCIMON
:�U,TITR SUMMARY
q 0 q -*000-4), i -OVO
CONay RUC -.70 11.y9.11 2i�q$.YM
PLP.N CHECK M, 101-000-439-319 $308.55
MEURM410.41, YVE 01-000.421.00D 953,50
TT I •tEr"TR ICI t 11 MEZ 101-0(0 -420-000 $130.98
l.rfi„s T)1�i41' F121 101- M.-419-000 5110148
!r1'R0 U f 4a1'1O'N FEE : RMD 101- 00-2A 1-000 $9.30
lvpT�g.[LIA,I'119p�'��}�f�1181 101. 00-423-000 0.00
p$
Alf ACT fl3 pt
no
P12, >C3F3 : PLMt 101.0840.41.1.345' $100100
1011-000-439.31$ •��ad1.T?0
0
.
' 3 T'MAL C:c"1k3S1"y%ti iMOW AND RLM O£il%'CIX
$3: 4—%06
2 3 2001 F.
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NOW
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4ke,C1A 6106
01196106
F LA QUINTA
NCE DEPT
1 2
RECEIPT
DATE
BYE,,.
DATE FINALED
INSPECTOR ,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Q�_
Underground Ducts
Forms & Footings
_ _�
l/
Ducts
Slab Grade
Return Air
Steel
Roof Deck
_
-v`
7 ,
Combustion Air
Exhaust Fans
0. K. to Wrap
_
�2
U��
F.A.U.
Framing
_��p?
7
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
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
Heater Final
Water Piping
/ _
y
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Y_�.7_ p (
5 �%
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
Utility Notice (Perm)
4 4 "
P.O. BOX 1504
Building / 78-495 CALLE TAMPICO
`Address±A QUINTA, CALIFORNIA 92253
Mailing —
Address
Clow
Address
id- (90, ttr* I `i'Ll-6S I n�eA -2
& Classif. 5 q 4, I Lic. #
Arch., Engr.,
Designer
Address Tel.
City ZipI State
�.
0Q.0"'. t.'L253 Lic. #
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
IM,
SIGNATURE DATE
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, after, 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
lot the alleged 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 contractors) licensed pursuant to the Contractor's License Law.)
1-1 1 am exempt under Sec. B. & 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
f7 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.
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 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
ateMailing Address
City, State, Zip
312,2-, P'Ee 5e_�7
.)e B ( CJ_
APPLICATION ONLY �- I
P�
BUILDING: TYPE"CONST. 11 OCC. GRP.'
A.P. Number �1 f 1,-- Boot--- 4
Legal Description Unl_ - ?lo
Project Description U I to L" a Z --
Sq. Ft. No.
Size 1501 Stories
New OV Add ❑ Alter ❑
on
No. Dw. '
Units
Repair ❑ Demolition ❑
PERMIT
AMOUNT
Plan Chk. Dep.
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 Setbac
FINAL DATE
Issued by:_
Validated by:
Validation:
WHITE = FINANCE . YELLOW =APPLICANT
D Permit_
BAR 2 1
LCITY OF 1A OUINTA
FINANCE DEPT
PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Date 4/23/01
No. 21923
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
APN # 773-175-004
Jurisdiction La Quinta
Owner NamePaz Construction
No, 51-820 Street Eisenhower Drive
City La Quinta. zip 92253
Tract # Lot # 20
Type of Development Single Family Residence
Comments
Permit # 0104-030
Log #
Study Area
Square Footage 1,492
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 1,492 or $ 3,058.60 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/ Valley Independent Bank - Agustin Paz Telephone
Name on the check' ,
By Dr. Doris Wilson r
Superintendent
� y `
Fee collected /exempted by Arlene Garcia Payment Received $3,058.60 ' 6 f" t
Check No. 244494
Signature
NOTICE: Pursuant of Assembly Bill 3081 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
collect 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:
CHICAGO TITLE COMPANY COMPANY
10661KY 017-055084
WHEN RECORDED MAIL THIS DEED AND,
UNLESS OTHERWISE SHOWN BELOW, -
MAIL TAX STATEMENTS TO:
AUGUSTIN PAZ
and EVA PAZ
52995 AVENIDA MENDOZA
LA QUINTA, CALIFORNIA 92253•
GRANT DEED
LINE FOR RECORDER'S USE
773-17570047.4 & 005-
c�'
The undersigned grantor(s) declare(s):��W Ql%Q
Documentary transfer tax is $52.80
(XXX) Computed on full value of property conveyed, or
( ) Computed on full value less liens and encumbrances remaining at time of sale.
( ) Unincorporated area: ( ) City of , and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
JAMES L. MONTGOMERY, TRUSTEE,
hereby GRANTS) to
AUGUSTIN PAZ and'EVA PAZ, husband and wife as joint tenants
the real property in the City of La Quinta, County of Riverside, State of California,
described as:
Lot 20 and 21, Block 117, Unit #12, Tract Santa Carmelita at Vale La Quinta, as per map
recorded in Book 18, Page(s) 79 inclusive of maps, in the office of the County Recorder
of said County. -,J.
Dated 'January 10., 2001
State of California
County of
On
before me,
personally appeared
) S.S. JAMES L. MONTGOMERY, TRUSTEE
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 w-ithin instrument r 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 hand and official seal.
Signature
•:....MAIL TAX STATEMENTS TO:
s
�
1 ,
(This area'for official notarial seal)
T-
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 Buie pWAb €%partment as your
correction list. Please attach additional explanations as necessary. 3 �( TE)
APPLICANT PAZ CONSTRUCTION ASSIGNED TO-- -
SITE ADDRESS 51-820 Eisenhower -.D •rive
APN
773 _ 175 -//004 BINNO.: CASE NO.: 2001-428
LEGAL: LOT 2 BLOCK 117 UNIT S.C.@V.L.Q.
CHECKED BY: Greg Trousdell 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 n�hers.
REQUIRED ITEM
Y
N
COMMENT/CORRECTION
Compatibility Review
Case logged and number assigned
cs j of
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: �,
t ;
p`� ov ��O ,
�
Colorsgot—
G
Mm
Cal'
onduon9
Materials
Architecture
Other Requirements:
.�
v
G�IVI-) YL-
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
Occupancy Group
51-820 EISENHOWER DRIVE
SFD Bldg. P.6rmit No.: 0104-030
R 3 Type of Construction: VN Land Use Zone: RC
Owner of Building: PAZ CONSTRUCTION CO
Building Official
Address: 52-995 AVENIDA MENDOZA
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 08-13-01
POST IN A CONSPICUOUS PLACE