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0104-088 (SFD)IW (44 W O d 'W �tYP oZt� �0o H 0 UJ LU a� Z Cl) N ON U °) CLa Z U-) QCr 0 X W. � m J Q QU lirnH Z_ ob' 5 C3 J 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 /591754 B1 C9 0611011.f; ate pSignature of Contractor 7 A 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 S tion 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: CarrierPolicy No. TAIL, FUND229.00 I',3fi133' 11011090 (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 shallot 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 slect to the workers' compensation provisions'of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. n gate: - j Applicant j 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 i for a permit subject to the conditions and restrictions set fo application. 1. Each person upon whose behalf this application is made & eac IL whose request and for whose benefit work is performed under or any permit issued as a result of this applicaton agrees to, & shall, ie & hold harmless the City of La Quinta, its officers, agents and a IC 2. Any permit issued as a result of this application becomes null nd work is not commenced within 180 days from date of issuan a of permit, or cessation of work for 180 days will subject permit to c ncel to ify AMc I certify that I have read this application and state that the above inf&FFRRI'QR *9 correct. I agree to comply with all City, and State laws relating to the building co struction, and hereby authorize representatives of this City to enter upon nth above-mentioned property f/o/r in pection purposes. Gignature (Owner/Agent) / 1 It A, Date If- BUILDING PERMIT PERMIT# DATE VALUATION LOT 0104.LW TRACT S89.335<10 21. X11?, l2. JOB SITE APN ADDRESS 51-80 F-twNHOMI'M DI.IMFI 773-175-005 OWNER CONTRACTOR / DESIGN RNEER A))I /VN11511�7vMW9CC) yAG.OrESSLiUCRO9 Co &� �:+y�AI�•1JiE OIN:29A>JiVEy�A ME LA. Qai LN.rA CA 5 21;33 1-4 L,7iwm CA 92121.3 (760)54asi.. 302 y C.B111 5537 USE OF PERMIT 15 !,et<AK'.LY DWELL40, SPU -. PftW1T DOJ? a 1,40',:' INCLUDE BLOCK WA11`4L4 DIiIVKWAAY.A.P)MO-��a7:,H OIR ,p°001, (MA9;rTf.A P%.KN 0-1) '1'l AC'! CONSTRS9'L°a'ION 11421,00 GFS' PORCHi'PATIO 36.00 F r FT.WC)OD FZNC;E 200,01;111-P UAR.P.0Z 510.00 V ,` ITY]MATED CrOS"`.i` OF C,°OV'Y.>C1!zo(I ON 13'��33�.1dJ FERMTr 1140f, SUMMARY FIM .vDIEPC 817 101.000.139-318 425010D t::C3A€.5"T7ttiCTION Mif 101-000-•418-1200' $5504.30 PIAN 01 IFCK FRE 101 »00rD--4392318 $300.:2 MZCHA*N1C.A.I,L'EE 101-000-421-000 $60.00 EL ..CT RICAL FER 101-000-420.000 $129.44 3'f U MTf THO ME 101-000-419-000 $110.73 'ROW IMC TITIN FFE-P=:f D 101-000-241-000 $9,93 C4RADI14U f Als 101-000-4:2:1-©00 $20.00 PRWk59 PIX14 -00" 41-343 UZ! $3,430.14 R :32001� 1133 Fn•PaIDY • , S 4 250, 00 T03A L Pg1f":1's"� Hh DUT NOW 53,100.74 ITY OF LA OUINTA FINANCE DEPT RECEIPT DATE fa -V r DATE FINALED INSPECTOR V INSPECTION RECORD OPERATION DATE I INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS IMECHANICAL APPROVALS Set Backs Forms & Footings O 6 ( l/,_ �' �/ Underground Ducts Ducts Slab Grade Return Air Steel Combustion Air Fans Roof Deck O.K. to Wrap Exhaust F.A.U. Framing ��1 ~� 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 I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection 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 0 -( -D Utility Notice (Perm) �oslil 0� Building C f� Address 4%,40 T 6 41�v 4 P.O. BOX 1504 78-495 CALLE TAMPICO ,a4a�n LA QUINTA, CALIFORNIA 92253 Mailing / Address? City Zip Tel. L & OL., , 41 -z2"-A- p State Lic. City J & Classif. 5 51 g Lic. # 3 Address T City IZip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70pp) of Division 3 of the Business and Professions Code, and my license is in full force and effect. 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, 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 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). l: I, as owner of the pr party, 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.) I I 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.) 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 r7 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 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. 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 i9 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 sof this city to enter the above• mentioned property for inspection purposes. Signature of a0plicant Date Mailing Address City, State, Zip G,r S APPLICATION ONLY BUILDING: TYPE'CONST. OCC. GRP. A.P. Number i'1 Z — 1 :1,'(' vara IC" Legal Description lat^T % ( U L,cve__y Uu ; T- Z, Project Description 'mat ✓ c.. ,rs. �LhC��►_w ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setb ertLine FINAL DATE, Issued by:— Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Sq. Ft. Size No. Stories NoDw. , Units New Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL zz" n REMARKS t` ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setb ertLine FINAL DATE, Issued by:— Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Notice: Document Cannot Be Duplicated Date 4/23/01 No. 21922 Owner NamePaz Construction CO Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE t APN# 773-175-005 Jurisdiction La Ouinta Permit # 0104-088 No, 51-840 street Eisenhower Drive Log # city La Quinta zip 92253 Study Area Tract # B 117,U12 Lot # 21 Type of Development Single Family Residence Comments Square Footage 1,421 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 1,421 or $ 2,913.05 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/ Valley Independent Bank - Agustin Paz Telephone Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Arlene Garcia Signature ti Payment Received $2,913.05 '! Check No. 244495 NOTICE: Pursuant of Assembly Bill 3081 (CHAP$49, 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 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 .ti 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 PAZ CONSTRUCTION SITE ADDRESS .51•-840 Eisenhower Drive APN 773 - 175 -. 0d•5 'BINNO.: 2� CASE NO.: 2001-429 LEGAL: LOT 2 BLOCK 1-17 UNIT ('lam 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 numbers. AcG, !� - / ��lir) REQUIRED ITEM Y N COMMENT/CORRECUON Compatibility Review e. Case logged and number assigned, v6 Verify legal and APN information 4\0A �_Ve� Consistent with MDG on file (as.applicable MDG filing required (5 filings since 9/3/98) Consistency with street/surrounding area: \'Xio eN ,, Colors 1 vJ�� Materials I Architecture Other Requirements: J - �� Z/ ado b - C 7 -LO C 8MM,�gr�.� Wegr, ,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 SPACE ABOVE THIS -LINE -FOR RECORDER!,S'7IISE APNe 773-17500424 & 0 �1 GRANT -DEED, G _ d ,. The undersigned grantor(s) declare(s): I' , N O 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 GRANT(S) 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. Dated January 10, 2001 State of California County of } S.S. JAMES L. MONTGOMERY, TRUSTEE On before me, personally appeared 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 hand and official seal. Signature �, MAIL TAX STATEMENTS TO: (This area for official notarial seal) 1 11 Certificate of Occupancy City of La Quinta Building. and Safety Department This Certificate issued puisuant 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: SFD 51-840 EISENHOWER DRIVE R 3 Type of Construction: Owner of Building: PAZ CONSTRUCTION CO Building Official VN Bldg. Permit No.: 0104-088 Land Use Zone: RC Address: 52-995 AVENIDA MENDOZA City: LA QUINTA, CA 92253 By: STEVE TRAXEL Date: 08-13-01 POST IN A CONSPICUOUS PLACE