0004-329 (SFD)LICENSED CONTRACTOR.DECLARATION
` f? 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.
O ch License # Lic. Class Exp. Date
r- Q LO
r UJ
I��, 545 s4 I3l C.9 OSrfi?012f
r.9
Z r- Date / 11 `0 Signature' of Contractor—
(Do
ontractor
O� �..
J V OWNER -BUILDER DECLARATION
W LU r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
N License Law for the following reason:
Z_ ( ) 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'construci the project (Sec. 7044, Business & Professionals
Code)!{
C'`) () I am exempt under Section B&P.C. for this reason
LO
N Date Signature of Owner
ON
Q WORKER'S COMPENSATION DECLARATION
C) I hereby affirm under penalty of perjury one of the following declarations:
Lo H O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q pe ffgfmance of the work for which this permit is issued.
m Q U (V)) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
OL LO
Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier STATE FUND 229-00 No.
co Z)229-00 UNIT 0011090
O
J (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
3 subject to the workers' compensation provisions of Sectin 3700 of the Labor
Code, I shall forthwith comply with those' ovisions. /q
Datef1'J,-, 212C12 'Applicant "� !' °JiL tom: 4L • ,a
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) t .�� ��-u t'�'�"t Date _2200-0
BUILDING PERMIT PERMIT#
VALUATION LOT OW4-329 TRACT
DATE-"61*1
X91;294.10 4
ZLK210 U20
JOB SITE %
APN
ADDRESS
53-305 1 ISZ�' I TO�'TN D.RrVY.
'774-05-616OWNER
CONTRACTOR /DESIGNER / EN (NEER
LA Q'UM A PARx`NIM
PAZ CON Uf"'i tON co
PO LOX 154
529.95 t-1V-NIDAIIATE+DOZA
1AQU.DTTA CA 92255
U%QUINTA
CA
92253
('760)564.3023
MIA
5537
USE OF,PERMIT
SWOLE PAluC1LY Y))1i1A.1:I1 G
SP1 • PP,-R,IbI1`f DOfaS NOT INCLUDE BLOCK WAL,I»S OR. POOL
TRACT CONST,RUCTIO14 1,473,00 SIS
PORCHIPAY'IO 96.00 SP
0ARAMCARPORT (9F) 0,074,90
5 FT. 'WOOD FENCE 100.00 LF
Eb"MJA1D COSI' OF C'O;OiSMg7MON
91,994:10
Me MM"Ry
CIONSTRUCTION FEE 101.000-41 "00 $0031151)
PLAN CHECK FEE 101-000-439-318 $509.79
FEE DEPOSIT 101-000-439-318 4150100
MFC ANICAL FXF 101-000-421-000 $61.00
�Y1
ELECTRICAL FEE 101.000.420.000 $124,30
PLIJMBINO FEE 101-000-419.000 $118.75
STRAW MOTION PEE - RESID 101-000.241.000 $9.13
w
� '
ORA.UINO FF1E 101-000-423-000
INFRASTRUCTURE FEF 225-000.443.342 52,006,26
F <
PREC1SIE PIA14 101-000-441-.345
i_
rrl`
H-LJB-TOTAL COl`i4MMYNOW AND PLAN OW-CrC
$3,%I A2
JZ 33 PRE -PAM M"
-$250.00
TOTAL PEMT Y PPE
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
��.� �.�� �s_._z �+rJ '�.� .ys� .are _a-��.��.� _. � a.:�_---.—�..:..- r--"-•---..r—....,.�----r}.�_-...�..�.�--•�--".-� .
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
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
—2 _1�
Compressor
Insulation
—pa
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
417
Final
Final
BLOCKWALI A PROVALS
POOLS - SPAS
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
�J
;�% Q%gam S l
Heater Final
Plumbing Final
Plumbing Top Out
/ /
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
o
Encapsulation
Gas Piping
Gas Test
BOO S
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
r' G:F.I.
"Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) - fr
COMMENTS:
f
Building
Address
Owner
Mailing
Address 1
City Zip
Contractor
V LYtr Co I- ST L&
Address
Cit Zip
p
Gl)t r,. q z
4
P.O. BO x 1504 APPLICATIO NLY
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 0,7 v
S
BUILDING: TYPE'CONST. OCC. RP.
A.- A.P. Number —n4— o58 --r— oil,
IL Tel.
Legal Description LSC" 4" -PA-0c—v— �-) �% OPs—, ; 'Z, 4
Project Description
— -Z-S'12
State Lic. city
& Classif.� ei !&n S Lic. # 55
Arch., Engr.,
Designer 12i�M4St RJ
Address I Tel.
F --c "?a AS
City Zip State
L is O✓,&.A . 927_c- Lic.#
LICENSED CO7TRACTOR'S DECLARATION
I hereby affirm tz3f,;t'i
a licensed and r provisions of Chapter 9 (commencing with Section
7000) of Division `usinessan Professions Code, and my ticg(�se is in full force and
effect. �.�.Lkt U . 2 1-1-04XD
SIGNATURE "' DATE
OWNER -BUILDER DECLARATION
I hereby affirm at 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031 S, 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 thathe 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 live hundred dollars ($500).
l; 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.)
I1
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.)
tl 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
n 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
Ihereby 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 a0plicant Date
Mailing Address
City, State, Zip
Sq. Ft. Q No.
Size t 4 1 Z Stories
New EK Add ❑ Alto
Estimated Valuation
ition ❑
PERMIT * _AMOUNT a�(
Plan Chk. Dep. 1 Uu ---X/ .
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 Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Val
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Date 5/2/00 APN # 774-085-016
No. 20379 Jurisdiction
Owner NameLa Quinta Partners Permit # 0004-329
No. 53-305 Street Eisenhower Drive Log #
City La Quinta Zip 92253 Study Area
Tract # BLK21 OU20 Lot # 4 Square Footage 1475
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 1,475 or $ 3,023.75 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 CCNalley Independent Bank/Agustin Paz
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by
Signature
Mary Ann L. Boda Payment Received
Telephone '
r
�. �$3 023.75 ,
• Check No. 216336
NOTICE: Pursuant of Assembly Big 3081 (CHAP 849, 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 Distdct('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 DeptJApplicant Copy - Applicant/Receipt Copy - Accounting
r
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: 53-305 EISENHOWER DRIVE
Use Classification: SFD Bldg. Permit No.: 0004-329
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC
Owner of Building: LA QUINTA PARTNERS Address: P.O. BOX 134
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
Building Official
Date: 09-01-00
POST IN A CONSPICUOUS PLACE
RECORDING REQUESTED BY:
CHICAGO TITLE COMPANY COMPANY
99.9195KC 97057225 r63
WHEN RECORDED MAIL THIS DEED AND,
UNLESS OTHERWISE SHOWN BELOW,
MAIL TAX STATEMENTS TO:
WILLIAM THOMAS BUFFIN
A.P. LENCH II
DOC N 2000-053385
02/14/2000 08:00A Fee:6.00
Page 1 of 1
-Recorded in Official Records
County of Riverside
Gary L. Orso
Assessor, County Clerk 8 Recorder
M S y
A R L COPY LONG REFUNDT NCHO E
GIANT DEED APN: 774-085-016
The undersigned grantor(s) declare(s):
Documentary transfer tax is N' O
(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,
MICHELLE EICHSTEDT, AN UNMARRIED WOMAN
hereby GRANT(S) to
WILLIAM THOMAS BUFFIN, AN,UNMARRIED MAN and A.P. LENCH II, A MARRIED MAN AS HIS SOLE AND
SEPARATE PROPERTY EACH AS TO AN UNDIVIDED 1/2 INTEREST AS TENANTS IN COMMON
the real property in the City of LA QUINTA, County of Riverside, State of California,
described as:
Lot 4, Block 210, Unit No. 20, Tract Santa Carmelita at Vale La Quinta, as per map
recorded in Book 19, Page(s)' 38 inclusive of maps, in the office of the County Recorder
of said County.
Dated January 28, 2000
State of California
County of RIVERSIDE } S.S. MI�E EICHSTEDT EICHSTEDT
On.. JANUARY 30, 1999
before me, KELLY COLLIER
personally appeared
MICHELLE EICHSTEDT
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 p rson(s), or the entity upon
behalf of which he pe n(s) acted, executed
the instrument. h / \ /)
WITN NSmy
n a d . ffi
.I
Signatu e
MAIL TAX STA EMENTS 0
s
WILLIAM THOMAS BUFFIN
9
KELLY CO
# 0234268
NOTARY PUBLIC•CALIFORMA n
d RIVERSIDE COL 672003
CpMM. W. .
Chicago Title Company has recorded this
instrument by request as an accommodation only
and has not examined it for regularity and suffi-.
ciency or as to its effect upon the title to any real
property that may be described herein.
(This area for official notarial seal)
A.P. LENCH II
11