0002-147 (SFD)_U)
N ILI,
O ch
Lf)
W
OZr�
O oF- C:)
ww"
I— Il
Z
. ch
L0
N
O0)
U
d Q
rFZCr
0
LL
X W —
mUU
O
4 rn H
Z_
00
r- d
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 # Liq Class Exp. Date
/ate 6 14.1 Signature of Contractor (01z"
1 z
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
i
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
Vrf�oance of the work for which this permit is issued.
liave and will maintain workers' compensation insurance, as required by
3700 of the Labor Code, for the performance of the work for which this
11
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier ST ,., Policy No. ,
n 11. sf.y. fi:'�21fci .,,r°�' j�j' 00.111094
(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
sug)ect to the workers' compensation provisions of Section 3700 of the Labor
C6de, I shall forthwith comply with those provisions. ,
ate: 14 - 7 Q09pplicant w P • 4. ,
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) I Date 4 - f �- ! Gem
�� 1 `I..0 BUILDING PERMIT PERMIIIfltfi�l4� �
DATE VALUATION $1 4),1 Z':.e80 LOT i TRACT 13110. � f2{D
JOB SITE S3-3255 irfSE1NL3OWER DFtiN ,
APN 774-6-354)17
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
110 WIN" 13.1;
.541 F: ROSS
LA QUtN'I:A. L;A 92253
U'L CYNT!tO CA 9224.. =
(760 053 472 -553'7'
C
USE OF PERMIT �c� 7
S1N,,-; i:, IAN -11.6V (�YV!:di�..N j
i
IPPV - t'LtN.0 J, iJLJLZi .707,.0 i. 1NQv LUJ3): JSJ .A,,k. W AL.I, i l +t4.1'i1tl.L (�LQP AIAf i.( k -A. 2
o-� 5
5 t"3'. wc"_ l p I. -FIN B 200.00 L
.—r TINA'tA' 'i'D 13,0 P'J10. OF.I'
t.:C,ifl: TRILL 110N 4 EZE 10.1-OOJ-4t8-000 s5`l4.SU
TSI. AW ("t f f?("4', VKC, i A I41CM0419-1'1 R � Sri(f 117
r
Ct f�tYw'nYr.♦' ,yY'f Ah1_fow
PRf .Vl nr3
/r,I�
itiltl.I4.�P1�. 11ii,J J1
U-U_X t—RI ;E\�..1�.1�-:I i14� Clflii-�sl�*{il�C! �129.A
1?LIA- INQ FM- ' 101-E9W-41,9-000 5190.75
OR R i\T�f.KG FRF $773 0(1
1T'c 31,�fa7,C>t)
T'itMSET'T;AN 101-000-441-345 sloom)
nai: I) .,K)srr !0l -000-43!x•318 4250.00
�.1 TK -"i" f fiC)i�f 'V�iT1 Iii .A 1 C ;1 F (C'
£'1 �b7'i 5!i
U."S.S' " `'t =P i M F ES
_$25111.010
TO-I'Al., PERMIT IT E}VY.11.13UC N()W
$3,171.56
RECEIPT
DATE
Y
DATE FINALED
INSPECTOR
N
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
ti
_ _
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
5- --QO
S'
Exhaust Fans
O.K. to Wrap
- B,l- cr
5
F.A.U.
Framing
6- l ,3 - OO
5-7
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 7
BLOCKWALL APPROVALS
Final
POOLS - SPAS
Steel
Set Backs
6=S-Oz7
S-
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
F /'
Neater Final
Water Piping
l/V-�
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
, C
S _
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole -( - CO
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final S
Utility Notice (Perm)
COMMENTS:
/9(4z 00 T4hf
.19
Building . - 3ZS' E%sew Owen Dqu
Owner
Mailing
Address
City 5' Zip ITel.
Address
Zip
& Classif. L Q _,_ A ^ice I Lic. #
Desigy.
ner,
Address
O
City ` . Zip State
. i.. - ._ .__,__ I Lic.#
0
u�►,H,rc�
P.O. BOX 1504 P
78-495 CALLE TAMPICO
QUINTA, CALIFORNIA 92253
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm thar°l'am licensed urlder provisions of Chapter 9 (commencing with Section
7000) of Division 3/'of the Business apd Professions Code, and my license is in full force and
effect. �\ .h I /ii. L ^ +����'I
SIGNATURE ,'� rL�4r�4-Y t DATE
OWNER -BUILDER DECLARATION
I hereby affirmhat I am exempt from the Contractor's License Law for the following
reason: (Sec. 703 .",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).
1; 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
orimprovement 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 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 contractor(s) licensed pursuant to the Contractor's License Law.)
11 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
Fl Copy is filed with the city. O 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, alter 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 aliplicant Date
Mailing Address
City, State, Zip
ILDING: TYPE'CONST. OCC. GRP.
Number ::)"14 r)a� -- r) I:'
,I Description i crr 4 VaUoe V :2 U" t'P "7 0
ict Description -_,I ✓ s. I. 1= '=h►—r . t>_.r k ->n LA A -
Sq. Ft.
Size
New Q
No. No. Dw.
Stories Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
mated valuation
PERMIT
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 Setback from Property Line
FINAL DATE
INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
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 4/14/00
No. 20295 Jurisdiction
Owner NameLa Quinta Partners
No. 53- 5 Street Eisenhower Drive
City La Quinta zip 92253
APN # 774-085-017
La Quinta
Permit # 0002-147
Log #
Study Area
Tract # B210, U20 Lot # 5 Square Footage 1421
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 1,421 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 CCNalley Independent Bank/Agustin Paz
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Mary Ann L. Boda Payment Received
Check No.
Signature
Telephone
..$2;913.05
216273
NOTICE: Pursuant of Assemb)ytill 3081 (CHAP 549, STATS. 1998) this will serve to notify you that bre 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 Olstdct(s) or to another public entity authorized to
collect them on the Olstrtct('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
I
RECORD291v REQU�S'rRD 8Y i
I CHICAGO TITLx COMPANY COMPANY
9919_97KC 97n57227
w rzg .F.ECO== MALL• ==a DEED ANA,
UNLESS OTHBRIWISE SHOWN BELOW,
MAIL TAX STATEMENTS TO;
AGUSTIN PAZ and EGA PAL
52995. Avenida Neudaza
La Qui.nta, CA 922$3
t1n . 61K P. 3/3
�A
APP: 774-085-0
GRANT .DEE
'Phe unders ig. ed graritor (s) declare (s) e
Documentary transfer. :ax is $15.50 f
(XXX) Computed on full -value of property conveyed, or
Comp -,ted or, full value .less liens and encumbrances remaining at time of sale.
( ) Unincorporated area: i ) City o' , and
FOR A VALUABLE CCNMMLNTION, receipt of which is hereby ack cwLedged,
AZ:_C3 JEAN HolS1J, au unmarried woman
hereby. GRAz47(S) to AGU5T77.4 PA2 and EDA PAZ, huebaad and wife an Joint tenants
the areal property to tia,City of LA OL'IN7A, Ccunr_y ofp.iverside; State !of California,
descriY)ed ao :
Lot S, Block 210, Unit No. 20, Tract Santa Cartaelica at vale La ;L;Inta, as .per `nap
recorded ir. Locle 19, Page(s; 38 inclusive c_ traps, i:l the office of the Cc%,.r.ty Recorder
of said County.
Da.tad Saptember 21, 1099
_tate of Califcsnia
County o: .%,�S >� rte [1 r? /:iL—Ji _} S . 5 .
before me,
Peraca'Ally 'a pearad
personally known to me (or proved to me on
the basis of satisfactory e�viderce) eo be
the person W whose name W 31/arc sutscribed
to the within inscrument end acknowledged kc
me that ekecuted the rams '_n'
h;s e /their thor_xe3 caput ty{wza-) , and
that by his a /their:signatureGs7 on the
irsc,_•iment the person ve9: or the entity upon
behaif'of which the person W) acted, executed
the Lnstr.ne t.
ALICE: JEAN ;`_G
WITNESS my hand an Ctticla'_ sea...��
Signature(This area for official ;.ctar'_al' seal?
KAIL TAX STAMMENTS TO; Same
.,
le
RC DISTRICT - PLANNING REVIEW-FORzMJJ CCB �Ll'�/rq
/1RFioO
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
a.sterDesign Guidelines by the applicant. It shall be transmitted to the Building and Safety Department as your
correction list. Please attach additional explanations as necessary. -r O,t 4(/`NT
APPLICANT LA OUINTA PARTNERS O RFNn
SITE ADDRESS 53-395 Avenida Eisenhower V'! 3h1��
APN 774 - 085 - 0-17 BIN NO.: CASE NO.: 2000-190
LEGAL: LOT 5
BLOCK 210
UNIT 20 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.
REQUIRED ITEM
Y
N
COMMENT/CORRECTION
Compatibility Review
Case logged and number assigned
Verify legal and APN information
F
Consistent with MDG on file (as applicable
MDG filing required (5 filings since 9/3/98)
Consistency with street/surrounding area:
Colors
3 �-'• Materials
(W
J0�GpE��'� Architecture
N
GP
N�
\j psi
E
4L
1
P
O er Requirements: