0104-105 (SFD)LICENSED CONTRACTOR DECLARATION
C/) ; ;l hereby affirm under penalty of perjury that I am licensed under provisions of
F Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
O =) C) • License # Lic. Class Exp. Date
r- d u7
LU r` Mti$6 E 08/37/Zr
cZ Date Signature of ContractorVC,° 1.
O r`
OWNER -BUILDER DECLARATION
Ha I hereby affirm under penalty of perjury that I am exempt from the Contractor's
CD 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 construct the project (Sec. 7044, Business & Professionals
Code).
Cl) () I am exempt under Section , B&P.C. for this reason
u*)�.
N Date Signature of Owner
O�
d Q WORKER'S COMPENSATION DECLARATION r
p 1 hereby affirm under penalty of perjury one of the following declarations:
LO Cc
O () 1 have and will maintain a certificate of consent to self -insure for workers'
X LULL compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work for which this permit is issued.
Q U (J I have and will maintain workers' compensation insurance, as required by
QQ Section 3700 of the Labor Code, for the performance of the work for which this
d Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
cD —) ,4Q'i11AP
�o
(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 Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: -r %— Applicant—
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverages unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Buildin Safety
for a permit subject to the conditions and restrictions set f D n his
application.
1. Each person upon whose behalf this application is made & ea sn at
whose request and for whose benefit work is performed under or rsu nt to
any permit issued as a result of this applicaton agrees to, & sha I nde nifyAP
& hold harmless the City of La Quinta, its officers, agents andemplopes.
2. Any permit issued as a result of this application becomes nulancellation and v 'd if
work is not commenced within 180 days from date of issuace of such Cl
permit, or cessation of work for 180 days will subject permit to.
Icertify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upor.
__the'above-mentioned property for inspection purposes.
Signature (Owner/Agent) �^. ' l ! Dateu> �� e
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0104 ,05 TRACT
f"= SHWI&1M20 11. M21 O U710
JOB SITE
APN -77 - 08S- uZ3
ADDRESS qq,�� ��tpp�Crrpp y�y�ya� ry��9 y`'��(�{}mac
445 FL4i.tl�.E.7il.�6K/'l�P.�Y'iR Dbpi Vd1.
..I� _
OWNER
CONTRACTOR / DESIGNER / EN (NEER
JACK Mclas. s"U.l ,D1..5'iW COV DEV 1.IJ:
CON&MU M :tON :t9&W3 R ISYMEVS INC.
PO BVIK 6218
P. 0. BOX 628
1;,A.QU"i1`i'tA CA 92253
IAQXW.A CA, 922L-3
(760)771-3593 06u$ 5830
USE OF PERMIT
"fit OLF, FAWLY?' DWEILWG
SP73 - Pf ,R241`1' DOI?S NOT tAaf`:1,.UDE P,1A-XK WAl..1.WPt tr)1,6SF'A O
DR.1b1'MAY APPROACH, Mt' SUR 98 KA.iAU.'3'1%1 DISCOUNT ON P X1,14
CHOCK FEE FOR,MEST:NIPLE PFRMIT ISSUANCE
` RA.0 T CUNST1?.UCTIION OHM aF
PORCHIPATIO 40,00 SY
$ �'. WOOD FENC1r 200..00 LF
CUl1.R AOR 49.9.00 SP
10,17MA 1) COQ` W C''.3,MFERUC ION
FERM.1' T'1LE MARY
A95, DEP0131T "W0.00
s;CJAI4TRUK:'Y'1ON IPM 101-flOD-418.000 $671.00
PLA14 + `l�'ECK FFE 1.01.000.439 31 Q $139,04
MFCt•IIANIC A1<FEE 201-00 4-421-000 $61.00
ELEC'TRICA1,, PUK 101.000.420-00ro 1i12OM
€^L U&IB;11d0 PAY, 101-000-419-000 $128.15
S`I°Rc:?NO MO VOW WE - 91.iuL b 101-400y241.000 $14A
ORADINC FEX 101-000-423-000 $70.00
DEVEWPIR IMPACT , M-;"1 SUVA
k'a1€ti�G% Irk" RAk 101-•000-441.345 $IIR°O.Cd!
ALI
eT� . • r..
2 0 2001 ;t EW, P:U�1 AH) PRO
42503.00
WEAL FIMMUr E EMS VUE NOW
s-2,qw .
OF LA 11111A
INANCE DEPT
RECEIPT
DATE j
B
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
I
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
/ $ Q
(/'-
S7
Ducts
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
7_� �p (�
c��
F.A.U.
Framing
Insulation �/�
Fireplace P.L.
�_ �-�
$- - O t
ejZ
S -t
Compressor
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
BSI su t
57
Final
Final jZ= Z -0Y
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
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
QQ//
✓C�
_
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping I 29Z -O
Gas Test
X -3T_.Q C
37
Appliances
Final
Final n
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)yE
COMMENTS::
CAtb (vpTT..
.�-D
12 18101
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 4/18/01
No. 21903
Owner NameJack McKenzie Desert Cove Dev. LLC
APN # 774-085-023
Jurisdiction La Quinta
Permit # 0104-105
No.53-445 Street,Eisenhower Dnve Log #
City La Quinta . zip 92253 Study Area
Tract # BL210 U20 Lot # 11 Square Footage 1,788
Type of Development Single Family Residence No. of Units 1
Comments
'Cashier's Check for the amount of $10,407.85.*
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:
C
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of
2.05 X 1,788 or $ 3,665.40 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/ PFF Bank & Trust - Lisa Bailey Telephone
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Paula Ruiz Payment Received $3,665.40
Pa I d� - i, U, 4. Check No. 520999739
Signature
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 9D -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
BYE 0(�
Icr�S
~t . � DOC q 2000--4 1 44 1 1
-.5 CORDING REQUESMI) BY ft=
1 •f 2 Ooo 1 1Nt Paid
OLP REPUBLIC TITLE CO R•oerd•d in Officialtivera R•esrd• .
Caunty W Rlr•r•ltt•
0•ry L. Orem
AND 1tA RECORDS MAIL Tp Rsa•a••r, County Clerk g R•oord•r.
GLORIA A.
AQ AVENIDAAKMADERO
LAUINTA. CA 92233
v,
✓ A I R t I I I coir I — I aervo I = aw+
A.P.N.: 77 TRA /: Q 16 Order No.: 5M)1-13 Fscrow No.: 15693-1R
,• ' • I GRANT DEED -
( UNDERSIGNED OM ECLpAe1130) THAT DOCUMENTARY TRANSFER TAX IS: COUNTY $42.90
l j ue
computed on full value icairoaluc ofrolleas or oencurnbrances remaining at time of We.
( 1 unincorporated arra; I X I City of La QMinta , and,
FOR A VALUABLE CONSIDERATION, Receipt of which is hereby acknowledged;
ROBERT U. THONIPSON and SHIRLEY L. THOMPSON, Husband and Wife as Corntnualty Property
.hereby GRANT(S) to GLORIA A. PARKS, an Unmarried Woman
the fdli8 Ing described property in the City of La Quluta, County of Riveralde State of California:
LQrIS I1 ND IZi�hl BLOCK 210 OF SANTA CARMELITA AT VALE LA QUANTA. UNIT NO. 20, IN THE
CO OF RIVERSIDE, S'1 ATE OF CALIFORNIA, AS PER MAP RECORDED IN BOOK 19 PAGE 38 OF
IN TIIE OFFICE OP T1LB COUNTY RECORDER OF SAID COUNTY.
ROBERT H. THOMPSON
r.. �. ,y. ��� Its
SNIRLEY L THOMPSON
.,t f STATE OF RNIA AS
a COUNTY OF _�`v S ) p
i
`pnaon0y appeared C 1 r \-a e... n S
rA ?v personally known awe (or proved m rose an the Y of sadsfactory r:vldence) b be Ata perwoo whose naum ! War suWMbed to die waWn lmtrum`ed
sed ackwwkd;ed a me "Wabe/fby eseam - the same In iM/be+hWr audmrLud aapachydW and dug byda✓he+rrlr tlaoaamW an tete Inmrumme
dre persona ma mdry upon behalf of ukkh the penoo(ttl aped. executed the knuummL
N?TNPSS I yy m oRkW sem
4
C
1
C
N
c
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 Vhe filingof aster
Design Guidelines by the applicant. It shall be transmitted to the Building and Safetyart t as your
correction list. Please attach additional explanations as necessary.�OP�
APPLICANT
Construction Design System, Inc
IiOl
COMMENT/CORRECTION
Compatibility Review
SITE ADDRESS
53-445 Eisenhower Drive
APN 774 _ 085
_ 023 ' BINNO.: CASE NO.:
2001-444
LEGAL: LOT
11 BLOCK 210 UNIT
20
S.C.@V.L.Q.
CHECKED BY:
Greg Trousdell
DATE:
CO(
Inform the assigned Building planchecker 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
o #
Consistent with MDG on file (as.applicable
pale
MDG filing required (5 filings since 9/3/98)
Consistency with street/surrounding area: to
4 p1
C000rp
jMateria 1' '", 7 E�
Rn'
chitecture cl
010
CO(
m J ��
peP
Other Requirements:
Cv ezz
!�
/760-L
N
C DD
DESIGN S INC.
A (onsfruction Mana
gement Company
Custom Homes v Commercial Buildings
License #767086
P.O. Box 628 kv Lo Quinta, CA 92253
TEL. (760) 771-3593
FAX (760) 771-4093
E-mail: cds.b.uilders@gte.net
November 28, 2001
City of La Quinta
C.D.S., Inc. is no longer the General Contractor for the following
addresses. Please remove our name as builder on record. 'if you have
any questions please call our office (760) 771-3593.
77-585 Calle Durango
77-570 Calle Ensenada
53-445 Eisenhower Dr.
77 -740 -Calle Colima -
Please -send any correspondence to the owner.
Desert Cove Development
Jack Mckenzie
124 Castlewood Dr.
Pleasanton, - CA 94566
Cell # (925) 580-7883.
�7,
Ci
74--
C'C'
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:
SINGLE FAMILY DWELLING
53-445 EISENHOWER DRIVE
R-3, U-1 Type of Construction: VN
Bldg. Permit No.: 0104-105
Land Use Zone: RC
Owner of Building: JACK MCKENZIE/DESERT COVE Address: PO BOX 628
DEV. LLC
Building Official
City: LA QUINTA, CA 92253
By: KIRK KIRKLAND
Date: 2-12-2002