0108-126 (SFD)U)
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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. c
License # Lic. Clas ,,^ Exp-DWe , _
11
L�Sxlis�+ ` moi= .,!�i.°•�r�3'JS:t
Date * - `�` 4z—Signature of Contractor`
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
- r s
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
Section 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.
KATE COMP
(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 syybject to the
workers' compensation laws of. California, and 'agree that if I1,,sKould become
subject to the workers' compensation provisions of Section„3700 of the Labor
Code, I shall forthwith comply wt those provisions f”
Date: r` t,.,�F` Applicant' e=—•� ;,-.
Warning: Failure to secure Workers' Com nsation 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 ort 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 t —
any permit issued as a result of this applicaton agrees to, & shall, indemni
& hold harmless the City of La Quinta, its officers, agents and employee .
2. Any permit issued as a result of this application becomes null and void
work is not commenced within 180 days from date of issuance of su
permit, or cessation of work for 180 days will subject permit to cancellati - n.
I certify that I have read this application and state that the above informatio is
correct. I agree to comply with all City, and State laws relating to the build ng
construction, and hereby authorize representativesof this City to enter upon
the above-mentioned property for inspeciio`ri°purposes. ; ..
Signature (Owner/Agent) �' �°� � — Date ��� ' keb
BUILDING PERMIT - ,, PERMITk
DATE// VALUATION LOT Q�"SRv�9 TRACT
ti!
/ � ;a l o.olg M I rif AT.'K' 7 0 7
JOB SITE
APN
ADDRESS
54-4 i'Li :6 =f.gr"0'tsltl't:1Gt D.R.;t% i -
p 74-221-4414
OWNER
CONTRACTOR / DESIGNER / EN INFER
'.F. Afi3%„�::EN 'EVASS � srXOR INC.'
PAIRS)FN EVANS, DFMG.I N.C.
1 s0; f")X 621
Ro. BOX, 621
PUER .101? CA 92501
Ta::1Vi"'RISIDE C& 91,501
(760)399-1413 ' CBVI 6246
USE OF PERMIT
kMRM'17K:kAJLY DWELTING
fD - PF -WAIT .06,V3 'NOT iNdCLIWE Ii001P.3P,", DR. VMVl FWAY
APPIwOd►CK SO LY COM13114WCION 4' 1IICTAI 9.4014° 0AR-:A WlsL L ftl%
IY Y 0.fUMi24 'WA1,L,;C1'TY u+1 AVDA%O
TPIAbpp"fyyn� 'f)C/r�1LLy��luudyy�
1d J.,p�ryryi
99Cl'14
c/c,�pbl yty�
CtAl'fili.A,FICA15./S'a./RT
6 .l! f" WALL 515,1°0 LF
5 Trr. W.AJIL 50.00 LF
Y-.F3E IA'I C0!; ' OF, +?"O,f EUR"UR.d.MI3
,�i ����gqyy!!.�..y��yFy�e. j ��pp ��''''II }}������
RY
PLAN C1.,W-K FEL301-113W-439-'.41818 1$2.116€
IrLt�e0.EIVII 101-000-4.39-318 4250.00
t,�k:C4UHX!ARpPEE )01-000-14711-000 %53150.
1t.LIM'Z''MCA1, Ff?.2 101.4 30-421,01µ00:1 PDA
PIXI"ImDITa FEZ 1 ?1.0010-419-009 $123,75
:: R,!X3:15 MOTION M. • iLl€?!t} 101-000-241.000 $9.63
C.)1:,i4,DWO FEE 101-N0-4234)00 0.4234)00 V010
D1Y,V J,0> F,R IAYr-JS.CT ft% $1,907,00
PhICISE PLA14 101.000.441,345 1140.0
C0+14T€?.I.1{' iON M- 31: fi 101-000.418-004:t
%iE [G'CALa t;oman.`: Tic i om Ji!'o 1'I, a i id''ire
a o 1XV5 PRE-PAXO:�7KES
4350,00
SEP 2 4 2001 .OTAL i WH r DARUNOW
1 ,
CITY OF LA QUINTA
FINANCE DEPT
RECEIPT
DATE '
y A, �
BY
I ALED
pL
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
_e
Underground Ducts
Forms & Footings
��
Ducts
Slab Grade
_ _A
�d
Return Air
Steel
Combustion Air
Roof Deck.
Q (
1/
_
5't
Exhaust Fans
0. K. to Wrap
Framing
0I v
�` _� (
sf
F.A.U.
Compressor -
Insulation
�/r r
(
f—
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
9 .Z(p• ®(
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
�j�
Heater Final
Water Piping�7
8I
/ —
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Sewer Lateral
//�
O.K. for Finish Plaster
Pool Cover
Sewer Connection
Q
` ` Z�: -
w
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
112/d�(
Utility Notice (Perm)
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 9/24/01
No. 22528
Owner NamePaulden Evans Design Inc.
No. 54-070 street Eisenhower Drive
City La Quinta
APN # 774-221-004
Jurisdiction La Quinta
Permit #
Log #
Zip 92253 Study Area
Tract # Lot # Square Footage 1617
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 1,617 or $ 3,314.85 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 BC / El Paseo Bank - Paulden Evans Telei—bone
Name on the check
By Dr. Doris Wilson -
Superintendent
Fee colle4/exepted byAnnette Barlow
Signatu
Payment Received $3,314.85
Check No. 02461
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, 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
11
4"00. -:2 F,' 01(TUE) 09:39 FIDELITY NAT TITLE TEL:1-619-1179-0394 P.001
RFr'ORDING REQUESTED BY:
R Ay National Title Company
Eec►0W No. 43031 -CO
Tills Order No.
When Recorded Mail Document
and Tax Statement To:
Mr. Paulden Evans
P.O Box 621
RivIrside, CA 92502
GRANT DEED
E THIS
The undersigned grentor(s) declere(s)
Documentary transfer tax is $26.40
1 X ) computed on full value of property conveyed, or
[ ) computed on full value less value of liens or encumbrances remaining at time of sale,
[ ) Unincorporated Area City of Le Quinta
FOR A VALUABLE CONSIDERATION, receipt of which Is hereby acknowledged. William DeVane and Eugenia
DeVane, Husband and Wife Community Property
hereby GRANT(S) to Paulden Evans Design"Center, Inc., a California corporation
the following described real property in the City of Le Quinta
County of Riverside, State of California:
Lot 21, Block 297 of Santa Carmelita at Vale La Quinta, Unit #27, as per map recorded in Book 19, Page 82 of
Maps, in the Office of the County Recorder of said County.
DATED; August 7, 2001
STATE OF CALIFORNIAA
COUNTY OF S S _
ONn before me,
personally appeared
personally known to me ( 's
of e) to be the personal whose
name(&) is/awsubscribed to the within Instrument and
acknowledged to me that M!'/shelOwy executed the
same in bis/her/tbOr authorized capacity(Wil, and that
by bis/her/tb@W signatureW on the instrument the
personWt, or the entity upon behalf of which the
personW acted, executed the instrument.
Witness my hand qpj official se
Signature
ELIZABETH C. WYCKOFF
Corrvnldon 0 1211414
We Ampift tin*
�i1oo�
MAIL TAX STATEMENTS AS DIRECTED ABOVE
F0-213 (Flev 7196) GRANT DEED
.y
0G.-28' 01(TUE) 09:40 FIDELITY NAT TITLE TEL:1-619-779-0394
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of California
ss.
County of a E L F rj
On rl D 0
Date
personally appeared
to
UNDA SUE DIXON
Commtsslan * 1�a W
Notq^r ft bflr - ca"Wrlid
tm Argelei! COtXwwww*
NyComm, Jul3.20M
Piece Notary Seat Above
- rsonally known to me
0 proved to me on the basis of satisfactory
evidence
to be the personx*"Whose name(pKistvf
subscribed to the within instrument and
acknowledged to me that he/she/they executed
the same in his/K/t4P ' authorized
capacityw, and that by his/t 4!W
signatureKon the instrument the personSp�, br
the entity upon behalf of which the person
acted, executed the instrument.
my hand a94 official seal.
Poolic
OPTIONAL
Though the information below is not required by few, it may prove valuable to persons relying on the document
and could prevent fraudulent removal and reattachment of this form to another document.
Description of Attached Document
Title or Type of Document:
Document Date: Number of Pages:
Signer(s) Other Than Named Above: —
2�
Capacity(les) Claimed by Signer
Signer's Name:
/ Individual
1u+r of tnumb Hera
C Corporate Officer — Title(s):
C Partner --- G Llmited O General
UAttorney in Fact
O Trustee
O Guardian or Conservator
C Other:
Signer Is Representing:
0 1997 National Notary Astoclatlon • 2350 Do Soto Ave. P.O. Bort 2402 • ChatswoM, CA 91313-2402 Prod. No. 6807 Roordet: Cog Tc+bFrae 1.000.876.8627
P. 002
0
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 per Section 9.50.090 of the Zoning Code. Its purpose is to determine:
1) that the proposed house design, does not duplicate the same architectural style,of any
house within 200 feet of the applicant, and/or 2) if there is a need for the applicant to file for
Master Design Guidelines. If the applicant does need to file a Master Design Guideline, please
transmitted this information to the Building and Safety Department as part of your correction
list. Please attach additional explanations as necessary.
APPLICANT PAULDEN EVANS
SITE ADDRESS 54-070 Eisenhower Drive
APN 774 - 221 -004 CASE NO.: 2001-5.34
LEGAL: LOT 21 BLOCK
UNIT
S.C.@V. L. Q.
Wal'1 "Nesbit, DATE:
CHECK AND APPROVED BY: �..... Y � 0
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
Verify legal and APN information
Wl�`7
Consistent with MDG on file (as
applicable
MDG filing required (5 filings since
9/3/98)
Architectural variety within 200 feet of
the surrounding area:
Colors
Materials
Architectural design features
s �d-4/wt
Ot�moved b
� mg oe��sPsston
0 pity Council
Community Dev. Dept.
Initials
Case No. tee- 2co5:7: �3a' e -r
Exhibit
1
Q With conditions
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: 54-070 EISENHOWER DRIVE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0108-126
Occupancy Group: R-3,, U-1 Type of Construction: VN Land Use Zone: RC
i.
Owner of Building: PAULDEN EVANS DESIGN INC.
Building Official
Address:
P.O. BOX 621
City:
RIVERSIDE CA 92501
By:
STEVE TRAXEL
Date:
DECEMBER 20, 2001
POST IN A CONSPICUOUS PLACE
NOV-05-01
MON 02:54 PM WILKIKINSON-
G EER I NG 909 682 20 14 P. 0 1
KEN WILKINSON ! STRUCTURAL ENGINEER
6956 INDIANA AVE. SU[.TE 49
RIVERSIDE, CA. 92506
VOICE (909) 682-2001
FAX (909) 682-2014
E-MAIL kenwilk(i�,airl.net
November 5, 2001
CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
LA QUINTA, CALIF.
Attention: BUILDING INSPECTIONS
i
Re: PAULDEN EVANS a 54-070 EISENHOWER DR. — LA QUINTA
Subject: VISUAL S'T'RUCTURAL OBSERVATION REPORT FOR NEW REISDENCE
To Whom It May Concern:
The following is any report in regards to -the structural observation provided. by JCM
inspections dated: 11/2/2001 at the subject property. The structural system as completed
through the final framing stage is in general conformance to the approved plans and
specifications.
All observed framing members and connections have met or exceea.ed the design criteria:
for this building. Thus all structural framing & connections have been approved by my
office.
a Wilkinson
uctural Engineer
Attachment: JC;M Inspection Repov
No- 1944
Fxp, 9.30V;;_L,;-
OF'
NOV-05-01 MON 02:55 PM WILKIKINSON—ENGINEERI
Elm Z�
JCM.Inspe4ticns
39725`Gerand Lane Sulte F
.
Palm Desert; CA 92211
L N S P L C T i O N S
Phone: 760-345.5554 Fax: 760.772.3895
INSPECTIONS
INSPECTION REPORT
Date:
Project Name:
Project No:
Q. r. P • i
Project Address:
City: Title 24
AWS r-01-101 Other:
- p O �►'t o
,1' File #
DO 1.1
Client:
Sub -Contractor: a App#
Q D 1.4
...r.
Other
General Contractor.
Architect: �'`\. Structural Engineer:
�, �v *r b- d+ -+IC b-
v.`
\ �\
Weather: S��n
61
Unresolved Items:
None
See Below
Description of Work Inspected:A
W
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I hereby certify that I have inspected
all of the above work, unless otherwise noted, a he st of my ability 1 have found this work to comply with the approved .
plans, specifications .applicable building laws. Final report issued at proiect completion.
Inspector: Jack C. Millin'*OV6yaatdt0
Contractots itepresentativ
h.. -Le,
za -1
1 -
,•.,�'
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c 1
Copy 1 Inspections Copy 2 Project Superintendent Copy 3 Governing Agency Page -A. M _ —
5
KEN WILKINSON STRUCTURAL ENGINEER
6956 INDIANA AVE. SUITE #9
RIVERSIDE, CA. 92506
VOICE (909) 682-2001
FAX (909) 682-2014
E-MAIL kenwilk@airl.net
August 14, 2001
CITY -OF LA QUINTA
BUILDING DEPARTMENT
Attention: RESIDENTIAL PLAN CHECKING
Re: PAULDEN EVANS - 54-070 EISENHOWER DR. - LA QUINTA
Subject: DEFERRED SUBMITTALS FOR TRUSS CALCS PER CBC SECT. 106.3.4.2
To whom it may concern
I have reviewed the submittal documents for the roof trusses and have found them to be in
general conformance with the design of the building.
Yoi►-&-truly,
ixmson c� No. 1944
ral Engineer Ea, 8-30-