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9612-108 (SFD)
LICENSED CONTRACTOR DECLARATION Nereby 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 35,11 79 H 1 itNY98 ate �-7 Signature of ContractorA 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. Se( ) I have and will -maintain workers' compensation insurance, as required by ction 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. CAI+CINW (This section need not be completed if the permit valuation is for $1 00.00'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 subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those plisiogs. t Date: 1, Applicant WN ti . Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. - IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. vSignature (Owner/X�_ennt) ��Aa� �- _: e_- DateTV � A� PERMIT # BUILDING PERMIT CONTROL # ��►�- 4572 DATE 'i16/97' VALUATION S� 1� .711 LOT � � TRACT 2+1>s90 JOB SITE ADDRESS 79420 LIMA. APN 169-604-0 11 OWNER CONTRACTOR / DESIGNER / ENGINEER WILLIAM C01:11 RNR Jig. vlARDAV Ct,N,%',I1 [X"fION (M. 1'-0. lst,}X 613 i'*2438 DESERT 1].ir_[VF PAlM DESEW1' CA. 92261-l613 RAN(N10INI[K's1G C'A 97270 idt i5t5fi-i7:>3- iilltllih6N,lr C€ IX 1248 . USE OF PERMIT^ . tif�1;) 'F.I7 _NA.. 2..k)ijAkii 076T. oHttA41 1'00E E N%—it' .vNCLIJOE al,i:tC K WALd. GR , 3,cKi2,0 1'$DitC.:11A'Xf10 579.0 Sr' 6tlRA(4,'X'AtifN fRT 767.!x) S 1!'1+:#ijOti1�1' fI!'fii=.1; 4+IfR'1:t11f�At'1' i6W 1+t'+rl?•t�i!^taS£rr'�,A "I AN'' tUi+ Vi A11si;t%f13�l.it.;a11. i) t..i ..lEil�-•�21•illn? �3S �) Z t.1 r� f'stft /1!, k l l ;t 101 t)i7(1•{121a.t)i?f) 2EH),.#! rn D i�f,f_I.?Ftftiidi'i # H+';i liit-(3ti11-rtl�•17!}{1)fi.i3f1 ® � C3 �'1'1�i3tb7f�t�lt,j'fCtt�C;�t1i.) • 161•i}l)Ij-?•1i-tJGQ �,^,5.rs, co Q �.jet�l�tl+a� 101, -0(K) -<11106f) 520.06 o � J ltd!'1i.A�31'1)E,I'fitt[Z�t%1)ii+1�'ri-1+1 Sfi,4r1(►t}' C Q LL o f"IRP('181- j)t,AN It)t-fiClfl..id4.j1S 'stuff } rlRT iii KIIf1.1t':,1'1;At V!; (kI-N) 701- WO -255- till V191.47 (�— U C0N,1Yr il.JUJ10N rANf PJ,AN ref11(`.'K r: K67R.65 L118S TIRE Nit) Ff. ' IOTA!+ It'11+.RMI'I' VEt N ME N(; W - r �7,�lZ13 tis RECEIPTDATE BY DATE FINALED INSPECTOR -wa 1741 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 — S % Compressor Vents Insulation 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 Pibg. Test Final 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 Utility Notice (Perm) �Ms OF LA QUINTA O OqSUZI SAFETY DEPARTMENT m-7012 PECTION REQUEST LINE m-7153 Owner LL COBURN, JR, Contractor MARDAV CONSTRUCTION CO. Permit Number 9612-108 POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES JOB ADDRESS 78-820 LIMA SFD - PERMIT DOES NOT INCLUDE BLOCK WALL OR POOL TYPE OF INSPECTION I DATE I INSP. FOUNDATION & SETBACK CMTlhlr`_ CTCCI I f i. 13 0-1 _ / U MAIN GROUND SYSTEM GROUND PLUMBING PRE-GUNITE DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED CONCRETE SLAB l JOISTS & GIRDERS ELECTRICAL GROUND WORK DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC ROUGH PLUMBING ROUGH GAS a GAS TEST HEATING & VENT -A/C FIREPLACE COVER NO WORK UNTIL AB DRYWALL INTERIOR EXTERIOR LATH POOL PRE PLASTER POO ENCE & GATE S ER aPTIC TANK FINALS ELECTRICAL f PLUMBING. FINAL GAS TEST HEATING - A/C HOUSE NUMBERS -JOB COMPLETED TEMP POWER HAS BEEN SIGNED ABOVE APPROVALS DO NOT INCLUDE RIGHT TO N, /96 TURN ON UTILITIES OR OCCUPY BUILDING P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Mailing�D / /3 Address }(r �/ (� l �IG.t / CJPS2f Zip _��/ Te / � Contractor .. 61iv1&0VJ1r% A7 / Address Zip I Tel.. State Lic. I City & Classif. Lic. # Arch., Engr., S Designer � IL�N1� -� 97? Address / Tel. City lZipState I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) 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). l7 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. g, 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 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) licensedpursuant to the Contractor's License Law.) (( r 1') I am e) 4npt un ePSec. . a P C. for his reason / _ Date Ownery 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 F3 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 lhg 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: ff, 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 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. 1 agreeto 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 applicant Date Mailing Address City, State, Zip BUILDING DIVISION APPLICATION ONLY UILDING: TYPE CONST: �/ . `� OCC. GRP. .P. Number f / / (/'ego v�J/'�' egal Description /— 49-7�/T / �O roject Description 5 D Sq. Ft. No. / No. Dw. Size 002 Stories ( Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ PERMIT Plan Chk. Dep Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. AMOUNT 7370-0 2_5 Infrastructure I TOTAL e7 SU . UJ 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: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FETES 1ST FL. SO. FT. $ 2ND FL, S0. FT. POR. SO. FT. (fit GAR. SO. FT. CARP. SQ. FT. WALL SO. FT. @ SO. FT. @ ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APP./EQUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. @ c BATH TUB SQ. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 1 / c SEWAGE DISPOSAL SQ.FT.GAR @ ?Ac SEWER REMARKS: VENTILATION tGASNG PERMIT FEE PERMIT FEE EE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL, AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ _$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL r Notice: Document Cannot Be Duplicated Date 12/9/96 No. 15061 Owner Name William Coburn Jr. Desert Sands Unified School District 82-879 Highway 111 Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE Jurisdiction No.78820 Street lima City La Quinta zip 92253 Tract # 24890-4 Lot # 41 Square Footage Type of Development Single Family Residence Comments Urandtathered 3002 sq. ft. APN # 769-600-013 Permit # Log # Study Area 116 1 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: Under Mitigation Agreement - EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 628.00 X 1 or $ 628.00 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 William Coburn Telephone Name on the check By Dr. Carol McGrew Administrator in Charge r. F Fee collected /exempted by Pauline Pearson Payment Received $628.00 Check No. cash Signature 0 At A &QV- 40TICE: Effective January 1, 1997, Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or sther payment identified above will begin to run from the dale 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 ;ntity authorized to collect them on the Districl('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 e "WR14AY HOMES" Order No. nprd in Requested Escrow No. American Title Insurance Loan No. FM H WHEN RECORDED MAIL TO: Mr. and Mrs. Bill Coburn P.O. Box 613 Palm Desert, CA 92261 MAIL IAX 51AIL-MLN16 UU: SAME AS ABOVE RAID Com'. Transfer Ta;; FR rt�ch"K K. Jtit iokir r,. 3'75238 CT RECEIVED FOR RECORD AT 2:00 O'CLOCK SEP 3 0 1996 nocorded in official Records J. SCHMIDT of Riverside County, California . �•_ 4AL Recorder 1 Fees $ CA .7- arAUlz rinvvt I rlls LINt VUN NLUUKUER' USE DOCUMENTARY TRANSFER TAX $ ..........1. ...4..G..U........... X. Computed on the consideration or value of property conveyed; OR ...... Computed on the consideration or value less liens or encumbrances remaining at time of sale. THE UNDERSIGNED GRANTOR Signature of Declarant or Agent determining tax —Finn Name GRANT DEED FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, CAPITAL PACIFIC HOLDINGS, INC., A Delaware Corporation, doing business in California as J.M. PETERS COMPANY, INC. hereby GRANT(S) to WILLIAM COBURN, Jr. and DONNA COBURN, husband and wife as joint tenants the real property 41 the City of LA QUINTA County of RIVERSIDE , State of California, described as SEE EXHIBIT "A" ATTACHED IIERE10 (TRACT N0. 24890-4) . ASSESSORS PARCEL NUMBER: 00-0 CAPITAL PACIFIC HOLDINGS, INC., a Delaware Dated September 19, 1996 corporation, doing business in California as J.M. PETERS COMPANY, INC. }. STATE OF CALIFORNIA., }ss. ' COUNTY OF ;� . { (r\'i' `{, - }. BY: On - j r '�"'; '� i. - ' l �i `% t� before me, Crai Foster, Vice President . `l! [ -I I l!il'-.1 f -, 1 ( i 1 r, t• i I l / L , C BY: personally appeared i (J j (I personally known to me (or proved, to me on the basis of satisfactory evidence) to be the person(s) whose narne(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in hisiher/their authorized capacity(ies), and that by his/her/their sidna- ture(s) on the instrument the porson(s) or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand;and official seal. C Sinner ... ]---Z.�"..�,, J. SCHMIDT k . �•_ COMM. # 997666 Notary Public -California CA Orange County My Commission Expires Sept. 13, 1997 E a o A Division Of CPH November 8, 1996 Mr. William Coburn, Jr. P.O. Box 613 Palm Desert, CA 92261 Dear Mr. Coburn: This is to inform you that J. M. Peters Companyfhas approved ur a yo ifectural-plans.?You should receive official notice from Mr. Dan Buckner of P. C. M. (The Cifrus -Course Management Company) sometime next week. Sincerely, J. M. P ERS COMPANY, INC Scott Coler Vice President, Division Manager SC/br 4100 MacArthur Blvd., Suite 200 P.O. Box 7150 Newport Beach California 92658-7150 (714) 622-8400 FAX: (714) 622-8404 J.M. Peters Company, a division of Capital Pacific Holdings, Inc. A publicly traded company listed on the American Stock Exchange AMEX/Symbol-"CPH" http://www.cph-inc.com S/ ` COACHELLA VALLEY WATER DISTRICT .: CASH RECEIPT DETAIL'S Received Fro GA Address: '© < i i Account No.LO � 064. (3 �' �' u 14 ,S 11P. Lot(s) 'T Service Address a , VN .aMeter(s) ❑ Service(s) ❑ Backflow(s) ❑ House Lateral(s) ❑ DetectorCheck(s) ❑ Meter Surcharge ❑ Sanitation Capacity Charge ❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - Fee - ❑ Plan Check Fees Water I Sewer - Tract - ❑ Bond Payment - A.D. - Bond Assmt. ❑ Customer Deposit ❑ Other G.A. Code :,a` (o 1q(- a1-fs90- $ a50•oo TOTAL Remarks: —\V kA "� CL, J n� o,.\ ❑w6py to: [ Ipc C -t xe_.j;j, 41� Cash Check Money Order A Water Service Cashier •..% CV -438(11189) CARLOS ELIAS REGISTERED CIVIL ENGINEER 38825 Charlesworth Drive Cathedral City, California 92234 Telephone (619) 328-7271 March 10, 1997 City of La Quinta Department of Building & Safety 78495 Calle Tampico La Quinta, Calif. 92253 Gentlemen: This letter concerns the residence now being constructed at 78820 Lima, La Quinta, California. On March 8, 1997,.I inspected the shear panels.at the kitchen front wall and the family room right wall. `These r shear panels comply with my design intent and are. st'ructur°ally adequate. CE: j i�Q P� F4 Fyc y G( 6 co LU #16839 � !F CAL%! Very tru��lggy yours, Carlos Elias CARLOS ELIAS REGISTERED CIVIL ENGINEER 38825 Charlesworth Drive Cathedral City, California 92234 Telephone (619) 328-7271 February 20, 1997 City of La Quinta Department of Building & Safety 78495 Calle Tampico La Quinta, Calif. 92253 Gentlemen: This letter concerns the residence to be constructed at 78-820 Lima, La Quinta, California. I have reviewed the layout and bearing `points of the roof trusses designed by Houston Lumber Company and find that their design is in conformance with my design intent. Very truly yours, j?,0FE S10 Carlos Elias CE: jrn #16839 CIVIL. lF�r C�.L1F�2,• , 12/20/96 to: Mark Harold La Quinta Building Department 78-495 Calle Tampico La Quinta, CA. 92253 from: Carlos Elias 38-825: ' 'Charlsworth Drive Cathedral City, CA. 92234 ph. (619)328-727.1 regarding: "Trussworks" Tuss Package for the Proposed Colburn Residence located at 78-820 Lima, La Quinta, CA.. I am the structural engineer of record for the proposed Coburn residence. I have reviewed the latest "trussworks" package and have found said package to be in substantial conformance with the design intent of the structural framing plan. Sincerely; / �" 4 Carlos Elias CE:gk C3ci1