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0011-026 (SFD)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. t License �y#qy a gyLic. Class Exp. Date 740745 d y Dat Signature �` 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: ( ) 1;fas 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, any 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. N(r) I have arid 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: Carrior Policy No. KAc'iJoP, P.d4cCIRC k'0h 1141-111 M 0114 (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 subject to the workers' compensation pr9,visions of S ction 3700 of the Labor Code, I ,shall forthwith comply with tkose'provisio, ,Aate:,d/�.J'''M Applicant,,, Warning: Failure to secure Workers' Co pensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result "of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for Iraspectlon ^p�iposes. Signature (Owner/Agent) BUILDING PERMIT PERMIT# DATE VALUATION LOT TRACT JOB SITE APN ADDRESS OWNER CONTRACTOR/DESIGNER/EN (NEER I i 4100 £AACANK7ITTRBLVD #200 410 MACARI.R.R. 33LV 3d2M 3aWPR WP/CH 4A 92,660 NEWMIX.17 AUAuH AA 92660 1503 USE OF PERMIT .`. 11) . P M1;A1 ' DOES TdOT 114CP..i.f,DZ ti.t,OCK 'WA.L,3.POC1UAPPROAChi CUSTOM (..wPK7h`A' UC'=t Micro 41moo 9,T+ FORCHfsJ, TIO M.00:bl OARAC#: ARt'O.R'f r `.=0 COST OF 4aWVAMR, WMI.4 PIT OT s 1�E S'6.TMMARY �. 31:CSTRUCTIO," SRIF, �1�iTCjt !$�th`3J 1,41:fP�. PLAN CHECK FEF, 1 19- 8 gin, PF��', D rT.& syr 101-O'CM-4 39-31 8 �Yr 0,1�a aYreC'HAMC-AipYFF_ 101-000-421-4200 ►I� ,fa#T ELX(,'-TRJC,AL F" 101.000-420.,000 VA8,44 ,��.U6HT$ ddt9 FEV, 101-000.419-000 $211,00 STROWO MO'1 IO'N FEZ - R -VOW 101-000-241-000 $38,14 W.e?.lY:idHO FER 101-000-423-000 .flo AF,T 3N POO,LIC PI AXII!' % - Ei :4?[ 701-000 155-000 34�3.4t InCUB<.,1MPAl, aYF=T', $1,917.30 1: M -pi -IM 411300M TOTAL S DUE NOW $4,41 RECEIPT DATEj BY y�^ I DATE FINALED INSPECTOR w 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 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=�3 Q(G BLOCKWALL APPROVALS Final POOLS - SJP—AS steel Set Backs Electric Bond Footings Main Drain -Bond Beam Approval to Cover Equipment Location Underground Electric Underground PI . 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 Sewer Connection Pool Cover Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) 7 '�' ' 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) 1 CITY OF LA QUINTA a BUILDING & SAFETY DEPARTMENT `y OF 777 - INSPECTION R NE 777-7153 Owner CAPITAL Contractor CAPITAL PACIFIC HOMES Permit Number 0011-026 POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES JOB ADDRESS 78-870 LIMA SFD - PERMIT DOES NOT INCLUDE BLOCK WALL/POL/SPA/APPROACH DRIVEWAY TYPE OF INSPECTION FOUNDATION A SETBACK FOOTING STEEL MAIN GROUND SYSTEM GROUND PLUMBING PRE-GUNITE ' DO NOT POUR CONCRET CONCRETE SLAB JOISTS & GIRDERS DATE UNTIL ALL ABOVE HAS BEEN ELECIFK AL GROUND WORK INSP. 0 DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC ROUGH PLUMBING ROUGH GAS & GAS TEST l e HEATING & VENT • A/C FIREPLACE ROOF BOND BEAM O.K. TO WRAP GROUT ❑ 4' ❑ 8' FRAMING � INSULATION PRE -ROOF COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED DRYWALL INTERIOR EXTERIOR LATH _ POOL PRE PLASTER PqQL FENCE & GATE SEWER SEPTIC TANK 3 , 7vi .� ELECTRICAL - PLUMBING FINAL GAS TEST HEATING -A/C HOUSE NUMBERS JOB COMPLETED TEMP POWER FINALS —T ABOVE APPROVALS DO NOT INCLUDE RIGHT TO 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 11/8/00 No. 21186 Owner NameCapital Pacific Homes Inc. APN # 772-102-013 Jurisdiction La Quinta Permit # 0011-026 No. 78-870 Street Lima Log # City La Quinta zip 92253 Study Area Tract # 24890-4 Lot # 36 Square Footage 1 Type of Development SFR Mitigation No. of Units 1 Comments is in the Citrus - grandfathered. 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 rriay'now be issued Fees Paid By OC / Wells Fargo & Co. / Greg Howe %Telephone', Name on the check r, By Dr. Doris Wilson ' Superintendent Fee collected /exem ted by Annette Barlow Payment Received $628.00 Signature &rt'T W / Check No. 0643003105 NOTICE: 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 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 :ollect 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 7� -G?o c ►mus �1 �1 rl'I�I iN -- P.O. BOX 1504 APPLICATION ONLY Building 78-495 CALLE TAMPICO Address % �(� ( r n ­._;�/ LA QUINTA, CALIFORNIA 92253 Owner 0'bt '6"`' BUILDING: TYPE'CONST. 1 - 1 ` OCC. GRP. Mailing If I Address lICaI P .,ie/J7.AJr AVE-' " S'FIO{ A.P. Number 7?a " Iaz - bI3 ' 9 City Zip Tel. ri��INClr�a { _ Legal Description Contractor Project Description GYYL. LIGtt!tL F"1'GU-OGC IM — /FL9.i f`lJ \\ Address / City Zip Tel. a,-7ri Zcw4 d £ 1 9 �t -,15:7 State Lic. City & Classif.- Lic. # Sq. Ft. �/S`"t i No. No. Dw. Arch., Engr., Designer Size Stories Units New Add 0 Alter O Repair 0 Demolition 0 c/2Ati/ I��� Address Tel. C,4f4,rvt) r/�.OtS-ruatip 1w91- LY57 - City Zip State td GIa �o7s Lic. # --C, 17s LICENSED CONTRACTOR'S DECLARATION ./y / I hereb affix III, I I ami{iceriseb under provisions of Chapter 9 (commencing with Section 7000) of ivls(onL3 of t e BusLiinbe s and Professions Code, and my license is in full force and effect. `�tSif a,, SIGNA7UPE ""� -DATE OWNER -BUILDER DECLARATION -Law EstimatedtValuation I hereby affirm -that I am exempt from the Contractor's License 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 PERMIT AMOUNT 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 0 Section 7031.5 by any applicant for a permit Plan Chk. Dep. ; j I S On subjects the applicant to a civil penalty of not more than five hundred dollars ($500). with Plan Chk. Bal. I fJ I, as owner of the property, or my employees wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 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, Mech. 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 Electrical ` ' 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. Plumbing - struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law to builds or improves thereon, for S.M.1. doesnot apply an owner of property who and who contracts such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading 1-7 I am exempt under Sec. - e. & P.C. for this reason Driveway Enc. Date owner Infrastructure WORKERS' COMPENSATION DECLARATION Ihereby 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 Cole.) Policy No. Company , . n Copy is filed with the city. 0 Certified copy is hereby furnished. TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS - ' WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($1001 valuation or less.)� he I certify that in 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. ri Date owner NOTICE TO APPLICANT., If, after making this Certificate of Exemption you should become ZONE: i BY: subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances: ' " Front Setback from Ce I Pin Rear Setback from R CONSTRUCTION LENDING AGENCY Side Street Setback from Cetrdte 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.) !! ON!111 Side Setback fromp�rt Ine c 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. FINAL DATE I PE Ok !�►� 1 certify that I have read this application and state that the above information is correct. Issued by: Da Permit 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. Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip WHITE.= FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Certificate of Occupancy City of La Quinta Buildingand 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: SFD Occupancy Group: R3 78-870 LIMA Type of Construction: VN Owner of Building: CAPITAL PACIFIC HOMES INC Building Official Bldg. Permit No.: 0011-026 Land Use Zone: RL Address: 4100 MAC ARTHUR BLVD City: NEWPORT BEACH CA 92660 By: KIRK KIRKLAND Date: 7-13-01 POST IN A CONSPICUOUS PLACE . OCT 13 2000 14:54 FR F I RST AMER I CAN TITLE TO 2798617 P.19/25 b roictober FIRST AMERICAN TITLE 13, 2000 02:16:25 pm PST j ERSIDE COUNTY 2000-01 TAX ROLL APN 1772-102-013-8 TRA 020021.- CITY OF LA QUINTA Legal'/ LOT 36 MB 21 6/001 TR 24890-4 j Mail 4100 MAC ARTHUR BLV NO 200 NEWPORT BEACH GA 926W Acq. Date: Doc No. 0511999 : D210740 Assessed Owners PLESCIA DOUGLAS R PLESCIA MADONNA R Assessed 2nd Half Values Taxes Land 153,000 Status 921.14 921.14 Payment Date 102.11 921.14 Total Tax Tax Install Penalty Balance Due Net 153,000 Total Taxes Due Special Assessments Included In Tax Amounts Fund Type Description 68-5859 MISC ASSMT CVWD AVLBLTY CHG IMP 55 68-2373 LNDSCP/LTG' LA QUINTA LDSCP & LTG 68.4882 MISC ASSMT CVWD STANDBY CHARGES Total of Special Assessments Additional Property information TAX CODE USE CODE VESTING PUI CODE 000 YR JT R07 Reference Notices • CUSTOMER SERVICE REQUEST ONLY • BILL: 000632606 r fileWCAProgram Files\BackWeb\NewSTS\html\reoort4100.htmI Report Origination ID: 03-RO3-0390 PAYMENTS AS OF 09/08/2000 1st Half 2nd Half OPEN OPEN 1,842.28 921.14 921.14 9211 102.11 921.14 921.14 STAMP AMOUNT 165.00 F . 1,842.28 Amount 30.00 11.74 10.00 61.74 10/13/2000