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