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0210-081 (SFD)LICENSED CONTRACTOR DECLARATION •I hereby affirm under penalty of perjury that I am licensed under provisions of dhapter 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 792225 0?131 /2( -,'Date 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 ,} 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,gMTA'f Policy No. (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 provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: Applicant 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 c 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. Signature (Owner/Agent). Date f.: ," BU1L-DIN.G PERMIT PERMIT# 02�(r1`t� DATE VALUATION LOT TRACT 6 b�k 35 JOB SITE APN ADDRESS 51.4m AI/L1 WA0BFX( Xq 7,13'163-•018 OWNER CONTRACTOR / DESIGNER / ENGINEER LEOldA.1• D LAIR- F.FIONJV�D 1-W PAIS M T:?F'Zmi l CA 92260 T>AL'M..:UF SERT CA 92260 (760)340-9882 t . L# 6426 USE OF PERMIT 7WI 0-12FAC�Y DWELT JOG , . 1813 "SY, STT. P "d MIT DORS NOT rNC.L.UDE HLOCK WALLS, POOL, Oil DIIIIIEWAY .APP1ZOACrt 't'la/a..CT C ONO TR,UC110N 1,Smoo OF POR.CHIPATIO 16.00 SFr (1AFi,A.GE/C..ARPORT 429.03 SF ESi'111W:ll.'= (.101i' 01r COW Intiv,noll 1.076.x..` 20 CONSTRUCTION PER 101.000 -1.18 -ON S"750 PLA.W CHECK: ffZ 101 ••000-439-3 18 $554.33 FEF DEPOSIT 101-000.439.318 42%140 MECH" 1CAL P'E',Y, 09,00 VAWTRICAL FE1? 101-000»420.000 5120110 FL:Sr BF.WC41YRE 101-000-419-000 $09.75 STROWO MOTION FRE - WID 101-000-241-000 CIF_03 )rrNQ 11121Z 101 -000-423-000 DEVEIA)PEtt IMPACT FEE $1�t1S,Atj PREC113Z PLAN 101-000-441-34.5 $100.00 :f .TB-.1'0`1`AT., C 0.1N6TTF TX,9n0)4 AN131:',t. Ate' e" 1',it♦ f"FC 9,Oti(1. �8 1.,F. SID :PREF. • 1AID .FET.S 4250,OCt _Q7 I .CAL Y�.fiti"' . r Y n `,S Y��1�, NOIN r CIiY®':IAQU T FINANCE DEP% . RECEIPT DATE ' BY DATE FOA1,12D INS E OR . / . Z 1,l �i0 ' F INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs 0 Underground Ducts Forms & Footings Ducts Slab Grade 14 Return Air Steel Combustion Air Roof Deck- Exhaust Fans O.K. to Wrap .0-2 F.A.U. Framing Compressor Insulation• O Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Elo— (/ Drywall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Waste Lines �� • o3 G/!i Gas Test Electric Final Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection 6 �-03 Encapsulation Gas Piping Gas Test Appliances Final 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 7 1-7—U-17 Final Utility Notice (Perm) COMMENTS: �livRyY"�G�I� U��gp/�i�s�t L'atlL6� y 141444.9 d pw"W �C Building Address T4hf " P.O. BOX 1504 <r���lj• �/f y��j 78-495 CALLE TAMPICO -�=z�. � yG . Vl fi��C7Q LA QUINTA, CALIFORNIA 92253 1.5NAkb LAA -1, Mailing ,. dd Address ��� i f� /_ o rf r1/K'rL,f City Zip Tel. r 11A�� Contractor City .'f ZILM Tel. ;7240 State Lic. City & Classif. 79'0:0 Z Lic. # Arcn., tngr., Designer Address ) 1 z CityI Zip I State. 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 rile 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 (8500). 1' 1, 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. If, 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($) licensed pursuant to the Contractor's License Law.) i1 1 am exempt under Sec. B. & P.C. fofthis reason Date yf t ('' (• Owner WORKERS' COMPENSATION, DECLARATION I hereby affirm that I have a certificate f consent to self -insure, or a certificate of Worker's Compensation Insuranceror a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company n 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 (E100) valuation or less.) I certify that in the performance of thg work. for which this permit is issued, I shall not m eploy any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT., If, 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 Ihereby 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 it work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. 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. Signature of applicant Date 'Mailing Address City, State, Zip APPLICATION ONLY UILDING: TYP—E'CONST. is P" •� OCC. GRP. J .P. Number 7.3- 143 _• r^/P -a egal Description L e, Bier!<35 ?:j.✓VLA roject Description J f" Sq. Ft. n Size �,.� 12 New ® Add ❑ No. No. Dw. Stories i Units Alter ❑ Repair ❑ Demolition ❑ Itimated Valuation-•.-=----- '' PERMIT AMOUNT �1 Plan Chk. Dep. rj Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL 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 DP Issued by Validated Validatior WHITE = FINANCE YELLOW = APPLICANT T PINK = BUILDING DIVISION Tract # Blk 35 Study Area Type Single Family Residence No. of Units 1 Lot # No. Street S.F. Unit 1 6 51885 Avenida Obregon 1812 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments Lot # No. Street S.F. At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, residential additions under 500 square feet, detached accessory structures (spaces that do not contain facilities for living;Sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that 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 Education Code Section 17620,and Government Code 65995 Et Seq. in the amount of $2.14 X 1,812 ' S.F. or $3,877.68 have been paid for 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/Guaranty Bank - Leonard Lam Check No. 2247821 Name on the check Telephone 760/340-9882 Funding; Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Monica Guillen $3,877.68 So.00 Payment Recd Over/Under Signature QYf GGu, NOTICE: Pursuant to Government Code.Section 66020(d)(1), 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 issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original -Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting CERTIFICATE OF COMPLIANCE J�F�sc Desert.Sands Unified School District � 47950,Dune Palms Road �o� Q eERMUOA DUNES r Date 11/25/02 La Quinta CA 92253 rn RANCHO MIRAGE d ti No. 23898 (760) 771=8515 {� INDIAN WELLSLM DESERT dd PALA QUINTA INDIO ^�y 4Qy^ ./ Q Owner Leonard Lam APN # 773-163-018 Address 111 Chelsea Circle Jurisdiction La Quinta City Palm Desert Zip 92260 Permit # 0210-081 Tract # Blk 35 Study Area Type Single Family Residence No. of Units 1 Lot # No. Street S.F. Unit 1 6 51885 Avenida Obregon 1812 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments Lot # No. Street S.F. At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, residential additions under 500 square feet, detached accessory structures (spaces that do not contain facilities for living;Sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that 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 Education Code Section 17620,and Government Code 65995 Et Seq. in the amount of $2.14 X 1,812 ' S.F. or $3,877.68 have been paid for 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/Guaranty Bank - Leonard Lam Check No. 2247821 Name on the check Telephone 760/340-9882 Funding; Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Monica Guillen $3,877.68 So.00 Payment Recd Over/Under Signature QYf GGu, NOTICE: Pursuant to Government Code.Section 66020(d)(1), 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 issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original -Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting RemordIn Re quested. First ��;�c gn'766. Company LEONARD K. LAN 111 CHELSEA CIR. PALM DESERT CA.92260 08/30/2002 08:00A Fee:7.00 Page 1 of 1 Doc T Tax Paid Recorded in Official Records County of Riverside Gary L. Orso �T9see9or,-County Clerk & Recorder 0. c , l I (!ll llfl ++ III I Ill ii �Il 111 ( l ! M $ U PAGE SIZE DA A R L COPY LONG REFUND NCHG EXAM G R A N T D E E D The undersigned Grantor(s) declare(s): Documentary transfer tax is $ 44.00 ASSESSORS PARCEL NO.: 773 163 018..Qcomputed ;.an ful value of:: proper,y.. conveyed° < ...., _ TITLE ORDER NO.' 6022"71 ( ') compuf`ed.on the full value less liens or IV)ESCROW NO.: 223940RW encumbrances remaining at the time of sale 0 . '- In FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged: FRANK F. CATHERINA r „1 hereby GRANT(S) to LEONARD K. LAM, A SINGLE MAN The following real property in the.LA QUINTA, Riverside County, State of California: described as: Lot 6 of SANTA CARMELITA AT VALE LQ #2, in Block 35, as shown by Map on file in Book 0, in the Office of the County Recorder of.Ri .39jrside County. Date: July 24, 2002ME ;& `FRANK F. CATHERINA STATE OF CALIFORNIA ) COUNTY OF SAN LUIS On 05AUG02 before me, the undersigned, Personally appeared FRANK F CATHERINA — pa*seaally known te me (or proved to me on the basis Of satisfactory evidence) to be the person,(,ej whose name (.s'l is/aar6 subscribed to the., within instrument and acknowledged to me that he/j�W/thy executed the same in his/hp/the-I authorized capacity(. r and that by his/ha?Ifr signature(Al on the instrument the person(.96- or the entity upon behalf of which the person(,erj acted, executed the instrument. Witness my hand and official seal. Signature— .. T MELODY FOSTER, NOTARY PUBLIC °` .,MELODY E. FOSTER ' COMM.1 9204632 NOTARY PUSL -CALIFORNIA 2 SAN LUIS 0SPO COUNTYO COMM. EXP. OEC. 92, 2002 a (This area for official notarial seal) MAIL TAX STATEMENTS TO: 111 CHELSEA CIR., PALM DESERT CA.92260 r THAW 9Ny T�to�DEt,���2�� /►+A/ o/V� ©✓c P®Sf. $rl ©F S14,V,fry zAIZS ^AY T- CITY OF LA QUINTA SUB -CONTRACTOR LIST P�n.ro�atcy �1 JOB ADDRESS�'LlI� _ rL GC OIV PERMIT NUMBER V Z 10-U p OWNER LN� BUILDER L�ONf�7 Q This form shall be posted on the iob with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this or list employees are authorized to work on this fob: Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and / or the voidance of building permit. For each applicable trade, all information request must be:completed by applicant. "On File" is not acceptable. Company. Name classification License No. Exp. Date ? Carrier Name . Policy Numbef 6cp: Date License No. (e.g. A;B,C-8) C8 (XXXXX) 782597 (xx/xx/xx) (Format Varies) STATE FUNDS (xx/xx/xx) 4560007595 (XX/)Q(1XX) 1/1/03 . ; .(-dxx/xx) 510 Exp Date (Xxp(X/) :l Desert Elite Concrete Owner B 792225 3/31/03 EXEMPT N/A N/A N/A 3/22104 N/A CL/i Desert Elite Concrete C8 782597 8/31/04 STATE FUNDS 4560007595 1/1/03 510 3/22/04 Sandpiper Plumbing C36 759456 2/28/03 Employee Group 1640402 10/1/03 Owner B 792225 .3/39/03 EXEMPT. N/A N/A N/A N/A Owner B C20 , 792225 749342. 3/31/03 5/31/04 EXEMPT EXEMPT N/A N/A, N/A N/A N/A 5951 N/A 1/31/03 --! La Ouinta Air-conditioning J M Electric C10 631350 10/31/03 EXEMPT N/A N/A 2907 Zl2� b C �w Ortega and Son s Roofng X39 C39 SfOS37 7628,49 7 3(/ 5/31: 3 S-rqT�' 16 , . ;nr1(?.� STATE FUNDS 15 7/10/03 L l S � C / (mac vz Q s �0.3 6i<E hok f f �/� AVIA Jim Spencer Floor Covering C15 591598 3/31/04.' STATE FUNDS 06891-77-01 3/3/03 4578 9/6/03 r - Desert Windows Inc. C17 C20 737824 632072 7/31/03 9/30/03 STATE FUNDS TRAVELERS PROP .046-0 ' 01183 TC2UB122 6/1/03 06/31/03 3085 3291' 12/31/02 8/25/0 * Paragon Insulation Sandpiper Plumbing C36 759456 2/28/03 Employee Group 1640402 10/1/03 3 0;:5 (� Owner B B 792225 792225 3/31/03 3/31/03 EXEMPT EXEMPT N/A N/A N/A N/A N/A N/A N/A /A Owner Cabinet Art C5 787248 11/30/02 Preferred Emplo ee 164040) 10/1/03 3005p 9 P Owner B 792225 3/31/03 EXEMPT N/A N/A N/A 0/03 N/A Owner B 792225 3/31/03 EXEMPT N/A N/A N/A N/A J & L Material c-61403 -4.1-@378- 8/3/03 STATE FUNDS 1576631 9/19/03 794 5/8/03- 4• _�i.~ , - � _. -� ',v " - -, - L x. Lt A " 5l. Dill �­, � c Cate..,, -b c a c - 1::. ! c 'Al 41 - BLfilb F Building ppartrr�en 'T,,h'h§1�iCertfflddieJs- issued.p"' uantto&�ifievtr I eq� w, t, "of S�­ yrs uiremen s ecti6h-409.6fthe .California -Blifilding'. C6b�b` ce jfyMg. thaf,­ at thelime s,!Jn' ofa a Is comp tan B C6,dd and�M6 ous -o d'- provisibhs bV'the - Wildiho,, c d6h, "and1br.d�§e;, cohii d r! man A 0 'AEj6�RESS--,'-51"885,-;AVENIDA�!OBkEb'*'N" BU1LD1NG,--,-,-,, S .Use �1assification: SINGLE FAMILY-MWELLING,--k. �-­Kildiqq_,'�,errhit 146`::,,02,10-081 Use Zone: RC 0 c c`u p ru6f16 anc Gf6u'p: �T, 6f -Const n V PF� fl_� 0 � :•,';t w.�' �^ ,�r � � f TFr i' ..- •_ \� �; �. ir�x.f�,. tir•:Y y .t M • Owner of BUilding: LEONARD LAW Addregs': 11.1 CHELSEXCIRCLE'­ 4,71 C i "rCA92260,,.,--, t��,,ST,21P: PALMMESERT. q c­PXRAWF0RW-' By-.�DANIEL, 'A. A Date: -0dedb6 8::2663 B6ildingpffidi6l' -IJ - 0 S T IWX CONSPICUOUS -PLACE