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2164 (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. License # Lic. Class Exp. Date . E3 1913 B 01131/.20( 1pat` e I! Signature of Contradtor 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 Policy No. t �a1.rAMIT EAGIL IN NWC48=4r. (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 Cg'8eL1 shall -forthwith comply with those provisions. ! f r ate: 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 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. + PERMIT # = BUILDING PERMIT - DATE ( VALUATION 118"1.10 LOT 12 TRACT g U JOB.SITE APN 774-241-023 OWN��EyR pp y/Lr A. vET `y PO .BOX. 399 1.AQUlWA CA *122153 USE OF PERMIT CONTRACTOR/DESIGNER/ENGINEER 51-5413 EiSE NHOWER DR. LA QU NTA O'A 922.53 060).%4-460-1 ; CBL# 2761 SM - 9e MAST z. MA -2 - PERAUT rx)M N01' fbk_LUDE I L.O(X cuss. OR }M)IL,. ITI ACFi x.:0111 i'iM"ii-)iv 1,409,00 SP GAR+t,l'acit`.t4d]"JR1 519.0 S11 i "1' Wtli11� I_L" C V ?ARJ.w L!' MIMATED CWT OV CM3TVUC-f ION 38,321.10 PL- RMiTEVE SUMttAA t"c is 3�vC" oN k"fs7' 101 -000 -418 -OW 00 PT. 4.14 tli`KIK, i+"- 10 1 -MN430-31 8 $4915.21 MFOIANWAL M 101.000-421-000 $53.50 k'si &,-r.wcjkL nm 101-tkN- 42043W $129-4) PIA M 11NO f'& 1611-iAfit3�J1�?-i1t1(i $110.75 111V OWI M0T ION sTW - RFM1) 14)11 -(KN) ?414.M L8.84 GRADI;tiG rte: 4- / INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE F INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings _ .�Q T Underground Ducts Ducts Slab Grade I r�r Return Air Steel Combustion Air Roof Deck Exhaust Fans 0. K. to Wrap/— y_ 00 F.A.U. Framing I— r 4— 0 0 S, T Compressor Insulation I _ t y — 00 S , -r Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final 00 BLOCKWALL AP ROVALS POOLS - SPAS Steel Set Hacks Electric Bond Footings 3`3 — Ca0 Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Water Piping _ Il (8/Q It Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection �/_ �.r_ g S7 Encapsulation Gas Piping Gas Test �y Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles - G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS - Building Address .J Owner Vo?,�-� 6 - Mailing _ Address --4,6 ,,6 City r lZi 4 t�'�citrcv�J P.O. BOX 1504 78-495 CALLE TAMPICO APP"ILY 21, LA QUINTA, CALIFORNIA 92253 NIA Address City Zip ITel. State Lic./ ,t City & Classif. t', ?��.` (1) t; ! Lic. # Arch., Engr., t Designer Address I Tel. CityI Zip I State I Lic. # LICENSED CONTRAGEOR'S DECLARATION that I am licensed and r %visions of" apter 9 r� mencing with Section 3 of the,eussiiness and Fr$fessions Code, and my lice injyll force and j -OWNER -BUILDER DECLARATION I hereby affirm thpt I am exempt from the Contractor's License Law for the following reason: (Sec. 7QQ,1,.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 (8500). I] 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, Bu)sness 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.) 11 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) licensed pursuant to the Contractor's License Law.) 17 1 am exempt under Sec. B. 8 P.C. for this reason Date Owner 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 (7 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 thip 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., d, 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. 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 BUILDING: TYPE'CONST. OCC. GRP. A.P. Number. --1:-7t,4 f -1A 1 — C) 2)� Legal Description C 5T 10, Il Y o Project Description 4 AUG 31 1999 Sq. Ft. I��(l�( Size New(R' _ Add ❑ PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS _% a i . _. , No. No. Dw. Stories ,� Units _ Alter ❑ Repair ❑ Demolition ❑ AMOUNT 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: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION - C'b Notice: Document Cannot Be Duplicated Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE Date 10/25/99 No. 19508 owner NameRobert & Sylvia Kellogg No, 54-475 city La Quinta Tract # Street Avenida Obregon Lot # Type of Development Single Family Residence Comments APN # 774-241-023 Jurisdiction La Quinta zip 92253 Square Footage Permit # , Log # Study Area 1409 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 mobilefitimes. has been determined the above-named owner is exempt from paying school fees at this time due to the followingreason: d It EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.93 X 1,409 or $ 2,719.37 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/Union Bank of California/Bob Kellogg Telephone 760 564-1962 Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Olivia Aguirre. I Signature Payment Received $2,719.37 Check No. 6528539 NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to collect them on the District('s)(s') behalf, whichever is earlier. Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting il 00-20. 1999 3:IIPM CONTEMPORARY HOMES (760)564=2534 No.0264 2 @uy�Rs C"p SALE ESCROW INSTRUCTIONS Y THIS DOCUMENT WILL AFFECT YOUR LEGAL RIGHTS - READ IT CAREFULLY! T0: COMMONWEALTH LAND TITLC COMPANY Escrow No.: 99.90%'6KC 72055 Fred Waring Dr. Date: 07/29/99 Suite A5 Page: 1 Palm Desert, CA 92260 (760) 836-3726 Escrow Officer: Kelly Collier THE ESCROW HOLDER IS COMMONWEALTH LAND TPTLE COMPANY WHICH IS LICENSED BY THE CALIFORNIA DEPARTMENT OF INSURANCE. Buyer, or his agent, will hand you or cause to be handed you upon signing of these instructions a deposit in the amount of ................:..................$ 20.000.00 Buyer will hand you additional funds prior to closing in the amount of .......... $79.000.00 Purchase Money Trust Deed in favor of seller ......................;.............$ . 80.000.00 TOTAL CONSIDERATION $ 179,000.00 and any additional funds and instruments required from me to enable you to comply with these instructions, which you are to use on or before August 26, 1999, and when CHICAGO TITLE COMPANY can Issue a Standard Policy of Title Insurance Owners form, with liability of $175,000.00, on real property in City of LA QUINTA, County of Riverside, State of CALIFORNIA viz: Commonly known as: VACANT LOTS (9), LA QUINTA, CALIFORNIA 92253 Lot (S) 6, 7, 8, 9. 10, 11, 12, 13, 14, Tract Santa Carmel ita at Vale La Quinta, as per map recorded in Book 19, Page(s) 44-45 inclusive of Miscellaneous Maps, in the office of the County Recorder of said county. EXACT LEGAL DESCRIPTION TO BE PROVIDED ON PRELIMINARY TITLE REPORT TO FOLLOW Except any reservations of record of minerals, oil, gas, water, carbons and hydrocarbons. Showing title vested in: ROBERT B. KELLOGG and SYLVIA KELLOGG,:husband and wife -as joint tenants DBA CONTEMPORARY HOMES Free from encumbrance except: A. Current general and special taxes for the fiscal year in which this escrow closes, and taxes for the ensuing year, if any, a lien not yet due or payable. B. The lien of supplemental taxes, if any, assessed pursuant to the provisions of Chapter 3,5 (commencing with Section 75) of the Revenue and Taxation Code of the State of California, C. Special improvement assessments, if any. D. Easements, rights, rights of way, covenants, conditions, restrictions and reservations of record. E. Deed of Trust to record in the amount of $80,000.00, in favor of sellers herein as their interest may appear. P 4Z