0102-198 (SFD)M. `'A 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 ny License is in full force and effect.
License # Lic: Class Exp. Date
i
t, Y•n yypqt,�'�yq jf a r
�,.�1..� fz,.a?l.� i..,;.,.
Date 0 Signature of Contractor — -
OWNER -BUILDER DECLARATION,.✓ `�,`c,r 0
I hereby affirm under penalty of perjury tl atXam exempt from the Contractor's.
License Law for the following reason: i" Z
( ) 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:
(„e)�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.
(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 o{ Section 3700 of the Labor
Code -,,I shall forthwith comply witp those.provlslons•-y r -t ', �' •, 7,��
D�: Applicant r -, ". t._ ..
.r
Warning: Failure to secure Workers,"Compensatlon coverage is unlawful anYl
shall subject an employer to criminal. penalties and civil fines up to $100,000,' in
addition ;to'the cost of compensation, damages as provided for in Section 3706
of the Labor -Code, interest and.,attorney's fees. , ^�
IMPORTANT Application is N eby made to the Director of Building and Safety
for a, permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state.that the above information Js
correct. I agree to comply with all City,"and State laws relating-to,ft'building
construction, and hereby authorize 'representative of -this City to enter upon, --
the above-mentioned property for inspect do purposes
f,,,., •i„J�i _ ?" (.:dry.`::»' ..=..a ?; t f -4A,.+.•
Signature (Owner/Agent) - Dated"
BUILDING PERMIT PERMIT#
DATE VALUATION LOTTRACT
JOB SITE'`----- • ,
ADDRESS
APN {
,r X 4-51 Aa -PNJD'S.: 0NT'$tZQ'A"
7K 151-W,
OWNER
CONTRACTOR/DESIGNER/EN (NEER
..
1@uP 3iCA.1y°7�u1�',pS'C{�:¢4y1"i/��r. "L(gJ:�Sry:' ;`�.Y"rg!.�+dyS
"f^%1I�,3gCy�.DTC. CC
. •c
°�`�r�: +ESy,�O '+"q94i�P 342,yp05
.11 " 70 *R`r.0 d+IyII:Ai.l diS;d1.S�3.�N.V Iy !it�r'.S r exp S'td.4,ls�'
L`'., Qta-nTPA CAI 9225:3
LA, (,mMA. CA 92253 .
(76T 4.-y MV4 85s_
USE OF PERMIT
�tb - PffP hT,1T.DO..E$'N0T INCx..f„RDS
91AV9,VIAF,,1000i + AMHIVI`��I,XYAPPROACH
1� I WOOD MCIT M00 LF
XNE14TIVED coffy pail, CONSWUMON
PLIZU1111 roll S SC
FRA i3AIVISIT 101.000-439-,318 -$210100
,gym€-c-nAmi",t3 ' ZZ 10 1-0130-41221-000 $62,00
a'01-.t29t�0-42C�-000y' 110
9���'YY1�Iy1���4''1'ICALLFEE gS.1
1"R UMBANO f 9pl, a0i�-01x0 ii-ii.9 1./00
#3 D :PION J .MOTION FEE - RESI ? 101-000441-000
Ok � 1NO FSFI 101.000.42 -000
UEir'ELA, PER INV.i C11' FEE
1'9=11479PIWN 101 $100.00
x' TB-Tl'J AT.. CO3`ITS3TUMOK ANDPYA- MUCrK
S3,585.%
LESS a\4°yIyD L
ab:M
TOTAL F%Rw 'IrDES 3MNOW
vd .
y
•
RECEIPT
DATc % /
BY t, / `
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
_ p (�
/
Underground Ducts
Ducts
Slab Grade
'
Return Air
Steel
Combustion Air
Roof Deck
— 3 - p
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
�_a�{ p t S-7
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines -
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
.ti
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
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
Water Pipingtal
_ �P
��-� �� t
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
=o� • O L
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole - / O
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
�. F.I.
Smoke Detectors
Temp. Use of Power
Final •
Utility Notice (Perm)
COMMENTS:
A+
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
X47-950 Du'ne Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Date 6/4/01'
No ` 22083:: .i' `� " Jurisdiction
OwnerNameLendel Ventures, Inc',
No. 51-861 Street -Avenida Montezuma
City La Quinta 1; Zip- 92253
APN# 773-151-006.
La Quinta
Permit # 0102-198
Tract # BLK 28 Lot # 6 Square Footage
Type of Development . Single Family -Residence
Comments
Log #
Study Area
1,846
No. of Units 1
i
At .the .present .ime, the Desert Sands,- Unified School -District does not collect fees on garages/carports, covered
patios/walkways, residential additions.undey_500 square feet, detached accessory structures or replacement mobilehomes.
It has been. determined the above-namedpwiier is exempt from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This.certifies that school facility feesimposed pursuant to,.Government Code 53080 in the amount of t
2.05 X 1,846 or $ 3,784:30 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/ Valley Independent Bank - Alfredlench Telephone 760 564-1866
' Name on'the check.
By 'Dr D.oris,Wilson
Supennten'dent'
Liz 1—ii%:I ',... :$3,784.308 -�
Fee collected /exempted by Paula Rutz. Payment Received -
l%� Check No. 240313 +
Signature `
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
tolled them on the Districi('s)(s') behalf, whichever is earlier. ""''j '�'�' ` e. i, is
Collector.: Attach: copy of county or city plan check application form to district copy for all waivers.
Embossed Original'- Building Dept./Applicant Copy - Applicant/ eceipt Copy - Accounting
Jan 2601 07:34a LENCH 7603458141 p.1
Jan -O6-2001 11:52am From-C0NOWEALTH LAND TITLE +T603e13i15' T-547 P.002/004 F-602.
RECOwIM REQUESTED BY: I • :ti
FIDELITY NATImx, TITLE• COMPANY `4
i0635KC , 33001450
KARL&
BARRABOY INVESTMENTS. LTR. 14VE MOTEe(fAi��
SPACE ABOVE THIS`LINE FOR RECORDER'S USE
APR;. 77151-55�
• GIT D -
The undersigned grantor(s) dec.lare(s):
- Documentary transfer tax is
(xXx) coloputed on full value of property conveyed, or
( > Computed on full value less liens and encumbeinces'r®maaning at time of sale. *
( ) Unincorporated area; ( ) City of and
FOR A VALUABLE ceNSIDERATION, receipt of which is heresy acknowledged.
x4zEL D. DUNNIGAN. TRUSTEE OF THE HAZEL MAWSON DUNNIGAN 1983 ,TRUST PKEEL)-JUNE 24_,19a!
Rereby GRANT(S)•to
` BARRABoY INVESTMENTS, LTD ,
the real propertyin_ the City of LA QUINTA• Counry'of Riverside, State of.California,
described as:' ,
Lot 6, B1ocx 28. Unit No. 2,, Tract Santa Carmel ra ar vale La Quinta, as per 0815,
recorded in.BooK 18,`?age (s) 55-56 inclusive of. maps. in the office of the' County.
Recorder of saidCounry.
Dated December 22, 2000 ,
State of Cal' forni� _� 7���'1C +L: Lir C% :•'� : ,�^�
County oS •1 "��/f •t &-z tat e.P j S. S. HAZELDUNNI(1AtJ, TRUSTEE T
On.
p before me, / L" 07,
A/ -t y personall appeared ,
--- HA7 c I. -
personally
personally known to me (or proved•_eo me on
ene basis•cf satisfactory evidence) to be
the person(a)'whose name (s)-is/ar-a subscribed
to the within ,instrument and acknowledged to 114ii LLM
1(&& that ras/-she/ttr�w executed cne same i G doR+e 191Wb
hW-hes/tii*rtr-autnoraaed.capacitytie3), and Po" Kok -Vanoft
that by b4-e/her/th6&-i signature,is) on the 1i1rC:anwi•8�i�
inserutnent the person(s), or the. entity upon
behalf of which the person(s) acted: executed
the instrument. `
WITNESS '-my.hand. and official sea:.
signature This area for official notarial seal)
HALL TAX STATEMEWS TO: -
a
w
Certificate of Occupancy-.--.--
Cit of LaQ
V
Building and Safety D!Dpartinent^°
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: 51-861 AVENIDA MONTEZUMA
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0102-198
Occupancy Group: _ R-3 Type of Construction: VN Land Use Zone: RC
Owner of Building: LENDEL VENTURES Address: 51-370 AVENIDA BERMUDAS
City: `LA QUINTA, CA 92253
r By: KIRK KIRKLAND
Date: SEPTEMBER 19, 2002
Building Official
POST IN A CONSPICUOUS PLACE