9809-104 (SFD)LICENSED CONTRACTOR DECLARATION � •�
'I hereby affirm under penalty of perjury that I am licensed under- provisions of
0tC ter 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
291778 B 913U04
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 ./i'- f? -P Signature of Owner *r _
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.
(This sed"Anee 'nd of E completed if the permit valuation`issfor 100:00 oar Ike s1.3
W I certify that in the performance of the work for which this permit is issued,
I rsh'all 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
subjZ to the workers' compensation provisions of Section 3700?of the Labor
Code, I shall forthwith comply with those provisions.
Pate: - 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.
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
Zthe above mentioned property for inspection purposes.
ignature (Owner/Agent) Date !.
BUILDING PERMIT PERM TN y R
y
1yr}3'
DATE VALUATION LOT '41 TRACTJOB
SITEf
ADDRESS Z ��j0
APN
�/
A MA MOiI�IIUM
773. 1-414
OWNER
CONTRACTOR / DESIGNER / ENGINEER
DORENE LEWIS
WILLIAM RUSSELL ROGERS
P.O. BOX 397'
369W JACKSON
BORREGO SPRINGS CA 92014
THERMAL CA 92774
(760)399-12M CBL#
USE OF PERMIT
111f\f 'tX r P / f .' i4 !1r]I I i1r••,
WD - BLOCK. W Ai" OR POOL Ab S14OWN ON PLAN BV LARAYR
Vi3lttalllT. BUII.IlW MAU PROV11* t3LAM SI.C.i—T, L)UTAfL F1,*
♦ O9iB nV A I VP %f V001 1Wn A T 'kill a V*'%V
NOV 13 1M
TRACT CONSTRI TION 1.401.00 Sr,
P+;)RCUPATiO 199.013 8F
O CART 444.00 !Y
OF LIDS QUl
t
EMMTED COST OF OWSTIIiUC.� 10N
E7,2W40
MRMIT FEE SUMMARY
CCft4VCRI 1CT1ON Ili 101-000-418-000 5585,- ►
IY,AN(IFrgiFI3 149 86
M. DEP03rr 101-{104-439-318 -3230.00
MUOM,WAL FkW 101-000421-400 $W.00
MACTRICAL FEF 1014X)0420 -OW $121.42
P1A11 TW-# FYM lfl1-00"19-Am $119 Stf
$MONO toi(7fION FM - RESM 101-000-241-000 38.73
ORAIANG FTC's 1014001-423-M s20.00
INFRASTRUIC'MIR-E FIE 2254)00-443-342 $1.907.48
PRPM<, ?''PLAN 1014*0-441-343 S2i-on
SI 113-TOTAi , C ONS'?"1 1, rrON ANT) PLAN (14ECK
T3,w 49
LESS PRE -PAID FEES
$25000
TOTAL�PUNiT FELS DUE NOW
$3,114,49
U-•n� J
RECEIPT
DATE
_
BY1
DATE FINALED
INSPECTOR
D
IL
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 41-A
Ducts
Slab Grade 41 LV
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 Wail Firewall
Exterior Lath
Drywall - Int. Lath i
Final
Final
BLOCKWALL AP ROVALS
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
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
Pool Cover
Sewer Connection — -7T
Encapsulation
Gas Piping
Gas Test Z
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.1.
Smoke Detectors
Temp. Use of Power
Final 4.
Utility Notice (Perm)
COMMENTS:
T-iht 4 4 Qum&
78-495 CALLE TAMPICO — LA OUINTA, CALIFORNIA 92253 - (760)'777-7000
TDD (760) 777-1227
December 8, 1998
Dorene Lewis
P 0 Box 397
Borrego Springs, CA 92004
Dear Dorene Lewis:
Please be advised of an addres change for the following structure. The structure
formerly addressed as 78-970 Calle Montezuma, APN: 773-201-014, Lot 15, Block
39, Santa Carmelita at Vale La Quinta, Unit #3, the construction of which building
permit # 9809-104 was issued will now be addressed as 52-196 Call& Mount zuma.
Please note this change and contact me directly at (760) 777-7012 if] may be of
further assistance.
Thank you.
Since ely,
l
Q
Greg But
Counter Technician
BUILDING & SAFETY DEPARTMENT
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253
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 11/13/98
No. 17997 Jurisdiction
Owner NameDorene Lewis
No. 52-196 Street Avenida Montezuma
City La Quinta zip 92253
Tract #
Type of Development
Comments
Lot #
Single Family Residence
APN # 773-201-014
La Quinta
Permit #
Log #
Study Area
Square Footage 1,401
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 mobilehomes.
It has been determined 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 Government Code 53080 y , in,the amount of
1.93 X 1,401 or $ 2,703.93 the property listed above and;that,buildinj ,
l kr w
permits and/or Certificates of Occupancy for this square footage in this proposed project may now b �ssuedIZI
Fees Paid By CC/1 st Community Bank/Larry Shields� /
T'elephor`.� 34��-0012
Name on the check
By Dr. Doris Wilson
{�-
Superintendent
Fee collected /exempted by Juanita Green
Signature
Payment Received $2,703.93
Check No. 082846
(NOTICE: Pursuant of Asse y 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 fro t e 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') 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
_ .. Recording Requested By �1®�09 ..
-tCHICAGO TITLE COMPANY
:
-RECORDING REQUESTED BY: P A i D RECEIVED FOR RECORD
CHICAGO TITLE COMPANY COMPANY DOC. TCo'tj(Af Tax AT 8:00 AM
98.7556KC.1 870366-52
WHOEE�L I R AD�O�Orr �,.�. cn£ ao` MAY 2 6 1996
NE Or6d
DOR£NE L. LEWIS
A�Oadof
P.O. BOY. 39? i' Ferri i
SORREGO SPRINGS, CA 92004
SPACE ABOVE THIS LINE FOR RECORDER'S USE
GRANT DEED �-201oa o
The undersigned grantor(s) declaie(s):
Documentary transfer tax is $27,50 _
(XXX)y� ted an full valuer of rope rt';"�F_onveye:d,, or _____+_�
( 1" C)rrputed on Lull value '_cs Liens and anc.umbrancec remaining at time of sale. T,
l ) Unincorporated area.: ( );City of and
;•
FOR A VALUABLE CONSIDERATION,r.+ipt of which is hereby acknowledged, L SF
r
WILLIAM R. RILEY, TRUSTEE CF THE[WILLIAM R. RILEY TRUST (199A
4 - •
hereby GRANT(S) to
� r
DORENE L. LEWIS, AN i,WMARRIED WOMAN
the real pr=6perty in the City of :LA,n,,UINTA, Courty of Riverside, State of California,
described as:
LOT 15 BLOCK 39, OF SANTA CARMEL , TA. AT .'ALE LA QUINTA, UNIT NO, 3,, .AS SHOWN BY
KAP ON FILE; IN BOOK, 12 PAGE 59, ('F MAPS, RECORDS OP RIVERSIDE COUNTY, CALIFORNIA i
f
Dated May 21 1998 i
State of California G
County of Riverside , } S. S. WILLIAM R. RILEY, TRUSTEE
On -_ Kay 22.• 199$ _ 1' -OF THE WILLIAM R. RILEY TRUST (199,0)-'----
before
199,)•-'""before ;ne, Kelly Collier y
personally appeared i
ldilliam R,_;�ley i '
Personally known to me (or pz•ove to me on
the basis of satisfactory eviden ) to be
the person(s) whose name(s) is/a subscribed
to the within instrument and ackdowledged to
me that he/she/they executed the Jame in
his/her/their authorized capacitY,(ies), and
that by his/he their signature(g) on the
instrument the son (s) or the `entity upon
behalf of which 'e per o('(s) ac ed, executed
the instrumfnt. �1 n
r
:CXOM,7.r()�,4
EiY COIUER 'a
•• 1057217CAUfo'C 190
WITNESS4STEMENJUS06:
o fi sea .
Signatu(This area for•official notarial seal)
MAIL TAsAm ,
T4ht .4 4 Q"
July 6,1996
78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 – (760) 777-7000
FAX (760) 777-7101
TDD (760) 777-1227
Ms. Dorene Lewis
P.O. Box 397
Borrego Springs, Ca. 92004
SUBJECT: Minor Adjustment 98-459 (Lot 15, La Quinta Unit #3)
Dear Ms. Lewis,
The Community Development Department has approved your request per the
attached exhibit, for a minor adjustment allowing a two foot encroachment into the
required 20 foot front yard setback, based on the following:
1. This minor adjustment is consistent with the General Plan in that the single
family use is permitted in the Low Density Residential land use designation of
the Land Use Element of the General Plan.
2. This minor adjustment is consist with the Zoning Code in that it is a permitted
use in the Low Density Residential District and complies with other applicable
Zoning Code requirements.
3. Minor. adjustments are categorically Exempt from the requirements of the
California Environmental Quality Act, per Class 15303 (a. and c.). Therefore,
no further environmental review is deemed necessary.
4. The uses surrounding this use are single family residential uses or vacant lots
proposed for single family residential. The encroachment of a portion of the
garage is necessary due to the irregular shape of the lot.
Approval is as shown on the enclosed site plan.Should you have any questions,
please call me at (760) 777-7064.
Very truly yours,
JERRY HERMAN
COMMUNITY DEVELOPMENT DIRECTOR
STAN B. SAWA
Principal Planner
enclosure
c: Greq Butler, Building and Safety Department `<�
IGIAILING ADDRESS — . P.O. BOX 1504 — LA QUINTA, CALIFORNIA 92253
c:\Itr app ma 98-459
Fau`
Garage
Bed/Office
4j
v