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0007-133 (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 63498I. X3 ' �D1f3l�E P-'�„1 D' ate 12 ��`. Signature of Contractor ' "t t 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,.wiII 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 erfoomance 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: Carver Policy No: SUATR VU14D (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 subje_ef to the.workers' compensation provisions of Secti6n;3760 of the Labor Co e, I. shall for comply with those -provisions. VI`' .v c , Applicant—' -L.. "A Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the'Director of .Building and Safety for a permit subject to the conditions and restrictions set forth . on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to,.& shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. l agree to comply with all City, and State laws relating to the building constr�qtion, and hereby -authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. 1, , 4ture (Owner/Agent)'Date ! ' BUILDING PERMIT PERMIT# DATE VALUATION \ LOT �4� TRACT !fi Co s: ig,197,` o 13 BLX196 JOB SITE APN ADDRESS 53-090 AV RI ALMOBTFMMA 774-141-011 .F OWNER CONTRACTOR/DESIGNER/ENGINEER XA Cj1TINTA. CIA 92M Y -A QX.iIZ fA. CA, 92.253 (160),564.,4604 03LO 22+61 USE OF PERMIT SWC411E FAtd£1X. y 1 Wra4,J if G w Z3 -PERP UT 0OKS NOT MCGU,t'i1.11Lt~ICK" WA1,100OUS:PA OR APPROACH DRIVEWAY Y TRACT CONSTRI,i>r'190 ),Moo 3F FtKJ1sf.:}31/1?A'iIO 471.00 Sr . , ,9w60 k$M3-dZ.RfMfnS.� 01019'r 0F`r�6./�71JMNI Lr,ARSy�LF1A. /'R PYRMI'V30% SUMMARY CONSTRUCTION FEE i 01-000.4.18.000 MOP V1„A14 CHECK fptT, 101.000-439-318 $6 171 19 101.000-421.000 ill EC'TRICAL lyEZ 101-0004ZO-£`00 PIAI1`v1I rHo I 101-000-419-000 Y2tl,9r4t! S'!'t,0140ma),XG14l •E3* aX) Iol"000-?.41-0Ot7 t3Rr.�f)1NCt F+I+riN 101-004-423-000 $20.00 Y. WEI�7:#t2A 1AQ4'ACT FLE.Ia $I,11a`�.ilU PRECISE.. PLAN 101-.000-441-345 $100100 X DEPOSIT =?c3- AWAL CO1,dIME.:MM1O11 AND T?,LPX CHECrK $3,811.62 MEWS YME-PAMPHES 4250,00 T WAL I i�'XUSY.1+Lc 4,S ))1.f 1g0W $3,5614 RECEIPT DA E, B / DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade v Return Air Steel Combustion Air Roof Deck - Z O l Exhaust Fans O.K. to Wrap - ck gSR F.A.U. Framing < < 67,1 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 lL- s -oma Final Final BLOCKWALL APPROVALS steel POOLS - SPAS 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 p 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 1,4 Final (01 vi Utility Notice (Perm) COMMENTS: 07-1-33 /LIZ -SE 4ff- 4 '.1 ����. ,IgLAG g-�r�F� %Gi�'I,ICV ore P.O. BOX 1504 APPLICATION ONLY Building?4/s. � 78-495 CALLE TAMPICO •3qq� Address ? v'E . K&mqc-z_uHA LA QUINTA, CALIFORNIA 92253 Owner V / J { • t BUILDING: TYPE CONST. _AV OCC. GRP Mailing 2 aa* Address A.P. Number 1 41 / ` 0 1 City Zi �f Tel. `O� S l.1T_ V&t1f_ C_ r � L Legal Description ► V C `�'1 � ' Contractor L Pct r Project Description Address W City Zip Tel. State Lic. City & Classif. Lic. # Sq. Ft* I p � No. 1 No, Dw. Arch., Eng r.,� �A Size Stories ! Units Designer 4�PbM7 k,�1��- A 1 A Newy Add ❑ Alter ❑ Repair ❑ Demolition ❑ City � Zip-, Lict# C 7o 43 6 3yo -zoo",? LIC f ASED CONTRACTOR'S DECLARATION I hereby -a rm that I am Ileensed under provisions of Chapter 9 (comrrpencing with Section 7000) of; Division 3 of the 8 'siness and Professions Code an m hcegse s in full force aec nd $1GNATURE / \I _DATE % OWNER -BUILDER DECLARATION "I/ Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5.Susiness 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 thealleged exemption. Any violation of Section 7031.5 by any applicant for a permit Plan Chk. Dep. subjects the applicant to a civil penalty of not more than five hundred dollars ($500). l: I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 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 strucl 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 S.M.1. such projects with a contractors) licensed pursuant to the Contractor's License Law.) I? I am exempt under Sec. B. 8 P.C. for this reason Grading Driveway Enc. Date Owner Infrastructure WORKERS' COMPENSATION DECLARATION 1hereby 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 r7 Copy is filed with the city. O 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 ($100) valuation 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. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY: subject fo the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: comply with such provisions or this permit Shall be deemed revoked. Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 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.) Side Setback from Property Line Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE ; INSPECTOR i 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. Issued by: Date Perm t 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- JUL '1 1 n0�® mentioned property for inspection purposes. Validated by: L Signature of a(Splicant —Date — Mailing Mailing Address Validation: 4� ,� City, State, Zip r1 I- WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Notice: Document Cannot Be Duplicated Date 12/21/00 No. 21394 Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE Owner NameM/M Avenida Montezuma No, 53-990 City La Quinta Tract # Type of Development Comments Street Avenida Montezuma Lot # APN # 774-141-011 Jurisdiction La Quinta Permit # 0007-133 Log # Zip 922253 Study Area Square Footage 1850 Single Family Residence 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 in the amount of 2.05 X 1,850 or $ 3,792.50 the property listed above and that building. permits and/or Certificates of Occupancy for this square footage in this proposed project in ow be,issued Fees Paid By CC / Valley Independent Bank'- Ismael CoronelTelephone4}760=564-4604 Name on the.check By Dr. Doris Wilson` .4 Superintendent 4` Fee collected /exempted by Annette Barlow Signature Payment Received $3,792.50 Check No. 235112 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 peril 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 FIDELITY RATIONAL TITLE INSURANCE COMPANY RECORDING REQUESTED BY: Fidelity National Title Company Escrow No. 41153 -CB Title Order No. 00531499 When Recorded Mail Document and Tax Statement To: Mr. and Mrs. David Chappie 77701 Los Arbolles La Quinta, CA 92253 314gq 12IPl i- 02-001 S DOG ss 2000-016389 01/14/2000 08:00A Fee:6.00 Page 1 of 1 Doc T Tax Paid Recorded in Official Records County of Riverside Gary L. Orso Assessor, County Clerk & Recorder 111111111111111111111111111111111111111111111111111111111 FA $/ U PAGE SIZE DA PCOR NOCOR SMF misc. I � I � A R L COPY LCNG RC -FUND HCMG E%fJ/ GRANT DEED JYHI C HDUVC IMI.J.LIIYC rvn nC\ VflvLl IJSE The undersigned grantor(s) declare(s) G Documentary transfer tax is $77.00 I X l computed on full value of property conveyed, oi [ l computed on full value less value of liens or encumbrances remaining at time of sale, [ l Unincorporated Area City of La Quinta SF FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, James Arthur Booth:and Leona Josephine Booth, Trustees of The Booth Family Trust dated August 22, 1996 A. L. hereby GRANT(S) to David Chappie and Charrie Chappie, Husband and Wife as joint tenants the following described real property in the City of La Quinta County of Riverside, State of California: Lot 13, Block 196, Unit 19 of Santa Carmelita at Vale La Quinta, as per map recorded in Book 19, Pages '33 and 34 Of Maps, records of Riverside County, California. DATED: November fif, 1999 STATE OF CALIF RNIA COUNTY OF Z1,4V2a 15� before me, personally appeared personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose namejUs -is/are subscribed to the within instrument and acknowledged to me thatJ�e�Lthey executed. the same in h4 -►er/their authorized capacity(ies), and that by b 944 f/,their signatureL!iLon the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. Witness my hand an official -eal Signature�(�G James Arthur Booth and Leona Josephine Booth, Trustees of The Booth Family Trust dated August 22, 1 Ja es A thur Booth, Trustee Leona Jo Vph06 Booth, Trustee IkEN S. SC:HICOR�A Commission # 1184132 l iOV,MYCornm. Notary Public - California Riverside County Spies Jun 17, 2M2 MAIL TAX STATEMENTS AS DIRECTED ABOVE FD -213 (Rev 7/96) GRANT DEED Certificate of Occupancy City of La Quinta Building and 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: 53-990 AVENIDA MONTEZUMA Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0007-133 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC Owner of Building: MR. & MRS. DAVID CHAPPIE Building Official Address: 48-100 VISTA CIELO City: LA QUINTA CA 92253 By: KIRK KIRKLAND Date: DECEMBER 21, 2001 POST IN A CONSPICUOUS PLACE APR =2072001 031:14 -:PMS YOUNG ENGINEERING 760 342 6164 P. 02 YOUNG ENGINEERING SERVICES 47-159 Yorngs Une, Indio ,G1 92201 Phone (760) 342-9214 Fax (760) 342-6164 April 20, 2001 Tom Hartung Building Official City of La Quinta RE : Channj a Residence 53-990 Avenida Montezuma, La 4 i'nta Dear Tom, We have reviewed the framing for the above referenced project and find it to be in general conformance with the approved structural plans. If you have any questions please call. Sincerely, Jeffrey B. Young S.E. K a l <.