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9909-106 (SFD)LICENSED CONTRACTOR DECLARATION r VT 1 hereby affirm under penalty of perjury that .1 am licensed under provisions of s a :;hapter, (commencing with Section 7000) of Division 3 of the Business and W �� ,Professionals Code and my License is in full force and effect. License`* ' '' Lic. Class Exp. Date rl r W s r� ly 1 - 1-Z : z- Date Signature.ofaContractor' Q. J U. - OWNER -BUILDER DECLARATION W W I hereby affirm under penalfy of perjury that I am exempt from the Contractor's ~ t1 License Law for the following reason: - ' Z_ 66' 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, Business & Professionals Code). t ( ). 1, as owner of the. property, am 'exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & -Professionals Code). s f M () I am eicempt�u7nder Section B&P.C. for this reason . N Date r•�"Z !" Jf°I"Signature of Owner�.i_�- Urn k •, Q'S COMPENSATION DECLARATION^ �oCL Z I hereby affirm' u_.WORKERnder:penalty;of'perjury one of the following declarations: 4`0 � p () 1 have and will maintain a certificate of consent to self -insure for workers' X W LL — compensation; as provided for, by Section 3700 of the Labor Code, 'for the O J' Q performance of the work for which this permit -is issued. m Q L) ( ) I have and will maintain workers' compensation insurance, as required by O CXQ Section 3700 of the Labor Code, for the performance of the•work for which this 1.01 Z permit, is issued. My, workers' .compensation insurance carrier & policy. no. are: Carrier Policy No. co 5 O 1• Q - (This section need not be completed if the permit valuation is for $100.00 or less). J �Xrl 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. agiee'that if I should become subject to the workers' compensation provisions of,Seotion 3700 of the Labor Code, I shall forthwith comply with, those provisions. Sate: �� �VAPPlicantf/i./,� 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 attorneys 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.thi§ application is made & each person at whose request'and for whose benefit work is performed under or pursuant to A 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 fog' 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 a1,1 City, and State laws relating to the.building construction, and hereby authorize representatives of this City to enter upon the above-mentioned prope%%rty for inspection purposes. Sire, re. (OwnedAgent,-/, 1A,1" 4 -. / l� :Z; Oate - 2 PERMIT # BUILDING; PERMIT DATE ✓aI/1y.J VALUATION Q t r�•�; LOT TRACT -V 14 JOBSITEJAPN ADDRESS ��-iri d} W� 1 :ItD:'s II�+�T�f�DL aiJ Ba 774-::$11-405 OWNER CONTRACTOR / DESIGNER /ENGINEER t{rJ:i7hit:q 'i:(1rl''i'''l'T�1':3Y.,1] [hirer(:"ryl�1 IJT t"11.4 '78363- HWY 11 i PAI16:93 irwir 1.11 P.Nism_ LAQUl'i TA i2:.A. 9W3. LAQT::LNIA CA 922153 (7htl)st'.4-3g 11 USE OF PERMIT S-INNO:LE FAZEctiII..Y ijWEI.,LNfa w rii-i, 0 i1T DOES NOT IKCiUDE iB,I;G'CK if+ffr LLS OR P100L mT tll: ! IVT 4r• MVtv'V,',r ll• N.�. AiYP ., f.li�..V.1Yi:1�•4�.Ur., ,l lti.►iY b�a4•},ViJ :21' , i3 lti fila%eii lv 16100 W r. ilXtl.L3fr.'ACMWOW1' 713.00 SF 1 STI:1iLUE D CO;Sr OF CONSTRUCTION :1�3�',�tIVBi�.R!'.8+:.�'�.b>a.►1<'ti�'3.�.aS3r . ; C UNI STKILI T 1C. N Ftig 101 d)tWA18-0t3t1 �9'7ti.t>U t MANc�A`�77ct{t:7�Fr~pa.'11,W 439.318 �ca6.134 X014,0 IV.E2CIMIA MICAL iridis 101-USif -42141100 111; 66. Jt) .. ELECTRICAL FEE 1'1,tJ1 Mi Nc1 F Ew i Q 10!)0-4.l w-t!(7U s 1:36.00 C'rRt.";)AfO Mf )9'i LYN Mili - M1•t-!J i -M- 0 G.t�sSD:t.� i"£!� 1C=-imO-_�i�3-t1C0 ��'p.00 • UsEVU t PER iitVAOT ME 41,90'7:fNi = - PRE'C1':*, ..PLAN 101.4)0-441-345 i z00.0Il; ART 1N ;POWlic l%,i,.KF;s _ R}•115-Yj 70i4Y) _ ?,55-ltifi .595.44 ME D131''O,St'1' 101-000439-3.18 4250.00 .9LJ t-'T%fr',A,.t . .AN P;3 Pt..AN. Cf-GiC K. � 3,9" 7,1 tt L, _N PRE i A: `r °�� CAIP - _ , TOTAL PEM.1714",lest DUENONV $3.67710 . a js 1 sC _. ;f.�3 �.,. RECEIPT DATE I B �j%-'rte-^ DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings _ i �C.v �� ~v Underground Ducts Ducts Slab Grade Return Air Steel Combustion Air Roof Deck 0' ZAN 57- Exhaust Fans O.K. to Wrap F.A.U. Framing 4,p ��� , 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 _ �J V.[ Final Final BLOCKWALL PPROVALS 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 P._ Waste Lines 0 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 =,�D �� Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole7— 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) _ Z97 COMMENTS: I Building Address Owner • iJe .4, v, (• - Mailing / Address • �+ b City Contractor �n inti —_---.�.�.,�-1l,.ly✓•.,r•,..,rs �-w�V+sw+ro.^r_��rs�wrd'i,fr'yrv^'1/'r fir.. �,,,, .... .1,.,..p J��•..�.� O ('/�,�v/., 0- P.O. BOX 1504 APPLIC ON ONLY 78-495 CALLE TAMPICO Y6 M07JTac ZOMA LA QUINTA, CALIFORNIA 92253 ev- Zip Tel. Zip State Lic.v I City 8 Classif. J 2J % Lic. q Arch., Engr., Designer Address I Tel. City IZip I State Lic. # I LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section I 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effec 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%.Iiness 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 ($500). i"J 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, 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'I 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 contractors) licensed pursuant to the Contractor's License Law.) 171 1 am exempt under Sec. B. & 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 n Copy is filed with the city. O 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 thg 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: 8, 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 lawsrelating to building construction, and hereby authorize representatives -of this city to enter "the above- mentioned property for inspection purposes. Signature of applicant —Date— Mailing ateMailing Address City, State, Zip BUILDING: TYPE'CONST..OCC. GRP. A.P. Number d -7-t 24 " - 00`? Legal Description • L OT I 'a rare tL- 26C). UNr1 2.4 Project Description Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ 0_m3rAG47(ilyPAev,fnP_ gil; it. 56,4-- 3411 Estimated Valuation PERMIT AMOUNT Plan Chk. Dep.j 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 v FINAL DATE INSPECTOR Issued by: Date Permit Validated by: 8 Validation: WHITE = FINANCE YELLOW = APPLICANT SEP -4-7:11999 PINK = BUILDING DIVISIONi. ,� �.� . ) tea" t NTi S JY �:` °" "`'.rte UW Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 Date 3/16/00 No. 20168 CERTIFICATE OF COMPLIANCE APN # 774-231-005 Jurisdiction La Quinta Owner NameBoettcher No. 54-320 Street Avenida Montezuma City La Quinta zip 92253 Tract # Type of Development Comments Lot # Single Family Residence Permit # Log # Study Area Square Footage 2244 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 1.93 X 2,244 or $ 4,330.92 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/1 st Bank/Mr. Boettcher Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Mary Ann L. Borja Payment Received Check No. Signature Telephone' 760=564=3411 I ,.> 'mss y A'v lit ti w ll. a,$4;330:92 ra 54043 NOTICE: Pursuant of AssemBy/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 O RECORDING REQUESTED BY: � � CCS ST TITLE CO. When Recorded Mail Document and Tax Statement To: Werner W. Boettcher & Tori Boettch 78 365 Hwy 111,#173 La Quinta, CA 92253 Escrow No. 971361JR Title Order No. R-157268-1 3415 19 173281 RECEIVED FOR RECORD AT 2:00 O'CLOCK MAY 16 1997 PAID leaordrd M a, -.j q__ds of Rive�•(de COun E c. Transfer Tax n.cerder NK K. JOHNSON Recorder . Co. Recorder Fees SPACE ABOVE THIS LINE FOR RECORDER'S USE APN: 774-231-005 GRANT DEED The undersigned grantor(s) declare(s) .� Documentary transfer tax is s41.80 City tax $ X I computed on full value of property conveyed, or f I computed on full value less value of liens or encumbrances remaining at time of sale, ( 1 Unincorporated Area City of� FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, MICHAEL J. BEAUMONT, M.D., INC. CORPORATION RETIREMENT TRUST U/A DATED 5/7/93, hereby GRANT(S) to MICHAEL J. BEAUMONT, M.D., TRUSTEE WERNER W. BOETTCHER AND TORI BOETTCHER, HUSBAND AND WIFE, AS JOINT TENANTS the following described real property in the City of LA QUINTA County of RIVERSIDE State of California: Lot 12 in Block 260 of Santa Carmelita at Vale La Quinta Unit #24, as per map recorded in Book 19, Page 44 of Maps, in the office of the County Recorder. DATED: April 28, 1997 • • • •- A • before personally appeared / yi 1 personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. Witness my hafili and official seal. S Michael J. Beaumont .D., Inc. Trustee SANDRA J. CRIPPS N Commission $1111819 < 11 Notary Public Cantornla (p San Diego County My Commission Exp. SEP. 18, 2000 MAIL'TAX STATEMENT AS DIRECTED ABOVE FD -13 (Rev 4/94) GRANT DEED 4 RC District - Planning Review Form This form is to be used by CDD staff for review of single family dwellings in the RC (Cove Residential) District, in order to determine the applicabitity of compatibility issues or need to require the filing of Master Design Guidelines by the applicant. It shall be transmitted to . Building & Safety as.your correction list. Please attach additional explanations as necessary. APPLICANT PROJECT ADDRESS: APN: . LEGAL: WERNER BOETTCHER 54-320 Avenida Montezuma 774-231-005 LOT 12 , BLOCK 260 , UNIT 4 . S. C. @ V.L.Q. CVD BY: Stan Sawa BIN NO:. CASE NO. 99-123 CHECK DATE: Inform- the assigned Building plan checker upon your assignment to this case. The CDD Executive Secretary maintains a log book to track applications and assign case numbers. REQUIRED ITEM Y N COMMENT/CORRECTION y.:>:.:.\•\\\ti.4\;••ti{'\ti.0\\\'��•�{�^.:*�`.. ..�..ti€ 4'':'\\ ^7i\'�hM�<•;•`.��'. 1^�•�%,�\ $J 4^\b•. k.i�••\.�:h• .4� \\�L� :.:`.. Case logged and number assigned Verify legal and APN information Consistent with MDG on file las applicable) MDG filing required 15+ filings since 9/3/98) Consist&ricy -vv'ith-street/surrounding area:. Colors Materials -Architecture e oar z,— v- sa-Ae " a i v OTHER REQUIREMENTS: Ivb re-gL4 ► C -e& .. 3 Gu y. c>Gtr� The zoning code, architectural and landscaping manuals, .and/or assigned inspector should be consulted where uncertainties arise. The completed checklist shall be maintained in the Building '& Safety address *file. Y Ce'dificateof a n Occu a c p y Cat of La' Quin . 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 fol%wing BUILDING ADDRESS:. 54-320 AVENIDA MONTEZUMA Use Classification: SFD Bldg: Permit No.: 9909-106 Occupancy Group: R,3, Type of Construction: VN-. Land Use Zone: RC Owner of Building: WERNER BOETTCHER Address: 78-365 HWY III PMB283 City: LA QUINTA, CA 92253 By: STEVE TRAXEL —7—t, Date: 12-12-00 Building Official POST IN A CONSPICUOUS PLACE.