SFD (9907-060)52510 Avenida Madero
9907-060
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
Date 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). r,
O I .am exe pt under Section , B&P.C. for tFils reason n
,Da'te' "" d `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.
(y, 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.
1
1..A5'l4.1,3" a k iVIL f "21!1IC1. W. .i ;+
4 11* ,
Y S
(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 anyperson in any manner so as to become subject to the
workers' compensatioP laws of California, and agree that if I should become
subject to the worker, ' compensation p rovisions df'Section 3700 of the Labor
Cade, I shall forthwith comply with thoge,p`rovlslons.
`Date: a-`°' Applicant
Warning: Failure to secure Worker6'`Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall,. indemnify
& hold harmless the City of La Quinta, its -officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned.property,fo? nspec tion purposes `
/ignature (Owner/Ag,nt'/ --Date
iy
PERMIT #
BUILDING PERMIT
»
DATE VALUATION r LOT TRACTJOB
SITE
APN
ADDRESSy .47%:- fl '1% iFA Ti Jt.E' ..'
OWNER
CONTRACTOR/DESIGNER/ENGINEER'
yy
1 iUD %Ili 1I,1t-)Q1 11(,)U••Xt1
°iTIJ,,ifeO if3E jr
3e a uA".^2.rF..eLe 6J1a 4".101 +A_ 2lS
I jrvv'I a WIVIIi•160 Va
USE OF PERMIT
SIN6 U` PANJ11.Y 1jWP1LIN(_#1
::H) - pri21a11 i DC411'5 1401' IN -.9 I)DJ, Lii.O lb. WALL G41 N.>s)Z,
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49►.1 '104"T" 11), (031 , Or 1,. OIN I 114111 ; r WIN
173. JS 8,;30
tt°(tIV:s'T:42.tt „`1'!t)1V h',$f 1(!!'t3ti1J•-63I d1iT{➢ Jti }i ; Ea
1 1..± Ai r Flf t`h. 1'FT+ t ii_f •rtti a'+" , ,' tf+ ;i?z Y6d
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IAI f1 ^•f' 1a2. fft .> ,' 0 tttif
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J,Sfcti of
RECEIPT
DATE
By T
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
/
Underground Ducts $ 7
Forms & Footings 99
Ducts
Slab Grade
Return Air
Steel
Combustion Air
_
Roof Deck :ZOQ. 1 -6-m
12, 1 le?
Exhaust Fans
O.K. to Wrap
/
F.A.U.
_
Framing Z( 6Aft-
- 60Compressor
InsulationV
— p — s
Vents•
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath /4>5f
Drywall -Int. Lath /
i - ea g 200
Zp—a0 ST
Final
BLOCKWALL((ApPROVALS
Final
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 T
ElectricsFinal
Waste Lines
/ /
Heater Final
Water Piping
/
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
%je/ 9
Pool Cover
Encapsulation
Gas Piping
Gas Test
/
Appliances
Final ;
COMMENTS: 7
6!/ B +ul7,f
17
Final _
Utility Notice (Gas) /L
ELECTRICAL APPROVALS
Temp. Power Pole Q 7
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) <r{
I i'St" %+ ,,." y;" A` " ". '"" '" '=1`ck v`o:* sY.,. „',•y,:=+''''^tl,:'' ':' '+':'1.l"1"" ,...r"'r"✓51'` ' `'`- i•.-.:-a-. .' •i....'v..-..1sT.:i: ::;
i I o 1 - D6d
P.O. BOX 1504 APPLICA I L
Building 2c/ / 78-495 CALLE TAMPICO
Address E LA QUINTA, CALIFORNIA 92253
Owner /J
BUILDING: TYPE -CONST. OCC. GRP.
Mailing
Address 6 '. iY2iYf NCi A.P. Number
OityZip Tel.
/
3f Legal Descripti
Contractor r Project Description
1v1_4
Address
City Zip Tel.
aI`Y OF LA QUINT—
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
A, 1, C Sjze Stories Units
.." ,
Designer
.
ner
T' f
Address _
V) l IZIp ILictq I
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,13usiness 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 wlfh 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
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
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, 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 or completion, the owner -builder will have the burden
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-
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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
17 I am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
Ihereby affirm that I have a certificate of consent to sell -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
WO R KERS' COMPENSATION INSURANCE (
(This section need not be completed i1 the permit is for one hundred dollars ($100)-. valuation
or less.) / ri I/
I certify that in the performance of thq 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
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 it 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
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing .
S.M.I.
Grading /j
Drjv;eway)Enc.
Infrastructure
11t I
l.rr
TOTAL
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
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 8/6/99 APN # 774-244-014 & 004
No. 19154 Jurisdiction La Quinta
Owner NameMr. Al Williams Permit #
No. 1 Street Santo Domingo Log #
City La Quinta Zip 92253 Study Area
.Tract # Lot # Square Footage 2,875
Type of Development Single Family Residence No. of Units 1
Comments
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
1.93 X 2,875 or $ 5,548.75 the property listed above ,
permits and/or Certificates of Occupancy for this square footage in this proposed project
Fees Paid By cc/Wells Fargo/Mr. Al Williams Tele
e
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by
Signature
Juanita Green
in the amount of
that uilduig ^
Y ;1
y: now bctlssuedti
-one 32%4-9i9
Payment Received $5,548.75
Check No. 7377001940
(NOTICE: Pursuant of ffisembly 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 rurgrom 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
FORESITE. ESCROW, INC.
41-995 BOARDWALK, SUITE G-2
PALM DESERT, CA 92211-5110
(760) 773-5333
FAX (760) 773-9289
SALE ESCROW INSTRUCTIONS
TO: Foresite Escrow, Inc. Date ; April 28, 1999
Escrow Officer : Lee Ellerbroek
Escrow Number : 2-28411
Al Williams, (hereinafter known as Buyer) agree to pATHERINGILL MORTUARY, (hereinafter known a'
Seller) the real property set forth herein per the terms, condi , Aeration and instructions hereinafter stated.
f- Terms of Transaction
I have handed Agent who will deposit into Escrow the sum of
I will Deposit, prior to close of escrow, the sum of
To Complete the Total Consideration of
$ 5,000.00
$ 71,000.00
$ 76,000.00
Furthermore, I will execute and deliver any instruments and/or funds which this escrow requires. to show tide as called for, all
of which you are instructed'to use on or before June 28, 1999, provided you hold a Policy of Tide insurance with the, usual
tide company's exceptions, with a liability of not less than $76,000.00, covering property in the County of Riverside, State of
California, described as follows:
See Exhibit 'A' attached hereto and made a part hereof
CONWONLY KNOWN AS: APN 774-244-014-6 &.774-244-004-7, La Quinta, CA 92253
SHOWING TITLE VESTED IN: Al Williams, an Unmarried Man
SUBJECT TO:
(1) General and Special County and City (if any) Taxes for the current fiscal year, 11 not due or delinquent,including any special
levies, payments for which are included therein and collected therewith.
(2) 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.
(3) Covenants, Conditions and Restrictions, reservations easements for public utilities, districts, water companies, alleysand
.streets, rights and rights of way -of record, if any; also exceptions -of oil, gas, minerals and i carbons, and/or lease, if
any, without the right of surface entry. f "'
ESCROW INSTRUCTIONS
ALL CASA TRANSACTION: Buyer hereby agrees to pay all cash. for subject property:
,_.
PRELIMINARY TITLE REPORT & C.C.& R. APPROVAL: ' Buyers are to receive a copy of the Preliminary Title Report,
Covenants, Conditions and Restrictions (if any), during escrow.. Buyers have 5 days after their receipt of same in which to
disapprove them. 'If no written disapproval is received into escrow within said 5 days, these items will automatically be
deemed approved.
MERGER/ANNEX/PLANS: This escrow is subject to the following: a) merging of lots. b) City . annexed land and c) Plan
approved by city for house plans. Buyer deposit of closing funds deposited into escrow will deem this contingency fully
satisfied and escrow is to proceed with the closing of this escrow. .
BONDS OR ASSESSMENTS: Bonds or assessme ow a lien shall be paid current by Seller; payments not yet due to be
assumedby Buyer.
ADDITIONAL' INSTRUCTIONS ATTACHED HERETO AND MADE A PART HEREOF
My initials below represent my agreement and acknowledgment of the foregoing.
Seller Initials: —. Buyer Initials:
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