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SFD (9706-138)LICENSED CONTRACTOR DECLARATION 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 ishin full force and effect. License # Li'0: ClassExp. Date J MOISignature Y Date of Contracto OWNER -BUILDER DEC 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 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. ( 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. M1�t►NEFFFM =# (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 tithe workers' compensation laws"bf California, and agree that if I shbbl8 become I to he workers' compensationtp ovisions of Se tion 3700 of the La for % NSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Slab Grade Steel Ducts Return Air 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 Wall Firewall Exterior Lath Drywall - Int. Lath Final Final V1, POOLS - SPAS BLOCKWALLYDROVA-L-S 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 f Heater Final Water Piping MvczPlumbing Final Plumbing Top Out V f r &AI Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: , Final Utility Notice (Gas) ELECTRICAL PP VALS Temp. Power Pole Underground Conduit Rough Wiring Low Vottage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G. F.I. Smoke Detectors Temp. Use of Power ' Final Utility Notice (Perm) Building 76-, 5 2 "D�D Ownerr\ � n l�AIJ \'n `L Address 4 4 " P.O. BOX 1504 78-495 CALLE TAMPICO Q bJ7 a LA QUINTA, CALIFORNIA 92253 City Zip Tel. S. VCrLtlN�11� 9?,JI t{ Contractor . 0 (� _ � IL r 1[ rN t Jr ty Zip State Lic. I City t & Classif. Lic. # Arch., Engr., Designer Address I Tel. City IZip I State I Lic. # f rLICENSED CONTRACTOR'S DECLARATION; I herebyy vlarn Ir at 14m licensed u derbrovisions o f Chapter 9 (commencing with Section 700p) of. Divtsion 3 of the,Business a d Professions Co e, and my license is in full force and effect. �l w>r, , `> Coq SIGNATURE DATE OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, after, 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 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 five hundred dollars (8500). 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 of 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. 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.) I-1 1 am exempt under Sec. B. & P.C. for this reason Date Owner 1. WORKERS' COM!I fNS'ATION"DECLARATION I hereby affirm that I have a certif%e„ot o sn pnn to self -insure, or a certificate of Worker's Compensation Insurance, or a cerrtt55fied.co'��t�efeof. (Sec. 3800, Labor Code.) Policy No. Company•� n Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' CrOMPENSATION INSURANCE (This section need not be completed II{tha permit is for one hundred dollars (E100) valuation or less.) \G I certify that in the DeAormance of he work for which this permiteis issued, I shall not employ any person in any n1pnner so'o become subject o theWorkers' Compensation Laws of California. "�� Date Owner NOTICE TO APPLICANT., it, 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 ame 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 laws relating to building construction, and hereby authorize representatives sof this city to enter the above- mentioned property for inspection purposes. Signature of a0plicant —Date— Mailing ateMailing Address City, State, Zip APPLICATION ONLY BUILDING: TYPE'CONST. OCC. G,RP. A.P. Number 773 " 33 — 402 bKXUP ` Legal Description Project Description Sq. Ft. 1r~1 j Size 1 New ❑ No. No. Dw. Stories Units Add ❑ Alter ❑ Repair ❑ Demolition ❑ valuation PERMIT AMOUNT Plan Chk. Dep. 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 FINAL DATE INSPECTOR Issued by: Date—Permit 111111111111111 Validated by: Validation: -, 4 W 1zli� ~ WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISIOhC V ` `'^PINTA Desert Sands Unified School District Notice: 82-879 Highway 111 Indio, CA 92201 Document Cannot Be Duplicated 619-775-3500 CERTIFICATE OF COMPLIANCE Date 8/19/97 No. 15985 Owner Name David Ross Miller No. 52040 City La Quinta Tract # APN # . 773-233-002 Jurisdiction La Quinta Street Avenida Mendoza zip 92253 Lot # Square Footage Type of Development Single Family Residence Comments Permit # Log # Study Area 1410 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 1.84 X 1,410 or $ 2,594.40 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/Capital Bank of North County/Miller #40982 Tele h'ne 967-0069 =" �� , p' 9 �w 0 Name on the check �`; ,;_7 r By Dr. Doris Wilson oil Superintendent Fee collected /exempted by Pauline Pearson Payment Received $2Sa4.'40 2,0 ` Check No. 49902 Signature P,# IOTICE: 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 allect them on the Dislrict('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 AUG 01 '97 03:22PM COMMONWEALTH TITLE P.1i1 RECORDING REQUESTED BY: ORANGE COAST TITLE COMPACOMPANY 97.6693KC R-157794-1 Jill III' ,1 ' '�'•'.M= air �, �� DAVID ROSS MILLER 1719 S. TREMONT S. OCEANSIDE, CA 92054 GP% T DEED THIS LINE FOR APN: 771-233- 'S USE The undersigned grantor(s) declare(s): Documentary transfer tax is $12.10 (XXX) Computed on full value of property conveyed, or ( ) Computed on full value less liens and encumbrances remaining at time of sale. ( } Unincorporated area: ( ) City of and FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, ELIZABETH HUARD, an uElma7Cried vomam hereby GRANT(S) to DAVID ROSS MILLER, A MARRIED MAN AS HIS SOLE AND SEPARATE PROPERTY she real property in the City of LA QuiNTA, County of Riverside, State of California, described as: LOT 21 OF BLOCK 94 OF SANTA CARMELITA AT VALE LA QUIN7'A, UNIT NO. 11, AS PER MAP RECORDED IN BOOK 18, PAGE 75 OF MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA . Dated June 13, 1997 State of California County of Riverside On June 16, 1997 _ before me, Kelly tallier personally appeared F.tizabatb Huard personally known to me (or proved to me on the basis of satisfactory evidene.e) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me chat 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 whit t e persons) acted, executed the instrument A _ WI.1-NE5 - my agof c 1 s7-� Signatur \`� MAIL TAX STATEMENTS TO. S&M AS ABOVE eaXF(!Y (,"*- rM7:."� m t x57217 '�h r �,, ,yam z8, t99g MYr;de.ecowsC Vo3& M61LrC 1FOR"AI. 1-699 b (This area for official notarial seal) n . '•,p.:)'`:f _r^aw _ -'`., Sor- - . .,R. _ ,. p^;��'::n,T . ,fit^'...,•,--,•��s:--. COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL Id 44345 Received From: CC. C U U4,- / 1 -.L { '" /(PV I&, /- (JULP Date- 6 - i Address: 1719-.V. ' 77 7 l �' ' ' Gl Li -t661, 9.7c,5,1- / / Account No. �/ U O Lots) / Trac Service Address -~ L� 0 IL4=71d.. `moi �1 C) d�> G.A. Code lii Meter(s) IN X50'00 a �] S.,Ic,(s)- l 50.00 ❑ Backflow(s) ❑ House Lateral(s) ❑ Detector Check(s) ❑ Meter Surcharge Sanitation Capacity Charge q.25'• 0 O ❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - Fee - ❑ Plan Check Fees Water I Sewer - Tract - ❑ Bond Payment - A.D. - Bond Assmt. ❑ Customer Deposit ❑ Olher TOTAL 3 Doi 5 O O — Remarks: �C-f. L4�7 (✓' i'c GLC (K _