SFD (9804-141)4
LICENSED CONTRACTOR
L 6Td DECLARATION
1 -pro f � 'Neby affirm under penalty of%perjur� that.1 am'licensed,under visions o
C ter 9 (6ommencinig with Section* - 7000) of Division 3 Of the Business `and.
Pr6fessionals Code, and my License, is in full force and effect.
'Lice nse #_ Lic. Class Exp.. Pate
12/31199
I
'll, ate
Si nature of Contractor h I Js
OWNER -BUILDER DECLARATION
1 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 ernployees with waiges*as'their/61e
is
compensation,. will do the work, and the structure is not intended Or offered for
sale (Sec..7044, Business & Professionals Code).
.1, as owner of the .property, am exclusively contracting with. licensed
contractors to construct the project (Sec., -.704.4, Business -& Professionals
Code).
exempt under Section, B&P.C. for this reason
bate - Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm -under penq�lty,qf- perjury one of the foll6wing Aeclarations:
i) l.have and will maintain a Certificate of consent to self-insbre for workers'
cor-6pensatiori; as provided for by Section 3700 of the Ldbor-Code, for the
perf&marice 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 theperformance of theworkfor which.this,
P 't is issued. My workers' compensation insurance carrier & policy no.' are:
=i
C er Po'licy..,'No.JX'.
13 1 12 9
ISTATE VN W23
.(This section need not be completed if the permit valuation is for $100.00 or less)..
O I Certify that in the perfor mance 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'- compensatioh laws of California, and agree that if I should become
'.,.subject to the workers' Compensation provisions of Section 3700 of the Labor
Code, I shall foh,with comply with those . * ions.
,,,,provis
Date: 7/2 Zy`,��, Al)plicdnt—/' ,
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 6e 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 pe'r'son at
whose request and for whose benefit work is performed Under or pursuant to If
v
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
,t1lea.bove-mentioned property for inspection purposes.
A,
,Sig6ature (Owner/Agent)( Date:'_ 3/.,t
PERMIT# CONTRQL'#„,:
G PERMIT-8044.4j
98044.4j,
DATE o L T;r TR A
S95A34.7 0 T
To 7
JOB SITE 4 ]APN
ADDRESS 5AV1,',N[DAAJEN1Y0tV
77 2��-
4- 441
OWNER #
CONTRACTOR/DESIGNER/ENGINEER
• •
t-JbNV,�V,1D.&, CoNT-41E. 1011,INSM
A,' _8C-TP00LS,,kN1D COINS
P0 MF .',f I�Ijcwr
Gtr.: 92270
--PAI D.&SERT :CA 0.226.k
4%
C,�0)568 3 CUO 725
USE OF PERMIT
T b6.139 N 0 N'al
MACr CON'STRUC ni,014 Sr..
6,FT W0017 IFENCE xOU. JS
.J
coNsayrwcudNca t0l-1100.418-000 S( )2 L50
PLANCHIFf-TT- 10i _0fW)_09_31R
rVIE-04ANICAL VES $60.00
, 1014ft-420-000 $16232
PL” U, N - 101-000-419-000 1W
_TjKG_FEE
S,1R0_N,,3N_f0TY0N
FEZ' 101.00041" 00
mpW-443-342 4 082.12
RZTRUC'1VRF, FEE 2254
-PRECISE PLAN 101'-(W-441-3145
07 T091FT. 101 250
F DF -000-439-118 .06
.10, CONSX. -0,!Yi ND PLAN C--,'
5V '07'!' WC N A k,
$1 47.35
316
-0-T
1, ES S PIZPAID PEES
.4750.00
PAID .0
vL.�,P'E).R1,VHT FEES` DITE.Now
JUL 2 7 1998'
IITY C F I fllmme",e
[RECEIPT
BY
ATE FINALED
INSPECTOR
INSPECTION RECORD
�t OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade Q
Return Air
Steel
Combustion Air
Roof Deck _9
Exhaust Fans
O.K to Wrap —
F.A.U.
Framing (6
Compressor
Insulation Q
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall 14,
Exterior Lath ( 8 e
Drywall - Int. Lath Q
Final
Final cs�
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
Encapsulation
Gas Piping
Gas Test f_Z! 3-ei f—f
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring E
Low Voltage Wiring 's
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
..Smoke Detectors
ILTemp. Use of Power
Final
Wilily Notice (Perm)
COMMENTS:
.,.�" , ' •,��..�.��+`,t',ntr`�:,,,nti � ,:�. r �f 't ,,.,r • , � •.a..� ,..r'� • ,.ti,r"4t . .r,, . .T•a-�..
P.O. 2.
BOX 1504 APPLICATION ONLY
Building
s�-Q /� fG 78-495 CALLE TAMPICO
Addressf V f'2- NJ70 LA OUINTA, CALIFORNIA 92253
Owner : 7
/C -f 4,U �.vN 2-C. a AlSaA)
(, Mailing Q
Address v. 130 A d 0
Ity Zip Tel.
X,4fJ&40,PfrA'GF 922-70
x Contractor
�6 Cr �
rf`00/.5 �'v,rr rc r-ror
X Auaress
P3. 60x 2 -52 -It
kCity Zip Tel.
�se.�; �2�.0 / S,
State Lic. City
& Classif. S T` Lic. #
Arch., Engr.,
Designer
Address Tel.
d o63
CityI Zip I State
Lic. #
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 Pro essions Code, and my license -is in full forc0end
effect �jy � ,}fj �•. &4.,_
/� j [ ar
SIGNATURE CC� , ' 7DATE
OWNER -BUILDER DECLARATION
I 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, alter, improve, demolish, or repair any structure, prior to'Its issuance also
requires the applicant for such permit to rile 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 (5500).
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
doesnot apply to an owner of properly who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
i] 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 self -insure, or a certificate of
Worker's Compensation Insurance, or a certified c -o ,y.�thsereof.{Sec. 3800,, bor Code.)
Policy /NO. Company 570 a (- A ZZ �-7
f)eCopy is filed with the city. ❑ 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 thq work for which this permit is issued, 1 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: It, alter 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 slate 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
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number 174 Z2-4 -01Z
Legal Description G d % dLl��?� U 2%
Project Description
Sq. Ft. No.I No. Dw.
Size I SSI' q Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated 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:t
Front Setback fr r Line
Rear Setback fro ear Pro
Side Street Setback from f Mer Line
Side Setback from gty Line
III
�`�
FINAL DATE INSPECTO
Issued by: DatePermit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
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 7/27/98
No. 17394
Owner NameHoward & Connie Johnson
APN # 774-222-012
Jurisdiction La Quinta
No. 54-035 Street Avenida Mendoza
City La Quinta zip 92253
Tract #
Lot #
Type of Development Single Family Residence
Comments
Permit #
Log #
Study Area
Square Footage 1,549
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 1,549 or $ 2,989.57 the property listed above and that buBdih& rw .
permits and/or Certificates of Occupancy for this square footage in this proposed project may,,now be,issued
Fees Paid By CC/Palm Drst National Bank/Purrect Pools & Cons. Teliphone 568"4963 rr"
ti i
Name on the check
By Dr. Doris Wilson .
) {,,'. r• , I S'
Superintendent x
Fee collected /exempted by
Signature
Juanita Green Payment Received $2,989.57
Check No. 80939
NOTICE: Pursuant of 4dsembly 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
L L
Lic, No, 49b913
Coo
3) 0 PhIll) M,cnue 6 CoAchda 6 Cahfornii 9225(-s 6 (619) 598-8039
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C-31NIZLE' "INE" DIAC37RMA
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ItL�
OLD REPUQLK, TITLE CO
RECORDING REQUESTED BY:
Fidelity National Title Company
!screw No. 08&C6
ThN Ord•r No.
When Recorded Mall Document
and Tex Statement To:
Mr. Howard A. Johnson
P.O. Box 1004
Rancho Mirage, CA 92270
POV03 -/3
Hp_r 2l1 II
.PAID
Ooc. Tra W#W To
RN.100. PAODA r .
RECEIVED FOR RECORD
AT uo O'CLOCK
DEC 2 9 1997
alAr
an RsoeltlK
77 f 4940 -01 r BRANT DEED sPACE Aeo
The undetsignsd grantor(s) defile- (at j
Documentary transfer tax is �v
( X ) computed on fuiNdLLe of.arty conveyed, or
Unincorporaatt
( )computed d 11 value less value of Yens or encumbrances remaining at time of �eale,
I 1 ed Area City of Ls Ouinta
FOR A VALUABLE CONSIDERATION, receipt_r
Verble, Husband and Wife as Joint Tenants � which Is hereby acknowledged, James 0. Vairble and Virginia H.
ocluirpd title as Virginia K. Var),1p
hereby ORANT(S) to Howard A. Jaluteon and, Connie -W. Johnson, or their succesaorx
Trueteeri of 016 Johnson Living Trust, U/A datmY hovember' S, ly96 as
the following described real property In the City of La Qulnts
County of Riverelds, Ststa of California:
Lots 1 and 2. Block 296 of Santa Carmelite at Vale Ls Quints, Unit #27, as per me
Map$, in the Office of the County Recorder of Said County.
ap recorded In Book 18, pe 8
e 2 of
174-2ZZ-olt — L•T 1 77-B55
7 74 - 2. ZZ - 01 Z - Lor 54-036- AV; Mr orq
DATED. December.2, 1997
F.02
i
cT�
STATE OF CALIFORN A
COUNTY OF
before me,
r�. ••Vie, personally appeared
Personally known to me (or proved to me on the basis
Of satlsfactory evidence) to be the rson(s) whose
PMAW Warp subscribed to the within Instrument and
scknowlsdged to me that he/she/the executed the
same in his/her(fi !r authorized c act exeexeles and that
by his/her/their si na ura(s)on the instrument the
parson(s), or t- ie entity upon behalf of which the
peraon(a) acted, executed the Instrument.
Witness my han jimd official seal.
Signature - f t
------ Inov a/Y41
BARBARA PEAISHO
t%—Fuy
Comm, li1128728NOTARY PUBLIC-CA1fi0RRIASsn lois 011rpe CMIVr comm. 14061 Nud i. toot
MAIL TAX STATEMENTS AS DIREC'
I e .
I
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:
Use Classification: SFD
Occupancy Group: R 3
54-035 AVENIDA MENDOZA
Type of Construction: VN
Owner of Building: HOWARD & CONNIE JOHNSON
Building Official
Bldg. Permit No.: 9804-141
Land Use Zone: RC
Address: P.O. BOX 1004
City: RANCHO MIRAGE, CA 92270
By: STEVE TRAXEL
Date: 05-10-00
POST IN A CONSPICUOUS PLACE