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SFD (0206-041)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 # LLic. Class Exp. Dsatteyy. f • Dater`✓` /a �` 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). ( ) 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. �( )fl�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 a!'AIE FWD Policy No. 12$0990 (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 subject to the workers' compensation provisions of Sect on" 3700 of the Labor Code, I shall'forthwith comply with those provisions..^" Date: �:-/�' '- `02•Applicant_- 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 Quints, its officers, agentsand 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 for Inspection purposes. t , Signature (Owner/Agent). -� * t ��� Date�� BUILDING PERMIT PERMIT# 0206•-041. DATE . VALUATION . LOT TRACT � MAC 134 ,, d cL_ JOB SITE ADDRESS .91-400 'nAVENIDA NAVARRO .' APN 104-009 OWNER CONTRACTOR / DESIGNER / EN (NEER Fes... PA+' 'C TMEZ COA3M.L`1`C ION' PAf:. m,. -c- cm" ,,.`rPr.�'C." c*y 71551 :?t. TfE ;1:.1. 1 ill, 4k111 2551 117TAC.Ia, STId:La�t..' 4111 CAR1.4111R CA 92008 ti'13WAMAD CA 92008 (7600 30-7431 CM -LA, USE OF PERMIT ION'0T.1,YAM .,'rf:MIKILLNG , SPU - LOT 16 - MASTER SAN FU'f:; PE * PERMIT IOES'NOT rNC,LC.l DE Ri,,OCK WA,(,1�.q, PW , SPA Off, DIW IWAV APP,t'�O4t'' i 'S�t7� TRACT COWSTRUC:TIOIN - 1,431 9? POPICH/Pivrio 10&00 SP f ksnRRLA7WO.2li8lYOR.•A .499-00 to COXF ilk" CO1V•�'�"k2:!� '3`'40 �' Yy �gp+ j.�p �:'��Sy"rs7it6�fAMD fTJAyY}B�i+i{tl+JkLl.'L,A 1i`.Uh/C�f�.,'Ltt:�:II,+A� y�99}S�9�ag3�e,r6�Y •� t ry�.yy co IJ t,d�ifii-9�d6/lt d"i.. 103-000,43Sk-000 PLAN ChlCK, F.L. 3 t°i ! -000"339-31 a FEE DEPOSIT:. `,. lQlDmi)(�Ct�;3���'I.€� •���4,� MZC:H.AN1C_ ,11., FR if?1-t?OQ- t l ��1EJt7 �6p;:+1G FL=VUC.AJ... FEE 101.000-420.000 SIO&TI MiJ1b1LYNO VEZ 10'1-0 15-4.19-000 Vxub STRO W0 MOTION F"' - RES"D 3 01-000.2 41.400. WI ORA INO FLS 10 1 -M-4214-000 $15.00 Dis`VR•LOP81A IMPACT H.!0: S2,40,00 P'F�u1Si? �1.t9Ai 101 t-000-441-345 �1.t�0.Qi7 = .. sa�aI�a��,{c.� .. 425000 LEMS PRE-PAID1,1W D .1 L 7r'It;PaffX'F. 191 D -03t NOW h 12 2001 CITYOFLAQUINTA FINANCEDEPY RECEIPT DATE J BY ��� DATE FINALED INSPE TOR d rOZ- INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings 7'A Ducts Slab Grade Return Air Steel Combustion Air Roof Deck (- - �j Z_ Exhaust Fans O.K to Wrap O F.A.U. Framing Compressor Insulation Q - p _ 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 BLOCKWALL APPROVALS 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 Water Piping -D Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection _ • D t. Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole .o ?i Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final X62 Utility Notice (Perm) Q' COMMENTS: ���.... w�y�°s,�,.i,�,�.�-,.x.'-r,T�,_.r�',,�,°:1F'?r'Y�'r.".'�,��u�'trg',�'•�F^�`tY'`'�C'ir',�,}'��''t���?.'' t�'�'t"^'i��'�``"yr't�•�'���„�w,�y��:Y�'w��y`'�`�;,''"'D ,f �! �j �i /V/�✓ P.O. BOX 1504 M a 78-495 CALLE TAMPICO APPLICATION ONLYBuildin �( Addrress � ��' fir— �� r fR''f . fes LA QUINTA, CALIFORNIA 92253 BUILDING: TYPE'CONST. .J ►� � OCC. GRP. Mailing t Address f /-9 7—e j% ©.A! f - A.P. Number City M .y Zip 7" Tel. Legal Description—4 C Contractor ,.— Project Description 4 ,1,Y/6- Al Address Zip State Ljc._� I City 8 Classif. Lic. # Arch., Engr., Designer Address Tel. City{: Zip 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 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,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 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 ($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 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 contractor(s) licensed pursuant to the Contractor's License Law.) 1'7 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. ❑ 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 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 I 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 Ihereby 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. 1 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 properly for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip Sq. Ft. / ` No. / No. Dw. Size / / Stories Units New,2- Add ❑ Alter ❑ Repair ❑ Demolition ❑ TOTAL , REMARKS' ZONE: W us 2901 11 U) t -- 1 Estimated Valuati C00FLAQUINTA Front Setback from Center Line PERMIT AMOUNT r Plan Chk. Dep. Side Street Setback from Center Line Plan Chk. Bal. FINAL DATE Const. Issued by: Date Permit Mech. Electrical Validation: Plumbing S.M.I. Grading Driveway Enc. Infrastructure k 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 Validated by: Validation: ., i•~1 WHITE = FINANCE YELLOW =.APPLICANT PINK = BUILDING DIVISION t Desert Sands Unified School DistrictFiEh 47-950 Dune Palms Road Notice: La Quinta, CA 92253 'Q BERMUDA DUNES r Document Cannot Be Duplicated 760-771-8515 b RANCHO MIRAGE WELLS d. PALM DESERT CERTIFICATE OF COMPLIANCE L INDoforn > Date 6/12/02 APN# 773-104-009 No. 23279 Jurisdiction La Quinta Owner NamePacific Trades Construction Permit # 0206-041 No, 51-400 Street Avenida Navarro Log # City La Quinta Zip 92253 Study Area Tract # BLK 134 Lot # 16 Square Footage 1,431 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: ' y EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 2.14 X 1,431 or.$ 3,062.34 the property listed above and that building ♦ r i permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued 4 Fees Paid By CC/ Mission Oaks National Bank - Frank Garcia TelephYane 76,0/ 578=9970 Name on the check. By Dr. Doris Wilson ` i Superintendent Fee collected /exempted by Paula Ruiz Signature Payment Received $3,062.34 Check No. 12034 NOTICE: Pursuant to Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity author zed to collect them on the District('s)(s') behalf, whichever is earlier. Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant - Copy - Applicant/Receipt Copy - Accounting 3 • a At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It has been determined the above-named owner is exempt from paying school fees at this time due to the following reason: ' y EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 2.14 X 1,431 or.$ 3,062.34 the property listed above and that building ♦ r i permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued 4 Fees Paid By CC/ Mission Oaks National Bank - Frank Garcia TelephYane 76,0/ 578=9970 Name on the check. By Dr. Doris Wilson ` i Superintendent Fee collected /exempted by Paula Ruiz Signature Payment Received $3,062.34 Check No. 12034 NOTICE: Pursuant to 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 author zed 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 3 the real property in the City of La Quinra Slate of California, described as County of Riverside re Lot 16 & 17 of Block 134 Unit No, Santa Carmelita at Vale La Quinta, as per 'tuap recorded in Book ,pages 6f Maps, Records of Riverside County, California Dated MAY Sig_ nature of Grantor Slate of California ) County of ^) BRYANT RUGG. On before me, personally appeared BRYANT Rfjrr_ personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose names) is/are subscdbedho the within instrument and acknowledged to me that he/she/they executed _ the same in his/herftheir authorized capacity(ies), and that by hls/her/their signature(s) on, the Instrument the peNon(s), or the enuty upon'behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. Signature MAIL TAX STATEMENTS TO, I Form 3195-4 (6-94)•' THIS FORM FURNISHED BY COMMONWEALTH LAND TITLE COMPANY t I F1 E 5 ING REQUESTED BY: .. ST/ri�.�iL-��- /�11► ✓i`O AND WHEN RECORDED MAIL THIS DEED AND, UNLESS OTHERWISE SHOWN BELOW, MAIL TAX STATEMENTS TO 3 -'/OV - Ali -E DAVID R. MILLER 1719 S. TREMOUNT OCEANSIDE, CA 92054 SPACE ABOVE THIS LINE FOR RECORDER'S USE The undersigned _grantor(s)declare(s): Grant Deed' A.P.N. 773-104-008/0Q9 Documentary transfer tax Is $ ( xx) computed on full value of property conveyed, or ( ) computed on full value less value of liens and encumbrances remaining at time of sale. ( ) Unincorporated area: ( ) City of ,and _ FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, BRYANT RUGG hereby GRANT(S) to DAVID ROSS MILLER, a married man as his 'sole and separate property the real property in the City of La Quinra Slate of California, described as County of Riverside re Lot 16 & 17 of Block 134 Unit No, Santa Carmelita at Vale La Quinta, as per 'tuap recorded in Book ,pages 6f Maps, Records of Riverside County, California Dated MAY Sig_ nature of Grantor Slate of California ) County of ^) BRYANT RUGG. On before me, personally appeared BRYANT Rfjrr_ personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose names) is/are subscdbedho the within instrument and acknowledged to me that he/she/they executed _ the same in his/herftheir authorized capacity(ies), and that by hls/her/their signature(s) on, the Instrument the peNon(s), or the enuty upon'behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. Signature MAIL TAX STATEMENTS TO, I Form 3195-4 (6-94)•' THIS FORM FURNISHED BY COMMONWEALTH LAND TITLE COMPANY t I F1 Certificate -.of Occupancy City of La Qu"inta 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: 51-400 AVENIDA NAVARRO Use Classification: SFD Bldg. Permit No.: 0206-041 Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC Owner of Building: PACIFIC TRADES CONSTRUCTION Building Official Address: 2551 STATE STREET #111 City: CARLSBAD CA 92008 By: KIRK KIRKLAND Date: 10-22-02 POST IN A CONSPICUOUS PLACE