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SFD (9709-009)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Divi ion 3 of the Business and Professionals Code, and my License is in full force and effect. License4# ��pLpic. Cla)jss Exp. Date tY..'t..# E14.. -(i7 a�, rirl Ypl vbate . ignature 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. ( ) 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 t , -.4 , �.,,. , Policy No. 11.,,E 4 .,t .1 (This section need not be completed if the permit v cation is for $100.00 or less). () I certify that in the performance of the wor or which this permit is issued, I shall not employ any person in any manner o as to become subject to the workers' compensation laws of California, a agree that if I should become subject to the workers' compensation prov i � ns of Section'"3700 of the Labor Code, I shall fo with with those pr, ions �yDate: /applicant Warning: Failure to secure Workers' Co pensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for'in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set' forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its -officers, agents and employees. 2. Any permit issued as a result of this application becomes null and -void, if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this app})cation and state that the above information is correct. I agree to comply with/all City,:,and State laws relating to the building construction, and hereby aut orize representatives of this City to enter upon the above-mentioned prope or inspection purposes. ignature (Owner/Agent) ^ ate � BUILDING PERMIT PERMIT# CONTR/O�L#" G 9709- 0409 �� DATE 1011097 VALUATION �r��iAS� �� ;9 LOT A.;V<.i TRACT 1 ; JOB SITE 7&710 A`T"' @ I Wlk NANAISJA APN 709J -074- ' 3 ADDRESS OWNER CONTRACTOR/DESIGNER/ENGINEER i�l'11 7r` ro y t 0"�3 5 r [NJ r4 . 9/i,"\�, .SL'CAf 4•k({ .)a l9 ..J .1 � niY. A 0��'�-'7•[�a 8F''f'�F'+Rr' . ♦l.l, P,() BOX 1.412 € ALM #.')ESI'sRT . (_-,'A u1 2tiS f 01XNIYA c'A 02S.4 f`?fit11.`+fi'f l:';�y t`fil.€f F�?ri USE OF PERMIT `ihl.�» }'Esttil'lll .lJt.1`rSIV(►l. iS�S�:.(,4it,tls•�l.t„+��.4ti.'.�1F1T,i..:i1.+'Wi f't�iF�1... %d:T 0)114S'C1t1U%`1'11 1.` 20,iiti Sr +%kiZ�1(:aks; f."."r1lQl�l i;d'i' +3211.410 5y V"af`�,a.t T14) /"Q$v 10 C70,1�140�`r"' � l r r �3 6 i..s^ �. !� e � ♦ 1.-410 ♦a t xi ; .� �. 3 i`i,Qf, �, Jtli tai (_14ftSTKL1(Tr1()NKIFF 101,40)4Kt" VIN41(14) i[t d1 i'P SZ; IkE0 iWtre 11r Pd1(°nr9fr a 101­X"2I-(0J re -1 0j zz ELK I Mk!A1,.1A,-f: „� lUla4.'4fA �3i)-Oi)O $lit3•(i%t � P11 f fN4l­kTNQ 041plrq w 1 t�fNlt «st flfitl tau -15 CY �9i1t0tic, MI:aTtf L) t01-OUO 2, t, 000 26 � OlkAt: NK; HIA, i0kKJU-422-0Xj Y).1�v 1 fti t• i?,1A�'f'tZ.� H:" � C flLtr A`�^:ti s� r� `� t1(iih�lr� . ;=12 !& t.1.1'i^. i'� Q X15 S. {{(��(a�,�` l,a, t "�"i�Ji],�.' I" 1.a I C, f�1-•i1all'10t i P1001155100 .'�11�Eri.'�tiY ++ ee SAl all t'it.a t..� f � , ,M ice' Ft3:-"POTAi,1,'O►`!S' "t•;1 t(17.f 3N ANI PI, ANN i'1 -!F01; �s4 j01 ;iia 'OT;t,.~E. PER I:i:`II' 1+1+,1+S 4)1)1+: NOW $4,941.49 RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade B Return Air Steel l Combustion Air Roof Deck - 1 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 BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. 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 Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole 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) COMMENTS: �► � ��',.� .,.«.- e►r-'"r� r };-,.,y..r.x.•..�...-: r,�„ -r- _ytr ^K�%viva-r•.!�"�•��'^•�rfis'�-,ivtl^'i.�Myrac^,."`'=r-:�+•.-,.1..»,y y .��1-...' '. _Y,r'r,. r... . A, 1�_� T *r P.O. BOX 1504 ABuilding78-495 CALLE TAMPICO ddrress 76-710 A ✓6 �]Ae}. j 4 LA QUINTA, CALIFORNIA 92253 Owner ^D O V& G -t L LU N y Mailing I ZZ Address . P. —1). t;onxractorp ', Address �(•- City Zip Tel 1_G2._ °1zz53 State , City & Classif. Lic. # Arch., Engr., Designer ,� Address Tel. City ( IZIp ISta Lic.t# LICENSED CONTRACTOR'S DECLARATION .I hereby affi that I am licensed under provisions of Chapter 9 (commencing with Section 1000) of Divisf# 3pf the Business and_ Professlons_Code, and my license is in full force and 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 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 then five hundred dollars ($500). l: 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, thefowner-builder will have the burden of proving that he did not build or improve for the purpose of sale.) I'I 1, 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 pursuan to the Contractor's License Law.) 17 1 am exempt under Sec. B. 8 P.C. for this reason Date Owner WORKERS' C( I hereby affirm that I have a ce Worker's Compensation Insurance, or Policy No. Compal ❑ Copy is filed with the city. QJ i SENSATION DECLAAN14TION to of consenLJp_selMns e, or a ce N licate of e ' 'ed copyi ereof-(Secr3800aCab ode.) titled 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 thF 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 theWorkers' 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 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 MA APPLICATION U LYI® SEP 0 3 1997 BUILDING: TYPE'CONST. We W OCC. GRP. A.P.,Number _7641 •- 076 GIW605LAOUINTA L al Description Lo r 3 t� -DG5 l..t.OA 142T P oject Description 5 '✓ 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 Sq. Ft. 'L3 /O 5 No. Size [ Stories No. Dw. ! Units i1 Nev49 Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation ' PERMIT AMOUNT Plan Chk. Dep. 60 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 Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Notice: Document Cannot Be Duplicated Date 10/10/97 No. 16156 Owner NameMr. Doug Gillund No. 78-710 City La Quinta Tract # Desert Sands Unified School District 82-879 Highway 111 Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE Street Avenida Naranja Lot # Type of Development Single Family Residence Comments APN # 769-076-003 Jurisdiction La Quinta Permit # Log # Zip 92253 Study Area Square Footage 2365 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 2,365 or $ 4,351.60 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 Redlands Federal Bank/Cashier's Check Telephone' 564-14'832,,, Name on the check ^ " By Dr. Doris Wilson Superintendent Fee collected /exempted by Ellen Patino Signature Payment Received i$1`4;351 � r, { - "_- Check No..743259939'- 40TICE: 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 ibove 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 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 Ul, i. - 1 J 'I . I0 -I0.1 i i J 10 acxo:c.Iflov"E mmy: 'ALU 11PUBLIC TITLE CO. AM V**k 1111COM tet, MAL I* Douglas Oillund PO BOX 16122 valor Oesere, CA 92235 -4 ABUSSORT PARM fO: 79$471-003-f MA 10.70 - Q/V TnE0FVERN0.: 30040943 ESCR74 NO,; 16067-003 GRANT DEED 363910MOEMIKORE]NO ATMICY&WO LRIVtmpw PAID �-SM7 oc. T#vrthK Tq �Mq� . Co. Ilw ttr� Ibs1 Ths VAN ra nroMOINs vet oxr rw undMylaood GrantOr(s) daf•*Wo) fM go DOCUMENT TRANIFER TAX 19, Cx 1 ad -fid- caner t Cty 1.1n $ pony W*d on the h11 Niue d the kttarest W ploWIV oonrey d, Or — WrW&M d on the tun value IM 00 %ifln of Ilsrrs or ancumbrances mmWft theroon at the Om d tilde — ON nnsfer is EXEMPT from trot for ft fWoOnp lea4m: FOR A VALUABLE CONSIDERATION, recelpt d wl Is het+mby ocknoWedgmd. A t m construction, a californla partnership hereby GRANT(S) to Douglas C. Oillund, a married man as his sole and separate property all that roe! property elltaatad M the ci ty of La pulnes County of Riverside , State of CelUomh, deecrlbed as: 21 Lot: 33 of Desert Club Treat Unit e5 as per map shown In Book 0, pages 61 and 62 of maps, Records of Riverside County,Califorais Dated June 11, 1997 A i M C suotlon STATE OF FORNIA, } a calif la partnership COU 0 �'' U. err O v I bMore me R Jforrle, Partner Eno NOteryvNice persoWygr.mred art �����w�►S[ ?3ikffi�^- gG 1'lp &^./Cl - Nanny Aberca, Partner pereonany known to wo (or proved to mm on the baWs d satlslactoq evidence) to be the person(e) whoes nmrtM(e) Ie/ars subscribed to Mae wlthin Instrument and ackraMsdged p� �pR�/11L�p T C�pIg�N�61�� to me that he/she/they axeMed the aeme In h1s/hw/Ihelr C CallfernY authorized apatlly(les). and that by his/her/thek elgrature(e) nbtkl pt oourM on the Instrument the perew(s). or the 9MIty upon b W of whkfi the persons) meted, sxoW the Instrument. WITNESS my afM cW Slgreturm lit MAIL TAX STATEMENTS TO: me4MINokwW us$ -%"uglas GI11und-PO Box 14122, Palm Desert, Ca. 92255 - — wws err, RAn • ze