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9710-069 (SFD)U) H 04 W Ouch I W C) Z (D0o H� J FW- a U) Z 4 LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am'licensed under provisions of Chgpter 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 1 ( } Signature of Contractor ' N a'1 : FE /d 1� OWNER -BUILDER DECLARATION Thereby 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. 1;Kll!'A1i'"PlON ON I ArI.t; (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, d"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 Section 3700 of the Labor Code, I shall forthwith comply with those provisions, r ) , yDate: - '� Applicant ` 1 1 it, / �=!'L Y i 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 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 for inspection purposes. ySignature (Owner/Agent)`"'/­J/_ ��`!1: �� """° • Date BUILDINGPERMIT PERMIT# CONTROL# DATE VALUATION LOT i TRACT A01-47JOB SITE`- ADDRESS 51-733 AAIIDA C:A::4�.1INI .B�V APN 73- 74-OZ3 OWNER CONTRACTOR/DESIGNER/ENGINEER :ACK L. CLAM- K. JR, JACK CLARK lrENF' AL 1CONTRLAC T01: LA 01-IlNVA, CA. 92253 1115 , USE OF PERMIT R� ..-1�ra`1'1'c[ t11EMCi iRivi� 1 i (�>ZtdV�.',�F.li ASii}1 dritii.r1N 90.00 11VF (.1AR.AV7ffYC AtOat,tWV 411MA+44 SF AL01.X WALL (HTILF) :in. -56 . 6 FT. W LDOD FENCE �(ift.Cit) l.h CIM �71 W? WINSI*RMUNION11 92,149,70 C:Q?ti'8'i'.,KfX f.f0N FI:E 101-000-+1)13-000 $60.(K) P11 8 N 1;tM1 rC;{K/ PFI; 10 1 8 <{h }_ri. U.31c Gfi4.7y1� X l.�v1 3„t1,#`t`11�1 NEt."t•{1i2LtCAL FE ,. i111 •ciu�-fir 1 i0Ei � n.[rt? ELt,4—rRiCAL FEE 101-000-420-M) S 124. f.9 !'"C.!W 01NO FEE Sf,"K+t.7R ,-[.�?Cl S�I7i1U1NO Flat; it'3l-4W1142-1•f" ba41.UU VNI"RXI fRVC"t'1_r103 FF Ei i 22.S-0013443_342 $:, 4 f3.:A1 PxtFc;'1.a1's .�'t.3�?�f 1()1 ^{lfll>•$�11-a.1.5 '�:.�. fstt 1D1 • 1Z''!'t'!�la Ct�IM�1'Y!i'l>!��"vl }fFV AND I�t .rel.. j'�'�:�.T..4/ AAk�. i! NOV 0 6 1997 1�r� rAL l:'C.RN41'T 1i09 FS iii)!+ NOW RECEIPT DATE BY f+ DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE = INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing .q,Al 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 APJHROVAL 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 APPVA Gas Test Electric Final _ Waste Lines %/� Water Piping l - �( Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Sh O.K. for Finish Plaster ewer Lateral Pool Cover ' Sewer Connectio Encapsulation G-ISTIPIRg— Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL A P ALS Temp. Power Pole �_ Underground Conduit Rough Wiring Low Voltage Wiring Frdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: J ' Tw�l 0 4 " P.O. BOX 1504 Building78-495 CALLE TAMPICO Address — '�J.� _ta-2�4,� 'Z.A LA QUINTA, CALIFORNIA 92253 _JQ dL C 1 A -r It 1V - Mailing Address City Zip Tel. ,N L C lAtAt ��✓� Address City lZip ITel. State Lic. City & Classif. t7� G v Lic. # Arch., Engr., Designer Address Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I herebyy affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) oPDivision•3 of the Business and Professions Code, and my license is in full for�p and affect )A C %L. G ALL �L `--^ i ti/ 9 l I'm SIGNATUR�E'`� 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 'lts 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 (E500)• f: 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 11, 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*1 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 F1 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 Lawsof C lif rnia. \ Date Owner L�L G NOTICE it APPLICANT: If, rafter 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 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 aliplicant -Date- Mailing ateMailing Address City, State, Zip q-7i©-o�`1 APPLICATION ONLY ILDING: TYPE"CONST. �I OCC. GRP. 1. Number -7 73 — 1 '24 -0 23 lar DescriptionLor 1( I.JL.X � 6 V LQ Description Sq. Ft. No. No. Dw. Size 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: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSIDE T 1 e � Issued by: Date er Validated by: u Validation: F E, ,•fir %-I i SNJ-�—/t U WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION -SUR -LIST, CONTRACTORC IOLvk `✓. ADDRESS �� OWNER JOB ADDRESS CAQA4ZA This form shall be gloated on the iob with the Building_ip$glection Card at all times in a conspicuous place. It is the responsibility of the General Contractor or the Owner/Builder to monitor the sub -contractors that are on this list are the same persons performing the work. Any changes to this list must be approved the City of La Quinta Department of Building & Safety luis[ to work being performed by a changed sub- contractor. Failure to comply will result in a stoppage of work and/or the voidance of building permit. TRADE SUB -CONTRACTOR'S NAME TYPE OF LICENSE STATE CONTRACTOR'S UCENSE...: NUMBER WORKER'S COMP: NAME/ NEMABER.ON ISE CITY BUSINESS LICENSE NUMBER/ EXP. DATE GRADE/ ti� EXCAVATE A, F1orP.S C��adirl� A/C -12 (pioo05;' q9�3 -97 1 45 4G�1 12N97 PIPELINES C-34 CONCRETE! FOUNDATIONS LoK�✓4�E. CO. C-8 3�3� 5 , >3 Go Uo `A&g ►3>ac - 3+2463 Z 53 2 s� q7 ASPHALT' A FRAMING B STEEL/ STRUCTURAL C-51 MASONRY C-29 PLUMBING J1^, GW 14A P6v%6 Ott C -3e X15 6441 41.4jC14i qR Fu u o 78 -RI -31,1,qs 1317 i 3 LATHING C,rvj A`lows} C-28b04+�q�1 Go az23o �o/a� j6�a �I2�`� DRYWALL a 4GOLDW CA Jw 4799o5 0 9t jqe, 4014 i1411 PLASTERING C✓wA io"K* C-38voqq j " l0 tl'i� 46 -mm E64a qa 45 WC 3223o'i -ol 1X73, �i= qe HVAC CA -1 10[4to C-20 48 y 61914 117 INS, co Of ;NE w' -WSDo7. 110 i1 �,WD 97 ELECTRIGen re dCAl @a/ izvlGt��S ��G�}yiG C•10 +- cwot13 .01,34 16 ExetAf1 X15 IZ97 ROOFING ECKLuND JZOqf�tICG IMC• C-39 '715643 N we 4205000 � � 1'144 12/4-1 SHEET METAL C-43 , FLOORING Jim _4V4ijiAr r leo,. Core iv5C-1 5 S+Q/S9tt 3 3+ q8 0 94 ►1Z d � 4 �'T58 1 48 GLASS/, GLAZING -I DG6.E r4 W ►AA1; of C-17 INSULATION 9.cN& IK5141A-hcoli C-2 381.234 �1�30�99 Rep- to.3u.. 3517327 1�''4' 143.Lln SEWAGE DISP. C-42 PAINTING/ DECORATING �'"t Kat+�v S%C C-33 , 6 1 0 Sy8 ;144 U EX&MpT �� neo 4�4 4, � CABINETS/C INSTALLATION AL � i KE '� rtrT -6 Dia P 541gol i� 5 FENCING �o►c.k. G►a�IL S�, C-13 LANDSCAPI JqL�(. Cl0.vit. ✓; C-27 POOLS C-53 OTHER SALE ESCROW INSTRUCTIONS THIS DOCUMENT WL AFFECT YOUR LEGAL RIGHTS - READ IT CAREFULLY! TO: COMMONWEALTH LAND TITLE COMPANY Escrow No.: 97.6658KC 72855 Fred Waring Dr. Date: 05/20/97 Suite A5 Page: 1 Palm Desert, CA 92260 (760) 836-3726 Escrow Officer: & ly Collier THE ESCROW HOLDtR IS COMMONWEALTH LAND TITLE COMPANY WHICH IS LICENSED BY THE CALIEFORNIN DEPARTMENT OF INSURANCE. Buyer will hand you additional funds prior to closing in the amount of .......... $ 12,000.00 TOTAL CONSIDERATION $ 12,000.00 and any additional funds and instruments required from me to enable you to comply with these instructions, which you are to use on or before June 16, 1997, and when ORANGE COAST TITLE COMPANY can issue a Standard Policy of Title Insurance Owners form, with liability of $12,000.00, on real property in City of LA QUINTA, County of Riverside, State of CALIFORNIA viz: Commonly known as: APN 773-124-023, LA QUINTA, CALIFORNIA LOT 11 OF BLOCK 56, $ANTA CARMELITA AT VALE LA QUINTA, UNIT NO. 5, AS SHOWN BY MAP ON FILE IN BOOK 18, PAGE 63 OF MAPS, RE -CORDS OF RIVERSIDE COUNTY, CALIFORNIA Except any -reservations of record of minerals, oil, gas, water, carbons and hydrocarbons. Showing title vested;in: JACK L. CLARK, JR., A MARRIED MAN AS HIS SOLE AND SEPARATE PROPERTY Free from encumbrance except: A. Current general and special taxes for the fiscal year in which this escrow closes, and taxes for the ensuing year, if any, a lien not yet due or payable. B. The 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. C. Special improvement assessments, if any. D. Easements, rights, rights of way, covenants, conditions, restrictions and reservations of record. 0 Certificate of Occupancy Citypf 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: 51-733 AVENIDA CARRANZA Use Classification: SINGLE FAMILY D1 ELLING Bldg. Permit. No.: 9.710-069 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC Owner of Building: JACK L. CLARK JR. Address: City: By Date: Building Official POST IN A CONSPICUOUS PLACE 1 54-350 AVENIDA HERRERA LA.QUINTA, CA:, 92253 DANIEL P. CRAWFORD JR. . 4/20/98