0110-276 (RPL)U)
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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under •provisipri hof
Chapter 9 (commencing with Section 7000) of Division 3 of the Businessand
Professionals Code, and my License is in full force and effect' t`
License # Lic. Class Exp. Date
CU 13-1
Date, 2f'-, • Signature of Contractor
OWNER -BUILDER DECLARATION„ jr l�–�r
I hereby affirm under penalty of perjury that.I am exempt from the Contractor's«,
License Law for the following reason: r`
() I, as owner of the property, or myo6ployees 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). 9
( ) 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:
Carver 'II PsI1;KYND Policy No. 220440""9671
PERMIT #"
BUILDING PERMIT>i,.,,,
DATE I VALUATION • d LOT TRACT
ADDRESS ^~ Y� —, APN r
OWNER
1..��b%�'�.f vr.•.Ad.7, VS'C.9.%hY'y J:iO'�v"..
18 129 CAME RSTAM 8XMI, 209
uk QtlZ,fildu C,A
USE OF PERMIT
CONTRACTOR / DESIGNER //9ENNGyINEEyR�
92253 'L.A. Q11114M CA 922S3
F(760)564-1666 859
1$dE3!'W'1'1O1.1. NXIL ZQzUJPM1LN'r l-'t+4i:),,dMIRE'
f
r
12�ohra.t'�i► t�13
1 .LZez A1MAT. CO OFLt�ld4a'91, R MS'°.J'.F7 +T.,Ye SSiVeF+co'
PERMT FEE
(This section need not be completed if the permit valuation is for $100.00 or less).
T^1,AN CHECK RIE,
3 0) -000,439-3 i a
S871^45
( ) I certify that in the performance of the work for which this permit is issued,
CC"NNRILIC` IOM VEX
101-000.418.400
$135.00
1 shall not employ any person in any manner so as to become subject to the
URCHANtC L Y99- -- POOL
101-900-421-000
$24.00
workers' compensation laws,of.California, and agree that if I should become
`"
_ Zl.,fCX CA],PTZ... E)OL
103.000_420„000
%�!�,gL
subject to the workers' compensation provisions of Section 3700 of the Labor
Code I shall forthwith com I with those rouision5
v y
Date...` - • �1'Applicant
Warning: Failure to secure Workers' Compensation cove►age'`i's 6nlawfu1p�n84,
shall subject an employer to criminal penalties and civil fines up to $10V00, in
addition to the cost of compensation, damages as provided for in Se�lon 3706
of the,Latior 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 asa 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,w,•
construction, and hereby authorize rep"resentati°ves of this City to enter upon
the above-mentioned property for inspection purposes.,
RECEIPT
—Signature (Owner/Agent) � � - 1Date;�f% • •a4uc� �!
�•••e•r i p <i
t
cf�20 2001 d...�
s •`.1:E:5".fi.A�i. t^_:�fZ�t�°T��3'n"�i�C753'.�1`5�� � ..� ._ �;31€s:7
e '}';�.�,:+`��91'�Z:£�'•'P.,E°s�ids'�:",Cak� �i�.ai1�
rTM' 1., T.�`.�I� T -E9 bVE NOW '° &318,75
DATE 1 A I BY
FINALED
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
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
'
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
_
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Final
Underground Pibg. Test
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:
.,- 1
,.NU W14jN RECORDED MAIL-TH;S UEEG nvii, LILESS 01i -'ER
WISE SHOWN BELOW, MAIL TAX STA7LNr N?S -TO-
NAME --
Mr. D. Paul Fansler,
ADDRE$- p O Box 5030,
c'T"
STA Fresno CA 93755. M
Zlv L J
Title Order No. Escrow No. 7-2977
Quitclaim Deed of "3qz _00-
The
n0
The undersigned declares that the documentary transfer taxis $ . no. _consideration ..... and is
❑ computed on the full value of the interest or property conveyed, or is
❑ computed on the full value less the value of liens or encumbrances remaining thereon at the time of sale. The land, tenements or realty
is located in
❑ unincorporated area ❑ city of.................................................................
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
MARLENE M. FANSLER a married woman, wife of vestee herein,
do es . hereby remise, release and forever quitclaim to
D. PAUL FANSLER, a married man as his separate property
the foliowing described real property in the
state of California:
county of Riverside
Lot 130 in La Quinta Golf Club Estates unit No. 1, as shown by Map on file
in Boo); 37, pages 96 through 98 of Maps, Records of Riverside County, California.
Dated
STATE OF CALIFORNIA l
SS
COUNTY OF — �" �• JJJ
On this the .___ Z=<day of 19 ; before me,
the undersigned. a Notary Public in nd for said County and State,
personally a eared !^
�. - —tom-•-
, personally known to me
or proved to me on the basis of satisfactory evidence to be the
person whose nameT subscribed to the within instrument
and acknowledged that Zl: executed the same.
I v
('�Cj./J /_
( Signature of Notary
FOR NOTARY SEAL. OR STAMP
OFFICIAL SEAL
JANICE F. DINWIIDDIE
NOTARY PUBLIC -CALIFORNIA
PRINCIPAL OFFICE IN
. yr
FRESNO COUNTY
My Commission Expires Mar. 17, 1989
MAIL TAX STATEMENTS TO PARTY SHOWN ON FOLLOWING LINE: IF NO PARTY SO SHOWN, MAIL AS DIRECTED ABOVE
Name Street Address City & State
SAFECO Stock No. CAL -0011A (Rev. 12-83)
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SPACE ABOVE THIS LINE FOR RECORDER'S USE
Quitclaim Deed of "3qz _00-
The
n0
The undersigned declares that the documentary transfer taxis $ . no. _consideration ..... and is
❑ computed on the full value of the interest or property conveyed, or is
❑ computed on the full value less the value of liens or encumbrances remaining thereon at the time of sale. The land, tenements or realty
is located in
❑ unincorporated area ❑ city of.................................................................
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
MARLENE M. FANSLER a married woman, wife of vestee herein,
do es . hereby remise, release and forever quitclaim to
D. PAUL FANSLER, a married man as his separate property
the foliowing described real property in the
state of California:
county of Riverside
Lot 130 in La Quinta Golf Club Estates unit No. 1, as shown by Map on file
in Boo); 37, pages 96 through 98 of Maps, Records of Riverside County, California.
Dated
STATE OF CALIFORNIA l
SS
COUNTY OF — �" �• JJJ
On this the .___ Z=<day of 19 ; before me,
the undersigned. a Notary Public in nd for said County and State,
personally a eared !^
�. - —tom-•-
, personally known to me
or proved to me on the basis of satisfactory evidence to be the
person whose nameT subscribed to the within instrument
and acknowledged that Zl: executed the same.
I v
('�Cj./J /_
( Signature of Notary
FOR NOTARY SEAL. OR STAMP
OFFICIAL SEAL
JANICE F. DINWIIDDIE
NOTARY PUBLIC -CALIFORNIA
PRINCIPAL OFFICE IN
. yr
FRESNO COUNTY
My Commission Expires Mar. 17, 1989
MAIL TAX STATEMENTS TO PARTY SHOWN ON FOLLOWING LINE: IF NO PARTY SO SHOWN, MAIL AS DIRECTED ABOVE
Name Street Address City & State
SAFECO Stock No. CAL -0011A (Rev. 12-83)