9705-093 (SFD)LICENSED CONTRACTOR DECLARATION "
I hereby affirm under penalty of perjuiji: 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 # Lic. Class Exp. Date
502905 1 12/1%3i
Date Com. 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:
( ) 1, 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 Cartier & policy no.,are:
Carrier Policy. No.
'4099 1`7
STATF FUND 142
(This section need not be completed if the permit valuation is for $100.00 or less).
X) 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.l should become
subject to the workers' compensation provisions of.Sectiori 3700 of the Labor
Cyode, I shall forthwith comply with those�provisions. v
Date: .. -7 "i+ ;Npplicant'
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 x
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 ofsuch
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.
/ignature (Owner/Agent)--ti -'''< `+✓Date<?
•• .• PERM T# - - 0°NTR°`"
BUILDING PERMIT .
- 5 4 21
DATE VALUATION LOT. TRACT '
$93,802.00 10 IN9 !,,Q4
JOB SITE
APN
ADDRESS
773-04"24
OWNER
CONTRACTOR/DESIGNER/ENGINEER i
3 A,ft1 VRq SI R.t1BC1:'l;ft C!CK)I)W,]N
(Z,t Ai'd 1;1.C"t3;5I �`C'Tt€J f'It?N
18101Si:AN11 l..AK-1? D.R'
-9fs3i3
31750 LANDAU . BLVD.
fif i i'ii1 I I� ..
G '!'f lk%Jt�;11. :1.1' " C,A. 92114
C760j3?& 7783. rt 1�1!
USE OF PERMIT
311>;�11POWl" tri`a1r9 NOT INCt.0%+.1r' KULOCk WALL8 00.1 t3f. L.
` '1'ii•lt�;.0 C:tiZdS'1'#�G�:`s a4li�}' 1,4f�J.{:�1 it
.
.
['Gt'CC j.1iNA'1 iia :360.00 SF
4AI itC:E1r;.A►�1"r. #2'i' 410AJ0 3F
6 IF f', WC r,)i3 i t N(,' "10 -N' LF
walrasmt) cost oV C.`owrRtiL"'1' O
93.302.00
1'�'!;�it'��l Rt ✓F;.1+: �ti'Ci.Etf•Rti�:l�li`2'1' •.
'
t;�;itdS"!°R�.IC"1'.t��nrl�i-� •:IOI-i`3U�3-�1�-'OIXi -- ��i2>�C►
.
PLAN C1,U C9,:F43s; �t),i 000-�139�-31� � x!5.95
101�Gt?-X121-4�flv
9 L; C3ttltr.r1L f il: 10)-l00-420000
l.Li f13:iN 1 P'; 10J,000-419-JtiO
S."ONO MMION M- RES11, 101-0ti0-241-000
c ibuy'1; O P11f .. 1,t71-ti0G�42 -0D0 &O.Qs�
CNIFRAI3`f'.RUC1".131 F'E'E 225-000-443-3:M2 31,9M.57
1.'i {C"1S:t�1?T;rt1�T 101,)00441-3a ��s.of3
�j� q ,� 9 /' t, �.w(��y� �(-'ry+y f7�j � I�)y-� Y t �7 i�j'
f. � TI J,�d.1 \ uliJ 4�J 1�'l.SF.Lw�v,-1.Lt�.✓N �:1SYD IlJ,J N Q Sfi.C,
p A :1 ,}
$3.450.45
$3.450.45
L SS P1;_1a�'11?.('.i5.
•�65� Ct0
JUN 27-1997
T Cff AT, IMM IT 1N`1<;�18'11�I9t" ilti�ll�V
CITY OF LA
RECEIPT
DATE
ij
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
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 Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROV LS
Steel
Set Backs 4o
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
COMMENTS:
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)
Building
Address O /U
c&ty/
"
gue l ® P.O. BOX 1504
�j78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Owner ,-�
/i e-ft•,� ,rets 1-10471 1)✓in
Mailing t�
Addresst _-6�v 'e '`er't^i
SZip Tel.
_XI/4Eya 9',��
r-_,7 e,Y".CA, a v'.0,-, -r A" q rl" f -'.
Address f /
City Zip Tel
State Lic. City
& Classif.f) �) S� Lic. #
Arch., Engr.,
Designer
Address Tel.
City (Zip ( State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 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 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 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 (11500).
d I, as owner of the property, or my employees with wages as their sole compensation, will
o 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 or completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose or sale.)
1 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 contractors) 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
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 Owner
NOTICE TO APPLICANT: U, 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
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 it 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 Address
City, State, Zip
APPLICATION ONLY
BUILDING: TYPE"CONST. ..1 A OCC. GRP.
,A.P. Number % %3 0 ¢ C Zit
Legal Description ,/-ra n F rl ()IJ 1 4
Project Description
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep. �,�• •D
Plan Chk. Bal.
Const.
Mach.
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 INSPECTO
Issued by:Date { i � �,
Validated by:
Validation: 5 199/7
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
s
Notice:
Document Cannot Be Duplicated
Date 6/25/97
No. 15718
Owner Name Mikey Goodwin
No. 51365
City La Quinta
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Street Avenida Rubio
Tract # Lot #
Type of Development Single Family Residence
Comments
Zip
Jurisdiction
APN # 773-044-026
La Quinta
Permit #
Log #
Study Area 114
Square Footage 1460
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 560 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 1,460 or $ 2,686.40 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 oc/Palm Springs Savings Bank/Czeranski
euuaiiucwiv Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Pauline Pearson
Signature
Telephone ,328-7783
Payment Received $2,686.40
Check No. 831504452
10TICE: 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
bove 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
oiled 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
MA p• �T1NEZ
: ,assismnt �
,t. Espanol
I •�
BUS (7601568.2521
41- t-\ fXX (160) 568.6283
Esrxow
.IE ESCROW COMPANY INC'
5 MONTEREY AVE., SUITE G
ALM DESERT, CA -92260
68-2521 FAX 619 568-6283
;CROW INSTRUCTIONS
COMPNNY INC._
via
NENWA MW I'M
.1
0-FT—Tor to May 21, 1997
will hand you the balance of .
I buyer, costs in the
purchase price + cla Cas Check
form of a California Cashier's escrow r
wired funds, will hand througned escrow
the sum of $5,000.00 with sig
instructions.
PAGE 1
CONSIDERATION
Paid Outside of Escrow $ 35,000.00
Deposit through Escrow 0.00
I.First Trust Deed 0.00
Second Trust Deed
TOTAL CONSIDERATION $ 35,000.00
I instructions, which
" for me to comply with these a CLTA
and any You can have issued through First American Title Co.
funds and instruments necessary for the total consideration
you are to use provided y of Riverside,
policy of title insurance with the liability
County
standard coverage P in the city
on the following described real property
State of California: of Block 48, as shown by Map on file in
Vale LaQuinta, California
in the Office of the County Recorder of Riverside County,
Lot 10 of Tract Santa Carmelita at
Book 18, Page(s) 62,
(Unit No.. 4)
SHOWING TITLE VSSTED INi Goodwin, Husband and wife as Joint Tenants
Marvin H. Goodwin and Roberta L. delinquent;
special district levies not miner iand
If now of record: General and exceptions of oil, gas, wa and
SUBJECT TO: ri hts, rights of Y
covenants, conditions and reservations retry), restrictions; Band streets;
without right of surface entry), alley Statutes of
hydrocarbons, districts, water companies, ter 498,
easements for public utilities, provision of Chap
Supplemental taxes,
if any, assessed pursuant to the p
1983 of the State of California.
paid
current by Seller, a lien not yet due and payable
(x) Bonds and/or assessments to be
to be assumed by Buyer.
' stments indicated by an "X" as of CLOSE OF ESCROW:
Make only the prorat ionsand adjustments
( ) Interest on Trust Deed of Record
fix) Taxes* ( ) Fire Insurance Premium i f any ( ) Homeowner Association dues
( ) F.H.A. Mortgage Insurance Premium, in accor
Rents dance with the
( ) -assessment,
*Seller and buyer are aware taxea.are,s�y subject to reproration of such taxes
Statutes of are to be handled
' the State of California:
outside this escrow.
Vacant Lot, APN#773-044-Ui4 La CA 92253
Q'�inta,_„c
of Corporations, Skate
COMPAQ
INC. is licensed by the Department
DIXIE ESCROW
California, License No. 9631188.
rior to the said date will hand you
foregoing = "`1Lr'ons and P therewith, prpyi.ded you hold the
I, Seller, agree to the for me to cI.omp Y lace title in
any
funds and instruments necessary Pay any encumbrances necessary to p
funds -.and instruments deliverable to me:,
the condition called for.
A
READ AND AGREE TO THE GENERAL PROVISION
BUYER AND SELLER HAVE S ATTACHED HERETO AND MAD
PART HEREOF.
Buyer's
Signature Sign
Seller's Marvin H. Goodwin
Signature
Hank Czeranski
Roberta.L. Goodwin
zeranski
Johanna C
Address: E. 1810,Island Lake Drive
Address: 71-750 Landau Blvd. v
Shelton, WA 98584
Cathedral City, CA 92,x,
�+qe;; Sz'�"�r .--.�.p.p•_+s+oac; :.�:,�.assn=_.m.o•mv�-+.�--a--,k,..,..V�.�w...6...�.-: w _ . •sa _ —�..I ..-w^i�e'v�
COACHELLA VALLEY WATER DISTRICT 1
CASH RECEIPT DETAIL
2C�O�l�/n�$-77� Z_Tg-.p
ReceivedFrom:C-Z8-W&59� eO1SJI—' Date• j
Address: J f ' %•SiJ ��/4j )A a(cT�
Account No. 60./601-3,t 035 0. 0 A Lot(s) p402 Tracf`7 � ,r
Service Address s 1 X1 ' Nr bA f2u V G.A. Code
,$
QG
81st($) /% r :3 / I �
�� '
Q.rvice(s) � d ...74 � OO
❑ Backflow(s)
❑ House Lateral(s)
❑ DetectorCheck(s)
❑ Meter Surcharge I
natation Capacity Charge O —Z. s r Z o
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account =Name
i ❑ Inspection Fee - Tract -
c
Fee -
❑ Plan Check Fees Water I Sewer -
Tract -
i
❑ Bond Payment - A.D. - Bond
Assmt. )
❑ Customer Deposit f�
❑ Ot)ier I
TOTAL $ 3 e
Remarks:
copy to: L✓ J ._ 1 U F
Cash Water Service
Check —37Z_
Money Cashier
Order D-438(11189)
0
y ,
CHARLES D. GARLAND ARCHITECT
lxx
33-163`CATHEDRAL`" CYN DR.
CATHEDRAL CITY CA 92234 r'
y I' `'t`vtti:v; •::iii:{: {. t ,
`,�•i::i:<``......>.; - (760) 324=7146 �• .. .
•17 June 1997..
'\ City of La Quinta
;K-K- Department of Building and Safety
La Quinta, CA 92253
'02 wtet.:::::. •,
........
-
Re: Goodwin Residence
k ; Subj.: Truss calculation Review
�kt:: iiii:•ii. �k M1ti�
:.iii `` ```' To whom it may concern,,
` I have reviewed the truss calculations prepared for the 'referenced pr0iect by Trussworks truss
.\ manufacturers and found them to be in conformance=with the structural design intent .of the
wk g
:. construction documents and structural calculations prepared for the project. A
If you have any further comments or questions regarding this or any other matter pertaining to
this project please do'not hesitate in contacting me.
Sincerely,
• :\:i':ti; viii:^it\ ii it • I 1 � • •
. tii......}}iii}' - 4
` Charles d. Garland, �*
`..ti b? ^.`• wti w<
4...:>:::>:i<:::Architect
$tit {:i:iiii::i::i:ivi , • ,
4v:t••ii'rjiiiiii::vii:: _ . ♦ - �
+ii\Xii:\iii+ r7. ♦ '
_ Y r •
::::. titx: t;Si:{
c.11 1 . a .
CITY OF LA QUINTA i
SUB -LIST
)NTRACTAR 7 7 Sri
NNER_ JOB ADDRESS
its form shall be posted on the lob with the Building InaRacdon Card at all times in a conspicuousIn aca.
is the responsibility of the General Contractor or the Owner/Builder to monitor the sub -contractors that
3 on this list are the same persons performing the work. Any changes to this list must be approved the
ty of La Quinta Department of Building & Safety prior to work being performed by a changed sub-
.ntractor. Failure to comply will result in a stoppage of work and/or the voidance of building permit.
TRADE
SUB -CONTRACTOR'S
NAME:
Y1(PE OF'
LICENSE
STATE::
CONTRACTOR'S!:
LIC@I>tii:,...
Nafl1Ab`Elf
WORKER'S.
COMP: NAMEf
NUNIER:O[A FB.E:. ;NUMBER/
,.
BUSINESS.
LICENSE
--EM DATE .
1RADIEV
xCAYATE.
A/C -12 .
C-34
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