9708-015 (SFD)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 # _ Lic.-Class -Exp. Date
yDate ''3 �' 17 Signature of Contractor.' /, �,, . } N % r -(A=
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 & Professiorials 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.
(This section need not be completed if the permit valuation is for $100.00 or less).
(y);'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 Section 3700 of the Labor
Code,.I shall forthwith comply.with those provisions. /-
yR te: Applicant'\> - •C
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 pehon 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.
i
ignature (Owner/Agent.;k- I;X;A �� S (W Zf4:5 .. Dates � r
BUILDINGPERMIT PERMITM °°NTRDL#
801197 S99.
DATE VALUATION ,60 LOT TRACT
JOB SITE
-6 40 AVErNIDA HIM10
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
RJOI.ARD L <4, 51AARON) h! SW,`,ti.tNEE
RIC HA.i2_l) 11, S `rtil_AT'
PO IRA 436
22-%2 CA.N"ON LiVKE DR. SO
LA t;,ff. IN'.1'A ("A 9.7?4'f
f:'t1.N1'C1N 1-.F' KF CA 925tV
(760)771-5447 C.'( Lif
USE OFPERMIT'
1�i• 1.J
N-31Civs T OOLIS Nl:)i INC:L%A% ok i't)L BU r D0Es.
iNC%IJ1)8 ::00 1. F., 6' Vi°i:k. 0 F'FN0.-.
TRAC."'r WSTRI'CT1G14 1,At"101'tlll S1
P »i:.l.!'fil1(0'10 4.'-W 3t
i'IAFt4Xt_si(%.rAR110RT 414 .00 SF
oX's (a.5 a
r:'C�Iti'3'Cfttit;"{'f(>1di t:td 101-i.li) AM -14 19-00)
Pi, AN a.'T.I1F.1* :. r,1I1% 101 -f)1"10 -.;b>9 -31a $sit ft
1; !;P 4u
Adii?:JIANii::Ali 1�L1. 101-000-4214jflo
.c
til,t:t "1t{fi'AL 1'1:1 10140)-420-t3t3(1
f:, ff�Lfll1.83(3 ! 1?1% IAi••(;1f1t).d14-p(111
N(', NII:r1'1l' fN F1-3: % l_ ;if t 101 -f}G 0.21.11 =3 19 X38
�.-4041)0.40 1,0; 101-040.423-0 )ti V20.-(1ti
1N1;RA>`1•R1JI`-r0RI3' FEE' ?'.15-(H)0-44.3-342 S7. 174,10
FOR V('I1W 171.A14 1{11••f)f10'4et.91 • t:`1S 4,'•S 1.4)
AlL0.1t'i•`i1
9, r1'.AI i.'(N 1`471411r'n0N Ai f PI A:N rIi14 1:
�t_'7t3�411
AUG 21 1997
MY OF LA OU WA
C
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
:r4« 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 Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWAL AP ROVALS
Steel:±
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APpRqVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping UPlumbing
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 tiikPkPVALS
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)
COMMEN
� ✓/ 1• t
j •f
Buildin
Addrress��=r�n^1 V aver I
-`-R1 dwra Ve- A4/4t
Mailing �; /
Address5/_c//5 C'Q(/ E.. Cy{hI(I�t
City 1 Zip Tel.
Address. �DO
/City Zi�j, [Tel.
State Lic. t" City
& Classif.3.aS (,eC..,. B I Lic.
\
I, , .
Tay/
QumAw
P.O. BOX 1504
78-495 CALLE TAMPICO
RU 610 LA QUINTA, CALIFORNIA 92253
ark A) • !&o / i/Q.
#
Arch., Engr. ,l
Designer
Address' Tel.
&'V
City IZip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby,affirm-that I,am'flcensed•,under provisions of Chapter 9 (commencing with Section
7000),of DWision 3�off he BuusineS/wand P'rofes�sio`' s Co e, end my Iicsnge Is In�full fyor�cje and
of oect. , .-,L P W 4./'
,NATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031 . 5,Susiness and Professions Code: Any city or county"which requires a
permit to construct, after, improve, demolish, 'or repay 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,N,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 live hundred dollars ($500).
(] 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, Bulsness 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.)
V%{, as owner of the property, am exclusively contracting with licensed contractors to con-
strubt 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.)
17 I am exempt under Sec. B. & P.C. for this reason
.ry /y� jet. :v �/ yA 1 i/ �.
Date/ L.>r,e/ / O nw er j,%.0 L12 .✓ v Y1640 JY•"
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. ❑ Certifiee_d�copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg work. for which this permit is Issued, I shall not
employ any person in any ma net so as to become subject to the Workers' Compensation
Laws of California, / -(
Date/..--`/ —/Owner „"'_"F'� :Jr �t11'r"'✓ �"�'.
NOTICE TO APPLICANT: d, 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 1 `at
Lender's Address
This is a building permit whenrproperly 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 aQplicant __—Date—
Me iling
DateMailing Address
City, State, Zip
o8 -o
APPLICATION ONLY
11LDING: TYPE CONST. OCC. GRP.
P. Number -3 -26 3 - 2F)
Igal Description
oject Description :S f 4
WHITE = FINANCE YELLOW = A
Validated by:
Validation:
1 `
PPLICANT- PINK = BUILDING DIVISION
r rY
Sq. Ft.
Size / (p O U
No. No. Dw.
Stories / Units
NWk Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation]
tt++ f �iro
PERMIT
AMOUNT
Plan Chk. Dep.
<-f7 • e 0
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
I
REMARKS
rr
r
ZONE: BY:
Minimum'Setback Distances:
i Front Setback from Center Line
Rear Setback from Rear Prop. Line r
Side Street Set ck Rom:Ce ter Line
Side Setback frovt`"'�Ptop �riierty ine
FINAL DATEINSPECTOR
Issued by: DateAUG ®1 1Permit
WHITE = FINANCE YELLOW = A
Validated by:
Validation:
1 `
PPLICANT- PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
827879 Highway 111
Indio; CA 92201.
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 8/21/97 APN # 773-283-028
No. 15992 Jurisdiction La Quinta
Owner Name Richard'& Sharon Swalve Permit #
No. 52640 Street Avenida'Rubio Log #
city La Quinta :. zip 92253 Study Area
Tract # Lot # Square Footage 1600 .
:r
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:
EXEMPTIONNOT APPLICABLE
This certifies that school facility fees imposed pursuant to' Government Code 53080.. in the amount of
1.84 X 1,600 or $ ,2,944.00 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage,iri this`proposed project may'now be issued
Fees Paid By cc/Bank of America/Richard Swalve, Tele ph(ine
<- -Name on the check
By Dr. Doris Wilson
Superintendent =
Fee collected /exempted by Pauline Pearson Payment Received $2,944.0.0
Check No. 20053698'02
Signature
r
40TICE: Pursuant of Assembly. Bill 3081 (CHAP 541%`i TATs. 1996) this -Will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run from the date on which thebuilding or installation peril for this project is,sssuedor on which they are paid to the District(s) or to another public entity authorized to
allec(them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to.district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
RKerlding Reqtw
'" RECORDINQ REQUESTED BY:
an
Order No.
When Recorded Mail Document
and Tax Statement To:
Mr. and Mrs. Richard Swalve
31415 Calle Jacumba-*
Quinta, CA 92253
A FN: 773-283-02U-0 Vj%0
GRANT DEED
ACE ABOVE THIS LINE FOR RECORDER'$ USIE
The undersigned grantors) declefe(s)
l`, -:'Documentary transfer tax Is 11.55
computed on full value of property conveyed, or
267462'
I U computed on full value less value of liens or encumbrances remaining at time of sale,
111ECEIVED FOR RECORD
AT 2:00 O'CLOCK
VALUABLE CONSIDERATION, receipt of which Is hereby acknowledged. Diane
FOR A V Marie Eichel
DIGIolaq
a married woman who acquired title as Diane Marie Eichel
P A t 1)
JUL 2 91997
Doc, Tmrir,(nr Tv
fodowino described real property In the City of La Ouinta
R,c~ o oftw Poop*
:,.,Lot 16 and the South 1/2 of Lot 17, in Block 164, of Santa Carmelita, at Vale
co ftwelftONOW1. cdow"
Quintag as per map recorded in Book 19, Pages 19 and 20 of Maps, in the Office
of the County Recorder of said County.
Fens
GRANT DEED
ACE ABOVE THIS LINE FOR RECORDER'$ USIE
DATED: June 26, 1997
STATE OF CALIFORPN
COUNTY
ON _j before me,
�tz h1n _k*)q!e1t pe anally appeared.
proved to me on •the basis
Of satisfactory evidence) to be the person(s) whose
name(s)d3Aw&subscribed to the within instrument and
acknowledged to me that ka6l5b/th" executed the
"Me In40sMthek authorized capacity(ies), and that
by Wvjfjidleir signaturefs) on the instrument the
person1s), or the entity upon behalf of which the
person(s) acted, executed the Instrument.
Witness my hand a o Ictal seal.
Signature
Di3ne Mario Eichel DiGioia
0 (AKIN AN BOYD
Omm 0 11042102
C. 0; d "MMY MIC - CALFCV.-C% S
MAIL TAX STATEMENTS -AS DIRECTED ABOVE
FD -213 (Rov 9/94) GRANT DUO
The undersigned grantors) declefe(s)
l`, -:'Documentary transfer tax Is 11.55
computed on full value of property conveyed, or
I U computed on full value less value of liens or encumbrances remaining at time of sale,
Unincorporated Area City of La Quinta
VALUABLE CONSIDERATION, receipt of which Is hereby acknowledged. Diane
FOR A V Marie Eichel
DIGIolaq
a married woman who acquired title as Diane Marie Eichel
6r*by GRANT(S) to Richard Swalve and Sharon Swalve, Husband and Wife as Joint Tenants
fodowino described real property In the City of La Ouinta
�!.Ccunty of Riverside, State of California:
:,.,Lot 16 and the South 1/2 of Lot 17, in Block 164, of Santa Carmelita, at Vale
La
Quintag as per map recorded in Book 19, Pages 19 and 20 of Maps, in the Office
of the County Recorder of said County.
DATED: June 26, 1997
STATE OF CALIFORPN
COUNTY
ON _j before me,
�tz h1n _k*)q!e1t pe anally appeared.
proved to me on •the basis
Of satisfactory evidence) to be the person(s) whose
name(s)d3Aw&subscribed to the within instrument and
acknowledged to me that ka6l5b/th" executed the
"Me In40sMthek authorized capacity(ies), and that
by Wvjfjidleir signaturefs) on the instrument the
person1s), or the entity upon behalf of which the
person(s) acted, executed the Instrument.
Witness my hand a o Ictal seal.
Signature
Di3ne Mario Eichel DiGioia
0 (AKIN AN BOYD
Omm 0 11042102
C. 0; d "MMY MIC - CALFCV.-C% S
MAIL TAX STATEMENTS -AS DIRECTED ABOVE
FD -213 (Rov 9/94) GRANT DUO
N 'CITY* OF-L`A,QUINTA'.
-SUBAST
CONTRACTOR .S r4 ADDRESSo�aB
OWNER JOB'ADbRESS
.'This form shall be posted on the job with�the Bu Idina Inspection Card -at all times in a conspicuous place.
It is the responsibility of the Gener'aL,Contractor or..the Owner/Build,er to monitor the sub -contractors that
_ are on this list are the same persons,,performing the work. .An* changes to this list must be' approved the
•'City of La Qui.nta Department of Building,& Safety'pl q 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.