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9907-100 (SFD)/ ,�CENSEDCONTRACTOR DECLARATION ^ ,| h6ebyoiimn under penalty of perjurylthat6l am licensed under onyisionoof Chapter (commencing with Section 7000) of Division u of the Business and Professionals Code, and myLicense iuinfull force and effect. ^'` . License w ' uu.o/aox Exp. Date / 5W567 B'0312,1/%cq `�- �� 40`o.".=o' ' OWNER -BUILDER DECLARATION ` �_ |��nn��that |omexempt from the Contractor's License Law for the following reason: ' ( ) |, on owner o/the property, or my employees with wages as their sole compensation, will dothe work, and the structure iunot intended u,offered for sale (Seo.7o44.Business uProfessionals oouo). ' ( ) |, as owner of the property, um axdvaivo|y contracting with licensed contractors to construct the pn4out (Sec.. 7044; euxinos» u Po»aovivna|u Code). �'/ ( ) | am exempt under a�mon�__. ouPo. for this reaovn_____`___ oat6 Signature of Owner ' - WORKER'S COMPsmSAT|OmDECLAHATON | hereby affirm under penalty of perjury ono�`of �m' following declarations: ,()| have and will maintain acertificate o/consent mself-insure for workers' oomponsmion, as provided f6i6y Section 3700 o/ the Labor Codo, for the performance o(the work for which this permit ioissued. '() | have and will maintain workers' compensation insurance, oorequired by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. my wm,kom'-compono�ion inavmnoo carrier & policy no. are: Carrier ` ' Policy No. A , I 'U(This section need not be completed if . , . valuation isfor $1les;) 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 worker ��e6mpensation laws of California, and agree that if I should become subj5pt,to the workers' compensation provisions of Section 3700 of the Labor Warni7ngFa, 7ure 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 mthe Labor Code, interest and attorney's fees. IMPORTANT Application iohereby made uuthe Director of *auimmnand Go�� for a permit subject m mo conditions and mmhmiono nou hmnh on his application. ' 1 �Each personupon 'Whose behalf this application ismade & each person no' whose request and for whose benefit work ioperformed under orpursuant m any permit issued aoaresult o/this uppnomonagrees to, mshall, indemnify & hold harmless the City ofLaQvinto. its officers, agents and employees. 2. Any permit issued as result ofthis application becomes nun and void i/ work is not commenced within 180 uuvo from date o/ iaovanoo o/ such pannu, or cessation ofwork for 18odays will ov�o� po,mi��ooan0000uion� . | certify that | have read this application and state that the above information io correct. l,agree to comply with all City, and State laws relating to the building constru , ction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) i(16,41- Date BUILDING PERMIT DATE VALUATION LOT TRACT JOBS11. I 7�14 OWNER CONTRACTOR DESIGNER / ENGINEER CA 92253 L.A.QlJ1lKYA_ jf,� USE OF PERMIT NQ FEE R11-000-419-000 lot. a 44 Al rEE� DATE BY E FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs e Z Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck .- -.GB CFz Exhaust Fans O.K. to Wrap - as-=C—z>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 t POOLS - SPAS BLOCKWALL APPROVALS ? steel Set Backs Electric Bond Footings Main Drain Bond Beam (Q- db Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping 'PLUMBING APPROVALS D Waste Lines EacTesttric al 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 ,7 -00 S Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors' Temp. Use of Power Final 4.1 Utility Notice (Perm) �:'�.-rv".-,creme-.-w—vl�-��+.,r. �F-,Fr 1'�+•�i(,Y Building 5� _ DW Address CIO c&ht 4 P.O. BOX 1504 �� "P l ^ `' 78-495 CALLE TAMPICO APPLICA Y 5 K' Q. , Zxd LA QUINTA, CALIFORNIA 92253 Mailing /i Address 5l QG Ave, (.. & V VD -Vi -L CL CityZip Tel. V�t l Contractor `,.LL /t 1QY�Y, Address City lZip I Tel. State Lic.I City & Classif. Lic. # Arch., Engr., Designer Address I Tel. CityI Zip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I 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 taw for the following reason: (Sec. 7031.5.8usiness and Professions Code: Any City or county which requires a permit to construct, after, 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 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 ($500). I' 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.) f'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 contractor(s) licensed pursuant to the Contractor's License Law.) 171 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. O 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., If, 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 1 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 appl Mailing Address_ City, State, Zip_ LDING: TYPE'CONST. OCC. GRP. �/ . Number -i " V 13 -�` ��. - 4 al Description �--6 21,'s illC)ck-k%S LA-_ Project Description Sq. Ft. No. No. Dw. Size Stories Units New O Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. ZS Plan Chk. Bal. t 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 INSPOA g- Issued by: Date Permit � •SP�ermit ° 1999 Validated by: Validation: 'i _ A i r-7 f WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 12/28/99 No. 19853 Owner NameJack Clark, Jr. No. 53-280 Street Avenida Rubio City La Quinta Tract # Lot # APN # 774-073-002 Jurisdiction La Quinta Permit # Log # Zip 92253 Study Area Square Footage 1506 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: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.93 X 1,506 or $ 2,906.58 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 CCNalley Independent Bank/Jack'Clark, Jr. Telephone-- By Dr. Doris Wilson Superintendent Fee collected /exempted by Olivia Aguirre Payment Received $2,9Q6 58 �klf , Check No. 209506 Signature INOTICE: 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 above 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 collect them on the Distrid('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 Rec-ordinq Requested By CHICAGO TITLE COMPANY RECORDING REQUESTED BY: 7ICAGO TITLE COMPANY COMPANY 99.8415KC 97055268 lk"'OLO AXRSTgJ&D�j` AND. JACK L. CLARK, JR. 51220 Avenida Carranza thbAhA/ APAWN A0A LA QUINTA, CA 92253 v3 280 ��c. 7%r -,dip .163002 RECEIVED FOR RECORD i AT 2:00 P.M. P i®`� rc3r)4' 78x QL �:)rd� APR 1.6 1999 Recorded in Official Records of Riverside County. California Recorder Fees $ SPACE ABOVE THIS LINE FOR RECORDER'S USE LOT 23 OF BLOCK 185, OF SANTA CARMELITA AT VALE LA QUINTA, UNIT NO. 18, AS SHOWN BY MAP ON FILE, IN BOOK 19, PAGES 30-31 OF MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA Dated February 6. 1999 State of California County of LLiE } S.S. On before me, = 1_1iC- personally appeared personally known to me (^r proved - to be the person('--0,.whose name/awe-subscribed to the within instrument and acknowledged to :•ne that /s4*e4 t e executed the same in authorized capacity and that by &1 /hn� * — signature) on the instrument the person), or the entity upon behalf of which the person) acted, executed the instrument.. WITNESS my handnd of ficial seal. Signature MAIL TAX STA EMENTS TO.sA AS ABOVE LOYOLA MARYMOUNT UNIVERSITY BY: Si ure, TitleJohn R. Oester Vice resident for Business and BY Finance Signature, Title WNNA.WMN cima"MN"W hibb • C1oOQ110 (This area for official notarial seal) N_--..— _ _ _ GRANT DEED 0 20 � �� S ------ -; The undersigned grantor(s) declare(s): y s Documentary transfer tax is $14.85 r (XXX) Computed on full value of property conveyed, or r._. i ( ) Computed on full value less liens and encumbrances remaining at time of sale. ( ) Unincorporated area: ( )() City of _L5 Qu 1. and FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, ILOYOLA MARYMOUNT UNIVERSITY _J hereby GRANT(S) to N JACK L. CLARK, JR., A MARRIED MAN AS HIS SOLE AND SEPARATE PROPERTY the real property in the City of LA QUINTA, County of Riverside, State of California, described as: LOT 23 OF BLOCK 185, OF SANTA CARMELITA AT VALE LA QUINTA, UNIT NO. 18, AS SHOWN BY MAP ON FILE, IN BOOK 19, PAGES 30-31 OF MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA Dated February 6. 1999 State of California County of LLiE } S.S. On before me, = 1_1iC- personally appeared personally known to me (^r proved - to be the person('--0,.whose name/awe-subscribed to the within instrument and acknowledged to :•ne that /s4*e4 t e executed the same in authorized capacity and that by &1 /hn� * — signature) on the instrument the person), or the entity upon behalf of which the person) acted, executed the instrument.. WITNESS my handnd of ficial seal. Signature MAIL TAX STA EMENTS TO.sA AS ABOVE LOYOLA MARYMOUNT UNIVERSITY BY: Si ure, TitleJohn R. Oester Vice resident for Business and BY Finance Signature, Title WNNA.WMN cima"MN"W hibb • C1oOQ110 (This area for official notarial seal) RC District ---P-lAn-n--ing-B-eV�w Form, This form i . s to be used by CDD staff for review of single family dwellings in, the RC (Cove Residential) District, in. order to determine the applicabititY of compatibility. issues - or -need to require the filing of -Master Design. Guidelines by the applicant. It shall be transmitted to Building & Safety as your correction list. 'Please attach additional explanations as necessary. APPLICANT:- Jack Clark, Jr. PROJECT ADDRESS: 53-280 Avenida Rubio APN:' 774-07.3-002.: LEGAL: LOT, 23 .BLOCK _18 -5-, UNIT 18 S.C..@ V.L.Q. CK'D BY: Leslie Mouriquand BIN NO: CASE NO. 99-93 CHECK -DATE: Inform- the assigned Building plan checker upon. your assignment t ' o this case. T ' he CDD Executive Secretary maintains a log book ok to track applications and assign. case numbers. REQUIRED ITEM y N COMMENT/CORRECTION E�,N"H Case logged and.nu mberr.assigned verify legal and APN -information Consistent with MDG on file las. applicable) MDG filing required 15+ filings since 9/3/98) k--*, 7--,,17 Cbiisisterity--with-street/surrounding- area:. Colors Materials Architecture .66 OTHER REOU IR EMENTS:'. 10? Th6. zoning code, architectural, and landscaping manuals, and/or assigned inspector. should be consulted where uncertainties arise. The completed checklist shall be maintained in the Building & Safety address"f ile. - ®EI Certificate of'O.c-cupan.cy City of 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: 53-280 AVENIDA ,RUBIO Use Classification: SFD Bldg. Permit No.: 9907-100 Occupancy Group: R 3 Type of Construction: VN Land Use Zone:, RC Owner of Building: JACK CLARK JR 1 Address: 51-220 AVENIDA CARRANZA —�6�� Building Official City: LA QUINTA, CA 92253 By: STEVE TRAXEL - Date: 09-21-00 POST IN A CONSPICUOUS PLACE