9801-077 (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
14
t..; L- 14W .11 .. tis
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:
( ') 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).
( ) 1, as owner of *the property,�am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
(t)I am exempt under Section , B&P.C. fort is 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.
Q. 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 �T{ (� Policy No.
1Tttt�%.I.LV1+1Jler`r^JCLi Alid"=4_ 000'i5
(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,
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 pr visions.
,(Date: ✓ n Applicant
Warningng: F� 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 i spection purposes.
fSignature (Owner/Agent) + �' . '..---- Date
CZ
BUILDINGPERMIT PERMIT X111 CONTROL#
DATE - VALUATION ;'J77�169.20 LOT .a . TRACTJOB
ADDRESS .1-345 E��` �+.1VD F, ; .:'�.f`'�. �>~ %, APN 771--082-043
OWNER CONTRACTOR / DESIGNER / ENGINEER
J�.i11..13.,.t7. i7' .,�frcf:'V'i.i1:l 6r.'� R tlttfs(Z. ,."y`1rnCr'/ r:,l IAII.. _. . 5lr� rf "
Zf45701 &KiNE 'i* IFar f•.� YJ llY.;..,.
SFii G
R2ANC;F10 MIR.M31' (..''. 92:70 BN D10 CiN. '_•2211)1
(7th))tg7- 15? C'BL4
USE OF PERMIT
a ,
t. VK
s.
aI't`%- 1'rrtM11`LU1:�; N+: T INCLUDE 131'14 i* WALLS OR f6a.f . HLAN �
('f- uaC Pt, wr iotd oy 1 ao,13). i2fr1.Il CD..) 75'°-,')1°(JR. NitR I La UJI ISSUANT-
9AIM..1'q..AN TYPr;.
i `ft-►T':^4.I., C ON;ST R1:)f-MON ANT) PLA II a 1".1-ff,'(r V,695.90
LESS PiRT )A1C Ft LES' $0.00
T(lTM,1i'rt?,RMI1' PERS' MId%.NOW $2.695."
RECEIPT DATE BY ' f DATE FINALED INSPECTOR
o,
JAN 2
3.1998
MA. c t�'044STR f
PO`I"tC TIATtO
W2,00
0AfZP1.` I C•/Va.1'"I��N,•�"
....S,,F E a{` �/�p�^ yp
+ a 6` '\.O' i Eai
7 ry3_1�,�\
� "Y E d V � tl
.}.�(��•
a �.TgyaS 7 8W /'t/'p��'@ /moi
B'Jw� B lj'Ql.TS It L.Od' '!-l;sl .l' <.I Y=
/^ p'g� / rip
L.u�A ��7'll .♦A?i.4t i4VIR4
"
6YI (
77,116 9 .
t:t +1vT�iT431!(" 1 rC2IJ .f Fs
! 01 _000-11 I. 8_000
Rti40,50
'ar.=lta 014.7 (7 FFF
10!_W()439_'11R
$1 M.01
Alrf°1rANICA:Lf X�
1014=42I -t3)
�14J.tirl
F.A.1Y.11 `10C A L
PI UN-1111NCi FUR
101-000-419-000
$121.58
fQ 1'Ri.)N0'N-f0T10W a17T - ?zFS!E)
1014)0004.1 -000
$7,74
(AWANG FIX.
11.0'k-000-423-000
S.,C9.f71
lYd1 Rid:+il2i)I .''I`L?i$L; rE iu215-000-443-:34Z
5i,'9i11.: 3
3?f3X`st.7V5P- PLAN
101-titK-441-345
i `ft-►T':^4.I., C ON;ST R1:)f-MON ANT) PLA II a 1".1-ff,'(r V,695.90
LESS PiRT )A1C Ft LES' $0.00
T(lTM,1i'rt?,RMI1' PERS' MId%.NOW $2.695."
RECEIPT DATE BY ' f DATE FINALED INSPECTOR
o,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
A
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor -
Insulation - -;7
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
UA S
Final
Final C
BLOCKWALL APPROVALS
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 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
�7d
Pool Cover
Sewer Connection
7
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
Finalf /f T
Utility Notice (Perm) �=�
COMMENTS:
Building
Address ~� V
Owner
'if 4
P.O. BOX 1504 APPLICATION ONLY
76-495 CALLE TAMPICO
m r- e .Z— LA QUINTA, CALIFORNIA 92253
t'r/4s
nnui, /..
Address y ' �. l ll beaAi-,
City, Zip Tel.
Contractor
Address
City Zip Tel..
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer
Address
City( Zip ( 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 o1 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 permitto 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 ($500).
I] I, as owner of the property, or my employees with wages as their solo 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.)
I'I 1, 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 or property who builds or improvesthereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Lew.)
] I am exempt under Sec. B. 8 P.C. for this reason
&
Date 1wne"r'„".[i.G.4••7�:
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'COMPENSATIONINSURANCE
(This section need not be completed if the permit is for one hundred dollars (E100) 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 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
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 sof this city to enter the above.
mentioned property for inspection purposes.
Signature of a0plicant Date
Mailing Address
City, State, Zip
BUILDING: TYPES'CONST. OCC. GRP.
A.P. Number ! 3 • �Iy`3
Legal Description / � L 07 �, t� { ALL/ 6.7 001' (O
Description
Sq. Ft.. No. No. Dw.
Size /rte . Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
n
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
,r
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 INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW ='APPLICANT PINK = BUILDING DIVISION
Desert SandsUnif ch
ed�.S.o'ol'�District
82 870, H` f h 111'
Notice: ig way
Indio, CA 9220.1
Document Cannot Be Duplicated , -:1,
6197775.-3500.
CERTIFICATE :OF COMPLIANCE
Date 1/22/98 APN # 773-082-018
No. 16535. Jurisdiction' La Quinta
Owner NameCoachella Valley -Housing, Coalition Permit #
No. 51-345 Street Ave, Ramirez Log #
City La Quints Zips 92251 Study Area
Tract # Lot # Square.Footage. 1210
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 .ori garages/carports, covered
patios/watkways, residential additions under` -500 -square feet; detached accessory structures orreplacement mobilehomes.
It has .been determined the; above-named owner is exempt Trom paying, school fees 'at this time due to the following
i... reason: .
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code'53080 in the amount of
1.8.4 X 19210 or $ 2,226.40'.' a the'property listed above and`that building
permits and/or Certificates of Occupar►cy'for'this square footage in-this'proposed.project may now be issued
Fees Paid By Cashier's CheckBank of America Telephone
Name on the check �.
By Dr. Doris Wilson
Superintendent `
Fee collected /exempted by. Ellen P,aftno Payment Received . $?,226.4:0 -
.
. I
CheckNo. 2006714095
Signature
40TICE: Pursuant of Assembly Bill 3081 (CHAP 549,.STATS..1996) this will serve to nbtobu that the 904day approval penod in which you may protest the fees or other payment identified
8bove will begin to run from the date on which the building,or installation permit for, this project ;is sssued or on which they are Paidtothe District(s)or to another public entity.authorized to
:ollect them on the District('s)(s) behalf, whichever is earlier.
_ o
Collector: Attach a copy of county or city plan check application' ",form to district copy, for all -waivers.
Embossed Original- Building Dept./Applicant '. Copy'- Appkari. , eceipt .Copy 'Accounting
ATTORNEY - IN - FACT AGREEMENT
I/We hereby appoint COACHELLA VALLEY HOUSING COALITION,
and/or any of its authorized agents as my/our attorney-in-fact for the purpose
of executing any notices of completion, waiver, of liens and/or executing
contracts with subcontractors, and/or release of liens and/or handling
building permits relating to that certain real property described below.
All that certain land located and being in the County'of Riverside, State of
California, described as follows:
LOT 6 BLOCK 67 OF UNIT 6 OF SANTA CARMELITA AT VALLE LA
QUINTA, AS SHOWN BY MAP RECORDED IN BOOK 18, PAGE 67
OF MAPS, RIVERSIDE COUNTY RECORDS.
Date Jose F. Cuevas
Date
RECORDING REQUESTED BY
____,eIICAGO TITLE' COMPANY
—7%QS WHEN RECORDED MAIL. TO
IrDOSE F. CUEVAS
34-060 REBECA WAY #71
RANCHO MIRAGE, CALIFORNIA 92270
L
Escrow No. 7741225 - F32
N0. 7741225 - SPACE ABOVE THIS UNE FOR RECORDER'S USE
CTC #7204056-K10 `
GRANT DEED
THE UNDERSIGNED GRANTOR(S) DECLARE (S) .
DOCUMENTARY TRANSFER TAXIS' $24.20
❑ unincorporated:areaX❑ Cityof LA QUINTA
X❑ computed on the.full value of the interest or property conveyed, or is
❑ computed on the full valueless the.value of liens or encumbrances remaining at time of sate, and
.FOR A VALUABLE CONSIDERATION; receipt of which is hereby acknowledged,
THE COACHELLA VALLEY HOUSING COALITION, A CALIFORNIA NON-PROFfT PUBLIC BENEFIT
CORPORATION
hereby GRANTS) . to
JOSE F. CUEVAS, A MARRIED MAN AS HIS SOLE AND SEPARATE PROPERTY
the following described real property is the City of LA QUINTA
County of RIVERSIDE , State of California:
LOT 6 BLOCK.67 OF UNIT 6 OF .SANTA CARMELITAAT VALE LA QUINTA AS SHOWN BY MAP RECORDED
IN BOOK 18, PAGE 67 OF MAPS,' RIVERSIDE COUNTY RECORDS.
Dated December 10,. 1997
THE`-COACHELLA VALLEY HOUSING COALITION
A CALIARNIA NOhL-PROFIT PUBLIC BENEFIT
STATEOF CALIFORNIA CUK�
COUNTYOF RIVERSIDE } SS.
On DECEMBER 'Xa , .1997 : before me, BY:
PHYLLIS M. MUNSEY
a Notary Public in and for said County and State, personally appeared
JOHN F. MEALEY
personally known to'.me (or proved. to me on the basis of satisfactory
evidence) to be the person(s) whose nime(s) is/are:subscribed to the
within instrument and acknowledged to me:that he/she/they,executed the
same in his/her/their authorized capaciiy(ies); and that by his/ties/their
signatures) on the instrument the person(s), or the entity upon behalf of
which the persons) acted, executed the instrument.
._MEALEY,'EXECUTIVE DIRECTOR
, i n o„l,,,7, un tn„n,,, a n, n„ , -
PHYLLIS M. MUNSEY -
Q'I Comm. #1067900 Z
Notary Public-Calffomta
Riverside County
Z My Commission Exires�
i Aiiiii'ti illiffu,:
WITNESS my and and official seal. „iru„uf11411
Sig tura of Notary ( Date My Commission Expires FOR NOTARY SEAL'OR STAMP
MAIL TAX STATEMENTS TO PARTY SHOWN ON FOLLOWING. UNE: IF NO- PARTY SO SHOWN, MAIL AS DIRECTED ABOVE
SAME AS ABOVE
Name Street Address City, State &.Zip
GD1--05/30/97bk