9709-029 (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
:1';,;;_u i 7,.31,/9t:
/Date 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).
( ) 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 S'6 I-LL�bI' Policy No. I Vft— 1-96
(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
PSubject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: Applicant
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
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
Ae above-mentioned property for inspection purposes.
Signature (Owner/Agent)
Date
BUILDINGPERMIT PERMIT#°NTR°`"
PI
DATE VALUATION ' SWI. 02,00 LOT 1f) TRACT I'At�
JOB SITE 51-445 A-ATNI8>;% RAM IR J,
APN 77341,82,022
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
PAVU-1t ROSS N IE. LE12
P:1.C1E?
1719 S'I`RE'N101%rJ'
P.O. Llk) '12"
S OCE A�+iS1EJl�, t� A 9jW54
LA Q HNTA CA 92253
(.614.1564-0 773 IfM
USE OF PERMIT
SF.0
SJ --U -1.1Is1tm-1 t.' !)Ub.a NO 111*A.vOL, bl.t, CK WALLS Lilt "JIL.
'1 A"v�: T t;i:YINS `Ri)i- TION L,140.w;SF
PO RCIN'A:110 42.00 3
cJrAleAQhJt:rifaP£?±t'.l 4aff3.0 ISF
EYf MIATED COST OF
Prfl: IJIMT ITE ;slitdlCMARV
a,'ON.40'f'ttl"ICITIONhEi 101400-11st-C3(l() `381.("),
PLAN (,l`1FCVZ F $491,69
iq-3: DEPOSIT
FLh+"E'R1CAJL. FFE 101_000-V04100 $122.$1
f f.i►Mtit"0.ts bid !�t.-(N)1 a.9'? (3(H) $1 Zi
ti'I'Iie.:►TJti (vlUt';ON f'I L: ••.i is?:):f? 101-0.010-11.:ll-d)t�D U,69
k1RALi4 iN 0 i'LE: 101.-Gtr)-423-i.it,'�1 :'20.06
t:t+1F^itAST'RIX7FW F E n5-i1m-443 342
r
'0
�i111'r'±Y)'7'A), C.'t iiVS"E Iti.Jt" 'it lR AND V!.AN ('141"Cit.
-PA rr'1t'1".1'111
If
?p_SD
10 10M Alli, P-E.R14#Vf F FES WE NOW
$3,124.19 ;
C�
RECEIPT -,,.,'6
'DATE
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 ko /
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
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping f
PLUMBING APPRPVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping VV V
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Stans
O.K for Finish Plaster
ewer Lateral
Pool Cover
Sewer Connection
Encapsulation
as Test
'Apces
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:
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
Date.
.: 7
i Received From: �
`
1
C ✓
'
�:
FAddress:
F Account No. d ^ G
(s)
Tract
Service Address : ¢� f •
G.A. Code
Meters)
'
Service(s)
❑ Backflow(s)
• ❑ House Lateral(s)
E ❑ Detector Check(s)-
.0 Meter Surcharge
Sanitation Capacity. Charge
❑ W.S.B.F.C.
❑ Temporary Construction Meter
1_
❑ Turn on Charge
❑ Uncollected Account : Name
0 Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water Y Sewer -.
Tract _
f❑ Bond Payment - A.D. - Bond
iAssmt.
❑ Customer Deposit
❑ Other
�Ud
,..
i
TOTAL
$ •��,�
j Remarks:
❑ Copy to:
Water Service
I
Cash
I:
Check
Cashier
Money
Order
CVWD-438(11188)
Desert*Sands Unified School District
82 879 H` I." A111
Notice: ig way. -_
Document Cannot Be°Duplicated Indio, _CA 92201: -
619m-775-356
CERTIFICATE OF COMPLIANCE
Date 10/10/97APN # 773-082-022
No. 16157 Jurisdiction . La Quinta
Owner NameDavid Ross Miller Permit #
No.'51-445 "Street .Avenida Ramirez .
City LaQuints , lip `922537
Tract # Lot # Square Footage
Type of Development Single Family Residence.
Comments
Log #
Study Area
1410.
No. of Units 1
At the present time, the Desert Sands Unified. <School•District do.es.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,froin paying school fees at this time due to the following
reason:
EXEMPTION NOT! APPLIC"LE
This certifies that school facility fees ifrtposed,pursiiant to Government Code 53080 in the amount of
1.84. X ' 1,410 or $ 2;594.40 the pe perty'listed'above and that building
permits and/or Certificate's of.Occupancy for this square footage in thisproposed project. may now be issued
Fees Paid By C C/Capital Bank of North County/Mil er - Telephone 564-0273
Name.on .the'check _
By Dr: Doris Wilson ^%
Superintendent
Fee collected /exemptedI.iy Pauline, Pearson .--P aynienVR66*eiV.ed $2,594.40
Check No:, 050120
Signature 11' AA
40TICE: Pursuant of Assembly Bill 3081 (CHAP 549 STATS 1996) this will serve to notify you,lhat the 90-day.appro4al period in whichyou niay protest the fees or other payment identified
above will begin to run from the date dA'which the building or installation permit for this,project is sssued on on which.they are paid to the District(s) or to another public entity authorized to
.,,act them on the District('s)(s) behalf, whichever,is earlier. '
r*�
Collector: Attach a copy.of county or city plan check application form.to=district copy"for all waivers.
Embossed Original-'Buildmg Dept./Applicant Copy - Applicant/Receipt . Copy - Accounting
THIS DOCUMENT WILL AFFECT YOUR ,.LEGAL RIGHTS -READ. IT CAREFULLY'.
TO: .COMMONWEALTH LAND TITLE COMPANY Escrow -No.: 97.6870KC
72855 Fred Waring.Dr ~,,.Date; 09/05/97
Suite A5 Page: 1
Palm Desert, CA 92260.
(760) 836-3726
Escrow Officer: Kelly'Collier
THE ESCROW HOLDER IS. COMMONWEALTH LAND TITLE COMPANY WHICH IS LICENSED
BY THE CALIFORNIA DEPARTMENT. OF INSURANCE. A
Buyer, or his agent, -will hand..you or cause'.to be handed you.upon signing of
these instructions a deposit in,the amount of .................... ..........$ 1,000.00
Buyer will hand you additional funds prior to closing in the amount-'of..........$MINIMUM
Proceeds from loan to be procured by -Buyer (First`Trust Deed)...................$FHA MAX
TOTAL CONSIDERATION $ 116,500.00
and any additional funds and instruments reqquired from me to enable.•you to comply..with these
instructions;�which you are.to use on or before .December 29,. 1997:, and when OLD REPUBLIC TITLE
COMPANY can issue a Standard Policy.of Title,Insurance.Owners form, with liability of
$116,500:00, on real. property`.in.City of LA:QUINTA; County of Riverside; State of CALIFORNIA
viz:
Commonly known as: AVENIDk RAMIREZ,'LA QUINTA, CALIFORNIA
LOT 10 OF BLOCK 67,SANT-X.CARMELITA AT VALE -tA QUINTA, .UNIT'N6' 6,• AS PER MAP
RECORDED IN BOOK.18, PAGE 67 OF MAPS, RECORDS OF.RIVERSIDE COUNTY, CALIFORNIA
Except any reservations of record of minerals, oil, gas, water,. carbons -and hydrocarbons.
Showing title vested in
AL CONLEE and LEAH CONLEE husband and wife
Free from.encumbrance except:
A. Current genera Vand speci aa. for..the fiscal year: in, which this escrow closes, and
.taxes for the ensuing year, if.any, a lien not yet due or..payable.
B. The lien of supplemental taxes, if. anyy, assessed pursuant to -the provisions of Chapter
3.5 (commencing with -.Section 75)'�of the Revenue and Taxation Code of the State of
California.
C. Special improvement assessments, if any.
D. Easements, rights, rights of:way,::covenants, conditions, restrictions and reservations of
record.
E.. Deed of Trust to record in the amount of amount to be determined, in favor of lender to
be determined:.
}
3. 1
_•ABOVE -APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON -UTILITIES OR OCCUPY BUILDING �-