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13111 (PLBG)Address 52'311 Ramirez Address Owner Mr. Xrs. George b xl Mailing Address Same City Zip La Quinta, CA 1.92253 Contractor Hendrickson Construction Address 68-31.5 Kieley Road cathedral Citi, IpCA 92234 P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Tel. Inc. 323-1747 &Classif. 5 1112 256104-11E '# 194 Arcn., tngr., Designer Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION R I hereby affirm that I am licensed.under provisions of Chapter 9 (commencing with Section 7000) of Drvision 3 of thhs,Busi es and:Proffeed's ons 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 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 thathe 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, 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.) ❑ 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.) ❑ 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� o Company OWC-opy 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 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 if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. 1 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 applicant— Date Mailing Address City, State, Zip BUILDING: TYPE CONST No. OCC: GRP. A.P. Number Legal Description e Project Description Sever Houk -up 131:11 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 Perm Validated by: Validation: Sq. Ft. Size No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑ Estimated Valuation $2r850.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing J . UU S.M.I. Grading Driveway Enc. Infrastructure TOTAL `7( 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 INSPECTOR Issued by: Date Perm Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ r ^ n 2ND FL. SQ. FT. ® POR. SQ. FT. ® GAR. SO. FT. ® CAR P. I SQ. FT. WALL SQ. FT. ® SQ. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM ' BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM HEATING (FINAL) KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ®c BATH TUB BOND BEAM SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL LUMBER GR. SQ.FT.GAR ® 3/ac HOUSE SEWER FRAMING FINAL INSP. GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS tt SEWER eR-9EPflZ-rA1 K _ OUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ -$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION7-30-423 CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL P10RecOP&RRDRG/STED BY fCHICAGO �fed yAND WHEN RECORDED M WRN�1\NLESS OTHERWISE SHOWN BELO TAX STATEMENTS TO: 0�.y r— THOMAS M & SUSAN TOLES —I NAME M STREET 48-100 Beverly Dr CITY. Palm Desert CA 92260 STATE IZIP TL Order No. Escrow No. P E = N ` v y c m a $ � V A GRANT DEED v� N ocfa 2z id g' d a 1Q PACE ABOVE THIS LINE FOR RECORDER'S USE DOCUMENTARY TRANSFER TAX $ —" ❑ computed on full value of property conveyed, or ❑ computed on full value less liens and encumbrances remaining at time of sale Signature of Declarant or Agent Determining Tax. Firm Name FOR VALUABLE CONSIDERATION, receipt of which is acknowledged, I (We), nnNAT.n T. - MF.NAlm, A SINGLE MAN (name of gemmfsll o es grantto THOMAS M. & SUSAN TOLES, HUSBAND AND WIFE, AS COMMUNITY PROPERTY frame of grantee(s1) all that real property situated in the City of IrA—QUINTA (or in an unincorporated area of) RIVERSIDE County, California, (name of County) described as follows (insert legal description): LOT 15 BLK 82 MB 018/070 SANTA CARMELITA VALE LA QUINTA UNIT 10 ` 21 773262008-7 o Assessor's parcel No. ao y - m a , E Executed on . �u� `6' 19�at - Icily and Stale( A STATE OF CALIFORNIA ~ SS ` COUNTY OF Riverside On this 28tl'bay of January in the year 19-2-2—, before me, Donald T.Mi-harry the undersigned, a Notary Public in and for said State, personally appeared Donald L Meharry personally known (Dine- - (or proved to me dory the basis of satisfactory evidence) to be the person_ whose name= subscribed to the within instrument, and acknowl- edged to me thatkelfe_ executed it. OFFICIAL SEAL ^ ^ PATTI ,E LONG NOTARY PUBLIC - CALIFORNIA WITNESS my hand and official seal.. yt RIVERSIDE COUNTY My comm. expires JUN 14, 1993 Notary Public In, and for said te. (This area for official notarial seal) MAIL TAX STATEMENTS TO Thomas.M .& Susan Toles, 48-100 Beverly Dr, Palm Desert CA 92260 NAME ADDRESS ZIP Before you use this form, read it. till in all blanks, and make whatever changes an appropriate and necessary to your WOLCOTTS FORM 778—Rev. Q-85 (Price class 3) panrcular transaction Consult a lawyer it you doubt the form's fitness lot your purpose and use. Wolcotts makes no GRANT DEED representation or warranty, express or implied. with respect to the merchantability or fitness of this form for an intended use or purpose. ©1985 WOLCOTTS. INC COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL i/ Received From: `�—'Jl '':A– ! �2/ Date: Address: C Q Account No. �' �_^�. _ -SCJ •!J ) . Lot(s) Tract C- a /4f Service Address G.A. Code Meter(s) % c/. $ r c ❑ Backflow(s) ❑ House Laterals) ❑ DetectorCheck(s) ❑ Meter Surcharge . Sanitation Capacity Charge ❑ W.S.B.F.C. t ❑ Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - Fee - ❑ Plan Check Fees Water I Sewer - f Tract - ❑ Bond Payment - A.D. - Bond Assmt. 1 ❑ Customer Deposit ❑ Other is TOTAL Remarks: ' WaterServlce i ..' Cashier CVWD-438 (11/89)