0205-252 (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
'I ovn/21
Jt
Date' Signature of Contractoro p ` W
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 fort'....
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 rCode, 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 ST&T>E.FUND Policy No. 124:013.92
(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 provisions.
Date:-', t, �`� � Applicant .:..,...,,,, ''I r
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 Applicatiori 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 ate .
whose request and for whose benefit work is performed under or pursuant tc
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.,) 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.
Signature (Owner/Agent) s_. � Date",=4 '
BUILDING PERMIT PERMIT#
CP�O�v
DATE VALUATION yy��,gg �q /� LOT q TRACT t' } y ( i
JOB SITE�Y A
ADDRESS �nz ., _ °s�_ 1!:i}�sJi A Aom
APN
13k322v0.14
OWNER
CONTRACTOR/DESIGNER/EN INEER
HAI
}'. i��e1`��t',�'t�SiTy..f�.•tf.�" t2�fC?�tN,
�s1'.1.,°.i�JR
M 7N'
1?O.0. OX 1251
aSY:��t"�.UCT1014
J4S'�80 AVJ.'i�, �1�.1T•rr1:T.['�DO
L-A Qt7.I1!'s A CA 92253
Lk QUINTA (,,A 92253
(760).564-4844 C.ri31lf3 196,
USE OF PERMIT
SFD - PEIMIT ",. OX3 NOT INCLUCIIE T!ItkICK i,VAL.LS, PCXOX; OR SIA, OR
DRIVEWAY APPROACH,
TILACT C 01-45TRUCT:1C+'14 1,$49.00 Ift
F^ORC H!lI.I? TIQ 19$.110 sig
,
GAMI1UCARPORT 461,00 SF
EMMA= COST € F d"ONST.' UC;': 10.11
� •��
XR.Aff : Y1"W STJAOrlal Y
C ONSTR.UCTIaN P:GF 101.000-418.000
plI AtY CHEWK VVE 103.000-439-311
FFE W -,POSIT 101-000-439-318 -$29,00
1MYCHANIC:.AL PEE 101-000-421-000 $60.00
ILFICTRIC AL FEIM .101.0,00-420-000 $111.90
P1.1um'BIND FE -F 101-000.410-000 X195.00
..
S'1'RON101 MOTION FEE AESID 101,000-M-000 $9.36
ORADYNO PXF 101 $20100
DR°`VELMIAd PACTtFE $1190M
PRECISE T'';A14 101 A000.441 "34S 5ti0f3.0�+
:T AND PLAIT' (41-MC.Ita,
a=il i!
$3,501,31
....... 1h;� ��.�?t����a
.�;�,I
JUL PERIA-17C FETES DVYT� HOW
CITY OF iLAQUINTA
3
FINANCE DEQ
RECEIPT
DA,,1TE- .:=
BY
DATE kINALED
INSPECTOR
s}
{
�N
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
/1f UZ
Underground Ducts
Forms & footings
�Z_
Ducts
Slab Grade
�/2_
Return Air
Steel
Combustion Air
Roof Deck
- v
Exhaust Fans
O.K. to Wrap
0
F.A.U.
Framing
_ %(� �/
Compressor
Insulation
rf
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
,��j
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
C( l
Pool Cover
Encapsulation
Sewer Connectionu �C, `� �-1 t
Gas Piping
Gas Test_
U
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole 7 s 6Y
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power O 2
Final Z�
Utility Notice (Perm)
C45rtific*ate- of. Occupancy-�
o 0
i►
City/ of La Qui - ta
Building'and'SafetyDepartment,�oti°
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: 52-755 AVENIDA RAMIREZ
Use Classification: SFD Bldg. Permit No.: 0205-252
Occupancy Group: R3 Type of Construction: VNLand Use Zone: RC
Owner of Building: EAST VALLEY CONST Address: 54-880 AVE ALVARADO
City: LA QUINTA CA 92253
By: KIRK KIRKLAND
Date: 12-13-02
Building Official
POST IN A CONSPICUOUS PLACE
CERTIFICATE OF COMPLIANCE �FT�Sc
Desert Sands Unified School District
47950 Dune Palms Road �q
Q BERMUDA DUNES r
Date 7/16/02 La Quinta, CA 92253 rn RANCHO MIRAGE
No. 23383 760 771-8515. �� INDIAN DESERT
ti
/ 1 WELLS
PALM DESERT �
/ t5? LAQUINTAy
�`e(Q O 1P
Owner
Don Hamilton
APN # 773-322-014&5
Address
PO Box 1281
Jurisdiction La Quinta
City
La Quinta Zip 92253
Permit #
Tract #
B157U16
Study Area
Type
Single Family Residence
No. of Units 2
Lot # No. Street S.F.
Lot # No. Street S.F.
Unit 1 1
52755 Avenida Ramirez 1548
Unit 6
Unit 2 2
52775 Avenida Ramierz 1687
Unit 7
Unit 3
Unit 8
Unit 4
Unit 9
Unit 5
Unit 10
ry
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 50
square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile home
It has been determined that 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
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14 X 3,235 S.F. or $6,922.90 have been paid for 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 CC 1 st Bank - Terry Hamilton Check No. 65131
ame on e c IER Telephone 760/564-4844
Funding Residential
By Dr.- Doris Wilson
.Superintendent
Fee collected /exempted by Crystal Scott $6,922.90
Payment Recd Over/Under
Signature (�
3
NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 issued, or from the date on which thos
amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.'
NOTICE: This Document NOT VALID if Duplicated
Embossed Original- Building Department/Applicant Copy -Applicant/Receipt Copy -Accounting
i
RECORDING REQUESTED BY:
`Aelity National Title Company
row No. 44202 -CB
Title Order No.
When Recorded Mail Document
and Tax Statement To:
Mr. and Mrs. Donald Hamilton
P.O. Box 1281
La Quints, CA 92253
_b GRANT DEED SPACE Aaove i his LIM rUH HtA.;UHutH_s Ust
The undersigned grantor(s) declare(s)
Documentary transfer tax is $68.20 .
[ X ] computed on full value of property conveyed, or
{ ] computed on full value less value of liens or encumbrances remaining at time of sale,
[ ] -Unincorporated Area City of La Quints
FOR A VALUABLE CONSIDERATION, receipt of which.is hereby acknowledged; Denise P. Melas, A Married
Woman as Sole and Separate Property, and Shandra Pickering, A Single Woman
hereby GRANT(S) to Donald Hamilton and Terry Hamilton, Husband and Wife as Joint Tenants
the following described real property in the City of La Quints
County of Riverside, State of California:
Lots 1 and 2, Block 157jof Santa Carmelita at Vale La Quinta, Unit #16, as per map recorded in Book 18, Page 99
of Maps, in the Office of the County Recorder of said County.
DATED: March 25, 2002
STATE OF CALIFORNI—
i
COUNTY OF L V v'1 C e 1 e S
ON LIZ lV L before me, Denise P. Melas
C% I-1 e S L e'c k. 5 oia Z.�: ��s J` ' personally appeared
C% S
Shandra Pickering
pefsan Hy-ktjewn-to-rrre (or proved to me on the basis
of satisfactory evidence) to be the person($) whose
nameare subscribed to the within instrument and
acknowledged to me that -kre"they executed the
same in.1* 0e /their authorized capacity(ies), and that
by -his "heir signaturetA on the instrument the
person(M•, or the entity upon behalf of which the. .GAMES LECK STOLTZFUS AL
personW acted, executed the instrument.
COmmisscttl # 122)597
Notaay Public - California
LOS Mg ales'COuniy
Witness my hand and official seal. MyC=m.Er-ir-s ay25,?D03
Signature C',
MAIL TAX STATEMENTS AS DIRECTED ABOVE
FD -213 (Rev 7/96) GRANT DEED