9806-159 (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
j it*,U d l5
,/Date 34--9 Signature of Contractor
OWNER -BUILDER
I hereby affirm under penalty of perjuethal I am exempt from the Contractor's
License Law for the following reason
( ) I, as owner of the property//o y employees with wages as their sole
compensation, will do the work, a d 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.
(,X) 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 Policy No.
(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' compensatio p ovisionsoof-Secti6r 3%r0 f-tt a Labor
Code,_1 ha I forthwi h comply with ho p" r"�o ision
/Date: ` Applicant
Warning: Failure to secure W,or rs' Compensation cov rage is unlawful and
shall subject an employer to cr' final penalties and civil fines up to $100,000, in
addition to the cost of cdmpsation, damages as provided for in Section 3706
of the Labor Code, intVst and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to'
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of -this City to enter upon
the above-mentioned property for'i spection purpo ss,
Signature (Owner/Agent). / Date
BUILDINGPERMIT PERMIT# CONTROL#
DATE VALUATION LOT TRACT
yr �1i7.791.f1$) 1 � X003
JOB SITE
APN
ADDRESS 5x 425 AVIINf A .fieA11`H1bVZ�
774-6 i ,. .;
OWNER
CONTRACTOR / DESIGNER / ENGINEER
9 1
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USE OF PERMIT
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PIWICISIF, PLAN 10149)0-4 1-'14:�
Y[ f'rc.POSIT 101_,91011411_= 18 _V50.09
,,O
11 'i'f tit', t. C'f1Pv4"1`fif !C'`I'fi' M ANI? PIAN t't1) t`
a rX
,` Ga LESS ITT, VA11)ILlS
`ilill) R'tf
JUL 3 0 1998 °r<)VAI 0'1?1$.1 1 ° slFPS WIFN(?W
S.£,fFatlla fi
�IE Y OF— 9 p un I
;RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
! L
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_
Underground Ducts
Forms & Footings
A
Ducts
Slab Grade Y �
Return Air
SteelCombustion
Air
Roof Deck
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 Wali Firewall
Exterior Lath
Drywall - Int. Lathr
Final
��16 s
Final
_
((
POOLS -SPAS
BLOCKWALL AP ROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lin
�Zj
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K forFinish Plaster
Sewer Lateral �j1�0
1
Pool Cover
Sewer Connection
v/�7�
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL'AP(((PROVALS
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
c
Final
711
Utility Notice (Perm)
l�G
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Date 7/30/98 APN # -,14-081-015'
No. .17414 Jurisdiction La Quinta
,Owner NameWorld Development, Inc. - Pernit #
No. 53-325 Street Avenida Ramirez `
City La Quinta zip 92253
Tract # Lot # Square Footage
Type of Development Single Family Residence
Comments
Log #
Study Area
1,375
No. of Units 1
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 An && amount of
1.93 X 1,375 or $ 2,653.75 the property listed above and that building v r.
permits and/or Certificates of Occupancy for this square footage in this proposed proRect may now Wiissued
Fees Paid By CC/1st Community Bank/World Development, Inc. �TPgephonty` 771-5571
'n y.�s
Name -on the check ti
-<
By Dr. Doris Wilsons
Superintendent
Fee collected/exempted by Juanita Green Payment Received $2,653.75
Check No. 081176
Signature
INOTICE: Pursuant of #e6embly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may prote_ t the fees or other payment identified
above will begin to run Iforn 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 District('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
/
FROM PHONE NO. 7715070 Jun. 18 1998 04:08PM P2
=" Fidelity National Title. Corripany
72525 Fred War'rn;r Drive ;uirr, 204 ' I'dtrn Desert, CA' 92260
3obna02 • FAk't%GOl 341-707F -
SALE ESCROW INSTRUCTIONS
(Lot
ElloCk
223 Date: June 4, 1998
Escrow No.: 1591 -ST
Escrow Officer:. Shirley Thompson.
Guyer will execute and deliver a new Loan
_ in the amount of . .. ............... ......... ....... ... s 11.700.00
Prior'to the close of escrow, Buyer will hand you the balance'of down payment.
plus closing costs, the sum of ....... I............... :............ $ 800.00
TOTAL CONSIDERATION::.. _ .............. ............. s 12,500.00
AND, on or before , Escrow Holder will be handed additional funds and/or instruments required to
enable Escrow Holder to comply with these instructions, which Escrow Holder is instructed to use when
in a position to procure/issue a Joint Protection Policy coverage forst Policy Of. Title Insurance from;
Fidelity National Title with a liability of 812,500:00, covering the following described property located ..
in the City of La Quinta, County of Riverside, State of California:
Lot 4, in Block 223 of Santa Carmelita at Vale La Quinta, Unit 21, as shown by Map on file in.Book 20 3
Page 22 of Maps, Records of Riverside County California. f ��
SELLERITRANSFEROR STATES THAT PROPERTY ADDRESS IS: h✓
Vacant L3nd1AP�IN:.'
ta, CA 92253p
SHOWING TITLE V7��f -' �d �� Lai
World Development, Inc., a California Corporation
FREE FROM ENCUMBRANCES EXCEPT:
t. Current general andspecialtaxes for the fiscal year in which this escrow clunes, and tuts for the
ensuing year; if any, a lien not yet due and payable;
2. The lien of supplemental taxes, if any, assessed pursuant to the provisions of Chapter, 3.5 '
(commencing with Section 75) of the Revenue and Taxation Code of the State of California;
3.. •Bonds and Assessments with no delinquent payments, if any;
4. Covenants. conditions restrictions, reservations, easements and rights of way now of retort!, if
any:
5. A First Deed of Trust, to record, securing a note in the amount of t 11.700.00 in favor of Robert
C. Hansen and Marilyn J. Hansen, Trustees of the Hansen Living Trust dated June 19, 1989 as to
an Undivided One Half Interest and Hubert W. Hansen and Anna Marie Hansen, Trustees of the
Hansen Living Trust dated August 11: 1976 as to an Undivided One Half Interest as Tenants in
Common.
PRQRATIONS:
Prorate as of Close of Escrow, on the basis of a 30 day month: -
Takes 1
CONSUMMATION of this escrow is CONTINGENT UPON THE FOLLOWING:
1. NEW LOAN: Buyer to execute a new First Trust Deed and Note, t0 record on your usual form,
dated during escrow, in the amount of 511,700.00,'in favor of Robert C. Hansen and Marilyn J.-'
Hanson; Trustees and Hubert W. Hansen and Anna Marie Hansen Trustees the,'OR ORDER, payable
at the place as designated by Golder hereof, at Use rate of no interest due, at which• time the
remaining unpaid principal balance will be all due and payable 2 years from the close of this
escrow.
Cscrow Holder is authorized and instructed to insert the appropriate maturity date On the face of "
the Note, over and above the signature of the Buyer,- at close of escrow without further approval
from the parties herein.
2- Escrow Holder is relieved of any and all liability and/or responsibility with respect to the terms and
Conditions of said Note and Deed of Trust including, but not limited to, the validity, sufficiency,