9603-005 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed;.under provisions of
I— Gapter 9 (commencing with Section 7000) of Division 3 of the Business and
c\I W „ Professionals Code, and my License is in full force and effect.
O Z M License # Lic. Class Exp. Date
O Lo n0385-7 13 Iti3Qi�►ti
� Z n Date- �" � Signature of Contractor
O
OWNER -BUILDER DEC ARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ D_ License Law for the following reason:
Z_ ( ) 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 nwnar of the nrnpPrty. sm exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
C0 () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
OC
Q WORKER'S COMPENSATION DECLARATION
C:) Cc Z I hereby affirm under penalty of perjury one of the following declarations:,
r H O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W �= compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
Go Q U ( ) 1 have and will maintain workers' compensation insurance, as, required by
O UQ Section 3700 of the Labor Code, for the performance of the work for which this
0 Z permit is,Issued2Myrwo�kers' compensation insurance.cadi&44061i6y no. are:
Carrier Policy No.
cb Z
r` O
J (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
3 subject to the workers' compensation provisions, of Section_3700 of the Labor
Code, I shall forthwith comply with t ose provlsions� '4 1
Date: ` �`? ApplicantJ f
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 enier•upon
the above-mentioned property for inspection purposes.
.f
Signature (Owner/Agent) rL N ` 47t" jln Date - 1" 5 �+
CONTROL#
BUILDING PERMIT PERM' �
, 003
0
DATE 41Z.af;%){j VALUATION ��,Fy+� } ,9r LOT tri TRACT LI
JOB SITE ADDRESS L-�.8P Ii'a� 100 RAN11 R ° ,
APN 774-Mt—M111
OWNER
CONTRACTOR DESIGNER
:
J 0F., vr L`K-•1 TI t1g♦II
gENGINEER
r Y
Q-:335 WASHIIUv'1't N 0,ij* .
14231 WANIIIttsf:'r'.0 ) NI'. JWi
PALM. MSMU (_"A 14144 1
PALM OFS['U OA 922( O
;61�?13fi{1,t);{i5
(619)iC(1_013+'3
USE OF PERMIT
;�tldi.t.I: t'F�d4i):t.�` lSWI>i.j,lF+lt,i
.
��Yt2���r.�t ttrct �P ci �►sv.cxr 04•
W AtC,WPA!r)O 1 i,UU St'
TRA+"T '0tNTR(Y_"( ION 1,400:0 SF
CVI 1NT. fE'D {'`OST tar CIONSTR[X.I10N
t,t�N!.ifF3{44,`I'(C;jiiFkli
f"'Ll:t''°#`! Pi Aj.. € EE
i iii A(Jiivi_3 I� ISt� I.OI-C}(It4c=i�"�••f}(i�i a�ii.iiii
INN (tA` I-R.tll1`iJR {441
INWCkiANK`iN.LFEW lot:-ilw tit,(u)t0
PLAN ('HEOKFIP _ 3! I EiQf3 I3i)�N IR SS'a
_
t'I �;i��i3u+i�r i f.:'r, iVI•i'}ii <SI(I $I itl.`o
P'11F'e;iS1' PLAN AN •` 3'W
,"`-�'f.'f.3�1(i G�1(ai'(C'i(V 4'l`?i±,- fi#�.`ii'f3 4{ll-��i)'�4.1�{4(3(1 �T►_.moi
° ��tfI31`tYIAtl1(".0N4'IWK., F1QN'.iVND PLAN CHItJa
V3f+.`*;,,2x^r,
t, S!i PR PAID HES
-S-1110.140
/r
0
App
��
19
RECEIPT.
DATE ��
BY
DATE FINALED
INSPECTOR
—4s
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
b
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
// (i
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
4.
Drywall - Int. Lath
Final
final
POOLS - SPAS
CKWAL
A ROVALS
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
(o
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
'Sewer Connection
Encapsulation
'Gas Piping
Gas Test
-
t Appliances
Final
COMMENTS:
�,,�
LAct cD lip �/ 6/ �� fi,-AZ
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole s
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F:I.
Smoke Detectors
Temp. Use of Power
Final Q
Utility Notice (Perm)
RECORDINC3jjE UE F�e.v
UN,11CN ��a � �
AND WHEN RECORDED MAIL THIS DEED AND, UNLESS OTHERWISE
A� SHOWN BELOW, MAIL TAX STATEMENT TO:
. Name Joe W.'Stemmer, Jr,. -
Street 54 425 Ave .' ' Al varado
Address La Quinta,' Ca 92253
y� Crty &
State
Zip
Title Order No. 612477 Escrow No.947448RW
r
T 355 Legal (2-94)
Z
H Q u' - W
® m = U ¢ i�
4C !qj
ti O
t=
a .�V pI . d. s
Q
SPACE ABOVE THIS LINE FOR RECORDER'S USE
Grant Deed
THE UNDERSIGNED GRANTOR(s) DECLARE(s) '
DOCUMENTARY TRANSFER TAX IS $ 36.30
❑ unincorporated area P City of La. Qui nta
Parcel No. 774-301-005 & 006
X computed on full value of interest or property conveyed, or
❑ computed on full value less value of liens or encumbrances remaining at time of sale, and
.FOR. A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
JOHN C. VAN BRUNT, a Single Man
hereby GRANT(S) to
JOE W. STEMMER, JR. and PICKY STEMMER, Husband and Wife as Joint Tenants
the following described real property in the City of La Qui nta
county of Ri versi de state of California:
Lots 19 and •2d in Block 311, SANTA.CARMELITA AT VALE -.LA QUINTA, as per map recorded
in.Book 19 of Maps, pages 59.and 60, in the Office of -the Recorder, of said County.
SITUS: Vacant Land, -Avenida Ramirez, La Quinta, Ca
Dated . Au_gust 30, 1994
STATE OF CALIFORNIA
COUNTY OF / _ } S.S.
On — �J before
me,
a Notary Pbli in nd for Id and St personally eared -
C�. .
personal) nown to me (or proved to me on the basis of satisfactory
evidence) to be the person(s) whose name(s) is/are subscribed to the
within instrument and acknowledged to me that he/she/they, executed
the same in'his/herttheir authorized capacity(es), and that by his(her/their
signature(s) on the instrument the person(s), or the entity upon behalf
of which the person(s) acted, executed the instrument.
WITNESS my'and a ffici F"seal
Signature
JQ& C. Van Brunt
(This area for official notorial seal)
MAIL 1 AA b1 A 1 L VMIN 1 b lU PAK1 Y btlU W N VN FULLU W 1Nli LINE; Lr NU YAK I Y bnU W N, MAIL: Ab U1KkA;'1EU ASU V E
Name Street Address City & State
41
RHEBA WEST '
aQ
Comm. # 985585
NOTARY PUBLIC • CALIFORNIA
y
'`'o"•
Riverside County X
14 CcIfM Expires Feb. 24.1997 -+
(This area for official notorial seal)
MAIL 1 AA b1 A 1 L VMIN 1 b lU PAK1 Y btlU W N VN FULLU W 1Nli LINE; Lr NU YAK I Y bnU W N, MAIL: Ab U1KkA;'1EU ASU V E
Name Street Address City & State
41