9603-101 (MISC)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
Date - Signature of Contractor
OWNER -BUILDER DECLARATION
1 -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 intehded.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 & 'Prof essionals
Code).
O 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, forthe
performance of the work for which this permit is issued. r
( ) 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' compensation provisions of'Sectioh 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
the above-mentioned property for inspection purposes.
Signature (Owner/,Age�n j _ d Date �'`,•��
BUILDING PERMIT PERMIT" - °°NTR°`# -
-�Q 3006
DATE VALUATION LOT .. TRACT
Y.24196��.f►i1 . .
JOB SITE
ADDRESS 78-56.5 SA' GIL0�.USH,
APN
646-311-006
OWNER
CONTRACTOR / DESIGNER / ENGINEER
MARY K'.3
7M5 SAt"YEBRUS.ii .AVE
LA QUI.NTA f,"A 92253
(� �
Cb aft...
USE OF PERMIT
.ANF'OUS
MISCELLANEOUS
SPE.CfA1; 1NSFECT..10'N
EI`.IMI. . k;0 COST or CHaC:'STIEtUCI'ION
0.00
PPAiiIFY ti'CE'N't.J;t\TMtlKY
NII .Curt;frAlT33,NJS 10-000.4` 1.000 !3f:(lf1,t10
SCTS-T(?'1A1. CfJtVs'1';E UC"1"1ON AI41,f1 PLAN CHECK
$100.00
PRE IS
`f`tl1., i9�;$.�iiI'' FE Fes` i) :U {VO'`1iifl.ditl
.
RECEIPT
DATE
13Y
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION I DATE I INSPECTOR
BUILDING APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
OX to Wrap
Framing
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wail Firewall
Exterior Lath
r)niwall _ Int I afh
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
ruw�
COMMENTS:
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)
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
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
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
ruw�
COMMENTS:
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)
787495 CALLE TAMPICO — LA DUINTA, CALIFORNIA 92253 - (619) 777-7000
FAX, (619) 777-7101
f
March 15, 1996
To Whom It May Concern:
On the above date a special inspection was conducted at 7 8-5 65 Sagebrush Avenue in
La Quinta to determine the condition of a third bedroom that was added after the
structure was 6naled by the County, and without a subsequent permit. The bedroom
was created by constructing an interior non-bearing wall on the east end of the living.
room between the two original bedrooms. The resulting room complies vv_th the
Building Code in effect at the time the house was built with one exception; bars have
been installed on the exterior of the window and cannot be released from the inside '
to allow emergency egress. Any bars or grates installed over windows of rooms that
are used for sleeping purposes must be able to be opened from the inside without
the use of a key, tool or special _ knowledge.
Please feel free to contact me if you have any questions regarding this matter.
Sincerely,
Tom Hartung }
Director of Building and Safety • -
MAILING ADDRESS - P.O; BOX 1504 LA QUINTA, CALIFORNIA. 92253 ;
Qu&M
u �
b OF THt
June 3, 1998
Riverside County Assessor's Office
3255 E. Tahquitz Canyon Way Rm 114 .
Palm Springs CA 92262
Re: APN# 646 311006'
Dear Assessor:
. Please -be advised that the structure located at the above mentioned parcel has been altered and now `
contains three bedrooms as opposed to the two which is currently reflected in your reco'r& Thank you for Y'
your attention in this matter.
Sincerely,
Tom Hartung, Director and uilding and Safety
Attachments
c Kate Kelly
4 _
e
M E T R O S C A N PROPER T Y P R OF I L E_
Riverside (CA)
*
<<< OWNERSHIP
INFORMATION >>>
*
_____________________
*
*
Parcel Number :646"311 006
S: T: R: Q:
*
Ref Parcel #
:000 000 000
Pos Interest:
*'
Owner Name
:Kelly Mary Kate
*
COOwner
*
Site Address
:78565 Sagebrush
Ave La Quinta 92253
*
-Mail Address
:78565 Sagebrush
Ave La Quinta Ca 92253
*
'Telephone
:Owner:
Tenant:
*
«< SALES AND
LOAN INFORMATION >>>
*
Transferred':06/01/89
Loan Amount
*
Document #
:183350
Lender
*
Sale Price
Loan Type
*
Deed Type
:Grant"Deed
Interest Rate
*
$`Owned
Vesting Type
*
*
*
______
*
<<< ASSESSMENT AND TAX INFORMATION'>>>
*
*
*
Land
:$17,281
Exempt Type :Homeowners
*.
*
Structure
:$77,196
Exempt Amount :$7,000
*
Other
Tax.Rate Area :20-042
*
Total
:$94,477
Taxes :$1,152.76
*
% Improved .:82
*
<<< PROPERTY DESCRIPTION >>>
*
*
*
Map Grid :849
GS
*
Census :Tract:451.04
Block:4
*
Land Use :RO1
Res,Singl'e Family
Residences
*
Legal .:LOT
,6 MB 022/053 DESERT
CLUB MANOR
*
:TR
1
*
Sub/Plat.:Desert
Club Manor Tr
1
*
Book :22
Page:53
*
<<< PROPERTY
CHARACTERISTICS >>>
*
Bedrooms :2
Stories :1
YearBuilt:1.979 AgPreserve
*
BathFull :2
Units
MiscImprv:No
*
Bath3Qtr
Bldg SgFt:1,222
Street :Paved ADDITIO11AL
*
BathHalf
Gar SgFt :400
Waterfrnt:
*.
*
Fireplce :Yes
Gar Type :Attached
Elect Svc:Developed RmAddtns .:No
*-
*
Cntrl Ht :Yes
Lot Acres:.13
Gas Svc :Developed RmAddSF
*
Cntr1A/C :Yes
Lot SgFt :.5,662
WaterSrce:Developed AddGarType
Pool :Yes
Roof Type:Tile
SewerType:None OthrPknq
The
Information Provided Is
Deemed Reliable, But Is Not Guaranteed.
C'7y
0P d A 11,TA
NAY 19 REC`,
May 17, 1998�R-.�`,�
Mary Kate Kelly
78565 Sagebrush Avenue
La Quinta, CA. -92253
Mr. Tom Hartung
Building and Safety
City of LaQuinta
784.95 Calle Tampico
- La Quinta, CA. 92253 _
Dear Tom:
Sometime ago I was in the process of selling my house and when .
the Property Profile was printed, I noted my home was listed as a
two bedroom when in fact it was three. We discussed it, and I
was advised because a building permit was not made for the
erection of the wall the city had no way of knowing without the
permit and it was that permit that then changed the profile.
(This is my best recollection, if this is in inaccurate please
advise.) Additionally, I was informed if I was willing to come
into the city and pay $100.00 for the change,'you would then
institute the change after the fact to correct the profile to
read a three bedroom vs. a two bedroom. Within a week after this
discussion I came into the City of La Quinta, paid the fee, and
expected the change to take place.
Recently I again obtained a profile of my home only to find the
house is again printed as a two bedroom. Can you guide me in how
to get this thing to read correctly?
Please advise me on how to proceed. I can be reached.at
(760)564-0291. Thank.you in advance.for your assistance'in this
matter.