9612-040 (SFD)LICENSED CONTRACTOR DECLARATION
I herebypffirm under penalty of perjury that I am licensed under provisions of
:,�napter 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
'bate Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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 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.
(,') 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 Section 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/Agent) Date
CONTROL#
BUILDING PERMIT PERMIT9612
0441
4522
DATE ►Puff!p o{ VALUATION ',.+`66,420+ 0 LOT TRACTJOB
SITE
ADDRESS'1_'7(1Ff4:,i�i)Ti.r►�f%1�i'..li'..4
APN 646-i•4(►�vii
OWNER
CONTRACTOR / DESIGNER / ENGINEER
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RECEIPT
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CITY OF LA QUINTA
BUILDINC-a-& SAFETY DEPAR DEPARTMENT
OF LA -Q NTA777-701 1 2
W S"PECTION REQUEST LINE
DEC 1.9 1996 777-7153
Owner SHERIAN G HORNBEAK
APISTRANO DEV.
9612-040
Permit Number
PLACE
POST 014 11101el 1 11. CONSPICUOUS
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 48-700 SAN DIMAS STREET
SFD - PERMIT DOES NOT INCLUDE
INCLUDE BLOCK WALL OR POOL
TYPE OF INSPECTION DATE f INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING 3
PRE-GUNITE.
DO NOT POUR CONCRETE UNTIL ALL AB V AS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS I
ELECT AL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL BO HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT - A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT 0 4' 0 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE S B N SIGPX
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER.
POOL FENCE & GATE
-SEIVEfl SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
Notice:
Document Cannot Be Duplicated
Date 12/11/96
No. 15073
Owner Name Grant Hornbeak
No. 48700
City La Quinta
Tract #
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Street San Dimas
Lot #
Jurisdiction
APN # 646-140-023
La Quinta
Permit #
Log # '
Zip 92253 Study Area 109
Square Footage 3124
Type of Development Single Family Residence No. of Units 1
Comments
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 in the amount of
t
1.84 X 3,124 or $ 5,748.16 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
'r
Fees Paid By cc/First Bank/Grant Hornbeak Telephone'
Name on the check ^
By Dr. Carol McGrew '� y
1
Administrator in Charge
Fee collected /exempted by Pauline Pearson Payment Received $5,748.16
Check No. 37029
Signature �9e_Ju 11� ��',&_AA Z'Vk-
40TICE: Effective January 1, 1997, Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or
Mar payment identified above will begin to run from 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
intily 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
• 't�,, •t *r may' � I� h .r
12-19-1996 4 : 0PH FPOH F I RSTRANK R PALH G"I 9 56,&"1 $45 P. 'I
tr
RECORDING REQUES rCl,) BY' ( �•�
RC.CENED FOR RECORD
,AT 2.00 0" LOC
When Recorded Mail IDocurnem
and Tax Statement 1'o:
FIRSTBANR, N.A. _
r Doc ra',)Sfer Tax NOV 2 2 1996 -.
FitiAf'f; r, ��,° e-
73-000 HIGHWAY 11] 0,`N4 , CO. Recartje( Reeorownowc�riuro� �"�
PALM DESERT, CA 92260 f dartia.Co,,iarwne 1
f Rosc�vw, �
Title Order No: --_� -- — SPACE. ABOVE THIS LINE rrO�.RECgRDER'S USE
APN: 646-140-023—+r ...� ----
T 613.41 � r 'DEED
rhe Unde-rsigned gra--itor(s) dreclarr3isi
Documentary transfer tax is $U __ City tax s
x I computed on full vaiue of property conveyed, or
i I computed on lull value less value of mens or erncumbrances remau1lnc� a: Lrne of sale,
1,nincorporawd A;ea City t-+
FOR A VALUABLE CONSIDERATION, receipt of whtch is hereby aQknowledged,
.101(hl R— BRADLEY ANDt EILEEN BRADLEY, HU$8AKA ,AND WIFF; AS. J'OIN`r T'ENAN'TS t
hereby GRANT(S) to SHEI IAN ,C- IiOR BEAK, 'A MARRIED WORAI3' Y
the iullowing described real proNerty,in tht, City of 6A QUIN'YA
Covin• of RIVERSTI)}; State of ca ifornia:
LU`r 28 OF LA QUINTA COLF .ESTATE LJ'!IT N0. I, AS SHOWN BY MAI' ON FILE: IN
5 BOOK 37 PAGES 96, 97 AND 98. OF MAPS, kECORDS OF SAID CO(TN-."-
f • r
DATED: _ NOVMER 19, 1996
STATE OF CALIFORNIAJIIN
COUNTY UE R1'V'ERS7U�'E �7-
ON __ iI4 ER 20. X446 before rile,
J'OY ANN .MOSS _ _ personally appeared E
FI? .F.F*1 BRADLEY
JOHN R. 13WLEY AND EILEEA BRADL' t'
(or Proved to me -on the
basis of satisfactory evidence) to be the personts)
whose name(s) Ware subscribed to the vvithin JOyANNP7105S
'.. COMbt. 106896 2;instrument and ackno viedaed to me that ;they _ -�q��11 '__ NotoryPubeC CCOO( la r -
executed the same in (, !their authorized = -.p PVF,S COUNTY
capacity(ies), and that by i /their signature(s) on MyComm•Es�usJUN21•t949
the instrument the person(s), or the entity upon
behalf of which the persomts) acted, executed the � r` _,;
instrument, y I
°5
Witness my hand and offinia! seal. 1
.Signature U-✓ _- -��
i
MAIL TAX STATEMENT AS DIRECTED ABOVE
PD -13 (Rev 4/94) ISP•ANT DEED
i
• i r
La Quinta Go fEstates
Community Association
P.O. Box 162
La Quinta, Ca 92253.
619/564-2177
December 4, 1996
Planning Department
CITY OF LA QUINTA
P. 0. Box 1504
La Quinta CA 92253
RE: Lots No. 28 & 29
La Quinta Golf Estates
Gentlemen:
The Architectural Committe of the La Quinta Golf Estates Community Association
has reviewed the proposed plans for construction of residences on Lots No. -28
and 29 submitted by Rancho Capistrano Development Company..
The plans comply with guidelines established by the Association and are,
therefore, approved as presented.
Yours truly,
TOM KENNEDY —
Chairman
Architectural Committee
. s .
C Ty CF LP n.UINTA
LJAN 14 REC'® JON TAN DY
®a oee �eue�r 3580 Condalia Ave.
WL' 6AYL b&a Valley, CA 92284
(619) 365-5045
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE TRUCT. STEEL ASSEMBLY ❑
❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB C N O ` n /^� ! l `1.��
rdI�
AW V
REPORT SEOUENCE NO.
T� F: STRUCTURE � � •-m � �
PERMIT NO.
DATE
Di TE
DAV OF WEEK
MATE RI L DERIPyI ON
J(C,
ARCHITECT
INSPECTOR
HRS. CHARGED
ENGINEER
ASSISTANTS -
HRS. CHARGED
SUB
INSPECTION GENERAL n , `_, , , � � tpu —, gt4, O CONTRACTOR � s• �(.���
DATE CONTRACTOR µ(yL('}fJ ,GC [�
1-l0- 1
6.S0ZtG- .S . lP- t�l�� EN D A -S Pi Ef4T .
Go cJ N e L i (o tj wT,2- j e� f,�✓ d� xot6
-mac.. u> t a• �'— �P'C_.._ Gaol � .
tx� ZC_ ) �p
COPY SENT TO CLIE 'J
CONTINUED ON NEXT PAGE ❑
PAGE OF
CERTIFICATION OF COMPLIANCE
IHEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. 1 HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS, SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
oGOVERNING BUILDING LAWS.
�A
/SIGNATURE OF REGISTER EOCT� 6�qIzz ^�®
DATE OF REPORT REGISTER NUMBER r®