0001-212 (SFD)LICENSED CONTRACTOR DECLARATION
,eby affirm 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 CSde, and my License is in full force and effect.
_ieen'�a # Lic. Class Exp. Date
Date. 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:
( ) 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).
( ) 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.
( ,) 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--:',,
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE jfj
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
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RECEIPT
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Building QJ7W S�A�
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Owner
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P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Address Da f U v C4461,6 N O 12. i
City ZipTel.
LAQvi,..iV Ir4 _ 92253
Contractor
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State Lic.
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Lic. # �s7
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Lic. #3s,rj009,
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) df Division 3 of the Busine�ss.�aand Professions Code, and my license is in full force and
effect._ ' �+FSii' _ _ , y 1 l A _- ),
OWNER -BUILDER DECLARATION f
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5, Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to 'its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (5500).
I7 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
I 11. as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
1 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -Insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
n Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is lot one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg 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.
Date Owner
NOTICE TO APPLICANT: If,' after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION L/NNDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that 1 have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
. Z..r _- • " y
APPLICATION ONLY
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number 6 4/6 477 –
Legal Description./— 10 %- /5 L GC C- 1
Project Description
Sq. Ft. ��gg No. No. Dw.
Size 661 Stories Units
New q�� Add ❑ Alter ❑ Repair ❑ Demolition ❑
Cc7mrac-r : LAKXcE M IJA*k.'f 341-2580
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.('}
Plan Chk. Bal. r _
Const.
Mech:
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
2000
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
r WMITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Date 3/24/00
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
APN # 646-140-013
No. 20216 Jurisdiction La Quinta
Owner NameVernon & Verna Veron Permit #0001-212
No. 48-7000 Street San Pedro
City La Quinta zip 92253
Log #
Study Area
Tract # LAGE1 Lot # 18 Square Footage 2862
Type of Development Single Family Residence No. of Units 1
Comments
PAYMENT: CC# 2004527075 for $5,523.66 + CK# 9441 for $343.44 = $5,867.10
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
2.05 X 2,862 or $ 5,867.10 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 2 Checks/Bank of America/Nancy Christensen Teiephune :-
Name on the check
By Dr. Doris Wilson"
Superintendent s'
Fee collected /exempted by Mary Ann L. Bora Payment Received r`.r $5.,67.107
n /J n Check No. 'See Above
Signature
NOTICE: 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 other payment identified
above will begin to nun 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 entity authorized to
collect them on the Dislrict('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
614,
QBE COAST n1y
RECORDING REQUESTED BY
AND WHEN RECORDED MAIL TO:
Vernon R. Veron
Verna L. Veron
78188 Calle Norte
LaQunita, CA 92253
A.P.N.: 646-140-013 TRA N: 0,;00t653
19
PAIQ
Doc. Transfer Tax
Riv. Co. Recorder
0158'70
RECEIVED FOR RECORD
AT 8:OOAM
JAN 16 1998
Rriaoa0b N oftw p�p,y�
of i�ra[dtb CaeMX t3ri[y�
Rtootder
Space Above This Line for Recorder's Use rt y
Order No.: R-161383-1 Escrow No.: 2-24002
GRANT DEED
THE UNDERSIGNED GRANTOR(s) DECLARE(s) THAT DOCUMENTARY TRANSFER TAX IS: COUNT $99.00
X computed on full value of property conveyed, or
X City of La Ouinta , and +
FOR A VALUABLE CONSIDERATION, Receipt of which is hereby acknowledged,
Charles R. Knox and Shirley Ann Knox, Co -Trustees of the CHARLES R. KNOX AND SHIRLEY ANN KNOX
REVOCABLE TRUST, dated January 25, 1993.
hereby GRANT(S) to Vernon R. Veron and Verna L. Veron, Husband and Wife as Joint Tenants
the following described property in the City of La Quinta, County of Riverside State of California;
Lot 18 of LaQuinta Golf Estates No. 1, in the City of La Quinta, County of Riverside, as per map recorded in Book
37, Page(s) 96, 97 and 98, in the Office of the County Recorder of said County.
Charles R. Knox and Shirley Ann Knox,
Co -Trustees of the CHARLES R. KNOX AND
SHIRLEY ANN KNOX REVOCABLE TRUST, dated
January 25, 1993.
By: /Q.
Charles R. Knox, Trustee
By:
Shirley Ann I ,Trustee
Document Date: —November 7. 1997
STATE OF CALQRNIA )SS
COUNTY OF 9 I V£.kS )'h �— )
On O 0 4 i • before me, /z /
personally appeared _ �/_ �Q / ��A] 0, Z Ay e LF
personally known to me (Eehalolf
me on ) to be the per,
and acknoyrle�ged to me that ey executed die same in eir uthorized capac
the pers s the entity upoof which the persons) acre execu[ed the instrument.
WITNESS my hand and official seal.
V
C�
hose nam s /ar cubed to within instrument
and that by r/their signatures} n the instrument
Signatur
DoemkOf ofcial notarial
WC4117M bow
..:,�
Mail Tax Statements to: SAME AS ABOVE or Address Noted Below . ;
IT
CommunZt.y Azzoc i.at i_on
P. 0. Box 162
La Quinta Ca 92253
Telephone: 760/564-2177 FAX: 760/564-4882
January 14, 2000
Planning Department
CITY OF LA QUINTA
P. O. Box 1504
La Quinta CA 92253
RE: New Construction
Lot #8, 48-700 San Pedro
Gentlemen:
The. Architectural Committee of La Quinta Golf Estates has reviewed plans
submitted by Christensen Homes, Inc. for construction of Veron residence.
We find these plans meet all specifications and guidelines setforth in the
governing documents of our Association and we do, therefore, approval these
plans.
Sincerely,
PETER MURPHY
Architectural Committee