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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 - is188 CALLS 1Wk"I'i i,A Qk1I NTA (_'A 022Y.3 USE OF PERMIT 5 �t•+.:.PL t�` 'X�I►.i aT'✓t,`�11 {��V1, ��.;'tf'r At •f'•D�i ."f'�I\'+►r 8..r airy 4VAN ifl '�. t�. lA1 ,■\l�• �1!A7 (4 ilk iB..',•.-'++, i'Ik'tf,4 .i ij li'k 11 4tjNi(1iAkI N I -PE 101-(Xx-lI8-(AXI 1.1 ir> O t�1.tNC'}I!=['Kbt�{< lilt-1aK1•.1'i4-iltt '�9i1 z; r't'.[;, 1�1.,1'`_ t IT (11-(i{ ii i ." �( tr 4iisti °l lriiti ti' A[. HA" t � 1-1:1f M !-• j i -{)(tit Ets .. le I:LCX." K14'AL t`IA_' 1014PiX)-41040) I'll.) (PORINO F 14, 10 1 _000-d 19-000 .:TR :1Nc7.0.T . TIt )N 101- T. ?11- 100 t.j AfAN(u 144; 10J-0(X)-42 w.0Wt 1MNAt.7.F'hki 51.E+1i!.tK+ ART IN PI Olt -IC f l , OVS - RF:M. t'. '101-01141-1i'i_4) stt�i �+t1 "I ti';-'IX41-41; ('01wl4'T)411 ICT!()N AND PVAN CHFC)z %;:1 c•<w {l°. 901ALNiN,T;MMI!'F)N;iFS[HiENOW I $3.949.0 RECEIPT DATE DATE FINALED INSPECTOR cr 0'. 3 -n > OR 0 I 0 I 0 =r -v CD 0 -n cn 0— m m m -n -n m @ 0 x 0 0) C/) ru, a ou ED 0) 5'**0) w 3 3 w w 0 Ak, m (A c to m a) 3 =r CL @ 0 (a M m CD 0 0 m m 0 >1 N At I li) s, Y% -0 i m u < a > r- - - - ----- ------ - Cl) CA CA z 21 I-D w a, Ca SL - ac 0. 0 0 S m 0 < 0 0 -n m 0 0 3 ;u 0 c -c-J, -a 0 'a M -0 0 C, M 0 (P c Q) 0 tA 0 3 C) m rin CL 0- CL z D =r :3 0 -0 m B fn > m v 0 m Vs 0 0 X z -0 > z C ol" lq`Z > > m Cl) 4 it m 0 4 0 w 1 Building QJ7W S�A� Address 4 q IVJ Owner IJ E 12- IL-7) Ah J E,c o A/ Tity/ " 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 GNArS7_IC1'V C EA1 1-4ustnr: /30 i?a f( /ir� 6,4 City /'a4 -nM D(-'Sr,ti Zip_, i2ZC( Tel. 3A 6J"0 State Lic. & Classif. 3,5–s City Lic. # �s7 Arch., Engr., G 14 r L i r r t5,,4 5 F— Designer /-4o M fx J /tit G r -i 'C' r1/ fc-� Address �t /-)0 1?vJ iG G –t Tel. -3 4/--2- City oesrn i Zip 1 State 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