9807-074 (SFD)LICENSED CONTRACTOR DECLARATION..
/+ her
runder penalty of perjury that I am licensed under provisions of
i -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
634981 t 1/00
,Dater' 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 emp!oyees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec:.7044,: Business & rqf sionals Code)�,�.,
as owner of the .�opert am exclusiVecontracting with licensed
contractors to construct tpetp'roect (Sec. 7044 Business & Professionals
Code). %t1 p0tf� ,a
() I am exempt under Se 1i n B&P.G'rtor this reason
DateSowner
}
WORKER'S COMPENSATION DECLARATION
I hereby affirm under pen lWpfjperjury one p the following declarations:
( .) "I have and will mai 0-�eer.tificate of consent to self -insure for workers'
compensation, as. providlfor'6y Section 3700 -of the Labor Code, for the
perfor'mance of the work for which this permit is issued.
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:
Cartier • ryry77 {�77;,���� ( ry ((}}• g�7w Policy No.
G�EitV1 N EACi'LE MS.
(This section need not be completed if the permit valuation is for $100.00 or less).
(. )< I c@rtfythat.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
Worker compensation laws of California, and agree that if should become
subject to the workers' compensation provisions -of Section,13700 of the Labor
Code;; shall forthwith comply ,�th.those provisions:
ate: >. Applicants r _A _I I
Warning: Failure to secure Workers' ' ompensation coverage is unlawful and
shall subject an employer to criminal pe aides and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of fhe 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. Eacfi 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
const ucti6n, and hereby authorize representatives ef'this City to enter upon
the above-mentioned property for inspection perp ses.
:/Signature (Owner/Agent) �'�f -- -'r �` ��✓
PERMIT# P
BUILDING PERMIT�,��,
j
DATE 31 `.J99 VALUATION ' $7 94.6. LOTJOB
SITE
AOQORESS S ^' ��C�F�LYIL�IL��ALOd��� -
APN •,%�itd�—IJ%�^ 'i�.�
OWNER
CONTRACTOR/DESIGNER/ENGINEER
RAYMOND STtIi.1 -EY
C0R6WJJ- i 4:'ONS' RUCIt ON,
47-430 DIANE S'T'
51.540 EISFNHOWER OR.
IA4TTif) C 92201
LA q.11N t'A CA 92M-
(760)564-4604 2261 '
USE OF PERMIT
SINGLE, 1~A14 ILL DW.t,.L1NG
g fi
qr.w Qp.
3rD - PREM � IT W&, NOT INCLUDE BLOCK WALES OIRT,,o %
C
TRACT OONSTRUCT1ON 3,615,00 `& �r.v•
MAK U 0-r 1999
� • I^1- C®-�
PORC1T.TAT10 445.00 S3
...
Gjr k.A:t;p/CAPj,o Cr 1.371.00 SF
k
'
El STIMA TED CTM3 OF C€3NSi'If'iFtTJCfTON
'=_ .084.60
T+`EX, SiUli'[fVaARY
(PERMT
CION81'RUC"'I'ION FFR 101-000-418-000 .1,41 4.Su
P?: AN CHEG?� FFF 1014)00-439-3_18 esv^n;g 7
1zsc- DF7'osn' 14111-U0AM39-318 4250,0
fvlL`• HANICAL FM,' 101410-411"000 10-411"000 M50
ElAC:`7 RIC'AL i l?E 101 -NO -420-000 $245.45
t'UIRVA31NO FEE 101.00114.19-000 52(►9,25
,TrR(:)Nr RVSIt; 101.000-21.1-000
GRADING Fa 101-000-42-1- ) �20.oi1
tNFRr11..'S't`RV(-, •URHFHE -225-000-443-342 $5,021.
A33.I' ftJ f'ifSl.1C 2�L.A.C'E5 RE81.r,01-Ut3(I-2,5,`,.000 $?r22.71
8(.YR— OTt1J,, C ONS'Z'1<:1.1CCi0N AND PLAN CHECK
�7,n*.5•uti
1.,FSS R1JJ?_I' kM FES
-S250.00
TMAL PE RMIT FEEN' 01JE NOW
$7,705.43
RECEIPT
DATE
BY/
DATE FINALED
INSPECTOR
"'i
1-W
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
t BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Z(
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Insulation
_ _9
AVents
Compressor
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
Final o �'
BLOCKWALL AP ROVALS
Final
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
Gas Piping
PLUMBING APPROVALSGas
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
Z
Appliances
Final
Final
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)
COMMENTS:
A1°,
Building -, � .Q�®
Address VV
} Owner/, J _
T4hf 0
�iGGICl/
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Address _ 41-1K)
/l ,6�.�y `r
City �� Zip Tel.
1�7L811!1
r; -/c if
State Lic. City
& Classif.
m
Arch., Engr.,
Designer,
Address Tel.
City Zip State
Lic. #,
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
CIGNATIIRE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness and Professions Code: Any city or county which requires a
permit to construct, after, 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 ($500).
C-1 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'I I, 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 contractor(s).licensed pursuant to the Contractor's License Law.)
i] I am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
Ihereby 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 it the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thq 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
,=any
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 LENDING 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 I 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 a0plicant Date
Mailing Address
` City, State, Zip
APPLICATION ONLY
ILDING: TYPE'CONST. OCC. GRP.
'. Number, %12' O 7'6 003 C)
Legal Description
Project Description' `y F
Sq. Ft. No.
Size Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
L5�'
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
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 aPermit
Validated by: i• y
�C
Validation:
J U L 13 `1999
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION '� )�.� ,t*'t, -;1 yr q :.
a." 0� 'god r t, e J , a
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
47-950 I)un.eTalms Road`
La Qi iota, .CA'92253
760-771-8515
CERTIFICATE OF COMPLIANCE
r
Date 3/5/99 APN#, 769-074-003-0
No. 18424 Jurisdiction La Quints
Owner NameRay Shirley Permit #
No. 50860 Street Calle'Paloma ,Log #.
City La Quinta zip 92253.. Study'Area
Tract # Lot # . Square Footage • 3615;•
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 .•replacementrriobilehomes.
It has been determined the above-named owner is exerriprfrom•pool fees at this time due to the following
aying sch
reason:
EXEMPTION NOT APPLICABLE.
This certifies that school facility fees imposed pursuant to. Government Code'53080 inr the amoun� of
1.93 X 3,615 or $ 6,976.95 the pioperty listed above and that building�,� - -
permits and/or Certificates of Occupancy for this square footagein this proposed.project may now be issued'/'
Fees Paid By ccNalley Indep. Bank/Coronel Construction Telephone.. 564-4604
Name on..the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Adriana Gauto Aayment.Received $6;976..95
Check No. 183185 t .
Signature
NOTICE: Pursuant of Assembly -Bill 3081: CHA 549; STATS. 1996) this'will serve lo'not -
( rfY you;that the 90iay approval penod irtwliioh you may protestthe tees or other payment identified
above will begin to run from the date on which'the building or installation permit for this proled is issued or on which they are paidto the District(s) or to anothei.public entity authorized to
collect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of: county or city plan check application form to district copy for'all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accoun'ting s
RECORDING: REQUESTED BY
CHICAGO_ TITLE' COMPANY' OOi5i3 RECEIVED FOR RECORD
AT 8:00 O'CLOCK_
Ai41b WHEN RECORDED MAIL TO
�MR 77
. & MRS .. RAYMOND SHERLEY
JAN---5 199
47430 DIANE STREET..
INDIO, CA 92201.-
PAI D Recorded to offkW Recoft
Doc. Transfer Tax : of Nverside county, CanU ts-
. •- - _
• . v • _ ReC4lrler
RAJ. Co. Recorder ' FOG$'T
Iv
Escrow N0. 7741378- F32
Order N0. 7721818 - F03 `
SPACE ABOVE THIS UNE FOR RECORDER'S USE
Parcel No:
GRANT DEED
7-07474 6969-003-0
THE UNDERSIGNED GRANTOR(S) DECLARES)
V
DOCUMENTARY TRANSFER TAX I& $49-.50
❑ unincorporated area Cityof ' LA QUINTA
0 computed on the full value of the interest or property conveyed; oris .
❑ computed on the full value less the value of liens or encumbrances remaining at time of sale, and
FOR A VALUABLE CONSIDERATION, receipt of which is herebyacknowledged, "
'
JOSEPH HODGES AND DOROTHY`P. HODGES, TRUSTEES UNDER DCLARATION OF TRUST DATED
FEBRUARY•19, 1991..
hereby. GRANT(S) to
RAYMOND SHERLEY AND JOANN D'.. SHERLEY, HUSBAND AND WIFE AS'JOINT TENANTS
the following described real property in'the' City of LA QUINTA.
County of RIVERSIDE'-.. :• , State of California:
LOT 64 OF DESERT CLUB TRACT`UNIT.5, IN THE CITY OF.LA QUINTA, COUNTY OF,RIVERSIDE,
STATE'OF CALIFORNIA, AS'PER.MAP RECORDED IN BOOK 21, PAGES 61 AND.62"OF MAPS, IN THE
OFFICE OF THE-COUNTY RECORDER OF SAID COUNTY., -
Dated December._19, 1997
STATE OF' CALIFORNIA
COUNTYOF RIVERISE } SS,
On 12/31/97 before me, J SEPH ODG S,, TRI TEE'
YVETTE GARZA-MUELA o /
a Notary Public in and for said County and State, personally appeared
JOSEPH HODGES, TRUSTEE & DOROTHY P•. HODGES, DOROTHY P.,.ORODGE.1 TRUSTEE,
TRUSTEE
personally known 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/her their thorized capacity(ies), and that by his/her/their' YVETTE GARZA-MUELA
si nature( ) r n e irtst , ment the p r n(s), or the entity upon behalf of Comm. # 1074141
hi a (s)a ,exec d h
IA
rument. VI NOTARYPUBLIG-CALIFORNIA f!1
Riverside County
WITN h n
1
a it is It
My Comm. Expires Oct in 106
na a of Nota Date My Commission Expires FOR NOTARY SEAL OR STAMP
. MAIL T ATEMENTS TO SHOWN ON: FOLLOWING LINE: IF NO PARTY SO SHOWN, MAIL. AS DIRECTED ABOVE.
SAME j,S- OVE''
Name
Street Address City, State & Zip
• GDt •05/30/8 k
-YOUNG ENGINEERING SERVICES
47159 Young Lane Indio, CA 92201 (760)342 9214.."
June 24, 1999
Tom Hartung
Building Official
City of La Quinta
RE. Sherley Residence, 50860. Calle Paloma L4,0umta;�:CA;
Dear Tom,
We have reviewed the shear'walls in question for the above referencedprotect, where there was a:"shear panel
break" in the shear wall. We provided a detail, which'will'correct-the'break'. and"create overall continuity.in the
shear wall.
In addition to the shear walls in question, the overall.framing of the residence is in compliance with, the` approved
structural plans:
If.you have any questions please,call.
Sincerely,
Jeffrey B. Yo g S.E.
�OFESSI
. bVo: 4044'
rn
.'Exp. 3'31' 0.1
�OF CALIF ,.
•r
CAL WEST ENGINEERING.
32-812 Aurora Visi Cathedral City,;Ca. 92234. --J760) 328-815,0, .(714),248-5139
December 17, 1998
Tom Hartung.
Building Official
City of La Quinta
Re: Truss Review - Ray Sliirley. Residence "
Dear Tom,
We have reviewed the .truss_submittal package prepared by Spates Fabricators for the above project and
found it to be in substantial"conformance withl the apprgved plans
If you have any questions.or, concerns pleasercall. "
Sincerely,
Jeffery B. Young S.E.
19