9606-077 (AR)LICENSED CONTRACTOR DECLARATION
U) 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
CV LU Professionals Code, and my License is in full force and effect
:3 c,) License # Lic. ClassExp. Date
I�0LO
Lij
27 432 B
31.197
ZDates �'`°' Si nature of Contractor
rn0�. r f g
U OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U) License Law for the following reason:
Z ( ) 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
0 N Date Signature of Owner
rn
a Q WORKER'S COMPENSATION DECLARATION
p (r I hereby affirm under penalty of perjury one of the following declarations:
Lo H O () 1 have and will maintain a certificate of consent to self -insure for workers'
X w 4: compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
C3 Q L) ( ) I have and will maintain workers' compensation insurance, as. required. by
O U Q 'Section 3700 of the. Labor Code, for the performance of the work. for which this
li Z permit is Sissed a Mlwaorkers' compensation insurance crier&,F,po�l� y no. are:
Cartier Policy No.
ob d
J (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
3 subject to the workers' compensation p ovisions of Section 3700 of the Labor
Code, I shall`forthwith comply with those,provisiq�S. `
Date: /Is
� Applicant 1,
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)3=ham Date`<'!
BUILDING PERMIT PERMIT# CONTROL#
960"77TRACT 3 5 2 9
.
DATE VALUATION 8/56 S2�,333.tlti LOT lz,l
JOB SITE
APN
ADDRESS 77-290 CAU LC C" 41f.1111JAHUA .
ii3-3Il.-Ui3
OWNER
CONTRACTOR/DESIGNER/ENGINEER
MC7N1:aZ111•IA 011S'17, INC...VE.
D, INVIAL1.f COMKI RUCT1 NT
73-5.40 ALLY SSANDKO DR. 1100
7.,M5 JON! DLC. &M. 1
PALM DESERT CA 911.
PAIM DESERT CA. 92269
61977640 1 1
(61.9)779-1.954 CUPr 4290
USE OF PERMIT
USO�WYW, ADDITION
420 S.F. 013EhT ACYLIS')r VAL. $22,906,00,190 S:F, PAT, VAL_ $2,527,00
{
•'RAC T LSyRM tXtt 420,00C?
. f'ctftt�W1�AT:IK") . f.9V.dn1 :�1r
f:. TIMA' .111' �3 COST Of CO, N8'FRtJCT10N
25,333.00
Pmmn' r, 14,E NIJ41mikRy.
PLAN CltECK R E' F I(ll-f)W 439-3153 $lrli.li3
C0NSTCtCTcT.1c)-61.FH8 101-000-418-000 $258.50
MECHANICAL Mi 101-000-421-000 $41-50
EL EC'1.'17IC A 1— F'E 1-014)00-420-000 $29.70
>rt71kS131'E�l47.11T . 101: -000 -419 -OW 939.00
STO.NG A140'p'[ON t�bF - "USID '101-00b,24140 5153.
.
GRAD (140:6`+'EE 1{}1, Ut2t)-�t2a-13Q0 $.7i►:70
HT1+ V1 A_.`iTRVC"iUREFla£: 22540-44204.
S1J13•T07'A:L CONSI;R.tJ'i .1'`�fJNI ANI.) PLA
}}N�pC..++14EC.}K � [!/` 1
I.d1•..A7'4 YiV]-.1'Ali3 C"f:, i.+!.)
Z-4—
(7[i�.�i/0�
so.00
83'. %J,.1t PERMIT FEES
IMF, NOW
JU C
��. Nom, ' 1gg t •
6
$1,072f40
By
"
RECEIPT
DATE "'"�.%
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O. K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath 9 a w
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain,
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. 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
Appliances
Final
COMMENTS:
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)
Desert Sands Unified School District
Notice: 82-879 Highway 111
Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF COMPLIANCE
Date 6/24/96
No. 14635
Owner Name Montezuma Oeste, Inc.
No. 77290 Street Calle Chihuahua
APN # 773-311-013
Jurisdiction La Quinta
Permit #
Log #
City La Quinta Zip 92253 Study Area 111
Tract # 169
Lot # 13&14 Square Footage 420
Type of Development New Residential Addition
Comments
No. of Units 1
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:
Add. of Sq. Ft. to New Construction
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 1.84 x 420 or $ 772.80
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 Wells Fargo & Co.
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson
Signature „;� LFo�l1�Sb'v�
Telephone
Payment Received $772.80
Check No. 0981017291
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
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
Date 7/10/95 1 Type of Permit I La Quinta
No. 13546 Permit #
Log
Owner Name Montezuma Oeste Inc.
No. 77290 Street Chihuahua
City La Quinta Zip 92253
Study Area 112
APN # Tract # Lot # 0 Square Footage 11818
Type of Development I Single Family Residence No. of units 0
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 1.72 X 1818 or $ 3,126.96 have been paid to D.S.U.S.D. for
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 Double "D" Construction
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by�Pauline Pearson
Signature P, A a L L 4 V; ,0 RA A A L a
Telephc-,J-e'�
i
Payment Received.
Check No. 1998
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
RECORDINQ REQUCiTED
Ase 'Olin 6tu10:1 NAIL TMA$ OLEO A41 10%9$1 0Tt191M11t 11101110
OUAM NAIL AAE tiA11KINT TO:
N•'^• rCity of La Quinta
s119411 c/o Community Development
Addle" p0 Box 1504
SIA14 La Quinta, CA 92Z53LJ
MAI► TAX aTATEMENTB TO
N•ef• f J. Fredari ck, Wi 1 son -i
90801 Beth C. Wilson
Addem c/o Coldwell Danker Sandpiper Realty
cltra 45000 Club Drive
alatO
Llndian Wells, CA 92210 ..J
TIM Dint NO. 11taft N0. I
t►ACE ABOVE THIS LINE FOR RECOROER4 Nit'.
GRANT DEED
THE UNDERSIGNED GRANTOR(S) DECLARE(S)
DOCUMENTARY TRANSFER TAX Is $
❑ computed on full value of property conveyed, or
❑ computed on full valueless value of liens or encumbrances remaining at time of sale.
❑ unincorporated area eclty of La gu i nta , AND
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
J. Frederick Wilson and Beth C. Wilson, husband and wife as joint teoArkts,.
hereby GRANT(s) to
J. Frederick Wilson and Beth C. 'Milson, husband and wife as joint tenants
the following described real property in the
County of Riverside' ,State of California;
Lot 13, together with lot 14, but excluding the west five feet of
lot 14 conveyed to lots 1.5, 16 and 17, Block 169 of Santa Cartnelita
Vale La Quinta Unit No. 17, as shown by Yap on file in 1)ook 19,
pa 19 and 20 of Maps, Records of Rivc..rsicle County, Califortzi<<.
This deed reflects Lot lAnr.. Adiustr-iert 95-190 nes Rpprovpd by the
City of Quinta.
Dated
STATE OF CALIFo 1 Il r �SS.
COUNTY OF
On this 00 - - --- day o Ct.iOL.( . In the year PZ 9! -.
before ° the undersipne No f'Ublic in and for aid Stele, personally
appoarAfJ� �- V 1 vti
C] personally known tome