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0003-339 (SFD)61 LICENSED CONTRACTOR DECLARATION 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 Professionals Code, and my License is in full force and effect. License # % Lic. Class Exp. Date /ate'��fl�J 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 sugject to the workers' compensation provisions of Section 3700 of the Labor Vde, I s all forthwith comply withAose provisions ,�„ te: �� ApIicant% `- '--- `t- "�— f 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 thes,above-mentioned property forAnspectiori purposes. /Signature (Owner/Agent) -�... �� '7 Date BUILDING PERMIT PERMIT# DATE VALUATION LOT 00li)—l-339 TRACT,64 ''7 6 24 JOB SITE 365 1,� �tq�y;fTyAtT�TA ADDRESS 77 �- j LA1.41L �•ICSd (l.btlCi.V ei \ �APN 7 (�,—V°i ilvl OWNER -- _ CONTRACTOR / DESIGNER /ENGINEER ,GLOR &RAR= 0WNER\F3MI-FR LAQDINTT.A CA 92253 (760)771-0071 CBI* \ USE OF PERMIT: �24GLR FAMILY DWM.,LWC§- SM - PERMIT INCLUDFS ROLL Y BLOCK WAIL PER APPROVED PLAN. POUT DOES NOT MCLUDE .FOOL. TRACT CONSTRUCTION 11573.00 aF PORCfVPATIO 97.00 S 0AMAGRICAldPORT 537.00 9F 6 FT. WAIIL 90.00 1.y 5 FT, WOOD SCE 1X00 1.N ton OF CON''ii1CT��C'.l o 100,197.70 yy��y� { � pn �y�r�yyFySIT[A�TM ,`.iL,LR.l�'.Li S �1�,i3rE s ViY.L1Yif11 z Y - , CONSTRUCTION 101-000-418-000 $643,00 . V AN CHN.;CIy". F:ZR, —' 101-000-439-31£3 $533.13 MkCHAXICAL FEE 101.000-421-000 353.50 F%ZCTRICA1, "E 101-.000-420-000 $129.30 PLUMBING ME 101.300.4194= 31IVAI S'TRONO MOTION PEE - RI -SID 101-000-211-000 $10.03 GRADING IFEX; 101-000-421-000 SX00 DEYELADPER IMPACT FEL' 11,90'7.00 PRECISE PLAN 101.000.441-345 S I00.Q0 FEE DEPpS1'C 101-000-439.318 4250.00 9t3.16 -TOTAL CONVIRUCTION AND PLAI.\T CHECK $3,506.70 LP.. PRE -PAID FEF -3 4250.00 '}'t7 AL FEl�.'A Y FIKES DUE NOW RECEIPT DATE B j�7fo f('� DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Equipment Location . Underground Ducts Forms & Footings Underaround Plba. Test Ducts Slab Grade Return Air Steel Combustion Air Roof Deck -rj - pp $-(-„ Exhaust Fans 0. K. to Wrap 7 •-( - &_0 n7 F.A.U. Framing - 0 Compressor Insulation coo M-7 Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation I Condensate Lines Party Wall Firewall Exterior Lath 1�7 Drvwall - Int. Lath 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 cep Encapsulation Gas Piping Gas Test Final COMMENTS: Final ELECTRICAL APPROVALS Z Power Pole around Conduit Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) Final Final 0,421 t ell, BLOC KWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location . Underground Electric Underaround Plba. Test 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 cep Encapsulation Gas Piping Gas Test Final COMMENTS: Final ELECTRICAL APPROVALS Z Power Pole around Conduit Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) - uCv —I Ch� �� P.O. BOX 1504 C Building r i E TAMPICOt �� PLICATIO L Address �l - I fil'JOA'92253' i Owner f ILDING TYPE'CONST..� OCC. GR ! Mailing �7 Address — -2q5' A v ali,e4 ,1 A.P. Number V / % City Zip Tel. o ,� a v t k V •�, { q ��,i ,2 53 17r- o -771 00-71 Legal Description Y X Contractor i v ".' *" ,(l iId �� Project Description Address City Zip Tel. State Lic. City & Classif. Lic. q Sq. Ft. No. No. Dw. ArchEngc, Size )r' �� Stories ( Units ., Designer New 0,--- Add O Alter ❑ Repair O Demolition p �\ 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. SIGNATURE DATE OWNER -BUILDER DECLARATION Estimated Valuation 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 A requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT - AMOUNT I\\V 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 Plan Chk. Dep. subjects the applicant to a civil penalty of not more than five hundred dollars ($500). I! 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. do the work, and the structure Is not Intended or offered for sale. (Sec. 7044, Buisness and Const. 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, Mech. provided that such improvements are not intended or offered for sale. If, however, the building orimprovement is sold within one year of completion, the owner -builder will have the burden Electrical of proving that he did not build or improve for the purpose of sale.) I ' I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law doesnot apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading 1 I am exempt under Sec. B. & P.C. for this reason Driveway Enc. Date V/ 7i //1 7Owner Infrastructure 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 C7 Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for 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 Califor / Dale�wner '..t/r J'A/1.l-'1i. NOT! TO PLICANT: If, atter 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 she 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 i +•'t r tA%r AO f�� Q 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 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: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-5515 CERTIFICATE OF COMPLIANCE Date 4/20/00 No. 20322 Jurisdiction Owner NameGloria Parks No. 77-265 Street Calle Chihuahua City La Quinta zip 92253 APN # 774-043-001 La Quinta Permit #0003-339 Log # Study Area Tract # Lot # 24 Square Footage 1573 Type of Development Single Family Residence No. of Units 1 Comments At the present time, the Desert Sands Unified School District does not collect tees 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 1,573 or $ 3,224.65 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 i Fees Paid By Check/Wells Fargo Bank/Brian Devlin Telephone G Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Signature Mary Ann L. Boda Payment Received Check No. $3,324:65' - 7377002277 (NOTICE: Pursuant of Assam-* Bill 3081 (CHAP 549, STATS. 1898) this will serve to notify you that the 9Uay approval period in which you may protest the fees or other payment Identified I 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 DlsMet(s) or to another public entity authorized to collect Cham or the Distdct('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 DeptJApplicant Copy - Applicant/Receipt Copy - Accounting 'RECORDING REQUESTED BY: AND WHEN RECORDED, MAIL TO: Cc to/m7 -? 3�T ( 120-, Brian evl 53145 Avenida Madero La Quinta, CA 92253 --o (j./_ ASSESSOR'S PARCEL NO.: 774-043-001 Oct" 0/J TITLE ORDER NO.: ESCROW NO.: 19514-004 GRANT DEED DOC . p 2000-100609 03/20/2060 08:08A Fee:6.00 Page 1 of 1.Doc T Tax Paid Recorded in Official'Records County of Riverside `Gary L. Orso Assessor,` Co}mty Clerk 8 Recorder II I M S V PAGE SIZE DA POOR NOCOR 5MF 'am I A R L COPY LONG REFUND NCHG EXAM (O The undersigned Grantor(s) declare(s) that the DOCUMENT TRANSFER TAX IS: $ 22.00 County $ City T xx computed on the full value of the interest of property conveyed, or �B — computed on the full value less the value of liens or encumbrances remaining thereon at the time of sale — OR transfer is EXEMPT from tax for the following reason: FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Henry C. Griswold, as trustee of the Henry Griswold Living Trust established pursuant to that certain document entitled "Declaration of Trust" dated June 19, 1995 and executed by hereby GRANT(S) to Henry C. Griswold as Trustor and Trustee Gloria A. Parks;.a single woman all that real property situated in the City of La Quinta County of Riverside , State of California, described as: LOT 24 IN BLOCK 176 OF SANTA CARMELITA AT VALE LA QUINTA, UNIT NO. 18 AS SHOWN BY MAP a ON FILE IN BOOK 19 PAGE 31 OFMAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA. 1 i Dated January 31, 2000 STATE OF CALIFORNIA, } . Henry Griswold, trustee COUNTY OF Riverside } ss. On March 17, 2000 , before me Cindy Burgin , Notary Public, personally appeared Henry C. Griswold, trustee personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(e) whose names} is/a -- subscribed to the within instrument and acknowledged= CINDY BURGIN m to me that he/she/fhey executed the same in his/heFfth& �. , COMM. #1180893 n authorized capacity(ies), and that by his/beF ft it signatures} M , NOTRRVE�DE'�� NIA -1 on the instrument the person(s), or the entity upon behalf of My�m•E)OresApffl 2002 °f which the person a ted, e_ xecuted the instrument. WITNESS my h a! -seal Signature MAIL TAX STATEMEN TO: (This area for official notary seal) SAME AS ABOVE - NAME ADDRESS CRY, STATE & ZIP RC DISTRICT - PLANNING REVIEW FORM This form is to be used by CDD staff for review of single family dwellings in the RC (Cove Residential) District, in order to determine the applicability of compatibility issues or need to require the filing of Master Design Guidelines by the applicant. It shall be transmitted to the Building and Safety Department as your correction list. Please attach additional explanations as necessary. APPLICANT GLORIA PARKS 3 9V SITE ADDRESS 77-x-5 Calle Chihuahua APN 774 _ 043 - 001 BINNO.: �JL/ CASE NO.: 2000-218 LEGAL: LOT 24 BLOCK UNIT 18 S.C.@V.L.Q. CHECKED BY: Fred Baker DATE: Inform the assigned Building plan checker upon your assignment to this case. The CDD Executive Secretary maintains a log book to track applications and assign case numbers. REQUIRED ITEM Y N COMMENT/CORRECTION Compatibility Review Case logged and number assigned Verify legal and APN information Consistent with MDG on file (as applicable Uj�T11Y flEVEIOP� MDG filing required'(5 filings since 9/3/98) Consistency with street/surrounding area: Colors Materials Architecture -ASE N0. Other Requirements: i Certificate of Occupancy City of La Quinta Building and Safety Department This Certificate issued pursuant to the requirements of Section. 109 of the Uniform Building Code, certifying that, at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following: BUILDING ADDRESS: 77-365 CALLE CHIHUAHUA Use Classification: SFD Occupancy Group: R 3 Type of Construction: VN Owner of Building: GLORIA PARKS �d Building Official Bldg. Permit No.: 0003-339 Land Use Zone: RC Address: 53-745 AVENIDA MADERO City: LA QUINTA, CA 92253 By: STEVE TRAXEL Date: 10-13-00 POST IN A CONSPICUOUS PLACE