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9802-118 (SFD)f, 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 kDate Signature of Contractor A?,u�� �``"""^°^�•--�--- v 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: Cartier Policy No. S, iVrF FUND 1286*990-%, (This section need not be completed if the permit valuation is for $100.00 or less). a () 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 C lifornia,� and agree that if. I should be' ome subject to the workers' compe satti n prXisioris of Section 3700 of the L bor Gode, I.ShalI f rthwith comply Wlth these fircvisi ns. ii Date:; S I k Applicant -,a�.k✓ IV_1111N, 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. VSignature (Owner/Agent) Date BUILDINGPERMIT PERMIT # CONTROL#. DATE VALUATION LOT, 16603 JOB SITE' ADDRESS 52_v,12.,,; %r[gjft)A.lVll, U, APN 77S•I03,013 OWNER CONTRACTOR/DESIGNER/ENGINEER 1) {. Yr ;' Yl `Y4' 1pi i t. .�' "•1 hal 1719 S'i'1�t°: iOiNIT , SX C)CI .A+iSt0,P, CA 92054 USE OF PERMIT S O -PER-Rif :00 S %G7' .INCLUDS13LOCK WALLS taR POOL, 1'AC;T CiDNMI R 'C`1`1CtJ 0r3 S1'' PORA I &A110 71W 3F 0ARA0I1/:I1R_P0-RT 50€i"C►k) Sk 6 Q r, woor) :LANCE LF PV,R°l%1f VEE 1Jl!'1 1A :Y CONS" 1:' UC'lf [C1v TEE lt1j.-GLA-411-000 $594,50 PIT ,A& Cts. K FEr� 51X3"53 M111CHANICAL.F i01�tl�t)=42,C�fK)t3 �5 .` ELECIMdr-A , MM 1.01-000-420-000 S122.85 :PLUN4BI Q M. 101.-000-41,1-000 d1�l.5t! Sp.1'4Z( N1 0 i1�t0'jQ ..NFff9-1'H8.0 1()1-000-241-4)4i0 r3.9ca GRAI)MIG FE13714)1-013(3-42 3-L3(34; `�t�.4)U 225-000-443-342 51.943.17 101-'000-441-345 S45.00 KANCHW:YS FER 4T50.00 • f � k L1E3r_ft�TAL CO?�S'�a�.i1G�10N AN � PLAN C°HF_ X Sa:3M 95 LESS PRE—RAID FIEFS 4250.00 TOTAL 1'1l3RA(bIC 1 Fr!,Si DUENOW S,3,138.9s R ECEi� T i j• (/ DA BY i DATE FINALED INSPECTOR W INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION' DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs - Underground Ducts Forms & Footings Ducts Slab Grade 3-[- Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap_ F.A.U. Framing �' Compressor Insulation y Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wail insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final �I , Final BLOCKWALL APPROVALS Steel POOLS - SPAS 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 Sewer Lateral O.K. for Finish Plaster Pool Cover Sewer Connection i Encapsulation Gas Piping Gas Test 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 GT.I. Smoke Detectors Temp. Use of Power c Final- UfiW Notice (Perm) COMMENTS: 'T T''�►�ti�`"►�Gi+�'+'7`���i'A'al'�I`.iV�..�'�:.+�s�`r`'� �� `Rr�'�i���w+i i��Gl'�1 4. VEJoAP_E:7_ P.O. BOX 1504 78-495CALLETAMPICO APPLICATION ONLY Building ��4� ,d,K'I .� '1.- Address LA QUINTA, CALIFORNIA 92253 Owner Mailing BUILDING: TYPE CONST. OCC. GRP._ Address A.P. Number City Zip Tel. �,.:� � `( �( Legal Description Contract( r� C .` ` Project Description . i7 L ' Address City Zip Tel. State Lic. City & Classif. Lic. # Sq. Ft. No. • No. Dw. Arch., Engr., Size Stories Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip -,,----.,,State n Ltic. # ` ` ,LICENSED CONTRACTOR'S DECLARATION I herebyy affirm th@t I am licensed under provisions of Chapter 9 (commencing with Section - 7000) ofi0iv'i Ion the, Busi tress and.Professions Code, my4wense is in full force and effect. � \l� '��'�'^- SIGNATURE DATE _ OWNER -BUILDER DECLARATION' Estimated Valuation I hereby 'affirm tha ,l 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 permil 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 PERMIT AMOUNT 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 /y��� �-• 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 (8500). I.; I, 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. 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 f3 of proving that he did not build or improve for the purpose of sale.) I'1 1, 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 does not 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.) 7 --- - . I.. I am exempt under Sec. B. & P.C. for this reason Grading Driveway Enc. PA, icl Date Owner Infrastructure WORKERS' COMPENSATION DECLARATION B 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 ❑ Copy is filed with the city. O Certified copy is hereby furnished. Mill' I"- 0 A TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) v ,. 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 ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 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.) Side Setback from Property Line Lender's Name' Lenders Address FINAL DATE INSPECTOR This is a building permit when properly tilled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. Issued by: Date Permit .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. Validated by: Signature of aQplicant Date Mailing Address Validation: City, State, Zip WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Desert Sands Unified School District Notice: 82-879 Highway 111 Document Cannot Be Duplicated Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE Date 3/6/98 APN # 773-203-013 No. 16698 Jurisdiction La Quinta Owner NameDavid Ross Miller No. 52-025. Street Avenida Juarez City La Quinta zip 92253 Permit # Log # Study Area Tract # Lot # Square Footage 1410 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 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 amo,Lnt of .- 1.93 X 1,410 or $ 2,721.30 the property listed above and tha nuildingt permits and/or Certificates of Occupancy for this square footage in this proposed project may now,be issued 4 Fees Paid By CC/Capital Bank of North County/David Miller Telephone 967=0069 Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Rosita Jones Payment Received $2,721.30 Check No. 052401 (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 run 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 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 - Accounting 4V i' FEB.20.1998 5:14P.M COMMONWEALTH RECORDING RSQtTZSTED 8Ys OLD REPUBLIC TITLE COMPACOM13ANY 98.7174KC 106030-13 WHEN RECORDED XAIL THIS DRED ,i►14D, UNLESS OTHERWISE SHOWbT BELOW, KUL TAX STATZMMS TO: DAVID ROSS MILLER NO. 039 P.1/4 GDA W TEED APHs 773-$03-013-8 IF The undersigned grantor(a) declare(s).- Documentary eclare(s):Documentary transfer tax is $16.50 0=) Computed on full value of property conveyed, or ( ) Computed on full value less liens and encumbrances remaining at time of sale. ( ) unincorporated area: ( ) City of and FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, DAVID GRIMMETT, AN UNMARRIED MAN hereby GRANT(S) to DAVID ROSS MILLER, A MARRIED MAN AS HIS SOLE AND SEPARATE PROPERTY the real property in the City of LA QUINTA, County of Riverside, State of California, described as! LOT 2, OF BLOCK 6, SANTA CARMELITA AT VALE LA QUINTA, UNIT NO. 1, AS PER MAP THEREOF RECORDED IN BOOK 18, PAGES 46 OF MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA Dated 8ehrary 2, 3.998 State of California County of RIVERSIDE } S.S. On MRIYARY 20, 1998 before me, KnLY COLLIER, NOTARY PUBLIC , personally appeared DAVID GR OMTT 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 with.in instrument and acknowledged to .,me that he/she/they executed the name in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument t person(s), or the entity upon behalf cf whichtht� pe1 \ n(s) acted, executed • the •instrumetlt . ( 1'� A WITNESS my a d of ici se Signature UArL TAR STA 8 TO' KELLY COLUR Comm, i 1057217 NOTARY a' Nb came. apr� M28,1899 (This area for official notarial seal)