Loading...
0306-187 (SFD). LICENSED CONTRACTOR DECLARATION 1.;,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 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 mate`&` IP; ' 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. (This section need not be completed if the permit valuation is for $10.0.00 or less). (d) 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. 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 i 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 rep esentatives of this City to enter upon the above-mentioned property for,.insrction purposes. Signature (Owner/A`geert)'101� J�- P 1W5 V'JP. SFD P.'?E.R.t 'I 1)00 (7'Y iklF.;I.. J'OC 1�i., C;K"th►r.i,L; T•' OI. �%,ra TAA'DT 1. L!110.001 10 'Pa<i�5.•i;.l�dlsaPN�:>'PIf-1 1:?';�1aet�� �� F .. �on:f�:k4�'1� � t,'�Kt�7:• �;;�:�" r;�;�.'�S°4'�?�t:«`�`.143JV :D<:�;y,;,ti!►a.+� CONs'1' UC.')'IOW.F ":011-OC9, 741SA' 0 K,AV CKiQCK ng FEF IID:E1i*0$17 1Q1- C4f=4 : i8 -$`g IN }��.:7}ll:l�kl+iCf `a73'�'s �i�y-Q�i?-+�i1'�^•4F�3e`,) '�.1��t.fi�`• ' +STC W,? MOTION F)�>;,. - r;V, ►'1la 101 -0004 A! •:Y40 $11-46 101-00 OeA41 3 $17P2,t3f2 iiia,-�3°f:�;I;i�:L,�t;;Cik�1;3"(:1ttE(�14i•,!�3:�`:a:���.,�1Pif'�E�l�t:'�� eii•�,"� `'�'.:�,� Er? .._ .., I '4'i�.t..°:E�.##i :!•'.. FJ't1v 1<is?1, >at�3,,i' .iS3 SEP 0 803 CITY O� ire UNTA . FINANCE DEPT. RECEIPT DA ;r BY .µms.- DATE FINALED L INSP�63gR - BUILDING PERMIT PERMIT# DATE �i�VALUATION ��qq dd qq ��6y��yy .LOT .: - , TRACT 147<w , ' xr. JOB SITEa}� ' APN ADDRESS.4"'Fo'caMA AVp OWNER CONTRACTOR / DESIGNER / EN (NEER hyy9.o1;1�Y�y.:ft±',fi,- ix''cU`6Y} nrzv ,:,wc. PALMI D1DT0 3`.'' 92:261 USE OFPERMIT MXi, FM'4DIp YI}' dO 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 i 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 rep esentatives of this City to enter upon the above-mentioned property for,.insrction purposes. Signature (Owner/A`geert)'101� J�- P 1W5 V'JP. SFD P.'?E.R.t 'I 1)00 (7'Y iklF.;I.. J'OC 1�i., C;K"th►r.i,L; T•' OI. �%,ra TAA'DT 1. L!110.001 10 'Pa<i�5.•i;.l�dlsaPN�:>'PIf-1 1:?';�1aet�� �� F .. �on:f�:k4�'1� � t,'�Kt�7:• �;;�:�" r;�;�.'�S°4'�?�t:«`�`.143JV :D<:�;y,;,ti!►a.+� CONs'1' UC.')'IOW.F ":011-OC9, 741SA' 0 K,AV CKiQCK ng FEF IID:E1i*0$17 1Q1- C4f=4 : i8 -$`g IN }��.:7}ll:l�kl+iCf `a73'�'s �i�y-Q�i?-+�i1'�^•4F�3e`,) '�.1��t.fi�`• ' +STC W,? MOTION F)�>;,. - r;V, ►'1la 101 -0004 A! •:Y40 $11-46 101-00 OeA41 3 $17P2,t3f2 iiia,-�3°f:�;I;i�:L,�t;;Cik�1;3"(:1ttE(�14i•,!�3:�`:a:���.,�1Pif'�E�l�t:'�� eii•�,"� `'�'.:�,� Er? .._ .., I '4'i�.t..°:E�.##i :!•'.. FJ't1v 1<is?1, >at�3,,i' .iS3 SEP 0 803 CITY O� ire UNTA . FINANCE DEPT. RECEIPT DA ;r BY .µms.- DATE FINALED L INSP�63gR 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 O Exhaust Fans O.K to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath � � - Final Final BLOCKWALL APPROVALS POOLS - SPAS 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 CT --c 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 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: CERTIFICATE OF COMPLIANCE J�1FSc Desert Sands Unified School District o� 4 �o 47950 Dune Palms.Road `,� /► q Q BERMUDA DUNES •r Date, 9/5/03 La Qulnta CA 92253 En RANCHO MIRAGE t� I {� INDIAN WELLS ti . ALM DESERT No. 24919 .(760) 771-8515 dd P LA QUINT �y Owner Mountain Cove Dev. Inc APN # 774-065-003 Address P O Box 3578 Jurisdiction La Quinta City Palm Desert Zip 92261 Permit # 0306-,'87 Tract # BLK 204 Study Area. Type Single Family Residence No. of Units 1 Lot # No. Street S.F. Lot # No; Street S.F. Unit 1 22 53060 Avenida Navarro 1913 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments At the present.time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiosiwalkways, residential additions under 500 square feet, detached accessory structures (spaces that do not contain facilities for Irving, sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that the above-named owner is exempt from paying school fees. at this time due to the fol -owing reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $2.14X 1,913 S.F. or $4,093.82 have been paid 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 CC/Canyon National Bank - Larry Shields Check No. 1544D Name on the check Telephone 760/71.1670 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exepted y S harpq McGil Freya Payment Recd $o.00 - $4,093.82 Over/Under Signature I 1.0l NOTICE: Pursuant to Government Code Section' 66020(d)(1), 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 issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document. NOT VALID if Duplicated Embossed Original - Building Department/Applicant Copy - Applicant(Receipt Copan - Accounting � L MHY-1b-2003 00:18 P.01 Q a2ireize®200 Fee.19 037 Recording h �'i:(:cJiLd tJ� Pays 2 of 2 8:0 T Tex P9 0 First American Title, Company Raeerded in offlo[al Records County of RJv�rside Cary L. oryo Asbesaor, Coi,"y Cl*rk 8.keeorder. When Recorded Mail Document and Tax Statement To: tv1 r • Larry Shields �Il�lll� P.O. Box 3578 b I U.. PAGL' ass CA PCOR NOWRTI e..► .nlleo - 3 ._ Palm Desert, CA 92261 it A R CDPY LOlC FiF7ND NCHG E7tIW SP�OVE THIS LlnE FOR AFc0RDEq'S> USE The undersigned grantorls') declare(s) Documentary transfer taX . is 8195.00 I X computed on full value of property Conveyed, or ( computed on full value less value of liens or encumbrances remaining at time of sale, 1' w I I Unincorporated Area City of La Quinta FOR A VALUABLE CONSIDERATION receipt of which is hereby aakhowledged, Frank Myrl Griswold, Successor Trustee of The Henry .Griswold Living Trust dated June 19, 1995 hereby GRANT(S) to Mountain Cove Development, Inc., a California Corporation the following described real property in the City of La Quinta County of. Riverside, . State of California: v DATED: January 31, 2003 STATE OF CALIFORNIA COUNTY OF C -W. ON before me, ` personally appeared personally known to me (carproved to MA on the basis of satisfactory evidence) to be the person whose namei is!ake subscribed to the within instrument and acknowledged to me that; he/shgitMW xscuted the same in his/htr/their authorized capacity(l and that by his/I%/th`i4r slgnature� on the instrument the pdrson 1 or the entity upon behalf of which the person\ acted, executed the instrument. Witness my hand and official seas. Signature U C� Frank Myrl Griswold, Successor Trustee of The Hanry Griswold Living Trust dated June 1 1,995 dwf-f ee- Frank Myrl .Griswold, rustee LINDA A. GAGNON Commission 0 "31309 E Notary Public • California ,t Orsrnge Cainty MyC:or—. Expires Sul 13, 2005 MAIL TAX STATEMENTS AS DIRECTED ABOVE FD -2:3 (Rev 7961 GRANT DEEO .