0106-041 (SFD)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 Ex/p. Date
�+ 1,-
'bato z { - Signature of Contractor t
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). 01.
( ) 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
r
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.f
(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
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions. &
-Date-.,' ., 2 L Applicant—
Warn! ' ng:
pplicant 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 applicatcn agrees to, & shall, indemnify r'
& 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)' ` `? ( Date-
BUILDING PERMIT PERMITN
DATE J VALUATION LOT OaO6•041 TRACT
26 DLK 146
JOB SITE
APN
ADDRESS
77.3-332401
OWNER
CONTRACTOR / DESIGNER / EN &NEER
PAXYLDR210
PAUL DEM
iii -7151:X°, (111
81-713 .T. -A Y I I i
IND10 CA 92201
1VIDA10 CA 92201
(7 Y3.24-89115 r :uft
USE OF PERMIT
N*FD - LDT 26. PEI`MJT''D0re.SW0T INCLUDE, HSCK: 1NA3"POOLfSPAa:
OR. I RNFI Y APPROACH
S Rfk{:'P. COAPS`i RIUCTION 1.701.00 V
ENTI.' 1'I"D) COST Ole C0L1.N-fl Ui7fI N
101,273,30
P.WmnlFE fferAMARY
C'MR)RUCT1014. 101 -000-418-000 $06.39
F3.A`N C"r 'K, FTIZ 101-000-439-316 $54127
FEE DC.I°OMT 101,000-4.39-318 4250M
NfEC.HAVICAL I;°.E9 101-0,0-421-000 $64.00
I?1,E,1, TWCA1, F89 101 _0001420.1000 $1.116,09
PLF,3§y1BY140 "S ) 01-000.4151-000 $124.00
avji lNo FEZ 901 -WD -423-000 $20,00
i<'�Iti`1r9LOPE.R IMPACT P13E $1,907.00
PTi,I?CTSf;+Pi." 1Qi-tfitaa •1- :� $!bY?.Oti
-
V. 'ON.RRITC.710MAND iyl'.,A MEM
I.Fi P.l"rR-PAIDTm_r,�V
42,1 ,00
1:4
FEB 7 0 8 2002 � AL MiMT, - a 8 DVENOW
10.295 9
RECEIPT
DATE .� °
B,Y::",^
DATE FINALED
INSPECTO
�'�f.�16-7,u2
INSPECTION RECORD
OPERATICN
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings -
Slab Grade
Ducts
ReturnAir
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap ,a $T
F.A.U.
Framing (0- S .a Z
Compressor
Insulation _ p
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 l!>� - U'L— 't
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 Z_ _
Heater Final
Water Piping . o
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection 3� o v
Encapsulation
Gas Piping
Gas Test O - 7
Appliances
Final
COMMENTS:
7 3 0 -o a ac
I' X �,q S
�.lSo�LZtp� ?
(, t i-- •e— - / C' 2 -
Final _
Utility
Utility Notice (Gas)�iU2
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 (y Z
Utility Notice (Perm)
Notice:
Document Cannot Be Duplicated'
n
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
4
Date 2/7/02
No. 22924 `
Owner NamePaul Delio '
No. 77-825 Street Calle Nogales Log #
City La Quinta Zip 92253 Study Area
Tract # BLK146. Lot # 26 Square Footage 1703
APN # 773-332-001
Jurisdiction La Ouinta
Permit # 0106-041
Type of Development Single Family Residence No. of Units 1
Comments
Construction 1703 s.f
Paid in Combo w/Cert., 22923
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
2.05 X 1,703 or $ 3,491.15 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 CCNalley Independent Bank -Paul Delio Telephone 760-324"-8515
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Nicola Wong Payment Received $3,491)<15
Check No. 261985
Signature
NOTICE: Pursuant to Assembly Bill 3081 (CHAP 549, STA S. 1 6) 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 o Ilation 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
y
Order No.- 102631
scrowallo., 6-6632
FIDELITY NATIONAL TITLE INS. CO.
8
c
WHEN RECORDED MAIL T0:
Q
Paul Delio
O.A.-
4i c.,
® a lqq~ }
�Z
81-715 Highway 111
Indio, Calif. 92201
a
$
SPACE ABOVE THIS LINE
FOR RECORDER'S USE
MAIL TAX STATEMENTS TO:
,WUMENTARY TRANSFER TAX $........44 :00
AS Shown above
...... Computed on the consideration or value of property conveyed; OR
...... Computed on the consideration or valueless liens or encumbrances
remaining at time of sale.
Signature of Declarant or Agent determining tax — Firm Name
CORPORATION GRANT DEED
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
T.P.M. HOLDINGS, INC. A NEVADA CORPORATION
a corporation organized under the. laws of the State of,
GRANT to
^, PAUL G. DELIO, A SINGLE.MAN .
the real property in the City of
County of RIVERSIDE
SEE EXHIBIT "A" ATTACHED HERETO
Dated May 14, 1990
STATE OF CALIFOF IA,a '.p lss.
, does hereby
, State of California, described as
r
EXHIBIT "A"
- PARCEL 1 -
Lot 22 in Block 8 of 'SANTA CARMELITA AT VALE LA QUINTA
UNIT NO. 1, as per map recorded in Book 18,page 46 of maps,►" �-
in the office of the County Recroder of Riverside County,
California.
PARCEL 2.
Lot 26 of Block 146 of SANTA CARMELITA AT VALE LA QUINTA UNIT
NO. 15,,as shown by mapon file in Book 1Q _
Records of Riverside Coutny. �,���
CITY OF LA OUIiVTA
BUILDING & SAFETY DEPT.
APPROVLD
DATE ?��1 BY
GpArt .- 1�E0
E rRA'(r�l DA rj6 512-710 Z
d Certificate of Occupancy
City of La Quintal
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
ol%wing:
BUILDING ADDRESS: 77-825 CALLE NOGALES
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0106-041
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC
Owner of Building: PAUL DELIO
Building Official
Address:
81-715 HWY 111
City:
INDIO, CA 92201
By:
KIRK KIRKLAND
Date:
OCTOBER 7, 2002
POST IN A CONSPICUOUS PLACE