The URL can be used to link to this page

9707-137 (SFD)LICENSED CONTRACTOR DECLARATION y1'6ereby affirm under penalty of perjury that I am licensed under provisions of H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and c,4 W ',:Professio6als Code, and my License is in full force and effect. O � M �? " License # Lie Class Exp. Date i \w`ay's' o Z r` /Date �Signature of Contractoro�1. H o 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 r 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). ` O I am exempt under Section B&P.C. for this reason Date J 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. t e) 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. 4'iif4xi (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'thddt a provisions. ( VDat�2 i_'"% x -t Applicant `�- Warning: Failure to secure Workers' Covmpensation 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 propel for inspection purposes. } tjF} t ij r ` i ,�ignature (Owner/Agent1)'`- _,C,; .- Date �• f ' PERMIT # CONTROL # BUILDING -PERMIT 8,216 DATE VALUATION �^'; LOT w " TRACT ti �v JOB SITE ADDRESS 51-7 � Ew�fi��. ID A COIC1142 APN 7l.�.-•A:%110i � OWNER CONTRACTOR/DESIGNER/ENGINEER .. LA. QlAN TA. CA 922K3 - ttil9i�Eu'l.fl2T.► t."i31,,�f 143+;5 USE OF PERMIT ri 17.0 SIM) - PrEki%RT 1XG%8 NO- .t KCLt. DF BLOCK W VJ.9 OR 1h. 0L TRACI' 00N3Tii1,7%•"N0* i; t 1CI Cif; S'^ �1v.tiW�Sstr 41.4111 `moi eG� � itiit'Ai•� �I,�� 4�t•_�Jib �. tii! �,.�y'�:"S,.'!f•a�tlil,.�� .� t•. �•,�+ . ••��ffl4�.tlii E:{:>tJ::t'ktJift'Ir:ytv04t; e NAN ('1114.14 VVV ,In rv1#i� ti��{�1lty rr{, t 1iFi lttl-Qt)t1-1 ,'.-fiiiCr 55:. + };{.{:i."f'ttts:.lt. }�%3: i(!f-tH�!•fixt!-t1[}>'J ;�1ti,'..3z� d }� ..,I;rlfat.F�,,".�3'i:.st;l�•f:!'s-lfa;,,11.1 fJf•ta(!{I-�•�i-Jt.O ��;L rn � e.;{t[tl"+fll`is:0 Ff3ii - � ltil..fHtC'F-«�.3-iri►li .9�ri�txi � ,� yi'"itrf(XN' RJ 4.11 lit (i ' mow- E_CIO f�r•lr+',1^1? trf.rAi tt11.{?tis)..l.tT- idh G'',SJ�1 GV wTfC;CIn;�'"I'w_Ifl71101 AND PIAN CM.""K i k PR12-RAIDFiIt" s e- '144.I'All.l'FAt14i'i' VF-Ai.N 011F,N43W $3,l.�+�.7�► RECEIPT DATE BY DATE FINALED INSPECTOR -• .T. 4ft I INSPECTION RECORD i -OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS ; MECHANICAL APPROVALS Set Backs Af Underground; Ducts Forms & Footings Ducts I _ Slab Grade Return Air I Steel Combustion Air Roof Deck r Exhaust Fans 0. K. to Wrap F.A.U. Framing , _ Insulation Compressor I Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wali Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath i Final Final 17 7- 1,0-� BLOCKWALL APPROVALS POOLS - SPAS steet> Set Backs Electric Bond i Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final_ Gas Piping I PLUMBING APPROVALS Gas Test i Electric Final l Waste Lines Heater Final I Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans f O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping i Gas Test, Appliances Final Final Utility Notice (Gas) ELECTRICAL APP OVALS 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: 7 f u�itrGv 5 I - 795 Avc Coare z P.O. BOX 1504 APPLICATION ONLY Building 78-495 CALLE TAMPICO Address L ti Z. LA QUINTA, CALIFORNIA 92253 -"'D\-t Q" �D vtUSS K, \ \ la_ I Mailing Address ` Contractor Address p I I el. State Lic. City & Classif. (�,j j r 3,C6! I Lic. # ti 9 S Designer Address Tel. State Lic. # LICENSED CONTRACTOR'S DECLARATION\ I hereby tfirm th I m I cpnsed under provisionswPChapter 9 (com encing with Section 000) of Divi.kon 9 toe B iess.,and. ProfesgZons Code, and my Ili a is in full force and OWNER -BUILDER DECLARATION I hereby affirm that 1 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 requires the applicant for such permit to file a signed statement that he is licensed pursuant to 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 subjects the applicant to a civil penalty of not more than five hundred dollars ($500). l: 1, 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, Buisness and 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, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) I1 1, as owner of the property, am exclusively contracting with licensed contractors to con- 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 such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) I-) I am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 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 n Copy is filed with the city. ❑ Certified copy is hereby furnished. 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 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. Date Owner NOTICE TO APPLICANT: If, after 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 shall 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 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 adplicant —Date— Mailing ateMailing Address City, State, Zip BUILDING: TYPE'CONST. ' �' OCC. GRP. A.P. Number UI V Legal Description Project Description V R Ii Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL 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 11INSPECTOR s Issued by: Date Permit Validated by: PA k A� Validation: J U L 2 5 1997 WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION C f -�-N/ ()C: `VDesert Sands Unified School District Notice: 82-879 Highway 111 � 01 922 Document Cannot Be Duplicated Indio, C619 -77A A 922 CERTIFICATE OF COMPLIANCE Date 8/22/97 No. 15995 Owner NameDavid Ross Miller No. 51-795 City La Quinta Tract # Street Avenida Cortez Lot # . APN # Jurisdiction La Quinta zip 92253 773-152-014 Permit # Log# Study Area 112 Square Footage 1410 Type of Development Single Family Residence No. of Units 1 Comments ai ing address: 17.19 S. Tremont S. Oceanside, CA 92054 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: Detached Accessory Structure EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.84 X 1,410 or $ 2,594.40 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 Miller/Cashier Check/Capital Bank of NO. County Name on the check By Dr. Doris Wilson Superintendent Telephone ; `1 .9 y c. Fee collected /exempted by Julie O'Neil Payment Received $2,594.40 n „ Check No. 049980 Signature NOTICE: Pu'suan t sembly 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 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 a istrict('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 AUG 20 '97 01:40PM COMMONWEALTH TITLE RECORDING REQUESTED BY: ORANGE COAST TITLE COMPACOMPANY 97.6693KC R-157794-1 DAVID ROSS MILLER 1719 S. TR' MONT S. OCEANSIDE, CA 92054 GRANT DEED 5 LINE FOR P.1/1 The undersigned grantor(s) declare(a)- Documentary transfer tax is $12-10 (XXX) 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 POR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, ELIZABETH HUARD, an unmarried woman hereby GRANTS) 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 21 OF BLOCK 94 OF SANTA CARMELITA AT VALE LA QUINTA, UNIT NO. 11, AS PER MAP RECORDED IN BOOK 18, PAGE 75 OF MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA Dated June 13, 1997 State of California County of Riverside J S.S. On Jame 16. 1997 before me, Belly Calker _ personally appeared Elizabeth Heard 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 within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument thperson(8). or the entity upon behalf of whic trone pers(s) acted, executed *� t the instrun WITNES my d a�oE •111se Signatu MAIL TAX STATEMEWTS TO SAIF AS ABOVE' °rxn�micrto5�CJos yIa�—� Y. 3s 28, 1899 .a r a xEUY cows ypCRmp 1057217a (This area for official notarial seal) 0