0305-152 (PLBG)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
482,180 C21 CX1211f3QW,
7
�— / 1 /,
Date Jp� J Signature of Contractor ft 47
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 VIRCJINJA SURETYC! Policy No. DK 000747
(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:. Applicant � � �1r /,? 47
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.
Signature (Owner/Agent) lW/ Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 03W4 5.12TRACT
JOB SITE
ADDRESS 514" AMMMA CORT 7.
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
51.790 AVENIDA COR'I'EZ
36'703 W rA DKIVE
LA QT.JWrA CA 92253
QA�) AL CITY SQA 19=34
(760)324-1911 MI 769
USE OF PERMIT
PLilWBING
F,FPT1C:ABANDON; 30",R. HOOK -U1)
VALUATION 213.%00 iii
rl�.�aMIr TKIE 1TUMNURY
PLC: MB100 FC -F,,. SWFR 101.000.419.000 $30.00
p ;
MAY 15 2003
CITY OF Lit QUiNTA
_.
FINANCE DEPT.
SUD-T OTAL C:O I',RT.€C7'10W AA) PLAN C -I CK
$30.00
IMS MP FIMS
$0.00
` C R'AL PIle, R IT F'.RY5 DUE NOW
M.00
RECEIPT
DATE
BY
DATE NAL
INSPECTOR
I �"
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 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
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. t
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
5
" '
co
COD
Escrow No. I RAN5-CAL ► i i i~E GO.
Loan No.
WHEN RECORDED MAIL TO:
Richard J. Siddons
76-724 Daffodil Drive
Palm Desert, Ca., 92260
MAIL TAX STATEMENTS TO:
I___ _ ABOVE ADDRESS
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SPACE ABOVE THIS LINE FOR RECORDER'S USE
DOCUMENTARY TRANSFER TAX $ ... AGI.Nel ........................
...... Computed on the consideration or value of property conveyed; OR
...... Computed on the consideration or value less liens or encumbrances
remaiping at time of sale. /
nature of Declarant orA9ent d rmining tax Flr Name
l
QUITCLAIM DEED
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
RICHARD JOHN SIDDONS AND BONNIE M. SIDDONS, HUSBAND AND WIFE,
do hereby REMISE, RELEASE AND FOREVER QUITCLAIM to
RICHARD JOHN SIDDONS AND BONNIE M. SIDDONS, HUSBAND AND WIFE, AS JOINT TENANTS,
as to an undivided 1/2 interest and GREGG KARMAN, as to an undivided 1/2 interest,
the real property in the City of La Quinta,
County of Riverside State of California, described as
Lot 23, Block 30 of Santa Carmelita at Vale La Quinta, Unit #2 as shown
by map on file in Book 18, pages 55 and 56 of. Maps, records of said
county.
Dated December 21, 1987
I
STATE OF CALIFORNIA }ss.
COUNTY OF Riverside }
nn December 21, 1987
before me, the undersigned, a Notary Public in and for said State, per-
sonally appear&l chard JohN Siddons
and Bonnie M. Siddons
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.
WITNESS m nd an official seal.
i
Signature��
MAIL . AX STATEMENTS
Ri r John Siddons
Bonnie M. Sic�c�ons
fr 3 t 1 v .,y,•.�r .-
h
n(� i. -' -•-�. -. air ' - Ir: -•r:
(This area for official notarial seal)
AS DIRECTED ABOVE
1085 (6/82)
r
RECORDING REOUESTED BY
TRANS-QAL 17-11 LE Co.
AND WHEN RECORDED MAIL THIS DEED AND, UNLESS
OTHERWISE SHOWN BELOW, MAIL TAX STATEMENTS TO:
NAMtcI
Richard J. Siddons
STREET 76-724 Daffodil Drive
ADDRESS '
Palm Desert, Ca., 92260
CITY, '
STATE
ZIP L
'9 0 G a` /L i E 7�
Title Order ...... Escrow No ... 1.9'$7.7..0 i This space for Recorder's use
Grant Deed
THE UNDERSIGNED GRANTOR(s) DECLARE(s)
DOCUMENTARY TRANSFER TAX is $ 8.25
❑ unincorporated area ® City of La O u i nt a
Parcel No. 773-153-002-4
❑ computed on full value of property conveyed, or
[-)computed on full value less value of liens or encumbrances remaining at time of sale, and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
STANLEY A. SMITH, TRUSTEE OF THE STANLEY A. SMITH REVOCABLE
INTER-VIVOS TRUST, u/d/t December 26, 1984
hereby GRANT(S) to
RICHARD JOHN SIDDONS AND BONNIE M. SIDDONS,
HUSBAND AND WIFE, AS JOINT TENANTS
the following described real property in the
count)- of RIVERSIDE , state of California:
Lot 23, Block 30 of
as shown by map on
of said county.
Dated October 8, 1987
Santa Carmelita at Vale La Quinta, Unit No. 2,
file in Book 18, pages 55 and 56 of Maps, records
STATE OF CALIFORNIA
COUNTY OF C4 e— SS.
On this day of in the year
G$ 7 before me, the undersigned, a Notary Public in
and for said County and State, personally appeared
Stanley A Smith
personally known to me (or proved to me on the basis of satisfactory
evidence) to be the person r whose name
subscribed to the within instrument and
acknowledged that he- executed the
same.
Signature��
Name (Typed or Printed)
Notary Public in and for said County and State
kfl a V/',
.� j
an ey mi
OFFICIAL SEAL
CINDI QUALLS
qb
NOTARY PUBLIC • CALIFORNIA I
PRINCIPAL OFFICE IN
ORANGE COUNTY
My Commission Expires August 9, 1991
FOR NOTARY SEAL OR STAMP
MAII. TAX STATEMENTS TO PARTY SHOWN ON FOLLOWING LINE; IF NO PARTY SO SHOWN, MAIL AS DIRECTED ABOVE
Name
1.101
Street Addresi` ti,
City B State
A_,_
.44- --
4=6- ,?
OF �
R
OFFICE OF
E. LEON SPAUGY
AGRICULTURAL CQiMMISSIONER
COMMISSIONER
�1 s
AND
JAMES 0. WALLACE
O d
V
ASS;S;A%t COMMISSIONER
S�
WEIGHTS & MEASURES
CLEMENT
SEBENVENISTE
49-613 Hwy 86, Suite B-12
���,,",,,•'3
'Coachella, CA 92236
4 r 9, t Sq
619-342-8291
DATE �1 L �� 5� CASE NO: at_at : S�
DEVELOPER'S NAME: K, /� i, [ 1's to-,bAj Q
ADDRESS: -7 L. `7OE L
TELEPHONE:
Dear Developer:
After reviewing your landscaping plans, all plant material listed is not in
violation of quarantine laws.governing the Coachella Valley. If substitutions
do occur and they differ. from plant material listed, this office must be notified
immediately.
Thank you for protecting and preserving the Coachella Valley's pest -free environment.
Agricultural Ccmu.ssioner's Office
cc: Indio and Riverside Office
� f _70/c> C-0 P_-rlt` Z L A. Q U I a1`7'v�
1-en�'T 2-,-2,
i IN
CASH RECEIPT DETAIL
Received From: Ple
Address:
Account No. tr��' '� �y�r
Cf'Y`
i3Ot(s)
Service Address
❑ Meter(s)
Service(s)
❑ Backflow(s)
❑ House Lateral(s)
❑ DetectorCheck(s)
—
❑ Meter Surcharge
N!IQ Sanitation Capacity Charge
❑ W.S.B.F.C.
11 Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account- Namo
Ll Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water. I Sewer --
Tract--
❑ Bond Payment - A.D. - Bond
❑ CustomerDepo,
❑ Other
fly 95391
TOTAL $
Remarks: �L�E �rf
,Copy to: -
Cash WaterServloe
Check
.•vim .5.:. fi {{
Money Cashl
Order.GVWD-438 (11109)