9903-195 (RER)LICENSED CONTRACTOR DECLARATION
U) reby affirm under penalty of perjury that I am licensed under provisions of
H I!hapter 9 (commencing with Section 7000) of Division 3 of the Business and
W, ),rofe sionals Code, and my License is in full force and effect.
=)„, ; License # Lic. Class Exp. 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). _
O I am exempt u der Section B&P.C_ . for th;s;teason T
Date T” �f; Signature of Owner--- - l
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 Policy No.
(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
Pode, I shall fortwith comply with those provisions. %
Date: Ret 4f;,ri' Applicant
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. l
Signature (Owner/Agent) =Y s < f it Date f
BUILDING PERMIT PERMIT#
"�l1�»1y5
DATE VALUATION 96,940 .4g) LOT 27. TRACT 73769
JOB SITE
ADDRESS 1SS 7" 0 S;O1i1��;SWTA AY APN 604-151-016
DOWNER
/33 J. r �?�1T�'�,t�.u',t�U it
8810 SC7t ESTA WAS`
LA QUINTA CA 92253
CONTRACTOR / DESIGNER / ENGINEER
C 13flif
USE OF PERMIT
RESiDNTIAL RC�.:,ivx(.1DEL
CONVI IT PORTION OF GARAGE TO FANIILV it+JOM
N-0.60 17T
IF
PER.MU .Mi E S4 UnWiiRV
PLAN t;HECK Ed
t01-00()-439-318
S."4 50
iY'iwgTRi ir-r .w 0r.
101-(1418-41 f, ()4M)
").(X)
Mfit~"IM11+1[cAl. FEE
101.000"4:.1.000
521.50
! L.fs(;,MICAL. FEE
i01 -dip 420 -WO
514.00
:i'PE(ONG M(YrION FRE - RE•S10
101.0W-241-000
V?F
SLIB-T 3'IAi, CONR ti JC'iION AND 1s1.,AN 0411 -'CK
LESS. M, E, -PAID FEES
T'C19 A1, f'i; 't49.4`f
FEE'S DUE NOW
TE I BY DATE FINALED I INSPECTOR
6,940.00
119 69
$0.00
$089.69
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
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.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
_
r
Desert Sands Unified School District
47-950 Dune Palms Road
=Notice: La Quinta, CA 92253 k...
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE ,
Date 3/29/99 APN # 604-151=016
No. 18505 Jurisdiction `La Quinta
Owner NameAdele Dannebaum Permit #
No. 78810 Street Sonesta Way Log #
City La Quinta Zip 92253 -Study Area +
Tract # Lot # Square Footage 200
Type of Development. Residential Addition No. of Units 1
Comments
onvert portion ot garage to tarmly room
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:
Residential Addition 500 Sq Feet or'Less ,
EXEMPT,
This certifies that school facility fees imposed pursuant to Government Code 53080 in the ate.. au'nt of
0.00 X 200 or $ 0.00 the property listed above and that Building t7"
permits and/or Certificates of Occupancy for this square footage in this proposed project may noSi"--;issued
Fees Paid By n/a}
Telephone 345�h8b2 --
„�. t V;
' Name on the check ��'�y,�"�
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Adriana Gauto Exempt
Check No.
Signature',
$0.00
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 71
collect them on the District('s)(s) behalf, whichever is earlier. r
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'
Mark Dannebaum
78-810 Sonesta Way.
La Quinta, CA 92253
March 15, 1999 '
City of La Quints
Building & Safty. Department
78-495 Calle Tampico ,
La Quinta, CA 92253 i
To whom it may concern:
As the owner of the single family residence at 78-810 Sonesta Way, in the City of La
Quinta. I am authorizing Mr. Jack Godwin to act as my agent in regard to the construction
• and remodeling of my garage.,
Sincerely, ,
Mark Dannebaum
1 •
. 1
,r
ADELE DANNEBAUMi
78-810 SON ESTA WAY
LA QUINTA, CA 92253
•
MARCH 24, 1999
THE CITY OF LA QUINTA -
78-495 CALLE TAMPICO
LA QUINTA, CA 92253
BUILDING & SAFETY
ATTN: GREG BUTLER
DEAR GREG,
MY SON, MARK DANNEBAUM, HAS MY PERMISSION TO PROCEED WITH THE PLANNING AND
CONSTRUCTION OF THE GARAGE ADDITION AT MY HOME AT 78-810 SON ESTA WAY.
SINCERELY, r
ADELE'DANNEBAUM
l�
RECORDING REQUESTED BY
Stewart Title Cmpany
F
AND WHEN RECORDED MAIL TO
I
NAME Adele F. Dannebaum
ADDRESS 78-810 Sonesta Way
CITY& La Quinta, CA 92253
STATE I
NAME
MAIL TAX STATEMENTS
CL
O
W
a
QZI
SPACE ABOVE THIS LINE FOR RECORDER'S USE
Documentary transfer tax $ 137.50
same as above +J Computed on full value of property conveyed, or
ADDRESS ❑ Computed on full value less liens & encumbrances
CITY& remaining thereon aitime of sale.
STATE Lr _'�f � •�'
�Signgnat-urgpf_declarsntoragent-deonMittFR-tetC�-fltm•Yiam--- e'_'�"�'--
❑ Unincorporated area City of 1a Quinta
Escrow No. _. 210557___
Title Order No. -- — I Grant Deed
—L-6-0 dl -.6.
L'1 THIS FORM FURNISHED BY STEWART TITLE COMPANY OF RIVERSIDE COUNTY,
FOR A VALUABLE CONSIDERATION, receipt of whichvs hereby acknowledged,
TRIAD PACIFIC DESERT DEVEOPMENT,a general partnership organized under �10t�•
the laws of the State of California t
hereby GRANT(S) to
Adele F. Dannebaum, an unmarried woman
the following described real property in the City of La Quinta
County of Riverside , State of California:
Lot 27 of TRACT 23269, as Shown by Map on file in Book 205'page 86 to 94,`.:-
r_-.,,;-_ clusiver--nf-Maps, Records- Of, Riverside -,Cour
ty;:--Cetlifornia: - _-----.--_
This conveyance is made and accepted ^and said property is hereby granted u
and
subject to each and all of the Covenants, Conditions and Restrictions contained in
that certain Declaration of'Restrictions recorded August 22, 1989 as instrument No.
284419 and August 29, 1989 as Instnunent No. 294787 and as modified by an Instrument
recorded October 18, 1989 as Instrument No. 361435, all of Official Records of
Riverside County, California, which by this reference hereby are incorporated herein
and made a part hereof. 1
DATED March 13, 1991
STATE OF CALIFORNIA,
ttounty of*
On before me,
the )un rsigned, a Notary Public in and for the said State, residing therein, duly
eomst ned and sworn, personally appeared
P IY�itit'riµ'n5fit rqe
to be the person(s):
TRIAD PACIFIC DESERT DEVELOPMENT, a
California General Partnership .-.;
By: TRIAD PACIFIC RESIDENTIAL PARTNERS,
II, L.P., a California Limited
Partnership
R & S Acquisitions, Inc. a
California ration,
Its General Partner
utNtaeurry•eviderra)•�:..••.r.�• - _...--- -- --- ------
...._ Gc4T.3•L i�r`r.�ri S4i;G _..r3.syR_i:i l: .. r..Y Y.:.<i:-_.,... .. _.
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
F
For your protection you should be aware that as "Owner/ Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in,his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law to put their license number on all permits for which they
apply. =
If you plan to do your own work, with the exception of various trades'that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer. '
If you are an employer, you must register with the -State ind Federal Government as an employer•and you are subject
to several obligations including State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance. '
For more specific information about your obligations under, Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions. + - "
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they'are performing 'their own work
personally. `
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020N. Street, Sacramento, California 95814.,
Y ,
Please complete and return the enclosed owner -builder verification form'so,that'we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very' truly yours,
CITY OF EA QUINTA
DEPT. OF BUILDING AND SAFETY .
`
.78-495 Calle Tampico
La Quinta, CA 92253
(760)777-7012
(7 77-7011
!�5zl�
OWNER'S SIGNATURE/DATE
i
PROPERTY ADDRESS
W08 - /g z�
PERMIT NUMBER(s)
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