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9805-088 (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 Exp. Date 4 2 NM 13 7/31./98 / vDate /� Signature of Contrail r, OWNER -BUILDER DECLARATION I 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. S,<) 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 � 7!, . ,t Policy No. Ac• . .�TA,a,�.f.3i� �.�.:sfi`1`,�t4 (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 CCo'de,.I s all forthwith comply wit t Ose provisions. Date: % 69 Applicap: _Y4 144f,/ il, Warning: Failure to secure Wo kers' 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 inspectidn purposes. f ,,Signature (Owner/Agent) ^jA__Dat M � CONTROL# BUILDING PERMIT PERMIT980415-081; DATE VALUATION S..(i(4,$68.00 LOT 11 TRACT 17,115 J1l 19/56 IrFf.7� `1 JOB x -. 10 /,�. 1./� APN 7733 (6s_otl ADDRESS , OWNER CONTRACTOR/DESIGNER/ENGINEER DAN':►,IJP ROSS 4lI.i,,LE2 PACIFIC TR-ADV'S C4:iNSTRC. MION 170- jh S TPLEN10M 17 .19 S'i'kTIN( INT S OCEANS I DE OCEANSC.A. 92Wq S OCEANSIDE C`•A. 92054 (760).967-0069 011111.1 1955 ' USE OF PERMIT tii�i1 t 91-U - K'sR,WI T 1 OEN 146T I14C:L UDE BLOCK WALLS Ca li00, T, TRACT t ONO S'l�J.�UC1101.4 87.1U 0 9 i999 fal3lt(:Pf%1.�J�1'JCJ 42.(K) V i.Yf\#i.tt iFJr;Af `iilt'1' 471.00 Yl? � 1; F 1', W'C:K��1:1'FENC'R 200.00 LF ESTIRAI°.TED MTf OV i:.°;;�N'ST.9WJUa ICON 10O.M.00 P:FIRMii'd' FEE 3"W,aARY C0N.Stt0C`1'!0%F4 Ml', SCA1.00 151yAN CHECK FR $549.18 1k X,'13A.V1:GAL ME 301-000-421-000 - E1r- :'ir(dZ;;AL FEE 1.01-000-420•000 31:►9.�3 Pi:t-N911.NE)VIM, $148.50 ,qT1 ONG MO'E'SGN 1'3:7:•- t2ESM 1.0 -000-141-O(V `610.09 GRADING FEE ;01_000-423-000 320.00 1N1`-*RK&TI iT(:,"rtJitBVEC '22S-000-443,342 $Z21f8.7J PlIECIS13, PLAN 101-000-441-34-5 $25.00 AXT iii T110.1C .1C PLAc ES - RFST -1014)0-2.55-000, 117 FEE 1 *3:' slll 101-000439-318 ;+r)1'3-'310'['4' i. C'0N9T`( JJC'iJ0N ANTS KAN C1K.QI:CK i T.,E:'S ,PRE-t�AiC> FEES -$250.00 TOTAL PCMMIT FBV'.S :'0UET40W U S71.i's RECEIPT DATE By, DATE FINALED INSPECTOR A , INSPECTION RECORD OPERATION DATE I.INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs c_A Underground Ducts Forms & Footings 0 Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap? _ _ F.A.U. Framing Compressor Insulation _ fuloa 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 // 3 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 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 COMMENTS: /, p %1�X �jll/�!� !r►�i�ZL 9��0 Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole f Underground Conduit Rough Wiring Low Voltage Wiring FBdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final c _ Utility Notice (Perm) ��o Building Address_ 2�0 AV P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA CALIFORNIA 92253 t t • Uwner Mailing Address 1 9 S �•� ae. (City Zip Tel. L �C�AvJ�.9i Contractor ,, 1\ �.', I, '71-,Z 0��. 5 Address I City izip Tel.. State Lic. G City & Classif. �� Z S 3 D Lic. # c1 S S Arch., Engr., Designer Address Tel. City IZip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I heretiy`afllr that I �m licensed undpr_provision' sof Chapter 9 (commencing with Section OQO) of IV that h��8usin`ess and Professions bode, and my license is in full force and OWNER -BUILDER DECLARATION I hereby affirm that I 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'— issuance also requires the. applicant for such permit to rile 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 or 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). I-] 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, 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.) 1] I, asowner 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 contractors) licensed pursuant to the Contractor's License Law.) 1-1 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I 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 r7 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. 1 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 a0plicanl Date Mailing Address City, State, Zip APPLICAT'101W IAM998 .d i 1 Y ®F L A QUINTA ILDING: TYPE'CONST. : OCC. GRP. / f. Number 7-n '4 �� ' oil >•' ial Description , U Iject Description Sq. Ft.1 (p No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ L Estimated Valuation 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 INSPECTOR Issued by: Date Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 7/9/98 No. 17310 Owner NameDavid Ross Miller APN # 773-065-011 Jurisdiction La Quinta Permit # No. 51-240 Street Avenida Velasco Log # City La Quinta Zip 92253 Study Area f Lot # Square Footage 1,646 Single Family Residence No. of Units- 1 Tract # Type of Development Comments 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 1.93 X 1,646 or $ 3,176.78 the property listed aboveaa`nd iliat"buildings permits and/or Certificates of Occupancy for this square footage in this proposed project riay row be issued;: =3 Fees Paid B Capital Bank of No. County/Pacific /Pacific Trades Cons. ' _ Y P t3' �',} �� elephore7�y0-967=0069 Name on the check By Dr. Doris Wilson `- 4L�~., Superintendent J Fee collected /exempted by Juanita Green Payment Received $3,176.78 Check No. 055080 Signature `!i zdz!L� NOTICE: Pursuant of embly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 day approval period in which you may protest the fees or other payment identified above will begin to ru om the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to collect them on the Di2i., behalf, whichever is earlier. Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting - r J 7/LV/�V 1VLi lY•VV 1'AA 1V IJV VVUVIV RECORDING REQUESTED BY: AND WHEN RECORDED, MAIL TO: David Ross Miller 1719 S. Tremont SOUTH OCEANSIDE, CA. .92054++: ultia1,11:11'ea uranror(s) declare(s) that the DOCUMENT TRANSFER TAX IS:-, TiTLE ORDER NO:: 820S103 24.75 County s city ESCROW NO.: 17766-004 XX computed on the full value of the Into of property COrlVeyed, Or --. computed on the tui[46e less the value of liens or encumbrances 4 remaining thereon at the time of sale G RA N.T D► E E D _ OR transfer is EXEMPT from tax for the fdl 1 s - owing reason: FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Henry C• Griswold; trustee' hereby GRANT(S) to David Ross Miller, a married man as his'sole-and separate property: all that real property situated in the - City of La Quinta County of Riverside , State of California, described as: LOT 11 IN BLOCK 69 OF SANTA CARMELITA AT VALE LA QUINTA; UNIT NO. 9.,AS SHOWN'BY MAP ON FILE IN BOOK'18, PAGE 69 .OF MAPS, RECORDS OF RIVERS ID$ CUNITY,.CALI,AS SH ' IA Dated Aril 22, 1998 STATE OF CALIFORNIA, } ' " Y Henry C• '�Griswold-, trustee COUNTY OF ss. 0" , before me , Notary Public, personaily appeared 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 i authorized capacity(les), and -that by his/her/their slgnature(s) -on the Instrument the person(s). or the entity ,upon behalf of which the.person(s) acted, executed the instrument: WITNESS my hand and 'official seal. Signature MAIL TAX STATEMENTS TO: , (rhi..sto.ofM&j„oUgw4g SAME AS ABOVE= '• NAME ADDRM ' QTY, STATE l DP �y AT ER ESTABLISHED IN 1918 AS A PUBLIC AGENCY aiSTM0 COACHELLA VALLEY WATER DISTRICT POST OFFICE BOX 1058 • COACHELLA, CALIFORNIA 92236 • TELEPHONE (760) 398-2651 • FAX (760) 398-3711 DIRECTORS: OFFICERS: JOHN W. McFADDEN, PRESIDENT STEVEN B. ROBBINS, PETER NELSON, VICE PRESIDENT GENERAL MANAGER -CHIEF ENGINEER TELLIS CODEKAS MARK BEUHLER, RUSSELL KITAHARA ASST. GENERAL MANAGER PATRICIA A. LARSON JULIA FERNANDEZ, SECRETARY DAN PARKS, ASST. TO GENERAL MANAGER May 11, 2004 REDWINE AND SHERRILL, ATTORNEYS File: 1112. Luzma Bassi 42-500 Bob Hope Drive Rancho Mirage, California 92270 Dear Ms. Bassi: Subject: Account No. 606014,470.0.4 51-240 Avenida Velasco, La Quinta In response to your inquiry, this district does not have available information regarding the completion of actual hook up to our sanitation collection system for the above -referenced property. In researching our records, we found that the subject property has met our sewer requirements. It is the homeowner's responsibility to connect their pipeline to the sewer lateral. If you have any questions please contact Rosie Anacleto, Customer Service Representative, extension 2420. 9I� bc: City of La Quinta Post Office Box 1504 La Quinta, California 92253 Yours very truly, Richard Shonerd Customer Service Supervisor TRUE CONSERVATION USE WATER WISELY