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0008-263 (SFD)LICENSED CONTRACTOR DECLARATION I her eby 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. "s"L'cense# Lic.Class' Exp.'Date 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). () ;Ieam exempt under Section B&P.C.'for this'reason dVte 1/A/%'..ft_) Signature of Owner, ,n�.- 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 Section3700'of the Labor -Code, for .the performance of the work for which this perrriit 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 ho.' 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�ompensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor C&B, I shall forthwith comply with those provisions; gate: ` 0 ///20 Applicant l IS -l'. 1,76 . i j, Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal. penalties and civil fines up to $1.00,000; 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 subjectto 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 e thtiove-mentioned property for inspection purposes. ,;Signature (Owner/Agent) ��` 5i I Date 1121 00,. BUILDING PERMIT PERMIT# DATE VALUATION LOT -91 TRACT J j1 l�� p q q JOB SITE IAPN ADDRESS 514WO AV°XMA byELA49 C Ok 77;> 174-W7 OWNER CONTRACTOR / DESIGNER / ENGINEER JOSE tylAOTtM MR. OLOR 30.000 Y_0'_ TfMWAWAY 30.9W MCNIZ'9;O"iA'WAY "JTHO T KD M -W CA WI/#s THOUS,AIG) PALMS C.+ii.. (92276 7,78 USE OF PERMIT (ig._ FAMILY DwYaZING SM) - PERMIT DO93 -N&r b'I•SCD:,t P/r, DYdVy3:WAY.APRRCJAC:H%t3&,C}t::t."'b';fAIA. TRACT CONSTRUCTION 1,401.00 SSI{ PORCH/PATIO 369A sit' 110AARACIFICARPORT. (N) 01913100 S h"P. 3Ai'OOD VEINCF: 200.00 LF CONS`FR1,IC TION IOU 101.000 -41R.- l{9 ?$43.511' PLAN C.HECK`. FEE 10 1 18 MECHA arMI t 611. �earPh xa • c�vf) ��a,a© ELECTRICAL, PER,70% %tC`0-4251-CUC1 1' 1.1i�+li41i`�4'7r FRE 1+�I. W-419.000 5116115 S9'RO-00 MOTIC14 FEE • @"r'uSI,D 1 01,-0010-2.'1-000 eSIZAl7a�li�. l 101-000-423-000 SAN. u laliVEWPER IMPACT 1722. $1-",F 00 PHO,IStPLAN 101.000-041-30. $10,0100 I? DEPOSIT 101 00-439 81M-'€OTAL.0"0142rfRUus.". 0.14 AND PLAK CIMCM SS P'.RE—PAW ISWS -VA50.00 TOTALYARIN-1111-TEVS ME NOW RECEIPT DATE BY DATE NALELm INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings�, Ducts Slab Grade j Return Air Steel Combustion Air Roof Deck ?/ O Exhaust Fans O.K to Wrap O ( F.A.U. Framing /'y Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath ,Qta. M.l -a [ Final Final U ffY 4 0/ BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. 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: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole -� Q 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) P.O. BOX 1504 Buildingj 78-495 CALLE TAMPICO Address -5100b&, e / f.56 0 LA OUINTA, CALIFORNIA 92253 Owner�as � mailing ) Address U�- je© City n Izip ITel. �I Address ity lZip Z 7K-1 State Lic. City & Classif. Lic. # I Arch., Engr., / Designer f�b rir / Gf P Z,,. Address / / Tel._ City (Zip (State;2&02S-J I ILA <. -._ Lic.# LICENSED CONTRACTOR'S DECLARATION I hereby affirm that am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason; (Sec. 7031. S, Business and Professions Code: Any city or countywhich 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 or Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). 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.) II I, 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 doesnot apply to an owner or property who builds or improves thereon, and who contracts for such projects with a contractor(S) licensed pursuant to the Contractor's License Law.) 1-7 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 n Copy is filed with the city. O 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 thg 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 Ihereby 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, end'issubject to expiration if work thereunder is suspended for 180 days. - -J .. . 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 applicant Date j Mailing Address City, State, Zip APPLICAON ONLY LDING: TYPE'CONST. OCC.GRP.. f Number al Descriptio n)d"� AAA &' a 6? 4aJI- reA /1" 4'11 " ject Description ua i r- #S" Sq. Ft./ �ia Z No. No. Dw. Size Stories / Units New P-' Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation f PERMIT WOO 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: r 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 10/2/00 APN # 773-174-007 No. 21038 Jurisdiction La Quinta Owner NameJOse Gloria Permit # No, 51-880 Street AVenida Velasco Log # City La Quinta Zip 92253. Study Area Tract # Lot # Square Footage 1407 Type of Development Single Family Residence No. of Units 1 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 2.05 X 1,407 or $'2,884.35 the property listed=above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued Fees Paid By Cash - Elizabeth Gloria . Telepfioeei°r 343-1'278 Name on the check , ":� ;,,• �, f By Dr. Doris Wilson ` . -✓ -- Superintendent s'u. Fee collected /exempted by Ellen Patino Payment Received • Check No. N/A Signature OTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified bove will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to ollect them on the District('s)(s) behalf, whichever is earlier. - Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting RECORDING REQUESTED BY: ��M'.� k Wd AND WHEN RECORDED, MAIL TO: Jose Gloria 30900 Monte Vista Thousand Palms, CA 92276 F&C t) oK eAy/od 94e DOC " t2000-2 1163 05/26/20�I0 08:00A Fee:6.00 Page 1 o i Doc T Tax Paid Recorded in Official Records County of Riverside Gary L. Orso Assessor, County Clerk 8 Recorder _ I III II I II I II I IIIII III IIIII III IIII IIII III IIII IIII III _ M U PAGE SIZE DA PCOR NOCOR I$ INCHGEXAM A R L COPY LONG REFUND EJ ASSESSOR'SPA(CELNO.: 773-174-007-4 Theundersigned Grantor(s)declare(s that the D F AX IS: TITLEORDERNO.: 5091331 $ 17.60 County $ City ,qNj �20�L��4i ESCROW NO.: 002987 -JH xx computed on the full value of the interest of property conveyed, or computed on the full value less the value of liens or encumbrances GRANT DEED remaining thereon at the time of sale — OR transfer is EXEMPT from tax for the following reason: FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Margaret Ann Nesman Mennell, a married woman as her sole and separate property who acquired title as Margaret Ann Nesman, an unmarried woman. hereby GRANT(S) to JOSE GLORIA and ELIZABETH GLORIA, husband and wife as joint tenants as to an undivided one-half interest and JOSE GUADALUPE HERNANDEZ and OLIVIA HERNANDEZ, husband and wife as all that real property situated in the City of La Quinta joint tenants as to an undivided one-half f—R3x ide State of California, described as: interest. Lot 7, Block 62, of to Carmelita Unit No. 5, as Per Map recorded in the Office of the recor er o e County at page 63 of Book 18. of Maps. Dated May 10, 2000 STATE OFC LIFOR } COUNTY OF KiJlC-__)(L 1 s ss. 0 NCI0 before me V L , Notary Public, personally appeared gersp�lly known to me (ter proved to me on the basis of satisfactory evidence) to be the person(s) whose name(e) is/are subscribed to the within instrument and acknowledged to me that 44e/she/they executed the same in _hir&/her/t4eir authorized capacity(lier, and that by bis/her/ttMr signature(s) on the instrument the person(4 or the entity upon behalf of which the perso (s) acted, executed the instrument. WITNESS my fi d androp fficiavu: l. Cinft nnira A � eA RANDEE WEINBERGER Commission # 1197710 z z Notary Public - Carifomia Z Los Angeles County My Comm. Expires Oct 3, 2002 MAILTAX STATEMENTSTO: v (This area for official notary sea]) Certificate of Occupancy City of La Q,uinta r MD 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 .ADDRESS: 51-680 AVENIDA VELASCO Use Classification: SFD - Bldg. Permit No.: 0008-263 Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC Owner of Building: JOSE GLORIA Address: -30-900 MONTE VISTA WAY _ City: THOUSAND PALMS, CA 92276 By: STEVE TRAXEL Date: 05-14-01 Building Official POST IN A CONSPICUOUS PLACE H