9806-161 (SFD)LICENSED'CONTRACTOR DECLARATION
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 Jt Lic. Class Exp. Date
743967
,,date Signature of Contractor
i_.
OWNER-BUILDER
EC�. ARATION
I hereby affirm under penalty of perjury that II 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 Policy No.
S11INTE FIND
(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 f6v, s of Section 370.0 -of -the Labor
Code, I_shall forthwith comply with those,pjevlsi ns.,.�''�,i
,X Warning: Failure to secure Wo ersCompensation coveragefis unlawful and
shall subject an employer to,crimlgnal penalties and civil fines up to $100,000, in
addition to the cost of compens tion, damages as provided for in Section 3706
of the Labor Code, interest ar�tattorney'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`2his-City o enter upon
the above-mentioned proert�fispection.purposes. '
•r
gnature (Owner/Agent) ��j<�-� ! `Date 7�/19
BUILDING PERMIT PERMIT#
DATE - VALUATION LOT to TRACT `
JOB SITE
ADDRESS/.��•7� AV.VnI I,�1 a` Y�.J.�.:�. L6v
APN 7,73-1 74-0.10
OWNER
CONTRACTOR DESIGNER ENGINEER
Vi1yRLD DEVELOPMENT, rN1C
WORLD DEYrLIrJPfD r NC
`fst3130'X* 13287
PO 13CVX 1328 7
PALM. MF?Rr CA 92255
PALM, DESERT CA 922.5.5
Cf6017714571 0131, 5028
USE OF PERMIT
SPO
f k
.grf3 - WO RW ) m's TR:R 43 (sw) i'fiE2Afer,' 11( �S s g0TrlIDF POOL Op.'
FILOCK Wt\f..1.:S �
i'RA i' c.:O IS?"r 4375A);;.)
PO[ti.;I3/PM 0 03.00 SF
l%A;I'tA:t3krGARlrSj1�'r - _ _ 466.00 SF
6'rif. WCWJDFfsAti"'1i 2M.00LF
r
t WSTIMATxIM CQST Or' CONSTRUFTJI N
87.797.60
PERi44:1AT POW Si lltMAHV
('X-Xi`f RflC1'I0N FE 1f 1-()din-��l2fi-ti(){) r $SFfS.SU
PLAN 0tr 1.KA-"M_. 1.01-Gam?-A:39-a1E1 �I95.52
MUC1iA.' ICAL l".1 E 101•-000421-000 $33.50
f.t;!'ii.ZCa1T..f's:{Ii: =000•420-000
4'i.(,f11B1itit7 FT -2, $1:17.30
NT -110 -NO- NI(D EVOIN i�di - t ,fi4> 9fty-nti(�.?4.l-fits? tf�
ORM3:C110.€11 101-0004211000 320.00
t1V1; Ctt1.� TIIU �`i t'l t 9 P -M 225-00.40-.`: 421 81,885.41
AC-1C:ISli PLAID
1ZEF DEPOSi1' 41250100
SUB -1 MAL CONSTRUC,W)INI U"
J
LESS 1'!1:.E-P.MD FEE's
��:w slj.OFD
'.:atf2C:I$+,Te10VV+
�i3.a3iA3:df►
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVAL'S
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.
FramingL
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath �� 9
Drywall - 19L Lath / 9f
6
Final
Final —
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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
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 7/21/98! APN # 773-174-010
No. 17348 Jurisdiction La Quinta
Owner NameWorld Development Permit #
No. 51-940 Street Avenida Velasco i Log #
City La Quinta Zip 92253 Study Area
Tract # Lot # Square Footage, 1375
Type of Development Single Family Residence No. of Units 1
Comments
r
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 1,375 or $ 2;653.75
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 CC/Valley Independent Bank
Telephoe�e ,;7�7+15>>f71'
Name on the check
_e
By Dr. Doris Wilson
tr C << r
Superintendent
Fee collected /exempted by. Ellen Patino
Payment Received 175,
Check No. 170532 `k,tt«,�
r
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
Fidelity National Title Company
72925 Fred Waring Drive Suite 204 • Palm Desert, CA 92260
(760) 341-4102 • FAX (760) 341 .2076
SALE ESCROW INSTRUCTIONS
Lot 10
Block 62 Date: June 5, 1998
Escrow No.: 1608 -ST
/ V Escrow Officer: Shirley Thompson
Buyer will execute and deliver a new Loan
in the amount of .........................................:... $ 12,200.00
Prior to the close of escrow, Buyer will hand you the balance of down payment
plus closing costs, the sum of ................................... $ 800.00
TOTAL CONSIDERATION ...................................... $ 13,000.00
AND, on or before August 4, 1998, Escrow Holder will be handed additional funds and/or instruments
required to enable Escrow Holder to comply with these instructions, which Escrow Holder is instructed
to use when in a position to procure/issue a Joint Protection Policy coverage form Policy of Title
Insurance from Fidelity National Title with a liability of $13,000.00, covering the following described
property located in the City of La Quinta, County of Riverside, State of California:
Lot 10, Block 62 of Santa Carmelita at Vale La Quinta, Unit 11 as per Map Recorded in Book 18, Page
75 of Maps, in the office of the County Recorder of Said County.
SELLER/TRANSFEROR STATES THAT PROPERTY ADDRESS IS:
Vacant Land/APN #773-174-010, La Quinta, CA 92253 cQ
SHOWING TITLE VESTED IN: r,
World Development, Inc., a California Corporation V 11OP�/
Y
FREE FROM ENCUMBRANCES EXCEPT:
1. Current general and special taxes for the fiscal year in which this escrow closes, and taxes for the
ensuing year, if any, a lien not yet due and payable;
2. The lien of supplemental taxes, if any, assessed pursuant to the provisions of Chapter 3.5
(commencing with Section 75) of the Revenue and Taxation Code of"the State of California;
3. Bonds and Assessments with no delinquent payments, if any;
4. Covenants, conditions restrictions, reservations, easements and rights of way now of record, if
any;
5. A First Deed of Trust, to record, securing a note in the amount of $12,200.00 in favor of Hubert
Walter Hansen and Anna Marie Hansen Trustees of the Hansen Living Trust Dated August 11,
1976.
PRORATIONS:
Prorate as of Close of Escrow, on the basis of a 30 day month:
- Taxes
CONSUMMATION of this escrow is CONTINGENT UPON THE FOLLOWING:
1. NEW LOAN: Buyer to execute a new First Trust Deed and Note, to record on your usual form,
dated during escrow, in the amount of $12,200.00, in favor of Hubert Walter Hansen and Anna
Marie Hansen Trustees of the Hansen Living Trust Dated August 11, 1976, OR ORDER, payable
at the place as designated by holder hereof, at the rate of no interest due , at which time the
remaining unpaid principal balance shall be immediately due.and payable in 2 years from the close
of escrow. Escrow holder is authorized and instructed to, insert the appropriate maturity date on
the face of the Note, over and above the signatures of the Buyer, at close of escrow without
further approval from the parties herein.
Escrow Holder is relieved of any and all liability'and/or responsibility with respect to the terms and
conditions of said Note and 'Deed of Trust including, but not limited to, the validity, sufficiency,
enforceability, and/or collectability of same. The undersigned hereby acknowledge they have been
advised by Escrow Holder to seek their own independent counsel as to all matters concerning the
recital(s), if any, contained therein.
The parties hereto recognize and acknowledge that the comprehensive National Energy Policy Act
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