Loading...
9811-111 (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 Al Lic. Class Exp. Date /te_j//' . 1 i�� iJ &.31aW1 ip / —/',""Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's i 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 t9 -,property, am exclusively contracting with licensed contractors to construtothe 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 p6nalty of perjury one of the following declarations: () I have and will maintain a certificate of consent to self -insure for workers' compensation, as provii ed 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. > 111h "111 1M i'11Gt.1 t'. L' mIANh.e 'Tf, c - t rii_.� (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 Codyl`'shall forthwith comply with those provisions. l te: f — Applicant �..Y. .E - Warning: Failure to secure Workers' CompensationpCoverage 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. ~! ( r: Signature (Owner/Agent).�� sy .- _ �'' �• Date—// BUILDING PERMIT PERMIT# DATE VALUATION LOT q TRACT JOB SITE S S A �t ADDRESS 52-200 <�VENIDA Iv4PTA MSCO APN i 7.10-212:i �)i11 OWNER CONTRACTOR / DESIGNER / ENGINEER ;:<yttc�,�i�t,t.i: �. ����.°r�ti�;��� ►t� t.lrr�,.t,1;�� ��� �.,��:�:� � 6,f>��:�� 1yy34�! jv'J(1?3 JAC ll l`kki 77P01gqi���iXy� ��yy LdAAJO�{'aV�fA CA tl`A 9W, V°1 f�fzfl)' y`a.R 0) USE OF PERMIT :�14'��s'l,�l`���111.1 a)�b`11.1.,1'�t� •4 71 t Rif c4i'lla'AtiE�t'I�kZI"z,)1�°!' ,ylt,.t)1) ihr, � , b V111_ Wt i0fo FE14c'1., 040.0 LV 1t �tw3lf.i ill �A`}.l�v��.t• €� c� �Qi �•rT®r" F,Y.2 L L,`6a`Y t4 t79., �� 9_ � 1.01 1) �►�.` tl Tit AV("F)V(IL P91t? 10-1 L10�`I)G#1`vt,: i �An'.Ul) iif.444R1CPjIt,H4 1OI-t0f)"V0441) P11¢ lun,"ItPHH1.- 1t11_091it, 41t)t)t) OR14131Nt.1!'di)i M-0110 kit,€,} fNVR"U, R1(t''114P.PiM ?2,4—M,1441—,.ala YA04114F, M AN 101-4)t)f1. J4J_1 S (M fit fW` WAW. 0 1P8MV 4.110 ' ANNT) f31.ANi f `.➢4Ff k RECEIPT DATE BY h DATE FINALED INSPECTOR -;a 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 ar Exhaust Fans O.K to Wrap F.A.U. Framing Y Compressor Insulation r� . E Q 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 POOLS - SPAS BLOCKWALL (,APPROVALS steel Set Backs Electric Bond Footings —/— Main Drain Bond Beam — —Q �j �, 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: Final Utility Notice (Gas) -C ELECTRICAL APPROVALS 71 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) Z } Desert Sands Unified School District si 47-950 Dune Palms Road Notice: La Quinta, CA 92253 ' Document Cannot Be Duplicated 760-771-8515'. CERTIFICATE OF COMPLIANCE Date 1/14/99 APN # 773-225-011 No. 18240 Jurisdiction La Quinta Owner NameMichelle Erchstedt Permit # No, 52-200 Street Avenida Velasco Log # City La Quinta Zip 92253 Study Area ' Tract # Lot # Square Footage 1470 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 the amount of 1.93 X 1,470 or $ 2;837.10 the property listed above 2rid'that build ng permits and/or Certificates of Occupancy' for this square footage in this proposed proje t' may no bei sued Fees Paid By CC/Valley Independent Bank/William Thomas' Telephone "' 564 8470_ Name on the check ''r-�5�� "" • �` . r ,• By Dr. Doris Wilson Superintendent Fee collected /exempted by Juanita Green Payment Received $2,837.10 Check No. 183020 Signature NOTICE: Pursuant of P#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 run 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 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: CHICAGO TITLE COMPANY COMPANY- 98.8029KC 87009955 WHEN RECORDED MAIL- THIS.DEED AND, UNLESS OTHERWISE SHOWN BLOW, MAIL TAX STATEMENTS TO: THOMAS BUFFIN C/O Power Brokers 50949 Washington Ste 1—E GRANT DEED I FOR RECORDER'S U APH: 773-225-011 The undersigned grantor(s) declare(s): Documentary transfer tax is $.00 (XXX) Computed on full value of property conveyed, or (...) Computed on full value less liens and encumbrances remaining at time of sale. ( ) Unincorporated area: ( ) City of ,,and FOR A VALUABLE CONSIDERATION,,receipt of'which is hereby acknowledged, MICHELLE EICHSTEDT, AN UNMARRIED WOMAN hereby GRANT(S) to THOMAS BUFFIN, AN UNMARRIED MAN the real property,in the City of LA QUINTA, County of Riverside, State of California, described as: LOT X11, BLOCK 74 OF SANTA CARMELITA AT VALE LA QUINTA, UNIT 25, AS PER MAP RECORDED IN BOOK 18, PAGE 70, RECORDS -OF RIVERSIDE COUNTY, CALIFORNIA . Dated November 24, 1998 State of California County of Riverside S.S. On November 24,-1998. before me, Kelly Collier personally appeared Michelle Eichstedt 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 authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon. behalf of which -tie person(s) acted, executed the instrument. 1 �' WITNESS.Ty ha d Signature MAIL TAX STAT NT n' fici seal. THOMAS SUFFIX SAME AS . ABOVE l t R c ICHELLE EICHSTEDT �.�•',. KELIY COIUER ([ Comrn, q 1057217 r � voTPJtY PuauC CAlF0fiN1� • �� Riveride Count My Conan , fxpims May 28,1999 (This area for official notarial seal)