06-1287 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:' 06 07
Property Address:
54353 AVENIDA VELASCO
APN:
774-251-017-6 -000000-
Application description:
WALL/FENCE
Property Zoning:
COVE RESIDENTIAL
Application valuation:
7900
Tiht .4 4 Q"
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
---------------------------------------- - - - - - - - - - -
LICENS ONTRACTOR'S DECLARATION '
I hereby affirm under penalty of perjury that I a ice sed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business an Pro ssionals Code, and my L'cense is in full force and effect.
License Class: Bn/�, License No.: 3 8 .
/Date: w rector:
OWNE7e,prior
R DEC TION
I hereby affirm under penalty of perjury that I am exemhe Co ctor's State License Law for the
following reason (Sec. 7031.5, Business and ProfessioAny ty or county that requires a permit to
construct, alter, improve, demolish, or repair any structo ' s issuance, also requires the applicant for the
.permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section'7000) of Division 3 of the Business and Professions Code) or
that he or she 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).:
(_ 1 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 and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
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 or she did not build or
improve for the purpose of sale.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
I—) I am exempt under Sec. , B.&P.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: ' 3/30/06
Owner:
CHARLES KLILERE
54353 AVENIDA VELASCO
LA QUINTA, CA 92253
Contractor: D
JONES ELITE HOME
30665 BAY HILL C `,3 0 2006
CATHEDRAL CITY, C 9 23.*
(760)641-3765 �Q�1NTA
Lic. No.: 833738 CIT`..DMrrE
------------------
WORKER'S COMPENSATION DECLARATION
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 and policy number are:
Carrier STATE FUND Policy Number 00017752006
_ I certify that, in the performance of work for which this permit is issued, I shall not employ any
person in any manner so as t0ectme.subiect to the workers' ompensation laws of California,
and agree that, if I should b om subject to the workers' c nsation provisions of Section
3700 of the Labor Code, I al rthwith comp) with t e ovisions.
�p1 App"
WARNING: FAIL E TO SECURE WORKERS' COrOF
ACTION CO RAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIVIL FI S UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. -
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this 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 application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being -
performed under or following issuance of this permit.
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 c ssation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the abov info, ation is correct. I agr to comply with all
city and county ordinances and state laws relating to the
nstr tion, and hereby aut ri representatives
of this county to gnter upon thyabove-mentioned property for ns tion purposes;
(Applicant or Agent):_
D'
LQPERMIT
Application Number . . . . . 06-00001287
:Permit . . .. WALL/FENCE
PERMIT
Additional desc .
Permit Fee 99.00
Plan Check
Fee
.00_
• Issue Date
Valuation
7900
Expiration Date °. 9/26/06
Qty Unit Charge Per
Extension
BASE
FEE
45.00
• 6.00 9.0000 THOU BLDG
2,001-25,000
54.00
-------
Special Notes and Comments
------------------
------
---------------
30 L.F. 5! GARDEN WALL, 290 L.F.
6'
GARDEN WALL,ORCO SYSTEM'
Fee summary Charged
Paid Credited .,
Due'
- --- ----------
Permit Fee Total 99.00
----.------
.00
----------
.00
99..00
Plan Check Total .00
.00
.00
.00
Grand Total 99.00
.00 '.00
99.00
D'
LQPERMIT
dpitz
zJIff 96&:3.
rl RE—INSPEC ION FEE -OF- $3G' ti
' w WILL BE CHARGE -IF THE APPROVED ,
F' r' PLANS AND 10& RD"AR �{
EMT ON f
s THE SITE- FOR SCNEDULED'�
INSPECTION.
rNO EXCEP NS.
.r
Mill
•' V1
q
3 Zdeop
EXHIBIT A
DESCRIPTION OF PROPERTY
Order No. RPD -2164034 (REQUIRED)
Street Address: 31665 Sierra Del Sol,
Thousand Palms, California 92276, Thousand Palms, CA 92276
Legal Description:
LOT 22 IN BLOCK F OF SHANGRI LA PALMS NO, 1, AS SHOWN BY MAP ON FILE IN BOOK 21 PAGE 99
OF MAPS, RECORDS OF RIVERSIDE COIUNTY, CALIFORNIA;
EXCEPTING THEREFROM ALL MINERAL AND OIL RIGHTS AS RESERVED BY NAT MALNICK, ET AL BY
DEED RECORDED OCTOBER 6, 1951 IN BOOK 14.05 PAGE 127 OF'OFFICIAL RECORDS OF RIVERSIDE
COUNTY, CALIFORNIA.
A.P.N. 650-171-007-7
F
Page 8
c2001 First American Title Insurance Company
All Rights Reserved
5
(tea De 01 -Te--. /1 / —r2 i .), le , — z- A _JV —/\
Permit #
6
City Of La Quinta
Building 8t' Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: J'Ltl ��?
CQ
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:
Telephone'
Address:16
36& / R
U
Project Description:
City, ST, Zip:
L G
T ele n
Ph o e. d
State Lic. #: ?J
Arch., Engeesigner
City Lic. #;
0
25
Address:
City, ST, Zip:
`„
�L�g
Y
�9 } / zv
hl
/
Tele hone:
P
n
Co stru ch on T YPe:Occupancy: • ,
State Lic. #:
Project type (circle one): New Add'n Alter
Repair Demo
Name of Contact Person:I�Ttqpurues
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Pe sorl
41-371,6—
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
91-
Plan Sets
Plan Check submitted S(Z
Item
Amount
Structural Cates.
Reviewed, ready f r corrections
Plan Check Deposit
Truss Cales.
Called Contact Perso $ j1�oS
Plan Check Balance
Title 24 Cates.
Plans picked up .. s 51Aa/i
e
Construction
Flood plain plan
Plans resubmitted 101(#)195Mechanical
Grading plan
2nd Review, ready or corrections issue
Electrical
Subcontactor ListCalled
Grant Deed
Contact Person 1e%/
Plans picked up fO 7S
Plumbing
/
H.O.A. Approval
Plans resubmitted\\\ O�
Grading
IN ROUSE:-
1rd Review, ready for correcti s/issu
Developer Impact Fee
Planning Approval
Called Contact Person /'
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
0
Total Permit Fees
�, � � , c�sUy,-,w . ,.--„ , /1/D/ �'tc'Crf� try `��'-� L��,✓ /�S/�ors c. S — /FYI (�T A��
Date 11/28/05
No. 27875
Owner M/M Kliere
Address 54353 Avenida Velasco
City La Quinta Zip
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
LI1illF.
���lFlFrps,��
4 o
BERMUDA DUNES r
rn RANCHO MIRAGE !�
rJ INDIAN WELLS
PALM OESERT y
LA CUINTA
QINDIO y�
O
774-251-017
Jurisdiction La Quinta
Permit #
Tract # Study Area
Type Residential Addition No. of Units 1
Lot # No. Street S.F.
Unit 1 54353 Avenida Velasco 1188 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments
Lot # No. Street S.F.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiosAvalkways, residential additions under 5
00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile ho
mes. It has been determined that 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
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.24 X 1,188 S.F. or $2,661.12 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By OC/EI Paseo Bank - Gary Jones Check No. 501137266
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected
Signature
McGilvrey
Telephone 641.3765
Funding Residentia(l,'(-,y
— air•
1
Payment Recd$�;pp
t.
$2 661.12 00,0fZU rid
.L
NOTICE: Pursuant to Government Code Section 66020(d)(1), this rhe to notify you that the 90 -day approval period in which you may protest the fees o
r other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original -Building Department/Applicant Copy -Applicant/Receipt Copy -Accounting
55A The Kleier Group Inc 760 568 0664 P.O'_
P.O. !iox 1504
l.n Q1. 1 I TA, CA 1,IF4)P.NIA 92247-1504,
7N-405 C:AIA.e T.AMI"IC,u
r.k. C..\1.ivoRN1 :)`> 53
FINAL NOTICE OF VIOLATION
1760) 777-70G
FAX (`i 60) 777-7i i
5i2!2005 Case# 12:73
Charles D. &Mary Kleier
R.O. Box 26264
Federal Way, WA 98093
RE: VIOLATIONS OF THE LA QUINTA MUNICIPAL CODE AT 64353 Avenida
Velasco (APN 774-261-017), LA QUINTA,'CA.
On 2;25/2005, you were notified by this office that you were in violation of the City's
Municipal Code. Our records Indicate that you were'made aware of the nature of your
violation the action necessary to correct -the violation. and that you were given arnple
time to remedy the violation.
Another inspection was made of the subject property'on 411512005. That inspection
revealed that the necessary corrective action had not been taken. This letter will serve
as notice that if the violation' is not corrected before May 13, 2005 an administrative
citation will be issued or a notice to appear in court io seek compliance,
if you have any questions concerning this matter, you should contact the undersigned
immediately at (760) 777-7021, Monday thru Friday. between the hours of 8:00 a.m.
and 5:00 p.m.
Sincerely. J
Com`
Jackie Misur ode Compliance Officer
0
c.t-31-0715 0I:17P The Kleier Group Ind 2533692555 P-01
Recording Requested By;
GreenPoint Mortgage Funding, Inc.
rowwany Name)
And WV ien Recorded flail To:
GreenPoint Mortgage Fundiug, Inc.
Compar y Namol
iNarne o!Naturai Parson,
981 Airway Court, Suite E
[Street Address]
Santa Ross, CA, 95403-2049
r![ icy, State Zip Code;
[Spa:e Above This Lino For Recording Dow
DEED OF TRUST
DEFINiTIONS
Loan Number: 0484339555
MIN: 100013800843395555
Words used in multiple suctions of this document are defined below and other words are defined in Sectiuns 3, 11, 13, t8,20
and 31. Certain rules regarding the usage of words used in this doctiment are also provided in Section• 16..
(A') "Security Instrument' means this document, which is dated June 18., 2604,
together wifn all Rides to this document.
(B) "Borrower" is Charles D Kleier and Mar7r Meier, Husband And Wife
Borro•aver is the trustor under this Security Instrument.
(C)• "Lender" is GreenPoint Mortgage Funding, Inc..
Lender is a Corporation organized and existing under the IwA-, of the State of New Worse. Lender's address is 11.0W od
Hollow Drive, Novato. C,Ik 94945.
(ID) "Trustee" is Marin Conveyancing Corp..
(E) "MEIiS" is V1ortgage Electronic Registration Systems, Inc, MFRS is a separate corporat.ior that is acting solely as
a nominee for Lender and Lender's successors and assigns. MERS is the beneficiary under this Security Instrument.
MFRS is organized and existing under the laws of Delaware, and has an address and telephone number of P.'J. Box 2026,
Flint, M.1 48501-2026, tel. (888) 679-:MERS.
(F) "Note" means the pTcrn.ssoiy note signed by Bo:-rewer �.nd datsd June 18, 2004. The 'Note states that Borrower
waves Under Two hundred Tivent?- Thousand and 00/100t1ig Dollars (U.S. S220,000.00) plus interest. Borrower hes
promisad to pay this debt 11) regular Periodic Pa,Tnents and to pay the debt in full not later than July 1, 2034.
(C) ,. "Prupei ty" nicans the property that is described be!ow under the heading "Transfer of Rights in the Property."
CaLforula Dred of Trust -Single Family-Faunte Mae/Freddie Mac UNIFORM MTRUMENT rtERS Modified Furm 3005 01 /01
—TOE CGMPLIANCE SwRCFINC.— Page of 13 14301 CA NK100
wwv. npliurt:enueu <om 1 ■ (1 1
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G P M W D 6 4 3 3 5 5 5 i" 7
r# -31-05'01:18P The Kleier Group Ind 2533692555 P.02
(H) "Loan" means the debt evidenced by the Note, plus interest, any prepayment charges and late chcrges duc ucder. inc
Note, and all sums due under this Security Instrument, plus interest,
(1) "hiders" means all (siders to this Secunry Instrument fttat are executed by Borrower. The following Riders are to,
be executed by Borrovier jeheck box as appiicabfej:
y Adjustable Rate Rider Condominium Rider ^ Second Home Rifler
Balloor Rider u Planned Ucit Deveiopment Rider u Biweekly Pavricnt Rider
4 :;amily -Rider: Revocable Trust Rider
Other(s) (specify)
(J) "Applicable Lase" means all controlling applicable federal, state and local. statutes, regulations, or•'tnances and
adrninistratrve rules dnd orders (that have the effect of law) as well as all applicable final, nun-appealabie judicial opinions.
(K) "Community Association Dues, Fees, and Assessments" means all dues, fees, assessments and other charges that
::re imposed on Borrower cr the Property by a condominium association, homeowners association or, sir,ilar organization.
(L) "Electronic Funds Transfer" means any transfer of funds, other than a transaction originated by check. dr h., or
similar paper instrument, which is initiated through an electrouic terminal, telephonic instrument, computer, or mm nedc tape
so as to order, instruct, or awhor im a financial institution to debit or credit an account. Such term includes, but is no limited
to, poini-of-sale transfers, autorlat•:d teller machine transactions, transfers initiated by telephone, wire transfers, and
automated clearinghouse transfers.
(M) "ESCTOW Items" means !hose items that are described in Section ?.
(N) "Miseellaneuus Proceeds" means any compensation, settlement, award of datnages, or proceeds paid by any third
patty (other than insurance proceeds paid under the coverage, described in Section 5) for. (i) dama&e to, or destruction of,
the Property; (ii) condernpation or other taking of all or any part of the Property; (iii) conveyance ir lic;u of condemnation; or
(iv) misrepresents. ions of, or omissions as to, the value and/or condition. of the Property.
(0) "Mortgage Insurance" means insurance proUcting Lender against the nonpayment of; cr default on, the loan
('P) "Periodic .Payment" means the regularly s::heduied amount due for (i) principal and interest under the Note, plus
(ii) any:unount~ under Section 3 cfthis Security Instrument.
(�} "RESPA" means the Real Estzte Settlement Procedures Act (i2 U.S.C. §2601 et sec.) and is implrmewing
regulation, Regulation X (24 C:E.R. Part 31500), as they r6ght be amended wort time to time, or any additional or successor
legislation or regulation that governs the same subject matter. As used in this Security Instrument, "RESPA" refers to all
requirements and restrictions i.hat are in, is ragard to a "federally related mortgage loan" even if the Loan dues not
qualify ;s a "federally related rnor gage loan" under RESPA.
(h) "Successor in Interest of Borrower" means any page that has taken title to the Property, whether or n-ot that party
has assumed Borrower's obligaiimts order the Note andlur this Security Instttment.
-Califombi Deed of Trust -Single rarnily-Fannie. Hive/Freddie Mac UNIFORM INnRUIKF-rl
NIERS Modified Form 3005 OMI
—TKE (:OMPUArCr SGURCP:, INC.—
Page 2 of 13
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01:18P The Meier Group Ind 2533692555
't" QtA1NSF;ER OF RIGHTS IN THE PROPERTY
P.03
he beneficiary of this Securit , instrument is MFRS ;solely as. nominee for Lender and Lender's succeioors and assigns.) an
dthe successors and assigns of MFRS. This Security Instrument secures to Lender: (i) the repayment of the Loan, and ,fl_
renewals, exit rasions and modifications of the Note; and (ii) the performance of Borrower's covenants and agreements under
this Security Instrurnept and the Note. For this purpose, Borrower irrevocably grants and conveys to Trustee, in trust, with
pavmr of sale, the following described property locate', in the County of Riverside:
[Type of Rycaading JurisdicConl ;Name of Recon ing Jurisdiction)
Lots 5 and 6 in Block 291 of Santa Carmelita at Vale 1.2 Quinta, Unit #26 as per Map recorded in Book 20, Page.Mi of
.Maps, Records of Riverside County, California.
Assessor's Identification Number: 774••251-017
which currently has the address of 54353 Avenida Velasco
(streetl
La Quinta Ce.lifbrnia 92253
(lip Cede!
(`'Prop-rrr Address"):
TOGETHER .)WITH all the improvernents now or hereafter erected out the preperty, and all easement;,
appurtenances, and fixtures now or 'r!ereaf'er a pan of the property, All Tepl.acec.le nts and additions shali also be covered �1-y
this Secur',ry instrumr:•.nt. Ali of the foregoing is referred to iv; this Security Instrument as the "Property." Borrower
tiziderstands and agree.; that ME.RS holds only Iegal title to the interests granted by Bcwovacr in this Security instrument, but,
if necessary to conrply with law or custom, (as nominee for Lender and Lenders successors and assigns) has the right:
to exercise any or all of those interests, including, but not limited to; the right to foreclose rad sell ihc; Propery; and to take
any action required of Lender including, but not iimiied to, releasing and canceling this 3.curity'Instrarnent.
BORROWER COVENANTS that Borrower is :awfully seized of the estate hereby conveyed and has the, right to
grant and cowveey the Property and that the Properri ;s uneu wrib.ered, exe;art for encumbrances of record. Bcrriowcr warrarrti
and will defend generally the title to the Property aninst all claims and demands, subject to any encumbrances of record,
THIS SECi)RITY IINSTRUMENT combines uniforrr, co.ene_nts for national use and ncn-uniform covenants witia
limited ;mations by jurisdiction to corstitutc a uniform security instrument covering real property.
M. -FORM COVENANTS. Borrower and Lender covenant and agree as follows:
I. Payment of Principal, Interest, Escrow .)terns, Prepayment Charges, and Late Charges. Borrower shall
pay *vher due the principal of, and interest on, the debt evidenced by the Note and ai y prepayment charges 3rd late charges
due under the Note, Boy-, ower shall :rlso pas Funds for Escrow hems pursuant to Section 3_ Payments due under the Note
arrd this Sceurity Instrument shall be made is U:S. currency. However, if any check or other instrument received by Lendcr
as payrneut under :he Note or this Security lrstrumeni is returned to Lender unpaid, Lender may require that any or all
subsequent payments due under the Note and this Security instrLrment be made in one or more of the bllowing forms, as
selected by amender: (a.) cash, (b) Honey orrler;.(c) certified check, ban.)• crreck, treastsars check or cashier's check, prosidtA
Catifernta Deed of Trust airQle Fxr,.�iiyFsnnie Ntae/E'reddie Aiuc. UNIFORM ASTRUNENT
MERS Modkined Fonn3oo5 :itfol
—THE Cf MPLrANC£ &WRCE. INC.—
Page3 of 13
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478-105 CALLE ESTADO — LA QUINTA, CALIFORNIA 92253 - (619) 564-2246
t. FAX (619) 564-5617
October 5, 1992
RE : Special Inspection at 54=3-5'3 Velasco°�-rt--
To Whom It May Concern:
In regard to the special inspection done on the above mentioned
property the following are our findings:
1. . Several room additions were done in the early 1960's with no
evidence of permits. All work appears to comply with building
codes of that time. Since periodic inspections were not
conducted during construction it is not possible to inspect
nor make statements regarding work that is covered.
There does not appear to be any observable structural problems at
this time.
Should you have any questions,.please do not hesitate to contact
me.
Sincerely,
PUILDING AND SAFETY DEPARTMENT
jonnie
Day
Building Inspector I
Tom Hartung
Director of Building & Safety
/lc
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253
0 4
P.O. BOX 1504 APPLICATION ONLY
Building /Y� 7&105 CALLS
Address ( �) LA QUINTA, CALIFORNIAORNIA 92253
Owner,.-
1,
wner,.-
1, e LA / A-
Mailing
Address ��i�j��f11�YliGIC.0
CityZip t Tel.71-
1 J
-1 Xb
Contractor
ress
Zip Tel.
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I 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. 7031.5,Business and Professions Code: Any city or county which 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 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).
l7 1, 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.)
I 1 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
does not apply to an owner of 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. 8 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. ❑ 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.)
1 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
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.
1 certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives sof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Dale
Mailing Address
City, State, Zip
BUILDING DIVISION
BUILDING: TYPE CONST.
A.P. Number
Legal Description
Project Description
OCC. GRP.
Minimum Setback Distances:
Front Setback from Center Line
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Validation:
Estimated Valuation
PERMIT x
AMOUNT
Plan dhk. Dep. f
Plan Chk. Bal.
Const.
---^-�
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
OASJ A? 4,11 907ho09-14-92 io
iU CASH i TOTAL i IUO.00
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:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. @ $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. C'
MOSILEHOME SVC.
BAR SINK
GAR. SO. FT.
POWER OUTLET
ROOF DRAINS
CARP. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APP./EQUIP.
DRINKING FOUNTAIN
SO. FT. @
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION S
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
SO. FT. Q c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/. c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR @ 3/ac
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
g plus xg
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION —
—
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESANITIALS
GARDEN WALL FINAL