9904-130 (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
410376 B 08/31/19!
Date Signature of Contractor
OWNER -BUILDER DECLARATION'
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
(, ) 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, Business & Professionals Code).
( ) 1, 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.
FREMONT COMP. WN99742808-02
(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,l should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith'comply with those provisions.
Date: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
-for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made'& each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
A hold harmless the City of La Quinta; its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation..
1 certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT# V�j I .-
DATE VALUATION LOT 9904-130- TRACT i-
S937,879.10 57/58
JOB SITE APN
ADDRESS
79-175 TOM FAZIO LANE NORTH 761-522-005
OWNER CONTRACTOR / DESIGNER / ENGINEER
TOM & CINDA HICKS
200 CRESCENT COURT Ste 1600
DALLAS TX 75201
USE OF PERMIT
SFD - PERMIT
S,
.
PORI
G.O. LANGLOIS CONST.
77849 WILDCAT DR.
PALM DESERT CA 92211
(760)772-2333 CBL# 1274
NCL E BLOCK WALL OR POOL T,D
- ,$uiL-r
W CONSTRUCTION
(PATIO • -
11,425.00 SF
1,380.00 SF
1,506.00 SF -
L \ '
ESTIMATED COST OF CONSTRUCTION
PERMIT FEE SUMMARY -
CONSTRUCTION -FEE, 101-000-418-000 $3,353.50
' PLAN CHECK FEE ':* ' -101-000-439-318 52,700.00
FEE DEPOSIT - `� 101-000-439-318 41,250.00
MECHANICAL FEE -^ 101-Ooo-421-000 $252.50
ELECTRICAL FEE 101-000-420-000 $571.00
PLUMBING FEE 101-000-419-000 $385.50
STRONG MOTION FEE - RESID • 101-000-241-000 593.79
GRADING FEE 101-000-423-000 $20.00
INFRASTRUCTURE FEE' 225-000-443-342 56,000.00
ART IN PUBLIC PLACES; RESM 701-000-255-000 52,094.70
SUB -TOTAL- CONSTRUCTION AND PLAN CHECK
LESS PRE -PAID FEES
TOTAL PERMIT FEES DUE NOW
RECEIPT DATE BY DATE FINALED INSPECTOR
937,879.10. _
$15,470.99
-$1,250.00.
$14,22099
n
�La Quinta Bldg Dept To: JOHN GRABLE
Date: 4/9/99 Time: 11:20:24 AM
Page 2 of 2
�,f3o
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APR 15 1999
City of La Quinta r�o;�, ci,
151999
APR
BuNdhg ac saW Wow Op
• " DEPT.
P.O. Brno 1504, 76-495 Calle Tampioo .r 3
!a Quh ta, CA 922 53 - (619) 777-7012 801t& RS p
"..
Building Permit Application and Tracking Sheet��
Project Addr s: GO !f �1' 7' QM A4Z1Q 4NO AV wner's Name: D N G G a
A. P. 14..b �`�• SZ Z S� `
Address: 20 0AVIISV
Legal Description: ;�^
8 City,ST, Zip: -- 7-110/
/�
Contractor: 6 V. L n/6;AW L�6��5 Telephone: 2 ♦ Z ♦ SI, V
Address:- N/�`bG�j'
Project Description: 5lN6ljf 1PAIMA9, 5�
City,ST, zip: jOAkM&fGA, 2Z
!N/ 5 .Gl GoNO
Telephone: 0. 7712 • Z
1- S t. r- - c *e, z fff'1polr,
State Lic. #: ft City Lic. #: Z
%vb Q e ! Q C�dQ.i
Arch., Engr., Designer: ` AA1-
40 To 00 ONJO OXII AHD
Address:O #20o PA✓�
� IAO C
City, ST, Zip: g•A.Ix • 7$205"
�G
f AMS wll//yfrog/ pzV,0 GvPPGR-
Telephonel /0.12 , 4 3 3
Construction Type: V CS, Occupancy:
State Lic. #: C — 2070
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:t%QYA( 6�i`j W A6
Sq. Ft.: //7�
#. Stones:
# Units:
T,q
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APR 15 1999
f1.
•
•
4
78-495. CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 – (760) 7774000
FAX . (760) 777-7101
TDD (760) 777-1227
December 1, 1998
Mr. Dale Kelleher
Keith International; Inc.
41-865 Boardwalk, S-101
Palm Desert, California 92211
SUBJECT: PARCEL MERGER 98-340
Dear Mr. Kelleher:
The Community Development Department has approved Parcel Merger 98-340.. Please have the
enclosed paperwork, recorded with the County of Riverside. Once recorded; please send copies. of
the material to our -office for filing. Enclosed is a letter addressed to the County Recorder stating that
PM 98-340 can be recorded.
Should you have any questions, please contact me at (760) 777-7067'.
Sincerely,
DEVELOPMENT DIRECTOR
Associate Pinner
GT.
Enclosures
c: Building Department Manager
Greg Bulter, R & S Counter Technician
W1-9-99
/VO
98 -39,0 /I�co2oirs�p,.J
ParcelM 98-340 - 29I. a -�
MAILING ADDRESS — P.O. BOX 1504 — LA OUINTA, CALIFORNIA 92253 ��
4
78-495 CALLE TAMPICO - SLA QUINTA, CALIFORNIA 92253 (760) 777-7000
FAX (760) 777-7101
TDD (760) 777-1227
December 1, 1998
County Recorder
County of Riverside
P.O. Box 751
Riverside, California 925.02-0751
SUBJECT: RECORDING OF PARCEL MERGER 98-340
Dear Colleague:
The City of La Quinta has approved the above noted Parcel Merger. Please allow its. recording as
presented by the applicant.
Should you have any questions, please call me at (760) 777-7067.
Very truly yours,
Y HERMAN
O M TY DEVELOPMENT DIRECTOR
;I
O SDELL
Associ to lanner
GT.
PM 340 County -29
MAILING ADDRESS P.O. BOX 1504 — CA QUINTA, CALIFORNIA 92253
„,DX160 R=X4Z.M,®A,mM„J3SOnvm
Thomas O. Hicks
Croda Cree Hicks
200 Crecent Ct. Suite 1600
Dallas, TX 75201
(No fee, Government Code 6103
MAIL TAX SPA'MMEM Tl)
Thomas O. Hicks
Cmda Cree Hicks
200 Crecent Ct. Suite 1600
Dallas, TX 75201
•
•
TITLE ORDER x ESCROW x SPACE ABOVE THIS LINE FOR RECORDER'S USE
APN . 761-522-005 & 006 GRANT DEED
THE UNDERSTANDING GRANTOR(S) DECLARE(S)
DOCUMENTARY TRANSFER TAX is $
❑ computed on full value of property conveyed, or
❑ computed on full value less value of liens or encumbrances remaining at time of sale.
❑ unincorporated area m City of La Quinta , AND
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged.
NAME Thomas O. Hicks and Cinda Cree Hicks, husband and w fe as Joint Tenants
hereby GRANT(s) to
NAME Thomas O. Hicks and Cinda Cree Hicks, husband and wife as Joint.Tenants
the following described real property in the County of Riverside, State of Califomia:
Lots 57 and 58 of Tract 27728 as per Map Book 249, pages 1 through 13, inclusive, Records of Riverside County, State of California, in
the City of La Quinta.
THIS DEED REFLECTS PARCEL MERGER NO. 98- 340 AS APPROVED BY THE CITY OF LA QUINTA.
EXHIBITS "A” AND "B"
STATE OF
COUNTY OFr7 i v (TZ•�
before me, the undersigned, a Notary Public, in and or said State, lly
its O. E Cinda CM Hicks
WSprdd
personally known to me S
❑ proved to me on the basis of satisfactory evidence �• BECKY A McCONNE i 1,
to be the person whose name is subscribed to this instrument, and acknowl- ' � 8" d 108"
edged to me that /he (she or they) executed it Cq t�11/89
Yl M '