9802-061 (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
743867
;;Date Signature of Contractor 1`
OWNER -'BUILDER DEC Z'ARATION v
I hereby affirm under penalty of perjuryit�„l 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.
33 I E FUND
14'2414.14
(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 Sect* - n 3700 of the Labor
Code, 1 shall fort, ith comply with those,pravisions,. 1 --
'/Date: t��.�1G”` Applicant7/ �---
Warnirig: Failure to secure.Workers Compensatio overage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of comp-ensation, 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 uport 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,"
I
Signature (Owner/Agent) Date "`� �A
11�
BUILDINGPERMIT PERMIT# CONTROL#
DATE VALUATION ' 0 LOT TRACT "3
JOB SITE
ADDRESS 78-743.,%,%'�;N!J)A flgJa�UNGA
APN 769-06&604
OWNER
CONTRACTOR / DESIGNER / ENGINEER
l
1. 4y D EYL,��yU
-11"' [NICCCiCAnRIN��pplJ,%.
1.900 AVE OF THE STARS 025
PO BOX 13787
.LOSS AMELES CA 9W67
PftsI.11!l Dr!,sr. R r C,A 92255
V60}'77;-'1999 C C. Lf� .8
USE O��F�� PERMIT
91-D-,1�i ttlbiH DOES 1VisT INCLUDE BLOCK WALLS 0R
rtli
PAI
is
APR 4 '1999
#, TRA.Cr CONSTRUCT JON E, i05.0i1 St
1-10Ri'HIPASJ'O) 447.00 SFw" TY
•��
p�
�.v0� �v I NTL
.0\diAS3.P:JCARO:PU12.`t 714.00 SF
BUXX WALL ( f yrAx) 562.90
6 FT. WOOD FENCES 200.6'01.F
FIXIIAIATIUM COS! 0196' CONS-rdix—TION
.1.1 4M,3.90
PC ..kNi f .1+XIE SUiilittiARV
C�t0NS`€'R+Cfi:r'�trjCy>-�I Fiat ,
.
71011-OIt1�f€�}.418-iJ(t10y p2.G'9i
PLAN wilx �C.J.ii i 1�t'�6�SJ" 4�� �.F i� 580-83
170 )EPOSIT 10 i-000_zt, -3750,00
IkiECHA,NICAL IQJ-000421-000 360:40
:.EC'11z3CAc, 301.- M -c 20-0011 S137.46
Pl_.i IMBIN01'T' 103.-00-419-000 $146,.75
STRONG 140TION 1FEE - RESM) 1.01-000-241-000 $1.`1,48
'
ORADWOFF.i 1t31-GQG-4 3-f100 $20.00
tNF1tfiS°I'.fdUCTIIRE FE -E 22'154)00 443-342 .'$'2.307.96
1°REC!SF'PLAN 103.-1E011-441-345
ART IN'PUBLIC PL.Accss - t�.:E.SE,U 70n.d)t3o-2,s5-0013
S1J!3= l t�itl.1 COI<15'i.'ILC.Eh"1. ON AAiTl PLAN C.HEC::(s.
$4,109.44
LESS !'.1'.E-pA,CE.ri,XS
423��3V)
TMIAQ, ff"EWA';T r .F1" ES .IIieI TE' i"NOW
.f
RECEIPT
DATE
BY /
DATE FINALED -•
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Underground Ducts
Ducts
Slab Grade
g
Return Air
Steel
Roof Deck
,
Combustion Air
Exhaust Farts
O.K to Wrap
W9
F.A.U.
Framing
//
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
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
J/
Encapsulation
Gas Piping
Gas Test
_
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
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
t
Final
Utility Notice (Perm) 7 7"
COMMENTS:
e
J
a 1 Desert Sands Unified School District
Notice• 827879 Highway 111 "
• Indio, CA 92201
Document Cannot Be Duplicated, 619-775-3500 }
• CERTIFICATE OF COMPLIANCE ,
Date 4/23/98 APN # 769-066-004
No. 16958-LaJurisdiction Quinta
f
Owner NameWorld Development, Inc. Permit #
M
No. 78-743 ' Street= Avenida Tujunga Log #
,
City La Quinta :� Y, Zip ' 92253 Study Area ,
q g 1705
Tract # Lot # Square Foota e
Type of Development Single, -Family Residence' No. ,of Units 1
Comments
SFD
-
t
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 6,the'jfbllc. N umi .t
reason:
.EXEMPTION NOT APPLICABLE ``r<.'
j ra'c�
This certifies that school Government Code 53080 in the as of nt of facility fees imposed pursuant to � .
1.93 X 1,705 or $ 3,290.65 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 ccNalley,Independent Bank/World DevelopmentTelephone 760772-1919
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Olivia Aguirre Payment Received $3,290.65
Check No. 161385
Signature _
77
NOTICE: Pursuant t Assembly Bill 3081 (CHAP 549, STATS. 199 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 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
collect them on the District('s)(s') behalf, whichever is earlier., `
T
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
NAII. TAS STATEMENTS TO PARTY SHOWN ON FOLL(Rtel%V. E�y���fi�; i� p;g8'j�,;ry��'`Q�$7g��9V MAIL. AS, QIRECTED .ABOVE
fi Name ' t Street Address * , rlf„ c,306 a, n,.
= t`a`�t3 '! • : 43PM' FROH , RGTH INDUSTRIES I 1 JC 31® 552 0993; - - , P. 2
RECO G QU _ *' . "
RD3N Rl: E5/,1�/'EwD' BY '
WITEN R -0m)Cu -MAIL TO ,.
z PAR�`PARTNERS, LIC t .;
i 1.900 AVENUr: OF THF, : STARS STF;' 725
LOS ANGEIt%S, CA 9006,7
Escrow No. 131106 t •. ,
r r Ng. / sprat ascvE :tr;is to 4z w%. rtamRoEa•5 use .
Y t ' .\J 1 DEE i� 3�3sor' a RaY:oi Noy '
—r 69-066-004-6.
RA
• 77.1E UNut'skL51GNiU GRc'�i�R'0R(S) UCCLl1RL(S) • _ •
DOCUASCNTARY TItANSFFft-rAX IR $23.10
unincorporated area `7tU City of .,~
D. eOnlPuled On tho full value of the interext or property conwyod, (sr is '
r ❑ co'"Puted on the full valueless the value of liens Or encu nthrances sernaimin& at time of sale, and
FOR A ; VALUABLE •CONSIDERATION, rcccipt of which is licreby acknovvlcdg4 ,
_LOUXS-M',• RVSSO, SUCCESSOR TRUSTEE, and
ANGELA FRUSS0 F
�. ,bcrcby GRANT(S)' to
PAR PARTNERS; LLC, A. LIMI`T'EDLIABILITY COMPANY
the folio wing described real �roperty in the city of
CoutatyOf,,RIVERSIDE • ,S talc ofCalifornitt:. t ,
i1. t.
LOT '27 OF DESERT CLUB TRACT-UNIT-S-, AS PER MAP RECORDED..114 BOOK, 21, PAGES 61 'AND'-62 OF
MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORRIA'.
Dated. aunen 6, 7.997.
Y
' STATE OF C I;IFORNI A,
COUNTY Ofc-69
On'p0orc me, LOUIS M. RUSSO, SUCCESSOR TRUSTEE -
ary Pbc tq an �r saidC g my and State, personally appeared '
p a (or proved to me on trio baslx of satislactory-
cvldence) to.be ihe'peison(s) whos®-name(g) it/are subscribed to1he
within ;nslrument and acknowledged to me that 4/Sh0/tww executed the -ANDELA RUSSO
Earle in,*gner/4w;r authorieEd copaclty(loq. and that by lljc/natfthvlr
signawrep) on the Instrumcni the porson(i),'or the ontity upon behalf of
wnien the person0) actod, executed the in3trumiin% ' _ t . CERAtD R. NM
n � � Cvmmtsstt��'r03ae0.T
i ri
WITNESS my hand and official scat,' t ?1�trT�;N;►J .PftC rCalforrt'p�
MA.f2—.31 —9'8 TUE 1 5 : 48 1 800 732 7046 P . 0 1
—04-1993 1 : di1Pt•1 FROM ROTH INDUSTRIES 'INC 7310 552 099-; P. 3
RECORDING REQUESTEDBY 272734"
AND WHEN RECORDED MAt.� TO RECEIVED FOR Ar=CORD'
F AT 8:00 O'CLOGK
PAR PARTNERS, LLC
1900 AVtNUR OF TBS STARS ST. 725
z,os AtaGrI•rs, cn . 9oo67 . 7PA
�►�, AUG -1 1997
RECORDING REQUESTED QY dgr a Wte,vdc^a.nb.eN�a�s
FIDELITY �lATIONAL YITLE INSURANGE CO• f�ocor9nr
�_. r roes 3 w,
Escrow -No. 7-07108 '
• �``1137 05— SPACE Atfove T►a^. UNC 96A naconosn•s lista
GRANT DEED X69-0 . 004- No,
769-066-004-6
TTL' L'NDEWIGNED GRANIrOR.(S) DI:CLAW!(S) r
DOCUMEWAR>M\,SPURTAXIS $-23,10 �' +� C�,� �-C�( C��•
Q unincoTNrmcd arca ® city of
cnrnpvtcfjon the full value or ihu inletext of properly conveyed, or i t
❑ computed c -n the full value less the value of licu,s or encumbrances remaining ar tine of sale, xnd
FOR A VALUAKE CONSIDERATION, receipt of which is hereby acknywlcdpcd,
LOUIS M. RUSSO, SttCC£SSOR TRUSTEE, and, �.�: 1�.0 �•.�.�;c, �..c��,:\..1 t rc.s� d�. �'c� �t� jar
O c� ANGELA RUSSO
hereby GRANT(S) to
PAR PARTN.ZRSI LLC, A LIMITED LIABILITY COMPANY
the following described real properly in the City of
County Of .RIVERSIDE ,Stub of CaliforniZ;
LOT 27 OF DESERT CLUB TRACT UNIT 5, AS PER MAP RECORDED IN BOOK 21, PAGES 61 AND 62 `OF
MAPS, RECORDS OP RIVERSIDE COUNTY, CALIFORNIA,
Dated June 6, . I997° -
ppry`. Crt'\, C\0,�.
STATE OF CP&1+QRUXtL.
COUNTY OF
On r. . AXIS -:22. S' 7 beton me,
L0151 -3M. SS0, S CC£SSOR TRUSTEE
a Notary Pu¢tlo In and for said County andState, personally appeared
gam(
poMortally known to me (or proved to me on the basis of satisfactory
evidence) to be th® person(s) whose name(a) is/are subscribed to the
within instrument and acknpwiedSod to me that he/she/they exeeut4d the ANGELA RUSSO
same in his/her/their 0uthoiized capacity(ies), and that by his/her/their
s19nature(s) on the Insuument the porson(s), or the entity upon bchalr o►.
which the person(s) acted, executed the Instrument.
t'fiTNE$S my hang A0 �official zeal, p� '~��'
,�•,,. F'Iv1At_ SEAL_
Notary Publl,;, Norh C:.t�ti�a
,/� Cutin
Signature of Notary
�
Ss� t a }r1: , n,j
-- -- - - - - T",r6,F....._...,.w +�n SEnI On STAMP