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9512-026 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm 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. 317390 B 2/2W95 License # _3/ / -75 9'0 Lic. Class Exp. Date Date - //ra 6 —Signature of Contractor _.. i OWNER -BUILDER DECLARATION I hereby affirm that I, 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 37.00 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 C'I'ATP-`F-11111 Policy No. 6natao. (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 I Code, I shall forthwith comply with those�provi�s�ons. Date: %r�-VIVA - Applicant Warning: Failure to secure WorkersCompensation 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 ate. whose request and for whose benefit work is performed under or pursuant to: any permit issued as a result of this application agrees to, & shall, indemnify & hold harmless the City of Indian Wells, 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. Signature (Owner/Agent) Data ALCM � BUILDING PERMIT PERMIT i' #51L-026 DATE VALUATION �xi �Z{j�c� LOT }� TRACT .72 JOB SITE ADDRESS 151-185 AVENIi1A VALLF-10 APN 773.dP+�2-%119 OWNER CONTRACTOR JERRY L(JQO.BLDG & .DEV. MARIO ACEVES 79860 BOQa JEirON IVY' , 51-1.85 AVENIDA VALLEJO BERMUDA D ES CA. 9220.1 LAQUINflA. CA 92253 (619)345-4236 CBL#!' 1973 DESIGNERIENGINEER f USE OF PERMItANGLiti FAMILY DWELL114G Permit dm not .tncjnde block 'wuU or pool. FEE DESCRIPTION FEES TRACT CONSTRUCTION 1,400.00 SF - PORCV- PATIO 140,00 SF GARAGrUCARPORT 440.00 SF 6 FT, WOOD FENCE 200.00 LF ESTIMATED C(A. T Off' CONYfRUCI ION 88,206.00 PERIMIT FEE SUMMARY PLAN CHECK FF., 101-(M-439-3.18 $500.86 CONSTRUCTION FEE 101-0004M.000 $590.00 IM EC;".IiAN1CAL FM 101-0.0.0-42,1-000 $60.00 ELECTKICAL FEE 101-000-420000 $121.30 PLUft4BiNG FF.1 101 -MO -4.19-000 $1341:75 3TONG MCY110N FEI - RESID 100-000.241-011(} W112 MADING FTE 101>000-423-000 $20.0 I NF.RASTRUCfURF FU.. 225-000-443»342 51.904.49 PRF -Cr" [SE PLAN 101000-441-345 $25.00 FEE DEPOSIT 4250.00 , SUB -TOTAL C0NS'1'1WCTIQN AND PLAN CHECK - > °;• LESS PREPAID FEES S3,365.22. 4250.00 ^, Y 3OTAL PERAW FEES DUENOW DEC �3,lX5.12 1 1995 BV RECEIPT i DATE BY DATE RNALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs / 9,� Underground Ducts Forms & Footings Q Ducts Slab Grade Return Air Steel 1;0_16100'r— Combustion Air Roof Deck Exhaust Fans O.K to Wrap 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 APPROVA S POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam 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: ArIMMve— 0 -IV 517,P - — �'� GGTd27 %//�6�i�SOG�;1 W /1 10W 1�6�/n6�a.�j�a.•� Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power PoleQlGid�i�<% 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) V fi(�P�PeO. BOX -1504 APPLICATION ONLY Building,j( 7&1;05 CALLE ESTADO Address I P,� �\� ew 1L4nLA QUINTA, CALIFORNIA 92253 Owner "A"r) Mailing Address `- Zip ITel Cont City Zip 9 Tel.. ttL"V1k_ IIA State Lic. City & Classif.' Lic. # Arch., Engr., A Designer , so Q.Q q li- Address , , Tifl. '4�5- 'cj 1� rt -3 C-'tLt-J I -t4G _-,� -0-4:19 Cityp. Zip ' State t HSL iM t��J•c 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). I71, 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.) 1 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.) 1-1 1 am exempt under Sec. B. & 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 0 Copy is filed with the city. 0 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.) I 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 tot—'_1 expiration it work thereunder is suspended for 180 days. r I certify that I have read this application and state that the above information. I corre t. I agree to comply with all city and county ordinances and state laws relating'tdibuilding construction, and hereby authorize representatives of this city to enter they abovs0 mentioned property for inspection purposes. `J 41'� V Signature of applicant Date\` Mailing Address City, State, Zip BUILDING DIVISION BUILDING: TYPE C-773! ON-S7T:2. /�OCC. GRP. A.P. Number ! / ! — O / -2 — iq- ,Legal Description Lot O Ixg, / Project Description Sq. Ft. No. No. Dw. Size Stories - Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ I^ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. ZC�p Plan Chk. Bal. Const. Mech. Electrical Plumbing. S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS 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%• / tssue�dby: ``�l Valued by:_` Vi\fi rte'—`� INSPECTOR rmit CONSTRUCTION ESTIMATE NO, ELECTRICAL FEES NO. PLUMBING FEES 1ST FL: S0. FT. @ $ UNITS SLAB GRADE 2ND FL, SO. FT. @ BONDING YARD SPKLR SYSTEM POR. SQ. FT. @ MOBILEHOME SVC. BAR SINK GAR. SQ. FT. @ POWER OUTLET ROOF DRAINS CAR P. I S0. FT. GAS (ROUGH) DRAINAGE PIPING WALL SQ. FT. @ OTHER APP./EQUIP. DRINKING FOUNTAIN SO. FT. @ TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ 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 LAUNDRYTRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM. B.T.U. ITEMP 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. tai c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ, FT. RESID @ 11A 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 R 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 x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL Desert Sands Unified School District Notice: ` 82-879 Highway 111 rIndio, CA 92201 Document Cannot Be Duplicated 619-775-3500 CERTIFICATE OF COMPLIANCE Date 11/30/95 APN # 773-062-019 No. 13923 Jurisdiction La Quinta Owner Name Permit Aceves - Permit # No. 51185 Street Avenida Vallejo Log # City La Quinta .Zip 92253 Study Area 113 Tract # " , Lot # Square Footage',.* -1400 i 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 ffacility fees imposed pursuant to Government Code 53080 in the amount of 1.72 X. 1,400 or $ 2,408.00 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 Jerry B. Lugo %S Telepl one. 345=4:236 Name on the check \' By Dolores A. Ballesteros Superintendent Fee collected /exempted by Pauline Pearson Payment Received $2;408.00 Check No: 2477 Signature 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 MY wr1Ll' R(A.VRi/aJ/�,a. ,v: Mario B. Aceves Maria Luz Aceves OCT 311995 POBox 1266 PAID Thermal, CA 92274 Doc. Transfer Tax f:RANK K. JOHNSON ta,....ar�• ...��ow.r..... Rr t,o• ReootOet Qaeadar 6'q ric 7& Space Ahrme Tina Ldtaoorsler a Uac Ody A.P.N.: 773-on4i RA A: C20Cj(y^ OdeNo.: SM3769L42 Escrow No.: 2-19679 GRANT DEED THE UTVDERStGNED GRANTOR(s) DECLARE(sl THAT DOrl SIF_NTARY TRANSFER TAX IS CMINtY # 14.Sti X 1 computed on full value of property conveyed, or " [ J computed on full value las value of liens or encumbrances remaining at time of We. [ JJ unincorporated area..[ X•1 Ciryof LaOuitna,and FOR A VALUABLE CONSIDERATION, Receipt of which is hereby acknowledged. Judith B. Palmer, a Married Woman as her and Susan B. Nines, an Umnarried Woman as Tenants. in Common hereby GRANT(S) to Mart B. Aceves and Maria Luz Aceves, Husband and Wife as lout Tenants the following described property in the City of La Quinta, County of Riverside State of California; Lot 8 Rik 72 of Santa Carmellta at Vale La Quhnta. Unit 9 of. Tract . in the City of , County of Riverside, as - per. ' map recorded in Book 18, Pages) 69, In the Office of the County Recorder'of said County. = • " _ � r Judob B. Palmer Susan B. Hina Document Date: October 4. 1995. STATE OF j?,9k OWjAPGAOVSYL VAA1t^-' AS COUNTY OF AL t_% 4 )1<--IVY , - On "IC. 7, 27 pis before me, 1 �}C�flr}J/l(� F iLiYG'�t-Tt./�i A persm lyappared r—Jud2ttj B. Palmer personally known to me (or proved tome on the basis of sansfacuiry evidence) uo he the persons) whose nameM os/are subscribed to the within instrument and acknowledged to the that de/she/they executed the same in his/her/their authorized capacoty6es► and that by his/her/their signature(s) an the inunin enr the person(:) or the entity upon behalf of which the persons) acted, executed the instrument: ` VMtITI1SS my h ad ud officw seal Signature a .. This area for nfrtcial notarial seal. Thsodora F. Krw�K . Naha Public l� �Carnyrl pge Mertt)er, Ps*trrglv.ra Ae.oaraort d NO�bea ,