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9703-053 (SFD)LICENSED CONTRACTOR DECLARATIONa,,rt 4 J t� I he7eby affirm under penalty of perjury{that I am.licensed.under provisions of ,.►ChaP_fer 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License #ytLic. Class Exp: Date Date Signature of Contractor • f OWNER -BUILDER DECLARATION , d I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: T; ! ( ) I; as owner of the property, or my employees with wages as -their sole 1 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 & ProfessionalsZ Code). (.) I am exemt.under Section ' B&P.C. for this reason Date1ri 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: Cartier. Policy No. FUND (This'section need not be completed if the permit valuation is for $100.00 or'less). O (;certify that in the performance of the work for which this permit is issued, I shall'not employ any person in any manner so as to become subject to the workers'°compensation laws of,California, and agree that if I should become subject to°the workers' compensation p&isions of Section 3700 of the Labor yCode, I'sl�all fo hwith comply wi h t`o$e prii�sloons. u' Date: `' ` t, 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 orpursuant'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 "ofsuch,, 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 i spection purp(;&s. , 1jSignature (Owner/AgentOV\ �' ate'7, c. �rPERMIT# CONTROL# ` BUILDING PERMIT''• t >. �•1irQ1.3-�+:�.� a r: g DATE r VALUATION -1 LOT TRACT N. JOB SITE °r; r t e{ ADDRESS APN OWNER f' i CONTRACTOR / DESIGNER / ENGINEER ` f�Oaf'k��i�tA:i%.- s: � ` I Jgl�,,.•rl: RADE IS t�IV.: 1,,A (' UIN YA, * CA. 02.253 1 A Q1,1•I%i''.1 A CIA 92253 USE OF PERMIT SV 0 PWD - .i'hkN i i .i30i : NU IN(�'i: DE KOC K WAIIS 09.POOL. PLAN .FOR 1,434,% OF `afl:fvfl :PLAN. V '{ Itit+; 'i.' CwAfS 1'12(1(' 1� r1 t,=1i0-�1+� aF 1'r iitCI' Wil 110 . 42.00 !fit: i3rA14A0FVCAitP0Xr X19+9. 0.1W 3"310�A°Q'D' MST 'NT ��,!�4►z.ti8 ,0N,VX'1(rrt:c 0N1 -PAT 10.1-000-418-000 $551 PLAN C';'tMYXFYTY 's i POSIT 4250)JU OVIRC RA IC4 FM'. .: 61: -Cly 42,1, -ilk EL (NR.tCA1: R.1 101.43(i#i-420•-000 S122.9,A PLUMB MOV'E; L '101-000-419-000 S1?7.ca SIT 014G M.0 r ON Mn K.z,MIDO'121400_2:s41�00o Mr,Rj S'I111X„"1rLTR.H.!1ffi '225,0}-443-342 0,942.71 PR CISE'.I'LAN. lis-tlW-441-345 $25.0 SUB -MAL C0N1,rJ RLI(_`T'±.0Y4 t1N.Ci' LAN CH8C"K $3rt1��.49 LESS. PR TPAID Ph S RECEIPT . DATE BYp ,' DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Stab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap %OR F.A.U. Framing Compressor Insulationalp 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 Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines 7 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) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) P.O. BOX 1504 - ' APPLICATION ONLY V A�7&105 CALLE Address � Cj LA QUINTA, CALIFORNIAORNIA 92253 Owner Mailing BUILDING: TYPE CONST. OCC. GRP. ' Address Q, fl X `1'Z'Z A.P. Number _773- 13111 -001—V City Zip Tel. R -.. Zos-1 Legal Description to Contracto Project Description Address 77 3 — 121 — O 1 .a -3 -zi5ki- State Lic. City & Classif. �?>� Lic. # Arch., Engr., Designer Address Tel. CityI Zip I State Lic. # �� CICENSED CONTRACTOR'S,DECLARAT40N I hereby ffirrP that 1 a�i licensed under provisions-af Chapter g�commencing with Section 3oa) o`f bivlsidpJ3 of the •BusirLess.and Professions Code, and my license is in full force and OWNER•BUILDER DECLARATION I hereby affirm hat 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 or 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). 17 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 l I, as ownerof the property, am exclusively contracting with licensed contractors to con- struct the proiect. (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.) i 7 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. ❑ 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 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. 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 it work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I(aee to comply with all city and county ordinances and state laws relating to building consgrtruction, and hereby authorize representatives sof this city to enter the above-. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, Slate, Zip BUILDING DIVISION Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ ❑ Demolition ❑ CITY "0"F A 0!J!kiTA Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. -2-5D` Plan Chk. Bal. Const. Mech. AAL 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 s FINAL DATE INSPECTOR Issued by: Date Pere Validated by: Validation: MAR 14 1997 CITY "0"F A 0!J!kiTA CONSTRUCTION ESTIMATE NO, ELECTRICAL FEES NO. PLUMBING FEET' A.C. UNIT COLL. AREA jib 1ST FL. SO. FT. g $ UNITS HEATING (ROUGH) 2ND FL. SQ. FT, tc� FORMS YARD SPKLR SYSTEM POR. SQ. FT. MOBILEHOME SVC. BAR SINK GAR. SQ, FT, g POWER OUTLET ROOF DRAINS CAR P. S0. FT. 0 OTHER APPJEQUIP. DRAINAGE PIPING WALL SO. FT. r0 TEMP. POLE DRINKING FOUNTAIN SO. FT. @ GROUT URINAL ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation WATER SYSTEM FLOOR DRAIN MECHANICAL FEES =$ WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER 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, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ®c BATH TUB SQ. FT. p c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID Q I 1 c SEWAGE DISPOSAL LATHING SO.FT.GAR fg ?Ac HOUSE SEWER MESH GAS PIPING PERMIT FEE INSULATION/SOUND 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 APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ 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 l CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL Desert Sands Unified School District Notice: 82-879 Highway Y11, z Indio, CA -92201 Document Cannot Be Duplicated ` 619-775-3500 CERTIFICATE OF COMPLIANCE . Date 3/28/97 APN # 773-131-015 No. 15378 Jurisdiction La Quinta Owner Name David Ross Miller,Permit # No, 51565 Street Avenida Vallejo 'Log # City La Quinta ;i Zip 92253 Study,'Area 112' Tract # Lot # Square Footage 1410 Type of Development. Single Family Residence No. of Units 1 s Comments At the present time, the Desert Sands Unified School District does not collect fee's` 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: t ibTICE: Pursuant of Assembly 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 will begin to run from the date on which the building or n. stallalioh permit for this project is sssued or on which they are paid to the District(s) or to another public entity.authorized to celled them on the Distrid('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 EXEMPTION NOT APPLICABLE, f This certifies that school facility fees imposed.pursuant to Government Code 53080 s, in the amount of 1.84 X 1,410 or.$ 2,594.40 the property Iisted'above' and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may nowjbe issued Fees Paid -By Capital Bank of North County_ a, �y Telene1«1 564.0273 Name on the check` �= By Dr. Carol McGrew -2 Administrator in' Charge Fee collected /exempted by Pauline Pearson IN Payment Received `$2~,�594.40 Signature Check No. `5174 ibTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified will begin to run from the date on which the building or n. stallalioh permit for this project is sssued or on which they are paid to the District(s) or to another public entity.authorized to celled them on the Distrid('s)(s') behalf; whichever is earlier. - Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting ., �' -, ,�- �; .:. r` ,,, ,: �� �, � ': :, , 4 v° 1 1, } �• .�' -• . : ` �� . •. • X73 : (31— o d I S � � � . SALE ESCROW INSTRUCTIONS U r, 8 Coua�mu�tH 'HIS DOCUMENT WILL AFFECT YOUR LEGAL RIGHTS - READ IT CAREFULLY! _ 0: COMMONWEALTH LAND TITLE COMPANY' Escrow No.: 97.6457KC s 72855'Fred.Waring Dr. f Date:.02/20/97 Suite A5 Page: 1 Palm Desert, CA, 92260 (619) 836-3726 Escrow Officer:'Kelly Collier 'HE ESCROW HOLDER IS COMMONWEALTH LAND TITLE COMPANY WHICH IS LICENSED. �Y THE CALIFORNIA DEPARTMENT OF INSURANCE. uyer, or his .agent, will hand you.•or cause to be handed you upon signing of . hese instructions a�'deposit in-th'e amount'of........:....::..:......,;.....,,,,,$ `500.00 uyer will hand you'additi-onal..funds prior to closing -in -.the amount of...:......$MINIMUM . roceeds-from loan to be'procured by Buyer (First•Trust'Deed).:.:...: $FHA MAX )TAL CONSIDERATION $ 97,000.00 id any additional funds and instruments.required from me to enable you to comply with these istructions,-which you are to use on•or-before May 15, 1997, and when-ORANGE•COAST TITLE 1MPANY can issue a Standard Policy. of Title Insurance Owners form,.with liability of 17,000.00;'on real 'property in City of LA-QUINTA, County of Rivers.ide, State of CALIFORNIA viz: )mmonly kno as:,AVENIDA'VELLEJO;" LA'QUINTA,'CALIFORNIA (Exact address to be determined) 1 3 BLOC 54, SANTA CARMELITA AT'VALE LA QUINTA, UNIT NO. 5, AS PER MAP .0 ED IN 0 18; PAGE.63 OF MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA + :cept any reservations of record of minerals, oil; gas, water, carbons and hydrocarbons.'^ sowing title vested in: ,NDRA NEAL HENTON', (Exact•vesting to be determined) ee from encumbrance 'except: A. Current general and special taxes for the fiscal year in which this escrow closes, and taxes for the ensuing year, if any, a lien not yet due or payable. B. The lien of supplemental taxes, if any, assessed pursuant to the provisions of Chapter - 3.5 (commencing with Section 75) of the Revenue and Taxation Code of the State of California. C. Special -improvement assessments', if any. D. -.Easement -s,. -rights; rights of way, covenants, conditions, restrictionsland reservations of record. ,. - f E. Deed of Trust to record 'in the,amount'of•FHA MAX, -in. favor of a lender to be determined.