002738 (SFD)Building
52-440 AVM10a
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Address
City Zip Tel.
Sm*a ricomm 95406 5- 78--1M
Contractor
ress.
lZiD I Tel.
State Lic. City
& Classif. � Lic. #
Arch., Engr:,
Designer
Address Tel.
City (Zip y (State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of tDivision 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, after, 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 "'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).
❑ 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, 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, 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 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
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff 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.
r
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:)
Lenders 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.
I certify that I have read this application and state that the above information is correct.
1 agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection
� purposes.
Signature 5
of pi
-� ` `- Date !. k
Mailing Address
City, State, Zip
HARD COPY
No.
002738
11LDING: TYPE CONST. OCC: GRP
P. Number 773-263--010
Description U* 1.3
t Description Sifle family dbollim
DW 1453
Sq. Ft. 4,22
Size _
New 4� Adtd C
No.
Stories
Alter O
I so . wan
No. Dw.
Units
Repair ❑ Demolition O
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 12 4"8Permit
Validated by:
Validation:
A 6 8 5 3 12 4 .1 854.71 Ck
Estimated Valuation
8 75.705..00
PERMIT
AMOUNT
Plan Chk. Dep.
250*00
Plan Chk. Bal.
Const.
411.00
Mech.
30.010
Electrical
75.13
Plumbing
99 .00
S.M.I.
5,29
Grading
20.00
Driveway Enc.
2040
Infrastructure
1,135.13
TOTAL
2,104.71
1,8541.71
.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 INSPECTOR
Issued by: Date 12 4"8Permit
Validated by:
Validation:
A 6 8 5 3 12 4 .1 854.71 Ck
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. � SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT.
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH) METER LOOP
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEOUIP.
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
�+
INSP. y ;3O T
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
REMARKS:
SO.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEEE
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
ND 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
OWOUND. REINF. �l A
I
GAS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
A
GAS (FINAL) P. POLEIt ',
G OUT
WATER HEATER SERVICE
NAL INSR�/
?ni() BEAM / 7i G
WATER SYSTEM
$
GRADING
CU. yd.
plus x$
$
MBER GR.FINAL
�+
INSP. y ;3O T
r RAMING 34A
INAL INSP. l/.' (6
!! v
OFING 31-34Z7
vA) II: d Rri wnCcecez
./ IriAl / 3/1b�� Q
'Ply
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
/
VC- LATHING -e
MESH
INSULATION/SOUND .
FINISH GRADING
P. -_FINAL INSPECTION V -S11 -S 1
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESANITIALS.
GARDEN WALL FINAL
11�1OF1E0
2= =0
y BERMUDA DUNES r
RANCHO MIRAGE
INDIAN WELLS ti
d, PALM DESERT
d' LA QUINTA
',0 INDIO y�
Desert Sands Unified School District
82-879 HIGHWAY 111 • INDIO, CALIFORNIA 92201-5678 • (619) 347-8631
December 3, 1986
I
* City of La Quinta
Department of Community Development
78=105 Calle Estado
La Quinta, CA 92253
Re: Lot 13, Block 83, -Unit 10, Avenida Vallejo, La Quinta, CA
1 unit
Gentlemen:
The developer of the above referenced project has
mitigated its impacts on our overcrowded schools by
payment of the amount of $628 per unit. This amount is
to be applied to the cost of additional district
educational facilities made necessary by such new
development.
Sincerely,
John D. Brooks
Assistant erintendent
Business vice
By:
/ Richard M. Beck
Facilities Planner
JDB/vmm
* This certification of payment of developer fees is valid
for issuance of building permits only until and including
December 31, 1986.
CHICAGO TITLE. COMPANY .
Order No.
+ &row No.
Loan No.
WHEN RECORDED MAI L. TO:
Kenneth Martin..
P.O. BOX 11218
Santa Rosa CA 95406
COPY t Document Re
owl
on as NO..
has not been compared with
ar.igi nal.
WI! LIAM E. CONERLY
County Recorder
�pIV•`rSI^E COUNTY, (,A' 1170 -NI'
SPACE .ABOVE THIS. LINE FOR RECORDER'S USE
MAIL TAX STATEMENTS TO:
DOCUMENTARY TRANSFER TAX $..none—no consideration
...... Computed on the consideration or value of property conveyed; OR .
same ...... Computed on the consideration or value less liens or encumbrances
remaining at time of sale.
Signature of Declarant or Agent determining tax —.Firm Nome
GRANT DEED
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, .
JAMES G. LAIER, SR., who acquired title as
JAMES G. LAIER, SR., and KATHLEEN MATOVICH, as Trustees under Trust Agreement
dated July 1, 1973 for James G. Laier, Sr.
hereby GRANT(S) to
Kenneth C. Martin, a -,married manas his sole and separate.property.
the -real property in the•City of
County of. Riverside State of California, described as
Lot 13 of block 83 Santa Carmelita at Vale La Quinta Unit No. .10, as per
map recorded in Book 18, page 70 of maps, Records.oftRiverside County.
Chtcoco,nveny has rWOrdsd -h!s
RECEIVED
lr.tmomentto fry, .n c-....._ .-.. .
-NOV 14198
CITY OF La QUINTa
COMMUNITY DEVELOPMENT DEPT is
e tember 24, 1986
Dated Sp
Jk4ES G..LAIER, R., trustee'
STATE OF CALIWfM )ss.
COUNTY OF )
On September 26,-1986
before me, the undersigned, a. Notary Public in and for said State, per-
sonally appeared
James G. Laier Sr.
DAWN M.
i! OFFICIALrAI
personally known to me (or proved to me on the basis of satisfactory MARTIN
evidence) to be the person(s) whose name(s) is/are subscribed to then19WW within instrument and acknowledged to me that he/she/they executed fi{y COM. Elp. ,ler
the same.
WITNESS my hand hai i seal. .
(This area for official notarial seal)
Sianature
1002 (6/82)
MAIL TAX STATEMENTS AS DIRECTED ABOVE "
REMARKS:
f
Signature