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9805-087 (SFD)LICENSED CONTRACTOR DECLARATION I h?.reby 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 8 C36 vDate � Signature of Contractor' W. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury 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 3700 of the Labor Code, for the performance of the work for which this permit is issued. ( j Ihaves nd 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. FUND (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 Code, 1 shall fort)with comply with- those Prov s ons'' VDate: YY Applicant Warning: Failure to secure Work re s' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work f`or 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property forinspection purposes. Z .fir.. 9 /Signature (Owner/Agent)!-''- `" `'-' BUILDING;RERMIT PERMIT# CONTROL# DATE I VALUATION-+�y+.� -.' � LOT ,fll�.11�� TRACT JOB SITS ` APN ADDRESS 4-315 ANIENID VAUi,�i..'30 774-2444027 OWNER CONTRACTOR/DESIGNER/ENGINEER RAQL`-,1.13AJ1FS P1 REWHIC;A C'Oj?ITIMIUC 1't0N 68385 VER NO RD, 59-383 VERANO RO,ND CNI"EN'LJt A.I. CI'f`1' CA W234 C:A'[`4-I.L'fJRA11 CITY CA 92.234 t7ii©j3 •�39t3 C RI.tf 4460 USE OF PERMIT SRR x`11UVUr :a).Nti'I'te.UC110N 1.,f.' A.00 17 3"Gs32.t„ HfVATK3 236.W a:F c'.0AR.A(_1c.A1 V0R'r 402.003F 6 FT. WALL 310.00 I.F. Ownjl."Wlr D C'aST QF C,ONISTS.MION, 117.901.20 PLs k N C'fLC;K. F EF 101-C> -439-31$ $578.49 A4EC.KA.X't(;AL C'.FF 101-000-421_-i1fM) $53150 EXEC"IRI<;A1-. M, 101-000-420-000 $144. P1I.C.dM1IA NO FEE 101-t`iW-419-•000 SW630 S'1'ItOT401007'[C?i+t'FEE -RF..S10 ta.1.000-`141-000 $11, i9 rRAMNOT-IFIL ?C?t-0t>0-423Oth'1 S^ ,rut CwRAS".' zurnatk*: wa 25.000-443-342 f%RMSE PLAN 101-000-441 6 $15.00 A91JN PUBLIC: PLAC..i?S - PtESIC 701-(}Uf7-2_55-ow $29.63 cols"mi Tf"ReN f -.I 1, !01-Q0Q_-418-0M_ S702,50 ;;fes 1��:w`1�53't" 1`� �(#00-•iy9-3;.g -.•°nGStl.t}J,J su iF :A:.tf CON'S"r!2J'iCt`1nN A�11 !'i.:.ol� C,'Hji C ;t: ' dj� � r' I LSS PRE -.P I11 VEM'S '�o 4250,00 V ti 3 `a d °i�:&cl4t�-r FFA; . D(1 Now RECEIPT DATE/-� BY DATE FINALED INSPECTOR OPERATION DATE I INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck O.K. to Wrap _ % Exhaust Fans 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 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 QQAf Pool Cover Sewer Connection 0/ Encapsulation Gas Piping Gas Test ��®�ixa Appliances Final 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) COMMENTS: /''..� „c1 -*'moi 4'�il•-I"'_iv..''r+ y.ri+�4ixy .'�Y"f�ry, M� '�Iw. Ftr,�r t .y %�S� SS's r i��vl r ;• n.L�--yam r.<r.r`ri.r,r� w �. ., �f $O 062-7 ( PAID Bilding P.O. BCX 1504 APPLICATION'�i 4 5 1998 u / �f j� �% 95 CALLE TAMPICO Address /�!'l % 7T /Il%. V'411 !�/I LA 78-4OUINTA, CALIFORNIA 92253 144 Olt -141 L1,1 V11 <-0 S Mailing / p �� n Address CJf� 3rF lleg4wa RD. City Zip Tel. t'--A7W, 1'/ �'�a39 3� -939 Contractor UA.ti /7�7 I?E 2611/e/? Address l TP--- 3 ?1- �/�'RA t to R7 IAT11 _ RW - State Lic. 561City 0 7 & Classif. Lic. # Designer �t 6,A-4 Address Tel. CityI Zip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION I herebyy affirmaffirm tcensed.untley Drovislons of Chapter 9 (commencing with Section 7000) of Division,3 of the'Busines's.end Professions Code, and my license isInfull force and $iGNATURE4 _-1 M • 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, atter, improve, demolish, or repair any structure, prior to 'Its issuance also requires the applicant for such permit to rile 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 (8500). I.' 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'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.) 1-7'1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have 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 r7 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 (5100) 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 1 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 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives got this city to enter the above- mentioned property for inspection purposes. Signature of a0pticant Date Mailing Address City, State, Zip `iTY OF LA QUINTA JILDING: TYPE'CONST. OCC. GRP. P. Number Description ;t Description r TOTAL 7T 61.5/J (lw 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 =INAL DATE INSPECTOR ssued by: Date Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Sia. Ft./ No. Size Stories No. Dw. Units New go" Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT (Plan Chk. Dep. I/Mo. OG Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL 7T 61.5/J (lw 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 =INAL DATE INSPECTOR ssued by: Date Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Desert Sands Unified School District " 47-950 Dune Palms Road ' Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 7/14/98 APN # 774-2447027 No. 17317 Jurisdiction La Quinta Owner NameRaquel Davalos Permit # No. 54-315 Street Avenida Vallejo Log # City La Quinta zip 92253 Study Area r Tract # Lot # Square Footage 1804 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 facility fees imposed pursuant to Government Code 53080 in .the amount of 1.93 X 1,804 or $ 3,481.72 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 Cash - Juan Perezchica Telephone' 320"9358 Name on the check By Dr. Doris Wilsons «. Superintendent r `" Fee collected /exempted by Ellen Patino Payment Received ' $341A a$ i- . 7.�'. _p w e ') Check No.' N/A Signature fOTICE: 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 ibove 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 ollect them on the District('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 �041"1-24./1998 11:24 5646177 F !Mdinj YBmlean1tl Insu lLcs RECORDING REQUESTED BY: i AND WHEN RECORDED, NAIL TO: + Enrique Davalos 54380 Avenida Martinez Lia Quinta, CA 92253 ASStOR'S PARCEL _- 774-244-028-6 TITLE ORDER No.: 774-244-029-7 2055983 774-244-030-7 E9CRCAW No.: 1372 -DB 0-20 -0® REh1AX OF THE DESERT Ale. 54,35 PAID Doc. Tr.Btl W TOt FRANK K. JOHNSON Rlv. Co. Recorder PAGE 63 M..:1 3021 • 1 ,• RECEIVED. FOR RECORD AT 8:00 O'CLOCK Rmunild A O&W Ramds d WW"QA". 4)t Rwotim q ♦=m s THIS SPACE FOR RECORDERS USE ONLY The undersigned Grantor(s) declare that the C.. _T R TAX IS: $ 107.80 County $ City f l xx computed on the full value of the interest of property tor.(eyed, or computed on the full value less the value of lions or enWmbrart1c7 remaining thereon at the time.of We. OR transfer is EXEMPT from tax for the following reason: FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Bruno B. purvenaa hereby GRANT(S) to Enrique Davalols, a Single Mail all that real property situated in the City of LA QUINTA County of Riverside, State of Califomia, described at: AS PER EXHIBIT "A" ATTACHED HERETO AND MADE A PART. HEREOF: Dated July 26, 1996 STATE OF CC."WM OF -tefore me t ... . otary Public, personally appeared Q. hm (or proved to ma on the basis of satisfactory evidence) to be the parsonO whose na is/are subscribed to the within instrument and acknowWged to me that heli executed the same in er/thair authorized capaclty(les), and that b I hadtheir signatures) on the Instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the inatrunnant. WITNESS my hand and official seal.. sir alure Bruno B. Purvenes P Carl G. urvenes-Smith, His Attorney in Fact 'MAIL TAX STATEMENTS TO: Enrique Davalos - 54360 Avenida Martinez, Le Quinta, CA 92253 _ .to 1 ams for oftWI nowry seal) -,,'/24/11 11:24 '' 5648177 REMAX OF THE DESERT PAGE 01 /Cwt.. - - ...._..� ..rw...... _._......�......d3.�7f:'�j•N I,+e r�'irNlA4ks. rns.+ v ` 302171 Escrow tic. : 1312 -DB ( 1 ISXIIIEt7_l'___7!' f IN THE UIOZNCORPQRA'IED AliEA-0V THE COUNTY OF RIVEMSIDE, S•1'A, E or CALIFORNI)1: ' e !. tl PARCEL 1: LOT 1., BLOCK 289, SAN'T'A CARMin,rrA AT VAT,E ISA QU.INTA, UNIT 26, AS PER MAP RECORDED !1 IN BOOK 20, PAGE 50 OF MAPS, IN TitE 'C)FFICI. UN THE COUNTY RECORDER OF SAID COUNTY. 'PARCEL 2: LOT 3, I#LOCK 289, SANTA CARMELITh AT VAIs. i,A QUINTA, UNIT 26, AS. PER MAP RECORDED IN BOOK 20, PAGE 50 OF MAPS, IN'THE OFI`ke Ole' 'i mi, COUNTY RECORDER OF SAND COUNTY. �i 9 : ' PARCEL 3 : LOT 21; l ,Or.K 289, SANTA' CA'RMELITA AT VALE I,A 'QUINTA, UNIT 26, AS PER MAP RECORDED. IN HOOK 20, PAGE 50 'OF, MAPS , IN TIM ,( FFTC H OF THE. COMITY RECORDER nF SA'I.n COUNTY. s PARCEL 4: LOT 23, BLOCK 289, SANTAl CARMI Ti)'TA AT VALE LA OUINTA, UNIT 26, AS PER MAP RECORDED IN BOOK 20, PAGE 50 OF, MAPS, Z,N 'I'fiE;4(.�i l'7( l'ss OF THE COUNTY RECORDER' OF SAID COUNTY. t 'r. '` l �,. ' I'F.• � ; 1 � � 1 i,.' .{ r( 1 � �+I: '' ! r - I F 1 if r r ! r 1 t '�' 111 1�/„ 1 • - . IPit^ ' . . t ' 1. �'k 1. ' t � 'I,I T ,1 1•.1'. 1ty�i ' ` ; _��t , t; `l i � ' 1 . ' . ; ` 1.. ��{(•• t Illi r • 't t 1 ,q , i, i 9 : ' t� r t 1. •, + t 'r. '` l �,. ' I'F.• � ; 1 � � 1 i,.' .{ r( 1 � �+I: '' ! r - I F 1 r if 1 i - � - . IPit^ ' . 1 �'k 1. ' • �{ _ I '''' i ... � t - � � ,/ 1ty�i ' ` ; _��t , t; `l i � ' 1 . ' . ; ` 1.. ��{(•• t Illi r ,q ,