9911-131 (SFD)1 LICENSED CONTRACTOR DECLARATION
I herebyiaffirm under, penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing Iwith Section 7000) of Division 3 of the'Busiriess and
Professionals Code, and my License is in full force and effect.
License # Lic. Class'! "+ Exp. Date
61.972 4
�Date�— Signature of Contractor
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.
(K) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the per of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
STATE, F UND 14961047.9",
(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
CCo%, I shall forthwith comply with thosprovisionst
wate: 1.- '\n^rApplicant Y,r
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 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 Bove -mentioned property'for inspection purposes.
ignature (Owner/Agent)rD r1\ '?'`� ��••� Date 1-
PERMIT #
BUILDING PERMIT�_��
DATE VALUATIONit �os.S 90 LOT h TRACT"I3 i2 U28
ADDRESS 54-800 AVENI AA'f4�,�l� EU0
APN V4 302_601
OWNER
CONTRACTOR DESIGNER ENGINEER
PE & OfORGEA;1E KILDSIRN
XIII AMIS'vCJrlR L1(4MV1N,
512811MIR AVE -
5128 AIUIR A E1VUE
SAN 1J1_E-GO CA 92107
Stlh1 DIE -00 CA. 9207
(tSt912.21t :i R1 Ci CRL# 596A
USE OF PERMIT
S.NGLF, F''ANELY.DVD-h1l.. VK0
Skiis - PFIi.t` IT DO -a X O 1INCLUDE BLOM WALL (DR POOL.
"1ai i
XI�RC1•ti'PA7110 141 +lC+ aP
U-AkA0FYCAlt1'0X1' 441,00 SF
5 FT. WOOD F'BNUZ 200.00 L,1:' `!
1i&fIVIATED C' ST Cil CLNIS T.R,UCTIf-IN
101940/019
PERMIT FEE, SUMMARY
C;ONS'. RUt:° AGN FEE 10.11-000-418-000
Fps.A•N C'Mi :K 1? . 101-000-419-3 19
NIEC'.IILiANA"All, F0
EM:CT1I.i0. 1 .FFR 10i�000-420-,0017
PLUMBtNtr 1,W 1.01_00(1-1119_000 1116.75
f','i'12(lNl7 )bT01101N FF IR - RES11) 1011-0,W-741-0. 0 $14)10
GIZAVIT, r:.k". 1'; 101400-423430 $20.40
i')tiVi31.0PE1: 1h4P1\CT F1G1~ Sl,vt1?.tlt1
i
! RIX- 111SEPLA 101-0011-4141-345 1tJi4,Ot1
} 1
",
j RT 1rf $2.41
r ai; L?1r`PQ.` rr 1.01 <tlllJtlA'M-314 4250.00
SUIR-TOTAT., CONSTRLfcMONO AND PLAN CREC K ;"
�;�,54;2.f17
r�
LESS PRET.101) Q.1111 S
�t�;
w 17 ;�; -$2513,10
TOTA .PERIM'. T FE&S IDUM NOW
n
RECEIPT -_ _
DATE
BY'
DA I D
INSPECTOR
l�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
y
Return Air
Steel
Combustion Air
Roof Deck
_
�-
Exhaust Fans
O.K. to Wrap
_
F.A.U.
Framing o9
I7_ d3Q:, ca?
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
- 3D
Drywall - Int. Lath
Final
Final
r _
POOLS - SPAS
BLOCKWALL
6APPROVALS
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
Water Piping
Heater Final
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
5-7
Appliances
Final
COMMENTS:
Final
_
Utility Notice (Gas)
ELECTRICAL PPROVALS
Temp. Power Pole (- / ( _0Z) 5-7
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) O
P.O. BOX 1504
Building78-495 CALLE TAMPICO:�-. APPLI T N ONLY
Addres��`E-} j Q LA QUINTA, CALIFORNIA 92253 ti
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BqLDING: TYPE -CONST. OCC. GRP.
Address
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A L", C,
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A.P. Number -
Legal Description
noA�-
L v �- j Z U 2 X75
pity f i
Zip
Tel.
Project Description
L)
Contractor , j
Address
City
Zip
Tel.
State Lic.
& Classif.
�� ►�
City
Lic. #
Sq. Ft.
Size
No. / No. Dw.
Stories ( Units
Arch., Engr.,
New �. Add ❑
Alter ❑ Repair ❑ Demolition ❑
Designer'
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of D7' I lion 3 of the Business and Professions Code, and my license is in full force and A
effect. f f�` �i ),/ --) )
' C)f
SIGNATURE r �- F i , 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 th
requires e 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
lot 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).
C., 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. (Seo. 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 1, asowner 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.)
17 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
Ihereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec, 3800, L�bor Code.)
Policy No. Company- �� %�f fir' •J +-
r7 Co is filed with the cit O Certified�c6pf 'is r
Copy y. py is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (3100) 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
ame
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 1 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 -of this city to enter the above-
mentioned property for inspection purposes.
Signature of a0plicant Date
Mailing Address
City, State, Zip
Estimated Valuation
PERMIT I AMOUNT
Plan Chk. Dep.
Plan CH k. Bal. a
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
I Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line ;
1'
FINAL DATE—INSPECTOR--
Issued by: —Date---YPa&1
Validated by: NOV n 11999
Validation: 8 QUINT-
WHITE
�iyt
./ITY LA � UIN G d
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 1/3/00
No. 19869
Owner NamePete & Georgeann Knudsen
APN # 774-302-002
Jurisdiction La Quinta
Permit #
No. 54-800 Street Avenida Vallejo Log #
City La Quinta Zip 92253 Study Area
Tract # Lot # Square Footage • 1665
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 1,665 or $,3,213.45 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 CC/Valley Independent Bank/Pete Knudson Telephone 619-226-1886
Name on the check
By Dr. Doris Wilson
Superintendent ^ : ,, 4
u !It
Fee collected /exempted by Ellen Patino Payment Received $3,213.45
Check No. 209528
Signature Z--
40TICE: 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
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.
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
MAIL TAX STATEMENTS TO: -
same as above
THIS DEED IS BEING RECORDED IN COUNTER PART
`7
APN:
TRA:
SPACE ABOVE THIS LINE FOR RECORDE �nnSE
DOCUMENTARY TRANSFER TAX $ ..................
.....Computed on the consideration or value of property conveyed; OR
.....Computed on the consideration or value less liens or
encumbrances remaining at time of sale
Signature of Declarant or Agent determining tax -Firm Name
GRANT DEED
FOR A VALUABLE CONSIDERATION,, receipt of which is hereby acknowledged,
Mary Howard
hereby GRANT(S) to
Pete Knudsen, an unmarried man ,
the real property in the City of La Quinta
County of Riverside, State of California, described as
Lot 22 in Block 312 of Santa Carmelita at Vale La Quinta, .Unit 428, as per map recorded
in Book 19, Page 60 of Maps, in the Office of the County Recorder of said County.
Dated September 26, 1994
Mary Howard
STATE OF E,4MZ_R_NI-A� } ss.
COUNTY OF Itfl)+lSr'�i }
On S -- �zZ �i w� t I c� ri q before me,
Dennis Rutgers
personally appeared Zvi N ir�? I, CQ
,personally known to me (or proved to me on the basis of satisfactory
evidence) to be the person(s) whose name(s) is/are subscribed to the
within instrument and acknowledged to me that he/she/they executed the
same in his/her/their authorized capacity(ies). and that by his/her/their
signature(s) on the Instrument the person(s) or the entity upon behalf of -
which the person acted, executed the in ment. DENNIS RUTGEf3S
WITNESS my han fficial seal ' NOUN PU JC441NNWA
HUNEAN COUNTY
MY OmrA*n Egkn 1,31-00
Signature (This area for official notarial seal)
MAIL TAX STATEMENTS AS DIRECTED ABOVE 1002 (1/9a)
Recording Requested By.
CHICAGO TITLE COMPANY'.
U
HCl
Order NO.' 577247
Y
Q
Escrow No. 3935
O�'
�:
Loan No..
I- o iv�
v
LL
t`-
w
T -q
WHEN RECORDED MAIL TO:
Z
p ai T- 8$
a
V
Q �p�
0
W
CD
Pete Knudsen
[L
a
W<.
P.O. Box 1258
Q [�
La Quinta, CA 922.53
MAIL TAX STATEMENTS TO: -
same as above
THIS DEED IS BEING RECORDED IN COUNTER PART
`7
APN:
TRA:
SPACE ABOVE THIS LINE FOR RECORDE �nnSE
DOCUMENTARY TRANSFER TAX $ ..................
.....Computed on the consideration or value of property conveyed; OR
.....Computed on the consideration or value less liens or
encumbrances remaining at time of sale
Signature of Declarant or Agent determining tax -Firm Name
GRANT DEED
FOR A VALUABLE CONSIDERATION,, receipt of which is hereby acknowledged,
Mary Howard
hereby GRANT(S) to
Pete Knudsen, an unmarried man ,
the real property in the City of La Quinta
County of Riverside, State of California, described as
Lot 22 in Block 312 of Santa Carmelita at Vale La Quinta, .Unit 428, as per map recorded
in Book 19, Page 60 of Maps, in the Office of the County Recorder of said County.
Dated September 26, 1994
Mary Howard
STATE OF E,4MZ_R_NI-A� } ss.
COUNTY OF Itfl)+lSr'�i }
On S -- �zZ �i w� t I c� ri q before me,
Dennis Rutgers
personally appeared Zvi N ir�? I, CQ
,personally known to me (or proved to me on the basis of satisfactory
evidence) to be the person(s) whose name(s) is/are subscribed to the
within instrument and acknowledged to me that he/she/they executed the
same in his/her/their authorized capacity(ies). and that by his/her/their
signature(s) on the Instrument the person(s) or the entity upon behalf of -
which the person acted, executed the in ment. DENNIS RUTGEf3S
WITNESS my han fficial seal ' NOUN PU JC441NNWA
HUNEAN COUNTY
MY OmrA*n Egkn 1,31-00
Signature (This area for official notarial seal)
MAIL TAX STATEMENTS AS DIRECTED ABOVE 1002 (1/9a)
b 1'
RC District - Planning Review Fore»
This form is to be used by CDD staff for reviewof-single family dwellings in the RC (Cove
Residential) District,, in order to determine the applicability of compatibility issues or need
to require the filing of Master Design Guidelines by the applicant. It shall be transmitted to .
Building & Safety as your correction list. Please attach additional explanations as necessary.
APPLICANT: Pete & Georgeanne Knudsen
PROJECT
ADDRESS: '54-800 Avenida Vallejo
APN: . 774-302-002 `
LEGAL:. LOT 22 , BLOCK 312 UNIT S. C. @ V.L.Q.
CK'D BY: Fred Baker
CASE NO. '99-155 ..CHECK -DATE:
BIN NO:
Inform the assigned Building plan checker .upon., your.,assignment to this case. The CDD
ExecutiveY Secretary maintains a log book to track applications and. assign case numbers.
The zoning code, architectural and landscaping manuals, .and/c r assigned inspector should
be consulted where 'uncertainties arise. The completed checklist shall be maintained in the
Building '& Safety address file. r
Ce uflcate-ofoccdpanc, WIL .Y a
Cityof LaQdinta-
Building'
�� and Safety- .Department Of T�
This Certificate issued pursuant to the requirementsof Section 109 of the Uniform Building -Code,
certifying that, at the time of issuance, this structure was in compliance with -the various ordinances
of the City regulating bui/ding construction or use. For the fol%wing: -
BUILDING. ADDRESS: 54-800 AVENIDA VALLEJO
Use Classification: SFD Bldg. Permit No.: 9911-131
Occupancy Group: R 3 - Type of Construction: VN Land Use Zone: RC
Owner of Building: PETE & GEORGEANNE KNUDSEN' ` Address': 5128 MUIR AVENUE-
City: SAW DIEGO, CA ,92107 -
By: STEVE TRAXEL
Date: 06-09-00
Building Official _
POST IN A CONSPICUOUS PLACE