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0212-131 (SFD)LICENSED CONTRACTOR DECLARATION I hereby 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 r roressivnals Cuue, and my LiceNse is In tun Torn and effect. License # Lic. Class Exp. Date 4:01.700 A 08 Mr— 03A, 1 /2( 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. IQ/) 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 noavare:. Carrier STATE FA.FLPdc Policy No. 90061758`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 Code, I shall forthwith comply with those provisions. .-late: 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 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 above-mentioned property for inspection purposes. Signature (Owner/Agent) Date G PERMIT PERMIT# BUILDING a nATF - „a1_, o „ ...TION -g - - LOT ' } - _ -INAUI 2034 JOB SITE �t� �,}A ADDRESS ' ,57_g4,5 S0XTJ.*JJ A�'li.w «z�t:Y LAKY. APN OWNER CONTRACTOR/DESIGNER/EN (NEER JAWS & S+SaLAANG.FCRD 1ANGFOWD CO}TTPPON 'sm-6 0 311Yf+>YRSA1410, .48-.5 1 QtY1,43PIC.D1UYr' RAIM DEUM ' CA. 92260 PALM. D�t�3`S' CA 92260 (760)074-3M CUL4 2792 USE OF PERMIT 4,641. SPO - PISRAIT DO.MM 140T NICI.l ]DE KAXX WAJA S, VENCK; POOL Or, 803 A SEPARMF. DR$6T�'�dVA5t"APPROACH PUMI`)' ig UQUIReD TRACT CONSTRUCTION 4,641-0 8F PORMPATIO 1,297 00 wf? d1F`tRAGYM:ARPORT 11924.00 8F fOWT, VEM i<l1:fUMARY - COlNSTRUCTICIT4 FEE; .101'.000.418.000 $1,304.50 PLAN CHECK FEE 101-000-439-318 v; -nag FEE DEPOSIT 101.000.4351.319 4110 ►0100 MECHANICAL FRE 101-000-4,21-000 $,cVo—ib MEC'.C`.RIC,AI. ME 101.0MR-420-000 $280.42 » P.LUll413OTO FEK 101.000-4.19-000 $160.75 STR.O110 MOTTON F - ht1-SW 101-000-241-000 $210.913 € RATYU4l' ME 101-000-X423-000 $15.00 OE47•.I��OP�IZ ImPAO'°t' FI4.F.. $2,405.00 AIT IN PUBLIC PLtA.Cn - RE ail: 270-000-445-000 �223.3't ' r 0 ATS D .M-, `kT CHVX f.0 $15,810.31 D e ;LSI?. 3 :I`R.L-PATi7 412.6,?' _211000100 'TMS ��:T>� XMV FMAR 0 4 200 t%0, 1 CITY OF LA•QUINTA FINANCE DEPT. RECEIPT DATE BY %FI L D INSPE J INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE TINSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts a Slab Grade Return Air Steel Combustion Air Roof Deck • a 3 Exhaust Fans O.K. to Wrap Q F.A.U. Framing d2o Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wali Firewall Exterior Lath Drywall -Int. Lath , Final �� �- O� Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Footings _ Electric Bond Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final Gas Piping PLUMBING APPROVALS Gas Test _ Electric Final Waste Lines �� 3 Heater Final Water Piping _ Plumbing Final Plumbing Top Out �3 Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection 3 Encapsulation Gas Piping Gas Test — OAppliances !-�j`(y? �j',y✓JA, 3� i Final COMMENTS: Raw, qA;M 1Z67?f7Aj Vika. Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G. F.I. Smoke Detectors Temp. Use of Power _L Final Jn j—(� U Utility Notice (Perm) Building Address Owner 'j—/�./y��� ��-lel / o/ci� % Mailing Address I • l M�L�11(/ r P.O. BOX 1504 APPLICATION ONLY v 78-495 CALLE TAMPICO �� �/�%��I LA QUINTA, CALIFORNIA 92253 -y l ) BUILDING: TYPrE'CONST. OCC. GRP. ti,' )A A.P. Number ! 00 c1 O Tel._ ^DQ �.T q %1L ZgC73 T Ze Legal Description hDc�0 _ % Project Description AddressS,._ 0 � City Zip Tel. State Lic., /v'1 1 © C) City & Classif. `/T//-Lic. q Arch., Engr., Designer � � y Add s ' D® Tel -3 S70 Cig Zips, State �� Lic. q 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,Susiness 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 thealleged 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, 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, Bulsness 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'I 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 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 (l Copy is filed with the city. O 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 (E100) valuation or less.) I certify that in the performance of thip 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., IL alter 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 Ihereby 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 if 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 -of this city to enter the above. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip Sq. Ft. �6 q/ No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated valuation PERMIT Plan Chk. Dep. 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 INSPECTOR Issued by: Date Permit Validated by: Validation: WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE Coachella Valley Unified School District P.O. Box 847, Thermal, CA 92274 (760) 398-5909 — Fax (760) 398-1224 Project Name: _ Owner's Name: Project Address: 57-845 Sout Project Description: single f This Box For District Use Only DEVELOPER FEES PAID AREA:. AMOUNT LEVEL ONE AMOUNT: LEVEL TVO AMOUNT: MITIGATION AMOUNT: COMM/IND.ANOUNT: DATE: RECEIPT: CHECK N: INITIALS: CERTIFICATE OF COMPLIANCE (California Education Code 17620) e 9227 Date: ftrch 4, 2003 Phone No. APN: 762-250-004 Tract #: 28034 Lot #'s: 0212-131 Type of Development: Residential XXXXX Commercial Industrial Total Square Feet of Building Area: 4641 sq. ft. Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement under penalty of perjury and further represents that he/she is authorized to sign on behalf of the owner/developer. Dated: T% Signature: SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE) Education Code Gov. Code Project 17620 65995 Approval Number of Sq.Ft. 4641 Amount per Sq.Ft. $2-i .1-4 Amount Collected $ 9,931.74 C Building Permit Application ompleted: Yes/No By: Carey A Carlson Asst. Supt., Business Serv. Agreement Existing. Prior to 1/1/87 Note: Not Subject to Fee Requirement C Certificate issued by: E1yi ra' Mattson Signature: Office Technician NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a written notice to the project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of these Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall serve to advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of any other requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether payable at this time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This Certificate of Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School District, and up to three (3) such extensions may be granted. At such time as this Certificate expires, if a building permit has not been issued for the project that is the subject of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance. MV:c/mydocs/devfees/certificate of compliance 1 09/30/02 C PAST -1- ,.,ir n REfMING REQUESTED BY: AND WHEN RECORDED, MAIL TO: James O. Langford. 72670 Sundown Lane Palm Desert, CA 92260 ASSESSOR'S PARCEL NW 762-250-004 1'9A 02o -16-71I TITLEORDERNO.: R-150945-3 ESCROW NO.: 21463-001 GRANT DEED DOC is 2002-573778 10/15/2002 08:00A Fee:13.00 Page 1 of 3 Doc T Tax Paid Recorded in Official Records County of Riverside Gary L. Orso Assessor, County Clerk & Recorder M S LI PAGE SIZE DA POOR NOCOR I SMF MISC. T DL u 77 A I R L COPY LONG .REFUND NCHG EXAM The undersigned Grantor(s) declare(s) that the DOCUMENT TRANSFER TAX IS: $ 167.20 County $ City xx computed on the full value of the interest of property conveyed, or — computed on the full value less the value of liens or encumbrances remaining thereon at the time of sale — OR transfer is EXEMPT from tax for the following reason: FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, John J. Gogian, Jr. as Trustee of The John J. Gogian, Jr. Revocable Trust of 1983 dated April 18, 1983. hereby GRANT(S) to James O.Langford and Lois Darlene Langford, husband and wife as joint tenants all that real property situated in the- City of La Quinta ' County of Riverside 0, State of California, described as: COMPLETE LEGAL DESCRIPTION ATTACHED HERETO AND MADE A PART HEREOF BY THIS REFERENCE ' g { Dated October 07, 2002 STATE OF CALI RNIA, - } John J. Gogidr. COUNTY OF %G1� ss. 0 before me Notary Public, personally appeared personally known to me ( f 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), an th t by his/her/t it signature(s) on the instrument the erson(s or the entit up n be If of which the persons cted, cuted the instru t. WITNESS o icial seal. MAIL TAX STA yEMENTS TO: James O. Langford -72670 SunLLane, Palm Desert, Ca. 92260" NAME ADDRESS , Jr. Trustee RUT H jkFURST Commission 0 4 3fX930 Notary Public - Celgamia z ` F2iverni�s^ :c+ul�ty -r COmmiSelon / 1366930 Notary Public-.Cellfomia Riverside County MY COMM. EXOSS Jul 27, 2008 (This area for otficia no ary seal; CITY, STATE & ZIP w i l ICLEINE O I 1 1 1 111 1A I fes• 0 r% rk /r 1 P'f VIK I L" IhL IT I IL I f% i ' 1 1 Mr. & Mrs. Landford: Your plans dated Nov/Dec 2002 meet the CC&R's requirements pertaining to set backs, building heights, landscaping and elevations. Please note the exterior color restrictions in the CC&R's. I am enclosing the postal service requirements for mailbox location. Good luck with the cit plan check and construction. Sincerely, I Kleine th Valley Group/Lions Gate is • i i 41910 Boardwalk, Suite A-10 • Palm Desert California 92211 • (760) 776-4840 • Fax: (760) 776-4842 • CA. # 390365 • AZ. # 141156 ,SPECIAL INSPECTION SERVICE REGISTERED INSPECTOR'S WEEKLY REPORT JON TANDY 37630 Medjool Ave. Palm Desert, CA 92211 Office (760) 772-7192 Fax (760) 772-7193 Pager (760) 776-3338 TYPE OF INSPECTION PERFORMED �� ❑ REINFORCED CONCRETE 11MXRUCT. STEEL ASSEMBLY ❑ POST TENSIONED CONCRETE ASPHALT ❑ REINFORCED MASONRY ❑ FIRE PROOFING ❑ S�; ;14r HER ' .` lJ�lr �y /J JOB LOCA11 G7 `�1Soo ktk REPORT SEQUENCE NO TTURE PERMIT NO 013P1Do DAY OF WEEK MATERIAL DESCRIPTIONP 30 ARCHITECT IN CTOR v- HRS CHARGED �� �Ak 6. 1 E EEFI �7CONTSUB ASSISTANTS HRS CHARGED INSPECTION DATE GENERAL CONTRACTOR RACTOR (S s lCLZ x_] i � gas FE u)zcvj l ci L S We A w( e. -- c ct EA!J C -r4 t C WIL uv\, o •t'- ro �- COPY SENT TO CLIENT ❑ NTINUED ON NEXT PAGE ❑ PAGE OF CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE NOTED I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS SPECIFICATIONS, AND APPLICABLE SECTIONS OF THE GOVERNING BUILDING LAWS A-�( A-,- �� tl SIGNAT]U�REE OF REGIST-EkubIIINSPECTO(RR - V v G _TSS-4-� �_+'� L ATE p REPORT REGISTER NUMRFR u mmm�mm-ml.ml ■ ■ -� Certifica to of Occupancy - OF Building Y � & Safer Department This Certificate is issued pursuant to the requirements of Section 109 of the California Building Code, certifying that, at the time of issuance, this structure was in compliance with the provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 57-845 SOUTH VALLEY LANE Use classification: SFD Building Permit No.: 0212-131 Occupancy Group: R-3,U-1 Type of Construction: VN Land Use Zone: RM Owner of Building: JAMES & LOIS LANGFORD Address: 72-670 SUNDOWN LANE City, ST, ZIP: PALM DESERT CA 92260 By: PHIL CARUTHERS Date: 10-14-2003 Building Official POST IN A CONSPICUOUS PLACE