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9911-114 (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 Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date ok t 05857 13 11! 130` W L pate Signature of ContracLE_tz OWNER-BUILDER LARATION 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. ( ) 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: Carrier :'I1 Policy No. . 1- M -j3 (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' compensafon provisions o..Section 3700 of.the Labor Code, �I �shall yforthwith comply with ose pr vision, Hate: fd L 9 Applicant2 Warning: Failure to secure WQe'rs' 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) t Date/'6'0, Cl? BUILDING PERMIT PERMIT#11 DATE VALUATION S92.987,40 LOT .� TRACT R5,1'2 JOB SITE 51-275CM, LF IIUIcatilibME APN 76941.1-014 ADDRESS OWNER CONTRACTOR / DESIGNER / ENGINEER frit: 11! t"7'aC� (Ii St:T> ti/+: N a. L 1.IY t1�11+Av tllrr �t!r'1.A.�44�"I i/ TO alll. r 1 td► 1H •a as\. \.r \� A , 42355 WASHilott. MN S1•S'I'E 355 •12333 WASH1NGFON ST. #355 - PALINA DF—K— sR l' (.-,A 92211 PAUI DES1`:121' CA 92211 {'rfrtl)i(S(�-W33i C'13119 21119 USE OF PERMIT tir1J VkkMfl UUL:;; 1401 'INCLUJ.111 Wi .Ui QK tL (i i'.i#O `I'11x�G i %�i•i;"">'S'i2(3G"1'1.C3t3 1,19�.C+() ;;1� P0Rr tVPA'1'10 96AW) S1: 0t!k#tA.GECAN K)RT 461 iNJ SF S 11—C. W004) FENCH tk?.CK1 Li: HSTiAXATl'°>€)COST ala' CQNSTxzx+. CTI<C1:N A4 -0 PERMIT FRE SUMMARY 4.'QN8'11 -1'100 FFE lol[_()(1(141t4A)0 Y4_00 PLAN (`"WI'K �TT t O 3 41104 —0.9-3; X NXIC'11tV 1CA1,17is`�f3 101-1)00.4,21-fW,1 $33.54f FtLi~+:.!'RiCAL FE!: $06 .98 PLifMBINU 4 qr. 1(F1-(1(1(1•Q1-iill() 3iij?.7:5 5'(72 Nr IbKy" 014 M, _ R1111R D IPI _MX)_'i11..11401 GRADING, 1117 • $20.40 WN ,4j1.71 R IMPACT I%R $ i W7.t?t) MUSH If)(=EK?fT-+3$1-;!•'35. '�likr,ilet i'F(";1?fi Pc"1!�tS`4' f A 1-i1f1f1.•f1Q4_� 1 ft T'�„�fi,irCi S011.7'0TA1, CONIRMTlf'' ON A Nn P1.A N C1> IC �?, v.oc) E: LM, PR -PAID FEESFEES, 25 0.(}0 '! (YfAll X%a1d;11Ff P'MEN DUE (NOW RECEIPT DATE BY c DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS -Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Z1 Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap Framing F.A.U. Compressor ` Insulation y ZZ, 57 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 14POOLS-SPAS BLOCKWALL P ROVALS 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 _ _ Water Piping /_ Q� 57 ( 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 -((� Appliances $, 15 P,,T - L - oo "7 Final COMMENTS: 0 p Q ' Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole 2 -� - P 5 % 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) Tay/ P.O. BOX 1504 w APPLICATION ONLY Building78-495 CALLE TAMPICO Address 5 ' .1.75 CAI L e. f)E l4G P9E LA QUINTA, CALIFORNIA 92253 Owner Mailing c�C• 1/�/ / l% _ Address iNAS�rtU'V���i I Lll/,C�e� IZipolI" a ITe�� I Contractor ity slate LIC.L;Ity & Classif. Lic. # Designer • Address I Tel. CityI Zip`s I State Lic. # LICENS ? CONTRAC PR'S DECLARATION I hereb affir th�rffllc�nA%edtlerprd�vi 'ionsofChapter 9 (commencing wit Section i 3dv8rofess ns Cade, and mis eisi I orce and - � , ,l SGN'TU. [s DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors 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 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 ($500). I- 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.) 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.) i] I am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation insurance, or a car 'tie �c%� the eof. (Sec�3800, Labor Code.) Polic No. Company 'rr✓c��" --� Copy is filed with the city. ❑ Certi ed'copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM. WORKERS' COMPENSATION INSURANCE (This section need not be Complied It the permit is for one hundred dollars ($100) valuation or less.) I certify that in the perform ce of thg workfor ich chi permit is issued, I shall not employ any person in any mann r o as t come ubject t the Work Is' Compensation Laws of C�liforri . Dat "7 V f" Owner NOTICE TO APPLICANT: a r ma rng this C 7'-ai of emp ton you should become subject to the Workers' r om enation provisions o! a Labor Code, you must forthwith comply with such provisions r 1 rs 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 if work thereunder is suspended for 180 days. I certily 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 Mailing Add City, State, BUILDING: TYPE,'CONST. )OCC. GRP. " � A.P. Number , -- [ -t_ 1 Legal Description (d) (3(t(-' •- neq Project Description Sr(z tq&A Sq. Ft.) j � No. No. Dw. Size '�(� Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ LI Q P r 5-1 valuation PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL AMOUNT REMARKS 11111, WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION f .. ZONE: BY:— Y: Minimum Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Cent r t Side Setback from Propeln FINAL DATE INSPECTOR a V 99 Issued by: Date J Permit Validated by: 7►� Y v p__a� yyyyyy�- Validation: J 11111, WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Notice: Document Cannot Be Duplicated Date 12/3/99 No. 19690 Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE Owner NameJoe W Stemmer No. 51275 'Street Calle Hueneme City Palm Desert Tract # B5,DC2 Lot # 2 Type of Development Single Family Residence Comments APN # 769-113-014 Jurisdiction La Ouinta Permit #9911-114 Log # Zip 92260 Study Area Square Footage 1492 No. of Units 1 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 1,492 or $ 2,879.56 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/ Washington Mutual / Joe Stemmer Telephone 360-9365 :. Name on the check By Dr. Doris Wilson Superintendent' Fee collected/"e pted by Lucy Renteria Payment Received $2,879.56 Check No. 104629223 Sign NOTICES biffid;nt 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 Dislrict('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 ASSESSOR'S PARCEL NUMBER COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY ASSESSESSUi g EPARTMENT OF ENVIRONMENTAL HEALTH ERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM APPLICANT. Submit this form with four copies of a SCALED plot plan (1-20 SCALE) drawn to County specifications as indicated on the attached check list. pl A non-refundable filing fee is required when the application is submitted. Check must be made payable to the County of RiversideApp o jalof this applic�w, n shall remain valid for a period not to exceed one year from date of payment. r135 $214.[D S # N% r/�#�K .%+�L �$ . CAS ] ent, Contractor, Contact Person Address City r State zip .st= Q 142241 Telephone 3b0 93 (05 S^5' +Irr)1 �4 ner k)s-�M���z �'' Address City State Zip `��3� (LAC, � S P►r'�es�a.� Gi 420 Telephone 360831, b Property Address City Z Size NVater Age goy' Wdll ,Ilse of Pe;mft, P/P, SUP; PUP, etc. c rA.V41 cp'y 2)&AF((!Nb w1/4ra-e,4,146- 0 rx l6Ur ter Legal Description L B% r. �f•OCK 5� �f'� �" �( 6{d %M1i ��h4 r { ��.7 j�©0 44d _Dwelling MH>S ,,rFrep-etc- / % W;4 9 4N%T ature of Applicant /P /s `q% Date K BOX IF REQUIRED lox is checked, this application shall be consider d rejected until ❑ Detailed Contour Plot Plans Required (1 to 5 foot interval) rmation is provided and the fee paid. Resubmi als later than 90 er date noted below may require repayment of fees. ❑ Staff Specialist Lot Inspectiori Required g Tank Agreements Completed Thomas Bros. Page Grid tion of Existing S.D. System Require d ❑ Date Lot Inspection Completed: Initials . arance Required for DOH-SAN-007, Santa An Region Only) Remarks: tion Report Required ❑ Maintenance Booklet Provided lily Boring Report Re tuired ❑ Final Inspection by Department of Environmental Health is required. Initials Date Please call 24 hours PRIOR to inspection. Repo by Lic/Project # Date t �f Soil Type 6^O +FI Approved By Date am(s) No. Dwelling Units(004Aj (1) Septic Tank Soil Rate Grease/Sand Tank Replacement Bedrooms, Fixtare'Unds Grease In bpd 'nt Trap g Addition ���M� � f �g�i / tt / X00 Gal. �. d u1A g ... r wra Bar Sidewall Allowance Leach Bed sq. ft. of Bottom Area mow, t. rock/ sq. ft. running ft. InstAN% Lines) ft. long ft. wide with ��inche, Inlet Tested Dept ❑ NA min. s rock below drainlines or Proposed Bottom Tested Depth design for slope: (3) Pit Diameter No. Pits Pit Below Inlet (BI) Seepage Pit Maximum Other: Total Depth Allowable r Depth •� % denctor iD TD~V�/ V. , proved: Date: Well Drilling Permit # SIGNATURE Approved: Date: SIGNATURE tion Approved: Date: Only Approved: _/�� ,L Date: �'� �� �LCa•� ,: ,ad,P /.T../".r� Xl�_^-' i,� ,.r.Fi/G e:.E'�.S" G�`v� /�G`f/..�!! ,.r.1E./�°'� l-� "4ua-ec.I l'e'ery `. 1e . "zet:.v 444"A pplication isAPP015/DENIED'forathe category:Checked;iruSECTION.B-• FOR OFFICE USE ONLY e; regarding the des Ing of a subsurface disposal system as indicated on the mpanied plot plan, using the requirements set forth in SECTION C above. A build- for l ( CC Lot) permit .is necessary the installation of the above-designed system. No con. Revenue code Fee $ .071)4. rLctlon Is permitted in the required reserved 100% expansion area. r ,1) Septic Tank must be 100' minimum from any wells.q /0 n-+�•!'t�r r'�"�f @eCheck # l04PZ G Ar&, NW/Nf (2) Leach lines must be 100' minimum from any wells, including expansion area. / Date �� ! .79A 7 Initial Sewer lines must be 50' minimum from any wells. �•/ -a �f ter+ Seepage pits must be 150' minimum from any wells, including expansion area. C / l� �► N (it d.. 7-AU-1(4 kA;-C4 4"'Alf i Signature of Health Official ' Date DEH -SAN -122 (Rev 9/98) UIStr10utl0n: WHI I t—UTTICe 1-IIe; Yti-LUW—Applicant; PINK -1610g. Uept.; UULUtNHUL—F'IanS/HecoraS 1 RECQRDING REQUESTED BY: � "'�kecording Requester! By AF'rER RECORDING MAIL TO: _ Joe W. Stemmer, Sr.. R-202 . a�ttt,tivtu run n�Vvnl. � � AT 2:00 MLOCK • FEB 21 1995 Ron, ft d M,Jffim piooms d am" cm".Cedar, Reoador Aw s .�... — — — — —ABOVE SPACE FOR RECORDER'S USE--- FULL SE---FULL RECONVEYANCE SUNBIRD FINANCIAL, INC. A CALIF. CORP., as- Trustee under Deed of Trust, dated �ittle..26. 19.92 , made by... JQE-JL. Sj.EHMER,_$R, an_A1nmaarried Man_ Trustor: and recorded as Instrument No. 374181.. _._ _._ on _ .00#Aat e.r _L — — 19 92! t —..._ in Book -nn- --------- , Page------------- _ , of Official Records in the office of the County Recorder of Riverside, California, describing land therein as Lot 2 in Block 5, DESERT CLUB TRACT UNIT NO. 2, as per map recorded in Book 20 of Maps, page 6, in the Office of the Recorder of said County. having received from holder of the obligations thereunder a written request to reconvey, reciting that all sures socured by said Deed of Trust have been fully paid, and said Deed of Trust and the note or notes secured thereby having been surrendered to said Trustee for cancellation, does hereby RECONVEY without warranty, to the person or persons legally entitled thereto, the estate now held by it htereunder. IN WITNESS WHEREOF, SUNBIRD FINANCIAL, INC. has caused its corporate name and seal to be hereto affixed by its PRES IDENT`thereunto duty authorized... STATE OF CALIFORNIA COUNTYOF _River"-;ide February -_17 , 1995 __ berorc me, B�Nota 4p eul taln,geSifr said Counly and State, personally appeared A..._fi....---W --- _. - - personally known to me (or proved to me on the basis of satisfactory evidence) to bn the parson(s) whose name(s) IsAXA subscribed to the within Instntment and acknowledged to me that*/shelll= executed tho some in AKIharAKA authorized capacity(ies), and that by)b)Obedt!W signature(s) on the instrument the person(s). or the entity upon behalf of which the person(s) acted. OKecuted the instrument. WITNESS ,a d end oflicial snal signntu-�1=4 7 E_ SUNBIRD FINANCIAL, INC. A CALIF. CORP. as Trustee By C-- RHEBA WEST, PRESIDENT ANN CROUDY ' Comm. # 967761 NOTARY PUBLIC . CAl. OMA Riverside Cau My Groan, Wks# Jun. 14.1 ng A