0208-240 (SFD)7/Z �o Z
r2a-�240 T4ty/ 4 Qamm
_ P.O. BOX 1504 APPLICATION ONLY
BuildingS p� 78-495 CALLE TAMPICO
Address S/ — ' r�/� l�l/�-� LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address
City
Contractor
U C71L . �t-
Address
City lZip I Tel.
State Lic. j City
& Classif. I Lic. #
Arch., Engr.,
Designer
Address Tel.
City I Zip I State
Lic. ff
LICENSED CONTRACTOR'S DECLARATION
1 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
1 hereby affirm %hat 1 am exempt Irom the Contractor's License Law lot the lollowing
reason; (Sec. 7031.5, Business and Professions Code: Any city or county which reouires a
permit to construct, allot, improve, demolish, or repair any structure, prior to Its issuance also
reouires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chaplet 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.! 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 Contraclor'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.)
Ii 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 contractors) licensed pursuant to the Contractor's License Law.)
t 1 am exempt under Sec. B. & P.C. for this reason
Dale 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
I"! Copy is filed with the city. Mi Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the peril is for one hundred dollars ($100) valuation
or fess.)
I certify that -in the performance of (hp work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Dale_ Owner
NOrICE TO APPLICANT: It, after making this Certificate of Exemption you should become
subject to The Workers' Compensation. provisions of she Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
s 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 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 properly for inspection purposes.
Signature of aOplicanl Date
Mailing Address
City. Slate, Zip
BUILDING: TYPE"CONST. OCC. GRP.-
A.P. Number '7'2-3 "% 2/- 0 o 1—,S"—
Legal
J
Legal Description �0% cl <� A
Project Description `S / AJ,!&1f- %� i� J �i��i f��•��"�/ i �.'
REMARKS
ZONE:
BY:
Minimum Setback
Distances:
Front Setback from Center Line
Sq. Ft.
Size 4 il D
No.No.
Stories I----
Dw.
Units
New Add ❑
Alter ❑
Repair ❑ Demolition ❑
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
S�
Al,' is
- -
Estimated Valuation
Estimated
PERMIT
AMOUNT
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 = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
RECORDING REQUESTED BY
WHEN RECORDED MAIL THIS DEED AND,
UNLESS OTHERWISE SHOWN BELOW,
MAIL TAX STATEMENTS TO:
Wally S. Miles
P.O. Box 604
La Quinta, CA 92253
SPACE ABOVE THIS LINE FOR RECORDER'S USE
Quitclaim Deed
A.P.N. 773-121-002-5
The undersigned grantor(s) declare(S}
Documentary transfer tax is $
( ) computed on full value of property conveyed, or
( ) computed on full value less value of liens and encumbrances remaining at time of sale.
( ) Unincorporated area: ( ) City of , and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Wally S. Miles,
a single man
do hereby REMISE, RELEASE AND QUITCLAIM to Wally S. Miles, a single man and
Rory G. Putman, a married man as his sole and separate property
the real property in the City of La Quinta , County of Riverside , State of California, described as
THE NORTH HALF OF LOT 9, BLOCK 23, OF SANTA CARMELITA AT VALE LA QUINTA,
UNIT NUMBER 2, IN THE CITY OF LA QUINTA, COUNTY OF RIVERSIDE, STATE OF
CALIFORNIA, AS PER MAP RECORDED IN BOOK 18, PAGES 55 AND 56, IN THE
OFFICE OF THE RIVERSIDE COUNTY RECORDER
Street Address: (Unassigned)
North portion of Lot 9 Avenida Diaz
La Quinta, California 92253
Dated -2 -.2
State of California )
County of e i y"s la -0 ) S.S.
�O�,n,�Jw 2 y" re 2.00;. befome, ' V`I tAt i IQ "OS
tvvttap iA PUb j 6 personally appeared WO—L(M S
Itis i I -C's,
personally known to me (or proved to me on the basis of satisfactory evi-
dence) to be the person whose name) is / ae subscri to the within
instrument and acknowledged to me that he / Ste executed the
same in his / hpi / th�r authorized capacity(i and that by his � /
t�g(r signaturef.0 on the i trument the pe n or the entity upon be-
half of which the persor>cted, executed the iument.
WITNESS m and and official eal.
Signature /
MAIL TAX STATEMENTS TO,
Form 3196-8 (Rev. 5-94)
Signature of Gsantor
S
OFFICIAL SEAL
MICHELLE RAMOS
COMM #1246380
Notary Public -California
RIVERSIDE COUNT' r
My Commission Expires
DECEMBER 20, 2003
This Document provided by Commonwealth Land Title Insurance Company
Rory G. Putman
2790 Vincentia Road
Palm Springs, CA 92262
Work Phone (760) 772-2630
July 22, 2002
City of La .Quinta
Building & Safety Department
78-495 Calle Tampico .
La Quinta, CA 92253.
To Whom It May Concern:
This letter is authorization for Mr. Wally S. Miles to act
as agent for me to construct two (2) houses in the city of
La Quinta as an owner -builder. The two lots are decribed
as Lot #9 on Avenida Diaz and Lot #14 on Avenida Vallejo.
If you have any questions concerning this.letter, contact
me at'the above-mentioned telephone number where I can be
reached during normal working hours. Thank you for your
attention to this matter.
Sincerely,
Ror G. Putman
Owner -Builder
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/ Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself,. you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law to put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State grid Federil Government as an employer and you are subject
to several obligations including State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may. be financial risks for you if you do not car'ry but these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under Staie
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760) 777-7012
FAX: (76 0) 7 7011 /
J
Ovwl
SIGNATURE/DATE
PROPERTY ADDRESS
PERMIT NUMBER(s)
�- � (. CITY OF LA QUINTA SUB -CONTRACTOR LIST
JOB ADDRESS A PERMIT NUMBER tug,/GS OWNER
-�j-,} �✓ BUILDER DZX
Times This form shall be posted on the job with the Building Inspection Card at all in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
Trade / Classification
Contractor
State Contractor's License .
Workers Compensation Insurance
City Business License
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
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