9808-217 (SFD)LICENSED CONTRACTOR DECLARATION
U) 0, hereby affirm under penalty of perjury that I am licensed under provisions of
• F-, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
WProfessionals Code, and my License is in fuhforce and effect.
O ch License # Lic. Class Exp. Date
rd L 425391 � � 7i�i,l4fi
r- -.
r—
oZ r- D e ( ° �' VSi nature of Contractor r�
O r
r- U C:) OWNER -BUILDER DECLARA ON
W WW I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
Z( ) 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). -11
C () I am exempt under Section B&P.C. for this reason
LO
N Date Signature of Owner
ON
d Q WORKER'S COMPENSATION DECLARATION
o 1 hereby affirm under penalty of perjury one of the following declarations:
Lo H cr
O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W u- compensation, as provided for by Section 3700 of the Labor Code, for the
O _ Q performance of the work for which this permit is issued.
C3 Q U ( ) I have and will maintain workers' compensation insurance, as required by
O C)Q Section 3700 of the Labor Code, for the performance of the work for which this
LO
H permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Cartier Policy No.
cob Q STATE t. L3ND
J
(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
3 subject to the workers' compensationi'provisions of Section 3700 of<the Labor
Code, I shall forthwith comply with fhose°provisions. \j
Date,.✓t . al . 1, 14 A Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000,,in
addition to the cost of compensation, damages as provided for in Section 3706•
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application. &:
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
' correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby. authorize representatives of this City to enter upon
the ve-mentioned property for inspection purposes.
Signature (Owner/Agent)f*� > 4 Date
PERMIT # CONTROL #
BUILDING PERMIT �� - a� . M .
"
.
DATE 1,()1131" VALUATION S100.7#8111) LOT y TRACT ,-P8*5
JOB SITE
54-03.55 F'bVENICDA M.f Z
APN '774494-014
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
qq
'P C11711'r'O FS
1719 S TR%i4ONr
s 719 S MEM abrr
S Oi EANS1DE CA, 92054
S OCEANSIDE CA 92054
(760)967-069 C8ul 195
USE OF PERMIT
KINGLl FAMIL i DWELLING
' SF - PMMT i OES NOT INC1,ME RIk<% WALL OR. POOL
I
�! RACT COINW UC'"i`AR 11,154 .00 5F
P0RC:fiYi•'iXQ0 36.00 SF
ti.tA (A4JJV(;ARPQ.KT M91.Uu S.F
6.E'r- WOOD FENCE ;:Ctta.UO LF
PERMIT FEE SUMMARY
0ON3't`RUC%7110Nf E 1.01.000-41$-000 $bl'3.d1U
Pt'M-4 CHF{; ly c 6 t it l _8010.1-439W 3 4 9
NNIUCHA.NNICAI.11 "M 10.1-00042.1-000 $66.50
EL- TRICAL 1•- ax 101-11100420-000
NLUN41,8 NOFIEF •101-000»419-000 $133.50
!z ast�;�tf ikfC97'it 1iJF -ft4 ;TI3 I(nI-0f!o-2,41-00.00 Sat).(W
ORAIM A }1410 1,111,11K, 1101-000-423'600
!NFRAS't'R.i1 ICURR allrl 2.25-000-413-•342 $2,2103.71
£'fd1Gi:;ISF? PLAN 101-000-441-345 525,00
ART IN'ia1'1RLIC 111, CF8 -01091t; 7111,4100-255-000 $1.17
ME DEPOSIT � 101-000.139-318 42%00
�
PAQB-",, AT,CGfMS'i'#Z.I.iCTION AND PLAN CHECK
$3,799,1'7
LM PRE -PAID FEES
4230.co
OCT 13 1998
`11'4)'1'111€,,.i'.�;R1�'8'1'.'�+EF,.S*.'!�@.1E'NCIVY
1
91TY OF LA Q� 5NTA
RECEIPT
DATE
BY�,
DATE FINALED
INSPECTOR
d.
;
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel oe
Combustion Air
Roof De
Exhaust Fans
O.K. to Wrap
G -Q
F.A.U.
Framing
-
Compressor
Insulation
a-! g
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
2S
Final
Final s
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bo
,pd Beam
Approval to Cover
_
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
/ S
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
/ /�
J7-
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas) 'tet
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
r
Final _
Utility Notice (Perm)It
COMMENTS:
494 "el
OCT. 9.1998 4:58PM COMMONWEALTH
RECORDING REQUESTED BY:
CHICAGO TITLE COMPANY COMPANY
98.7886KC 87037997-E p, q
DAVID ROSS MILLER
1719 S, TREMONT
S. OCEANSIDE, CA 92054
NO. 250
SPACE ABOVE THIS LINE FOR RECC
GRANT DEED
APN: 7747194:-
P.
'S USE
The undersigned grantor(s) declare(s).-
Documentary
eclare(s):Documentary transfer tax is $17.60
(XXXI Computed on full value of property conveyed, or
( ) Computed on full value less liens and encumbrances remaining at time of sale.
( ) Unincorporated area: ( ) City of , and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
WILL USTES OF THE WILLIAM R. RILEY TRUST (1990) "
hereby GRANT(S) to
DAVID ROSS MILLER, A MARI$D MAN AS H7 SOLE AND SEPARATE PROPERTY
real property in the City of LA QIII A, County of Riverside, State of California,
�a tee.
LOT 2, BLOCK 256, UNIT NO. 24, SANTA CARMELITA AT VALE LA QUINTA, AS
PER MAF RECORDED IN BOOK 19, PAGE 44-45, OF MAPS, RECORDS OF RIVERSIDE
COUNTY,'CALIFORNX.A
Dated August 14, 1998
State of California
County of Rivera j,da
On sa'ntember 79. 1998
before me, Kelly rnlller
personally appeared
jJ11iam R. P-11ey
personally known to me (or proved to me on
the basis of satisfactory evidence) to be
the person(s) whose nams(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 pe,on(s) acted, executed
the instrument.
WITNESS
Signature\4.
MAIL TAX STA
1 seal.
SAM AS AWVE
W7
WILLIAM R. RILEY, TRUSTEE
OF THE WILLIAM R. RILEY TRUST (1990)
01057217
CliY {
�q1N�� couaa� 14�
(This area for official notarial seal)
_ _ 0
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
Date 10/13/98
No. 17887
Owner NameDavid Ross Miller
CERTIFICATE OF COMPLIANCE
APN # 774-194-014
Jurisdiction La Quinta
Permit #
No. 54-035 Street Avenida Diaz Log #
,City La Quinta Zip 92253 Study Area
Tract # Lot # Square Footage 1646
Type of Development angle r armly xesictence
Comments
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 1,646 or $ 3,176.78 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/David Miller Teleplic ne --
Name on the check
By Dr. Doris Wilson -
Superintendent '� c ' -
Fee collected /exempted by Ellen Patino Payment Received ��' ' $3,223.10
f� Z;
Check No. 9946 -�•�
Signature �
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
."act 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
t