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0008-089 (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 5.33670 B 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. 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 GOLDEN MOLE Policy No. TWC 322374-04 (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- naf or Code, I all fohwith comply with those prd'vis orfs. r ,0ate: n %plicant— 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 tfie Labor Code, -interest -and attorney's -fees. —T_ 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,; Z') 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? 1 ® Ignature (Owner/Agent) �a°'� .` Date i BUILDING PERMIT PERMIT# DATE VALUATION LOT -0}� TRACT OW" si.(1,q0if1.20 17 1 LKM JOB SITE ADDRESS .4-140 AMMA DIA.Z PN A7 / / -21 - �t✓ a� OWNER CONTRACTOR / DDEESIGNER/ ENGINEER � KppRKTlvIL Ttt©.E (LEVRAT1014 72.850 SO1V MA.ROAD 3 97 25 C3ARA NUJ UWE, SUI -Tri, C PALM DOM' CA 92260 PALM D IMKI' CA 92219 �^ (760)345.7186 0WO 1137 USE OF PERMIT S11i G1Y- FAYafMY 1:)ViL7i%WG SPD-PLAN.(TUV1t1A,A MASTER) PF.IZ RIT DUES NOT 1'NCI.,UDE SLOCK ALL, OR POO& 759 PLAN CHECK F"EE REDUCTION FOR MUMPLE ISSUANCE OF SAME PLA14 TYP& MALT CONSTRUCTION 1,771.0D SF PORCI• I ATIO 25.00 Sig t}ARA0V AR.PORT (SF{) 8,702.40 5 V . WOOD FENCE 200.00 LF .R'SUA4AIa�O COST OF CO NST.E IM.r.,ION 100W.20 P1MAW b EE SUMURY CONSTRUCTION FEE 101.000-418-000 1664.00 PLAIN CHECK FIDE 101-000-439-318 $414.40 MECHANICAL P99 101-000.421.000 $60.00 ELEC;TRICA1, YEE 101-000-420-000 $134.27 PLUMBING FEE 101.000.419.000 $1161`73 STR.ONO MOTION FEE -M-31D 101-000-2241-000 $10.69 ORMNO FER 901-000.423.000 %20,00 DEVEUMR )IMP,ACT FEE $1,907.00 PRECISE PJAN 101.000.441-34.5 8100,00 —FF.,I-D2POSL7' — X101-000-439-318 4230.00 4 SI:1WTOTAL C0:2aMIRUCT1011-AMID PLANC1i1ZOK 53,427.21 LUSS PRF 1M IP N.. 1 A 4250.00 ,.�.. TWEAL MEMMT FTEMS DVS "ITS' Off' LA RECEIPT DATE ABY / / I DATE FINALED INSPECTOR ' 'C7 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck O • v Exhaust Fans O.K. to Wrap p . F.A.U. Framing Compressor Insulation -1 no 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 BLOCKWALL APPROVALS POOLS • SPAS 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 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection p Encapsulation Gas Piping Gas Test 1-17 Appliances Final 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 Final Utility Notice (Perm) (p S COMMENTS: y--r�..^"'s-'+f'�"""'""'}�.("'''o"Y.'''.y'.+✓w^4i{`,^-`1.�"s"y,y�.�':"3•,ry'kb�s""wv�.'^'�°-h,.r-f Ys"'J7•aw''"�iy..f.'r�-'+.r'r^',/%�+..,,r-.r..:..�-•-.•''-'`�.--+\:.-•�['xd-„a^�,....r�—..-..+:::,.-�.,, ^.�:--:r�...�.�. e k06 1-4 rF Building Address Owner .,f DEPT P.O. BOX 1504 r/l 78-495 CALLE TAMPICO SL/ �- I Q d ' ,�rcA 2z ti LA QUINTA, CALIFORNIA 92253 Res I u City Su A, 90tc- CeiAP Address Ro City Zip Tel. f'avt q�a�0 -760-17 37 State Lic. City & Classif. 3 3 G Q Lic. # 11'3 '7 Arch., Engr., Designer Address Tel. City IZip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions J Chapter 9 (commencing with Section 7000) of Division 3rof the usiness and ofessio e, and my license is i full force and effect. �' V -,z -C it 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,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 rile 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 thathe 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 ($500). I.: 1, 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 oflered 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 contractorts) licensed pursuant to the Contractor's License Law.) 17 I 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 r7 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 ($100) valuation or less.) I certify that in the performance of the workfor 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, atter 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 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 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 sof this city to enter the above- mentioned properly for inspection purposes. Signature of aOplicant Date Mailing Address City, State, Zip APPLICATION ONLY BUILDING: TYPE'CONST. OCC. GRP. �R A.P. Number -7-79 - ZO J — 6691, cq< Legal Description Project Description SF!/ %amu V�c,L /t'I ��'�tz F� �✓ A� Sq. Ft. No. Size Stories New ❑ Add ❑ Alter ❑ �� AM —7-61 A= Estimated Valuation PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS No. Dw. Units Repair ❑ Demolition ❑ AMOUNT v r 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 Notice: Document Cannot Be Duplicated Date 8/23/00 No. 20927 Owner NameMark Tuvell No, 54-140 City La Quinta Tract # Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE Street Avenida Diaz APN # 774-201-008 Jurisdiction La Quinta Permit # 0008-089 Log # Zip 92253 Study Area Lot # 17 Square Footage 1771 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 2.05 X 1,771 or $ 3,630.55 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 rt Fees Paid By CC / 1 st Bank / Mark Tuvell Telephone ; Name on the check By Dr. Doris Wilson Superintendent I Fee collected/exempted by Annette Barlow Payment Received $3,630.55 � Check No. 55075 Signature 10TICE: 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 x lect 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 Ott REPUBLIC TITLE GU. RECORDING REQUESTED BY; AND WHEN RECORDED, MAIL TO: Mark Tuvell 72850 Somera Palm Desert, Ca. 92260 Ad 4 Z ASSESSOR'S PARCEL NO.: 774-201-008 _.T- RA- 03 o - ors, TITLE ORDER NO.: 503161-13 ESCROW NO.: 6035 -DS GRANT DEED DOC N 2000--190908 05/19/2000 08:00A Fee:12:00 Page 1 of 3 Doc T Tax Paid Recorded in Official Records County of Riverside Gary L. Orso Assessor, County Clerk & Recorder I • MMISC. 1 z- _. � T A I R -'L COPY LONG REFUND NCHG EXAM - VA THIS SPACE FOR RECORDER'S USE -ONLY The undersigned Grantor(s) declare that the DOCUMENT TRANSFER TAX IS; $ 20.90 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, Pete F. Nungara enne ;, aray,'husband and wife, as joint tenants hereby GRA T(S) to Mark Tuvell, a married an as his solekand separate property al situated in the City of La Quinta County of Riverside, State of California, described as: Lot 17 Block 255 Santa rrTtelita at Vale La Quinta No. 24 as per, map recorded-in'Book 19 pages 44 end: 45: of maps, the County Recorder of said County. Dated April 28, 2000 �u� ✓ ��� �� � � STATE OF CA f RNI, COUNTY OF r' i ll ON before me ./ J/ Ll. `"! f' �F'l. it Pete F: Nungaray i Notary Public, personally appeared r r) L'o, c i -out < . cr r r.Q Henrietta N ngaray ; personally known to me (or proved to me o the basis of satisfactory evidence) to be the person(s) 'whose name(s) is/are subscribed to the within instrument and - e acknowledged to me that he/she/they executed the same°' In his/her/their :-1 ,�„;,�;,�e,.9 DIANE SEDIN Comm 1148047 authorized ca acit les , and that b his/her/their si nature s),Ibn the instrument p y( ) y g O .<.. a+ o Notary Public-Cahfornia A the person(s), or the entity upon behalf of which the person(s)'Iacted, executed ' `; Riverside County T My Commission Expires the instrument. Z °, Pa �`� August 19'2001 WITNESS my hand. official sea . Signature i (;%�_— �_ "- MAIL TAX STATEMENTS TO: r .fi This area for official notary seal) y Mark Tuvell`,,( 4 COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL Received From: Address: t -T; .60164 -Date:'. Account No/',,(`,Tract Lot(s) Service Address 41 CD I C, G.A. Code -ff'Meter(s) f $ -Er Service(s) 0 Backflow(s) 0 House Lateral(s) • Detector Check(s) • Meter Surcharge ._O' Sanitation Capacity Charge 0 W.S.B.F.C. 0. Temporary Construction Meter 0 Turn on Charge ti 0 Uncollected Account - Name 0 Inspection Fee - Tract - Fee - 0 Plan Check Fees Water t Sewer - Tract - • Bond Payment - A.D. -'-Bond Assmt. • Customer Deposit • Other TOTAL $ 61 c) rl Remarks: COPY to: r Water service Cash Check MoneyCashier Order cvw6-438(11x89) I