0211-067 (DSF)LICENSED CONTRACTOR DECLARATION
IIhereby 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
'aNrofessionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
ate X% A Signature of Contracto<:!�' ••¢ ' � �""""�
00
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).
( ) 1, 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:
Carver ,<,+TATE F TND Policy No. iown-lA
(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.
bate: e1. I Z 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-96ove-mentioned property for inspection purposes.
1-11 1�-
Signature (Owner/Agent] �' """ Date tv,
BUILDING PERMIT- %•PERMIT#"
-�TRACT
DATE SIM/2 ,VALUATION 1� *+� LOT 201 76157
ADDRESS 78-= AZ%.dXE J ,a WWW APN 643-100-022
OWNERCONTRACTOR /DESIGNER /EN (NEER
MIM mfyl .&R BEN NfsCE '
.
76.853 DULCE DMAMAR MOfit 23:19
LA. Q%rINTA's CA 92.233 30.(3LM DE&S".t:'x CA 921260
(:160)345-2030 CIBU{ 7RD
USE OF PERMIT
2:1R3viMIMCIN
i,1Ei1?fO 20 MY CIAR.D,15N TrV',f4.LX.d;TUC;CO FROM GARO Nx.15,°,T, 1-74
YREPA,R-ATMPDR Oi1EST HOM, AT3DC'i10W
VA.L11hTION
71$0 10 I's
PF' ' .M1f'k�w°,'.3T."AAEdY
DEMOItl`s"ION FFE 10HY 23-000 $45,00.
CITYVIA.OFL.A QUINTi4
•6
0[iR=1f UR—TOTAL. C014I ITZ [ 1C':'S.3i?Y AN. -P PI.AM f ;1 I.P oX
21,500-00
RECEIPT DATE
EINY DATE FIN LED INSPECTOR
r
INSPECTION RECORD
OPERATION
DATE 7
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
_
Final S
BLOCKWALL PP OVALS
Final
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. forFinish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
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)
COMMENTS:
a
r 0
City of La Quinta
Developers PM -10 Approval Form
Prior to the issuance of a Demolition Permit for the project listed below, Public Works
approval must be obtained. Please return this form to the Building and Safety Department
only after approval.
Project Address: ? F- F 5 5 %J o LC E I r— I- m aA
Scope Of Work:L-
I�AI�/Z pow/,/ VC'Q1z1S1 '7A- RF l ieucks J01V7A11V 7RAUk a(
Public Works Departjpent Approval is Hereby granted:
fl 1-710 e
Senior Engineer Date
i r .
11/08/2002 08:45 FAX 7603602726 BEN NANCE
City of La Quinta Building Dept
P.O. Box 1504
La Quinta, CA 92253
To Whom it may concern;
This letter is authorizing Ben Nance Enterprises, Inc. to do necessary
demo work to make way for new room addition located at 78-855
Dulce Del Mar, La Quinta CA.
Sincerely,
Charles Sindelar
la 001/001
r
NOV-08-2002 12:57 FIRSTBANK LOANS
a_—.WjLiCJ•l
FirstBank
73000 Highvay III
Palm Desert, CA 92260
Lcaxx # 3056178 [Space Above This:
DEED OF. .TRUST
is
7608363566 P.02/02
01/07/2000 ea:00A Fee:83.00
Page 3 of 13
Recorded in officjal.Reaordat
County of Riverside
Gary L. Orso
Assessor, County Clerk 8 Recorder
111111111111111111111111111111111111111111111111111
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PAGE
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(� THIS DEED OF TRUST ("Secariry Instrument") is made on DECEMBER 29 1999 The trustor is
t"^1 Charles J. sindelar Jr. and Nancy W. Sindelar, Husband and *ife as Joint Tenants.
i� ('Borrower"). The trustee is Chicago Title company
560 E. Hospitality Lane
San Bernardino, CA 92408
("Trustee"). The beneficiary is First'sank
,
which is organized and existing under the laws of the State of Colorado , and whose
address is 73-000 Highway 111, Palm Desert, CA 92260
("Lender"), Borrower owes Lender the principal sum of
FOUR HUNDRED TWENTY—EIGHT THOUSAND AND N0/100 '
Dollars (U.S. $ . 428, 000.00 )_
This debt is evidenced by Borrower's note dated the same date as this Security Instrument ("Note"), which provides
for monthly payments, with the full debt, if not paid earlier, due and payable on JANUARY 1, 2030
This Security Instrument secures to Lender: (a) [he repayment of the debt evidenced by the Note, with interest, and all
renewals, extensions and modifications of the Note; (b) the payment of all other .sums, with interest, advanced under
paragraph 7 to protect the security_ of this Security Instrument; and (c) the performance of Borrower's covenants and
agreements under this Security Instrument and the Note. For this purpose, Borrower irrevocably grants and conveys to
'Trustee, in trust, with power of sale, the following described property located in Riverside County, California:
See attached Exhibit A
which has the address of 78855 Dulce Del Mar, La Quinta
California 92253 [Zip Codcj ("Property Address");
CALIFORNIA -Single Family.FNMA/FHLMC UNIFORM INSTRUMENT
(00 8R(CA) (9212),01 UMP M0MrjAGE FORMS • (et>o)s2ta29t
CA3065 (9/29/93) DisiAbuted by FcmiMon Tcchnolagies, Ine. - (SCO)BV-3799
[Street, Gry],
Form 3005 9/90
Amended 8/91
TOTAL P.02