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0106-164 (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 d f �' a� ^�� ' 6i "�-� Signature of Contractor 1 r ��•-' 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, asbowner of the property, am exclusively -contracting withlicensed contractors construct the project (Sec. 7044,. Business & Professionals Code). L e O I am eXempt under Section B&P.C'.for this reason Date 0 Signature of Owner 'WORKER'S COMPENSATION DECLARATION' I hereby of rn under penalty `of•perjury one of -the following declarations: () I havg &nd will maintain a certificate of consent to self -insure for workers' compensaf�„as provided for by. Section 3700 6f. the Labor Code, for the performanof W6`work for which this permit is issued. ( ) I -hare and will maintain workers' compensation, insurance, as required by S ction 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. Policy No. STATE FUND (This section .need not be completed if the permit valuation is for $100.6O!or less). O I-certifythat in the performance of the work for which this permitris issued,' I shall not employ any personin. any manner so as to become subject Jo the workers' compensation laws of California, and agree that if I should become subject.t.o the workers' compensation provisions of Section 3700 of the Labor Code, I shall.forthwith comply with thoseprovisions.. T /Date: l' l, ^r Applicant /.'fi" 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 forinSection 3706 of the Labor Code,.interest and attorney's fees. r,•,: 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 thebuilding construction, and hereby. authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. F " .e'Signature (Owner/Agent) !x-'` Date BUILDING PERMIT_ DATE_cVALUATION PERMIT# �• {E� TRACT .... JOB SITE ". __ APN ADDRESS OWNER- CONTRACTOR /DESIGNER LENGINEER , rr (p}��y�y cc�� fig+. py�97�y ��p^1 f. p �•�p•�(+•( yy�d'y,yo�wp•�-���, l� �y, ��y A,I:dYdrd� Y.fa•���'�[JI X1d�y J{.6�7�. t�., } S `. ttl h+SScLV�dJ3;afr V•G•4'L ,4yJ f'i,C�7� l4'7Ls. NIg3,l ostt 1* mbs ", 2, A 5 .51-370 AVI, - �A. [4RU'DA35 still- ^• 2, x u. , `td'.,�QUENTfis' ',`CSA 9 T 53 i�AQVINTA E.A. X2253 s USE OF PERMIT g,+T31,:`JN f 1II�r�S,11f�'. °S"Wiz1'.E:H. AI.I Y1;5VEI11rIPIG 51-370AN•YWI3.AP3f�.tEMUV—A.S SUYYZ 1:1.m.9 '- S.F1> I ��P, P' t,'1' l OMN NOT 114CLUDE Bi.rOM lKWLIS, P004 OR DRIVEWAY' T6,cr COMAtTkUCTION "1,509.00 �F i 99'C a AT cies' or t:Ol STRI C 110H PWRbUT Me 9M'•�•,A�,RY. ti � i:"i31`f t.3 i'R UC`t IO n'2 1 01-000418� 000 ��i13, �9. PLAN F<tPWX ME 101.000-439-3': S �4139.9t 101-000439-318 -M- 0.00 . KRCt; ENNICAP.. J EE. 101-006-421 -.000 $73.00 V=') RIC,AL, Oil .10-1.06tt-420FC1 O $1101126 P���yy c�♦P�,y 101-000-419-WO 01••Qfa0-411-flt3ti i"{3/a�.iitt �p���kk'Atq=.'ayaFnyr /�� 7 5y��o �py� qt!' O �t,�SP31�.D l ? 6,Y'VlV ITE + Y,Sf�`1),1.�' '101-000-241-000 ' Will t ORADfAf'a PER 101 ••000-423.0010 $20.00 RA+f r,'.' r•` .i: �1;4b."�•UO yyDWEID;P1 1PAIMIM P?l.�t' N 2 ppy ,,((�� 3 02-f)i1(}•�*441 "345 JAN 1-4 2001 DATE' COMP.W.1- ION AND PUN Cl= LL PERVEr )FEES DI; stow . S, BY ,' DA FINALED INSPI �ALC 2. 0 u�:5t7,0iJ ��p,UG mTe.J. •y INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING Set Backs Forms & Footings Slab Grade Steel APPROVALS r' �.;) ``'{ J (,� MECHANICAL APPROVALS Underground Ducts Ducts Return Air Combustion Air Roof Deck O.K. to Wrap Framing (JY -,Z r%�i/ S• S . o L Exhaust Fans F.A.U.. Compressor Insulation .�36 ..� L Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Party Wall Firewall Exterior Lath _n Drywall - Int. Lath Condensate Lines Final co v �— _v Final POOLS - SPAS BLOCKWALL APPROVALS 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 l=�Q- p2 Water Piping �L� Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection _ -En-capsulation Gas Piping Gas Test Appliances Final COMMENT�"- - ` Final Utility Notice (Gas) l�v ELECTRICAL APPROVALS Temp. Power Pole f?� O. Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final_jt Utility Notice Tlihf 4 " P.O. BOX 1504 Building _ 78-495 CALLE TAMPICO Address J - `7 /r7%) ?� �L�.p= LA QUINTA, CALIFORNIA 92253 Mailing Address City Zip Tel. Address City_� Tel. Zip % 7 State Lia... _ City _ G & Classif. ��. �� `� ''a Vic, Lic. # = G; Arch., Engr., / Designer rJ l✓,�L� l �� Address r Tel. / jCity Zip State < 'S Lic. # LICENSED CONTRACTOR'S DECLARATION I 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 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, after• 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). (.: 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 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.) 1'1 1, 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 I hereby affirm that 1 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 177 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 i1 the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thF 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. Date Owner NOTICE TO APPLICANT: If, after 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 1hereby 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 stale 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 property for inspection purposes. Signature of applicant —Date— Mailing ateMailing Address City, State, Zip i APPLICATION ONLY BUILDING: TYPE'CONST. OCC. GRP. A.P. Number --73 - _�I/l_ i Legal Description �% 14 F -Gr.,­c Project Description "'-.,rte . � � i. ��.._ 7"�-+✓d /' L-- `ji Sq. Ft. I No. Size/ -�/ Stories New`] Add ❑ Alter ❑ ' No. Dw. Units Repair ❑ Demolition ❑ stimated Valuation PERMIT AMOUNT Plan Chk. Dep. '\ Plan Chk. Bal. \ Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure JUN 112001 CITY OF LAOUINTA rINANULUVI TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback frcrn 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 D VISION Desert Sands;Unified School District " 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated .760-771-8515 , "CERTIFICATE, OF COMPLIANCE, M . 1 f. :I 'Date 1/14/02 APN# ' 773=.183-010 .No. 22834 Jurisdiction La Quint - owner NameLendel Ventures Inc a Permit # 0106-16.4 ' No. 51-960', Street, Avenida Villa wog # City La Quints Zip 92253 t study Area ' Tract # ,B 120 U12 Lot # 14 ` .Square Footage' 1509 } Type of Development Single Family Residence No. of Units 1 Comments ' r 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 niobilehomes. • It I has been determined the above-named owner is exempt from paying school fees at thi's time due to th-Y following reason _ EXEMPTION NOT "APPLICABLE This certifies that school facility fees imposed pursuant to ir_ the amount of ' .2.05 X 1,509 or $ 3,093.45 the property listed above and that wilding permits and/or Certificates of Occupancy for this square footage in this proposed project may now lye issued y Fees Paid By CC/ Valley Independent Bank -AP LerichTelephoge 760-564-1866 Name on the check' By Dr. Doris Wilson _ Superintendent s Fee collected /exempted by Annette Barlow Payment'Received $2,093.45 ` Check_ No 261918 . Signature ICE: Pursuant to Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protBst the fees or other payment identified ve 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 o another public entity authorized to act them on the'District('s)(s') behalf, whichever is earlier. a,uuccwr: tcuacu a copy ul CuuLly or CR,' plata CneCK application corm Lo District copy Tor all waivers. Embossed Original- Building Dept./Applicant ` Copy-'Applicant/Receipt • Copy - Accounting r The un dersi Grant DNO�1.P,N. 773-1 83-01 0 I ; gne d grantor(s) declare(s): Documentary trarisfor tax is S ( xF) 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, Grace & Ebenezer' Ajilore hereby GRANTS) to. Lendell Ventures the real property in the Clry of La Quinta Colanty of ,Rivers ide Slate of California, described as Lot 14 Iaf 'Block' 120, Unit No . , . Santa Carmel ita at Vale La ` Quinta, as per map 'recorded in Book Pages of Maps, records of. Riverside County, California. Dated June 5, 2001 - - Slgnature of Grantor Slate.of California ) County of ) SS. _ Grace & Ebenezer Ajilore On before me, personally appeared — -• _ Grace & Ebenezer Ajilore personally known to me (or proved to me on the basis of satisfactory evidence) to be the Person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they ezeuted _ the same in histher/thelr authonzod capacity(ies), and' that by `- h13/her/their signature(s) on the instrument trig person(s), or the e_nuty upombehalf of which the person(s) acted, executed the instrument.' . i WITNESS my hand and orficat eeal..