11452 (BLCK)Building 53-280 VILLA
Address
f�Gl�GV
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
CAU'AND SALLY WILSON
Mailing
Address SAME
City Zip Tel.
LA QUINTA 92253 564-0910
Contractor
OWNER BUILDER
Address
el.:
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City (Zip (State
Lic. #
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.
I hereby affirm that I am exempt from the Contractor's License Law for the following .
reason: (Sec. 7031.5,Bustness 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 rite a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
• 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 rive hundred dollars.($500).
as owner of the property, or my employees with wages as their sole compensation, will
ado 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 safe. ff, however, the building
or improvement is sold within one year of completion, the owner -builder win have the burden
of provingthat he did not build or improve for the purpose of sale.)
❑ 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.)
❑ 1 am exempt under Sec B. & P.C. for this reason '
f /
LDatej OO ri /V�ner 1t^' r'•� r. .A/
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance;.or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company '
O Copy is.filed with the city. ❑ 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 (8100) valuation .
or less.)
I certify that in the performance of thg 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: ff, 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
1 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 property 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 property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
No. 11452
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description BLOCK WALL — 5'
6'
X-94'
$ 2601
ZONE:
7 ,
BY: '
Minimbin Setback
Distances:
Front Setback from Center Line
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
. Alter ❑ Repair ❑ Demolition ❑
Side Setback. from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Validation:
Estimated Valuation
'$8,535.01
r,
PERMIT
AMOUNT '
Plan Chk. Dep. ,
Plan Chk. Bal.
Const.
$ 08.OU
Mech.
Electrical
Plumbing
S.M.I.
.90—
9O..Grading
Grading
Driveway Enc.
Infrastructure
TOTAL '
$108.90
REMARKS
ZONE:
7 ,
BY: '
Minimbin 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:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FLEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO, FT, ®
CAR P. Q. FT.
WALL SO. FT. ®
SO, FT, ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
IKITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE,TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Vic
SEWAGE DISPOSAL
` f'2'.eh V-� �5t ex,—r
�ijh t' wtSf
-h3
lWl$a $ p
(� '✓ `0 /�C/9
SO.FT.GAR ® 314c
HOUSE SEWER
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK jig
OF
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF. D
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM Q / 9/L
rr�
WATER SYSTEM
GRADING
cu. yd.
1 $ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
i
ROOFING
` f'2'.eh V-� �5t ex,—r
�ijh t' wtSf
-h3
lWl$a $ p
(� '✓ `0 /�C/9
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL
ALLSTATE INSURANCE ~COMPANY I
HOMEOWNERS•DECLARATI:ONS. IF YOU HAVE.'ANY QUESTIONS.!:
PREM_I-UM.STATEMENT- PLEASE CONTACT YOUR ALLSTATE
Policy AGENT OR OUR NEAREST OFFICE `
Number 0 14 17276.8.05/24 !
Policy .749 643863 .. i
:....:, :...... :....:
` Mailed to CARL
WILSON `&• SALLY WILSON !
53.280;AVENIDA VILLA
LA-QUINT'A 'CA 92253-3478:
THE ADJUSTED ANNUAL .PREMIUM IS
YOUR POLICY•HAS BEEN CHANGED EFFECTIVE ON SEP 15, 1992
FOR THE FOLLOWING REASONS,
is
.CHANGE JN,MORTGAGEE, SERVICIN.G.AGENT:•AND/OR LOAN NUMBER-
CHANGE�IN DESCRIPTION AND/OR.LOCATION OF PROPERTY
THERE IS NO,CHANGE IN PREMIUM - FOR THE CURRENT PREMIUM I:
.
PERIOD, THEREFORE YOUR BALANCE IS- NOT AFFECTED. l .
YOUR POLICY IS PAID IN FULL
2% NEW HOUSE,,DISCOUNT APPLIED.
CARL LOAN NO.
Policy,WILSON & SALLY WILSON 9232328710 '
Issued to . 53280 AVENIDA LA:.
LA;QUINTA CA -92253-3478
AGENT- JOSEPH F FORGETTE
Payment Record PHONE=, 714, 652=2857
Date
Paid ..
Amount _ , ED -1. 64 �"033 0183 494052 2 70 1 6501602 3 9 _83 1151
Pala 000000 40
' Check -
Number
( .
Office use only
I
��ymen} Notice,: ,, . THANK YOU FOR LETTING US SERVE YOU. Please tear atom alis tine. Return
e A699
r
4
l bottom portion with your payment.
Policy number ` Date due
0 14 172768 05/24 NHP -REQ.
DO NOT PAY
f
MORTGAGEE ,HAS BEEN'BILLED
Please mark (X) how satisfied you are with our service.
CARL
1.
'
WILSON 8 SALLY- WILSON
Not
Not - At All
0 Completely 0. Very Somewhat , 0 Very
-
Please make your check or
money order payable to: 643863 09/25 03C30649 70 H
}
ALLSTATE - 01417276805244000000000000000000000000
j
INSURANCE CO. -.
• .I
The POLICY PERIOD shall begin and end, at the Location of Property involved,
ALLSTATE INSURANCE + COMPANY
ted below (See reverse side for additional policy provisions).
DECLARATIONS MEMORANDUM Ca6i�
ISSUED 09-25-92
0 14 172768 05/24 BEGINS ON MAY 24,. 1992
AND'CONTINUES UNTIL
CANCELLED
CARL AMENDED — SEP 15, 1992
•:: WILSON & SALLY WILSON 12 01 A.M. STANDARD TIME
53280 AVENIDA VILLA. LA QUINTA CA 92253 1ST MTG' "
LN 92323287104
•DWELLING.IS OF FRAME CONSTRUCTION AND OCCUPIED•^
BY 1 FAMILY '
PREMIUM INCLUDES SURCHARGE FOR CALIFORNIA RESIDENTIAL`'
EARTHQUAKE RCVRY FUND (CRERF) OF 60.00 & 9 1..00 ADM',FEE
Name and PERFORMANCE MTG OF COACHELLA VALLEY LOAN NO..
Address ITS SUCRS &/OR ASSN.. . 9232328710
• - � . of First ,
Mortgagee 3501-,S HARBOR BL 200
i SANTA ANA -CA 927044914
The following coverages and limits of liability apply as shown below. If the word "amended" followed by a date
appears above, the insurance'applies only from that date.
POLICY`COVERAGES-AND LIMITS OF LIABILITY
A DWELLING PROTECTION(REPLACEMENT GUARANTEE) 988,000
10 ADDITIONAL PRO'TECTION.•PROVIDED FOR OTHER STRUCTURES
C.PERSONAL PROPERTY, PROTECTION REPLACEMENT COST 61,600
LOSS OF USE OF YOUR RESIDENCE ACTUAL LOSS SUSTAINED
X FAMILY_ LIABILITY -EACH OCCURRENCE 100,000
Y' GUESTMEDICAL PAYMENTS EACH PERSON 11000
E EARTHQUAKE DAMAGE- DEDUCTIBLE. OF 98,800 APPLIES 88,000
— YOUR EARTHQUAKE DEDUCTIBLE IS'COMPUTED AS 10 PERCENT
OF YOUR COVERAGE A LIMITS. }
{ WC WORKERS' COMPENSATION
'PRIVATE•RESIDENCE.-EMPLOYES) INCLUDED IN TOTAL -
OCCASIONAL CLASS" POLICY PREMIUM
THE PROPERTY INSURANCE ADJUSTMENT -CONDITION APPLIES
USING THE BOECKH PUBLICATIONS BUILDING COST INDEX
DEVELOPED BY THE AMERICAN.APPRAISAL ASSOCIA'TES;INC-.
LOSS°-DEDUCTIBLE(S) APPLICABLE
9250 ALL PERIL'DEDUCTIBLE APPLIES TO COVERAGE(S)A & C
SUBJECT TO -THE FOLLOWING FORMS AND ENDORSEMENTS"
AU1774 DELUXE HOMEOWNERS.POLICY
X4154 'EARTHQUAKE NEW COVERAGE
AU9611-2 AMENDATORY ENDORSEMENT
AU319 LENDERS LOSS'PAYABLE _ .
ALLSTATE INSURANCE COMPANY
",.
HOMEOWNERS DECLARATIONS NEW PREMIUM PERIOD
PREMIUM STATEMENT
MAY 24, 1992:, 12 01 A.M.,
PolicyFROM
Number 0 14 172768.'05/24 TO MAY 24m 1993 STANDARD
•..: ...
- TIME .
Policy 749 643863
Mailed to CARL
•WILSON•& .SALLY,WILSON
53280 AVENIDA VILLA
`
LA'QUINTA CA 92253=3478-
TOTAL PREMIUM FOR THE PREMIUM 'PERIOD STATED IS:$ 5.76.00**
BALANCE 6 576:00
* INCLUDES CRERF`SURCHARGE OF:-$. 60."00 & $ 1.00 :ADM FEE
- 2% NEW -HOUSE DISCOUNT'APPLIED ;
•
CARL LOAN NO.
Policy WILSON & SALLY WILSON 0013116497
AVENIDA VILLA
LA QUINTA, CA :92253-3478:
AGE'VT- JOSEPH F FORGETTE
Payment Record PHO!gE- 714 652-2857
We
Paw r
ED -1 64 033 083 49,4052 2 7,7 -1 6501602 3 9 83 1151
,,�
vain . 000000 40
cls
Number Office use only
is One..Retum '
Payment Notice THANK YOU FOR LETTING US SERVE YOU. � tea'aironA099
portio your payment.
Policy, number Date due
0 :14 172768 05/24 MAY 2.4, 1992 _ NHP REQ:
c i
CARL
WILSON-& SALLY WILSON
Please make your check or 643863 04/01 03C34645 70 1R H
money order payable to: ,
ALLSTATE - 01417276805244000000000000000000000
INSURANCE CO.