0012-015 (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
'Q Professionals Code, and my License is in full force and effect.
O M License # Lic. Class Exp. Date
r LO
r-- t` 57 X5'1 tXTC f 10M- W(
o Z r,- Date Signature of Contractor /f 1
co 0/
J U
C:) OWNER -BUILDER DECLARATION
LU W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
d 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).
LO () I am exempt under Section , B&P.C. for "this reason
O
C\1 Date Signature of Owner
0).
d Z WORKER'S COMPENSATION DECLARATION
C:) Z I hereby -affirm under penalty of perjury one of the following declarations:
p () 1 have and will maintain a certificate of consent to self -insure for workers:
X w LL compensation, as provided for by Section 3700 of the Labor Code, for the
Oto Q performance of the work for which this permit is issued.
Q �I have and will maintain workers' compensation insurance, as required by
p 086ction 3700 of the Labor Code, for the performance of the work for which this
LO
Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
ao C;LAREDON PIAN' INS 01KR.0022-674
r, d
Q (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' compensation pro �is� n ecti ri3700 of the Labor
Code, I shall forthwith comply with those provlsl�ns.
Date: ' / yApplicant /Y A✓` ✓ /
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 above-mentioned property for inspectio�pUrposes.
Signature (Owner/Agent) j Date
f
BUILDING PERMIT PERMIT# _
DATE VALUATION. LOT 2}�}a;ti✓�l TRACT
7,4.733 s Rz s3 2t;
JOB SITel
APN
ADDRESS
Wflims AW T DA IZKP"R ?1.
_
74-2,13411 a
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CA'NCf C faSON
�*: rY I-' .e— t i
v°LiAT.I, 0Ji�wWSION' & RT14tDELDTC
yy�A���y£�i��
!
77067 (!ALI 1rLAWj
p L:� ?'��'`°. �'� CA 5 421 1
T'A1f M DR41 .0 Ch 92211
(760)345-9564 C LA 2.213
USE OF PERMIT
SIFD - PEIRMIT DOES NOT 10C:LUDE BLOCK tWA.II, POOL &SFA OR
DIUVEW AY A.! PROACK M 92.F?l'iUC`,(IOX IN PLAN tiHti K: RE, POR
MU1;FIPLF9 ISSUANCE OF gMlw PA.AW TYPE.
TR,kCT C'ONSTR€XOTION 115".00 SF
PORCH/PATIO 60.00 SF
c.iARAIJIM-d RPORT (SF) 0,290.40
5 FT. WOOD FE11iCF✓ 3130.00 LF
. - .1 ITIMAIZED COS' 0,11' COM:l'. UC.110ff
37,473.80
FRIMa E Auhu fiwc r
CUNSTIJCfIONFUR 101.000.418,000 9630.30
P'IAN CHUCK I11M 101-000.439-3118 $130.95
➢JIL"C:FMIC:A]LFEE 101-000.421-00I $62,00
F:I..XCTR,ICAL FIRC . 101,.000••420-000 $113.21
PLIUMBIVIO FU 101 -M -4.19a000 $.11617$
STRONG MOTION FEZ o RBNI0 1011 -OW -241-000 V.75
CSi3AD1`90 FV9 101-000-423-000 $20,00
1n.EVX3„CiP9-X IMPACT N'1r,L' $1,907,I)0
PRECISE FLAN 101 :n000-4.41-345
MDE4►OSIT 1231-iyi7fi'�1°1cw-�1>� •ffi3S9.fitl
1!
4 ,
SUS-I.�7!'"iAL C2JY��u'.iZllE.411.0N AND1';:�f..�PRE-PAM
$3,.G9�90.�1 C)i
t•�al•[ac y�,r,.�l y ��g�,�-++
L17708 .f. RE S.a Mf,7•p.x.S
-�ii.50,00
• � f
RECEIPT
DATEBY,
12-12-1
k4 ,
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms
5 ,
Underground Ducts
Ducts
& Footings
/ p'
1
Slab Grade
Return Air
Steel
Combustion Air
Roof Decky��0
D!
Exhaust Fans
Q.K. to Wrap
tj �? - B! S%
F.A.U.
Framing
_ _ _ _
5
Compressor
Insulation
"0
Vents'
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_
4,
Final
Final
10Y10(
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
_
�� 57
Heater Final
Water Piping
!� '
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
f O/
Encapsulation
Gas Piping
Gas Test
�,(- o S
Appliances
Final
COMMENTS:
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
—9-4-6w
Final
Utility Notice (Perm)
V" 0
s
P.O. BOX 1504 APPLICATION ONLY
Building ) 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
Owner
Mailing BUILDING: TYPE -CONST. OCC. GRP.
4
Address A.P. Numberj/
Citv lZip _ _! , L T'' S? j/ )/./.
a
State Lic.— City
71 & Classif. 5 W-3 /✓' Liicc'. #/) Zv
Arch., Engr.,�fll< %/ "7v
Designer
City `' ZipZz Statety Lic.
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed and i povlsions of Chapter 9 (commencing yyy+++ith Section
7000) of Divi 3 o ithe8 siness- n ro essfons Code, and my license is in Jlill force a. nd 1
effect. /�
NA7 R / 6' 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, atter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file 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 that. he is exempt therefrom, and the basis
for thealleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than live hundred dollars ($500).
I: 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, 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. It, 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.)
II
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 contractor(s) licensed pursuant to the Contractor's License Law.)
11 1 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 Compen tion Insu ance a certified cop there f. (Sec. 38gp..Lapffor ode.)
Policy Na ;9 Y, 2 y L
,Copy is filed with the city. 0 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 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
Ihereby 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 represe atives -of this city to enter the above-
mentioned property for in on roses
- Signature of applicant Dale��
Mailing Address _
City, State, Zip
Legal Description ,�a , / yine fntly-04114f
Project Description «� 2E v12.
Sq. Ft. No. No. Dw. /
Size Stories % Ugggh
NewW Add ❑ Alter ❑ R p*L Demolition ❑
ion
PERMIT
Plan Chk. Dep
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
Cil
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
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
Date 12/27/00
No. 21406
Owner NameJames J. Molnar
CERTIFICATE OF COMPLIANCE
APN # 774-213-011
Jurisdiction La Quinta
No. 54-085 Street Avenida Herrera
City La Quinta zip 92253
Permit #0012-015
Log #
Study Area
Tract # BLK283U26 Lot # 5 Square Footage. 1578
Type of Development Single Family Residence
Comments
ived an official check for $6,469.80.
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
2.05 X 1,578 or $ 3,234.90 the property listed above and that 6iiilding
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be.issued
Fees Paid By OC / Washington Mutual Bank - James Molnar Terephone�
Name on the check ;.
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Annette Barlow
Signature b�Lkv'
Payment Received. $3,234.90
Check No. 225093208
JOTICE: 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
Vlect 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
RECORDING REQUESTED BY
AND WHEN RECORDED MAIL TO
r —1
ame Lance C. Gibson
reet #5 Running H.
ddress Palm Desert,Ca. 92260
ity &
.ate L J
MAIL TAX STATEMENTS TO
ame
treet
ddress
ity &
tate L ,J
.DOC N 2000-461124
11/17/2000 08:00A Fee:9.00
Page 1 of 1
Recorded in Official Records
County of Riverside
Gary L. Orso
Assessor, County Clerk 8 Recorder
11111111111111111111111111111111111111111111111
IT
SPACE ABOVE THIS LINE
CAT. NO. NNO0580 Individual Quitclaim Deed
TO 1922 CA (2-83)1h THIS FORM FURNISHED BY TICOR TITLE INSURERS
The undersigned grantor(s) declare(s):
z Documentary transfer tax is $
i a ( ) 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,
LINDA GIBSON KLINE, A MARRIED WOMAN, WHO ACQUIRED TITLE AS LINDA L. GIBSON
hereby REMISES, RELEASES AND QUITCLAIMS to
I..ANCF C. GIBCON
the following described real property in the LA QU I NTA
County of RIVERSIDE , State of California:
Real property, Lots 5,6, and 7 of Block 283 Santa Carmelita at Vale La Quinta, Unit
#26, as per map in Book 20, page 50 of Maps, records of Riverside County California.
STATE OF CALIFORNIA �ss. COUNTY OF Riverside
On August 23, 1988 before
me, the undersigned, a Notary Public in and for said State,
personally appeared . Linda L. Kline'
personally known to me or proved to me on the basis of sat-
isfactory evidence to be the person _whose name is
subscribed to the within instrument and acknowledged
that S e executed the same.
WITNESS my hand and official seal.
' o
Signatu e � f
Title Order No
OFFICWLSEAL
KELLY J. SCHLACHTER
NOTARY PUBLIC • CALIFORNIA
D o PRINCIPAL OFFICE IN,
'►O . RIVERSIDE COUNTY
o My Commission ESP. May 11. 19H
(This area for official notarial seal)
Escrow or Loan No.
MAIL TAX STATEMENTS AS DIRECTED ABOVE
U
PAGE
SIZE
DA
PCOR
NOCOR
SMF
MISC.
HA
C..
R
L
COPY
LONG
REFUND
NCHG
E%AM
SPACE ABOVE THIS LINE
CAT. NO. NNO0580 Individual Quitclaim Deed
TO 1922 CA (2-83)1h THIS FORM FURNISHED BY TICOR TITLE INSURERS
The undersigned grantor(s) declare(s):
z Documentary transfer tax is $
i a ( ) 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,
LINDA GIBSON KLINE, A MARRIED WOMAN, WHO ACQUIRED TITLE AS LINDA L. GIBSON
hereby REMISES, RELEASES AND QUITCLAIMS to
I..ANCF C. GIBCON
the following described real property in the LA QU I NTA
County of RIVERSIDE , State of California:
Real property, Lots 5,6, and 7 of Block 283 Santa Carmelita at Vale La Quinta, Unit
#26, as per map in Book 20, page 50 of Maps, records of Riverside County California.
STATE OF CALIFORNIA �ss. COUNTY OF Riverside
On August 23, 1988 before
me, the undersigned, a Notary Public in and for said State,
personally appeared . Linda L. Kline'
personally known to me or proved to me on the basis of sat-
isfactory evidence to be the person _whose name is
subscribed to the within instrument and acknowledged
that S e executed the same.
WITNESS my hand and official seal.
' o
Signatu e � f
Title Order No
OFFICWLSEAL
KELLY J. SCHLACHTER
NOTARY PUBLIC • CALIFORNIA
D o PRINCIPAL OFFICE IN,
'►O . RIVERSIDE COUNTY
o My Commission ESP. May 11. 19H
(This area for official notarial seal)
Escrow or Loan No.
MAIL TAX STATEMENTS AS DIRECTED ABOVE
Adoo 031311U313-
e eq of Pel ul eq ism uoj1B?t{IuOS
.PIWO
�l elwo{Ile� to olelS •�a^W W AiA1313 A NnOO
1�AiAw u1 10 Pus �pulfto oap 10 � Pu•ln v eq at ® 1 Pey a ol, u
jjw a3wU33..
v eq o& poi w eq.pu MU
ate L... •... -�:
SPACE ABOVE THIS LINE FOR RECORDER'S USE ;
cA. No. NNOosso Individual Quitclaim Deed�� i
ary a
TO 1922 CA (2-83) THIS FORM FURNISHED BY TICOR TITLE INSURERS
The undersigned grantot(s) declare(s): .f>=
ZJ Documentary transfer tax is $
( ) computed on: full value of property conveyed, or
a ( ) computed ori: fuWvalue less value of liens and encumbrances remaining at , e of sale.
( ) Unincorpor IJe Fea: ( )City of , and
FOR A VALUABLE'CQNSIDERATION, receipt of which is hereby acknowledged,
LINDA GIBSON KLINE�'A MARRIED WOMAN, WHO ACQUIRED TITLE AS LINDA L. GIBSON
hereby REMISES, RELEASES AND QUITCLAIMS to ,.•.;_
-„•the:following:desrnbed real --property they LA QtaINTA
County< -of RIVERSIDE , State of California:
Real property, Lots 5,6, and 7 of Block 283 Santa Carmelita at Vale La Quinta, Unit
#26, as per map in Book 20, page 50 of Maps, records of Riverside County California.
i3S'rA
Dated: August 4 -1 ARR
STATE OF CALIFORNIA ”
$S.
COUNTY OF...,.....: «..�::R v—e:r'side........
On August' 23, 1988:: before
me, the undersigned, a Notary Public in and for said -:State,
personally appeared -Linda L. Kline
' personally known to me or proved to me on the basis4'of sat-
isfactory evidence to be the person_ whose name ` `°> is
subscribe¢ to the within instrument and acknowledged
that she executed the same.
WITNESS my hand and official seal.OFFOALSEAL
if
= KELLY 1. SCHlAp11Ek•
Signat e , NOTARY PUMIC-CALfWF99A
• PRINC MP OFFICE IN
RIVEFMCOU(M
My C=fffi w Exp. May 11. 1990
(This area for official notarial seal)
Title Order No. Escrow or Loan No.
• MAIL TAX
STA TEMENTS..AS.C)IRECTED ABOVE
r
RC DISTRICT - PLANNING REVIEW FORM
3YS
This form is to be used by CDD staff for review of single family dwellings in theRC (Cove Residential)
District, in order to determine the applicability of compatibility issues or need to require the filing of Master
Design Guidelines by the applicant. It shall be transmitted to the Building and Safety Department as your
correction list. Please attach additional explanations as necessary.
APPLICANT Molnar Construction
SITE ADDRESS 54085 Ave Herrera
APN 774 _ 213 - '016-9. ' BINNO.: 9-cl• CASENO.: 2000-345
LEGAL: LOT 5 BLOCK 2 8 3 UNIT
CHECKED BY: Wally Nesbit
DATE:
S.C.@V.L.Q.
11/7/2000
Inform the assigned Building plan checker upon your assignment to this case. The CDD Executive
Secretary maintains a log book to track applications and assign case numbers.
REQUIRED ITEM
Y
N
COMMENT/CORRECTION
Compatibility Review
/ A
Case logged and number assigned
Verify legal and APN information
°W"4A IS LI.1-0A &TdSa-'
Consistent with MDG on file (as.applicable
1"VA - Z,,,n HT AP -C -ocwv,%I(
MDG filing required (5 filings since 9/3/98)
Consistency with street/surrounding area:
_ Colors
Materials
Dv
uj(��� rchitecture
Ub'
6
✓
��,,..�� Sa/Qw••� - ��� co( o✓Ls
31 %a S c -,?e4— a-92 G--9
o r�
(i—T- !�
G�si S ✓ I TW A/4-00.5-tOS A—'al-
Z
Other Requirements: jmr ttmn C g�
(;-n T+ 'Z N'* -I C — Vf211'7 &96AL C—Alf, z
/S ? ,,,,r Gw-�O72 S- J
0
Certificate of Occupancy
City of La Quinta
f
Building and Safety Department OFTME°`V
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification: SFD
Occupancy Group: R 3
54-085 AVENIDA HERRERA
Bldg. Permit No.: 0012-015
Type of Construction: VN Land Use Zone: RC
Owner of Building: JAMES J. MOLNAR
Building Official
Address: 77-027 CALIFORNIA DR.
City: PALM DESERT, CA 92211
By: STEVE TRAXEL
Date: 08-09-01
POST IN A CONSPICUOUS PLACE