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0305-154 (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 an Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date 579391 B H3C / 1021 1 P - L) Signature of Contractors ' Datef9 �= -'�'✓- - ^ � OWNER -BUILDER DECLARATION`S-'/�% 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). 4 1 () 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 bf the Labor Code, for the performance of the work for which this permit is issued. /�( .) 1 have 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 STATE FUND Policy No. 161520"2 (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, Icshall forthwith comply with,those provisions -1: o, 16�~ ,!iate:.(_.2 APPlicant"^,/?A-, i✓�� �-- Warning: Failure to secure Workers�.,Comperisa lot n coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. I ' 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for,inspection purposes. Signature (Owner/Agent)•s� ��- '�/�� �-� Date BUILDING PERMIT PERMIT# ; ID - VALUATION LOT TRACT JOB SITE ADDRESS 544,$.S AVEWMAUtiu ,2A. APN OWNER '• CONTRACTOR / DESIGNER / EN (NEER x ANc7 GMSOR MOLNAR CONSIRUCTITON & :1�.. 0DE1:INe 54-085 AVF_iM)A HETRH .'r.A 710027 C'A1• PORN7.A DR . LAQtWTA CA 92253 PAWD37�""s�EiT Ch .,92211 I (700)345.9564 CM01 22114 USE OF PERMIT mso u.A'. S1''47 Prams- DoFt WT 11-46LUDE BLOCK WALT, POOL OR DRIVEWAY APPROACH 0 .,. ti • TRACT CON TRl CC w 1,Si'ik.00 SF PORCHIPAT10 45.00 SF �r�JCA1�0�.T ats6,r�� ;AFP 30" rDlrA, IRD COSY OF, C'NSIRU(^':TTON .Plrs.'l(�i►>3l FEE 9UMMARY CONSTRUCTION FEE 101.000.418-000 $621.50 PLAN CHECK FTE 101-000-439-318 $515,39 EE DEPOSIT 101.000.439.318 4250.0 MECI-AN1CAL- EF, 101-000•.421-000 $59.06 ELEC°lTdlC rid. T+1w? 101-600.420.0004 PLUMBI NO FEE 101-000-419,000 $113.00 STRONG MOTION FEN - WID 101.000.241.000 $9.34 ORAADINQ ME 101-000.423-006 $15.00 DEVELOPER IMPACT FSS 52,405.00 PRECISE PLAN 101-000-441-343 $100.00 Sm-T0vkl,. Ct7wf al'C.", 01' f3N') PX" Cl;'f.E.rx $3,950.48 LEES FIZE-1'ATD FEW 4250.00 -741- TAL PF-RWr 14MUS 01191K0W 0 4.2003 CfT�° i c.'2A Ui7A RECEIPT' DATE BYE FI AGED INSPEC INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE TINSPECTOR 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 /N .O Compressor Insulation p 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 Pibg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines — — G 3 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection—Q'j Encapsulation Gas Piping Gas Test lzo Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVAL 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: 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 (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that 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 Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $2.14 X 1,578 S.F. or $3,376.92 have been paid for 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. Fees Paid By CC/Downey Savings & Loan - Lance Gibson Check No. 03610100554 Name on the check Telephone Funding Residential By Dr. Doris Wilson Superintendent Fee collecte Signature Payment Recd $3,376.92 So.00 Over/Under NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting > P X74 3 018 A RECORDING REQUESTED BY AND WHEN RECORDED MAIL TO r ,e Lance C. Gibson #5 Running H. irroo Palm Desert,Ca. 92260 to L —1 MAIL TAX STATEMENTS TO r � J DOC 0 2000-461124 11/17/2000 WON Fee:9.00 page I of 1 Recorded in Official Records County of Riverside Gary L. Oreo Assessor, County Clark & Recorder 11111111111111111 IN 11111111111111111111 gn me L J J DOC 0 2000-461124 11/17/2000 WON Fee:9.00 page I of 1 Recorded in Official Records County of Riverside Gary L. Oreo Assessor, County Clark & Recorder 11111111111111111 IN 11111111111111111111 gn MMM NUM MUM MMM �NNO MMOMMMm mna m .inimoe© CAT. NO. NN00880 Individual 0u tClalm Deed TO 1(722 CA 14--83i nib 'THIS IOgM FURNISHED aT TICOR TITLC INSu't1MS The undersigned grantor(s) declares). Documentary transfer tax is $ ( ) computed on full value of property conveyed, or ( ) computed on full value less value of bens 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 LANCE C. GIBSnN the following described real property in the LA QU I NTA County of RIVERSIDE , State of California: Real property, Lots 5,6, and17\of Block 283 Santa Carmelita at Vale'La Quinta, Unit 026, as per map in Book 20, page 50 of Maps, records of Riverside County California. Dated: nagiaet 9,19AA STATE OF CALIFORNIA COUNTY OF Riverside SS. On August. 23, 1988 before Inc. the undersigned, a Not;uy Pablie in and for said State, personally appeared Liddel. L. Kline "nally {mown 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 ne executed the same. WITNESS my hand and official seal. signet 1 as Gibson Kline OFFCKsk KELLY J. SOUND 1 110rNM PII811C • Gl/OANA PROOOR&0III'N Nl f r>r o001' doe fta ON 11. Lilo