9806-146 (SFD)f �J
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
425381 13
9a"te Signature of Contractor
OWNER -BUILDER DECLARATION
7/31/9
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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, 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:
Carrier Policy No.
;;;t'r1`f'1.., fJi ..1i S2ittj° i}
(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.
Date: - 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 above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
46
S-".469.60DATE VALUATION LOT TRACT
-:� CI. �y
11IeT� I 1 S
JOB SITE' 4 — ` t APN
ADDRESS 51-555 EISE�lt�.�►W � R OR 773434 013
OWNER CONTRACTOR / DESIGNER / ENGINEER
DANID ROSS MILLER. PACIFIC'T`PAD'GS (_',% S1` UC°1' ON
1719 S TREMONT' 1719 S'1't2.i MONT
S OCE ANSIDE CA 92054 S OCEAN S1IN CA 92054
(7W)9r.,7-00(,9 C.BL# 1955
USE OF PERMIT
SPO
Sr"D -1 ERRM T DA.,S NOT :div T VUE IA..C''e!;`K WALLS OR POOLE PAM
1111 3 1 1000
C;ft,►ieWIYCAii.I'OXF I 523^00 SF
6 I="I`. WCK7.tJ FENIC;1? 200.(0 1,17
y � 3
I . a INI ATTIO COST OV CONSTRUCTION
PIKR iW .V ,%, SIS C1i9:t`!'1.'A'RY
C 0'WTYR t!i;'.T'IOK I-'FLI
10 t-00041 84'100
$599
$505. 505.
f)
wII'C117�i!�
•
� 1Fr-3471µJ43)
t(j! !ii1
".F�Wt{��/tn/,
;7
..lN
'.(�ft'.\1ice`.+
t{�ASl€Y.'�iIf1fA4�:_F�Ilt
"
tt;1Et1i
i01.-C3(1)_42S3-"
a133
RLIUMOW; FIRE
101-0-4:119-000
$127$9
Rsif.1]F
tdb4
nai•4
Is a.tyr, +2) .;111F
!IL
.'�'71
t.Atlr,!t.r�i'FleVf.�
S20
�>>tAin
�)
.t
itE43
225 W-44 342
$1,1917
MIdX1SC I'll, AN
IM -000-44I345:
$25
`i'•
'��4F`\��lnF.i�
kti�lA''c'
FFii'l\.*YF
101-000-139•318
.1125)
S(,.f1V T ("MAI:, CONST'RUCMON AND PIAN CHECK
LESS PRE. -PAID FEES
LA 0Ul6VTA
$3,463 J 1
4250,90
'i't)'t'.AL PE.4iNr'11' 7+ EES DII E fQOW I 53,213.71..
RECEIPT I DATE I BY
INSPECTOR
INSPECTION RECORD
OPERATION
I DATE
I INSPECTOR
OPERATION
I DATE
I INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 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 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. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation 3
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole j01
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)
COMME TS:
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
Date 7/31/98
No. 17438
APN # 773-134-013
Jurisdiction La Quinta
Owner NameDavid Ross Miller
No. 51-555 Street Eisenhower Dr.
City La Quinta zip 92253
Tract # .
Type of Development
Comments
Lot #
Single Family Residence
Permit #
Log #
Study Area
Square Footage 1446
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
1.93 X 1,446 or $ 2,790.78 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/David Miller Tel -epnone
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Ellen Patino Payment Received
Check No. 055803
Signature V �`
VOTICE: 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
tilled them on the Distrid('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
k;,
P7
JUL.14_1998 1:53PM COMMONWEALTH
RECORDING R9QUESTED BYt
OLD REPUBLIC TITLE COMPACOMPANY
WHEN RECORDED XAIL THIS DEED AND,
UNLESS OTHERWISE SHOWN BELOW,
MAIL TAX STATEBM=S TO.-
DAVID
O:
DAVID ROSS MILLER
1719 S. Fremont
S. Oceanside, CA 92054
GRANT DEED
NO. 374 P.1/2
FOR RECORDER'S USE
APN: 773-134-013
The undersigned grantor(0) declare(s).-
Documentary transfer t4x is $.00
(XXX) Computed on full value of property conveyed, or
(...) Computed on full value leas liens and encumbrances. remaining at time of sale.
( ) Unincorporated area: ( ) City of , and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
WILLIAM THOMAS BUFFIN, AN UNMARRIED MAN
hereby GRANTS) to
DAVID ROSS MILLER, A MARRIED MAN AS HIS SOLE AND SEPARATE PROPERTX
the real property in the City of LA QUINTA, County of Riverside, State of California,
described as:
LOT 1, BLOCK 115, SANTA CARMELITA AT VALE LA QUINTA, ONIT NO. 12„ AS
SHOWN BY MAP ON FILE IN BOOK 181 PAGE 79 OF MAPS, RECORDS OF RIVERSIDE COUNTX
CALIFORNIA
Dated May 14, 1998
State of California
County of Riverside-
On June 1. 1998
before me, Kelly C011jer'-
, personally appeared
willimn 0=2 'Ruf f1:4
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 executed the same in
his/her/their authofixed capacity(ies), and
that by his/her/th r signature(s) on the
instrument the pe on(s)or the entity upon
behalf of wh1ch pe o (s) acted, executed
the instrument.,
WITNESS �� T -Y -.)16n/ N' ffi ' al seal.
Signatu
MAIL TAX 1`A T0: DAVID ROSS MILLER
SAS AS ABOVE
KELLY COWER jh
NOTARY A 18LC 57�A
Rkmkla Comb
Q
M/ Conan, qhs Mq 29,19M "A
(This area for official notarial seal)