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003412 (SFD)P.O. BOX 1504 No . 003412 412 Building 78-105 CALLE ESTADO Address 53-345 Fise!*Vwx LA QUINTA, CALIFORNIA 92253 Mailing Address 247 E. r9albTaitZ Iftiv 02 City Zip Tel. -ftlm SPzIngs. 32262 322-1020 Contractor Address State Lic. City & Classif. 387934 Lic. # 895 Arch., Engr.; Designer Address Tel. City Zip State 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. t ' SIGNATURE `w•""" 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, alter, 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 Processions 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 five hundred dollars ($500). ^ ' . ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale: (Sec. 7044; Buisness and . Professions Code: The Contractor's License Law does not apply to an' owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are ,not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will'have the burden of proving that he did not build or improve for the purpose of sale.) O I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code:. The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) O.1 am exempt under Sec. B. & P.C. for this reason Date Owner BUILDING: TYPE CONST: OCC. GRP. A.P. Number 774—O$&" 018 Legal Description 121_,4-1v P Project Description SiMlFs FaMi14I DWeJJ4 z WORKERS' COMPENSATION DECLARATION I hereby affirm that I 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 ❑ Copy is filed.wilh the city. O Certified copy is hereby furnished. _ TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS r 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 thg work for which this permit is issued, I shall not , tR G cx / Ad. 311*) f , , 4e0_( employ any person in any manner so as to become subject to the Workers' Compensation d�..'-�(.:),; I fV M Ill- 1 11- a ' 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 I I 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 properly 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 sof this city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address ' City, Slate, Zip 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 9/2AIR7 Permit Validated by: Validation: HARD COPY T- Sq. Ft. 1529 Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT r AMOUNT Plan Chk. Dep. , tlf1! Plan Chk. Bal. Fr t p Const.' Mech. Electrical '77.17 Plumbing S.M.I. r Ga Grading n on Driveway Enc. 74 O>B Infrastructure I'SRP 07 WORKERS' COMPENSATION DECLARATION I hereby affirm that I 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 ❑ Copy is filed.wilh the city. O Certified copy is hereby furnished. _ TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS r 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 thg work for which this permit is issued, I shall not , tR G cx / Ad. 311*) f , , 4e0_( employ any person in any manner so as to become subject to the Workers' Compensation d�..'-�(.:),; I fV M Ill- 1 11- a ' 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 I I 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 properly 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 sof this city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address ' City, Slate, Zip 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 9/2AIR7 Permit Validated by: Validation: HARD COPY T- CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS �6SLAB GRACDEIG• �' ROUGH PLU ONDING 6.. T YARD SPKLR SYSTEM 2ND FL. S0. FT. ® FORMS SEW R C ANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR SO FT @ GAS (ROUGH) METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) EMP. POLE/ ;L DRAINAGE PIPING CAR P. S0. FT. ® GROUT I WALL SO. Ff. FINAL INSP. DRINKING FOUNTAIN SO. FT. @ WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ _ $ WATER PIPING NOTE: Not to be used as property tax valuation FRAMING// -d I/, �n FLOOR DRAIN MECHANICAL FEES e WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM IKITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE,TEMIPERM 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 ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/4c HOUSE SEWER 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 ETBACK / _ `/, V� b ROUND PLUMBIN S G UNDERGROUND A.C. UNIT COLL. AREA �6SLAB GRACDEIG• �' ROUGH PLU ONDING 6.. T HEATING (ROUGH) STORAGE TANK FORMS SEW R C ANK ROUGH WIRING DUCT WORK ROCK STORAGE ,/4OUND. REINF.�_� GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEDUIP. 0'/2-'REINF. STEEL 16 - GAS (FINAL) EMP. POLE/ ;L GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ _ $ LUMBER GR. FINAL INSP. FRAMING// -d I/, �n FINAL INSP. OFING // �U. e REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS, GARDEN WALL FINAL HtCORDING I toutSl ED 011 AND WIMIL NI ii ICOAD T 1 AU lint KED AND IINLEU 81NENWIst %MOWN {FLOW Name COACHELLA VALLEY LAND CO. ATTN: TOM STAR street Address 732 WILLIAMS ROAD City A PALM SPRINGS 5"" CA. 92262 MAIL Name 5ueel Address SAME AS ABOVE city a State —71111,104111090 EsceoW No. 20 7 7 6 6PB SPACE ABOVE THIS LINE FOR RECORDER'S usF 11GRANT DEED f THE UNDERSIGNED GRANTORS) DECLARE(S) DOCUMENTARY TRANSFER TAX is $ 17.60 J§ computed on full value of property conveyed, or 0 computed on full value less value of liens or encumbrances remaining at time of sale. 9 unincorporated area 0 city of AND FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, PHONSINE THORBURN, WHO ACQUIRED TITLE AS PHONSINE THORNBURN IS hereby GRANT(s) to COACHELLA VALLEY LAND COMPANY, A CALIFORNIA LIMITED PARTNERSHIP the following described real property in the Count of RIVERSIDE State of California: LOTS 6�AND 7, BLOCK 210 OF SANTA CARMELITA AT VALE LA QUINTA, UNIT 20, AS P MAP RECORDED IN BOOK 19, PAGE 38 OF MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA. Dated July 21, 1987 STATE OF CALIFORNIA COUNTY OF Ilk SS. Onthis—dayof j4%jAk�� in the year 19111, before me. the underst ns�ed. a Nary Public in and for said State, personally appeared -1�otJSi1►JE TO�yRitJ personally known to me (or proved to me on the basis of satisfactory evidence) to be the person_ whose name C, subscribed to the within instrument, and acknowledged to me that he_ executed it. WITNESS my hand and official seal. a Signature OTARY PUBLIC IN AND FOR SAID STATE 3�' -PHONS INE TW6—RtURN _ OFFICIAL SEAL LIONEL PETERS �G l NOTARY PUBLIC - CALIFORNIA LOS 0CLLES COUNTY f".y comm. e>:pire JAN 21. 1989 (11115 area for official notarial seal) co -.t (4/85) MAIL TAX STATEMENTS AS DIRECTED ABOVE.