9801-062 (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
Professionals Code, and my License is in full force and effect.
License # Lic. Class,,,,. Exp. Date
�.q r
/Date Signature of Contractor a
OWNER -BUILDER DECLARATION
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).
( ) I, 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.
(j() 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.
(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,
1 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 provisionsiof Section 3700 ofrthe'La6or
Code, I hall forth,w''th'comply with those provisloWs»
('Date: Applicant IV V/
Warning: Failure to secure Workers' Compensation coverage is nlawful 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 isnot 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 authorizelrepresentatives of this City to enter upon
the' above-mentioned property for inspectiion purposes. /
/Signature (Owner/Ag nt) /- Date`
BPERMiT#
BUILDING PERMIT
°°NTR°`#
5►�t1 A-tti>x
DATE 3113198 VALUATION S401,653.60 LOT 29 TRACT � '�. 39 4 9
JOB SITE
ADDRESS. 79485 U110
APN
!i►nl-� ,
OWNER
CONTRACTOR/DESIGNER/ENGINEER
JOE
RANCHO CA IS" !RAMC DEVE1,C)PNIMMIf'
P.O. 60IN 14424
19CM COUfV'`f'ii.Y C LU.t' DR #201
PIVLM f31 SEPIT CA !T2255
fat N13S
CA. 92201
('�Ci0j3�5.77�c�4
C'13x.ft !t),.)
USE OF PERMIT
SF1)
:T -D - fdUMT ,DOE NOT iNt;;`i M4,; .t`�;!.00K WALLS OR POOL.
4,7S 6. 00 *,
P0JkC.HfF1A,,TJ,0
�3A1tJ1Cfi%t,r1:1t!�i)k'k° 933:{)(1 .`t�
L W lf.Gk9�.z"3tM,i.4,.1'a�l s�V.F-ii.4:.19#iiY"4ii1:�0. Pio'.t�t�
� �9i�.i.�ll:•.3.�lil
..,
C0NS`i'.RVC'I'fQN;i EX,- 101.000418-0W 51,695.E
Pflhllf CHF(IlK F ERHI WA -000-439-319 191,3175,1i
1"S:.t: 1r�ITOS`T .1011400-439-518 -St 00.00
1MM'1U1(.;AL F): !t)1 0U(1.42U-(}t2U $284.12
C"
1,11AMNO1_1F6 a014x)0-09 0 $244.50
S'rfiUNl113 MOT I"REBID 10I.-110 -741-ice &10,17
GRAD INC F23
1NFRXSTRUrCjVU, 9,NFt? 22?4M-443„342 Sb,twix)
Q
A7F r 1N NUBY tC-PL.K ,S, - RE 1r r 01 -M0.-25.5-100 S7 _11-;.13
1 V
St S-'?7TAZ; Ct);wtiliUC:I`ttN:)f 9 P. CIC
1.1`SS .I��tE-PAW FFI S
-'GI,t)UO.t;ii
:1't3 t".AL '✓k::It1MWt' . 1?. + 5 : r'! 1 , Nt fi t✓S9,,i:t
.57
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
g
Ducts
Slab Grade
G �fj�
Return Air
Steel
ombustion Air
Roof Deck
�_
Exhaust Fans
O.K to Wrap
– _��j
F.A.U.
Framing
�E
Compressor
Insulation
_
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath�,
_
Drywall - Int. Lath
{�$�
2w. I T e S
7 y— Q,' Ate
Final
Final
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
Waste Lines
_���
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_
��_! • //
Eocepsulation
Gas Piping .
Gas Test
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
t
,
l
.
Final
Utility Notice (Perm)
/ b - O��/ . W
�,
JON TANDY
Op m
8Q/�® 8 R��� 3580 Condalia Ave.
Yucca Valley, CA 92284
,SPECIAL INSPECTION 8,q,
4�� 7, (760) 365-5045
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF❑
INSPECTION
PERFORMED
REINFORCED CONCRETE TRUCT. STEEL ASSEMBLY ❑ S
❑ POST TENSIONED CONCRETE 70ASPHALTTHER s
O REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCATION L- V t'
�j
REPORT SEQUENCE NO.
TVP S URE p �n _
IW, /N VJ!/ ,1 (_
PERMIT N0. '
D E' n
(�
DAY OF WEEK
MATERIApDES�PTC � "1
IICCTIT1
ARCHITECT
INSPECTOR
—j"m c4
HRS. CHARGED
.`
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION GENERAL If ,_
DATE CONTRACTOR 44&. 6(p'-s7v4 'i a CONTRACTOR . S • (e��✓J c o
o•. dzAqGc 4 TOP
4DN W PGT, ts� L A TE- S (b -ecl_ s
t/ -S ' `b-S-
�-f ,
L'oe4-✓o Let
COPY SENT TO CLIEN
CONTINUED ON NEXT PAGE ❑
PAGE OF
CERTIFICATION OF COMPLIANC
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
�SIGNAT7 v REGIST ED INIMA-ECT) -I
DATEJJaaOF REPORT REGISTER NUMB) -ER 7
•
Building{
Address
Owner— y j
Mailing _
Addressy_
City .
�
/' A I J r—
i^
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
/--:IN C, 11 ),tib' - >, ,;L' v f? -S
State Lic! City J
& Classif. S 9 ._ Lic. #
Arch., Engr., / / ` t�
Designer MR ( ti t %7`' 2- (f j
Address Tel.
Ci�typ^'; Zips `� / / State
��' ��oC CJ ('3 Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I,amliicerised under provisions of Chapter 9 ,commencing with Section
7000) of Division 3 of`the Busi9ass and Pro. assigns Co/de, and�rtlyli�ce}n's'e'i's� in full force and
effect. (� 1 f/�iiY ► /—dl��.
ZGNATU1l P / / / v= DAT
OWNER•BUIL'DER DECLARATION 1
I hereby 'affirm that I am exempt from thepContractofs Licens1w for the following
' reason: (Sec. 7031.5.Susiness and Profession`s 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 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 thathe 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., 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 L completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpgse of sale.) :... • - .r,. ka
1'1 1, as owner of the property, am exclusively cont'racting 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 coniracts for
such projects with a contractor -s) licensed pursuant to the Contractor's License Law.)
17 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 Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
n 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 ($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. r
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 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.
1 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
o(�
APPLICATION ONLY
rte.
BUILDING: TYPE'CONST. / OCC. GRP. j
A:P. Number
Legal Description /-i -74 `(4C71 r
_
Project Description
Sq. Ft. No. No. Dw.
_Size Stories Units
New ❑ S Add ❑ Alter ❑ Repair ❑ Demolition ❑
DA
ZONE:
BY:
Estimated Valuation
LA
PERMIT
911MOUNT
Plan Chk. Dep.
1�16/
Plan Chk. Bal'.?
Const.
Mech.
INSPECTOR
Electrical*
Date Permit
Plumbing
r
S.M.I.
Validation:
Grading
Driveway Enc.
Infrastructure
r�
k
TOTAL
REMARKS
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:
I 1
c
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 3/5/98
No. 16694 Jurisdiction
Owner NameJohn and Pat Walser
No. 78-885 Street, Lima
City La Quinta zip 92253
Tract #
Lot #
Type of Development Single Family Residence
Comments
esi entia - ranat ere
APN # 769-590-021
La Quinta
Permit #
Log #
Study Area
Square Footage 1
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:
ti 1~ w
EXEMPTION NOT APPLICABLE �^^
This certifies that school facility fees imposed pursuant to Government Code 53080 ih, the amount of
i
628.00 X 1 or $ 628.00 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/1 st Bank/Rob Capetz Telephone
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Rosita Jones Payment Received $628.00
Check No. 040641
Signature _
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
�� ~��,�:�: - ; a•.t 452598
iiE Ma PEO i:: •, , . ;: S:I�:s ^QI•(�an; N� FOa RECORD
::ai' AI 5:00 aC�K
AND WHEN RECOQDEO. MAIL TO, 0 199
DEC 1
Joe Walser, Jr./Patricia Walser Ox. I b
P.O. Box 14425 Rj0°RI~
PALM .DESERT, CA. 92255 Riv. Co. I'^Co:cer
,„m rA� Tori gra usEorwrr ... � • ,
ASSESSOR'S vARi.EGNQ: 769-590-0?2 The undersigned Grantor(s) declare($) that the DOCUMENTTAANSFER
TAX IS:
r'�
TfPi�"rDER'1Qir� * ; aY'•
ESCROW NO.: 1 7299-004 M computed on the full value of the interest of property coriveyed, of..
computed on the full value less the value of liens of encumbrance9:
GRANT DIED --
remaining r�ttax OrthOf�0wi season:. :'
FOR A VAWASLE CONSIDERATION, receipt of which Is hereby acknowledged.
'A 'Jimmie Austin, trustee of the Jimmie Austin 1982 Trust dated May 21; 1982, as`.
restated.November 4,.-1995 -
`. hereby.GRANT(S) to
Joseph Walser. jr. and Paericia Walser, Musbaad and Wife, as Joint•Tenants Wi.tb.:right of
Ma Vi vorehip :
all that real property situated In the Ci W of La Quin ca
.1111;
: Country of Riverside , State of California, described as:. �..1.
LOT Z9 .OF TRACT NO• 24890.. AS SHOWN ON A MAP FILED SN HOOK 218, PAGES .1 TiIItOt7CN 1
ZXCLUSZvr op MISCELLANEOUS MAPS, RECORDS OF RZVERSZDE COEWT, CALIFORNIA
COMPLETE LEGAL DESCRIPTION ATTACHED HERETO AND MADE APART HEREO'
BY THIS REFERENCE
1Dated November 25.'1997
O=CLAHO•yA _ f • s.•nmfe Anstin, tzs�seee
STATE OF�fiQ4lAlC
COUNTY OP SEMINOT���
c ember r ._ be!o a
r me Rnnria
.t7n Dp_ r �• fix.:•^ e: �,.,`:,.:`ji.F Wit.
{
-Hill , Notary Public, personally appeared
I Jimmie Austin
personally known. to me (or proved to me on the basis of
:. �� �.;):,�,^ •,;
satisfactory evidenCe) to be the person(s) whose name(s)
O • ' '
,
IS/am subscribed t0 the within instrument and .acknowledged
J : "'," O " '•
to me that he/sbgpoy. executed the same In his/he�+eir
-
_ r::a c::y r:r.
: 0 l -t fl n d' °:
authorized capaCiry(IvQ. and that by his/her{tfteir stgnature(s)
behalf of
_ .
Y '
ons or the entity upon
on. the instrument the pars (). tY P
.. ) .,• c`i � j , . p
j.
whleh the per=n(s) acted Quacuted t instrument.
�'r ``
WITNESS my hand nd oHlc se
•
Sionatuie
Mt" &MI
MAIL TAX STATE O:
SAME AS ABOVE- --
AOO��CnC
r,Y}Y, 87A7F • 20'
��
The Citrus Course Homeowners Association
March 4, 1998
Rancho Capistrano .
Attention: Rob Capetz
P. 0. Box 980
La Quinta, CA 92253
Re: The Citrus Course Homeowners Association
Lot 29—Walser
Dear Mr. Capetz:
The Architectural Committee for The Citrus Course Homeowners Association is
writing to advise you that they have completed their review of the plans for the
construction of the residence at the above referenced lot.
The plans have been approved as submitted. A stamped approved copy of the
plans submitted for this job is available for you to pick up at the Professional
Community Management office in Palm Desert.
Thank you for your submittal,
Sincerely;
FOR THE ARCHITECTURAL COMMITTEE
John Peterson
Community Manager
C: File
Managing Agent: Professional Community Management, lnc.
23726 Bincher Drive • Lake Forest, California 92630 • (800) 369-7260
It