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0006-247 (SFD)LICENSED CONTRACTOR DECLARATION I heret_y affirm under penalty of perjury that I am licensed under 'provisions of Ch -rter 9/(6omrriericing with Section 7000) of Division 3 of the. Business and .,Pq :19.' -st,onals Code, and my License is in full force and'6ffect. w` cense # _ Lic. Class Exp. Date B MCI \Date Signature of Contractor OWNER-BUILDER,DECLARATION ` I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law,for.the following reason: ( ) I, as-ownerIof 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).. • • '• NI) 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••�: -fpr this, reason Date Signature of .Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty 'of perjury one of the following declarations: O 1• have and will maintain a certificate of. consent to self -insure for workers'- compensation, as provided' for by Section 3700-ot'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., 16 13519 (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 forthwithcomply with -those -provisions:: Date:' -'Applicant ' [''°"i4-d� Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100000, 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 fore 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 applicator agrees to, & shall, indemnify & hold harmless the City of La.Qulnta, 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 per to cance'llatiori: I certify that I_have,read this application and state that the above information'is correct. l agree to comply with allCity, and State laws relating to the. building construction, and hereby authorize *representatives of this City to enter upon the above-mentioned property for inspectiompurposes. tP f�,t° .Date.,i s. s1 Signature (Owner/Agent) . � +"., t BUILDING PERMIT PERMIT# DATE VALUATION . , LOT.. O .16,27 TRACT •� f 1s��V. JOB SITE APN ,. ADDRESS SA OWNER CONTRACTOR / DESIGNER / ENGINEER 1011� . T T( 1. J. T V1 I-AY".s..aOR 018)9}91.6783 ICIA1.4 6347 ' USE O�F+PERMIT �=� : tI-PEk.KIT,i) DES NOT.TN(.Gt: DZ'tTF=K'bi.AUZ T,;!t i2f3&T/,d:WA.Y APPROA-CH TRP, :T CONS'dRUC'T10N OF PO1R-CHMA r!9 SIP. 0A%2A<:4M PORT (S` ) 1 S9fl.t+0 ESM.IT ,9`8?.iD COST OF C(D:9ar, ,I"4•,17130.N CONSIT-1 1"'TXN YZE, 101-000418-000 51,;06.00 PLAN CHEzfz FEEP $976A6 FER,DIPOSI:f :' i(7iaiJOQ '. 3R .x$710100 - tViE.GC3�r�;f+31(�,A,L,;f+'t?tir , �•t�'1->tlt�t-�.1,.LtCC �4i�.:k0' _ F:' x'C'['124C`•mi .5� '. • ..... (3'1:rl ;la4�fJ�0 if $I INI STRONG MOTION .FEEv. R9121D.. 101.000-2,41••13 2i eJP_A., )Da4t' loan'' 10) -0007423-00.0,'.7, $1i?.OLI. DFIVELtyM IMP.f►,OT'Mi ART IN F'i.ETif. C Y• d�•��C'r.�- {V yv�'+�'{' /�/`yy �'yTT(- (�q,�(' (�4,_i�i , r7 (��,� /� �(�/�'�{p 6ilJA.�'"~L.L1'TAL+• 1..rVd�� ,.LLIJVA�.4\J'�:tW 3'J171��1,,.+c����1.sCN�,!R�b1�-r7j.1S?hptt(IYLq..q� i E.'.r.�.S14 . PAIS �y,�]iS .99 DEC 05-2000 -olT �� �(4+OYr<�► • td, 17. RECEIPT DATEk BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR ' BUILDING APPROVALS MECHANICAL APPROVALS ,Set Backs _ _ Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Z _ _ Exhaust Fans 0. K. to Wrap - F.A.U. Framing _/ Compressor Insulation _ _9 O% _ Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath - Final GIS c� o Final �j ��, �( 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 I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines � Neater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection /Z Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) _ ELECTRICAL APPROVALS ,�� e,—,� 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 ,v j Final Utility Notice (Perm) 4yR.,v.�.��.X1�Yer'A�O '�•�7.0 .�/ -- T•'•TL `y{'r-Ri�•1'Y� N ? �1.!P"'P'�.�'��Vi-�.F�M'�r?t`rd�Si-1 ii f a � �i r•' riV 7 / G^ P.O. BOX 1504 APPL ATIO ONLY Building78-495 CALLE TAMPICO ` Addres�� CSI Wo>s r�$1� LA QUINTA, CALIFORNIA 92253 Owner -1©RN fin+. LANG Address %314 5.1 POI N CI/aNA ?t. City Zip Tel. I'AU,, DESC nr q a Utz) 760. A40. ASS 6 Contractor KEN R I VER S V Address Zip _ I Tel.. State Lic. P 00 Z,5 City & Classif. 7 Lic. n Arch., Engr., Designer C' t Address Tel. CityI Zip I State I Lic. q LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section effect 7000) of Division 3 of the Business and Professions Code, and my license is in full force and . . SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that'I am exempt from'the Contractor's License Law for the following reason: (Sec. 7031.5,Susiness and .Professions 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 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: 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.) b< 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.) 17 1 am exempt under Sec. B. & P.C. for this reason e r� Date G'ZI' 00 Owner /` l�—p., �1U • Qwt.� 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 ma oas to become subject to the Workers' Compensation Laws of California. r� Date !7 `Z _"'1 Owner < °`C^ W , � C—% NOTICE TO APPLICANT., If, a er making this Cerbficatehof 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 ILDING: TYPE'CONST. OCC. GRP Number I. ar -1410 TnACT ZG 1. Z I Description ` mt Description W'1- 615 MON-CES-S4\ L.A444x L f.\ Q L%I WTA ctkiii: Sia.-aS, - Sq. Ft. No. ' size 3S 5O Stories New Add ❑ Alter ❑ valuation PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure No. Dw. Units Repair ❑ Demolition ❑ 300, oao.— AMOUNT 57-�_�0 ti. 3 f TOTAL I 0 REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback -rom Rear Prop. Line Side Street Setback from Center Line Side Setback tom 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 r Notice:' y La Quinta, CA 92253 - Document Cannot Be Duplicated 760-771-8515 *; - w CERTIFICATE OF COMPLIANCE Date .11/13/00 - APN 4 . 643-120-012 No. 21197^R k _ •Jurisdiction La Qui -ata. .�'•- Owner NameJohn Lang �• Permit #, No, 47-615 Street Via Montessa Log'# -' City La Quints Zip 92253 _ Study Area r` Tract # 26152 ", Lot # 240 Square Footage 3550, x Type of Development Single "Family Residence No. of Units 1 i 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 exempffrom paying school fees at this time due 6 the following reason: EXEMPTION NOT I APPLICABLE This certifies that school facility fees imposed pursuant to . Government Code 53080 T in the amount of 2.05 X 3,550 or $ 7,277.50 the property listed above and that building-, permits and/or Certificates of Occupancy for this square footage in,this proposed project may new be issued Fees Paid By CC / Downey Savings / John Lang ;- Teti�phnne 77-16013-40-2551& Name on the check By Dr. Doris Wilson 'V A - ' Superintendent k.�5�r1 f •� Fee collected /exempted by Annette Barlow. Payment Received $7,277.50 �. /J w Check No. ` 03610066276 Signature • = ^- r. NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90day approval period in which you ma:.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 Districto) 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 RECORD�XNG REQUESTED BY AND WHEN RECORDED MAIL TO: John W. Lang and Eugena M. Lang 4637 Westchester Drive Woodland Hills, CA 91364 i DOC N 2:000-119 . 0,0S 03/31/2000.08:004 Fee:19.00 Page 1 of 2 Doc T Tax Paid Recorded in Offlcial Records ( County of Riverside °t � Gary L. Orso Assessor, Courty Clerk & Recorder III VIII IIII IIII M .POOR NOCOR SMF "Sc. SLFDA COPY LONG REFUND NCHG ExAM A.Y.N.: TRA #: Ur.)- { Order N GRANT DEED THE UNDERSIGNED GRANTOR(s) DECLARE(s) THAT DOCUMENTARY TRANSFER TAX IS: COUNTY $131.50 [ X ] computed on full value of property conveyed, or [ ] computed on full value less value of liens or encumbrances remaining at time of sale, iKP [ j unincorporated area; [ X ] City of La Quinta , and FOR AVALUABLE CONSIDERATION, Receipt of which is hereby acknowledged, Vanette R. Fontenette & Delain'J. Yearout-Kemper, Trustees of the D.V. Trust of Sept. 24, 1996 N hereby GRANTS) to John W. Lang and Eugena M. Lang, Trustees of the John W. and Eugena_ M. Lang Trust dated 7/22/88 - f - the following described property in the City of La Quinta, County of Riverside State of California; j' See Exhibit "A" attached hereto and made a part hereof. Vanette R. Fontenette & Delain J. Yearout-Kemper, Trustees of;the D.V. Trust of Sept. 24,.1996 By: 1A JO Vanette R. Fontenette, Trustee Delain J. Yearout-Kemper, Truste Document Date: -March 2, 2000 STATE OF kAsstrmurvs( )SS ` COUNTY OF IC.�LQ1G ) Al On p before me, ��A/217L S/4LE i personally appearedr*ALTrl` :2VM#j&TTC •tr UE1_a+y'f/IF I�pKT JCEA1�>ir 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 authorized ca aci ies and that b his( still g re(s) p CYC ) Y �P14h�1� itl ngtpre s on the instrument the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument.GaR�U• ��J �9•,�� " WITNESS my hand and official seal.•r�\SSIQN'•,• yC) ,. :C Signature Y h10T;g9 me • .o _ L- CnS This Ar !9 NoYAhj ng ll,vCal. J 'WASHING Mail Tax Statements to: SAME AS ABOVE or Address Noted. Below