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9510-026 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm 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. 441979 BI 4130196 License # Lic. Class Expo D Date 10...o -'"r `i SignatureofContractor Tr'����✓✓ OWNER -BUILDER DECLARATION I hereby affirm 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). ( ) 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 „; l rayn Policy No. I j-14-0.) (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 application agrees to, & shall, indemnify & hold harmless the City of Indian Wells, its officers, agents and employees/ 2. Any permit issued as a result of this application becomes nulland vold/f work is not commenced within 180 days from date of issuance of s,u0 permit, or cessation of work for 180 days will subject permit to cancel) 19n• I certify that I have read this application and state that the above informa�j9.n s correct. I agree to comply with all City, and State laws relating to the b�il ,� i construction, and hereby authorize representatives of this City to enter upon til above-mentioned property for inspection purposes. j Signature (Owner/Agent � c +---- Date �t o A`c# BUILDING PERMIT PERMITS r ai Cimi_fiifD DATE 1()/M)/4'!' VALUATION $171,253.1% LOT�,�? TRACT 2()156 JOB SITE ADDRESS 47-235 ViiiRAVFANNA APN 64X146-1903 OWNER CONTRACTOR MICHAEL BBRCr1N CONST1 IATIRON LEE AND D ANNIE GLA:SKE - '77.1851 CALL E M01,TfHREY 47-295 VTA RAVENNA LA Qi11t CA CA 92253 LAQUINTE1 CA 92253 ('60)%4-:177 r'13.1.# W1 DESIGNERIENGINEER 301- N WALLING 45-190 CLUB T)R. . 's USE OF PERMITjuviax,FAMILY DWELLING pva re,.x ry Cyd-. - ro.. rk q.,.a..a Pernut, does ;'lust .include lil wk well far 1x0,1. FEE DESCRIPTION FEES TRACT CONSTRUCTION 2835.00 SF P0RCk{ PXt'I.0 1€ 8.00 SF ' GAR:AGEICARPORT 7.56.00 18F CST11* L I i3 COS 1, Of C©NST;WCULOIN .171,2_153.50 P, EP RAl1.1' L' fl,% 81Jf11ib`LARY' FFE DEPOSIT -$250X* PLAN CHECt;. P1M 101.0004.19.3.18 S^54.89 CONI-21iRU r7OINFEE 101-000-4.111-000 $891.50 WXHANICAL FEE 101.000-421.000 $vt3.10 F.LEt:.TPJCA1, FEE 1.01-000-420-000 $194.35 PLUMBING FEE 101-000-419-000 S 1'; 7.00 $TONG MOTION n0:- RE So 100-00'l;-2 d -000 $17.13 t3RADfNG FFF 101-000421-000 $24).00 Al+dtiT ASTRU tUREF E 225-000-4.43-342 $3,797.06 PRECISE PLAN 101-000441-345 $715.00 ART IN PI.JDI..IC PLACES - RESIC '701 -0()0.2.55 -OW $178.15 SUS -TOTAL CON5TRUC17ION AND PLAN CHECK $6,153.55 LESS PRE -PAID .HEIN S `►� -$25().00 1 './ TOTAL !T101IT FE%5 DI6J1+, NOtiV $5,9ti3.Sf3 1995 TQ'I*AL 1''RO,3;t+,C''14' IPI+.RM;;T FECS b,1�3»at► RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION j DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs /A# Underground Ducts Forms & Footings // Ducts Slab Grade Return Air Steel / Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing 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 Final Final BLOCKWALL APPROVA S POOLS - SPAS steel Set Backs Electric Bond Footings / Main Drain Bond Beam Aplfroval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines p 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 Gas Piping Gas Test Appliances Final 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 Final / 6 Utility Notice (Perm) COMMENTS: / 44 O. BOX 1504 APPLICATION ONLY Y Building 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner (j //�� /_ 1 EF_ +-0 I .4 lin �' �'iA S KE BUILDING: TYPE CONST. OCC. GRP. Mailing n Address ¢ g _ l/¢0,14- f S Z Q2 a_ (o cf 3 -/00 - 00a> - % � S A.P. Number City Zip Tel. ZA ��t y 4,+ 9�� S� Legal Description -aT` 1 F'i�/ �C T�✓aC'r aZ% Contractor ` f . Project Description Y r . 0" c+i' ( l/ ' F+ iA ✓ AL Al /� Address City Zip ° Tel. x 'a a w...x"� ZZS'S State Lic. City 1% 2 G & Classif. 4'4- � Cr �q � Lic. # Sz a t. p� O 3 � Stories Units Arch., Engr., Designer �-� (,�� l� ` �A New Add ❑ Alter ❑ Repair ❑ Demolition ❑ Addre sTel. o 360 -ba5'C City 1, Zip State _VNG41+ l s �(® Lic. # Fss LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Sect on 7000) of Division 3 of t e,BusL ess and Professions Code, and my license is in full force and effect. q - 30 - 9 5 - SIGNATURE v DATE r - OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the followitag Estimated Valuation t reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, atter, 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 PERMIT AMOUNT the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of 1 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 pernft Plan Chk. Dep. ,�,f subjects the applicant to a civil penalty of not more than five hundred dollars ($500). (__1 I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness a.rd Const. Professions Code: The Contractor's License Law does not apply to an owner of property w.eo builds or improves thereon and who does such work himself or through his own employees, Mech. provided that such improvements are not intended or offered for sale. If, however, the buildi.eg or improvement is sold within one year of completion, the owner -builder will have the burden Electrical of proving that he did not build or improve for the purpose of sale.) L 1 I, as' owner of the property, am exclusively contracting with licensed contractors to crn- Plumbing struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License L. -.w does not apply to an owner of property who builds or improves thereon, and who contracts or S.M.I. such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading 1-1 1 am exempt under Sec. B. & P.C. for this reason Driveway Enc. Date Owner Infrastructure 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 r] Copy is filed with the city. O Certified copy is hereby furnished. 1 TOTAL , o 1 CERTIFICATE OF EXEMPTION FROM REMARKS 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 t�/rb,e/c9',- subject to the Workers' Compensaton y Laws of California. _ n� 1 Date Q -Owner NOTICE TO APPLICANT: If, after -making this�Certificate of E emption you should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forfh4th Minimum Setback Distances: with such provisions or this permit shall be deemed revoked. Front Setback from Ce Rear Setback from a Top. e + - CONSTRUCTION LENDING AGENCY Side Street Setba� m C e ' I hereby affirm that there is a construction lending agency for the performance of We work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback f� PrOq fty Llnel Lender's Name Z • 1 C Lender's Address .!� v ' •r I This is a dre:buildingFINAL DATE .%1NSPECTO permit when properly filled 0 days. and validated, and is subject o expiration if work thereunder is suspended for 180 da s. ,/ I certify that I have read this application and state that the above information is correct. Issued by: Date Per I agree to comply with all city and county ordinances and state laws relating to buildirg n �" construction, and hereby authorize representatives -of this city to enter the abovd tJ mentioned property for inspection purposes. Validated by: Signature of applicant Date Mailing Address Validation: City, Stale, Zip BUILDING DIVISION CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. @ $ 2ND FL. SO. FT, d POR. SO. FT. @ GAR. SO, FT. CAR P. SO. FT. WALL SO. FT. ted SO. FT. ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEOUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEM/PERM 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 ® 1V. c SEWAGE DISPOSAL SO.FT.GAR @ 3/ac HOUSE SEWER REMARKS: VENTILATION 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 SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL, AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP, FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE L SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL marecr Vn a WUNR I uneWIm I iAw GARDEN WALL FINAL DESERT SANDS UNIFIED SCHOOL DISTRICT 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be Duplicated 619-775-3500 Date 110/25/951 Type of Permit I La Quinta No. 113814 1 Permit # Owner Name Lee & Diane Glaske Log No. 47295 Street Via Ravenna City La Quinta Zip 92253 Study Area 123 APN # 643-100-003 Tract # 126152 J Lot # 182 Square Footage 12835 Type of Development Single Family Residence I No. of units 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 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 1.72 x 2 835 or $ 4,876.20 have been paid to D.S.U.S.D. 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 Michael Bergin Construction Telefihnne 564-31,77 Name on the check <_- 7, By Dolores A. Ballesteros ;; u Superintendent Lam. Fee collected /exempted by Pauline Pearson � Payment Received Signature PA , LAA I i'O, A tZ yy $4,876.20 Check No. 1058 Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting SENT BY:Xerox Telecopier 7020 ; 9-27-95 ; 9:22 ; 6197739289- 619 564 5204;8 1 1- - .:l aLaw t e0. AND wfrnrt IMCORoRD MAML TO: L. Lee Glaske Diane 0. Glaske 48-114 Calle Serann la Quints, CA 92253 A.P.N.: TRA /: D?oa 643-100-003-2 COPYof Document Recorded 9..-�%... S~as No. 3 .14..... on ....9..... �Qared �vi'h anginal. Hzs not be n con RIVERSIDE COU;V" nor -CORDER Spw Abon Thu Lin for Rmoader's Use 0* Order No.: 353966.20 Escrow No.: 2-18977 GRANT DEED Iiia UNDMIGNED GRANTOR(s) DSC.ARE(s) THAT DOCUMIMARY TRANSFER TAX IS: COUNTY 5154.00 (x 1 computed on full value of pro orry txmvey�, or tmb' unideorpo� area; { i Cityoff ': dme o• e.�r, FOR A VALUABLE CONSIDERATION, Receipt of which is hereby st;,lato+avledged, Larry L. Chun and Peony E. Chrism, who Acquired t tte as Porgy IL Patter, Haeband-and Wife u Joint 'tenants hereby GRANTS) to L. Lee Glask and Diane G. Gtasire, Husband and Wife as Joirt Tam the following described property in the City of LA Qainta, County of Riven'ahieftbef California; LEGAL DESCRIPTION IS ATTACHED EMM Larry *-77- -777. au .1 tt Pinny E. STATE OF CALIFORNIA ),SS COUNTY Og Riverside ) On Sept. 12, 1995 before m Cheryl Sue Brown pyaPP" Larry L. azen an Penny . azar: pm=Uy brows to me (or proved to me on the bait of Udshcrosy evidcm) to be ILC peri) whou =moo) Wats wbae &W to the within Waftsom= trod AdmowMgW to me that hc/ahe/they exec the acme in hir/La/dtett capscMios) Ind Ibu by bWba/tbdr ds nur(s) on the intaumew ft person(,) or dw eudty upon baWspf which the person($) atxod, exeeuad the tammaeat. WrrN&" moo S• er a Drokw 'this sten► fon oRkW tmtsds, rust. -------- f CHERYL SUE BROWN t'X1MM.1097J84 s� �� Notatin PubNc — CaiHomto RIVERSIDE COUNTY Connor. Espies$ APA 22.1497 I Mail Tax Statements to: SAME AS ABOVE or Address Noted Below SENT BY:Xerox Telecopier 7020 ; 9-27-95 ; 9:23 ; 6197739289-+ 619 564 5204;# 2 IOt 18Z of Tooct 26152, In tie catty of Lai OAntm, Qm%ty of ltive>rsirde, State .cf as dmm by Mq 00 file iA 800k 227, Pages 77 ftmugh 85, of MVV it the OWoe Of tha County Ae000cdw of said County and mtunded by ResauUm NO, 91-108 xeo rft MnTh 26, 1992, es L%tnnMt No. 105176, of Officid R,Im do. th=eftom au cil, gas and otim hydrocerJ= substances lye within and 1AXler that: P=Lm of =14 land, lying kalr7W a depth of 500 feet, maamm-ed vertically f= the aisfam of seid.land, with= howmer any right to enter upas the snrfaoe of mid, lad or. irnt o that pot tjm f the mftwfaoe f, lying baUm a depth of 500 feet, mee=md vactically fzam said Mafaae, as zesatved in the Deed z+e=rded Feb ru=y 17, 1993, of Official Reooxds. Fa=el 2: A no,oo2lneive easement far irk; egram, use and enjMment cf the - -n - am Including arW mnm— area =wood to the ; (as defined in the Decla=aticn zmO=ded Novel 27, 1992, as. Dent Nb. 415112, of Official records. . i6 yi •.nwr • . ' l.a1y _•nr^�ti+Tl�tR•'.� "•: i'ra,Q •. .. . ,