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9807-029 (SFD)LICENSED CONTRACTOR DECLARATION 1'h6reby 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 a d effect.- License # Lic. Class Exp. Date ate 9:Signature of Contractor OWNER -BUILDER DEGLARATION I hereby affirm under penalty of perjury 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 Policy No. ; . 1K I'D CENTURY 1M. C �tlAti -ui-^wry (This section need not be completed if the permit valuation is for $100.00 or less). O I certify that in the performance of the ork for which this permit is issued, I shall not employ any person in any ma er so as to become subject to the workers' compensation laws of Californ' and agree that if I should become Subject to the workers' compensation i visions of Section 3700 of the Labor Code, I shall forthwith comply with tho or visions. ,,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. fi 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 1,8,xr0 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 a ity; and State laws relating to the building construction, and hereby autho representatives of this City to enter upon the above-mentioned property o inspection purses. ;Signature (Owner/Agent) e PERMIT# CONTROL# BUILDING PERMIT DATE 9, 098 VALUATION S,319,9 61C.iD0 LOT TRACT {1, `� i . 18122 JOB SITE ADDRESS 131171 V.I. A.Lrt6ZO APN OWNER CONTR^AC1eT.O8R/.Dr+ESSII•G�tNERt�/��EtNTGIIvNEYE/R��7 rrp� 1 pp p, y )) g�77 r(/"''ttqq �� 'yy{• K NArc M. & iV!fi114Y E CORN C�1,1, . �, HCl&M 4.ONS RUl.,i't4 N P.O,-BOX 214�� 78-070 CI LLE i;MX LA QU.Ii+ EA CA 92253 LA Q P—NI 1A. CA. 9225:1 (760)564.45.12 01- Ltr 0261 USE OF PERMIT 1.14G1„~ FAMILY DWIRLLFN4 SFO- P.rAV I DO S ?+It,7:C >7�'CLUnE.�3T OC"`t4 "tAr1 LLS (�R.e'+at3L TRACT ONSTReTCTION 5,180,00 sp FO#2GEi81Xf10 1,500.00 4 CsARAGMARPORT 956.00 OF S,A;r '�.wesy le�Q.E� A.�J �:{•D .�4 ai�1�.n'J �al� •. Ji..+yf'c�r.t.ib0.a �r�r ,�rp,i,Ailq!�.]i��8i�"k�3.',a �y p` �g. FEE .¢95:.9.ed "U AI'.Rw.tS� �9iJ.NINIlr'�.l� V f;0N5',CRUC".MIN }SLE 1014)G0• -410 -OW $,t;40.50 P4.,A-W CHECKFFE.; 101.000.419.318 $!,18109 s C 1"lyCaN.t'f 101-000-•439.3.18 4750.00 Nri-C11A1V C;A•LFE'E' iGU-ai l-iX tt62,50 E4,ECTRICAL FEE W1,000.4204M i,y2 $311,1101N.0 NKO Et�,t'V �'E - IW!,,11) 1,0,1400 4.9.1.400 Gliilt3af`Yu 101-000.42.3-0170 Sti�.Ot; W RAS RUC.' AR FEF, 4.113.1t, AR [' sT+' ,P1 RA-JC-F%,A 1 701-QOt1-255-OW $549-90 PAID 8{1,a4 _ _' '0NFrR"L "IT��7N I�NI)1':LA C 113:x'1; $911-90-66SEP 0 LESS PRF-rWDF,,EES 750.00 r+• J$. ®F Lk Q�,� 6AiC\IWRIt 9 kI.C!eXriS �7��tla Now RECEIPT DATE BY A DATE FINALED INS - PECTOR 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 _ (j —pj (,L/ Exhaust Fans OX to Wrap F.A.U. Framing J Compressor Insulation c Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath L - Drywall - Int. Lath • Final Final /U 2 _ POOLS - SPAS BLOCKWALL APPROVALS Steel TEL Set Backs Electric Bond Footings. Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Z Underground Plbg. Test A_- 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 r Connection A46r Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: %� d__ 6.q T c J /d G f q 0 --e �eQ ..� S Final /U - - Utility Notice (Gas) ( j t 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 /• _ t4tifitr Notice (Perm) Qf— �� ��. � w—•,+.. T -'t,. _� u ,�+,.•.r, �.r'�. � i'°tr�.+!c:olt7�i�rr ,t. ,ipwKwv+r-r w � v �r ; ._.---�j?y -..— .,,� . _... � ��,tr� „�,y,>�„'Mv+..�r+(,�,,.�.w,ix� P.O. BOX 1504 APPLICATION ONLY Building. 78-495 CALLE TAMPICO Address i i♦'iir'Th ! d 9 A LA QUINTA, CALIFORNIA 92253 MailiTfg4=_/Y r r -or ,­ J — --. . - _ Address ,� vAW City Zip Tel. (766) State Lic. I City & Classif. Lic. # Address ' a "1 UE NSE LC/9 Lic. n_ E2 44 r ONT W RATION '- 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. 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,z alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to rile 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 thealleged 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). 1] I, as owner of the property, or my employees with wages as their sole compensation, will dq)fie work, and the structure is not intended or offered for sale. (Sec. 7044, Bulsness and Pr74fessions Code: The Contractor's License Law does not apply to an owner of property who ,Dullds 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 lhafhe did not build or improve for the purpose of sale.) , 1'1 1, 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 doesnot 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.) 1-1 1 am exempt under Sec. B. 8 P.C. for this reason Date .Owner n n ! rl _G+yy A IA' r C Y WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certihce 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. O 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 thg 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. Date Owner NOTICE TO APPLICANT., d, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith complywith such provisions or this permit shall be deemed revoked. i 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. I 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 a0plicant Date Mailing Address City, State, Zip /,- TYPE'CONST. OCC. GRP A.P. Number..�����.,�.•r�'°'. Legal Description r Project Description kiVIOG AfLEA ` Ft. No. No. Dw. Size ..f, �Q'11 Stories Units New ❑ , Add ❑ Alter ❑ Repair ❑ Demolition ❑ Infrastructure 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 IINSPECTOR Issued by: Date Permit s Validated by: h_9 Y 4 Validation: JUL if WHITE = FINANCE YELLOW =APPLICANT PINK= BUILDING DIVISSI ITy Es4iinattdd�Valtiation PERMIT AMOUNT Plan Chk. Dep. tp Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure 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 IINSPECTOR Issued by: Date Permit s Validated by: h_9 Y 4 Validation: JUL if WHITE = FINANCE YELLOW =APPLICANT PINK= BUILDING DIVISSI ITy (1 i ' 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 0 Date 9/1/98 ( _ APN # 761-540-015-5 No.. 17630 Jurisdiction , La Quinta Owner NameKent & Mary Cornell Permit # No. 80-821 Street Vista Lazo ' Log # City La Quinta Zip 92253 Study -Area Tract # Lot # Square Footage 5180 Type of Development Single Family Residence r No. of Units 1 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 niobilehomes. 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 5,180 or $ 9,997.40 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 B CC/Valle Independent Bank - M Cornell ' Y Y pY Telephone X64 1366 Name on the check By ,Dr: Doris WilsonJJ` Superintendent c. Fee collected./exempted by Ellen Patino Payment Received Check No. 166364 1 Signature 40TICE: 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 ;oiled 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 f ' i y 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 niobilehomes. 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 5,180 or $ 9,997.40 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 B CC/Valle Independent Bank - M Cornell ' Y Y pY Telephone X64 1366 Name on the check By ,Dr: Doris WilsonJJ` Superintendent c. Fee collected./exempted by Ellen Patino Payment Received Check No. 166364 1 Signature 40TICE: 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 ;oiled 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 FtECE1VED FOREC RO `�..' :.. .1 .. AT 8.00 O'CLOCK ,.. . CIA RECORDING REQUESTEL b Y x MAY -1199 7 ORANGE COAST TITLE COMPANY P A 1.0 F x Doo, Tmnsfer Tax. WHEN RECORDED MAIL T0. RANK K. JOHN60N P-.. and Mary E. Cornell Riv CO"peCOrd@t' , Kent M. , OX 244 XF:est_� La. Quinta, t;A.. 92253 X ' �- D Dls" `WOW 73. GRANT DEED (PlannedDevelopment) re Documentary transfer tax is $ s_ conve ed or computed on full value of property y . 1 computed on full value less. value of liens .and encumbrances remaining at time of sale. t s C_ ity of La Quinta. or „(; ). unincorporated area.' OR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, 983 F Jr: Revocable Trust of and • JOHN J.. GOGLAN, JR., as Trustee of the John J. Gog1 'a E, Cornell, husband to •Kent'M. Cornell 'and Mary dated April ,18, 1983 hereby grants,("Grantees") the following and wife as Joint Tenants rypf Riverside, State of a described real property situated in the Ci of LQuinta, County California. r PARCEL 1 r 15 f of Tract No. 28034 according to Map recorded in Book 25,8 ot _ " Pages 69 AND 70' inclusive of Maps in the Office Lof said County Recorder of California. ti RESERVING_ THEREFROM, easements set forth in the DeclarDaeC arationof � ) Conditions and Restrictions anenancs, d Easements for South Valley Estates NE 18 1996 recorded in the fice of said County'Recorder of California on Of as Instrument No. 225089 AND THERST AMENDMENT, RECORDED JUL INSTRUMENT NO. 276970 BOTH OF QFFT CIALPARCEL 2 fsive easements`,appurtenant to Parcel 1 above, on and over the " Common Area " A non exclund egress of as defined in the Declaration for access, use, occupancy,' enjoyment; n Area is for the e ousf Owners-ofof Lots which are the amenities located thereon. The Commo subject to,the Declaration and -is not -for -the use of the general public. [02/14/95]