0307-207 (SFD)LICENSED CONTRACTOR DECLARATION
Iterebyaffirm 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. r
"license # Lic. Class Exp. Date
745922 B��'1C,,P-•--� .;-'�---��i"3L��'��.
Date' t ki ° Signature of Conntra� -'
OWNER -BUILDER DECLARATION M -
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)...,,.
( ) -- l_as owner of the'.property, am exclusively contracting with licensed
contractors to 'construct the project (Sec: 7044;•,Business & Professionals
Code): f ..--_
O I am exempt under Section - .,-B&•P.C7T6? th19-reason 1 +
Date P, 1. ? �1" d Signatre of�wner
WORKER'S COMPTION•DECLARATION'�f
I hereby affirm under penalty of perjury one of the- following declarations:
O 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:
Cairier STA'!' `PU14D Policy No. Ims- 03, 11
(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-prou sii ons~-' - /)
Date: cel - e1 S ' - i Applicant
Warning: Failure to secure Workers Compensation-c8ve rage 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'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 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 authorize"representatives bf , is City to enter •upon
the above mentioned property for inspection purposes.
Signature (Owner/Agent) ""_ _ Date �)�" �il)
BUILDING PERMIT' PERMIT# -
�SJfii?(J r
DATE OTj TRACT
1 28034
1 - rVALUATION Val, 03 f0
_
JOB SITE
ADDRESS 6�• -V"fnr,LA! .. '�
APN
OWNER :+CONTRACTOR
DESIGNER EN (NEER
PTFI RIE Lr1,rat
CA�aasiBi �nosl4Ao"s c
' 39559trM�M`�T)R
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8�10*D10 BLVD. -MT D18.
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8NLQ CA 92201
't
(160)342.11'33 0 -But 5,392 ;
1,A.
USE OF PERMIT
' 6?37 3F St GL r"?ANOL Y }3iib;'L''LL- W1. Rl?1d.AAf'f OOVS VOT MCIAJI E,
P001A, PAMIAICKNVAT.13 6R DRIVEWAY APPROAC"K'200 1. 00,
. TACT CICY ?67TRUCTION.. i 47s 1Jt3,.V'� .9
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LvARPLOrWCAEiP.Ok3 A l rz.00 8P
or, CONSU:RMTbtIM
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1'1��t�t`:i' �+".i%1"L �€il1/,I�tll;�1.4�'�
•
CONSTRUM1014 MIS 1011MO-41&000 $3,01.00
,
x?IkdCJk:r;iK_101-000-4-39-3181c
FEE Di POSIT. 101-000-439-318 •S1,zS�.flt9
16TECHANIGAI, F. $150.00
ELECTRICAL PRE" 8333.117
Pl.t? fJ l0 FX F, lo -00"19-000
' STIZONO N10 IG'.F ;»'1 Z, - :F f; 31V 101-000-24 1.000 $40
L'3f3J2dC; ?-V& $1569
..
DEVELOPUR IMRAC".T r' >s �� s
PRMSE, PLAN 101-000-441-345
A.�'I 114 PUBLIC PLACES RNli 2-7Gati00-M4S-0®C
S�.�Xb^SI.:Ii.t'TL� OMIL I.TUJ.4O .HN31) V`J...AsLVAA 5...1.7.Ui4rr
11"Ess TYPE. 1� ln`b �n
\ �U,J3lf.'.S•4
\`n,250.0D
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FINAEIN.
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fix: _,,..:--"' ;`;
• y, 9
RECEIPT
DATE "
BY /,/
DTE FI f.E�- INSPE R
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
oh
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
% o
Compressor
Insulation
B - //• o S
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 APPROVALS
POOLS -SPAS
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
Waste Lines
Gas Test
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
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVAL
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
Utility Notice (Perm)
COMMENTS:
Coaa'a.ala- Valley Unified School District
This Box For District Use Only, ,
P.O. Box 847, Thermal, CA 92274 DEVELOPER FEES PAID
(760) 398-5909—Tax (760) 398-1224 AREA: AMOUNT
LEVELONEAMOUNT: LEVEL TWO AMOUNT: MITIGATION AMOUNT:. COMM/IND. AMOUNT:
• DATE: RECEEPi' CHECK H; MITIALS:
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name: Pierre ' Letel l i er Date: January 5. 2004
Owner's Name: Pierre Letel 1 i er Phone No.
Project Address: 80 -830 -Vista Lazo. a Qui nta, CA 92253
Project Description: new residence
APN: 762-260-023 Tract #: Lot #'s: 23
Type of Development: Residential XXX Commercial Industrial
Total Square Feet of Building Area: 6,738 sq. ft.
Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement .
under penalty of perjury and further represents that he/she is authorized to sign on behalf of the owner/developer.
Dated: O `' o s 5ignatiA e. r
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code Gov. Code Project Agreement Existing,
17620 65995 Approval Prior to 1/1/87
Note:
Number of Sq.Ft. 6,738
Amount per Sq.Ft. $ ' 2.19:,
Amount Collected $ 14,756.22
Building Permit Application Completed: Yes/No
Not Subject to Fee
Requirement ,
By. are M. Carlson
Asst. Supt., Business Serv. '
Certificate issued by: E1yi ra- Mattson : ` Signature:
Office Technician
NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND -STATEMENT OF FEES
Section 66020 of the Government Code asserted. by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a written notice to
the project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period'to protest the imposition of
these Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall
serve to advise you that the 90 -day protest period. in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of
any other requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether
payable at.this time or in whole or in part prior to issuance of a Certificate of Occupancy: As in the latter, the 90 days starts on the date hereof. This
Certificate of Compliance is valid for thirty (30) days from the date of issuance. Extension will be.granted only Cor good cause, as determined by the School
District,.and up to three (3) such extensions may be granted. At such time as this Certificate expires, if a building permit has not been issued for the project
that is the subject of this Certificate, the owner will be reimbursed all fees chat were paid to obtain this Certificate of Compliance.
MV:c/mydocs/devfees/certificate of compliance 09/30/02
� r
RECORDING REQUESTED BY
AND WHEN RECORDED MAIL THIS DEED AND. UNLESS OTHERWISE
SHOWN BELOW. MAIL TAX STATEMENT TO.
Name Pierre L'etellier
street 81101 Indio Blvd. Ste D18
A#`rmindio, CA 92201 .
City a
State
Zip
Title Order RO.R150964-3 F$cmw Na 21724
CTC 1-101 (8-93)
Grant Deed
THIS DEED IS BEING RECORDED TO CORRECT
THE UNDERSIGNED GF,AN'TOR(s) DECLARE(s) -
DOCUMENTARY TRANSFER TAX IS $ —0-
❑ unincorporated area XN - City of La .0uinta
Parcel No. 762-250-023-3
0 computed on Aill value of intent or property cottveycd, or
❑ computed on full value Icss value of liens or emumbrances remaining at -time of sale, and
FOR A VALUABLE CONSIDERATION, receipt of which is _hereby acknowledged,
John J. Cogian, Jr.. -as Trustee of. The'John J. Gogian Jr. Revocable Trust of
hereby GRANTS) to 1983 dated April -1.8, 1983.
Pierre.Letellier and Kathryn Letellier, as trustees of The Letellier:Family
Trust dated.April 11, 2000
the following described real property in the City of La Quinta. -
county of Riverside , state of California:.
Lot 23 of Tract: No: 28034 According to Map recorded"in Book 258
Pages 69 and 70 inclusive of Maps; in'.the Office of*the County Recorder of
Riverside, California, more -completely described as per Exhibit "A" attached
hereto and made' a part hereof by this reference. --,-
Dated August 25, 2003 John J. Gogian Jr. Revocable Trust
of 1983jed 4/18/83
STATE OF CALIFORNIA
COUNTY OF Riverside
8/25/03 betwe me,
On n J: ian .Jr Trustee
Ruth A. Furst - �s
a Notary Public In and for said County and State, personally appeared
e e ne, Attorney in Fact Ni
�Personally known to me QjK
to be the person(s) whose nanWs) Islam subscribed to the
within instrument and acknowledged to me that bels executed
the same In Mstherltholr aufhksized 'Vies). and th hisl ddieir
signature(s) on the Instrument i pe n(s), or th mi i behalf
of which the person(s) ex the i ern.
WITNESS my ha=QW7seal i . 1
Signature 1.' 14
2:�f' 1 -
MAIL TAX STATEMENTS TO PARTY
Attorney in Fact
^+VIII A rt IRST
' r
• FR. Ew.
.2O0g
(rolls area for official notodw seal
OWN ON FOL[ OWING LRC; IF NO PARTY SHOWN, MAIL AS DIRECTED ABOVE
F
r PARCEL II;
LOE 123 of Tract No. 28034 according to Map recorded in Book 258
Pages 62 AND 70 inclusive of Maps in the Office of said County Recorder of
California.
RESE MVING THMMMOM. easements set forth in the Declaration, of. Covenimts;
Conditions and Restrictions and Easements for South Valley Estates ("Declaration")
recorded in the Office of said County Recorder of California on JtrN>r 18. 1996
as Insrtnment No. 225089 AND THE nUT 40MMM, RECORDED JULY ,
INSTRi1IATNT NO: 276970 BOTS OF•OFF C CORDS.
P &CEL 2
A non-exclusive easements appurtenant to Parcel l above, on and over the "Common
Area"
as defined in the Declarkion for access, use, occupancy, enjoyment, ingress and egress of
the amenities located thereon. The Common Area is for the use of Owners of Lots which aria
subject to the Declarationand is not for the use of tinegeneral public.
AR L3;
One Cl ass A membership in SOUTH VALLEY GROUP, .INC,, a California
Nonprofit Mutual Benefit Corporation., ('Association").
Grantees in accepting this deed and the conveyance hereunder do hereby
and severally, :for the benefit of Grantor and for the benefit of the Association nd each, ]annd
all members of the Association that Grantees will promptly. My and Mull
mply with
the Declaration, the Bylaws' and the Governing Documents prescribed by the �
ociallion
Grantee:j hereby agree, jointly and severally, promptly to pay in full any dues, fees or
assessment levi�M by the Association.
The obligations of Grantees herein set forth shall be c-Oveiwnts running with the
above-described.! property, it being umferstood that said membership in the Association and
the obligations thereof will automatically pass t6 Grantees, successors in title in the
above-described property whether such succ=ors acquire tide by foreclosure or othezwise, .
and shall be binding upon the Grantees above, named, th* jam, devisees
administrators. successors and asci - • executors,
title shah be bound b the foregoing provided: � -Gtan� � their said successors is
y regoing covenants only as long as they, reVe�v�,, own title to
the above-described property.