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9705-029 (SFD)LICENSED CONTRACTOR DECLARATION iereby affirm under penalty of perjury that I am licensed under provisictns of .:,t �t,pter 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 610086 -B 1/31/`)9 mate �� 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 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: 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: 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, 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 700 of t e' Labor Code,4111 forthwith comply with those.provisions. Date:I Applicant U r -_ f L ` Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his, application. I 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta,.its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void_y--,' work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. ` I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upo the above-mentioned property for inspection purpo es. Signature (Owner/Agent) �f. �' / -•--(Date v - , • BUILDING PERMIT - PERMIT# C°NTR°`# 97054)29TRACT 5424 DATE VALUATION LOT S1010872.90187 2320,) 769 JOB SITE APN ADDRESS 44-3.15 VILI.lF:. A DIUVC 604 .1,74 01 OWNER CONTRACTOR/DESIGNER/ENGINEER M1' WD1 JOHNS01,1 4't,A:4':NUM t3 ATLG°G3• T INC 69115 RAMON RD 2607.11(ORiZCN RD C'A'114WR AL MY CA 92234 CATIJIsD:RAL CC'1'Y CA 92234 (766)&i4-7256 CB1,101 3296 USE OF PERMIT 51�1i %4) w P060T 00_!P .a WALLS o)i'.l'1J' 'i LU%,C R CONSTR.UC 1 i£N 1,9.31.00 S111,- i1o.l2e.1,1141!>,"0.103 �tS.lN1 f11 l4kWA019(:A1t1'0.k'r 8.00 S I;$`1111.a�:A'E1) C:ON dll+' (:'t3�'�"C1:1.I(.�1 tQ}V log.8-a.9!) CIONS 1'R 4111'It014 FIZ 101 -CIM -4118-000 5674.50 Pf,AAf'F'1((VK (�kt 1(li-fW-4, _3(i� V81!. IN11°r "ift, 4250:00 f41�s; i 1Afv1l t1i,1� iFl lij }..i�'i!i-=.�? 4.4Jt`!i3 q �E.5+3 (4.} C"lRICelf..4:EE' 101-000420-40) 1+1:�ti.yS Pf 9 tq,00N(> 1:L F: $1'!4 7! ";1 >€tC� htsa`(°tlLarr aE"r - 941 4t) 10 1 4XV -,b 11. - Wo 510.99 C ift.tit:.t l (JCa .t� l:ls" tit 1-Ih+it••/b�.�-t',Lf�ll ��+).CtO (tvl`��2A.�'I'i�'1ir'f`(.ilt!•iI�1E I?:'•i2fK)-�1�13-:3.�2 $'�'.�f;t3.r11 �°:. �� �• ° ra t tIt4.!'+..•r 4,.n+�l�t;.. t 11', 7, t PA f1i'�'=(YrALCt?NSl"lid.CT'lU.N%A.ND LAN(7,UtE.l�. 5-1,4�2.3s LESS PRE -PAID. FET -S' 4250,00 �_i US 0 2 1997 7'BfFAI.,:I'h,1t+41!-1:.' PIK,P',31 1)[131.N0W �S1,1f9'Z.JS in, OF Lir RECEIPT DATE : ABY J DATE FINALED INSPECTOR INSPECTION RECORD PW TOPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade V Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap 71 X F.A.U. FramingCompressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Al Drywall - Int. Lath Final Final 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 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 Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: 01Zl14� /Y Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Nottage Wiring Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final 41 Utility Notice (Perm) .a P.O.'BOX 1504 APPLICATION ONLY Building 78-105 CALLE ESTADO Address Act Al l n _ntar LA QUINTA, CALIFORNIA 92253 Owner Mn v- 4; .Tnhnc!^n BUILDING: TYPE CONST.- QVP.. Mailing OCC. GRP. . Address 69-115 Ramon Rd. #F1=530 A.P. Number inn_ 1'7n_n17 City Zip Tel. ra�ha�ra . �7'AA R _7 Legal Description r „a- m ; 11140 Contractor ` Project Description ,' Icl, P- TTAIi M PvP1 nn. _Int- . Tn1 •• �- ..,.. .,a _. City State Lic. a City & Classif. 610086– 3 1 1 Lic. # Arch., Engr., Designer rNr F _P ina ' -Address Tel. 9AAR7 Rwv 'i gtp,44 'A 2, City Zip State ., A Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 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._ 19 SIi I - DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: ,(Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter, 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 Ncense Law, Chapter 9 (commencing with Section 7000) of Division -3 of'the Business and Prof.•ssions 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 penalt,- of not more than five hundred dollars ($500). I-] 1, as owner of the property, or ny employees with wages as their sole compensation, will do the work, and the structure is mot 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 wso does such work himself or through his own employees, provided that such improvements'ae 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 imp'ove for the purpose of sale.) I l I, as owner of the property, an exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044,-E.rsiness and Professions Code: The Contractor's License Law does not apply to an owner of proerty who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's. License Law.) - i 7 1 am exempt under Sec. "- B. S P.C. for this reason Date Owner WORKEiB' 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. Cc-npany ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTWICATE OF EXEMPTION FROM WORKEiS' COMPENSATION INSURANCE (This section need not be complEed 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,manhtr so as to become subject ttS the Workers' Compensation Laws of California. Date �� % Owner�l,�.5.\..:. NOTICE ,TO APPLICANT: If, after making this Certificate of Exemption you should become subject to the Workers' Compe•sation 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 Zr��� ay\.. ic�++a�t`.H... _.T—L . I_, Ly Lender's Address_ a k..(-'`, fes.-.,,,+ �.. �k-/ftp This is a building permit wher. properly filled out, signed and validated, and is subject to expiration if work thereunder is sr:spended for 180 days. I certify that I have read this a.3plication 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 sof this city to enter the above-. mentioned property for.inspectio i purposes. Signature of applicant`�_�ii,, ;c�.r i-.w.j`tii\t;i�Date -1 Mailing Address '_ - 1= ��- City, State, Zip �iiti• ���_=�'�riS. C-�': ,Ll Gl a?�&l BUILDING DIVISION Sq. Ft. No. No. Dw. Size 1627 Stories 1 Units New © Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation { T 9 n n A .y . .� PERMIT AMOUNT Plan Chk. Dep. _ (� Plan Chk. Bal. Const. Mech. Electrical Plumbing .: 143s'ix y 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 Prope 4 A-013 FINAL DATE s INSPECTO Issued by: Date AdA V R Validated by: CITY OF Validation: An CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING*EES A.C. UNIT IST FL. SO. FT. @ $ 2ND FL. SQ. FT. @ POR. SQ. FT. @ GAR. SO. FT. @ CAR P. SQ. FT. WALL SO. FT. SQ. FT. ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING BONDING HEATING (ROUGH) NOTE: Not to be used as property tax valuation FORMS FLOOR DRAIN ROUGH WIRING MECHANICAL FEES ROCK STORAGE WATER SOFTENER GAS (ROUGH) VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) REINF, STEEL APPLIANCE DRYER TEMP. POLE GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED WATER HEATER LAUNDRYTRAY FINAL INSP. AIR HANDLING UNIT CFM BOND BEAM 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 SQ. FT. p c WATER HEATER FIRE ZONE ROOFING MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1 I c SEWAGE DISPOSAL SQ.FT.GAR @ 3/4c HOUSE SEWER GAR. FIREWALL 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 FINISH GRADING 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 APPJEQUIP. 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 SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC, FENCE FINAL GARDEN WALL FINAL IN5FL IUH'b WUNA 1 UMN1141 IALb Desert Sands Unified School District .� 82-879 Highway Ill ;Notice: Indio, CA 92201 . Document, Cannot Be Duplicated 619-775-3500 CERTIFICATE OF COMPLIANCE ' 5/30/97 Date . _ - APiv 504-174-017. No. 15582{ r Jurisdiction La Qumt'a „ 'Owner Name Marvin Johnson Permit # No: 44315 Street Villeta Dr. ; Log # City La Quinta zip 92253 Study Area 233 - Tract # Lot # Square Footage 1831; ` Type of Development Single Family Residence No. of Units 1 Comments At' the present time, the Desert Sands Unified School District does not collect.fees on garages/carports, covered 4 patios/walkways, residential additions under 500 square feet, detached accessorystructures 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 1.84 ' X 1,831 or $ 3,369.04 the property listed above and that building permits andlor Certificates of Occupancy for this square footage in this proposed project°may now be'issued Fees Paid By cc/Palm Desert National Bank/Johnson #44840 ` Telephone- 864 7256 Name on the check By Dr. Doris Wilson ; Superintendent R r. + _ Fee collected /exempted by Pauline Pearson Payment Received `" $3;369.04 Check No.* 71092 Signature AA OTICE: 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 )ove 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 illect them on the District('s)(s') behalf, whichever is earlier. r - `t N t l Collector: Attach a copy of county or city 'plan check application form to district copy for all waivers. rv: Embossed Original- Building Dept./Applican't Copy - Applicant/R_ eceipt Copy - Accounting' JUN -12-97 THU 12:08 PM PLATINUM: 760 864 7257. P. 02 1'7229'7 RECORDING R]EQvssrED BY RECEIVED FC RECORD AT 8:00 O'CLOCK r AND WHEN itCORAED MAIL TO: Marvin Johnson -MAY 16 1997 ' Mildred Johnson :P A i - '79526 DER IMUDA DUNES DR- pOc.Tiansi@ri81t BERMUDA DUNES, CA. 92201 FF%ANK K. JOHNSON ottuti«da.ceuety,CEPnna "- Riv. Co. Rewrdei pecoteer ' FeesS � q + Space Above This Line for Recorder's Use Only A.P.-N.: TRA #: d240.3_q- Older No.: R157175-1 Escrow.No.: 2-22742 GRANT DEED � r T#{B LJN9 itSIGN6D GRA AITOR(s} DPCI ARE(s) THAT DOCUMENTARY TRANSFERTRX IS: COUN 2 45' _ computed on full value of property conveyed, or �- computed on full value less value of liens or encumbrances remaining at time of sale, unincorporated area; ( City of La Quinta. ,-and r, - FOR A VALUABLE CONSIDE1tATION, Receipt of whicb is hereby acknowledged; f James E. Hayes and Tina Hayes co -Trustees of the Hayes Family Trust -dated 10/19/90 hereby GRANT(S) to Marvin /D. o inso�a and Mildreti ,•Johnson,, 'Husband and Wife as Joint Tenants the following described property in the City of La Quint:a, County of Riverside State of California.; ' )C+ot 182 of Tract 23269 as shown by map on file in boob 205, pages 86 to 94 of Maps, Records of Riverside County, l California . 4 • James E. Hayes and Tina Hayes j co -Trustees of the Hayes Family Trust j dated 10/19/90 By. acmes . Hayes, t stee i.. Tina Hayes, trus 1. Document Date: April 10. 1997 ' STATECOUNTY OF CAL 11?O r {l � .)� i , COUNTX OF ) '. On — ( — before me ttuz_ personally appeared personally known to me (or o d to nae on the basis of satsfacwry evidence) to be die pexson(s) Nvbose name(s) islats subscrib to the within. Mstzument and acknowledged [o me cbac a/she/dray executed rhe samo ua ltiaRter/their authorised capaciry(ies) and that Aislher/their signatures) on the iasttument the person(s) or Me entity upon behalf of which the person(s) acted, executed the ionsuutnent. ' WITN � my hand and offici 1, seal• , . *cwnftam 0129M Notary PJAG iCae►ontto _ 1 . area foraAftw 1►iscal. MV C"Mn a Erb 12. 201• F` : ' Mail Tax Statements to: SAME AS ABOVE or `Address.Noted Below. p m O r D m m Z o-4 D r pm mY cn m Z OO '*� r y 2 7o O m m r X y M p -0 r 3 cac.) -I -i Y cn mn O O :v � mO X m 2 M O r Z a Z n moo Z m c�Z O� D C N co O O m m p m n 0 n N 2 C 3 y p Tom a M m = C Z Z n m C nD Y a 7o cn cn Z D > m M -; O r D Z q Z -i d -1 D Z O0 Z cn r Z D G m Z C m n O r -i D D .4 __ m -i O O Z O 3 m O — n 7o Z r r O Z O 7o C O -ri m D G z O Mcn _v Z D D r O 70 D O~ m G� Z .� r l r � Y- C ' > a L N rn n '1/ z m ;r a F� 'In -pl z �n . 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