9806-009 (SFD)LICENSED CONTRACTOR DECLARATION
C I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
iV W Professionals Code, and my License is in full force and effect.
O t'o License # Lic, Class Exp. Date
W J/
oZ ti Date . Signature of Contractor -
CD 1
CO O � f f
J U � OWNER -BUILDER DECLARATION
W WW I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z_ ( ) 1, 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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
cY) () I am exempt under Section , B&P..C. for this reason
LO
O C\JN Date Signature of Owner
rn
Q WORKER'S COMPENSATION DECLARATION
p 2E Z I hereby affirm under penalty of perjury one of the following declarations:
r � O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
Om J Q performance of the work for which this permit is issued.
Q C) (.) I have and will maintain workers' compensation insurance, as required by
O LO Q Section 3700 of the Labor Code, for the performance of the work for which this
rn permit is issued: My workers' compensation insurance carrier & policy no. are:
't Z Carrier Policy No.
�0
J(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 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 of this City to enter upon
the above -mentioned property for inspection purposes.
Signature (Owner/Agent),., Date
BUILDING PERMIT PERMIT#
'�1RtH►-UIN1
DATE V',LUATION LOT I I TRACT I �.• -
I i ,_
JOB SITE ��_ r� ,
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
�,z i is Lam: l'rl Fk 'i SN' DR
51111+:S..+I,L li_l�`ify l'A, altH!`
USE OF PERMIT
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NOV 20 1900 f t , 1 ,%1 - I';•'I mif 1''VC-S IN 1, No %,
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION DATE INSPECTOR
BUILDING APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
O.K. to Wrap
Framing
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
Drvwall - Int. Lath
nal
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U,
Compressor
Vents
Grills
Fans & Controls
Condensate Lines
Final
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
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
Final
Appliances
COMMENTS:
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
Utility Notice (Perm)
Notice:
Document Cannot Be Duplicated
Date 11/19/98
No. 18017
Owner NameJOhn P. Dyck
No. 53-475
City La Quinta
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Street Avenida Velasco
Tract # B227, U21 Lot # 11, 12
Type of Development Single Family Residence
Comments
APN # 774-085-011/12
Jurisdiction La Quinta
Permit #
Log #
Zip 92253 Study Area
Square Footage 1,977
No. of Units 1
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
1.93 X 1,977 or $ 3,815.61 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project ir_ay now be issiwd
Fees Paid By CC/Wells Fargo Bank/Richard L Swalve Telephone 771-5452
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green
Signature i/l ai ' Z"_
Payment Received $3,815.61
Check No. 0503005122
NDTTCE Pursuant of Ass bly 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 fro 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
caller! them on the pistrict 's)ls'} 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
IIL-6
i ter,
40' �1� 78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 - (760) 777-7000
F'f aF� FAX (760) 777-7101
TDD (760) 777-1227
December 8, 1998
Mr. & Mrs. John P. Dyck
81-620 Avenue 49, #84
Indio, CA 92201
Dear Mr. & Mrs Dyck:
Please be advised of an address change for the following structure. The structure
formerly addressed as 53-475 Avenida Velasco, APN: 774-085-011 & -012, Lots 11 &
12, Block 227, Santa Carmelita at Vale La Quinta, Unit #21, the construction of which
building permit #9806-009 was issued, will now be addressed as 53-480 Avenida
Velasco.
Please note this change and contact me directly at (760) 777-7012 if I may be of further
assistance.
Thank you -
Sincerely,
Greg Butler
Counter Technician
BUILDING & SAFETY DEPARTMENT
MAILING -ADDRESS - P.O. BOX 1504 - LA OUINTA, CALIFORNIA 92253
RECORDING REQUESTED BY
AND WHEN RECORDED MAIL THIS DEED AND UNLESS OTHERWISE SHOWN
BELOW MAIL TAX STATEMENT TO:
Name
-dohn P.
Dyck
Street
81-620
Avenue 49 #84
Address
Indio,
Ca: 92201
City a
State
L
MAIL TAX STATEMENTS TO
Name
John P.
Dydk.
Street
81-620
Avenue 49 #84
Address
Indio,
CA 92201
City &
state
L
1`95023
RECEIVED FOR RECORD
AT 8:0❑ AM
MAY 15 1998
54"ded In Olilald Ram
mom
of RlvQndda
Recoldef 1
Fees S
�
`✓
SPACE ABOVE THIS LINE FOR RECORDER'S ust
GRANT DEED
THE UNDERSIGNED GRANTOR(S) DECLARE(S) i
DOCUMENTARY TRANSFER TAX is -0- '
❑ computed on full value of property -co tleyed, or
❑ computed on full valueless value of liens or encumbrances remaining at time of sale.
❑ unincorporated area ❑ city of La Quinta , AND
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
JOHN P. DYCK and VIVIAN E. DYCK, husband and wife, hereby GRANT to JOHN P. DYCK
and VIVIAN E.
-- DreaFproet'etcofhO totolofRrse,btlproperty in the Lauina; the
following
of California
the following described real property in the
County of Riverside , State of California:
Lots 11 and 12, block 227 of Santa Carmelita at Vale La Quinta, Unit 21 as per
map recorded in Book 20 page 22 of Maps, in the office of County Recorder of
Riverside County, California. ell,
This deed reflects parcel Merger No 98-333
as approved by the City of La Quinta.
APN 774 085-011
APN 774 085-012
C
S1
CI
Oi
be
aF
m
❑ proved to me on the basis of satisfactory evidence
to be the person whose name is subscribed to this instrument, and acknowl-
edged to me that he (she or they) executed it.
�. ��.'ea�1���ON
Commission = 1 1 fi 360 Z
` No -cry Pudic - Cal'`ornia
rivers ud C:,�'-.'y
My Cap', rn, "vJ- v 1.02001
Sign
PUBLIC IN AND FOR SAID STATE
(This area for official notarial seal)
T-Z17 MAIL TAX STATEMENTS AS DIRECTED ABOVE.
195023
EXHIBIT B
CERTIFICATE OF PARCEL MEAGER NO, s_
APPROVED BY COMMUNITY DEVELOPMENT DEPT
B DATE a5 a
EXHIBIT
CASE NO. P
r
LOT 11
o"
`� 500o sQ /T
U
Q
Loj 12
>
4 914 S Q FT LQ
L�l
80 �
Q
s
_-CALLS C01-I MA
DEPARTMENT USE ONLY
Record Owner This Certificate of Parcel Merger No. is
Address hereby approved.
Map Prepared By By
Address Title
Area/District Date
SITE PLAN 19s023
CERTIFICATE OF PARCEL MERGER NO, 98-333
E
kA
30'
100,
'4LOT r I
roo0
'�
20
7"12o'P05ED
C)
NEW HOUSE
�
-.J
LoT Iz
4914 so a r
80'
q
cn
CA L L E C d L l f4A
APPROVED BY COMMUNITY DEVE OPME T DEPT
BY DATE �$
EXHIBIT
CASE N0. aid -333
Record Owner John P. Dyck and Vivian E. Dyck FAmily Trust
Address 81-620 Avenue 49 #84
Indio, California 92201
Map Prepared By John P . Dyck
Address Same
Scale
1 "=40'
Assessors Parcel No. 774-085-011-9
774-085-012-0