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9912-0108 (SFD)48950 Avenida Anselmo LICENSED CONTRACTOR DECLARATION affirm,undel' penalty.of perjury that I am licensed under provisions of 9 (commell' q wi'lh Section 7000) of Division 3 of the Business -and mals-c,ode and my License is in full force and effect. # Vn Lic. Class Exp. Date- ;- .. 69? ,OS B -Date Signature of Contractor J OWNER -BUILDER DECLARATION 06130/'26 W hereby affirm under penalty of perjury that I am exempt from the Contractor's tLicense 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). (>f) 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, LDate LI `I - Da Signature of Owner _ Y' -J, - 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. 1 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 permiVis issued. My workers' compensation insurance carrier & policy no. are: Carrier STATE FUND Policy No. 046-00-0006579 (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 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 Co `I shall forthwith comply with thoseYprovisions. D te: Ll - / - Q (Applicant t. 11 . 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 thea Eve -mentioned property for inspection purpoosee}s. ig'nature (Owner/Agent) U y iry"en4,Date /__ 00 BUILDING PERMIT PERMIT# . DATE VALUATION LOT 9932-108 TRACT €14J04P2t1C S279,425-00 JOB SITE APN ADDRESS 48-950 ANIMIDA ANS•,ilx. MO 4531-331-01.0 OWNER CONTRACTOR / DESIGNER / ENGINEER Cf A XU & CAROL NORF." CI.,ASSIC BUII.DYRS INC 54-508 RJ' MIMS 45-270 CLUB DRIVE LA QTIWTA CA 92253 DMIAN JELLS CA 92210 (760)-172-1011 CBL# 4999 USE OF PERMIT S1N4 3LE I? AhMY D)WM.3NO ,SPT) -PE, RMIT DOES NOT INCLUDE BLOCKWALLS OR PORI, CUSTOM CONSTRUCTION 36200.00 S PORCH/PATIO 1,054,00 SY OARAMCARPO'RT 791,00 SF E151rn 'ATK D COST OF CONrte. lOG'MON 279.425.00 PERA4rr I'EI*` 81,TA4MARY CONSTRUCTION F13E 107000-418-000 $1,269,50 PLAN CHECK FEE 101-000-439-318 $1,021.28 FEE DEPOSIT 101-000-439.318 -$750.00 MECH.ANIC.AL FEE 101-000-421-000 $105.00 ELECTRICAL FEE 101-000.420-000 $203.40 PLUMBINO FEE 101.000.419-000 $145.73 STRONG MOTION FEE • RESItD 101-000.241-000 $27.94 GRADING FZZ 101-000-423-000 $20.00 DEVELOPER IMPACT FEE $1,907.00 ART IN PUBLIC PLACES - ,RLSIE 701-000.255-000 5193.56 SM=.I't:1itAL CdN81R€TC<' OW RAID KidTl CI3 K $4,886.63 LESS PRE -PAM FnS .x'750.00 `TOTAL Pk'"IT FEES D ITF. NOW S4,148.63 IIIIIII VIII III IIII IIII 04 IE ,_ RECEIPT DATE BY '' MESINE INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS ,. Set Backs"-- Underground Ducts Forms & Footings Ducts Slab Grade — pv Return Air Steel Combustion Air Roof Deck --- Exhaust Fans O.K to Wrap F.A.U. Framing = Compressor _Of Insulation 2=4_ a , Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath e7l Drywall - Int. Lath '10— C c✓ Final W 094V Final 700Zlen POOL _-SPAS BLOC KWA A ROVALS _ 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 Pl4ster Sewer Lateral _ /y Pool Cover Sewer Connectio wry Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final S Utility Notice (Gas) dear ELECTRICA A PROVALS 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 r Utility Notice (Perm) '7/ 2 Iv — `^O P.O. BOX 1504 APPLICATION ONLY Building 78-495 CALLE TAMPICO Address pj ,,►J,, ' L T LA QUINTA, CALIFORNIA 92253 Oer C''HM-F ` G,a,t Anti) N 02' 1 ` BUILDING: TYPE'CONST. q OCC. GRP. Mailing Address A.P. Number 5a ( V N l t f izip 12.2_! 3 Tel YA. ! ('-ffw Legal Description Co' tr c AProject Description CLASS L, Address i Zip 29Tel. State Lic. ` City / 8 Classif. J Lic. # Sq. Ft. No. No, Dw. 1 i — Size J Stories Units Designer J ,L/ f' Niel,) . e New j Q Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Ov !2_1 b, - e,:A Tel ' jr F I 0111111 it. Zip State PAW Lic. # LICENSED CONTRACTOR'S DECLARATION 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 r OWNER -BUILDER DECLARATION Estimated Valuation ./ 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 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 Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis ..,.. lot the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit Plan Chk. Dep. subjects the applicant to a civil penalty of not more than five hundred dollars ($500). (J 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 and Const. Professions Code: The Contractor's License Law does not apply to an owner of property who 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 building 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.) I 1 I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing strucI 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 S. M. 1. 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 (7 Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (5100) 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., 11, after making this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line Ihereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line Lender's Name Lender's Address FINAL DATE INSPECTOR 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. Issued by: Date Permit 1 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 inspection purposes. Validated by: Signature of a0plicant —Date— Mailing ateMailing Address Validation: II II I I I II IIIII I City, State, Zip 05 IE fl WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION F1isi American Thie Compan, .F RECORDING REQUESTED BY S-irst American Title Ins. Co. AND WHEN RECORDED MAIL TO: Charles E. Noreen 54508 Inverness Way La Quinta, CA 92253 A.P.No.: TRA #: 020 - O° -1-- 63 !- 33/- Gid 25864'7 IIIIIIIIIIIIIIIIIIIIIIIII 06 IE M $U PAGE SIZE DA PCOR NOCOR SMF MISC. A R L COPY LONG REFUND NCNG EXM GRANT DEED THE UNDERSIGNED GRANTOR(s) DECLARE(s) THAT DOCUMENTARY TRANSFER TAX is:. COUNTY $132.00 [ X ] 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; [ X ] City of La Quinta , and t FOR A VALUABLE CONSIDERATION, Receipt of which is hereby acknowledged, DEAN BELBAS N ' M hereby GRANT(S) to Charles E. Noreen , a married man as his sole. and separate property N the following described property in the City of La Quinta, County of Riverside State of California; LOT 80 OF LA QUINTA GOLF ESTATES NO. 1, AS PER MAP RECORDED IN BOOK 37, PAGES 96, 97 AND 98 OF MAPS, IN THE OFFICE OF THE COUNTY RECORDER, RIVERSIDE COUNTY. Dean Belbas Document Date: May 26, 1999 Dcm-:-vsA-T-rL..-vi F6 N'I'A )SS COUNTY OF On (- /7 7it II/ / 9 r 'r7 before personally appeadd MARLENE K. FRITZ NOTARY PUBLIC - MINNESOTA HENNEPIN COUNTY . MY Commission Expires Jan. 91, 2000 personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies) and that by his/her/their signature(s) on the instrument the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. Signature 6. Mail Tax Statements to: SAME AS ABOVE t-' s ®R� First American. Title Insurance Company A subsidiary of The First American Financia! Corporation PLEASE COMPLETE THIS INFORMATIC RECORDING REQUESTED BY: AND WHEN RECORDED MAIL TO: TRA: o zo DTT: 3a, o0 -DOC = 1999-258647 06/11/1999 08:00A Fee:9.00 Page 1 of 2 Doc T Tax Paid Recorded in Official Records County of Riverside . Gary L. Orso Assessor, County Clerk 8 Recorder ell D sse ����000 Title of Document THIS AREA -FOR RECORDER'S USE ONLY THIS PAGE ADDED TO PROVIDE ADEQUATE SPACE FOR RECORDING INFORMATION ($3.00 Additional Recording Fee Applies) STCSCSD 996e (Rev e/g71