9510-085 (SFD),i-T.i.r `LICENSED CONTRACTOR DECLARATION, A
I ht !eby.aLfl!T,!hat I am licensed under ,provisions (commencing Tcing
�Si!qion.FTqOq) &tT1si&V3'of,the Bu-siniiiis and: ProfessionaJi, Code, and �'my,!
Ucense is in full f6F64 ii ff. ei�t i'_4'
147-4216 tlU�1;
,fLicenie c. CIass._,.,;-,A-L._9,.,'&i� Date �l-e',-S�-�*i-""Il'i�':-7I
.,Datedreof Cc
�';jbliiNER461
CLARATI
I;hereby arm.1iat
Law for.the
't .s
�'i---i��,-�;empt'f�oin�,t#kW.C�6ntia�tor cense
foII6;ving*reason",,',.,.-
.71'_!�-!as �. o"' r' of. property I or my. em . ployees4ith` Wige`s'as''their Bole
ole',
compensation; wili'do-the w'ork,- and the 'structure- is not intended or 6ffiieil for'
sale' (Se;c*'M44; Business* & Profes'-sio;eJs Code).
owner of the;pioi5erty,-Iam e]i6l6sively 'contracting with licensed
contractors to construct the project '(S6c!'7_044,' Business & Pr6feisio6als Code).
im"iXemptundiir Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
hereby affirm ;under penalty of perjury one of the following declaraiions:',
V I have andwill maintain a certificate of consent to self -insure for workers'
compensation, , as - pr6vided for ,by, Section 3700 of the Labor Code, for the
performance of the wo'rk'fo'r which this permit is issued.
have and,will i-ne'untain'workers' componsatio n insurance, as required by
Secti6i�i_ 37006f the for the perlbirmancie'of the' work for which this
r perm it is issued.,,My workiirs'compeni6ti6n insurance carrier'& policy no. are:
- Policy No._)XQ_-7
:�-(This'sectibri neenot be completed if thepermitval0atitiff is f6r-$100.00 or less).
t
in the 06rformeince 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
w , o m
. r ers compensation laws* of California,,, and agree that if e
I � should becom'
k ' ' " "
',',-S-6bjc;6t.t6'the .w6'rk'er's',compensation provisions of Section 3700 of the Labor
Code I sh611 forthwith complyWfiiI th'ose' provisions.
Date:
Warning: Failureto secure Wor;kers'Compensation coverage is unlawful and shall
..subject an. employer to criminal. penalties and civil fines up to $100,000, in
-1 M ' * 'th ' 'of compensation, 'damages as provided for in Section 3706
,,ad ition to e cost
of the Labor Code,: interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a'peimit -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 application agrees to, & . shall, indemnify
& hold harmless the City of Indian Wells, 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 agreeto 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.
.S' nature (CXww/Ag"-----__ 1. Deis
ALC
BUILDING P ER M I T -M -i, 7,
PERMIT 8
4
JVALLIAT
DATE �
1914;,�,- -0,2 2742C
LOT. W. r Y.;4
R AC T -A, 3. A
A!tQ
'n
JOB SITE ADDRESS
52-0,10 AVE. OBREWIN 1�!�
APN 15xt _001t-
-%�.F�7734tX
0 N
CONTRACTOR �tj
A";^,"JGE 81TK V
14.
i�05
.4 RK,;A
PIA.
P.O. DRAWER 10'420 -
LXQUM,�
N531
IND (0b, CA.
(61(1--, dBil
(60)51-41.75
DESIGNERIENGINEE
,JIMSN FTA
94 8 7 K
!V
USE OF PERM
FAMILY DWELLING
.,;IN(3LE
I
SFD Perm; ilicludes 9211 of Y Itigh wall or poof p0multaizM, .
_!�
obtained sepaitately. - VY
IN,
FEEDESCRIPTION : FEESQM-
-t_ -11-i ''k
ic
T KACr CONST RUC VIONI 1,422.
VORCH(PATIO i92.
GARAGE)CARPDXF 432,
4 FT. WALL
A
%4
E.STMATED COST OF 90.22710
PERMIT FEE SUMMARY
PLAN CHRICK M, tof-000-4.39-318
CONSTRUCTION M. 101.0W-418-000 00
Mq-01ANICAL FM 101-0(?0-421-000
ELECTRICAL !'`a101a -000-420-ON
)LUN9Fi"40 FT, 101-006 419-00Y1 L0
M ., AV,
!TONG MOTION Fit - RESID 100-000-241-000
a)
GRADING FEF, 101-000423-000
4_4
1'NFRJV-,'TRVCTURF- FTKE 225-000•'441.342`$1,927.847 77r
Pi 101 -WO -4-41-345 $26,00;-Z
SE, kN
FEE, I)TY-OSrr 4250,00
SUD-TUrAL CON9rRUC."n01ttJ.'kN1_) PLAN CHECK
LESS PRE -PAID FE'es
.00
TOTAL PERKIff FEEN DUE. NOW.
TOTAL PRWECT 1!'ERN1111?+EES ..t3
'RECEIPT
I DATE
BY .
JDATE FINALED.
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
Exhaust Fans
O.K. to Wrap /
F.A.U.
Framing
Compressor
Insulation Z (o
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 APPROV LS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings i' %
Main Drain
Bond Beam s
Approval to Cover
G
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 G
Appliances
Final
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)
COMMENTS:
�� �� 5�� Alit- ��
AVS _ P.O. BOX 1504 APPLICATION ONLY .
Building / 78-105 CALLE ESTADO
Address oZ-0 %31e6&'D LAOUINTA,.CALIFORNIA 92253
Owner "" n
.j3 V) L,P ),i & Tb F- I Z.O i✓S IN c._
Mailing
Address �� O, �/(�lt� /o 3 3-D
City Zip Tel.
1���� �a3 mss.- ,SZ V- qIf
Contractor
Address
FlvC
City Zip Tel..
t_,M. Q,),„TPr S3 SG�J_yi7l
State Lic. City
& Classif. 13 - C f 73 a i (o Lic. # 3S ”)
Arch., Engr.,
Designer J V A) flG iy
AddressTel.
CityZip State
Ch7fiLcOR,� ct T X X.13 �,/ Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby -affirm that I am licenseV under provisions of Chapter 9 (commencing with Section
7000) of Div'sion 3 of I Business anddProfeyssiions Code, and my license is in full force andel
S GNATL / 11 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 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
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
[7 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, Buisness and
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.
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 that he did not build or improve for the purpose of sale.)
11 I, 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
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
1-1 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 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.)
Po icy No. Company
)jlCopy is filed with the city. ❑ 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, 1 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: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation 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.)
Leader's Name
Lender's Address
This is a building permit when properly filled out,'signed and validated, and is subject to
expiration it 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 applicant Date
Mailing Address
City, State, Zip
BUILDING DIVISION
BUILDING: TYPE CONST. -OCC. -GRP.
A.P. Number -7
Legal Description
Project Description
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep. DO
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
n
TOTAL ,60 %
REMARKS 7r
1
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street SetIback4som Center Line
Side SetbackNA7NS4T
fro Prop\ rrty Line;���
FINAL DATE R�
Issued by: D�te P79. 1 l� 1
Validated by: �9���1
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. $
2ND FL, SO. FT. ({0
POR. SO. FT. ({
GAR. SO. FT. 0
CARP. SO. FT. GD
WALL S0. FT. p
SO. FT. 0
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SO. FT. p c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID Q 11/. c
SEWAGE DISPOSAL
SO.FT.GAR 3/,c
HOUSE SEWER
REMARKS:
VENTILATION
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
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 APP.IEOUIP.
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
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
NtfIEO S
o
r
H BERMUDA DUNES
RANCHO MIRAGE
�- INDIAN WELLS ti
PALM DESERT a
,P __,OLA OUINTA
IND 0. y,
Desert Sands Unified School District
82-879 Highway 111 • Indio, California 92201-5678 • (619) 775-3500 • FAX# (619) 775-3543
BOARD OF EDUCATION
Gilbert L. Anderson
Ren6 L. Garcia
Jim Koedyker
Matt Monica
Amy Swan -Draper
November 27, 1995
To Whom It May Concern:
Facilities/Acquisitions/Construction
Desert Sands Unified School District hereby waives the payment of Developer Fees for
the Building Horizons Projects located at:
52-010 Avenida Obregon
La Quinta, CA 92253
and
52-030 Avenida Obregon
La Quinta, CA 92253
If you have any questions and/or concerns, please don't hesitate to contact me at (619)
775-3500, ext. 5272.
Sincerely,
Peggy Reyes, Manager III
Facilities/Acquisition/Construction
OCT-27-95 FRI 13,19 DIVE FAX NO. 6195686283 P.01
10/27/95 11:13 '&909 270 1429 FATCO DKINC. vi 001/UU1
CAIN
I 1 COPY c �-
RECORDING REQUESTED BY:�719 b
Sas pci LLL a .� :.•I.il P�. Lo n�.� T��iir
may,
When Recorded Mail DOC, iment
and Tsx Statement To :F �! ?� • �,;,r',�,�
Ruiz d zig: xorisona, nc. RIVER6 COUNTY, CALIFORNIA
4260.0 cook Straec;, ! uit e' 110
Pal'm besex.t., CA 9�; lily •
Escrow No. 10275-LF
Dille Order Nu.SPACl::ABOVE THIS%0NE FOR RECORDER'S USE
APN: 77-3=2.15-001 & 0,02
Code: GRANT/DEED
The undersigned grantors I .declare(s) -
Documentary transfer"tax ei 8 37..40. city tax 9
( X 1 computed on;f all.velu® of property Conveyed;°Or
! 1 computed orr f ,ll value less value of (lens or encumbrances remaining at time of sale,
f I Unincorporate( Area City of. La: ;OiAhta
6.
FOR A VALUABLE CONSI )ERATION, receipt of:Which Is; hereby acknowledged,
DAVID W. SHEARIER .ar d LISA A.SHEARIER`; Yiusband 'atld;wiFe; xiho eCquired title as
DAVID W. SHEARIER and LISA A. SHERYER husband'and"wi£e'
hereby GRANT(S) to
BUILDING HORIZONS, 71C., a.California.Non profit Public Benefie Coxporaeion.
the following described reg i property In the City of La Quint&
Couney of Rivereid:a` state of California.
Lots 1 and 2 in R1ock l of Santa Cermelata at XA,le 14 Qunt`a;,.Urlic #1 a map r d
in book 18, page 46 'of Maps, Records of Riverside Cout:cy,Calif oYttiai �.
DATEp; _fn6cr Sr1995
STATE OFaG
= -
CCUNTY F D id* W,. Sheariar
_,� before me,Zka.,�
• �_ :,personally: epp`ea(ed .
t1. L16a, A' Shearier
personally ,known to' nie (or pCoved�to„:ma`on :_{ha
basis of satisfactory ,ev1d nce) to`:be tfis<;person s)
whose "name►sj ' Ware s ibscribedr to' the,, with'
in
instrument and ackn6widd
dj ledao=me that:,he/shehhey .'
executed the same�',.m his/her/tP►eir authoriied
capeCity(ies), .and that by I islh8rhh h' 9ignatUr®Is)
the instrumani” fhe perac nls1, or.'the entity upon
behalf of which ths..'pers; in(s) aotad, executed
instrurnenq,j
Witney�hpM j:�%ffic al seal
JAMES O.'WALLACE
AgrlcuHural Commissioner .
Director of Weights & Measures.
OFFICE OF THE
AGRICULTURAL COMMISSIONER .
P.O. BOX -1089
RIVERSIDE CA 92502-1089
PHONE (909)VS-3000
FAX (909) 275.3012
CALVIN C. KAMINSKAS
Assistant Commissioner
DAN RILEY
Sealer, Weights & Measures
(909) 276-3030
FAX (909) 216.4128
83=612,_Avenue 45 Suite 7
.radio, .CA 9220.1
(619)863-8291
DATE I012 5�9.f CASE NO. .C�IOZ S 7f
DEVELOPER'S NAME: oYS '� C �=rS �c ya . `r,14 -0A&14 0R,2o•rf . I/VC.
ADDRESS: J•d• >vr& 1032o
1N0/0 c 4 °12202
TELEPHONE: S. 6 N Li 175
5 ;2 069e-.6 :/. Z.4 QYiNTA.
Dear Developer:dl
/ j
After reviewing your landscaping'plans" -:;Ali`;plan.t .material fisted is not in
violation of quarantine laws governing the Coachella Valley. If subs`t-itutions
-.do occur and they differ from plant material listed, this office --must be
notified immediately.
Thank you for -protecting and preserving the Coachella Valley's pest -free
environment.
"K•�--Y;:: r�=..-t/.;`ti'v'.'! �.^. :i{i. .• J'Y .�" ,'t Zs�•�, a.. Y...� tc� •�',. l.T•- r 4 , r'. .`i 1 �� `:P .jam' .i
EARTH SYSTEMS CONSULTANTS S.C.
1101 1 - )
79-8116 Country Club Drive
Bermuda Dunes, CA 92201 • (619) 345-1588
CJENTADDRESS
CLIENT PHONE
TEST
NL 43ER
.
PFK IECT
r�z:•IC�. ZUZv
U).,
ION
Z
✓
ooNrRACTOR
OWNea
WEATHER
--------------
TEMP
TIME
PRESENT AT SITE
TEST
NL 43ER
LOT
W.
ELEVATION
FIELD TESTING
REFERENCECURVE
MOISTURE.
CONTENT
%
DRY
DENSITY
lbs/cu. ft.
' MAXIMUM
CRY
DENSITY
%
MAXIMUM
DRY
DENSITY
lbs/cu. it.
OPTIMUM
MOISTURE
CONTENT
%
/It's
Y
N4, -
,-REMARKS:
REMARKS: �','�: ��/",,�c� co" t.t ,,. .�o�t o �'V
uj e�- T er,
;v
CLIENT REPRESENTATIVE SIGNATURE
FEELD REPORT
TECHNIC tIGNATURE
�s