0004-289 (SFD)LICENSED CONTRACTOR DECLARATION
'hereby affirm 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.
License # Lic. Class Exp. Date
�* 628404 B 4.07/31/2(
Ate � N'� C'� Signature of Contractor ' ----'��z/,-,;?�
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.. :s
Dated .- ?+�_' Signature of Owner
C.r
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.
))� I have and will maintain workers' compensation insurance, as required by
§ectien 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 STATE FUND Policy No. 1342304-99
(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. i
`Da{e: =` .4'- CA ' Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees. "
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that.l have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
.,the Above-mentioned property for inspection purposes.
uSignature (Owner/'Agent)"-%� '
./:--=r Date
Y
BUILDING PERMIT PERMIT"-
-289 '
DATE/ VALUATION LOT z.. TRACT
JOB SITE APN
ADDRESS 52-444 AV.B$mA CD Oi`d 773-25"10
OWNER
CALIMRpSi DESERT CONSMUCtOly
73170 AMER BMZM
PALM DU1 CR. 92260
USE OF PERMIT
L111 QW aat_174i I 4 iw :A �*
TRACTOR / DESIGNER / ENGINEER
CAUPOP RA DESERT C014STRUC'II014
73170.AMBM STi2M
PALM DESM C.A. 92260
(700)340-9844 CBL6 4801
VD. PERMITDOES NOT INCLUDE BLOCK WALLS OR POOL
SUB 4fMAI, CO.ATMIRUCTION' ANI) PLAN CHECK 53,40.70
LESS PRE -PAID/ -MES 4250,00 -
TMAL 1F�.,IT' TITES DYKE -NOW I Pxi x&7'0
�•r t.
RECEIPT I DATE I BY I DATE FINALED I INSPECTOR . II
.0 _r'%!
e
TP.ACT CONSTRUCTION I.539,00 v
PORCHIPATIO
132.00 aF
GA11AGEICARPCRT (NF) 9121100
5 FT. WOOD VENCE
2011,00 LF
1:RTXA COST Off' CONSMUC'1'1014
961-849.70
P ER3iW b'= guAdmARY
C013SMUCTION FEL
101.000.418.000
$621150
PLAN CHECCX FEE
101-000-439.318
$517.02
MECHANICAL FFE
101-000.431...000
$.53.50
ELECTRICAL FEE
101-000-420-000
9126.35
PLUMBING FEF/
101.000-419.000
$110.74
{; ".
s •9
;' ; '•.,�;
STRO140 MOTION FEE . RESID
101-000-241-000
$9.58
T �
GRAMNO FFP
101.000.423-000
$20,00
»3
DL'{iE ()PER IMPACT FEE
$1,907.00
PRECISE PLAN
101-000.441.345
5100.00
FEL DEPOSIT
101-000-139-318
.$250.00
SUB 4fMAI, CO.ATMIRUCTION' ANI) PLAN CHECK 53,40.70
LESS PRE -PAID/ -MES 4250,00 -
TMAL 1F�.,IT' TITES DYKE -NOW I Pxi x&7'0
�•r t.
RECEIPT I DATE I BY I DATE FINALED I INSPECTOR . II
.0 _r'%!
INSPECTION RECORD
- OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
`
Ducts
Slab Grade
_
pj'
Return Air
Steel
Combustion Air
Roof Deck
Q. jZ d
5�
Exhaust Fans
O.K. to Wrap
�J
✓
F.A.U.
Framing
L
Compressor
Insulation
lC - esm
_57
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
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
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
04
Heater Final
Water Piping_
QD
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Qp
Encapsulation
Gas Piping
Gas Test
91-49
Appliances
Final
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)
=o�
S
Building
kddress
T'
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""� ;_' APPLIC T
ONL
,••.78-495 CALLS TAMPICO
sc
QUINTA, CALIFORNIA.92253 r3-
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couTRACTOR'S:bECLARATION
BUILDING:'XYPE'CONST. ' OCC: G
P. 7
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A.P. Number,
City
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NO: DW.
Legal Description
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Project Description ' '
Size Stories
t�{e
Units
Arch:, En r
Designers '
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the Provisions of. the Contractor's•Ucense law, ter.-9.(commencing with.,Section! 7000) o/ •
Division 3 of the Business and Protesslotty Code, or drat; Ae is- exempt -therefrom, and Me basis
. for the alleged exemption. Any vtoIsOwt;.p/{Sec8orl `7031:5. Dy 'any -applicant for a perms
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couTRACTOR'S:bECLARATION
- LICENSED
..
I hereby affirm that 1 am licensed underproirlslons'of Chapter 9 (commencing with Section
4 700p) of Division 3 of the Business Protesslona �`
State Lic.
8 Classif.
6
' ' "� ri 4•
.►
City
LIC. q
l �� _ _ :J •^t. ..� 4,,,,f x .y = -Ti r r� "
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NO: DW.
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Size Stories
t�{e
Units
Arch:, En r
Designers '
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the Provisions of. the Contractor's•Ucense law, ter.-9.(commencing with.,Section! 7000) o/ •
Division 3 of the Business and Protesslotty Code, or drat; Ae is- exempt -therefrom, and Me basis
. for the alleged exemption. Any vtoIsOwt;.p/{Sec8orl `7031:5. Dy 'any -applicant for a perms
Netr �rlAdd'D 1Alter,0
-Repair❑ Demolition D n
:,subjects the applicant to a civil penalty of not moreadtart Bve Mmdred doaars (5500).
i
Plan Chk. Bali -,•s"' - -
'j 4'whr +-'
�..
'
�
,do the work, and the structure Is not -intended &offered for sale. Sec., 7004, Buisness and 4
(
7Ro/essions Code:,The Contractor's lJeense::L'aw does; mt:appty,to-en owner of property who
Const' -
+"
builds or improves thereon and who does • such "v hbnsell. or,through his own employees,
Address 3 y a
.;a�,'>':.
.e -
Tel.PAILJ
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City ;.
..
ZIP § a
ere'��
State
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:� .��47,
y s
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Llc
couTRACTOR'S:bECLARATION
- LICENSED
..
I hereby affirm that 1 am licensed underproirlslons'of Chapter 9 (commencing with Section
4 700p) of Division 3 of the Business Protesslona �`
and -Code,and my license is In full force and
'.�.. ' .
.'
a rr.
l �� _ _ :J •^t. ..� 4,,,,f x .y = -Ti r r� "
,SIGNATURE - �...:.•.--'�` •,,,.: - , DATE
'r-•. s OWNEWBUILDER DECLARATION
` I hereby affirm that I am exempt,Yrorri'th@'b;ikreotors License Law for the following
Estimated Valuation,
,reason: (Sec. 7031.5.Business,and 'Proressbnsb Code:; Any. City -of county; wAkA requires, a ',y,
.permit to construct, after, improve,-dsrnofth;r•or, repeh- any structure, -prior to -its Issuance also
+repuires the applicant lot such.petmh to Iiia a' nedsstatement that he IsJicensed pursuant to -
'• "PERMIT :"'� f -a%. -" 'AMOUNT
' .•t' - , , • •L
�,`-' ,� ;
'
the Provisions of. the Contractor's•Ucense law, ter.-9.(commencing with.,Section! 7000) o/ •
Division 3 of the Business and Protesslotty Code, or drat; Ae is- exempt -therefrom, and Me basis
. for the alleged exemption. Any vtoIsOwt;.p/{Sec8orl `7031:5. Dy 'any -applicant for a perms
�;+ -
-.Plan•Chk.' DBQ• So .
Od
:,subjects the applicant to a civil penalty of not moreadtart Bve Mmdred doaars (5500).
i
Plan Chk. Bali -,•s"' - -
'j 4'whr +-'
l! I, as owner of the property, or my employees �alth'wagesas theirsole compensation, will
'
�
,do the work, and the structure Is not -intended &offered for sale. Sec., 7004, Buisness and 4
(
7Ro/essions Code:,The Contractor's lJeense::L'aw does; mt:appty,to-en owner of property who
Const' -
+"
builds or improves thereon and who does • such "v hbnsell. or,through his own employees,
+
:provided that such irnprovements.are Trot !Mended or,''offered for sale. 8, however. the building
such
-owner-hulider.
Mech.-••
-
r- r..
or improvement is sold within one year ofc'campletiln;, thewill have the burden
Electrical
of proving that he did not build or improve for!h6 purpose o/sale.) _
Plumbing- - - t•
'� ""r
r j'
I'I I, as owner of the property, ant exclusively contracting with licensed.. contractors to con
structsthe project. (Sec. 7044,. Business:and-Ro/esslons.Code.- The Contractor's License Law
• S.M.I.
.does not apply to an owner ol,property :who'bu9ds. or'Improves thereon. rand who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
µrs* M «
Grading
'x'17 1 am exempt under Sec.-,� `L • B..B-P C. for is r on ^
�..Driveway
_
Enc.. r
y
' '.Infrastructure"
.Date 'L6' ;'Own - •t
WORKERS_'COMPENSATION'DECLARATION"
I hereby affirm that I have•a certificate of eminent to self -insure,' or a certificate of a
'
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
- -
•-^ °f` yc�i
Policy No. ,.
-
(] Copy is filed with the city.,' O Certifled copy Is hereby furnished.
TOTAL
a� Vim,• 4�
CERTIFICATE OF EXEMPTION FROM
REMARKS
'
WORKERS' COMPENSATION INSURANCE
- `
(This section need not be complefed ifthe+pemYl Is fo'r;one'hondred down (S 100) valuation ~'
or less.! - n''��t,a,.i's.. •.
I certify that in the of-tlpl•.work-for
,
performance which -this permitis issued, I shall not
employ any person in any m s t ub' t.to the Workers' Compensation
-
•" 1
g falif rn, > J+- j z '- x
1Laws_
DatO (jl J
e �
• IVOili E TO APPLICANT ff< aher, making itMs r rtdkate o xemptbn you shoukf become , .:
•
-
: ZONE:--_-'BY:,3f
,. - -
subject to the' Workers' Compensstion,,provisions.+df.Y the ; Labor - Code, you must forthwith'
comply with such provIsionsor Otis pemdtaAal/Dedaemedrewked. ' �`.:
f -Minimum -Setback'Distances .:•`:
',
,�
Front Setback from Center Line
-Rear:Setback from Rear Prop: Line
?
'f3'_
CONSTR� N'LENDING AGENCY
Ihereby affirm that there is a'construotion lending agency for theperformance of the
Side Street Setback from Center Line
'--' ,•
�-�
work for which this permit is issued (Sec ,3097 CMI Code.)
.- 'Side Setback from Property Line
'
-Lender's Name-
FINAL DATE INSPECTOR
-
-
ender's Address ''�"'"'+'•`++"''
This is a building permit when pperly filled out;'signed and validated, and is subject to
ro
expiration it work thereunder is suspended:fow'180•dsys, <, +
,
I certify, that 1 have read 'this-application`ana'state.thit the ;1.116 iniormatlon ��s correct
issued by '• 'Date Permit
-
I agree to comply with all city and.county;ordinances and stale laws relating to building
- -. r
construction, and hereby authorize representatives -of this city to enter ,the above-
.,
mentioned property for inspection purposea't•,�'+a"Y.{„ .
'..Date
Validated by:
Signature ofadplicant ` _wu�r`*ty�'+.,
• •'. ,... "; '' •
.. .
Mailing Address `3. ai+.4?4"14;'Y`5t'r--
Validation:-
_
. City, "Stale, Zip wNF•tt'$-1''S'rA'S3.''�'4''`k'
..,,
APPLICANT PINK.. BUILDING DIVISION
#1V
k • z LWNITE = FINANCE a
.YELLOW
a}u. ,;.
r
Desert Sands,Unified,,School District
{ j47=950'.Dune�Palms Road
Notice: r La Quints, CA`92253
Document Cannot Be Duplicated . 760-771,4515
.. ' r i'
'CERTIFICATEOF COMPLIANCE
Date 6126/00' APN #' 773-255=010
r:.
No. 20619 `Jurisdiction La Quints
Owner NameCalifornia Desert. Construction
aa: F Permit #000,.4-289
3
No. 52=444 Street" Avenida Obregon. Log #
City. La Quuita Zip 92253 '' r Study Area_.. "
Tract # BLK 412 Lot # .. $.' Square Footage 1527
Type of Development Single Family Residence k„ No. of Units 1
Comments
F ,
At the present timed the Desert.;Sands ..Unified School District doe0 not collect fees on Igarages/carports, covered
patios/walkways; residential additions 5,00•square feet, detached accessory structures or,replacement mobilehomes. It
has been determined the above-named owner is exempt from:paying•school ,fees at this time due to the,following-reason:
• Y
EXEMPTION-N.OT, APPLICABLE
This certifies that school facility fees imposed pursuant to . Governme1.nt Code 53080 n ttie:'amount of
a
2.05 X 1,527 ": or.$i3,130.35 theipropertylistedabove and that building
permits and/or Ce'rtificates.of.Occupancy. f, -this square footage m this-,propos project may now "be issued „
Fees Paid By CC/Union Bank of Cdl fornia/Doug PetersA Telephone 760-340-9844,
Name on the, check
By iDr. ' Doris Wilson
Superintendent:
Fee collected /ex*e-moled by Mary Ann L=°Borja Payment Received' $3,130.35
°Check, No.` 70191'82
Signature. c },
v' r
_4,7, V -
NOTICE: Pursuant of Assemb y • 3081 (C , ; 549',STATS£1998) this will serve to notifyyotTthat the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run from the date on which tie building or installation permit for -this pro)ectts sssued or on which they, are paid to the District(s) or to anotherpublic entity authorized to
<;
collect them on the District('s)(s') behalf, whichever is eadier.:., � ' t4 -
Collector:
; Collector: Attach a copy of county or c1ty`plan check apphcation'fo4rm to dWrict copy -for alhvvaivers.
Embossed Original- Building Dept./Applicant Copy - Applicaiit/Receipt .4Copy - Accounting
V
V
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
-ixAbraham Varghese and Santha'Varghese, husband and Wife as Joint Tenants
hereby GRANTS) to Pine Mouiiitain Real Estate, .Inc.
all that real'oraperty situated in the City of La Quinta County of.Riverside, State of alifornia,; described as:
Lot 10 Block 12 of Santa,Carmelmta =at Vale La Quinta; Unit No. 1 as per Map Record"in Book 18 Page 70 of Maps,
Records of`RiVeeside County; Caiifo�nia
Dated February ,1.7,.2600
_ STATEOF CALIFORM _ .
--- _
COUNTY DF QI'�E S I D E --r T -
ON 2 -2_3 -god 0 before meE-FFi? E�`� Q �tTlJAQp� Abah 'Varghese
Notary Public; personafly appeared'
.48-9. Ai#Pft ,_ -v, R64
!personally, known to rime (or proved to me on the basis of satisfactory evidence)
t6be the_person(s) whose n6me(s) Ware subscrmbed:to the within instrument, and .
acknowledged to me that he/she/they , executed the same in his/herhheir
authorized z.capacity(ies), and that by:his/her/their si®naiure(s) on the instrument
the person(s), or•the entity upon behalf of whlch*t persons) acted, executed'
he instrument.
WITNESS my hand d ial al;
1
Signature
Sahtha .Varghese
'
..
. JEFFREY D. DOWDT
OLD REPUBLIC TITLE CU.
m Comm. #1:206911
•'.N'
RECORDING
DOS2�®®_®043
Rivefiitle C6ntp
ANY Comnt Explrai Jan. 3, 2003
- REQUESTED BY:
S®
/280d>j 88`c00A, Fei8.,00
�' °f Doc T• Tax Pald;
AND WHEN RECORDED, MAIL TO:
Recorded' 1n,_0fflclal R�ecorde
C®unty"of Rtvorold®
David Peters
Gary L. orso
A®me®®or,'Coun@ Clerk
y-' Recorder
73170. Amber Street
- — - —
Palm Desert, CA 92260
s u t ,
I
LA P
-R L - COPY LONG. REFUND .NEMC EXAM
THIS SPACE FORs4CORDERSUSE ONLY
~�
ASSESSOR'S PARCEL No.: 773-255=010-6
The undbrsigned Grantors) declare DOCUMENT TRANSFER
.that'the
TAX IS:
TITLE ORDER No.::500702-13
$ 15:40• County $ City.,
ESCROW -DS'
x cgf ufed Qn tbo ful�__v_alue:i%�thelllterP_ t -,(1f nrnna c�yQ
-!,Vcomputed on the full value less the value<of liens
:M:A :�
orencu'ii5br2nces`'
remaining thereon at the time of sale:
_OR transfer Is EXEMPT from tax fo•r the following=reaspn:
V
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
-ixAbraham Varghese and Santha'Varghese, husband and Wife as Joint Tenants
hereby GRANTS) to Pine Mouiiitain Real Estate, .Inc.
all that real'oraperty situated in the City of La Quinta County of.Riverside, State of alifornia,; described as:
Lot 10 Block 12 of Santa,Carmelmta =at Vale La Quinta; Unit No. 1 as per Map Record"in Book 18 Page 70 of Maps,
Records of`RiVeeside County; Caiifo�nia
Dated February ,1.7,.2600
_ STATEOF CALIFORM _ .
--- _
COUNTY DF QI'�E S I D E --r T -
ON 2 -2_3 -god 0 before meE-FFi? E�`� Q �tTlJAQp� Abah 'Varghese
Notary Public; personafly appeared'
.48-9. Ai#Pft ,_ -v, R64
!personally, known to rime (or proved to me on the basis of satisfactory evidence)
t6be the_person(s) whose n6me(s) Ware subscrmbed:to the within instrument, and .
acknowledged to me that he/she/they , executed the same in his/herhheir
authorized z.capacity(ies), and that by:his/her/their si®naiure(s) on the instrument
the person(s), or•the entity upon behalf of whlch*t persons) acted, executed'
he instrument.
WITNESS my hand d ial al;
1
Signature
Sahtha .Varghese
'
..
. JEFFREY D. DOWDT
m Comm. #1:206911
•'.N'
NOTARY PUBUC�CAliFOANtA d+
,
Rivefiitle C6ntp
ANY Comnt Explrai Jan. 3, 2003
MAIL TAX STAVIW TO: (This area for official notary seam)
David Peters - 73170 tuber Street, Palm.,0esert, CA_ 92260
V
�r:.�.vi:t.. - - .Sa�..•,�,�P,l.du-e`::��3•:�, i.� ..,, . �• F;�; kvr�.-,x4�3?;�.e5��,.,d-Cids�.Sr n. .r ._.is.r :� 4 _. .a. •.
RC DISTRICT PLANNING REVIEW =:FORM
This form is to be used by CDD staff for review of 'single farmfyldwellings in the RC -(Cove Residential)
District,.in order to: determine the;applicabilityp compatibility�issues or need to -require the filing of Master
Design Guidelines by the applicant. , It' shall be "transmitted to the Building"and Safety Department as your
correction list. Please attach additional explanationsas necessary.
APPLICANT PINE' MOUNTAIN. -REAL,' . ESTATE, INC:-.
SITE ADDRESS 52-444 Avenida...-Obre.gon'
APN 773 _ 255 0,1.0 `. BIN'NO.: CASE NO': 20,00-227
LEGAL: LOT 10, BLOCK 12' UNIT S.C.@V.L.Q.
CHECKED BY: Fred .Baker , DATE:
Inform the assigned, Building- plan:; -checker upon your assignment to -,this case.: The CDD Executive.
Secretary maintains a log book4o track applications aiid'assign case numbers.
REQUIRED ITEM V N�` t COMMENT/CORRECTION
Compatibility Review ..
Case logged „and number assigned
Verify legal and APN.ir forn ation
Consistent with MD'on file (as:applicable
G
MDG-filing required (5 -filings since 9'/3/98)1-'
Consistency with street/surroundirig .area:. ,
Colors, __ : • Y�
,r
Materials '•:
"Architecture
Other Requirements: .
17
Cetlificate of Occupancy
Building Official
POST IN A CONSPICUOUS PLACE