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0007-155 (SFD)LICENSED CONTRACTOR DECLARATION Thereby affirm under penalty of perjury that I am licensed under provisions of rChapter 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 291728 B mAz 08/31/2( Date , ��� Signature of Contractor`r / 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: ( ) 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. d(� )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 STATES FUNi7 Policy No. 229 -OD UNIT 0004403 (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,.p Vions of Section. 3700 of the Labor Code, I shall forthwith comply with those provisio Dater/`&/�T/ Applicant 7- •-��� �'� Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. 'IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize Tpresentatives of this City to enter upon the above-mentioned property for inspe-cttionn purposes. �f Signature (Owner/Agerit)C'Date$ BUILDING PERMIT PERMIT# 0007-1.: DATE _ VALUATION LOT TRACT JOB SITE ADDRESS �2_� 52-450�'����� ��+���.�� 7 2 A55 OWNER CONTRACTOR / DESIGNER / EN (NEER tffARUORT 1.9AN'GEMENIT VM-LIAM RUSSF I, k2.OGEM P,O. BOX 3578 56900 J;PI;CISSUN' U PAI—M DRMT CA 92261 'THERMAL CA. 92274 (760)3n-1200 C.DU 1954 USE OF PERMIT M40LE 2?AM [LY DVIT T J_WG SK).PERMIT DOLS NOT INCLUDE BLOCK WALLS OR. POOL. TRACT CONSTRUCTION 0".00 SF POR.CHIPATIO 46.00 SY GARAGE/CARPORT (SI� IC072.40 5 FT, WOOD PENCE. 200.00 LF FsTn"73m con OF comm®('mon 513g"1." PFMAW VKT SL%@tiiVIA;i2Y CONSTRUCTION FEE 101-000.41.6.000 MONO PLAN CHECK FEE 101-000-439-318 $493.61 MECHA 141CAL PEE 101-000.421.000 $53.30 ELECTRICAL PRE 101.-0007420-000 $222.78 PLU MSINO FEE. 101-000-419-000 111 OM STRO'NO MOTION n?1? . IZZES ID 101-000.241-000 $8.83 GRADING FEE 101-000.423000 $20.00 DLVEL©PRfi IMPACT FEE $1,907.00 PRECISE PLAN 101.000.441.345 $100.00 FI>;L DEPOSIT 101-00"39-319 4290.00 MTB TOTAL CuAiMLTcMON AND PL..AN' GI YC"K $3,406.47 IMS PRE -PAID RM -$250.00 1 ' ' 7.'03 AL I,"EM0.I' DUh . OW $3,156,47 1 . JUL 2 6 2000 s' Ft§CFIPT� DATE DATE FINALED. INSPECTOR fAf �U// V� l �_'.... INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS t Set Backs Underground Ducts Forms & Footings Ducts [ Slab Grade Return Air Steel Combustion Air j Roof Deck Exhaust Fans [ O.K to Wrap F.A.U. { Framing Compressor Insulation Vents [ Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall { Exterior Lath Drywall - Int. Lath ! { Final { Final BLOCKWALL APPROVALS POOLS - SPAS Steel { Set Backs Electric Bond { Footings Main Drain i Bond Beam Approval to Cover f Equipment Location Underground Electric f Underground Plbg. Test ,. Final Gas Piping I PLUMBING APPROVALS Gas Test ; Electric Final J Waste Lines Heater Final t :Water Piping Plumbing Final 1 "Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover { ,. Sewer Connection Encapsulation ) '"Gas Piping Gas Test I Appliances Final { Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole -2_3-vO S, Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. .,Smoke Detectors ;Temp. Use of Power Final Utility Notice (Perm) COMMENTS: I } C E I I /cam oao�=iss Building 5d'.4 C Address ,,,J U Ow,Mr, Mailing p Address e? D , -3_-s-79` City Zi G4p,m Contractor W - R. �1ac:1�✓ ;$,..� t.'t';"ry-• ; �'a".,'. +'^:ij�lifi:. `Iiy_� v _ iy..' .�"�-j. "1yr'4*^..:�.7i:.e.+•*.�iT .., ,� � � q ... ^Y;: •_.tib �.. ��. _ „a,, �. j aJc4 P.O. BOX 1504 APPLICATION ONLY 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 �- A G*t Jf BUILDING: TYPE'CONST. OCC. GRP. A.P. Number 77 Tel. o f '7 "y 1— 1(.70 Legal Description Project Description "; iio o gni ty lZip Tel. State Lic. I City & Classif. a / 7 Lia # Arch-, Engr., Designer Address Tel. t. City Zip State 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. SIGNATURE DATE J - ' OWNER -BUILDER DECLARATION '1 4 Thereby 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 rile 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 five hundred dollars ($500). F" I, as oner 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 doesnot apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's. License Law.) f7 I am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 1 hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy theieof. (Sec. 3800, Labor Code.) Policy No. Company n Copy is filed with the city. 0 Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM.. WORKERS' COMPENSATION INSURANCE (This section need not be completed it 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 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 ENDING AGENCY 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.) Lender's Name - Lender's Address 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. 1 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 sof this city to enter the above. ' mentioned property for inspection purposes. Signature of applicant Dale Mailing Address City, State, Zip WHITE = FINANCE YELLOW = APPLICANT PINK =BUILDING DIVISION 2 Sq. Ft. Size No. ' No. DIN. Stories Units New _,. At6d ❑ Alter O Repair ❑ Demolition ❑ /j9i1157�- J( PA 1111 1 Q 2_000 " Estimated Valuation 311 PERMIT % `MO T/, Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing 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 Property Line FINAL DATE INSPECTOR 1 Issued by: Date Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK =BUILDING DIVISION 'Deseit-Sands UnifiedScli°ooi District, 47-950 Dune .auris Road Notice: La Quetta; CA`92253' Document Cannot Be Duplicated < 760 7,71'-851.5 CERTIFICATE OF COMPLIANCE { Date 7/26/00 A: APN-#'` 773-255:-011 No. 20777 Jurisdiction', La Uinta Owner NameStarlight Management -, Permit # No. 52-450- 'Street" Avenida Obregon- . .,. f City La Quinta zip' 9225'3' Study£'A�ea 't• Tract # Lot # %Sqi are;Footage 1397 - Type of Development Single Family Residence No. of Units 1 Comments - **Overpayment of .15 cents-donatioin' Ter Larry" Shields* a y At the present time, the DesertSands Unified School District does not collect fees' on garages/carports; : covered .�. • .1 , , X'. . patios/walkways, residential additions under 500 squa`e`flMj detached.accessory structures.or replacement mobilehomes. It has been determined the above-riamed owner -is exempt from paying school�fees at this time,due to.the following reason: EXEMPTION NOT APPLIICABLE �... This certifies that school facility fees imposed.pursuant to " Government Code 53080 in the amount of 2.05 X 1,397 or $ 2,863 85 yr °.t „ the property listed above and -that building permits and/or Certificates of Occupancy for,thts square footage iWthis proposed project may,now b2 issued Fees Paid By CC/ValleyIndependent Bank/Larry Shields Tel`epage 760 '399-1200 Name on'the check By Dr Doris Wilson ( r r f•- Superintendent - Fee collected /exempted by Annette'Barlow. PaymentReceiyed $2;864.00 - Check:No:' 216594 k Y1iV - LL Signature 4 NOTICE: Pursuant of Assembly 6i11-3681 (CHAP 549, STATS. 1996) this will serve to notdy you:that the 90day approval period in which you may protest the fees or other payment identified above will begin to run from the date -Em which the building or installation permit ford iis'project i'sassueG or on which they -are paid to the District(s) or to another public entity authodzed`to collect them on the District( 's)(s')'beliatf, whicheveris'eadier. Collector: Attach'a copy of county or city plan check application form to district copy, for all waivers. Embossed Original- Building Dept./Applicant XCopy Applicant/Rece'ipt Copy Accounting w Recording Requested By -• a,;�me�ican Tile Company fia, 4:.' RECORDING REQUESTED BY: First American Title Co.COMPANY 9722SE 2160663 DOC !i 2000-220299 08/09/2000 08:00A Fee:9.06 Page 1 of 2 Doc T Tax Paid Recorded in Official Records County of Riverside Gary L. Orso Assessor, County Clerk 8 Recorder WHEN MAIL THIS UNLESSRECORDED HOWNDBELOW, D� I MAIL TAX STATEMENTS T0. M s U I IIIIII IN 111111.11111111111111111111111111111111 IN I Starlight:Management,:Inc. / P 0 Box 3578 :.Palm Desert, CA 92261 A 1 R L COPY LONG REFUND �N~� APN: 773-304-0 /,773-255 GRANT DEE 01 The undersigned grantor(s) declare(s): I Documentary transfer tax is (XXX) Computed on full value of properry conveyed;' ora.: —•—J ( ) Computed on full value less liens and encumbrances remaining at time cf sale. 4, ) Unincorporatcd area: (XXX) City of La Quinta and FOR _A VALUABLE CONSIDERATION, receipt of which is.hereby`acknowledged, John D. Harrod and Colleen R. Harrod, husband and -wife as joint tenants and Verla J. i Neel, husband and wife as joint tenants, each as to an -undivided 1/2 interest hereby' GRANTS) to CMZ L��Q �. Starlight management, Inc a Nevada Corporation 0F��6 :the real property in the City of La Quinta, County of Riverside, State of California, rl.. 'described as: Legal Description as per Exhibit "A" attached hereto and made a part hereof Dated February 11, 2000 i. 'State of California fir�1/ County of Riverside } S.S1. JoD.. Harrod yY On March 16 ,_2_000 nr_ / ;Y before me, Sharon Conran -Elkins, Notary Public personally appeared Colleen R. Harro John D. Harrod and`Colleen R. Harrod p [Nibi*cAxx-AKx)=xxx. (or proved to me on a_ . ,t the basis of satisfactory evidence) to be the person(s) whose name(s) iWare subscribed to the within instrument and at to me that hum-i/they executed the same in o Sharon Coman•Elkins ? P>ixDdTer/their authorized capacity(ies) , and Q,R Comm. #1150452 , h .that b V�I NOTARY PUBLIC - CALIFORNIA'; y �/their signature (s) on the RIVERSIDECOUNrr C' instrument the person (s) , or: the entity upon Comm. Exp. Aug. 8. 2001 bahalf of which the persons) acted, executed the instrument. WITNESSm y. nd and official"seal. Signature / (,�/1 / (L u� (This area for official notarial seal) MAIL TAX STATEMENTS T0: i EXHIBIT -.A THE LAND REFERRED TO. IN THIS REPORT IS SITUATED IN THE STATE OF CALIFORNIA, COUNTY OF.RIVERSIDE,-.CITY OF LA QUINTA AND IS DESCRIBED AS FOLLOWS:. PARCEL 1• LOT 19, BLOCK 141 -OF: -.SANTA CARMELITA AT;'VALE.LA,:QUINTA.UNIT 15, AS SHOWN BY MAP ON FILE. IN BOOK 18 ..-PAGE 92 OF:. MAPS, RECORDS OF RIVERSIDE COUNTY,, CALIFORNIA.-. PARCEL 2• } LOT 11 IN BLOCK 12 OF.SANTA CARMELITA.AT VALE LA QUINTA, UNIT NO. 1, AS SHOWN BY MAP. ON.FILE IN.B'OOK 18 PAGE'46 OF MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA. RC DISTRICT PLANNING REV'IEW-FORM This form is to be used by CDD, staff for review of•single family;.dwellings in,the RC (Cove Residential) District, in order to determine the"applicability of compatibility issues or need t&re4uirel the filing of Master Design Guidelines by,the applicant Itshall be transmitte'd'�to the'Building,and Safety Department as your correction-aist.''-Please attach. additional'explanationsisnecessary..., ,• APPLICANT W. R. Rb.GERS SITE ADDRESS 52-45'0 Avenida Obr`egori APN 77.3 _ 2 5 5 011 BIN NO.: ,'CASE NO.: 200,0-271 LEGAL:. LOT BLOCK' .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 book"totrack applications :and; assign -case numbers. .REQUIRED ITE'M Y N" COMMENT/CORRECTION Compatibility. Review , Case logged acid number assigned Verify legal and APN information Consistent with,MDG on file (as applicable :; = MDG filing required (5 -filings. since 9/3/98); �� Cl a Cot+► .� 1, to WWOMW - .M Consistency. with. street/surroundmg area: ��` itiat ase NO. Colorstbn Materials. Architecture Other Requirements: . r y; Certificate of Occupa-ncy City of L,a Quinta Burldn and $�kf.ety, e artment 9► p This Certificate issued pursuant #o.. the requirements of Section 109 of the'. Uniform Budding: Code, w certifying that, at the time of issuance; this;structure was in ,co »p/iance with thee` various ordinances . .:; _ ,67 ...of the -CO regulating bui/ding construction or use., For the fol%wing: `BUILDI.NG ADDRESS:52 450 AVENIDA,OBRE:.GON Use"Classification: SFD' Bldg. Permit No.:. 0007-155 Occupancy Group: R-3 Type of Construction: VN . Land Use Zone: RC Owner of Building: STARLIGHT MANAGMENT". Building Official Address: PO BOX 3578 City: PALM: DESSERT, CA 92261 By: STEVE TRAXEL Date: 2-2-01 POST IN A CONSPICUOUS PLACE