0010-039 (SFD)r LICENSED CONTRACTOR DECLARATION
,*ti 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
.Date I `{�f) 7�"' Signature of Contractor
OWNER -BUILDER DECLARATION
Pl'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).
O 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 permiX.is issued.
O 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 Policy No.
(This section need not be completed if the permit valuation is for $100.00 l 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 $760 of the Labor.
Code, I shall forthwith comply W,(t. those.p'rovisigns: r`l
DJ c ^ Applicant
ate: U 1
Warning: Failure to secure Work ers',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 i
construction, and hereby authorize representatives of this City to enter upon;
the above-mentioned prope'ity,for inspection purposes. d / j;;•
ignature (Owner/Agent)
BUILDING PERMIT PERM T# - • v ..
DATE VALUATION LOT ((3.�:.'.I ' ' TRACT
JOB SIT£ '
APN
ADDRESS
7 7 y_a ys _ o /
S!�-2—V A NUDA 02DUEMN
OWNER
CONTRACTOR / DESIGNER./ ENGINEER
9ILT ;IM1311DRTZOMS
JOE =0 C-0119MUC'TTiDN
42.600 COOK 97M U'CTTE 110
79.5411) MeLLs -01M 1 &"
PAi:Qt?i aIDEM'1:' CA 92211
:1z22MODA UMV..8 (1k 912'.201
'760); 460-6118 C"; 116 3002. .
USE OF PERMIT
u
5+191X7'1a;12MIT i OES :NOT I1•Jtm'L17DE BLOC X't?J.r i6 UP121'a.LI.APPX:OACH
DRIVEWAY- - `8'3ri PLAN CHMCY FEE R11DUC TIOW FOR .I` ULT IKE PLAN
tu`3IJANCE
!'RACT MN sTRiiCTION 1,394.00 Sr. :..
PORCH/PATIOM.00 ap
;A[AsqwpPR (8) 10,11n,40
i
3 Iry. Vf00% MINCE 3Fftf.00 L
• i
7�.y�'�.1'.CJ� TED COSY M C`C3A�i�"'Y�d.1<3't'`�a'TON
99,21240 .
&yp�y� C
qyZ Y^ x. qq�p YM
CONSTRUCTION nX 101-000.410.000 $039.30
PLAID C;1aRCK IEE 101-000.439-318 $137.40
MWI1iANICAL FM 101.400.421.000 �nF.1so
ff:1,RCTR1t'.a41 FEF 101-000-420-t100, $111.71
FI.:t MBA 40 FEE 141-000-419.000 1 X-15
S TRCsfVC' t'C2C3TION 1YEE ° RES"ID 1131-000-241,-000
11 R/1DING 103.000-423-000 $20.00,
DW-2U)PER SM A.CT F1'''? $1,9117.€10
PRECISS PLAN 101-000-441-345 $10.0.00
FEE DEPOSIT '101 -(W -x$39-_9 18
i
n
SM-110TAL COMM, U TT1ON AND PLAN CMCK
$3,183.28
�i'i!'® 1933 JFyi!-PA1'D..R
��250,.00
OCT 18 20.00 TOTAX.)1 RYWIT1.1 IMES DUMI NOW
XY Ut- LA QUINT
t
RECEIPT
DATE
BYZ,.7
DATE FINALED
INSPECTOR
(,. - ./ e i (�
V /
y�'
I '
INSPECTION RECORD -
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
Set Backs 1
Forms & Footings 1
�7
Slab Grade J
-/71
l (r�
Steel !
Roof Deck 1
O.K. to Wrap i
—( -o
��� O
_
Framing }
3 .a l • O l
SZ
Insulation
Low Voltage Wiring ;
Fireplace P.L. I
Main Service I
Fireplace T.O.
Sub Panels ?
Party Wall Insulation I
G.F.I. }
Party Wall Firewall I
Smoke Detectors j
Exterior Lath I
_
3.02 3 0 L
$"T
Drywall - Int. Lath i
3 v�-Ol
Final
I.
.a fa p/ z^
' 1
1
Final !
3
BLOCKWALL APPROVALS
Set Backs I
Footings )
Bond Beam
i
I Final
OPERATION I DATE l INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
Condensate Lines
Final
Steel
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underaround Plba. Test
PLUMBING APPROVALS Gas Test
Electric Final
Waste Lines i T Heater Final
Water Piping I �(-�Plumbing Final
Plumbing Top Out f Equipment Enclosure
Shower Pans i O.K. for Finish Plaster
Sewer Lateral l Pool Cover
Sewer Connection i w- 00 Encapsulation
Gas Pioina I
POOLS - SPAS
I Gas Test I 1 To — t —O L I Z)L-Z I I I I
Final
I
COMMENTS:
I
..
Final I
Utility Notice (Gas) i
ELECTRICAL APPROVALS
Temp. Power Pole I
Underground Conduit
Rough Wiring
Low Voltage Wiring ;
Fixtures i
Main Service I
Sub Panels ?
Exterior Receptacles I
G.F.I. }
Smoke Detectors j
Temp. Use of Power
1
Final
Utility Notice (Perm) I
.a fa p/ z^
Building �3•���/
Address ✓ ((//
Owner „ a
Mailing
Address
City
J/� 1005'
Contractor
.70
ty
/I vP,1,6
Tity/
"
P.O. BOX 1504 .
il
78-495 CALLE TAMPICO
-02-011 LA QUINTA, CALIFORNIA 92253
i
APPLICATION OTIf a
/ /
To .
r 1 9 n S „.lP /%j '
BUILDING: TYPE'CONST. �CC. GRP.
cr-
A.P. Number -77w " 4yC' b //
CIC
Zipf/J rt /I Tel (A��_/l egal Description 42T /i IgGoC 14 /,7 44 so/.-,*C/I�r7fr
Project Description
Zi�i- Tel. � yD� �7��
State Lic. City
& Classif. %� �73a �lo Lic. ff 3azz-
Arch., Engr., /_ J �S
Designer OL
�Dl I�'01%�%�.S tN
AddO l/lPrs)PJ� /NLI1
City, Zip�� State
J�q6l
Lip. q
LICENSED CONTRACTOR'S DECLARATION
I herebyy affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000)yLUD vision 3 of the B/u�iness,and Professions Code, and my license is in fbll force and
attect. �C r %I 7 ����3y"'�1.�
S GNATIIR T' 1 � DATE
"OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8usiness 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 thealleged 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 (8500). '
I] 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. It 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.)
1*1 1, 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 contractor(s) licensed pursuant to the Contractor's License Law.)
f! I am exempt under Sec. B. & P.C. for lhis.reason '
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Com ensatfon Insurance, or a cert' 'ed co ihereoL(Sec:. 3800, Labor Code.)
Policy No.. Company �.A`
n Copy is filed with the city. ❑ 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 tha 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., d, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisionsof the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1hereby 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.
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
Sq. Ft. No.
Size % Storif
No. Dw
New 2-' Add ❑ Alter ❑ Repair ❑ Demolition ❑
PERMIT
Plan Chk. Dep.
Plan Chk: Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
infrastructure
TOTAL
REMARKS
AMOUNT
l
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
Issued by: Date . Permit
Validated by:
Validation:
t.
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
�r
J,4%f1Ep S
s .
—0
U, RANCHO (RAGE 0 Desert. Sands, Unified School District
RANCHO MIRAGE �
6 INDIAN WELLS y,
PALM DESERT `Y 47-950 Dune Palms Road • La gbinta, California 92253 • (760) 771-8515 • FAX: (760) 771-8522
J� LA,OUINTA Na
INDIO L, - Facilities Services -
r
BOARD OF EDUCATION
John Benoit
Tina A. Godecke
Jim Koedyker
Gary Tomak
Dr. Marcile K. Wright
August 11, 2000
Joseph R. Sitko, Executive Director
Building Horizons
42-600 Cook St., Ste. 120
Palm Desert, CA 92211
Dear Mr. Sitko:
In response to your request for a waiver of developer's fees, Desert Sands Unified School
District does hereby grant the waiver for the developer's fees for the 2000/01 projects
located.at:
52-230 Avenida Obregon, APN 774-045-011-5
53-250 Avenida Obregon, APN 774-045-012-6
Facilities Services is glad to be of assistance in this year's program.
Sincerely,
Peggy Keyes
Director
PR/ab
sRME COAST TITLE CO.
RECORDING REQUESTED BY:
AND WHEN RECORDED, MAIL TO:
BUILDING HORIZONS INC.
42600 COOK ST. SUITE 120
PALM DESERT, CA 92211 .
DOC 'ft- 2000-147038
04/20/2000 08:66A Feer9.00
Page 1 ;of -2 Doc T Tax Paid
Recorded in Official Records
County of Riverside
Gary L. Orso
Assessor, County Clerk 8 Recorder
a
M
PAGE
SIZE -
DA
PCOR
NOCOR
SMF
MISC.
ERf-.
0
A
COPY
LONG
REFUND
NCNG
EXAM
9
ASSESSOR'S PARCEL NO.: %%,7 —23 3 —006 - The'undersigned Grantors) declare(s) that the DOCUMENT TRANSFER
TAX IS:
TITLE ORDER NO.: R=185791-1
ESCROW NO.: 19698-002
$ 75.35 County $ City
xx computed on the full value of the interest of property conveyed, or
— computed on the full value less the value of liens or encumbrances
remaining thereon at the of sale
GRANT DEED - OR transfer is`EXEMPT from tax, for the following reason:
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
DAVID J. GASPERS, TRUSTEE OF THE DAVID J. CASPERS "TRUST DATED
11/6/97
AND DAVID J. GASPERS, AN UNMARRIED MAN
hereby GRANT(S) to
( BUILDING HORIZONS, INC. A NON-PROFIT PUBLIC BENEFIT CORPORATION
�) all that real property situated' in the City of LA QUINTA
County of Riverside , State of California, described as:
APN # 773-233-006-5... DESCRIBED AS FOLLOWS:
LOT 17 IN BLOCK 94 OF UNIT 11, SANTA CARMEL_ITA AT VALE, -LA QUINTA, AS SHOTAN BY MAP ON
FILE, IN BOOK 18, PAGES 75 OF MAPS, RECORDS OF RIVERSIDE COU-
APN # 773-131-020-2 ... DESCRIBED AS FOLLOWS:
Dated March 28, 2000
}
STATE OF CALIFORNIA, E S, RU T
COUNTY OF RIVERSIDE } ss.
On 3131100 before me I vI UAL
CONSTANCE GORSUCH
Notary Public, personally appeared
DAVID J. CASPERS .
CONSTANCEGORSUCH W
tJ ,r!'tv
�•�; •'� COMM. #1187728 �
personally known to me (or proved: to me on the .basis of - " t.�e NOTARY PUBUGCALIFORNIA 0
satisfactory evidence) to be the person(s), whose 'name(s) 100RIVERSIDE COUNTY w
My Comm. Expires June 20;2002
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 signatures)
on the instrum t the person(s), or the entity upon. behalf of
which the per o (s) acted, xecuted the instru nt.
WITNESSm hind'and o dial. -.seal,,..
Signature
MAIL..TAX STATEMENTS TO: (This area for official notary seal)
qq
BUIDLING HORIZONS, INC. -426.00 COOK ST. SUITE 12'00 PALM DESERT, CA. 92211
NAME ADDRESS CRY, STATE & ZIP
TOOT 8, BLOCK 54, SANTA CARMELITA UNIT 5, AS SHOWN BY MAP ON FILE IN BOOK 18, PAGES
63 OF MAPS, RIVERSIDE COUNTY RECORDS.
APN # 773-232-010-5 ... DESCRIBED AS FOLLOWS:
LOT 13, BLOCK 95, SANTA CARMELITA UNIT 11 AS SHOWN ON MAP ON FILE, IN BOOK 18, PAGES
75 OF MAPS, RIVERSIDE COUNTY'RECORDS.
APN # 774-045-011-5 ... DESCRIBED AS FOLLOWS:
LOT 11 IN_BLOC-K-=174"OF�SAW,N CARMELITA�AT--VALE SLA, QUINTA, UNLT NOs" 18. AS SHOWN BY
_
COUNTY, CALIFORNIA.
APN# 774-045-012-6 ... DESCRIBED AS FOLLOWS:
LOT 12 IN BLOCK 174 OF SANTA CARMELITA AT VALE, LA QUINTA, UNIT NO 18, AS SHOWN ON
FILE IN BOOK 19, PAGES 30 AND 31 OF MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA.
IVNIINN�IIIIINI�UI�II�11111�111�WY-m�:o,'='-
F-.
RC DISTRICT FLANNING REVIEW FORM,
This form is to beeusedby- CDD staff for review of single family dwellings m the RC (Cove Residential)
L X --a.3 ✓ r„ r�1C
j;.,
District, in order to determine ihe'applicabrlity of compatibility issues or need to require the filing of Master
Design Guidelines by the applicant 'It shall be'trarismitted to the Buildirig and Safety" Department as. your
correction list. Please attach additional explanations as necessary:
APPLICANT --BUILDING '•HORI-ZONS; r -
SITE ADDRESS_ 'S3- ,.Awenid' L. Obreegon
APN 7.7 4 - . 04-5 - BIN" NO.:: J'gp CASE NO:: 20,00-315
-BLOCK ' ,c. 17 4 UNIT S.C. V.L.
LEGAL: '. LOT A 16 @ Q
-
CHECKED BY. Fred Baker. DATE:' .
Inform the assigned Building plan checker'upon5your assignment to .this case: The CDD Executive
Secretary maintains a log<book to }track applicationsy assign case numbers.:.} ,
REQUIRED ,ZTEM .
COMMENUCO.RRECTION.
4.
Y
Compatibility. Review.
Case logged and number assigned
"
Verify legal and APN information'
Consistent with MDG on file (as.apphcable`-
MDG filing required (5 filing&ssince 9/3/98)'
^
Consistency with streeth urroundirig area:.
I^J
j#.
- / W Ire ft
id
v
3 ;
17 04
iColors
Materials
Architecture
r
'
Other Requirements:
�
w•/� 7"��\y/� (/JAS
V
APPR E0 B ,_ COMMUN
_4
:D
a Av
0
ENTpDEPT `
,.
E.
CASE
aH.
Certificate of -Insulation,
Your Home has been insulated with CertainTeed Fiberglass Insulation products, which are designed
for today's safety standards and tomorrow's energy requirements.
Fiberglass is inorganic and therefore permanently noncombustible, so it does not have to be treated
with fire -retardant chemicals that will likely lose their effectiveness over time. It has not been treated
with chemicals that can corrode wiring or metal. Fiberglass will not absorb moisture nor will it
settle over time as may other insulation materials.
This also certifies that CertainTeed'Fiber Glass Insulation has been professionally installed in this home
to provide the following thermal performance..
Job Name: SFR Tract.: Plan: Phase:
Lot #.: Job Address: 53230 Avenida Obregon, La Quinta, CA
Ceiling Area: R-38 Blown
Garage Ceiling: Between Floor:
With Living Above
Ext. Walls: R-19 Unfaced Overhangs: Knee Walls: R-19 Kraft
Interior Walls: With Living Above
Sub Floor: Party Wall:
Subcrntractor.. OJ Insulation Co., Inc.
6 S incent, a 91702 (62 0 Licence #465709
Conchita Ortiz, Secretary/Treasurer --or— ..Scott Jenkins, President—or—
Lou
resident or --
Lou Merola, Director of Operations Officer
R- means resistance to heat flow: The higher the R- value, the greater "the insulating power.
Ask . your builder for the fact sheet on. R- values. Keep this certificate with your other
valued papers.11f you. ever sell this home, this certificate should be passed on to the buyer.
is
Certificate of Occuanc
..p Y
Aff
Bufl,g and-Safiety D PPc!..rftn,,en-t
This Certificate- issued- pursuant to; the requirements- of Section --909 of the Uniform. Building- .Code,
certifying ;brat, at the time of.issuance, this structure was. in compliance with the various ;ordinances"
of the=Cify regulating building construction or use. For=th'e..: 6116,wing:
BUICDI.NG ADDRESS: 53-230 AVENIDA OB'REGON :;
Use Classification: SF.Dy,. {Bldg. Permit No.: 0010-039,
Occupancy Group- R-3 Type of Construction: VN- Land Use Zone: RC
Owner of Building: BUILDING' HORIZONS Address:. 42-600 COOK STREET #1-10
City: PALM .DESERT, CA 92211
By: STEVE_ TRAXEL
8� Date: 06-01-01
Building Official
POST IN A CONSPICUOUS PLACE