0010-040 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perju'ry 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 .
61.,.. .._-: i7�ff '5111 AGS.
Bate r. /! ' Signature of Contractor --J—-
7!`
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.
r'have and will maintain workers' compensation insurance, as required by
ecton3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Cartier Policy No.
YAYRhi014T NO CO :P'm"7i 83102
(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..S,ection 3700 of the Labor
,G/ode, l shall forthwith comply with those provisions.` 1
Date: �•> _ �� _ ,.., Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an:employer to crimihal,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
n
application. X'
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 applicators 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
the,above-mentioned property for inspection,purposes.
'Signature (Owner/Agent)'-4 % /i 1, t Date._'„
' BUILDING PERMIT PERM T#
DATE 1 VALUATION LOT TRACT.
00
JOB SWE
APN
O�
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN INEER
- ��f1.i.�?11�I>:� 1:Co.i1CD2�'�•
d���°� �1.�`�� �rD��'ha:��''.���'Yt..��� . �-
' 4 J-4500 C1.)01f 3rfF4 r SUIT
78-5 5 ,TfAR:AOTIrLAM, : •, ,4`'y
PALM UYSE T CA 92211
BryPdk��ry�fiD(I'�;DRgl�tirl�idES Lir./
(cJy;�2013002, %
7 60)3 ,60-6 6 1 8 C8.1✓0 x7002
USE OF PERMIT
SIN (211 •17AM1: Y 13';1 U240
5011-PERA1.11' DOES NOT INCLUDE BI.00°I:' WA.C.IPCDCbUSPA OItAPPROACH
ralaIa'9WAY
TiIACI' CONS'i'RU'CTJON 1,395,00 OF
PORCHIP&kTIO $5.00 Sip
Ci61R A.GEMARPOWT (9F) 100"nA81
f
5 FT. WC CID MINCE 200.00 L•11`
. �II6�7'.�'?<A C�i��"Y' t;)1iT C;�N'fd'�'�T�:�631�'
�„k5:2•�
CONSTRUCTION � . W 101 X000-41 8m000 W2 15 I
PLAN f. HFCK ME 101 _0010-439- 3 18 049.61
UECF1MICA..L FEE 101-00"21-000 S96.00
V:I+Et;TRIC;A,I.• ME 1014M-4'20-000 0114.71
KII,DN�,SM ME 101-000.419-000
STRONG MOTION ?LL - RIat1D 101-:-V0-241.-000
ORADWO RE 101.000-423-000 53E,•tt0
DRIVIP•.LO1PER I<rcS9?&CT s'o1? 1Y991"1.t30
PRECIVE PLAN 101-000-441-345
FEE DEPOSIT 101-.000-439-318 4250.00
x'43-' rAT tJ0HE r1*R. UC'1 X0Y MjD PI..r W CIMM
.j
OCT 18 2000 :�r(a a P��' TTE'5 ]XII HOW
s ,3,30A9
t- dam°► QAJ W
. .
RECEIPT
DATE if
By
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs !
Underground Ducts
Forms &Footings
Ducts
Slab Grade 1
-I 0
Return Air
Steel
Combustion Air
Roof Deck J
_
�. ��! O (
.� (
Exhaust Fans
O.K. to Wrap ?
�;(Lj1/�. t
F.A.U.
Framing
Compressor
Insulation I
3 '013 -Ot�
Vents
Fireplace P.L. f
Grills
Fireplace T.O. I
Fans 8 Controls
Party Wall Insulation I
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath 1
1
f
Final
Final
POOLS --SPAS
BLOCKWALL APPROVALS
steel
Set Backs 7
Electric Bond
Footings
Main Drain
Bond Beam i
Approval to Cover
Equipment Location
I
Underground Electric
1
Underground Plbg. Test
Final !
Gas Piping
PLUMBING APPROVALS
EacTestric Final
Waste Lines I
��-7
Heater Final
Water Piping )
Plumbing Final
Plumbing Top Out y
Equipment Enclosure
Shower Pans !
O.K. for Finish Plaster
Sewer Lateral {
Pool Cover
Sewer Connection i
/T j - 00
a
Encapsulation
Gas Piping I
Gas Test
Appliances
Final
COMMENTS:
-
I
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole I
Underground Conduit
Rough Wiring r
Low Voltage Wiring.
Fixtures ;
Main Service
Sub Panels
Exterior Receptacles
G.F.I. I
,
Smoke Detectors 1
Temp. Use of Power
f
Final
/ _
Utility Notice (Perm)
a0�o -a,P
T4ht u�l'It,�Gv
P.O. BOX 1504
Building? _ Je^f�/a 78-495 CALLE TAMPICO
Address �.7 9.0 a�%/i OUINTA, CALIFORNIA 92253
Owner 50 1 /d, euP7 h - r % ivn5
Mailing Address` X0-�l/C,/ Ooo/r .5( , .5&,* //
City nu/07 ® Zipgaai Tel
eN/0_Y / if
Contractor
Q.Vsco Cooz. s ; . s,Z /
City o 7q
Zip fl
op
State Lic. ty& Classif. y //73 -k ic.Archc. #
Designer ., gr._/eve Jam , QIeml.,5 I!N/SP 1
Addresser Tel.
116 d"6 (7_66J, a -33a
City// Jr Zipry��6/ State
�p!/� �P p Lic. #
LICENSED CONTRACTOR'S DECLARATION
I herebyy affirm that I am licensed under provisions of Chapter 9 (commencing wit Section
7000) ofDivision 3 of the Bu9sin/eYss�and Pr f�e�ss)ions Code, and my licen/se i♦s' In ful orce and
effect. `(! 1.. r .rl'7r[� I / / 3�Q (Y'►i
SIGNATURE �//i 1 DATE
V 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 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 live hundred dollars ($500).
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. If, however, the building
orimprovement 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.)
I l 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 contractor(s) licensed pursuant to the Contractor's License Law.)
V! I am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
Ihereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Co pe s ioA Insurance, or a certified t ereof Sec. 3800, Labor Code.)
Policy No, i`1 / C) Company
1`7 Copy 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.)
Icertify 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 Cal'lornia.
DaOwner
NOT CE TO APPLICANT: It, 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.)
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 a0plicant Date
Mailing Address
City, State, Zip
1
APPLICATION O LY
BUILDING: TYPE-CONST.�CC. GRP.
A.P. Number -77y- U y,r" o / L
T ! L d w-VC.ri. / 07L< <s!- C1T7iti Lr �jT4
Legal Description .L,9oT ✓�!t-�� LA ��✓..1i /# azw/ / �i ;o' /
Project Description .S,F
Sq. Ft. / �^� f► No. No. Dw.
Size -!tel Stories Units
New Pl 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
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:
J WHITE = FINANCE YELLOW = APPLICANT PINK =BUILDING DIVISION
J�r,EIEp Sc
1
Z
—0
y BERMUDA DUNES r
RANCHO MIRAGE C Desert Sands-',-Unified- School District
~ INDIAN WELL'S fil
PALM DESERT Y 47-950 Dunc Palms Road • La Quinta, California 92253 • (760) 771-8515 • FAX: (760) 771-8522
S LA OUINTA
`gyp INDIO y� - Facilities Services -
•
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 d'eveloper'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,
e
PeggY eyes
Director
PR/ab
'f COAST TITLE CO.
RECORDING REQUESTED BY:
AND WHEN RECORDED, MAIL TO:
BUILDING HORIZONS INC.
42600 COOK ST. SUITE 120
PALM DESERT, CA 92211
DOC N 2000-147038
04/20/2000 08:00A Fee:9.00
Page i of 2 Doe T Tax Paid
Recorded in Official Records
County of Riverside
Gary L. Orso
Assessor, County Clerk 8 Recorder
ASSESSOR'S PARCEL NO.: 22-7-2-3 7—C70( -- The undersigned Grantor(s) declare(s) that the DOCUMENT TRANSFER
TAX IS:
TITLEORDERNO.: R-185791-1
$ 75.35 County $
City
ESCROW NO.: 19698-002 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
G RANI' DEED remaining thereon at the time of sale
— OR transfer is EXEMPT from tax for the following reason:
7*�_-OZOo7
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
DAVID J. CASPERS, TRUSTEE OF THE DAVID J. CASPERS "TRUST DATED 11/6/97 At
O� AND DAVID J. CASPERS, AN UNMARRIED MAN..
hereby GRANT(S) to
„ BUILDING HORIZONS, INC. A NON-PROFIT PUBLIC BENEFIT CORPORATIO:'
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 CARMELITi
FILE, IN BOOK 18, PAGES 75 OF MAPS, RECORDS 01
APN # 773-131-020-2 ... DESCRIBED AS FOLLOWS:
Dated March 28, 2000
STATE OF CALIFORNIA, } f=o/%c.�,
COUNTY OF RIVERSIDE } ss.
On 3131100 , before me
CONSTANCE GORSUCH
rAI�3 C_�
, Notary Public, personally appeared
DAVID J. CASPERS
3 ^' • CONSTANCEGORSUCH
personally known to me (or proved to me on the basis of COYAM. #1187728
NOTARY PUSUC-CALIFORNIA �
satisfactory evidence) to be the person(s) whose name(s)°` My Comm. RIVERSIDE
R°azo 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 signature(s)
on the instrum t the person(s), or the entity upon behalf of
which the per o (s) acted, xecuted the Instru nt.
WITNESS m nd and o cial seal.
Signature -A i " Al OVA A 'A h
MAIL TAX STATEMENTS TO: (This area for cNiclal Horsy seal►
BUIDLING HORIZONS, INC. -42600 COOK ST. SUITE 120, PALM DESERT, CA. 92211
NAME ADDRESS CRY, STATE & ZIP
LOT 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 CARMEL I'TA 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 BLOCK 174,, OF SANTA-CARMELITA AT VALE, LA QUINTA, UNIT N0. 18, AS SHOWN BY
MAP ON FILE IN BOOK 19, PAGES 30 AND 31, RECORDS OF•RIVERSIDE COUNTY, CALIFORNIA.
APN# 774-045-012-6 ... DESCRIBED AS FOLLOWS:
IVNIINVN��IIII�IIIIII���IIUIIIk�Y-��=��-
RC DISTRICT PLANNING REVIEW FORM
This form is to be used by GDD staff for review of single family'dwellings-in the RC (Cove Residential)
District, in order t6 determine the a pplicabilitXof compatibility issues or,need to` equire the filing of Master
Design' Guidelines by the'apphcant` It shall be�transrnitted to'the Build 'ng o,'O. Safety Department as your
correction list.. -Please attaeh additional explanations as;necessary. ,
4W_
APPLICANT BUILD ORI ZONSP
SITE ADDRESS
` 774 _ 045 ��l. CASE_NQ:. 2:000-316
APN BIN N.O::
LEGAL: LOT Xr BLOCK 17 4 ,`w.
CHECKED BY: Fred .'Bakes`., r DATE:
Inform the assigned'. Building plan checker ,upon your assignmeiit'to=<this "`case. The CDD Executive
Secretary. ,maintains a log book to :trackapplications: and assign case numbers..
REQUIRED ITEM Y`4''COIVIiVIENT/CORRECTION
CompatibilityReview xv
17
Case logged and number assigned _ y n
Verify legal . and ' APN info : anon
., d
Consistent with MDG on. as:applicable .
r a r
MDG filing, required (5 filings since9/3198) -.
Consistency with st eet/surroundmg.area:.
Cblors
Materials,',..."i `-7 Q? 4,,
7
Architecture
'Other Requirements: z .,
Y .. TE Zr)
EXHIPIT
CASA !G.
��• ;`, ,v+ _. .� h.t - lq;.~ - -. ` � ` .. K _. ..^i i' � il` - -` ,� moi. •. e`l
� - r} • • .. ' j r - aF � �l�P ,M M y : I. •� � _ .! . - ... t" -.
i tr
Certie".f'InsuI-
ffikatatiori
t y Your Home.has bee" insulated with CertainTeed Fiberglass Insulation products, which are designed
fortoday's safety standards and tomorrow's energy requirements-, � v
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 no_ r 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: 53250 Avenida 9bregon, La Quinta CA
Ceiling Area: R-38 Blown F
- Garage Ceiling: Between Floor:
o , With Living Above
Ext. Walls: R-19 Unfaced n ' Overhangs: Knee Walls: R-19 Kraft
Interior Walls: _ With Living Above I
Sub Floor: Party Wall-
-. .` .. _•.• � � ,;• ,•
Y ' , , Subcontractor..'. OJInsuladon Co., Inc. -
. 600 ` intent, ' Ca 91702 (626) -60 0 'License #4657.09 `
Signed
_ Conchita Ortiz, SecretarvITreasurer.--ori R. , colt Jenkins, President—or�F - s
r .. _ . .-
Lou Merola, Director of 9perations Officers
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 paper!
Of If you ever sell this home; this certificate should be ;passed'on "to the buyer.
. 11i f
+f
, .
Certificate of Occupancy
City,of LaQuin . ta
�uld�ng and Safety Department _ Mo
This Certificate issued pursuant to the requirements of Section 109 of the '•Uniform Bui/ding ,Cede,
certifying that;_ at the •time of..issuance, this structure was, in•compiiance- with the: various ordinances
of the .City regu/a.ting building construction=,or wise. For the fo/%wing:
"BUILDING. ADDR'E�SS: 53-250 AVEN DA.QBREGO;N
Use Classification: SFD . Bldg. Permit" No:: 0010=040.
Oecupancy:'Group: R 3 '` -Type of Construction: VN-- Land Use Zone: ` RC,
Owner of. Building -x BUILDING HORIZONS Address: 42-600:000K STREET#110
City:. PALMDESERT, CA 922+1
By: STEVE TRAXEL
Id! Date: 06=01-01
Building Official
POST IN A CONSPICUOUS PLACE