13-0881 (SFD)81418 Amundson Ave
13-0881
IIIIIIIIIIIIIIIIIIIIIIIII
P.O. BOX 1504IE
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
444
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
13-00000881
81418 AMUNDSEN AVE
767-200-998-21 -330762-
DWELLING - SINGLE FAMILY
LOW DENSITY RESIDENTIAL
626002
Owner:
HEUSER, GEORGE J. TRUST
3031 GARDENIA AVE
DETACHED LONG BEACH, CA 90807
Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
I 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 Class: BLicens No.: 915336
feb ata: 1011 ll3 Contracto .
O R -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she 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).:
1 _ 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, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
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 or she did not build or
improve for the purpose of sale.).
(_ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , BAP.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/01/13
Q ZA U
Contractor: OCT 1.3 2013
DBCA INC
P.O. BOX 1482
LA QUINTA, CA 92247 CI' O LAWNTA
(760) 393-5271 FINANCE DEPT.
Lic. No.: 915336
------------------
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:
11 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 and policy number are:
Carrier TRAVELERS Policy Number YJUB282D7797-12
_ 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
/1 3700 of the Labor Code, I shall forthwith c m y with th se provisions.
Date: t/ Applicant:
WARNING: FAILURE TO SECURE WORKERS' COI IPEDI ATION COVERAGE IS UNLAWFUL, AND SHALL
ALTIES
SUBJECT AN EMPLOYER TO CRIMINAL PENAND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($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.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this 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,
the owner, and the applicant, each agrees to, and shall defend, indemnity and hold harmless the City
of La Ouinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
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 county ordinances and state laws relating to building construction, and he eby authpYize representatives
of this county to enter upon the above-mentioned property or inspection purpo s
I Date: d ✓ / Signature (Applicant or Agent):
LQPERMIT
A p_ZJ-tion Number . . . . . 13-00000881
(SVruct4re Information 6,968SF DWELLING/VB/RES-3/CL-A/13D [ENG]-----
5*0 tion Type . . . . . TYPE V, UNPROTECTED
Occupancy Type . . . . . DWELLG/LODGING/CONG <=10
Other struct info . . . . . CODE EDITION 2010
# BEDROOMS 4.00
FIRE SPRINKLERS 13D
GARAGE SQ FTG 1554.00
PATIO SQ FTG 1274.00
NUMBER OF UNITS 1.00
1ST FLOOR SQUARE FOOTAGE 6968.00
----------------------------------------------------------------------------
i
'Permit . . . BUILDING 2013
Additional desc . .
-- Permit Fee . . . . 812.55
Issue Date . . . .
Expiration Date . . 3/30/14
Plan Check Fee 00
Valuation . . . . 626002
Qty . Unit Charge Per Extension
BASE FEE 573.43
427.00 .5600 THOU BLDG $200,001-$1M 239.12
----------------------------------------------------------------------------
Permit . . . ELECTRICAL 2013
Additional desc . .
Permit Fee . . . . 252.44 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 3/30/14
Qty Unit Charge Per Extension
1.00 143.0000 LS ELEC NEW RES, FIRST 1 KSF 143.00
9.00 12.1600 EA ELEC NEW RES, ADD -L 1 KSF 109.44
----------------------------------------------------------------------------
Permit MECHANICAL 1^11
Additional desc .
Permit Fee . . . . 583.96
Issue Date . . . .
Expiration Date . . 3/30/14
Plan Check Fee . . .00
Valuation . . . . 0
Qty
Unit Charge
Per
Extension
5.00
35.7500
EA
MECH
FURNACE
178.75
6.00
35.7500
EA
MECH
CONDENSER/COMP
214.50
1.00
35.7500
EA
MECH
AIR HANDLER
35.75
12.00
11.9200
EA
MECH
VENT FAN
143.04
1.00
----------------------------------------------------------------------------
11.9200
EA
MECH
EXHAUST HOOD
11.92
Application Number . . . 13-00000881
Permit . . . PLUMBING 2013
Additional desc .
Permit Fee 691.35 Plan Check Fee .
Issue Date . . . . Valuation . . . .
Expiration Date . . 3/30/14
Qty
Unit Charge Per
Extension
30.00
11.9200 EA PLBG FIXTURE/TRAP
357.60
1.00
11.9200 EA PLBG BUILDING SEWER
11.92
19.00
11.9200 EA PLBG ROOF DRAIN
226.48
3.00
11.9200 EA PLBG WATER HEATER/VENT
35.76
1.00
11.9200 EA PLBG WATER INST/ALT/REP
11.92
1.00
11.9200 LS PLBG.GAS SYS, 1-4 OUTLETS
11.92
1.00
35.7500 LS PLBG GAS SYS, 5+ OUTLETS
35.75
----------------------------------------------------------------------------
Special
Notes and Comments
6,968SF
DWELLING/VB/RES-3/CLASS A/13D
(ENGINEERED] THIS PERMIT DOES NOT
INCLUDE
BLOCK WALLS, POOL, SPA, WATER
FEATURES
OR DETACHED BBQS OR FIREPLACES.
2010 CALIFORNIA BUILDING CODES.
October
1, 2013 1:16:33 PM AORTEGA
----------------------------------------------------------------------------
Other Fees
. . . . . . . ART IN PUBLI.0 PLACES -RES
106.5.01
BLDG STDS ADMIN (SB1473)
26.00
DIF COMMUNITY CENTERS -RES
129.00
DIF CIVIC CENTER - RES
942.00
DIF FIRE PROTECTION -RES
433.00
DIF LIBRARIES - RES
344.00
PLAN CHECK, ELECTRICAL
92.28
DIF PARK MAINT FAC - RES
40.00
PLAN CHECK, MECHANICAL
383.74
PLAN CHECK, SFD GRADING
143.00
PLAN CHECK, PLUMBING
677.03
DIF PARKS/REC - RES
2048.00
BLDG PC 200K -1M
1756.52
STRONG MOTION (SMI) - RES
62.60
TUMF: RESIDENTIAL
1837.44
DIF STREET MAINT FAC -RES
116.00
DIF TRANSPORTATION - RES
2842.00
Fee summary Charged Paid Credited
------------------------------
Due
-----------------
Permit
----------
Fee Total 2340.30 .00 .00
2340.30
Plan Check Total .00 .00 .00
.00
Other
Fee Total 12937.62 1200.00 .00
11737.62
Grand
Total 15277.92 1200.00 .00
14077.92
LQPERMIT
Coachella Valley Unified School District
83-733 Avenue 55, Thermal, CA 92274
(760) 398-5909 — Fax (760) 398-1224
Project Name:
Owner's Name:
Madison Club
George Heuser
This Box For District Use Only
DEVELOPER FEES PAID
AREA:
AMOUNT
LEVEL ONE AMOUNT:
LEVEL TWO AMOUNT:
MITIGATION AMOUNT:
COMMAND, AMOUNT:
DATE:
RECEIPT:
CHECK #:
IN
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Address: 81-418 Amundson Avenue,
Project Description:
APN: 767-690-013
Single Family Dwelling
Tract #:
Type of Development: Residential _ xx
Commercial
Total Square Feet of Building Area: 6,968
Date: October 14, 2013
Phone No. 760-393-5386
Lot #'s:
Industrial
Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement under
penalty of perjury and further represents that he/she is authorized twn on behalf of the owner/developer.
Dated: October 14, 2013 Signature:
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code
17620
Number of Sq.Ft.
Amount per Sq.Ft.
Amount Collected
Gov. Code
65995
6968
$3.20
$22297.60
Project Agreement Existing Not Subject to Fee
Approval Prior to 1/1/87 Requirement
Building Permit Application Completed: Yes/No
By: Elsa F. Esqueda, Director of Facilities and Maintenance
Note:
Pursuant to AB 181 any room additions or enclosures of 500
sq. ft. or less are exempt from developer fees. Any mobile
homes being relocated within the same school district's
jurisdiction are exempt from developer fees.
Certificate issued by: Laurie Howard, Secretary Signature:
NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES
Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a written notice to the
project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90-day period to protest the imposition of these
Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall serve to
advise you that the 90-day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of any other
requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether payable at this
time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This Certificate of
Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School District, and up
to three (3) such extensions may be granted.
My:C/[II,,(Ioc�/(Iee(,,;/artiftC;II C t)CColl)I]I l;c: ii;riu updnic(I ;.)UQ7 11/2010
FIDELITY NATIONAL TITLE COMPANY
SUBDIVISION DEPARTMENT
WHEN RECORDED MAIL TO:
Mr. & Mrs. George J. Heuser
3031 Gardenua Ave.
Long Beach, CA 90807
MAIL TAX STATEMENT TO:
SAME AS ABOVE
ANP - #767-690-013-9 —TVA,, /j)-o
DOCUMENT TRANSFER TAX $ 2,365. 00
XX Computed on the consideration or value of property conveyed; OR
DOC # 2007-0536968
08/21/2007 08:00A Fee:16.00
Page i of 4 Doe T Tax Paid
Recorded in Official Records
County of Riverside
Larry W, Ward
Assessor, County Clerk & Recorder
111111111111111111111111111111111111111111111111111111
S.
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SIZE
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LONG
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465
426
COR
INCOR
SMF
NCHG
EXAM
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Computed on the consideration or value less liens or encumbrances
remaining at the time of sale. /J T
Signature of Declarant or Agent de ermining tax — Firm Name 010
by
GRANT DEED
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, EAST OF
MAD[SON, LLC, a Delaware limited liability company ("Grantor"), hereby GRANT(S) to GEaRGE J.
HEUSER AND KIMBERLY HEUSER, husband and rfe as joint tenants {"Grantee"} the real
and__GEORGE J. lI Sig T st a ,of t e Geor J. T3 us r* '
property located in the t tl'y o �a (uinta, aunty al tFverside, State of California, described as:
*Revocable Trust Dated December 2, 1994
See Legal Description attached hereto and incorporated herein as Exhibit "A".
SUBJECT TO all matters of record including, without limitation, the covenants and agreements
described in Exhibit "A" attached hereto.
Dated: 8/13/07 EAST OF-MADISON, LLC,
a Delaware limited liability company
By: 120 Acre Partners, LLC,
a Delaware limited liability company
Its: Managing Member
'ECENEC.
AUG 2 8.2013
ITY OF LA QUINTA
1UNITY DEVELOPMENT
By: Discovery La Quinta Investors, LLC,
a Delaware limited liability ca pany
its Authorized sent iv
B
Josep L. Arenson
Its: Authorized Representative
STATE OF CALIFORNIA )
) ss.
COUNTY OF RIVERSIDE }
On August 13 .2007, before me, Dawn M. Sandorf, a notary public in and for
said State, personally appeared Joseph L. Arenson, Authorized Representative of Discovery La Quinta
Investors, LLC., to be the person whose name is subscribed to the within instrument and acknowledged
to me that he executed the same in his authorized capacity, and that by his signature on the instrument
the person, or the entity upon behalf of which the person acted, executed the instrument.
WITNESS MY HAND AND OFFICIAL SEAL.
MIT 1RF
COMM. p163816383t37 z
[SEAL] i Notafy Public - California X
Riverside County
Signature iComm. Ex ices Jam 1!� 2010+
EXHIBIT "A"
Legal Description
Parcel No. l :
Lot 21 (the "Lot") of Tract No. 33076-2 as shown on Subdivision Map (the "Map") recorded on
November 29, 2005, in Book 393, Pages 61 to 80, inclusive, of Maps, in the Office of the Riverside
County Recorder.
EXCEPTING AND RESERVING THEREFROM TO GRANTOR, and its successors, assigns,
invitees, licensees and employees, together with the right to grant and transfer all or a portion of the
same, all easements and rights for access, ingress, egress, encroachment, maintenance, drainage,
support, and for other purposes over the Association Maintenance Areas and other portion of the Lot,
reserved to Grantor in the following instruments:
l . The Declaration of Covenants, Conditions and Restrictions and Reservation of Easements
for The Madison Club Owners Association (the "Declaration"), recorded on September 13, 2005, as
Instrument No. 2005-754387, of Official Records of Riverside County, California (the "Official
Records");
FURTHER RESERVING THEREFROM, the right to enter the Lot for a term of twelve
(12) months following the recordation of this Grant Deed, to complete and repair any improvements or
landscaping located thereon as determined necessary by Grantor, in its sole discretion, in order to
comply with requirements for the recordation of the Final Tract Map, the grading of said Tract and/or in
compliance with the requirements of applicable governmental agencies. Such entry by Grantor shall be
preceded by reasonable notice to Grantee before such entry. If this reservation of right of entry is not
complied with by Grantee, Grantor may enforce this right of entry in a court of law. Grantee shall be
responsible for all damages arising out of said breach including attorneys' fees and court costs. This
reservation of right of entry shall automatically expire twelve (12) months from the recordation of this
Grant Deed.
Parcel No. 2:
Nonexclusive easements for access, ingress, egress, drainage, maintenance, repairs and for other
purposes, all as described in the Declaration.
SUBJECT TOE
Non delinquent general, special and supplemental real property taxes and assessments.
2. All other covenants, conditions, restrictions, reservations, easements, rights and rights -of -
way of record including, without imitation, the Declaration and the Map for Tract No. 33076-2.
Grantee, by acceptance and recordation of this Grant Deed, hereby (a) accepts and approves all
of the foregoing in this Grant Deed, (b) grants to Grantor and The Madison Club Owners Association
such powers and rights as are set forth in the Declaration, and (c) accepts, covenants and agrees to be
bound by and assume performance of all of the applicable provisions and requirements set forth in the
Declaration, including Section 13.15 establishing the procedure for resolving disputes with Grantor, and
the notice, which provisions and requirements are acknowledged to be reasonable and incorporated
herein by this reference thereto. This grant is conditioned upon the performance of such provisions and
requirements as are to be performed by Grantee under the Declaration. The restrictions on use and
occupancy of the Lot are set forth in the Declaration to which this Grant Deed is specifically and
expressly made subject.
GRANTEE HEREBY ACCEPTS AND APPROVES THE FOREGOING, granting unto Grantor
and The adiso lub Owners Ass iagip such powers and rights which are set forth in the
DecKr tic de d above, on + , 1007.
Georgelf Kimberly K. He s r
STATE OF a )
L 1) SS.
COUNTY OFn /.��7 ,t'p�� -f J ) n '
A }f J
On �J� . 2007, before nLe l a
notary public in and for'said State, personally appeared George J. Heuser and Kimberly K, He -user
personally known to me (or proved to me on the basis of satisfactory evidence) to be the persons whose
names are subscribed to the within instrument and acknowledged to me that they executed the same in
their authorized capacities, and that by their signature on the instrument the persons, or the entity upon
behalf of which the persons acted, executed the instrument.
WITNESS MY HAND AND OFFICIAL SEAL.
:MT:::
ON
363
[SEAL] UPOW"
UNW
Signature7, 2011