9804-122 (SFD)54705 Avenida Alvarado
LICENSED CONTRACTOR DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of
iChapter 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
0?13
Date Signature of Contractor
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).
()r) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). J'
() I am exempt under Section B&P.C. for this -reason s
,,bate E, i - ✓eY Signature of Owner,
4:—
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
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 or less).
Q) 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 Sectio -n73700 of the Labor
Code, I shall forthwith comply with those provi°sfo s.
yDatei 22V' ic5 APPlicant,41-_ !, . .mY / r
Y
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 representatives of this City to enter upon
the above-mentioned property for inspectionfp u rrpoose s?y' +
Slgnature (Owner/Agent) r ' G' Dater ~ S J
u
PERMIT # CONTROL #
BUILDING PERMIT
9804-122
DATE jj VALUATION x88,953 90 LOT TRACT
.7093
1; h,4/zj
JOB s
ADDRESS 54.705 AVENIDA ALVARADO
APN
774-272-022
OWNER
CONTRACTOR / DESIGNER / ENGINEER
PINE MOUNTAIN REAL MATE INC
OWNER E "BUILD R.
73170 AMBER ST ,
PALM DESERT CA 92260
CBL#
USE OF PERMIT
SFD
SM- - PERMIT DORS NOT 1NCi JIN W OCK WAI.:f;.S OR POOL
TRACT CONSTRUCTION I: SSA) SF
PORCUMATIO 15.0 5F .
- GARAODCARPOR.T 430.00 SF
6 FT. WOOD FFNCE 200.00 LF
I STIMA T ED COST Or CONSTRUCTION
88,953.911
PEI',2I1HT EEE SUMMARY
CONTrRUCTIONFiEE 101-000-416-000 $590.00
PLAN CHEr.K FEE 101-000-439-318 $499,42
MF.CH.A'NICAL Fhb 101-00"21-000 $60.00
ELECC'MICAL FEE 101-000-420-000 $128.78
PLUNIBINGFEE `r 10.1-000-419-000 5121.50
.
STRONG MOTION FEE - RESID 101-0100-241-000 $8.90
GRADING FEF: 10.1-000423-000 S2t),00
INFRA3` RUCT'URE n. -F 22_5-000.443-342 51,938. T3
PRECISE PLAN ;w 101-000-441.345
4
FBE:D 108IT 101-000-439-318 5250.00
JBJTT DAL CONSfRUC110N AND PLAN CHECK
$3,412.32
0 1,E -SS P1tE-PAID FEES
-$250.00
C0000 44 TOTAL PEi A11T I+ CES DUE 1VC►W
$3.162.32
t9 r—
_
. =i 1
IIIIIIIII IIIIIIIIIIIIIIII 06
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RECEIPT
DATE
BY r
D F ALD
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
_
Return Air
Steel
Combustion Air
Roof Deck
_ _
�
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
//r�
Compressor
Insulation
/�l/ 9-�
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
Z /
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond 71
Footings
Main Drain
Bond Beam
Approval to Cover
3Z"
9�E�/
�7 9
Equipment Location
01
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
(��
Encapsulation
Gas Piping
Gas Test
S
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
9eI.4
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)
a2
Notice:
Document Cannot Be Duplicated
Date 8/17/98
No. 17539
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Owner NamePine Mountain Real Estate Inc.
No. 54-705
City La Quinta
Tract #
Street Avenida Alvarado
Lot #
Type of Development Single Family Residence
Comments
Jurisdiction
APN # 774-272-022
La Quinta
Permit #
Log #
Zip 92253 Study Area
I
Square Footage 1,448
No. of Units 1
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered
patios/walkways, residential additions under 500 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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
1.93 X 1,448 or $ 2,794.64 the property listed above and that building 4,
permits and/or Certificates of Occupancy for this square footage in this proposed project niay now -be issued
Fees Paid By CC/Union Bank of California/Dave Peters ' o4none J340-4844
1 ;7 -
Name on the check ,
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green
Signature (____Juetx i
Payment Received $2,794.64
Check No. 5999017
NOTICE: Pursuant of A(; embly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that 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 the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
t
` IIIIIIIIIIIIIIIIIIIIIIIII
07
IE
APN # 774-272-022
La Quinta
Permit #
Log #
Zip 92253 Study Area
I
Square Footage 1,448
No. of Units 1
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered
patios/walkways, residential additions under 500 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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
1.93 X 1,448 or $ 2,794.64 the property listed above and that building 4,
permits and/or Certificates of Occupancy for this square footage in this proposed project niay now -be issued
Fees Paid By CC/Union Bank of California/Dave Peters ' o4none J340-4844
1 ;7 -
Name on the check ,
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green
Signature (____Juetx i
Payment Received $2,794.64
Check No. 5999017
NOTICE: Pursuant of A(; embly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that 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 the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
t
I IIIIIII VIII III VIII IIII 08mown
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084844
RECORDING REQUEsm BY:
OLD REPUBLIC TITLE COMPACOMPANY
98.7238KC 106276-13
WHb§LMO
LqjRR&kJyDEE &D,
CALIFORNIA DESERT CONSTRUCTION
dba PIM Mwtaln RS
73170 AMBER STREET
PALM DESERT, CA 92260
I
RECEIVED FOR RECORI
AT 8:00 AM
FD
PAID
oc. Transfer Tax
Fv. .
Co. r*,,vfLlar
ABOVE THIS LI
MAR - 9 1998
�ii11De1�
fM.u►. A.r1.r- �/
t?eoordrr
Fees $«.�,.�
%RANT DEED Arm: / /4-z7z-Uzz
7X8 0,:,70 - D/J`
The undersigned grantor(s) declare(s):
Documentary transfer tax is $18•.70
. full value of property conveyed, or
( ) 'C''�M 'ted`on full value less liens and encumbrances remaining
( ) Unincorporated area: ( ) City of
at time of sale.
, and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
ROBERT B. KELLOGG, TRUSTEE OF THE KELLOGG REVOCABLE FAMILY TRUST
hereby GRANT(S) to
CALIFORNIA DESERT CONSTRUCTION DBA OF PINE MOUNTAIN REAL ESTATE, INC. A CALIFORNIA
CORPORATION
the real property in the City of LA QUINTA, County of Riverside, State of California,
described as:
LOT 10 IN BLOCK 269 OF SANTA CARMELITA AT VALE LA QUINTA, UNIT NO. 25, AS PER
MAP RECORDED IN BOOK 19, PAGE 50 AND 51 OF MAPS, RECORDS OF RIVERSIDE COUNTY,
CALIFORNIA
Dated February 17, 1998
State of California
County of) S.S.
On
before mer
personally appeared
personally known to me (or proved to me on
the basis of satisfactory evidence) to be
,he person ka.) whose name (.a', is/4e subscribed
to the within instrument and acknowledged to
mP that he/sem/tphey executed the same in
his/heir/t.herir authorized capacity(yes) , and
that by his/hear/Wboir signature (a� on the
instrument the person(s), or the entity upon
behalf of which the person(ei acted, executed
the instrument.
WITNESS my, hand and of€s�. al seal.
Signature IAi9).�_\�atx.a¢.-...
MAIL TAX STATEMENTS Tot sAm As ABOVE
iE
L
- - M /. -
ROBERT B. KELLOGG, TRUSTEE
OF THE KELLOGG REVOCABLE FAMILY TRUST
.4.r�.�
l.ILLtAN L. VANCE
Comn*Von # 1090664
O Notary Pubdc -- California
Son Diego County
My comm. Expires May 17.2000
(This area for official notarial seal)
'k
A4Pirie
Mountain
Real Estate Inc.
73-170 Amber . Palm Desert, CA 92260
(619) 340-9844
APRIL 1-3, 1998
GREG BUTLER
DEAR GREG BUTLER,
PLEASE.BE.ADVISED THAT DAVID PETERS AND DOUG PETERS
6TH 4Ff•ICERS'OF PINE: MOUNTAIN REAL-' ESTATE INCA
- DBA,.',.DAL"IFORNIA DESERT CONSTRUCTION) .
_F#E : WI LL : BE...:T.HE:"ONLY ONES. WORKING ON OUR BEHALF ON
T; ° ,pfZQ04&— .AT` 54705 ALVARADO, IN THE CITY OF LA Qi
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77!:PETER S
IIIIIIIIVIIIIIIVIIIIIII
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DEAR GREG BUTLER,
PLEASE.BE.ADVISED THAT DAVID PETERS AND DOUG PETERS
6TH 4Ff•ICERS'OF PINE: MOUNTAIN REAL-' ESTATE INCA
- DBA,.',.DAL"IFORNIA DESERT CONSTRUCTION) .
_F#E : WI LL : BE...:T.HE:"ONLY ONES. WORKING ON OUR BEHALF ON
T; ° ,pfZQ04&— .AT` 54705 ALVARADO, IN THE CITY OF LA Qi
U I NTA..
TIN
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77!:PETER S
JCS$ ADI.ORESSS�.1Q iABDO PERMIT NUMBER �� _ OWNS AI
? hl % lt�l IaR�3mow Wh wIth the B Only I
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work.I
of buddinu permit r -&%r e.,h n11 ttolntu mint tlA CnrnrJeted hv•enolicant.
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