0202-123 (SFD)LICENSED CONTRACTOR 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 # Lic. Class Exp. Date
71:�iI (r 1'11x(
Date %/2 4 � Signature of ContractorYR�L,,�'� �
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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) 1`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.
Q) 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 STATE FUND Policy No. 046020009691
(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 Section 3700 of the Labor
Code, I shall forthwith comply with,.those provisions- "
Date: Applicant— 10
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 ins�ection:Purpbs'
Signature (Owner/Agent)''= -J- JJt- - Date
BUILDING PERMIT PERMIT#
23
DATE VALUATION oR Q4.��,
t i�!'!�i ��c, c J ,3o .IvJOB SITE °T �r TRACT
ADDRESS 77-6615i`1i.�7��.K sj�. TONTAi�a 1.�e4� APN
OWNER i CONTRACTOR / DESIGNER / ENGINEER
'ell/14 E ' '°�z1 MHE T, X CaWEER 03+1amiu"EON
660 CHICAGO AVE BUYIS <3-7
MUNMEMZ+ CA 'M_ M 1U1C)ii'N"TAIN C3LER 0.4%. 92561
(760349-9823 C1 Vf1 1_4615
USE OF PERMIT.
WIN= MAIL-TOWFELLWO
SPI) • PERMIT0Oa'�,;�'t OT INC1,LIDE BLOCK WA1,1., POOL OR DRIVEWAY
Wit 98 COD& ik%
1'12&CT t ON s k RUC'F'1P�AF 11$11?100 3F
POR-CIMIX110 10.400 SF
2_°�"�•'.Cl�t1A CO,' -Tr C.VF CONS?RiY'C,7110TT
SUB-T07'A , CONST RUCiOW AM)PLAN CHECK
AMU
RECEIPT I DATE / J I BY i " I DATE FINALED I INSPECTOR
4250,00
X4: 21%mt
PLN CHECK Me
101-000-439-318
65ft
FPE O&POSIT
101-000-439-318
4250.
MECHANICAL FU
F-191 TICAL 9z';'GF: A
101-000-420-000
PLUMBING TITIP51
101-V00-419-000
S'1'11.0M MOTION ''FF - 9010
101-000.241-000
jr $9,
n_ KAMM Re
101-000.42.3.0110+
4
DIVIZI OPER 11d91'ACT I=
�1 M120,
PRECIA FTL4141
101.000441.34fi
$100,
C:ak4VrRUCr101d mr,
0 -OCR)-418.000
$617.
SUB-T07'A , CONST RUCiOW AM)PLAN CHECK
AMU
RECEIPT I DATE / J I BY i " I DATE FINALED I INSPECTOR
4250,00
X4: 21%mt
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
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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
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
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
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)
* .'.�r`tiwy
7 7– �ojo✓ � TAtyl����i�J,!6/ji'Zl+� P.O. BOX 1504
/rvV 78-495 CALLE TAMPICO APPLICATION ONLY
AddresBuildins �' � LLtf (�1i1 LA QUINTA, CALIFORNIA 92253
Owner L,)-
�`
n r
Mailing C /
Address I Rl o �.•Ca cv) AN %l 6
Z (2-&?' I lei, aq)-??9
ty
State Lic. City
& Classif.Lia a
Designer
Address Tel.
CityI Zip I State I
Lic. N
I DECLARATION
of Chapter 9 (comSnencing with Section
Code, and my lic9hse is in full force and
OWNER -BUILDER DECLARATION
I hereby 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).
I: 1, 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.)
I 11, 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 properly who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Y7 I am exempt under Sec. B. & P.C. for this rea on—
Date !i i* 7 f/ G/Owner��� �1/-'77[A ( l
AW
r -
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3900, Labor Code.)
Policy No. Company
n Copy is filed with the city. O 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.)
I certify that in the performance of thg worryc for which this ermit is issued, I shall not
employ apy person in any menner-so as to pecomer. b'j cfto the Workers' Compensation
Laws /bf aliJo
L his.
Date Owner
NOTICE TO, AP 'ICANT: If, after making this Ce irrcale -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
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.
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 adplicant —Date—
Mailing
ateMailing Address
City, State, Zip
BUILDING: TYPE'CONST. �i'' — OCC. GRP.
A.P. Number
Legal Description
Project Description �f
Sq. Ft. /1"/ 3
Size
Newh Add ❑
imated valuation
No.
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure `
TOTAL
REMARKS �--
No. Dw.
Units
Alter ❑ Repair ❑ Demolition ❑
/ ] i . 1". , 1,
AMOUNT
C%
ZONE: r 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:
WHITE = FINANCE YELLOW = APPLICANT
PINK = BUILDING DIVISION
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 3/20/02
No. 23 063
Owner NameW/R Enterprises
N0.77665 Street Avenida Montezuma
City La Quinta
Tract # BLK150
APN# 773-085-001
Jurisdiction La Quinta
Permit # 0202-123
Log #
Zip 92253 Study Area
Lot # 21 Square Footage 1513
Type of Development Single Family Residence No. of units 1
Comments
ew Single Family Residence of 1513 sq. ft.
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
2.14 X 1,513 or $ 3,237.82 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
Fees Paid By Cash - Ed Whitson Telephone. 7909/779-6000
Name on the check
w
By Dr. Doris Wilson -
Superintendent `
Fee collected /exempted by Crystal Scott Payment Received $3,23.7.82
Check No. Cash
Signature
40TICE: Pursuant to Assembly 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
ibove 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
:ollect 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
SENT BY: HP LASERJET 3150; 7607732819; NOV-29-01 9:03AM;
10/30/2001 15:x' 760-773-2819
UU YAA YAMERIERICAN! TITLE
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PAGE 3
PAGE 04
4u VV L
1
- RV: 1994 0044841 I
ii 10/30/2001 02:16 PM I of 9
-no I
TO: American Title Escrow
American Title Insurance Company
Escrow Division
72393 Highway 111, Suite B
Palm Desert, CA 92260
(760) 773-3776 Fax (760) 773-3228
SALE ESCROW INSTRUCTIONS
Date: October 30, 2001
Escrow officer: Sharon D. Elkins
Escrow Number: 01 -1986 -SE
AMERICAN TITLE ESCROW CONDUCTS ESCROW BUSINESS UNDER LICENSE IDENTIFICATION NO. 371
ISSUED BY THE CALIFORNIA DEPARTMENT OF INSURANCE.
Ed Bernardino, (hereinafter known as Buyer) agree to purchase from Jeanne Kranhold, .(hereinafter known as Seller) the real
property setforth herein per the terms, conditions, consideration and instructions hereinafter stated. The Seller and Buyer
herein shall deliver these signed escrow instructions to American Title Escrow, (hereinafter known as Escrow Holder).
Terms of Transaction
Buyer will deposit, prior to close of escrow, the sum of
$ 60,000.00
To Complete the Total Consideration of
$ 60,000.00
Said total consideration is allocated as follows: $30,000.00 per lot.
Furthermore, 1 will execute and deliver any instruments and/or funds which this escrow requires to show title as called for, all
of which you are instructed to use on or before November 13, 2001, provided you hold a Policy of Title insurance with the
usual title company's exceptions, with a liability of not less than $60,000.00, covering property in the City of La Quinta,
County of Riverside, State of California, described as follows:
Parcel 1: Lot 18 of Block 218 of Santa Carmelita at Vale La Quinta and as more fully described in the preliminary title
report to be issued.
Parcel 2: Lot 24 of Block 64 of Santa Carmelita at Vale La Quinta and as more fully described in the preliminary title report
to be issued.
COMMONLY KNOWN AS: APN: 773-085-001 / 774-053-007, Lauinta, CA
Q s /- Z�' � Dq �' f/eyk,PJt
SHOWING TITLE VESTED 1N: Ed Bernardino, (Vesting to be Determined prior to Close of Escrow)
SUBJECT TO:
(1) General and Special County and City (if any) Taxes for the current fiscal year, not due or delinquent, including any special
levies, payments for which are included therein and collected therewith.
(2) Lien of Supplemental Taxes, if any, assessed pursuant to the provisions of Chapter 3.5 (commencing with Section 75) of
the Revenue and Taxation Code of the State of California.
(3) Covenants, Conditions and Restrictions, reservations easements for public utilities, districts, water companies, alleys and
streets, rights and rights of way of record, if any; also exceptions of oil, gas, minerals and hydrocarbons, and/or lease, if
any, without the right of surface entry.
INSTRUCTIONS TO ESCROW:
NO REAL ESTATE BROKER INVOLVED: As there are NO Real Estate Brokers in this transaction NO Deposit Receipt
has been executed, these instructions, therefore, constitute the only written agreement between the parties hereto.
r/
I_ CFr TD A Arc, A nrnrr -' -- . . .
1
RC DISTRICT - PLANNING REVIEW FORM
This form is to be used by CDD staff for review of single family dwellings in the RC (Cove
Residential) District per Section 9.50.090 of the Zoning Code. Its purpose is to determine:
1) that the proposed house design does not duplicate the same architectural style of any
house within 200 feet of the applicant, and/or 2) if there is a need for the applicant to file for
Master Design Guidelines. If the applicant does need to file a Master Design Guideline, please
transmitted this information to the Building and Safety Department as part of your correction
list. Please attach additional explanations as necessary.
APPLICANT VIR. Enterprises - Shevitski Construction
SITE ADDRESS e'a-'ti=r_e3r
APN 77-1 CASE NO.: 2002-611
LEGAL: LOT 2,4 BLOCK &q UNIT Cr S.C.@V.L.Q.
CHECK AND APPROVED BY
[dally Nesbit DATE:
Inform the assigned Building plan checker upon your assignment to this case. The CDD
Executive Secretary maintains a log book to track applications and assign case numbers.
REQUIRED ITEM
Y
N
COMMENT/CORRECTION
Verify legal and APN information
Consistent with MDG on file (as
applicable
MDG filing required (5 filings since
9/3/98)
Architectural variety within 200 feet of
the surrounding area:
Colors
Materials
Architectural design features
Gp Lo+'G S i"fl $.-r u t1-ff
su't/l�Uu^"ii'G /►2G/a
AppruveM
Other Requirements: 0 Planning Commission
17 City Council
Community D
Initials
Case No)&c oZ
Exhibit
VWith C
v. Dept.
...., .,.,_.�...
- -3- 7-
s
m
F
Earth Systems
�/ Southwest
79-811 B Country Club Drive
Bermuda Dunes, CA 92201 • (760) 345-1588
Client Name
Client Address
Client Phone
FIELD DAILY
A• r. I T ... -.Y' .. • . y lar .Y • .�
DATE JOB NO.
PROJECT /
LOCATION
CONjAJgROWNER
WEATHER TEMP Oat AM
oat • PM
PRESENT AT SITE {�
TEST
NUMBER
w..
j
FooTf1Vhf G
LOT
NUMBER
ELEVATION
FIELD TESTING
REFERENCE CURVE
MOISTURE
CONTENT,
96
DRY -
DENSITY
bs/cu. fl.
MAXIMUM
DRY
DENSITY
MAXIMUM
.DRY
DENSbsku.ITf.
OPTIMUM
MOISTURE
CO�ENT
FbFUZ
Tf;'
I iC.
VIA,
�(jvrrNGS f%1vc���
�;
i
I' (' /�
REMARKS: POW /1 J I 7- ) � 2 7—&S -r.
&Sr. S ArrtlKS 10
�►2 1-neg 1&9 A/Ohd A//�-
Ci.�,�n XV r, e,W1 A42 %,0,,JPV
LIMITATIONS: This report is to provide infon
corrective'acUon, additional testin and or obser
-.re ort is subject o review bytthe protect manap
- CLIENT REPRESENTATIVE SIGNATURE
BD-FS'001_(42/01 j
ling the status of the field conditions and our opinion as to the need for
guarantee or v