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SFD (9512-023)78835 Lowe Dr 9512-023 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Sectiori'7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. }cense # Lich. Class` Exp!6a.,t e "Date ntractor OWNER -BUILDER DECLARATION I hereby affirm 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 SignatureofOwner 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 GTa1,p 1z?1MIi1 Policy No. (KRAA0,17_44 (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 Lqb6r bode, ILII forthXuith comply with thopq, provisl ps Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. .1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application agrees to, & shall, indemnify & hold harmless the City of Indian Wells, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above mentioned property for Inspec 'on rposes rSignature (Owner/Agent) /> ' ✓ A`°' BUILDING PERMIT PERMIT9412 4)2. DATE 12/14/9.5 VALUATION Sff7r012.1111 LOT 178 TRACT 23268 JOB SITE ADDRESS 79-835 a,0'b E DRIVE, APN . 604-23X009 S NER CONTRACTOR • : Y1rL LAND )aEi :LUP.:i1 jC. EXCF,L LAND DEV INC P.O. BOX, 996 42-335 WASHMMN STE. F310 PALM DESERT CA 922.60 LA QUIN-CA. CA 4.2253 (619)360.2402 C,BIN DESIGNER/ENGINEER (619)360-2402 USE OF PEAMIT9jNGLE FAiNILY iiINELL,ING Pannit does itot include block wdU or pool. FEE DESCRIPTION FEES TRACT Ct.'tNS'I.IRiJMON 1.94$.00 SF PQRCHiPATIO 80.00 S:F GARAGE/CARPDXr 519.00 SF ES fl iNIATE,: a CaSI O COiNSB':i- UCTIOiii 117,012.0 lis "1117 r,EVSUMMARY PLAN CHFZK FIFE 101-000-430-318 SM Z2 CORISTRLIC'iTION FEE 101-000-418-000 $70.2.50 1VW:, A%1NICAi.,FEE 101-000,42.1.000 $66.50 ' EL:FCT:R.ICAL F K 101 -NO -120-000 5142.06 PLUXIBiNQ FEE 101-000-4.19-000 $164.75 NfO*tIG :. OTION FIE - RE -SID 100.000-241-000 $11.70 GRADING I EE 101-000423-000 $20.00 INMLiT UCTURB ME 225-iJi3CT-443-342 52,608.83 PRECISE PLAN 101-000-441.-345 $25.00 ART IN PUBLICPLACES . RESM 701-00.0-155-000 S42.53 FEET DEPOSIT 4250.00 'f TOTAL CONS'MUMION AND PLAN CHECK $4,379.51. LESS PREPAID -$250.00 / Dee IAL PERMIT.FEES DUE INTOW 1 s ^lN4,iZ9.51. gy 1995 RECEIPT DATE 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 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 ItaPOOLS BLOCKWALL P OVALS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final Gas Piping PLUMBING APPVALS Gas Test Electric Final Waste Lines 4Heater 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 Final Utility Notice (Gas) ELECTRICAL 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) PPROVALS fl I COMMENTS: '•— BOXLLE 504 APPLICATION ONLY c Building 1(f, 3 t/ r .n, LA Q 7&105 CUINTA, CALIFORNIA 92253 A(irlracj /s i ) \ t/'Ll' ' Owner fXcf_ Mailing _ Address City Zip Tel. Contractor Address Zip I Tel. State Lic. City & Classif. (-/ 4/ f 3 n Z_ Lic. # Arch., Engr., Designer A Address Tel. City( Zip ( State CA 4 H F R A ( ,,/ Z Lic. # LICENSED CONTRACTOO'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 ommencing with Section 7000) of Divisi7 of the Businespnd,ProfessYo° s Oode, nd.m .license is in full force and effect. I' 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 file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or 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 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 offeredfor 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 1 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.) I I I am exempt under Sec. B. & P.C. for this 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 Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company f7 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.) I certify that in the performance of thg 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: If, 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 it 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 BUILDING DIVISION BUILDING: TYPE CONST. OCC. GRP. A.P. Number 60 0 `/ a 3 3— © U f —_-3 Legal Description /- f / 7 V %s1 c Z 3 Z Project Description REMARKS 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: Validati Sq. Ft. Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. 2 S,0DD Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. v y Infrastructure TOTAL REMARKS 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: Validati CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. g $ 2ND FL, SQ. FT. p POR. SO. FT. @ GAR. SQ. FT. ® CAR P. SO. FT. WALL SO. FT. SO. FT. lq1 ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. I POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APP./EQUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB SQ. FT. rQ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ftq 1Y. c SEWAGE DISPOSAL SO.FT.GAR 3/ec HOUSE SEWER REMARKS: VENTILATION GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. L ' FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION _. FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL Notice: Document Cannot Be Duplicated Date 12/14/95 No. 13956 Desert Sands Unified School District 82-879 Highway 111 Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE Owner Name Excel Land Company No. 78835 Cit, La Quinta Street Lowe Dr. Tract # Lot # Type of Development Single Family Residence Comments APN # 604-233-009-3 Jurisdiction La Quints zip 92253 Permit # Log # Study Area 233 Square Footage 1948 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 1.72 x 1,948 or $3,350.56 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 Excel Self StorageTelephone,; 922-2001 Name on the check r, ; By Dolores A. Ballesteros P Superintendent r Fee collected /exempted by Pauline Pearson Payment Received' $3;350.56 Check No. 3463 Signature /(DALLI,&d.de 0J.1ALAAA,-q Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting NOV-27-95 MON 8:40 pf• F-ORQIN? REQUMWC4 NY tr 1, 1, •ret. a r1fSt Alfa Y ND WNIN MtCoftnao MAtt. TO V) ".-ItrEXCEL LAND, INC. Aeenaea R o. P o 9 G CITY h 'Y" iQ "Lr tvvcu+ y q;W2 Ti; J NAIL TA: •TATiM{MTa TO r- N.ws same: as above Aaona•• CITY • GrAYa I P. 01 N COR MLED ` Qx n IIL ` 8 .0 b — SPACE ABOVE. THIS LINE FOR RECORDER'S USE Pursuant to Section 11934 R b T Documentarytransfer'" 8-CPde••and"9ee':'j'2""Ord . No. 516 ❑ Computed on full value o prop* y votiveyy . dr Computed on full value less liens & enrumhrnnret remaininf thereon at time of *ale- ............................................................................... "$igniture of derlatent er B&Mdgiirrilinin tat =Firm none ' ✓r.t rh E]Uninrorttora(ed_Brea._.Cityof....... .. '.............. Grant Deed This form fund3hed by Orange Coast Title Company FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged. THOMAS A. THORNBURCH, an unmarried man herehy GRANT(S) to EXCEL LAND.DEVEWPMENT, INC.r.a California Corporation the following described real property in the county of Riverside , state of California: PANCnL l LOIS 177, 178 and 179, of Tract' No. 23268, as 'peY••map :ort file iu Book 213, Pages ' I67 to 73, of Maps, Records of Riverside County, California THIS DOCUMENT IS BEING RE-RDCORDED TO COPSOCT THE VESTING OF THE GRAMEE HEREIN. Dated May_6, 1992 STATE OF CALIFORNIA ) r~ Thomas A. Thornburgh Count of _ Ri.yerside) on June 8,, 1992 betare me. the under- signed --q Notary Public In and for said State. personally apparad -'-- - 'I'lihlflas-'ll. 'T ttr'nlitiiSh pnr•auSly kocwn w aw ow proved to .ae anthe hasis cf sutisfaaory evidence to be the persoo(s) whuse a,tne(s) Ware subssY'Ibod to the within irwtmmem and ackaowledged to me that lte/shchhey executed the some In his/hedMeir authorl=d capacily(ies), and that by bWher/litoir sigttature(s) on the lnsuvIncnt the permn(s), or the entity upon behalf of which the por- wn(s) actcd, excaded the Instmmem. WrrNESmy hand al seat. Signature FOR NOTARY BtiAL OR STAMP OFl2C><J►L gay, Kelly Lee ColliPU f r °TA,U1,E - QALiipq,Mb, Mr Qomm RUP" rocs Title Order No. _ LOCIVw No. I MAIL TAX STATEMENTS AS DIRECTED ABOVE