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SFD (9512-009),r LICENSED CONTRACTOR DECLARATION I hereby affirm 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. 629265 B 1/14/96 License # " Lic. Class Exp. Date date �l mt1. 441 SignatureofContractor, ,,51.,..... ' OWNER -BUILDER DECLARATION J 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 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 sejf-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 Sya, - it Policy No. rca,zs (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: ,/!_ 41 s9<' Applicants''`::./ 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 inspection purposes. Ig ( /Ag )'sem-~ 1,//D at -Signature Owner ent Date A"' t, BUILDING PERMIT PERMIT�1-12-0 $9 DATE 1Z 1 VALUATION �� 14'1 �8 •e�iS LOT Z1 TRACT :S L 1.` I 15 JOB SITE ADDRESS a1-895.AVENI A 1�I.FANDOZA TPN 77XIS1-019 OWNER CONTRACTOR i�:,Vi.,iF1XV41 DESERT SORT HOME DEVE:LOPMENi i 78.035 MY i 11' 7 5,, 63$ .Hi+JHWA.Y 111 LA QUiNTA CA 92753 LA QLMIJTYk CA 92253 CU -If 1864 DESIGNERIENGINEER USE OF PERMITINCLE b'ANIII .y DWS LL. k4o .P& MIT L)CI S NOT INCLUDE l3LOM WALLS OR POOL FEE DESCRIPTION FEES TRACT CONSTRUCTION 1,717,00 SF 1 oii mwrio 206.00 SP Gni"RAG11C'ARPO'RT 400.00 SF ` EXHUATE;D CAST OF CONSTRUCTION 1#3181Z90 PCHN(1C' N EEa Si) MM'ARY , FEE DEPOSIT 1 4250.00 PLAN CHECK FM 10.1-000-439-318 3� 12.90 CONSTRi1MON FEG 10.1*000418.000 $455.50 MECHANICAL FEF 101-M4,21-000 $.53.50 NKLECTRICAL 'FFE 101-000420-000 $1.31.60 STOI Oft,10T1ON FE - IZ?3M 100.000.241-000 $10.38 GRAD1140 FEIN 101-OW421-0()0 520.00 INFRASTRUCTURE FEE 225,400-"3-342 $2,274,14 PRECtSF,'PL AN 101-000-441-345 $25.00 ART IN PLIftIC PLACES - RESID 701-000-255-000 $20.00 "PLM1BfJNG FEE 101-000-419-000 $145.50 SUB -TOTAL CONSTRUCTMON AND PLA7J CHECK $3;883.52 LESS PRE -PAID FEES 4250.00 ;o a TOTAL 'PERM.IT FEES DUENow $3,fi33.52 OFA Q , 1� J RECEIPT 'DA� / BV 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 Steelft 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 7 Drywall - Int. Lath Final Final 4g 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 APPROVAL Gas Test Electric Final Waste Lines f10LHeater 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 /7 / f 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) Building— / Address J .// Owner Nt_ S /? i Sow h% Mailing Address 71 _ -3 City Zip T4,ht 4 7 P.O. BOX 1504 APPLICATION ONLY 78-105 CALLE ESTADO A LA QUINTA, CALIFORNIA 92253 ` L tiff 011/*711 1 f - ,- s3 1 sz-, y - _173 Contractor D4 SE,/?T S1/.' H /,l/VE7 0,d- V, 141e - Address 7,9 - 3� S CityZip Tel. ',4A at//�t/T•7 9Sri y _5l �73 State Lic. City & Classif. C Z ��.5 Lic. # Designer' 94" -SLAT -SO%✓ Address Tel. %fir - 3 Z ss ///C,// )414 >"// / City Zip State Z/9 D�///V2 '% 9y i s Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my licerise'is in full force and effect. SIGNATUR1 DATE OWN ER. BUILDERtECLARATION .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) 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 (3500). FJ 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 suchimprovements 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 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 contractors) licensed pursuant to the Contractor's License Law.) tl 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 Co�T'�ens�aIi I s ranee, or a certified co y thereof. (Sec. 3800, Labor Code.) Policy No. /1lC� Company �� T� 1Z Al y r7 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 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 pe mit is i sued. (Sec. 3097, ''vil Code), Lender's Name- i k. 5-7 /�'//�/F' / Lender's Address e,41- 4- • /Q ,/9 p 1 J /_ CQ 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 applicant//�%rJ 5�%/ �r>T s1L-x1s-�� Date Mailing Address%/ '] f? ll G✓/' ! 1 ' City, State, Zip /1 /? fie �' / r� 7 s' a BUILDING DIVISION JILDING: TYPE �CONST. �i (O',CC. GRP. P. Number -7/I3_/0/_6/1f /-/✓n G �9 gal Description - oject Description ZONE: BY: Minimum Setback Distances: Front Setback from Rear Setback from Side Street Set t 06 Side SetbackfromII rG A FINAL DATE INS Issued by: Date j Validated by: 1 Validation: L rop Ine Cienliekine Sq. Ft. _Size 1-%/ —7 No. No. Dw. Stories 1 Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. 5 Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. i Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Rear Setback from Side Street Set t 06 Side SetbackfromII rG A FINAL DATE INS Issued by: Date j Validated by: 1 Validation: L rop Ine Cienliekine CONSTRUCTION ESTIMATE NO, ELECTRICAL FEES NO. PLUMBING FEES 1ST FL SO. FT. g $ 2ND FL. SO. FT. POR. SQ. FT. @ GAR. SD, FT, @ CAR P. I SQ. FT. WALL SO. FT. (E? SQ. FT. @ ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. 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.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEOUIP. LAUNDRY TRAY 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. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 1% c SEWAGE DISPOSAL SO.FT.GAR @ 3hc 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 APPJEOUIP. 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. 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 12/1/95 Desert Sands Unified School District 82-879 Highway 111 Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE No. 13924 Owner NameDesert Son Development APN # 773-181-018&019 Jurisdiction La Quinta No. 51895 Street Avenida Mendoza City La Quinta zip 92253 Tract # Type of Development Comments Lot # Single Family Residence Permit # Log # Study Area 113 Square Footage 1717 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 1,717 or $2,953.24 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. x Fees Paid ByDesert Son Development, Inc. ,�f ephine 5564-56 3`P Name on the check By Dolores A. Ballesteros Superintendent Fee collected /exempted by Pauline Pearson Payment Received $2,953.24 Check No. 5384 Signature ` &a a 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 Th; t turnrN . ,, 92253 f • jCovertament Code 6103) MAIL TAX STATEMENTS TO . ,srt Son Home Development Inc. 78:`365 HWY 111 #185 Lo Quinta,CA.•92253 +,jInj DOPES NO ESCROW No_, SPACE ABOVE THIS LINE FOR RECORDER'S USE GRANT DEED THE UNDERSIGNED GRANTOR(S) DECLARE(S) DOCUMENTARY TRANSFER TAX is $ -0 ❑ computed on full value of property conveyed, or ❑ computed on full value less value of liens ori%n�6TP[jnces remaining at time of sale. ❑ unincorporated area ❑ city of _ , AND FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Desert Son Home Development Inc.,a California Corporation hereby GRANT(s) to Desert Som Home Development Inc., a California Corporation. the following described real property in the County of Riverside State of California: (PROPERTY DESCRIPTION) Lots 6 and 7,Block 118, of Santa Carmelita at Vale La Quinta,unit 12 as shown by Map on file in Book 18 Page 79 and 80 of Maps in the office of the County Recorder of Riverside County,CA. This deed reflects Parcel Merger No. -- as approvedf by the City of La Quinta. (deed notarized)� Dated — %.. STATE OF CALIFORNIA COUNTY OF SS. On this day of in the year before me, the undersigned, a Notary Public in and for said State, personally appeared p personally known to me p proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to this instrument, and acknowl- edged to me that he (she or they) executed it. Signature NOTARY PUBLIC IN AND FOR SAID STATE (This area for official n^io.,., . .0 MAIL TAX STATE$'ENTS AS DIRECTED ABOVE. NJ