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SFD (0106-187)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 11 C20 C36 Date.— Signature of Contractor �1`< -.--•-• —.---,•-^-.-.. -~-"'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 :fhe 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). () 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 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. 7ATlt:RTND 2.2,x-00.00203150 (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: fI Applicant `��' 'f "kll Gf {„•„ yN.%•'•^w•'?:fir ISN+' v(.u�'7/ Warning::.Failure.to.secur.e 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 inspection purposes. Signature (Owner/Agent) 4� u' i ,WDate ,,' .:�,,,.�„a.r:��,.y`•Ya"c�Nm:.+g;�P�"��+"'a�'''-u� �yn d' v +r' BUILDING PERMIT PERMIT# DA VALUATION LOTTRACT S97R,10110 16 RUK 121 JOB SITE APN ADDRESS OWNER CONTRACTOR/DESIGNER/ENGINEER CORP DGH DEV ELOP-Wad'! Y CORP 70.921 RUNAWAY ILAY 98.931 RUNAWAY BAY MMUDADUN.rES CA, 92261 BEf%iii:4:DA.U01M CA 92261 - (760)36 -8706 CMA 1526 USE OF PERMIT &.MOLF, rAWLY VMLIDIO S•1t1 - PERMIT DUDS VOT WC1.UDE f''0011 &SPA OR DRIlr.YWA"Y lal't.00CH - 75% PLAN C1'1'lltw.`K PLIF.11i'<OUC"' 1060 FOR IS JC1AN0 OF SAME PLAN TYPL? TRt1±:T CONS'MU TION 1y3s3.OQ SF POK11"M1.1.0 24.00 SY QXfdAMC•AIY.P0:91.T (SM, 0,624.00 5 IFP. 111001) lrhNC1; 200.00 Ur 6 p"C. 11YAAU, 121.M uF ISS;i;Tf ATE3. D +COS° ' 0p{ CONMU(M011 97,010.10 MAP 5;1)1 C1C.F€ 4 101-C1o)-439.318 &126.01 €N.3+g-,`g�,pCy't- 4350.00 �,,ttyy.��k�y�i��9l1ttLgg�•+�',,t���rySl,�Y�'qq 22�g tt fi +:�47�-I:v��1y[�► _Mn�1ViA.Lt RM'A' L M"i'iA'� A01-R/i+l�-421."�J00 ss&fio 91, LLITAICAI1 f`LS 101-000-420-000 13110.46 I'L4FMBIN-0 Tom+ '1012000.41,9 -HOLD 31W15 STRON10 14::C9`T ON FEE - R.ESIXD 101-000-241-000 $9.39 ARA.f31.1a10 F99 101-M-4213-000 $20,00 ' DF,VZ OP?P. IMPACT 1f1M $1,90?'x. o PREMISE PLAN 101-000.441-345 5103.00 COIQ';MUCT10�4 I -W, 1011.000.418t.•000 n. 1p l Y0 Wd21 H TIMP, IF DUE NOW a I /41 JUN 1 8 2001 CITY OF LA QUiNTA 5A.^ GP r RE m�m_ - .<--•DATE�r--- t `J - ' Bid DATE FINALED INSPECTOR 1 51 J i? G�� INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILNG APPROVALS MECHANICAL APPROVALS Set Backs --��� bt' _ �7 Underground Ducts Forms & Footings (o �� Ducts Slab Grade 6 Return Air Steel _ Combustion Air Roof Deck Pj- L'% -AI T Exhaust Fans O.K. to Wrap q_� —B( o�T F.A.U. Framing Compressor Insulation( .. Q ,�T Vents Fireplace P.L. Grills Fireplace T.O. Party Wall Insulation ! � /fj Fans & Controls Condensate- Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath ` _ C7TWt'��OT_ Final Final �� U( _ 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 7 -iL _O r / / 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) /4- O IF 3,� g=�` F �� s 4dir Building n Addressf)�r_Q' 0.0 (-kA City Zip ITel. v. Address ' ul�cv P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 State Lic. I City & Classif. L� _ Lic. # Arch., Engr., Designer r? f• K P !� S f� Address Tel. %t/ - CityZip State / /r) ' 'n'? 1- i Lic. # . LICENSED CONTRACTOR'S DECLARATION 1 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 license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: fSec. 7031.5,Business and Professions Code: Any city or county which requires a permil to construct, alter, Improve, demolish, or repair any structure, prior fo'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 thealleged 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)• 17 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, provitlad 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'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 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 n 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 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. 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 if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. 1 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 ap Mailing Addres City, State, Zi W D YAR 2 7 2001 PLICATION ONLY CITY OF LAQUINTA FINANCE DEPT BUILDING: TYP�^sE'CONST. S /F_ .1 y OC�Ct. GRP. / ' A.P. Number 14-1 – 0(02 ao S-- Legal Description Lr) r` A 0 �)�� . 0 (n !/ H r 1 e%0 Project Description � l— C Sq. Ft. No. No. Dw. Size / T ? Z Stories Units New I Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. 2 i /) -�— Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. 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 FINAL DATE Side Setback from Property Line INSPECTOR Issued by: Date Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Notice: Document Cannot Be Duplicated Date 6/15/01 No. 22132 Desert Sands Unified School District 47-950 Dune Palms Road La .Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE Jurisdiction Owner NameDGH Construction Corp. No. 53-100 Street Avenida Mendoza City .La Quinta zip `92253 APN # 774-063-005 La Quinta Permit # Log # Study Area Tract # Lot # Square Footage 1533 Type of Development Single Family Residence No. of Units 1 Comments F a r By At the present time, the Desert Sands Unified School District does not collect fee's 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 2.05 X ,1,533 or $ 3,142.65 the property listed above'and that _building s '`- permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued d Fees Paid By CC -Palm Desert National Bank - David Heusinkveld Teleph-&760-36,04706 Name on the check Dr.Doris Wilson Superintendent Fee collected /exe ted by Annette Barlow Signature Payment Received $3,142.65 Check No. 082221 40TICE: Pursuant of 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 " = OLD REPUBLIC TITLE M RECORDING REQUESTED BY OLD REPUBLIC TITLE AND WHEN RECORDED MAIL. TO: DHG DEVELOPMENT CORP., A CALIFORNIACORP. P. O. BOX 2982 PALM DESERT, CA. 92261 ' 004-13 A.P.N.: 774-063-005-6 TRA #: 020-015 Order No.: 33 - I o o Ave . % l edo z a -J GST DEED ®®C Int 2001-401061s 01/17/211191 06:901 Fee:0.99 Patio I of 1 Doc T Tax Paid Recorded in Official Records County of Riverside Gary L. Orso Assessor, County Clark 6 Recorder Escrow No.: 2-3250 THE UNDERSIGNED GRANTOR(s) DECLARE(s) THAT DOCUMENTARY TRANSFER TAX IS: COUNTY $24.75 [ X ] computed on full value of property conveyed, or ([ ]) computed on full value less value of hens or encumbrances remaining at time of sale, unmcorporated area; [ X ] City of LA OUINTA , and FOR A VALUABLE CONSIDERATION, Receipt of which is hereby acknowledged, LEON ATWOOD, a Single Man hereby GRANT(S) to DHG DEVELOPMENT CORP., A CAL][FORNIA CORPORATION the following described property in the City of LA QUINi'A, County of Riverside State of California; Ll LOT 20, BLOCK 206, UNIT NO. 20, SANTA CARMELITA AT VALE LA QUINTA, AS PER MAP RECORDED _ lEN-BOK' M RAGE 38, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA. IN 115] INN .. ;... Document Date: December 19, 2000 STATE OF CALIFORNIA )SS COUNTYOC ) On Ve /MJ,&J_ 2gQC20QQ before me, personally appeared Leon Aiwo a personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies) and that by his/her/their signature(s) on the instrument the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. Signature e This area for official notarial seal. �aAia JNDRAiSOLARF-Z Cif. 8.1i916p7 NOTARY. PLSW-,C(WF4MINIA an�eNalEry tub umm, ;`;adt: 4 Boz Mail Tax Statements to: SAME AS ABOVE or Address Noted Below A R4L COPY LONG REFUND NCHO EXAM Escrow No.: 2-3250 THE UNDERSIGNED GRANTOR(s) DECLARE(s) THAT DOCUMENTARY TRANSFER TAX IS: COUNTY $24.75 [ X ] computed on full value of property conveyed, or ([ ]) computed on full value less value of hens or encumbrances remaining at time of sale, unmcorporated area; [ X ] City of LA OUINTA , and FOR A VALUABLE CONSIDERATION, Receipt of which is hereby acknowledged, LEON ATWOOD, a Single Man hereby GRANT(S) to DHG DEVELOPMENT CORP., A CAL][FORNIA CORPORATION the following described property in the City of LA QUINi'A, County of Riverside State of California; Ll LOT 20, BLOCK 206, UNIT NO. 20, SANTA CARMELITA AT VALE LA QUINTA, AS PER MAP RECORDED _ lEN-BOK' M RAGE 38, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA. IN 115] INN .. ;... Document Date: December 19, 2000 STATE OF CALIFORNIA )SS COUNTYOC ) On Ve /MJ,&J_ 2gQC20QQ before me, personally appeared Leon Aiwo a personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies) and that by his/her/their signature(s) on the instrument the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. Signature e This area for official notarial seal. �aAia JNDRAiSOLARF-Z Cif. 8.1i916p7 NOTARY. PLSW-,C(WF4MINIA an�eNalEry tub umm, ;`;adt: 4 Boz Mail Tax Statements to: SAME AS ABOVE or Address Noted Below 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, in, order to determine the applicability of compatibility issues..or need to require the filing of Master Design Guidelines by the applicant. It shall be transmitted to the Building and Safety Department as your correction list. Please attach additional explanations as necessary. APPLICANT DGH,, Development Corp SITE ADDRESS 53710Q Avenida Mendoza t APN 774 - 063 - 005• BIN NO.: CASE NO.: 2001-438 LEGAL: LOT 20 BLOCK 206 UNIT 20 S.C.@V.L.Q. CHECKED BY: Stan Sawa 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 fik Compatibility Review r 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, in, order to determine the applicability of compatibility issues..or need to require the filing of Master Design Guidelines by the applicant. It shall be transmitted to the Building and Safety Department as your correction list. Please attach additional explanations as necessary. APPLICANT DGH,, Development Corp SITE ADDRESS 53710Q Avenida Mendoza t APN 774 - 063 - 005• BIN NO.: CASE NO.: 2001-438 LEGAL: LOT 20 BLOCK 206 UNIT 20 S.C.@V.L.Q. CHECKED BY: Stan Sawa 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 Compatibility Review Case logged and number assigned Verify legal and APN information Consistent with MDG on file (as.applicable MDG filing required (5 filings since 9/3/98) Consistency with street/surrounding area: N Colors Materials Architecture _ Other Requirements: -�( 6 f YOUNG ENGINEERING SER VICES why • Engineering *Arch itecture•Surveying• Building & Safety Services `. Letter of Transmittal To:�y_o¢ f o- ' Date: l } 6 Q yr n: _ Project: S _ Attn: W.O.: Tel No.: Tract No.: We are forwarding: By Messenger By Mail Your Pickup . No. of Copies Descri tion yd w►� �-� �lo�--s %N33 Comments: _[�/ow�4 ,�,�Arri✓u� Y This Material Sent for: . Your Files Your Review X Checking .. Other By: Phone # ` Per Your Request Approval At the request of: 47-159 Youngs Lane • Indio, CA 92201 • (760) 342-9214 -Bron Young • `I N AF %F %og. %r, %mp 8 %,OF %F8 W Lap City of La Q uinta Buildinf ��w g• and Safety Depattm''ent �� ofti° This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code, certifying that, at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building construction -or use. For the following: BUILDING ADDRESS:, 53-100 AVENIDA MENDOZA Use Classification: SFD Bldg. Permit N6.: 0106-187 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL Owner of Building:. DGH DEVELOPMENT CORP Building Official Address: 78-921 RUNAWAY BAY City, BERMUDA DUNES, CA 92261 By: RICHARD KIRKLAND Date: 11-19-01 O POST IN A CONSPICUOUS PLACE