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SFD (0212-039).j 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 1241,121 .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). ( ) 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 Sianature 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 STMT' ri' YND Policy No. 229. 00M.37-2003 (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: , "7 e, -• Applicant P % P , .,; 3 ; i x742 ds ., Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employes to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application, is hereby made to the Director of Building and Safety fo"% permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property forinspecti�on purposes. Signature (Owner/Agent) ��r Date,/ 2t�°<'? PERMIT# BUILDING .PERMIT DATE VALUATION LOT TRACT it)oS23�4m JOB SITE APN ADDRESS ,r -P- }i AVE1`t?DA Ar;EN007A 77-4-133-00 OWNER - CONTRACTOR / DESIGNER / EN (NEER LA QUMA T-) I°°NI .'�` LIM) LADMCrT'U3.4 F0 PIOX 1;�1 41480 11MURIAIM DR' LAQ fdAi. A. CA 0,253WZ+�E'3ZA:I:JL1WP$ CA 92201 C160)408-7528 =Vi 3724 USE OF PERMIT .. �1'C���.,1x.A7.t•3"I>t_:�' 1�ilV'%°Lrt.,S�ICi SkD - 1 &46 SQ. FT. •,R,*5;1DZ14Cr1 Pmnft div NOT MCI,,UDE blodr. war, fenvev, poo, 4r rpaa A Bey; -rate, )yirmn� is raga ed for drxvemy uppxuach firm the Pt' bAc lhdoAm l: ep arfxz►cat TRACT UMS'x`'Ti!:tJC' ION IS946.0 SP i 1i a ORCridPATIO - 34.00 S A: �a r l aia -104.00 Sir X51MAIZU) COW OF C0.11T?WRUCT10A' PF,R T 1#79 Sid'R/a1V/ARY C'01 uMUCTION VEt 10)-000-418.000 UAW PLAN CHECK Teri.: 101-000-439-318 $560.99 FEE DEPOSIT 101=000.439.318 -5:,� 0100 MWBANICAI FEE 141-00"21-000 �4f)m tL1r GTF 1 2a Pk i� 101 -000- 20.000 PL.UR B11.40 Fu? t X31-fi'Q<1- .3 9-QflTi 0140.?:5 STRO?tC MOTION FZF, RESID 101-000-2414000 $11.fsfi U LA,D)'fdf~t "W, ,.t 01;•000 -423 -WO $I . DEVELOPhRMACT RRE P11.1XISE PLAN AAk1f O1Tq 0ye.+, 1OITAMPLAN CU $4,,974,36 XY2.1 ?t, -P.11) yyV 4750.00 IDLIRWITRYST)UR, now 10 X.14-38 AN 2 9 2003' CITY OF LA QUINTA FINANCE DEPT. RECEIPT DATE BY DATE FINALED INSP O 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 iG F.A.U. _ _ Framing /i Compressor Insulation ! , . p. Fireplace P.L. Vents Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS -SPAS 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 ;�� �3 Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) �rld ELECTRICAL APPROVALS Temp. Power Pole 401C " Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors _ Temp. Use of Power�1� Y Final Utility Notice (Perm) COMMENTS: CERTIFICATE OF COMPLIANCE J�F>�sc Desert Sands Unified School District z4�,ejS1►7/?`�oo 47950 Dune Palms Road Q BERMUDA DUNES r Date 1/29/03 La Quinta, CA 92253 U!) RANCHO MIRAGE d No. 24097 (760) 771-8515 INS N WELLS QUINTA �i� PALM DESERT {�� INDIO 0 YJ Owner La Quinta Partners APN # 774-133-003 Address P O'Box 134 Jurisdiction La Quinta City La Ouinta Zip 92253 Permit # 0212-039 Tract # Study Area Type Single Family Residence No. of Units 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 53560 Avenida Mendoza 1846 Unit 6 Unit 2 Unit 7 .Uiiiit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments Over payment of $6.42. 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 (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that 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 Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $2.14 X 1,846 S.F. or $3,950.44 have been paid for 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 CC/Valley Independent Bank - David Addington Check No. 278062 Name on the check Telephone 760-408-7528 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Monica Guillen $3,956.86 Payment -Recd Over/Under Signature ZAlla a NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting .,..'.v�:: c • cuuc Z) unm _ I40 • Hou r'• • (/ �' y W THE ESCROW SOURCE, INC. F � 44-421 TOWN CENTER WAY, SUITE C, PALM DESERT, CA 92260-0000 • '3 t (760) 776-4640 • Fax (760) 776-_4650 Escrow No.: 02-3523-SASQ Escrow Officer: SARA QUINTERO q' Date: September 23, 2002 ESCROW SUNMARY; Buyer has deposited - _ . $ 1,000.00 Buyer will deposit prior to close of escrow " . 1 ` $ , ` . 41,000.00--, TOTAL CONSIDERATION: .. ,...- $ M 42,000.00 , Escrow holder is instructed to close on'or before October 28, 2002; The sum of $1,000.00, has been deposited herewith to be credited toward Buyer's costs. TITLENESTING ' Buyer to hand you' any additional funds and instruments `necessary for you to comply with. instructions herein. Obtain an Owners/ALTA Standard Coverage Form policy of Title Insurance from ORANGE COAST TITLE with their standard exceptions and provisions. This policy ie to have liability for an amount not to exceed $42,000.00. The policy is to be issued on real; property in the County of RIVERSIDE, State cif California, as follows: :. t?AXC!EL7NUM[BEK774=13.3_003-0 SLOT 22 IN BLOCK 242 -OF UNIT N0.23, SANTA CARMELITA AT VALE LA QUINTA, AS SHOEN BY �. MAP ON FILE IN BOOK 20, PAGE 25 OF MAPS, RECORDS IN THE OFFICE OF THE COUNTY RECORDER`OF SAID COUNTY, "UNINCORPORATED"-� M - Property Address: APN: 774-133-003-0, LA QUINTA, CA 92253 r The title policy is to show the title to the property to be vested in: MICHELLE EICHSTEDT OR ASSIGNEE ENCUMBRANCES/EXCEPTIONS -�-, The policy is to be free of encumbrances' except as (1) General'and Special Taxes and Special District Levies not due or delinquent; this will include " � the lien of supplemental taxes, if any, assessed pursuant to" Chapter.498, 1983 Statutes of they 'State of California. (2) Covenants, conditions, reservations (including exceptions of oil, gas, minerals, hydrocarbons, and/or lease without right of surface entry), restrictions, rights of way, and easements ford public utilities, districts, water companies, alleys, and streets. b (3). Assessments and bonds of record, if any, not delinquent. K. INSTRUCTIONS CLOSE OF ESCROW: The "Close of Escrow" shall occur 45 days after acceptance, Buyer and Seller shall deliver signed; escrow instructions to Escrow Holder within 10 days after acceptance. r DEPOSIT OF FUNDS INTO ESCROW: Each of the undersigned hereby acknowledges and `understands that pursuant to', State of: California Assembly Bill 512 ("Good Funds Legislation")' which became effective January 1,- 1990, funds deposited into escrow and/or deposited -with the Title 'Company for use inthis; escrow by the Property Owner, Buyer or New Lender in any form other than a wire transfer may,' . cause a delay in the close of escrow and/or disbursement of fiends at the time of closing, Each o,fd. the undersigned hereby indemnifies and .holds THE -ESCROW SOURCE, INC., and its'- . " DITIONAL INSTRUCTIONS ATTACHED HERETO AND MADE'A PART HEREOF***, • '' t ach of the above signed states he has read the foregoing instructions and understands and agrees to them. ' JUL-07-2003 02:41 PM CERTIFICATE OF FIELD ATION P.01 CF Dj Builder Name J Plan Number Sample Group Number Sample House Number wider: 1TG_yL tt41;r 4/6s Street Address: ,�j�,/� r Cityistatelzip: Z N C. q /t?� C� 47,2 3 7��d0 1 Copes to- Builder, HERS Provider HERS RATER COMP I NCE STT MEN The house was; XTested ❑ Approved as part of sample testing, but was not tested As the HERS rater providing dlagnostic testing and field verification, I certify that the houses Identified on this form co with the diagnostic tested compliance requirements as checked on this form. Distribution system is fully'ducted (i.e., does not use building cavities as plenums or'platform returns in lieu /'of ducts) Z1 Where cloth backed, rubber adhesive duct tape is Installed, mastic and drawbands are used In combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. rM INIMUM'REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct I]iagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Duct Pressurization Test Results (CFM @ 25 Pa) Test Leakage Flow in CFM If fan flow is calculated as 400cfmlton x number of tons enter calculated value here If fan flow Is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) =. Check Box for Pass or Fail (Pass=6% or less) Measured /values THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent 9(Yes ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) Is Installed and Access is provided for Inspection Yes Is a pass ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1 D Yes ❑ No• ACCA Manual D Design requirements have been met (rater has verified that actual Installation matches values in CF=I R and design on pian.. 2-'. 0 Yes ❑ No TXV is installed or Fan flow has been verified, If no TXV, verified fan flow matches design from CF -IR. Measured Fan Flow = Yes for both 1 and 2 is a Pass J ass fait ❑ ess Fail O ❑ Pass Fail AV C041 Certifica to of Occu ancy 0 Building & Safety Department This Certificate is issued pursuant to the. requirements of Section 109 of the California Building Code, certifying that, at the time of issuance, this structure was in compliance with the provisions of the Building Code and. the various ordinances of the City regulating building construction and/or use - BUILDING ADDRESS: 53-560 AVENIDA MENDOZA' � � Psi �( Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0212-039 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC Owner of Building: LA QUINTA PARTNERS Address: P.O. BOX 134 City, ST, ZIP: LA QUINTA, CA 92253 By: KIRK KIRKLAND 4 Date: JULY 10, 2003 Building Official POST IN A CONSPICUOUS PLACEr.