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9511-010 (SFD)LICENSED CONTRACTOR DECLARATION I he`eby affirm,that I am licensed under provisions of Chapter 9 (commencing with°{ Section 7000) of Division 3 of the Business and Professionals Code, ands my . License is in full force and effect. License #_ LiXWOO 13 Exp. Date 6/30/96 Date Signatureof Contractor 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 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 fol by Section 3760 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 Laboi Code, for the performance of the .work for which this permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier Policy No. (This sectjdh n " d h6;tl6 bmpleted if the permit valuati is'fdr'$ib0.00°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 Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose be this application is made & each person at , whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application agrees to, & shall, indemnify & hold harmless the City of Indian Wells, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is/' correct. I agree to comply with all City, and State laws relating to the building f construction, and hereby authorize representatives of this City to enter upon then above-mentioned property for inspection purposes. Signature (Owner/Agent) Dabs "`°" BUILDING PERMIT . PERM Ti 45111-11110 DATE 11/14/95 VALUATION$ ,2;���•� LOT 22 TRACT $LK 29 JOB SITE ADDRESS APN OWNER CONTRACTOR Y SUNROSE CORPORATION SUN:ROSE CORP7278.50 SQ.ME A XD. 51-W AVENID)A MORALES PALM MSERT . CA 9 260 BALM DESERT CA 92260 <i tn�a.n '14-40 .r •n f 3 vA y DESIGNER/ENGINEER y (;619;,)346-7840 USE OF PERMIT' FA IMPLY DWVELUNG ' Permit does mc -t inelude. block. wa11 or pool. A FEE DESCRIPTION FEES ' MCT CONSTRUCTION 1.,5Sfi3Ot) Sr' % GARA.WCARfi OR17 4.(0.00 W ; ESTIMATED COST OF CONSTRUCTION 1''ERMIT F EE SUMMARY PLAN CHECK FEE 1014000439-318 _... $510,83 ;nXSTRUC$;tON FEE 101-000,418-000 $603.00 IM CHAN(CM. FE!: W.00 fv.LIEXXRtC.A1:. FEW $12:.+.f6 PLUivtt3I GFRE 101-000-41.9-000 Si.YS.50 STON0 ,440 TION FIM - RES1D 1(}0-000-241-000 09.22 GRAD 1N0.1;E.r; iO.I0130 23-t)GO 520.00 JW17RASIRUMURE FER, 22,5-000-443-342 PILECI.W, PLAN 101-000-441.4345 $25.00 FEEDEPOSIT 42501110 SUB -TOTAL CONSTRUCTION AND PLAN CHECK $3,552.02 LESS PREPAID FEES -$250.00 O' OTAL`P1'✓RMf ftF.S DUE NOW 53,302.02 �ts 1995 TOTAL PROM CT PERMIT FEES t :3,552.1; RE T 'DAT r V7 1 BY DATE RNALED INSPECTOR 771 INSPECTION RECORD 4' OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set BacksUnderground Ducts Forms & Footings Ducts Slab Grade 11144— Return Air Steel / Combustion Air Roof Deck Z 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 BLOCKWALL APPROVA S 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 2 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 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 y Utility Notice (Perm) COMMENTS: �ts�� Iry Building Address Owner Mailing " Address 4 P.O. Box 1504 APPLICATION ONLY 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 City Zip Tel. rXv> l�� d - c'122fn f� 3 �f/ ��8-�/D Contractor. / / r f9%DSS (L�Y.r�o/q. / `l7l�l Address If Zip Tel. State Lic. City & Classif. 53,3 6,769 Lic. # Arch., Engr., Designer AN,e— _ Address Tel City Zip State 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 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: (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 ($500). 1-1 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 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.) 11 1 am exempt under Sec. B. 6 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 0 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.) 1 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 agr to comply with all city and county ordinances and state laws relating to building conituction, and hereby authorize representatives -of this city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailinq Address City, State, Zip BUILDING DIVISION BUILDING: TYPE CONST. - OCC. GRP. A.P. Number 773 t�r73 3 ' � ��� � b Legal Description 0%/ Project Description Sq. Ft. No. NoDw. Size /6T IO Stories Units New M01' Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. AMOUNT Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setbacr�f�n1 Ce tl�ter Line Rear Setback m Rea l Line Side StrelS back fromlenterLi�Line Side Setbldck fr&6ProDert• Line./\ FINAL DATE. Issued by:— Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. a $ 2ND FL. $p, FT. Cro POR. SQ. FT. (, GAR. Sp. FT, Q CARP. SO. FT. WALL $O. FT. SO. 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 APP.IEQUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM. B.T.U. ITEMP 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 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1 V. c SEWAGE DISPOSAL SO.FT.GAR @ 3/4c 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.IEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING CU. yd. $ plus xS =$ 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 DESERT SANDS UNIFIED SCHOOL DISTRICT 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be Duplicated 619-775-3500 Date 111/14/951 Type of Permit I La Quinta No. 1.13871 Permit # Log .Owner Name Sunrose Corporation No. 51810 Street Avenida Morales City La Quinta Zip 92253 Study Area 113 APN # 773-152-003 Tract # I Lot # 0 Square Footage 11550 Type of Development Single Family Residence No. of units 0 Comments 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 1 550 or $ 2,666.00 have been paid to D.S.U.S.D. 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. Sunrose Corporation Name on the check By Dolores A. Ballesteros Superintendent Fee collected /exempted by Pauline Pearson Signature D"C�X,01.'AO PaA1AAb1Y% 4r, r Telephone 346-21. Payment Received $2,666.00 Check No. 120 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 Y 74-900 Highway 111, Suite 113 C Indian Wells, CA 92210 Et (619) 776-5444 FAX (619) 776-545+5 INVESTORS TITLE COMPANY -ESCROW DIVISION FOR THOSE WHO CANNOT COMPROMISE THEIR STAND ON EXCELLENCE BUYER FINAL SETTLEMENT STATEMENT PROPERTY: APN 773-152-003 CLOSING DATE: La Quinta, CA 92253 October 31-, 1995 ESCROW NO.: 32-10508 BUYER: Sunrose Properties DEBITS CREDITS CONSIDERATION Total Consideration $ 18,000.00 $. Cash Deposit 500.00 Cash Deposit 117,100.00 PRORATIONS/ADJUSTMENTS Taxes at 212.13/6 mo. from 10/31/95 70.71 to 12/31/95 COMMISSION CHARGES Credit from Tarbell Realtors 700.00 ESCROW CHARGES TO INVESTORS TITLE COMPANY - ESCROW DIVISION Escrow Fee 236.00 86.00 Change of Ownership 25.00 25.00 TITLE CHARGES TO FIDELITY NATIONAL TITLE INSURANCE COMPANY Recording Grant Deed 6.00 REFUND 73..29 TOTALS 18,411.00 18,411.00 SAVE THIS STATEMENT FOR INCOME TAX PURPOSES.