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SFD (9609-068)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 S 7777ti b �n 3Ur�? r Date Signature of Contractor C 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 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 issrs`u, ed Vt,�wakers' compensation insurance ca rre�rpolicy no. are: Carrier Policy No. (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:" Applicant -�� o 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 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. irispection purposes. .. � /Signature (Owner/Agent)C_. 1'� �' Date � PERMIT# CONTROL# BUILDINGPERMIT 392-9 U""% DATE VALUATION LOT TRACT JOB SITE IM Jt- UU14 I AJIN V 1JLW ADDRESS 7­ OWNER CONTRACTOR/DESIGNER/ENGINEER S rARK CONM(K'nON CO. ST ARK. CON',TMUC nON CO. 39725 GARAND OL 30715 GARAND N PALM DFSFR'r CA 02111 PALM DESERT CA 97211 61034S4711 619:3459711 C, Iil,t! 7% USE OF PERMIT SINOU FAM11.3 UWELIANO .Wta-PW. MIT fNKI,LWL S 311 LF OF OARVEN BL(X'K WALL. ADDITIONAL PERMITS ARE TO PW 09TAINFID `tF3'ARATFLY. 'rRAc."I' t Y)N2ITRt k_TI(iN ►,1165►. t�U Pt Rt -M- MATIO 40().00 NF 0ARA(i1^.K ARPr:N2T 9".00 3F 4 FT, WALL 311.04 LF ESTIMATED COM'OF OONSTRUC nON x.762.% P1F.RMIT I►'lAt SUMMARY CONIORUr'n(INF'FF IOI fx)<3-d19-000 tt.133.t 1 I'LAN 0UX F13: 101-000-439-318 35►80.75 F I% t )SIT 4250.00 MECHANICAL FW 101.000-421-000 $124 (XJ F?1.w`t"}'R4('AL FIFE 141.4100 42049()Q1 S244.&8 Cn rn P1.1AM11tiN.'r FU. - 101-060-419-000 rn S'r(-)14(11+ UTION FEE - SIU 1014XQ-241-OW 524.06 0RA01I!40 FIY- , 101-(1(x)-423-000 520.04 O IMMANTRIW-f"ti#tE FST 225440443-:142 ft.172.97 Q( a - U-1 ART IN PUBLIC, PLACES - RE31I:: 701-000-255-000 5351.96 SURAX-ffAL CONStRt.KMON AND PLAN CHECK. 1,315.39 LESS PRE -PAID FEES -$250.00 TOTAL PERMff FEES OVE NAV 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 Steel Return Air 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 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 Encapsulation Gas Piping Gas Test Appliances 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 Tempt, Use of Power Final - Utility Notice (Perm) Final COMMENTS: V� b P.O. BOX 1504 APPLICATION ONLY 7&105 CALLE ESTADO :Ing fil o�ll ✓✓r4 / /l (/ / 2W Aatlress .� LA QUINTA, CALIFORNIA 92253 Ownera�—�. Mailing _7�� Address h/ City Izip Tel. Contractor 4i14:� COV,<� —112Z4CT l Dt- Address Zip ITel.. State Lic./ City & Classif. ��CO Lic. # Arch., Engr.,// Designer OC40 Address Tel. �73201 � /WL/ 1 i) -773 — City Zip State 1410 1;122' 'r-�V Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm,that,l am licensed u�tler provisions of Chapter 9 (commencing with Section 7000) of Division/3 off the Busineess., nd 0. ro/fe/ss ions Code, and my license -is i ffullIrf rce aynd effect. U//GI'y SIGNATURE DATE OWNER -BUILDER DECLARATION // I hereby affirm that I am exempt from the Contractors 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 repuires'the applicantfor 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 (8500). [7 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 or 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.) Il 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 7 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 [`] Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPEN SATIO N INSURANCE (This section need not be completed if the permit is for one hundred dollars (8100) 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 ateMailing Address City; State, Zip BUILDING DIVISION LDING: TYPE CONST. OCC. GRP. A.P. Number Legal Description Project Description By S '58 4 Size (p 1 No. 1 No.Stories Stories 1 Units I i r NewX Add ❑ Alter ❑ Repair ❑ Demolition ❑ ,LF 12, Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. ,SCJ• ov Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL 00 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--Rermi 0 i Validated by: Validation: n 1 In Al annr, I i By CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING t t IST FL. SO. FT. @ $ 2ND FL. SO. FT. @ POR. SO. FT. r@ GAR. SO, FT, @ CAR P. I SQ. FT. 0 WALL SO. 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.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APP./EQUIP. 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 @ 3/ac 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. 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 COACHELLA VALLEY UNIFIED SCHOOL DISTRICT CERTIFICATE OF COMPLIANCE (Government Code 53080) Project Name: Project Address: 81-990 Mountain View, La Qui nta, CA Project Owner's Name: Stark Construction Phone No.: 345-9711 Project Description: 1 Dwelling Unit Building Type (Check one): Residential -AX (Include No. of Dwellings) Com ercial Industrial Tract No.: Lot No.: (If tract, attach Schedule "A" of all lots by tract, square footage for each lot and total.) Assessor's Parcel No.: 767-480-014-1 (If Schedule "A" is used show Assessor's Parcel No. for each lot if one exists or Assessor's Parcel No. for parcels before subdivided.) Total square feet of Building Area: 3,869 Sq . Ft . Certification of Applicant/Owners. The person signing certifies that the above"information is correct and makes this statement under penalty of perjury and further represents that 4e/she is authorized to sign on behalf of the owner/developer. Dated: September 4, 1996 Signature: City/County Certification: (Signature) Optional (Title) SCHO_QIJ4STRICT REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE S ISFIED ACCORDANCE WITH ONE OF THE FOLLOWING (CIRCLE- ONE): Gov. Code Gov. Code Project Agreement Existing Not subject to fee 53080/6599 65970 Approval prior to 1/1/87 requirement. Note: Total Number of Sq./Ft. 3,869 Amount per Sq/Ft. $ 1.84 Amount Collected $ 7 18.96 School District Official • itle: Asst. Superintendent, Administrative Serv. Foch "T ' Pensis Date: September 4, 1996 Phone: (619) 399-5137, Ext. 235 Note: AB 2926 and SB 201 fees are capped at $1.84 per square foot for all residential construction, and at $0.30 per square foot for commercial/industrial projects. RECORDING REQUESTED BY: FIDELITY NATIONAL TITLE COMPANY 96.5726DT 8492 -TL WHEN RECORDED MAIL THIS DEED AND, UNLESS OTHERWISE SHOWN BELOW, MAIL TAR STATEMENTS TO: GARY STARK CONSTRUCTION CO, INC. 39725 GARAND, STE. E PALM DESERT, CA 92211 P A I & Doi;. Tra::n:i'c, Tm FRANK K. Rid. Co. F ^r• 241286 RECEIVED FOR RECORD AT 8:00 O'CLOCK JUN 2 8 1996 I le-orado w �mual'1-- HiversideCou/ t of County. Recorder �c Feos $ SPACE ABOVE THIS LINE FOR RECORDER'S USE APN: •-IL-� GRANS DEED -tTQ (V"n, The undersigned grantor(s) declare(s): Documentary transfer tax is $86'.90 �Y.`{X) Computed. on a1?. valu: ci F_ :• ._ :- c^.v�:y�, cr Computed on full value less lens and enc rances remaining at time of sale. Unincorporated area: ( j�') City of jrJfi,¢ and FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, PALM SPRINGS SAVINGS BANK, FSB hereby GRANT(S) to i STARK CONSTRUCTION COMPANY, INC, a California Corporation the realiproperty in the City of LA QUINTA, County of Riverside, State of California, described as: Lot 14, Tract 26769, as per map recorded in Book , Page(s) inclusive of maps, in the office of the County Recorder of said County. Dated May 1, 1996 State of California County of Riverside ? S.S. On May; 2. 1996 before me, Tina M. Cruz, Notary Public personally appeared Stephen Hoffmann and Sue Batts personally known to me the —W-7 -? 7 --vide) to be the person(s) whose name(s) ire/are subscribed to the within instrument and acknowledged to me that ivg6dw/they executed the same in Jmbqd=/their authorized capacity(ies), and that by /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 MAIL TAX STATEMENTS TO: PALM SPRINGS SAVINGS BANK, FSB /T Preside #/ Cf. �� 'j �� BY 2a Name/Title Sue Batts Senior Vice President QP'My TINA M. CRUZCOMM.I986173 mlNotaryPublic —Cclifoo RIVERSIDE COUNTY Comm. Expires FEB 28. 1997 ('this area for official notarial seal) 11 COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY ASSESSOR'S PARCEL NUMBER 1") 7 `►SS' b ry DEPARTMENT OF ENVIRONMENTAL HEALTH PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM APPLICANT: Submit this form with four copies of a SCALED plot plan (1-20 SCALE) drawn to County specifications as indicated on the attached check list. A non-refundable filing fee is required when the application is submitted. Check must be made payable to the County, of, Riverside. Approval of this applica- t ' "-t'11 tion shall remain valid for a period not to exceed one year from date of pavment: • + t61 ! �a a162. c LOG # 162. 0( Agent, Contractor, Contact Person Address City State Zip Telephone �°. C .�, .I S 7 R -N c`7 r to l 2S � v Su ,� rs t`�. a rA 94Z-// �t S I Owner Address City State Zip Telephone Z Job Property Address cG-A Lo w 4 `l� l�llkf��r� �,/ I/� !„A,�r, l(�U ifri%' 9 —7 3 U Lot Size Water Agency/Well Use of Permit, P/P, SUP, PUP, etc. Legal Description LU Ngip_ �t ]c weilin'g"MH Site Prep., etc. Signature of Applicant Date CHECK BOX IF REQUIRED % J ❑ Holding Tank Agreements Completed ❑ Detailed Contour Plot Plans Required (1 to 5 foot interval) ❑ Certification of Existing S.D. System Required ❑ Grading Handout Provided m ❑ WOCB Clearance Required ❑ Staff Specialist Lot Inspection Required Z (Attach For DOH -SAN -007, Santa Ana Region Only 0 ❑ Lot Inspection U❑ Soils Percolation Report Required LU U) ❑ Special Feasibility Boring Report Required ❑ Date Lot Inspection Completed: Initials Remarks: ❑ Maintenance Booklet Provided Initials Date ❑ Final Inspection by Department of Environmental Health is required. C/42 / Soils Percolation Boring Report by ` /� ` ^�' Ur./Pro)ect # Date Soils Map Page Soil Type Approved By Date No of Systems Type of System(s) No. Dwelling Units (1) Septic Tank Soil Rate Grease/Sand ❑ Holding Tank ❑ Replacement Bedrooms, Fixture Units/ Grease Intcp/Lint Trap AN f UNew ❑ Addition -3 +�+«x r w . 1. JJ 2-6 pr Gal. ❑ Existing Gal. f'fc7 Sq. Ft. Total Unear Sidewall Allowance Leach Bed sq. ft. of Bottom Area Ft. ur S+ ' Bottom Area J* ft. rock/ sq. ft. running ft. Install .. Lines) ft. long ft. wide with 2 7 v J Inlet Tested Depth O NA min. inches rode below drainlines or U Proposed Bottom Tested Depth Z Leach lines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Inlet (BI) Seepage Pit Maximum Other: Q Total Depth Allowable I.– Applicable i r Depth r W N/A Overburden Factor ❑ 5' �❑ 6' TD to Well Review Approved: Date: Well Drilling Permit # SIGNATURE Grading Plan Approved: Date: SIGNATURE Sewer Verification Approved: Date: REMARKS: Sa+e ./t"'i..•.�e.� Avg/rr ft��p�r/. r►e..n p� 1 /wI �" f/ ,r/ nar f �.� ivo •, Yt l C'•' M..r- ,f,. 1— J 1 This This application is APPROVEDIDENIED for the category checked In SECTION B FOR OFFICE USE ONLY above, regarding the design of a subsurface disposal system as Indicated on the aoompanied plot plan, using the requirements set forth in SECTION C above. A build- Ing permit is necessary for the installation of the above -designed system. No construe- Revenue code (1 Fee $ / tion is permitted In the required reserved 100% expansion area. (1) Septic Tank must be 100' minimum from any wells. �'�' :.... r ... r �Checka# �.ly ''��`` - ; Y (2) Leach lines must be 100' minimum from any wells, including expansion area. Qom( �A [1 '�7' �� T m. Date initial 0 (3) Sewer Tines must be 50' minimum from any well -------------------- s'^^^------- -- }� r ` Z O_ (4) Seepage pits must be 150' minimum from any wells, Including expansion area. H U W W Signature of Health Official 5� . 2 I, a G Date DOWSAN 122 (Rev 9/93) Distribution: WHITE—Office File; YELLOW—Applicant; PINK—Bldg. Dept.; GOLDEN ROL—Plans/Records i Palm Springs Savings Bank, Fsa August 23, 1996 Member FDIC Stark Construction Company, Inc. c/o Gary M. Stark - President c/o Gary F. Blecka - Secretary 39725 Garand # E Palm Desert, Ca. 92211 ca> omm 4W&:nh vlm coyw err Re: Homeowners Association project review. Nm *h`4IA CAWX1 (619)325-2021 1'a (619)31T•11R1 , Palm Springs Savings Hank, FSB (PSSB) acquired eight lots at "The Estates at [,a Quinta" through foreclosure on November 1, 1994. At that time PSSB filed to take over the responsibility of the Home Owners Association. arwml� 42osaulh r l►Qqw Dvin NmSp=S&CA9ZW Stark Construction Company, Inc. has applied for and was granted a construction w(619) 20 6 sem; (614) �z►-I tas � loan on subject lot # 14 of Tract No. 26769 in La uult t'$ PSSB has reviewed 1 Q � a, , � . the type of home to be built and has accepted and approved the design provided it meets with the City of La Quinta's and or the County of Riverside's Planning and 1199daNkm Zoning Department. MINI rk, Ilopa Odvo apo sal. . Raidw MnA G 92270 • {b19) 341 :a62Z I'm (619) M2337 Sirely, 68327 f4hm 111 CaTh "My,CA92234 Stephen !ones (619)328.8938 Fu, (619) 321-!012. Constru • n Loan 66W Mason Doukvw d oeust Aotspat4CA92= (619)329-4411 fns (619131MIL Palm Springs Correspondonce: P.Q. Box 2216, PalmSprings, CA 92263 (619) 325-2021 or (800) 821-4740