SFD (0208-127)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
628404 13 07131 M,
Dater % ^"� Signature of Contractor
G. r
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's..,-
License
ontractor's; License Law for the following reason:
( ) 1, 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).
as'owner of the,property, am exclusively contracting with licensed
contractors to construct fthe project (Seca 7044, . Business & Professionals
Code). ' y�
O I am exempt Under Section B&P.C. for this reason a :•
Date Signature of Owner ✓ .+:r ?r''+
WORKER'S COMPENSATION DECLARATION
1=here6y affirm under penalty of 'perjury one of the following declarations:
O I have and will maintain a certificate of consent to self -insure for workers',
compensation, as providedfor 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 A!'.1i;.1 E FUND Policy No. 1542"4•113
(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 37.00 ofA e Labor
Code, I shall forthwith comply with those provisions.
Date: S-� 49Applicant—
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to. criminal penalties and civil fines up to $100,000, in
addition to the cost of.compensation, damages as provided for in Section 3706
of:the Labor Code, interest and'attorney's fees.
IMPORTANT Application is hereby made•to the Director of Building and Sofety
for a permit subject to the conditions* and restrictions set forO ori;his
application. ,
1: Each person upon whose behalf this application. is made & each person at,
whose request and for whose benefit.work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify,,;
& hold harmless the City of La Quinta, its officers, agents and employees'_. '
2. Any permit issued as a result of this application becomes null and voi f
work is not commenced within 180 days from date of issuance of s
permit, or cessation of work for •180 days will subject permit to cancellati
-•'I certify that I have read this application and state that the above informatio
correct. I agree to comply with all City, and State laws relating to the build
construction, and hereby authorize representatives of this City to enter u n
the above-mentioned property for inspection purposes.
lllSignature (Owner/Agent)., `" " ' aDate
BUILDING PERMIT - PERMIT /1
DATE `: VALUATION; r"' � LOT TRACT••'
1,•149.7'0
JOB SITE'
ADDRESS r ,00 AV���k� IZO
APN
OWNER
CONTRACTOR / DESIGNER? EN 1NEER
TP1143L: RRM dbaCA1)EMMI IC0X '
VaC.M'tfid, :€tS dbtx CADSIC CONK'
A��� DMR. EM'S �I' ..
�{{�S{1�.�3LrE{2+
yy7*��5-)10
}}��. / j`�
. Tuf9i. .L.9.irMMT CA. 92„'Y60
gi�iip/yyyl y p}eg
.0 ALi%1 M74.g3E.R.T,.. , r , i"s`�1. 3T l+ 60 ...
.
ral�i0)} 40 1 wFrs'�G 480"
r
-
R,l, An CA OWS",ORT CO N,20T ,
USE OF PERMIT
t0INCrUFAW."'IrIt�:�°;1"l AUG••'13•i'17i€41'a:ftRBEIR,
S`y'fi'. ET
.
sFD 45X1531' PEWIT DOES NOT INCLUD& FJIXJ X WALLS, POOL
SPA. OR DRrvnwA.y API 1OACR.
TRACT COWSTRUCT.pl 2,sn OSS VP
FO-RCHIPA 10, . 15100 SC
�a�1?:olLfC,fA�`t�(�.[rTi `•kc"U.>7P kI�
C`i�U fi F �:�.�3%`7°S'�l:7�d""�,�.ON
� 94,1.49.76
Try� s$p�y g 7�, y�•�e p ap �,�q�g'yV�;l�4Li?1,11D
CONs3TRUCTION TYU, 301-000-418-000 t11'�A
'P 04 CHECK PR1�' 101-000-439-318
FEE DEPOSIT 101,-000.4.39-31.g
MtCHANIC:,A.31.FEE, 101-�1�Q,ri:�d- Shctli $��: dJ
t,
Ll„RiTRIC A1d. 101-+ 00.41t9-000
I�Iaf�7�f�11'CYF�i�1: 10i-(?f�,?-�1�-�?�f�• �- '�)�.�t�
i
STROM MOTION ION M;f�' - W3D 1133.000.2:41.000 X9.41
CRADING FEE 101-000.425-000 WAD
K1i;: ift PLAN '101.000.4 41 Y345. �l�i!.Iifl
DEVELOPER, IMPACT FM
/ �',
.I'(
N. .Mj
{'� �) (•�/'���,py,,-,,,�.ryyy $� �{ fq (y-yy..{��ry, �Q$.
I�i1 �is1��'��J W�.749 M•N.�1.Y �.{.��L.L1� ���.Y i"i ��M�} Vil�r�+n;'.�..tJ�h' •
.MJ'.'N.�1'�. 8l.li
$X33- PR LI -PAW MISII
t•
e TOTAL 112'SIV-{+%'F`: 1=161,, I)X'tr NOW
A11G.w n t2902 •
o
RE DPTDATE FINALED INSPC`AC—J
—
T
G�
INSPECTION RECORD
'OPERATION
DATE
'INSPECTOR
- OPERATION
DATE
INSPECTOR
BUILDING 'APPROVALS .,
MECHANICAL APPROVALS
Set Backs — p
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air a
Roof Deck Q_ -U _
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
BLOCKWALL APPROVALS
Final
-
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings _ O—p 2_
Main Drain
_
Bond Beam S U,2� /�
- �—
Approval to Cover
Equipment Location -
{tVo" 5V 3 C„t,c,
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines-O�p�
Heater Final
_
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer -Lateral --"
Sewer Connection e Z
Pool Cover
Encapsulation
Gas Piping
Gas Test _
Appliances
Final
COMMENTS:
i
-•
._
+
3
Final _
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole 1,7. O 2
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
Smoke Detectors
Temp. Use of Power — GE '
Final
Utility Notice (Perm)
CERTIFICATE OF COMPLIANCE .Fs
Desert Sands Unified School District'
47950 Dune Palms Road
q Q BERMUDA DUNES O
Date 8/6/02 La Quinta, CA 92253 C4 RANCHO MIRAGE d
No. 23457 (760) 771-8515 �t INDIAN WELLS
ti
PALM DESERT�y�
dQUINA
INDIOT`/�ly
V O Y
Owner Pine Mountain Real Estate APN # 773-213-004
Address 52600 Avenida Navarro Jurisdiction La Quinta
City La Quinta Zip 92253 Permit #
Tract # BLK146 Study Area
Type Single Family Residence No. of Units 1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 19 52600 Avenida Navarro 1527 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9 ,
Unit 5 Unit 10
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 (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 1,527 S.F. or $3,267.78 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 Union Bank - Doug Peters Check No. 7924456
Name on the check Telephone 760/771-8409
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Crystal Scott
Signature
$3,267.78 $0.00
Payment Recd ' Over/Under
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.
N0110E-t: This Document NOT VALID if Duplicated
Embossed Original - Buitdirtg 0epartment/Applicant Copy - Applicant/Receipt Copy - Accounting
a
RECORDING REQUESTED
OLD REPUBLIe�nu CO.
AND WHEN RECORDED, MAIL TO:
California Desert Construction
73-170 Amber St.
Palm Desert, CA 92260
ASSESSOR'S PARCEL NO.: 773-305-004/005
P164 D Zo - o.� 5
TITLE ORDER NO.' 500705-13
ESCROW NO.: 5706 -DS
GRANT DEED
'*111101.
DOC 8* Z000 -07:2M1131
02/20/2009 e8:eaA,Fee;28.06
Page 1 of 8 Doe T Tax Paid
Recorded in Official Records
County of Riverside
Cary L. Orso
Assessor, County Clark b Recorder
.-..._..!! ! i�lllN�I�i�lli�Il�llll�IIIII�!l�I4
llIllllll�I�I!
M7-7-
s I U 11 I S)[t 1 OA I PCOA 1 NOCOR I SMF M.6=
Cppv LONE• '��C+!O ctA,A i/��//'•
-The undersigned Grantor(s) declare that the DOCUMENT TRASF11�R
TAX IS: AS
$ /7,lvoCounty $ City
computed on the full value of the interest of property conveyed, or
computed on the full value less the value of liens or encumbrances
remaining thereon at the time of sale.
OR transfer is EXEMPT from tax for the following reason:
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
Paul S. Berger and Jamie Berger, Trustees of The Barger Family Trust
UJA/D/ July 1, 1997 as to an undivided one-half Interest and E. Stevon
Solton, a married man as his sole and separate property, as to an undivided one-half Interest.
hereby GRANT(S) to Piue..Nountain Real Estate, Inc.
all that real property situated in the City of La Quinta County of Riverside, State of California, described as:
Lot.' 19 in Block 140 of Santa Carmeiita, Unit 15 as per map recorded in Book 18, page 92 of maps, Records of Riverside
County, California.
Dated January 31, 2000
STATE OF CAPFORN
COUNTY OF j, _-
ON ��I d V q a13?12 , before me
Notary Public, personally appeared
a -ZTEvb.0 'yAn rno
personally known to me (or proved to me on the basis of satisfactory evidence)
10 be the persons) whose nerrre(s) islare subscribed to the within instrument and
acknowledged to me that he/she/they executed the same in TiWher/thelr
authorized capacJty(les), and that by his/her/tnelr signature(s) an the instrument
the person(*), or the entity upon behatf of which the person(s) acted, executed
the instrument.
WITNESS my hand and official seat.
Signature
Berger. Tru
o4ie Berger, Tnistee Q
r ��� <`'° L
E. Steven Solton
KAMMV 11 t>6d11F�
s Ceolrrdatow I r t4�.lt0
2CA990"0
to Are" COLN"
My conn oq*u Jun 73. ?Wl
I I Hata seal
MAIL TAX STATEMENTS TO: (ThJs area for OlriCe ry )
California Desert Construction - 73-170 Amber St.. Palm Desert, CA 92260
bzD8�127
P.O. BOX 1504 APPLICATION ONLY
Building ,;,,,;; ,�,/���. /�� /�gypp�,�,, 78-495 CALLE TAMPICO
Address" (7(iG/Yiffi%/tF'K/ClJ /V, ' ,fL7A,QUINTA, CALIFORNIA 92253
owner
Mailing _ - /
Address
City-; Zip,
jZ1 E 4, r
Contractor
Address `
T -
State Ljc./ L f I .#
8 Classif. i Lic
Arch., Engr.,
Designer
Address Tel.
CityI Zip I 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
!or 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).
I:1, 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. d, 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 1, 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
r7 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 (5100) 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 rof 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 io
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 a0plicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number � ? / 7� `3teg -
Legal Description
Project Description
r
Sq. Ft. y No.
Size (� ,. Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
_ !1
Plan Chk. Dep.
,G
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
Side Setback from Property Line n
FINAL DATE IN
Issued by:
Validated by:
Validation:_
6i
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
City of La� Quinta, -
k Building ry, 8t Safe Division '
..
P.O. Box 1504. J
.;.:.
784Ce-9alTampico
..::::.:::.::.::.;:::::
La Quinta,.CA'92253
:... X.
'
Buildin Permit Application and Tracking .Sheet
g
Project Address:_52 —6 C7U ,�
Owner's Name:. , ` 6 )I 1A �L TAT /tic
A. P. Number: _
/
Address; • , 3 / 90OM-15D2 4
Legal Description: �% 3 '�' �QTj—
Ci /r
ry,ST, Zip: • �� �Se� A .'2 2'60
olit NTA n
•
CCS7Rf l7G'
Telephone :
honeContractor. 0'
`7
X.
Address:.
Project Description: Ol'Y1 PJ "
Cin.ST. Zip:
ne:
Telephone: ho G �O' '
St ate Lic. # : 6 vc- O Q
City Lic.
Arch.. Ener.. Designer:
'
Address:
City. ST. Zip:
fi .• ..
hone: r
Tele
:
Construction Type: Occupancy:
State Ltc.
Addn Alter Re
Project �PaCcircle one : New -Demo . '
Name of Contact Person: Q��
�� %� 2S'
Sq. Ft.: l5 r
# Stories: y�
#Units: % 7
Telephone 4 of Contact Person: • 8 6 " :� % p
Estimated Value of Project:`
...................................:...................................
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:::::4.:::::...........................
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RLG 27 102
1E:15 FR
TO 9-7?18409
P.02/02
S°Ll.A
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OF EST
i TPCP
REPORT
Or rfcLD COMPaCTION TESTS
I ,COAI�IENTS
OUR A£PORT t/0.:}� • ��
GUENY;
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OAItY STAN LAAO I CAUEAA TION NUMCERS vtAIp TION, PERC EI+T,.h" GAUGE AOJtiSThI Ef IC a VARIATION f;p,
5 - SOII C&Milrt
COVNTS
ta0n1 SwEE7s
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} ^ VGE TYPE: T XLE AM BELL
MOI$TwRE:
OIS7URE; I .1101�IVNE: :.tO15TURE:
'
1GFi'IQ.; I, `��`•`
OERSIYY:
I OEN SirY; OENSIYYf I O:t;SRY:
i
)E•J� OA INrORrAIION
j
LOIL 10 .;
VISUAL CLASS15!CA IIJ•N OF 301L � MAX. DAY QED:SITY. ?C--
I OPTIMUM M0IS"URE. ?(,
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j
0
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING 2 CF -4R
Project Ti__tl/ee D to
Pro ct Address Builder Name
Uv
Builder o ct Telephone Plan Number
HER Rater Telephone Sample Group Number
v
/) -71d
rtifying Signature ate Sample,House Number
Firm: HERS Provider: �G0�f- �SSoG/4% S
Street Address: 7���0 �i'AGti/TOY� C.1Y ¢� City/State/Zip: '' u/hr G69 Gf 3
Copies to: Builder, HERS Provider
HERS RATER COMPLIANCE STATEMENT
The house was: X Tested ❑ Approved as part of sample testing, but was not tested
As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form
comply with the diagnostic tested compliance requirements as checked on this form. s..
RrDistribution system is fully'ducted (i.e., does not use building cavities as plenums or platform returns in lieu
�f ducts)
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.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Duct Pressurization Measured Test Results (CFM @ 25 Pa) values
Test Leakage Flow in CFM
If fan flow is calculated as 400cfm/ton is number of tons enter /�
calculated value here /-0/4,70 0
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fah Flow)
Check Box for Pass or Fail (Pass=6% or less)
e ❑
Pass Fail
J,J THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent
epKes ❑ No Thermostatic Expansion Valve (or Commission approved'
equivalent) is installed and Access is provided for inspection ❑
Yes is a pass Pass Fail
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
1. ❑ Yes ❑ No ACCA Manual D Design requirements have been met
(rater has verified that actual installation matches values in
CF -1 R and design on plan.
2. ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV,
verified fan flow matches design from CF -1 R. -
Measured Fan Flow =
Yes for both 1 and 2 is a Pass Pass Fail
Certificate of.0ccupancy
City of La, Quinta
Building and Safety Department
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: 52-600 AVENIDA .NAVARRO
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0208-127
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC
Owner of Building: PINE MTN. R.E. dba CA DESERT
CONS.
16'%L
Building Official
Address: 73-170 AMBER STREET
City: PALM DESERT, CA 92260
.By: KIRK KIRKLAND
Date: MAY 1', 2003
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