0004-029 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Ch9pter 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
/
'191728 B 03131f2i
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 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 STATEFUND' Policy No. 229-00 U14IT 00044133
(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
sect to the workers' compensation provisions of Section 3700 of the Labor
I Geode, I shall forthwith comply with those provisions.
Date: G �'✓ 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 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�ve-mentioned property foi i-nspecti�:purposes.
! �1Signature (Owner/Agent). ��'� �f�-'»^ Date
�J• � "" BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0004-029 TRACT
$99,123.30 21 BLI,',3 U I ;.
JOB SITE APN
ADDRESS 524MO A VIE- ISA rZIT 31.0 M -213-W3
OWNER
STARL113Yf 1f"AGFh4 W INC
PO 3578
LAQi3WA CA 92253
USE OF PERMIT
MN012 PA1v9my I)w Lwa,
CONTRACTOR/DESIGNER/ENGINEER
Vn LLIAM R[TS:1UJ . TsCICTi'T S
56900 JACKSONST
TIDI MA'L CA. 92274.1 + 'f
(760)3941-1200 CBU$ ;1954
SFD-PERMIT DOES NOT INCLUDE SLOCICWALL OR POOL
I .I ..
tY,
TRACT CONSTRUCTION 1,605.000
PORCH/PATIO `
90.00 SIP
OAttAMUCJ.ARPORT
463.00 9F
5 FT. WOOD FZNCE
200.00 LF
F9MnAT -t0 COST OF COXIST UCTION
99,123.30
MARY
P1+:PhUr 3i`M SUMMARY
C014STRUCTION FEE
101-000-418-000'
W4.4.30
PLAW CHECK FEE
101000-439-318
$529.92
MECHANICAL f -TE
101-000.421.000
S47,00
E1,I°..CTRICAI, FEE
101.000-420-600
$128.94
PILUMBING PEE
101-000-419-000
$110.75
STRO140 MOTION ION FF.E . RF,SID
101-000-241-000
$9.91
GRADW PEE
101-000.423.000
$20.00
DEVELOPER IMPACT FZZ
$1,907.00
PRECISE PIAAN
101-000.441-345
$106,00
FEE DFPOSIT
101-000-439-318
-$250.00
SUB -'TOTAL COAIMtJC° ION MID PLAN Cl-WXI $3.492.02
LESS M—PAID FN_33 -$250.00
RECEIPT i I DATE
TOTAL PE17.3►t1:1.1 r, EES AGUE NOW 1 ",242.02
DATE FINALED I INSPECTOR
.114%
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
i
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
(
Exhaust Fans
O.K. to Wrap
dip $ 7
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
—�
Drywall - Int. Lath
7
Final _�
BLOCKWALL AP ROVALS
Final
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
Final
Utility Notice (Gas) J�
ELECTRICAL APPROVALS
Temp. Power Pole 00
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) 5/7
COMMENTS:
Building
Address
3 �
P.O. BOX 1504 APPLICAT N
78-495 CALLE TAMPICO 7 -
?w0 LA QUINTA, CALIFORNIA 92253
Address 0 ? S
City %�� Zip Tel.
11i �ii� qip 2- ZC. 1 1 - 0012--
ress
- 11 ,. y
& Classif. #
Arch., Engr.,
Designer ��N (�SC r G
Address Tel.
P , . �.Y4 u 0y M6 G
City Zip State
I A/), L a+ -A 4 -) raj C"'7 LIC. #
LICENSED CONTRACTOR'S DECLARATION
I heretoLaffirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) ofNivisigp,3,o sjriess and Professions Code, and my license is in full force and
1'4, a([i
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 oi'counfy 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 (8500).
l; 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 I 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.)
Il 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. 0 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 (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
Ihereby 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.
1 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 Address
City, State, Zip
)
LDING: TYPE'CONST. OCC. GRP.
. Number '11 S (3^ ppm
al Description
ject Deicription
6 3� - vhA&rP-,,e_
Sq. Ft.No. ' No. Dw.
Size 0 Stories , Units
New* Add D Alter ❑ Repair ❑ Demolition ❑
PERMIT AMOUNT
� d
Plan Chk. Dep.
Plan Chk. Bal. I
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
(� Ink
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
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Date 4/7/00 APN # 773-213-003
No. 20262 Jurisdiction La Quinta
Owner NameStarlight Management INC. Permit # 0004-029
No. 52-040 Street Avenida Rubio Log #
City La Quinta Zip 92253 Study Area
Tract # BLK3 U1 Lot # 21 Square Footage 1605
Type of Development Single Family Residence No. of Units 1
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
2.05 X 1,605 or $ 3,290,25 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
"4- i. r
Fees Paid By CCNalley Independent Bank/Larry Shields
Telephone 7°760-399-1200
Name on the check, .
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Mary Ann L. Bora Payment Received
L�
Check No. 216243
Signature
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) 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 nun 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
collect 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 DeptJApplicant Copy - Applicant/Receipt Copy - Accounting
Lan
ENEFIT
Title Company
72-655 Highway 111 Suite B-9
Palm Desert, CA 92260
(760) 340-2592
CA (800) 644-2227
Fax (760),,776.-1235
SALE ESCROW INSTRUCTIONS'
TO: Benefit Land Title Ins. Co.' Date: February 1, 2000
Escrow Officer: Shirley Thompson
Escrow Number: 573229
BENEFIT LAND TITLE INS. CO., IS LICENSED BY THE DEPARTMENT OF INSURANCESTATE OF" ` _
CALIFORNIA. ,
,Starlight Management and/or. Nominee, (hereinafter known as Buyer) agree to purchase from Guy Laliberte and iMarc4EA,_
Laliberte,'(hereinafter'known as'Seller) the real property setforth herein per the terms, conditions:"co'nsideraiio"n.a.n'd"'r7?t"f�);'t,�-'.
instructions hereinafter stated. The Seller and Buyer herein shall deliver these signed escrowt same. .
instructions to, Benefit -f Land L-- c-
� 4"
Title Ins. Co." (hereiiiafterkno"'Wri as Escrow Holder), within 10 calendar days after'receip' of ' ' - "t)
.0
Terms of Transaction
Buyer has deposited to escrow by Personal Check the sum of $ 500.00
Ap,
Buyer will deposit; prior to close of escrow, the sum of
$ 9,250:00
Buyer to'obtiiiii a'New '1st Tru'st Deed loan in the amount of 61136 1" 1 il "I
$ 6,25b.106
To Complete the Total Consideration of
$ 35,000.00
fe?4, ;top. 0
0�wFurthermore, I will execute and deliver any instruments and/or funds which this escrow, requires to show title as 6alledifbE' I afl`�,
which you are.in
structed to'use'on or before March 2,'2000,'provided you hold a Policy of Title, in thRifie, usuall-',
title company's'exc"eptions", wiih'a' liability of not less than$35*,000.00, covering property'urPC6 vi
in the City f La?Ql�'��h"� ounty:of
Riverside , State of California, described as follows: a �` ?,I -A, - lz t7tt
Lots 20 and 21 of BlocW3, Santa C.armelita at Vale La Quints, Unit 1, as.per map recorded in Book' I� a&,464,,�
Maps in the Office'olf the, . County. Recorder of Riverside County, California. Z,
COMMONLY KNOWN AS: Vacant Land/Parcel No. 773-213-002 and 773-213-003, La Quints, California.
SHOWING TITLE VESTED IN- •Starlight Management and/or Nominee
SUBJECT TO:
% irk
(1) General and Special,Cou
nty and City (if any) Taxes for the current fiscal year, not, due or delinquent, including anytspE
levies" payments'fo'r which are included therein and collected therewith.
(2) Lien of Supplemental Taxes,`
if any,'
'assessed pursuant to the provisions of Chap�er 3.5 (commencifig.,�ith Scction'L",7"5)'
. I . 11 . .1.11
the Revenue an�d,TaxationCode6f the State of California.
(3) Covenants, Conditions'.P'nd'Restrictions, reservations easements for public utilities, districts, water, companies, 16 s�
streets, rights and'righis'�f way of record, if any; also exceptions of oil, gas, minerals' and hydrocarb�6ni's,` ta-ha/ -e e
any, without the right of surface entry.
(4) New.First,Trust Deed securing a'Note in the amount of $26,250.00.
INSTRUCTIONS TO ESCROW: vq.
MCA, c 4
DEPOSIT RECEIPT:' The Deposit Receipt dated January 29, 2000 and Counter Offer is hereby ac"owl6d' -'
ged to be ma
part of this agreement and the Buyer and Seller agree to be bound by the terms and conditions contaiAedj
.there6n;,
(5) Purchase Money FIRST Trust Deed to file, executed by the above grantees,'to secure one Note in"'ifie6a"d...atnountl'
$26,250.00,'in favor of Guy Laliberte and Marc E. Laliberte, prepared on your usual form and dated during, esti
bearing interest at a rate of 8.00% per annum from date of close of escrow:. payable at Beneficiary's.- designation,
payments commencing from close of escrow and continuing thereafter until said principal and interest ha've.been paid';}
...f � I�, 0-j. w i,
the close of ' escrow, Escrow Holder is authorized and instructed to endorse the slae:Uihe.ezecuted,, Note .'ji4oMfoef
. I , . . I I , .,. 1. I , t I 4, q , , tito
the interest'accruad date, first payment date and maturity date, if/as applicable,9 . k;,04",
over signatures thereon,, witfiouvlhri
approval of the parties hereto required.
1 4 �
Seller Initials:
ADDITIONAL INSTRUCTIONS ATTACHED HERETO AND MADE A PART HEREOF
"My initials below represent iny agreement and acknowledgment of the foregoing.
Buyer Initials:
Page 1
Cj_.�;0.
RC DISTRICT - PLANNING REVIEW F&Mfl& .I R�,co
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 W. R. ROGERS
SITE ADDRESS �52-040 Avenida Rubio
A,pN 773- 213 - 002 BINNO.: 1.� CASE NO.: 2000-203
LEGAL: LOT BLOCK �� UNIT ,� S.C.@V.L.Q.
CHECKED BY: Greg Trousdell f 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. c
REQUIRED ITEM
Y
N
COMMENVCORRE#T
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:
Colors
Materials
Architecture
)Z� Z
`" v
Other Requirements:
0(
�G-r 7
Certificate of Occupancy-
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
ollowing:
BUILDING ADDRESS: 52-040 AVENIDA RUBIO
Use Classification: SFD Bldg. Permit No.: 0004-029
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC
Owner of Building: STARLIGHT MANAGEMENT INC
-res., A -a
Building Official
Address:
P.O. BOX 3578
City:
LA O.UINTA, CA 92253
By:
STEVE TRAXEL
Date:
08-25-00
POST IN A CONSPICUOUS PLACE