0004-028 (SFD)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
j�{`f�291 i 8 D .08/31/2(
ate % 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 STATE FUNI'i Policy No. 229-00 UNIT 0004483
(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
worke/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.
Pate: y 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 onhis
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 a�ture
v mentioned property'for inspection purposes.
Si (Owner/AgenDate
PERMIT# �;pOZe�7
BUILDING PERMIT
DATE VALUATION LOT OON-028 TRACT
S",I23,30 20 ,".3 Ul
JOB SITE
APN
ADDRESS 5,o A.I�ITDAUI(7
OWNER
CONTRACTOR/DESIGNER/ENGINEER
8'rARLIOH,r le!IA•NPLGE1vLMU INC
WMI.iAM RUSSELL, ROGERS
PO 3578
56900 J.f C KSO14 U17
LA QUSNTA CA 92253
TMMAL CA 92274
(760)399.1200 CB14, 1954
USE OF PERMIT
S NOIR FA&LY DWE UXG
.7
SFO -PERMIT DOES NOT INCLUDE BLOCKWALL OR. POOL
�} M
TRACT CON STRUCTION 1,605.00 S,I,'
I
POiRCHIPATTO 90.00 aF
`• -t' "�`;
0Ai2ACEICARPORT 463,00 SF
5 FT. WOOD FENCE 200.00 IAF
ELA'T'ED COST Or CONYMUCTION
99,123.30
PEFIM FEE SLEMxV ARY
CONSTRUCTION PEE 101.000.418.000 1639.50
PLAN CHECK PME 101-000439-•318 $530.54
MECHANICAL FEE I01.000.421-000 $53.50
ELXCTR.ICAL PEE 101-000.420-000 $119.94
1PLU MB INO iii r 101-000-419.000 $110.15
STRONG MOTION FFE - RESID 101-000-241-000 $9.91
OPLAT}INO FEE 101-000-423-000 3-000 $20.00 .
DEVELOPER IMPACT FEE $1,907.00
PRECISE PLA14 101.000-441-3345 5100:00
FEE Dr.POJI'r 101-000-439-318 -1290.00
SM-7.rOTAL CONS'1'RUC110N AND PLAN C ECK
$3,500.14
LAS PIM -PAM FEE 3
4250.00
'I'OTA-11 _MRAM M.,N DIT NOS
�,2b►O:i4
RECEIPT
DATE / IBY f
DATE FINALED
INSPECTOR
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
- QC7 S-7
Exhaust Fans
O.K to Wrap
..:X2
F.A.U.
Framing
-p t,
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 AP ROVALS
Set Backs
Footings
steel
Electric Bond
Main Drain .
POOLS - SPAS
5
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
57
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
Utility Notice (Perm)
COMMENTS:
--.,�•...y � •... _ , , ,, , . t, _ u -...,.E _ :+- _
P.O. BOX 1504 APPLI A ON ONLY
Building78-495 CALLE TAMPICO
AddresS2_ ^ OG0 VULA QUINTA, CALIFORNIA 92253 C411'
Owner ,
'`-,'' U& A*1"
AddressU 3-S7k
City _ Zip ITel.
Contractor
W ' >�Q
Address
6
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer L,�IU C AA t)fC, . Pau
Address Tel.
f- u I -IV a Y V KJ" I! M I^ W rV
CityZip State
I A /-1 %.. rM C: 7 1 1► .1'- Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that L am licensed under provisions of Chapter 9 (comme0cing with Section
70001
of Divisioff3 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 coy 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 (8500). ,
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. If, however, the_ building
or improvement is sold within one year of completion, the owner -builder will have tfi. burden «,
of proving that he did not build or improve for the purpose of sale.)
I1 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'] 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. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE .�
(This section need not be completed it the permit Is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of the work ,for which this permit is issued, I shall not
employany person in any manner so as`.to become subject to the Workers' Compensation
Laws of California. T
Date Owner
NOTICE TO APPLICANT: ff, after making,(this Certificate of Exemption you should become
subject to the Workers' Compensation rovisions of the Labor Code, you must forthwith
comply with such provisions or this permit I be deemed revoked.
CONSTRUCTION LENDING AGENCY
1hereby 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 theabove 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 Dale
Mailing Address
City, State, Zip
11LD11741G: TYPE CONST. '7 OCC. GRP.
P. Number i
fgal Description
oject ,Description
Sq. Ft. 1 JR `? No. l No. Dw.
Size Stories Units
New'* Add ❑ Alter ❑ Repair ❑ Demolition ❑
'. PERMIT 11 ,1 I AMOUNT
Plan Chk. Dep
Plan Chk. Bal.
Const.
Mech. "'@
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMAR
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
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 4/7/00
No. 20261
Owner NameStarlight Management INC.
No, 52-060 Street Avenida Rubio
APN # 773-213-002
Jurisdiction La Quinta
Permit #0004-028
Log #
City La Quinta zip 92253 Study Area
Tract # BLK3 U1 Lot # 20 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
Fees Paid By CCNalley Independent Bank/Larry Shields Telep%one '760`399-1200
,�, <
Name on the check
elm
By Dr. Doris Wilson' or .
Superintendent,'
Fee collected /exempted by Mary Ann L. Borja Payment Received. $;;290r25.�_`'
Check No. 216242 , `; ;``�'
Signature
NOTICE: Pursuant of Assembly Bili 3081 (CHAP 549, STATS. 1996) 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 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
MA NEF/T 72-655 Highway 111 Suite B-9
Land Title Com
Palm Desert, CA 92260
an
p }� (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 INSURANCE, STATE OF
CALIFORNIA. .t.; .
LStarlight Management and/or Nominee, (hereinafter known as Buyer) agree to purchase from Guy Laliberte and Marc. E:
aliberte, (hereinafter known as Seller) the real property setforth herein per the terms, conditions, consideration and , � .
instructions hereinafter stated. The Seller and Buyer herein shall deliver these signed escrow. instructions to Benefit, Land
Title Ins, Co., (hereinafter known as Escrow Holder), within 10 calendar days after receipt of same. ' #
Terms of Transaction
Buyer has deposited to escrow by Personal Check the sum of
Buyer will deposit, prior to close of escrow, the sum of
Buyer to obtain a New 1st Trust Deed loan in the amount of
To Complete the Total Consideration of
$ 500.00,
$ 8,250.00 ";
$ 26,250.00
$ 35,000.00
t
Furthermore, I will execute and deliver any instruments and/or funds which this escrow requires to show title, as. called.for;
of which you are instructed to use on or before March 2, 2000, provided you hold a Policy of Title. insurance''with°the usual
title company's exceptions, with a liability of not less than $35,000.00, covering property in the City of La'Quinta 'Co'tiniy oK?: r...��
Riverside , State of California, described as follows:`''
Lots 20 and 21 of Block 3, Santa Carmelita at Vale La Quinta, Unit 1, as.per ma recorded in Book 18 a e 46 of
Maps in the Office of the County•Recorder of Riverside County, California. p ..P. g ' `
.xR..a?.. -: .4 /!i
COMMONLY KNOWN AS: Vacant Land/Parcel No. 773-213-002 and 773-213-003, La
• Quinta, California. ,
SHOWING TITLE VESTED IN: Starlight Management and/or Nominee
SUBJECT TO:
' :•'ice>;`,;i4 'S;; y�•�"•.?;y�ii:
(1) General and Special County and Cit if an Taxes for the current fiscal year, not due or Jelin uent, includin
Y C Y) q g any
levies, payments for which are included therein and collected therewith. ' '
(2) Lien of Supplemental 'faxes, if any, assessed pursuant to the provisions of Chapter 3.5 (commencing with Section., 7,5) ',of
the Revenue and Taxation Code of the State of California.
(3) Covenants, Conditions and Restrictions, reservations easements for public utilities, districts, water companies," alleye s,aiid
streets, rights and rights of way of record, if any; also exceptions of oil gas minerals and hydrocarbons, and/oLleas"its:-` a
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:
. ,tt.ny rritd•'�w'ir.
DEPOSIT RECEIPT: The Deposit Receipt dated January 29, 2000 and Counter Offer is hereby acknowledged 'to .ge macif, .a - '
part of this agreement and the Buyer and Seller agree to be bound by the terns and conditions contained thereon..,
(5) Purchase Money FIRST Trust Deed to file, executed by the above grantees, to secure one Note in the exact
$26,250.00, in favor of Guy Laliberte and Marc E. Laliberte, prepared on your usual form and dated during escrow;.;,;..:;.
bearing interest at a rate of 8.00% per annum from date of close of escrow; payable at Beneficiary's desi ton ; with;
payments commencing from close of escrow and continuing thereafter until said principal and interest have .bee paid pt t 5'�' ,3s=
the close of escrow, Escrow Holder is authorized and instructed to endorse the reverse side.of.the executed Note ai reflect:?;xi
;; oVrr
the interest accrual date, first payment date and maturity date, if/as applicable, over signatures thereon,' without 'further
q ..k
approval of the parties hereto required. - "Out,',
ADDITIONAL INSTRUCTIONS ATTACHED HERETO AND MADE A PART HEREOF
My Initials below' -represent my agreement and acknowledgment ojthe joregoing.
Seller Initials:
Buyer Initials:
_
Page
cV,
RC DISTRICT -PLANNING REVIEW FORM
4110 ,, 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.' 52-060AvenidaRubio
ApN 773.- 213 _ 003 BIN NO.: CASE NO.: 2000-204
LEGAL: LOT Zo BLOCK UNIT S.C.@V.L.Q.
CHECKED BY: Greg Trousdell DATE:
Inform the assigned Building plan checker upon your assignment to this case. The C" xe uti e
Secretary maintains a log book to track applications and assign case numbers. c
z 1n
REQUIRED ITEM
Y
N
COMMENT/CORK]tT
014
Compatibility Review
�?
Case logged and number assigned
o
Verify legal and APN information
Consistent with MDG on file (as applicablei
MDG filing required (5 filings since 9/3/98)
_ Z
Consistency with street/surrounding area:
T Colors
Materials
Architecture
Lr0 w
CL
Q m W v
L4
I G-�..
Other Requirements:
t