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0108-255 (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 6' 28404 B 103 Date"'-'�" Signature of Contractor- may' • -. 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 li 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: Carver 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 Sectionr3700 of the Labor Code, I shall forthwith comply with those provisions., Date: =%. ADDlicant 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 inspection purposes ^7 Signature (Owner/Agent) ' '9' Date`1'� BUILDING PERMIT PERMIT# DATE jj VALUATION LOT ()10S,2&jA TRACT ' JOB SITE / V V APN ADDRESS , OWNER CONTRACTOR / DESIGNER / EN INEER ' :�Cy�I;N•re��.q�p�d�'�rkilllz.:Kftp / &q'W1F.)2nAM..�72f.+.��(:�aq aCADM.RTf,101N° f a"'.S / A• R7ST:,&71'wn'.�. &r�L\sa�nr� � '7 �" A .P '4�L:].If,TA°moi.`. 17S�±-L'r5 PALM E'MT CA, 92260 PALM D'&' R7F CA. 92.160 >� 260)340. 9844 CBLO' 4601 USE PERMIT I eO�F,t !. �y� Y P �5f1f p yh e` i,PJ�S51�'!.&ax:.Ayi�AIY.I I AY �R.� Pvi'rLnL.si�dtif Sa SMWQ111YER CDC. 1. t"001.4SPA.Oft D11MINAV &'RO CH TRMn C01811RUCTION I'm go air PO:RaO1lRATIO 140.00 :ilk f 46�Fd.l �ik?�t; o OCZ9' �i,..itt,41i "S E511 a D COW OF COMMUMION 8319.9€ AO ''QQ��j�.!''pp ''77��gqt�y `T�•a-y; 7L {qy (+y �+y J�',q li:.9/.f.�LHE.i�A .BY l�+.i}w SW9idNllP:i,bA��+.�, VOMMUCTION FES': 103-000.418.000 S612.50 PLAN CHWIX, Rit 101-00 0.4-39-318 012.09 PEZ DEPOSSIT 1.01;,000_439,2316 MAN Adi,ZHANIC.€sA.FEE 101-0M-4214100 $60.00 fli, E 'f RICA ., nX 101.000.4%0.000 $111.35 PLUMi4NO!TY, 101-000-419-0700 $11&z S'i`s .0NO mO"i ,iovy FE - =141D 101.OKI- 1.000 $9.40 00.101,40PPIE 1011 000A423-00 $20.00 k?i3.T 13Y PI A'N `SOt$i0fKi441-34S �1Q0.f9Q LC RT RUMOR AND P11mi MOM LIMB MR -PIM MS 4210,00 SEP 2 8 2001 AL,PERNMITEEN DIM NOW CITY OF LA QUINTA FINANCE DEPT. RECEIPT DATE`%B DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings ( sy Underground Ducts Ducts Slab Grade Return Air Steel Combustion Air Roof Deck _ xhaust Fans O.K. to Wrap Framing _ �%_� Y ' F.A.U. Compressor Insulation _ ? p Z S� 7 Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final —/ 'Z 1p Final / ?j POOLS -SPAS BLOCKWAI I AW'PROVALS 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 _ �� j�—� s7 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection It t �o / 5T Encapsulation Gas Piping Gas Test _a _ Z (07 �T Appliances Final - COMMENTS: 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 6 b� 0 a s CITY OF LA QUINTA BUILDING &SAFETY DEPARTMENT Fb of C 777-7012 INSPECTION REQUEST LINE 777-7153 "PINE MOUNTAIN.REAL ESTATE, INC Owner Contractor CALIFORNIA DESERT CONSTRUCTION 0108-255 i Permit Number POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES 52-080 AVENIDA RUBIO JOB ADDRESS SFD- MASTER CDC -1. PERMIT DOES NOT INCLUDE BLOCK WALLS. POOL./SPA OR DRIVEWAY APPROACH TYPEOF INSPECTION FOUNDATION & SETBACK FOOTING STEEL MAIN GROUND SYSTEM O GROUND PLUMBING PRE-GUNITE !ELECTRICAL O NOT POUR CONCRETE UNTIL ALL ABO` HAS BEEN SIGNED ONCRETE SLAB OISTS 8 GIRDERS GROUND WORK ALL ABOVE HAS BEEN SIGNED COVER NO WORK UNTIL ABOVE HAS BEEN SIG DRYWALL INTERIOR 5� EXTERIOR LATH POOL PRE PLASTER POOL FENCE it ATE l SEWER SEPTIC TANK FINALS ELECTRICAL DJ_ PLUMBING FINAL GAS TEST G HEATING - A/C HOUSE NUMBERS JOB COMPLETED TEMP POWER ABTURN ON UOVALS DO NOT INCLUDE RIGHT O ILITIIES OR OCCUPY BUILDNG .11 ,� ._._..,•-��,iy. `'3 _ „1 v!: 7. 6 +� ,T";' FIVS-411 %V 4+""7F r+iC"k,r.+. t �„F P.O. BOX 1504 APPLICATION ONLY -J Building _ Q `� n 78-495 CALLE TAMPICO Address 17� (> LA OUINTA, CALIFORNIA 92253 Owners - Q kJOAL a1271' BUILDING: TYPE -CONST. OCC. GRP. Mailing % if ) J� Address 5) A.P. Number r/ / 3/' s 13 - oLa T - %Gity Zip JTe!, I- o r Z Z�0 �2, R / / Legal Description / �% n Contractor � Project Description Z/ O Will Address City Zip -, Tell L State Lic. City & Classif19-/ Z �Q Lic. # Sq. Ft. No. No. Dw. Arch., Engr., Size Stories Units Designer New Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am Ilcensed under Drov i?ions of Chapter 9 (commencing with Section 7000) of DivisiolL3,of the Bu�lness af0prol"'''ons Code, and my license is in full force and effect. d,/, Z �/ �%/%�� SIGNATURE- �.-/ rs .�X DATE OWNER -BUILDER DECLARATION I he 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). F2 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, asowner 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. 8 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. 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.) 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: a, alter 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 if work thereunder is suspended for 180 days. I certify that 1 have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives sof this city to enter the above- mentioned property for inspection purposes. Signature of a0plicant Date Mailing Address City, State, Zip Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Z p= -- 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 FINAL DA Issued by: Validated Validation WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quints, CA 92253 Document Cannot Be Duplicated 760-771-8515 t CERTIFICATE OF COMPLIANCE Date 9/28/01 APN # 773-213-004 No. 22547 Jurisdiction La Quinta Owner NamePine Mtn. R.E. Permit#0108-255 No. 52-080 Street Avenida Rubio city La Quinta Zip 92253 Log # Study Area Tract # Lot # 19 Square Footage 1527. r 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 1,527 or $ 3,130.35 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 of California - Doug Peters Tele h ne 766'340:,-'9844 li • ,;c. Name on the check "rr, x .,� •"'' By Dr. Doris Wilson Superintendent Fee collected /exempted by Annette Barlow Payment Received $3,130.35 Check No. 7426000 Signature OTICE: 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 bove 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 ollect 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 Dept./Applicant Copy - Applicant/Receipt Copy -"Accounting RECORDING REQUESTED BY: -"-± QLD REPUBLIC TITLF Co 7 AND WHEN RECORDED, MAIL TO: gCalifornia Desert Construction Palm Desert, CA 92260 ASSESSOR'S PARCEL NO.: 773-213-004-1 "T2H .040.0/'% TI?LE ORDER NO.: 500799-13 ESCROW NO.: 5757 -DS M I S U FACE D0 08 20ee-136946 28/2000 08:00A Fee:6.00 Page 1 of a ®cc T Tax Paid Recorded in Official Records County of Riverside Gary L. Orme, Assessor, County Clerk 8 Recorder 1111111111111111111111111111111111JJJ 11111 iJJ1 1J SIZE DA I PCOR ( NOCOR I SNF I WSC. l A ' R L j COPY i LCNG 1 REFUND NCHG THIS SPACE FOR RECORDER'S USE ONLY The undersigned Grantor(s) declare that the DOCUMENT TRANSFER TAX IS: $ 17.60 County $ City xx computed on the"fuli value 'of fhe rilerest of proaerty-co,veyed; _r _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, James R. Kirchgessler, a single man hereby GRANT(S) to Eine Mountain Beal Estate, Inc. , a California Corporation all that real property situated in the City of La Quinta County of Riverside, State of California, described as: LKP Lot 19 in Block 3 of the Santa Carmelita Unit No. 1, as shown by Map filed in Book 18 page 46 of Maps, Records of Riverside County. Dated February 3, 2000 STATE OF CALjFORNI COUNTY OFg( L� ON Fe 6^ tga/ % JAVY), before me lr`/ 4 qq, e 4 Notary Public, personally appeared ........... A personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that helshe/they executed the same in his/her/their authorized capacity(les), and that by hislher/their signature(s) on the instrument the person's), or the entity upon behalf of which the persen(s). acted, executed the instrument. WITNESS my hand and official seal. Signature s.. IV MAIL TAX STATEMENTS TO: California Desert Construction - 73-170 Amber St., Palm Desert, CA ames R. Kirchgessler l MAGGIE L. LO EZ COMM, # 1180,203 NOTARY PUBLIC -CALIFORNIA m LOS ANGELES 1Q My Commission Expires JUL ir "a 92260 (This area for official notary seal) RC DISTRICT - PLANNING REVIEW FORM r This form is to be used by CDD staff for review of single family dwellings in the RC (Cove Residential) District per Section 9.50.090 of the Zoning Code. Its purpose is to determine: 1) that the proposed house design does not duplicate the same architectural style of any house within 2Go-feet of the applicant,- and/or 2) if there is a need -for-the applicant to -file for Master Design Guidelines. If the applicant does need to file a Master Design Guideline, please transmitted this information to the Building and Safety Department as part of your correction list. Please attach additional explanations as necessary. APPLICANT SITE ADDRESS CALIFORNIA DESERT CONSTRUCTI 52-080 Avenida Rubio APN 773 - 213 - 004 CASE NO.: 2001-544 LEGAL: LOT 19 BLOCK CHECK AND APPROVED BY: UNIT Michele Rambo ' DATE: S.C.@V.L.Q. • 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. REQUIRED ITEM Y N COMMENT/CORRECTION Verify legal and APN.information X Consistent with MDG on file (as applicable _ �Q� pA 1 MDG filing required (5 filings since 9/3/98) Architectural variety within 200 feet of the surrounding area: Colors Materials Architectural design features y 0� Other Requirements: INSTALLATION CERTIFICATE (Page 3 of 8) 'CF -6R Site Address Permit Number t. DUCT LEAKAGE AND DESIGN DIAGNOSTICS <` • . DUCT LEAKAGE REDUCTION Pressurization Test Results (CFM @ 25 PA) '_ •: Test Leakage (CFM) Fan Flow If Fan Flow is Calculated as 400 cfm/ton x number of tons, or as 21.7. x Heating Capacity in Thousands of Btu/hr, enter calculated value here If fan flow is measured; enter measured value here Leakage Fraction = Test Leakage/(Measured or Calculated Fan Flow) = Pass if leakage fraction <_ 0.06 ❑ Pass Fail ❑ For AEROSOL TYPE SEALANTS ONLY - The following diagnostic testing was completed: Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK AFTER FINISHING WALL: , ❑ Yes ❑ No ❑ Pressure pan test or House pressurization test L, E]Yes ElNo 11Visual Inspp.ction of Duct Connections' ❑ ❑ Pass Fail THERMOSTATIC EXPANSION VALVE (TXV) - Yes ❑ No , Thermostatic Expansion Valve (or Commission approved � y equivalent) is installed and Access is provided for inspection ' , " ff ❑ Yes is a pass .-Pass• Fail , ❑ DUCT DESIGN 1 ❑ Yes ❑ No . ACCA Manual D Design calculations have been completed, Duct Design is on the plans and duct installation matches. plans. 2 ❑Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV, ' verified fan flow matches design from CF -1R. '. Measured Fan Flow= •r 4 r ❑ ❑ Yes for both' I_and 2 is a Pass Pass Fail ❑ I, the undersigned, verify that the above diagnostic test results and the work I performed associated with the test(s) is in conformance with the requirements for compliance credit. [The builder shall provide the HERS provider a copy of the CF -611 signed by the builder employees or sub -contractors certifying that diagnostictesting and installation meet the requirements for compliance credit.] Tests Signature, Date Installing Subcontractor (Co. Name) OR% Performed Genehl. Contractor (Co. Name) COPY TO: Building Department ' HERS Provider (if applicable) ` - - Building Owner at: Occupancy January 4, 2001 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: 52-080 AVENIDA RUBIO Use Classification: SINGLE FAMILY DWELLING Occupancy Group: R-3 Type of Construction: Owner of Building: PINE MOUNTAIN R.E. Building Official vti Bldg. Permit No.: 0108-255 Land Use Zone: 'RC Address: 73-170 AMBER STREET City: PALM DESERT, CA 92260 By: KIRK KIRKLAND Date: JULY 1, 2002 POST IN A CONSPICUOUS PLACE