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0012-179 (SFD)LICENSED CONTRACTOR DECLARATION r 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 +:7.8404 3112t " 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. kidI have and will maintain workers' compensation insurance, as required by Sectlon'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&ATE I ds Policy No. 1342304 -AD (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 p"`rovisions',� � DateApplicant s�.3%'.'s�`,�/ 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. f s, • IMPORTANT Application is hereby made to the Director of -Building and Safety for a permit subject to the conditions and restrictions 4 set forth on his application. . r_ 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuantft63 any permit issued as a. result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta,.its officers, agents andpb, 'e t 2. Any permit issued as a result of this application becomes. nul a v id I 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. p Signature (Owner/Agent) --�"✓ Datet' - BUILDING PERMIT PERMIT# b DATE VALUATION LOT. ��{��.- S. �9 TRACT �j / a@: ➢Q3.1; 15 BLK 1641 '017 JOB SITE APN ADDRESS _ 52-460 ,A."triS A IRT)TWO OWNER CONTRACTOR / DESIGNER / ENGINEER PINI. ItMJ. REALM= Pte: P 111. MN, Q C.P,: K dba CX DEPM COTS, dbta CA. D ERT CONST r .ptam =%MT M. 92.260 PALMDESERT CA 9226:6 C/60)7714409 CF.ii..ai - 4-S01 USE OF PERMIT MINGLE FAM[i.'1''DV4MLD4(1 SY) 4)1=A1T DOES NOT INCLUDE iitD::k,,wALi. %q)rJt'31h)R.1V'FWAY APPROACH. TRACT CONDTR UCTIOid Io3 l.QD PORCHfPAT10 140.00 4 *' (MlvAO&C'A,R ORT (N) Man n 5 FT' ' W047D VENC E 200.09 LF RAVIM 1": 7) COST Or CONYMITC''I' 014 ,45�(P.ltI9 C'OINSTMIC'TIM FEE 101-000.41 S-000 PLA.N CH.WK F&E 101-000.430-315. REDEPWIT 101.000-439.318 4250.10 MEC HANICAL WE 1I31 -€)L10 -'►2}. O+�A X55. 463 EbEC,'7Rtir FER itJ}'-£tii4}�i2tkuUt 1 X111, 5 PL MTH'NO IEE 101-(}00.419-00.0 $1161. S`FROM MOTION FEE R831D 1.01-000.241.600 t31r.A�HNU FRE 161-00"23-000 Z0.0i1 DEV BL> F Mi PACT 11"ES t+laDD'°fris.� Ppmaer PPIA + 101-000-441-345$)Ot1.gSD p x 6 20 u 1 SUB -TOTAL, OTAL, C:01 I•.xC°'1`ION AM.) PLM11:C",�'�. $3� 14.9.44 , L1'161,23 PRE-PAU i3`is _$250.00 LA ULA T 01YAL MITEN Mrs NO`i?t! $3,199.44 1 RECEIPT DATE i / BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Slab Grade - , Q !> Ducts Return Air Steel Combustion Air Roof Deck t 3_ p Exhaust Fans O.K. to Wrap F.A.U. Framing —fit crj 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 2—T S _ 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 Water Piping — l 7l Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral /� Pool Cover Sewer Connection Encapsulation Gas Piping G Gas Test 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 (Perm) Notice: Document Cannot Be Duplicated Desert Sands Unified School District .47-950 Dune PalrnsRoad ta Quinta, CA-- 92.253 760-771-8515 CERTIFICATE -OF COMPLIANCE Date 2/6/01 APN# 773-283-009 No. 21623 Jurisdiction La Quinta Owner NamePine Mtn. Rdil. Estate:­dba CA Desert_ Const:. Permit # 0012-179 No. 52-660 Street Avenida Rubio city La Quinta- zip 92253, Log # Study Area Tract # BLK- 164U 17 Lot 15 Square Footage 1527 Type of Development Single Family. Residence No. of Units Comments At the present time, the Desert Sands Unified School. District does not collect fees on garages/carports, covered patios/walkways, residential'additlons�uhder 500 squar*e feet, detached accessory structures or replacement mobilehomes. It has been determined the above-named owner is exempt fromg school fees at this.time due to the following reason: payin e EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to dovernment Code 53080 in the amount of 2.05 ..X 1,527 or the property listed above and thatbuilding permits and/or Certificates of Occupancy for this square fo6tage-in this proposed project may :now be issued Fees Paid By CC - Union Bank of California Teieiih6ne 760-71-1-8409 Name b4the 'check By Dr. Doris Wilson Superintendent Fee collected /exempted by Annette Barlow Signature";� Payment Received $3,130.35 Check No. 723.1888 NOTICE Pursuant of Assembly Bill 3081 (CHAP 549, -;STATS. 1998) this serve ill see to notify you that the 90 -day approval, period inwhich 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 s sued or on which they are paid.to the District(s) onto another public entity authorized to collect them on the Distri6t('s)(s') behalf, vvhich6Veris,earfier. " . Collector: Attach a copy of county or city plan , check applickion . f6rm to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/ReceiptCopy - Accounting RC DISTRICT- PLANNING REVIEW;=:FORM This form is to be "used by._CDD staff foureviewof single family:dwellings in`the RC (Cove Residential) District, in order to` determine the applicability of compatibility issues orneed to require the filing of Master Design Guidelines by the applicant •'It. shall be transmitted"to the.Buildifig and Wety. Department as your correction list. Please attach ad�ditional,explanatiorisas necessary. r APPLICANT 5,2.-6.6.0 Avenida: Rubio- L SITE ADDRESS y\�`— Pike Mountain/eal, .Estate S SS APN 773 _ 283_ -009'. BINNO.: ` CASENO::. 2000-356 LEGAL: LOT. % 15 BL,0CK 16.4" UNIT. x`.f. S.C.@V.L.Q. CHECKED.BY: M Wally Nesbit _ 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. z REQUIRED ITEM Y . N 'COMMENT/CORRECTION , Compatibility Rcview Case logged and number assigned Verify legal and APN information Consistent with MDG on file'(as.applicable ' i✓ /%h MDG filing required (5'filings,9ince 9/3/98) Consistency with street/siiiroundmg::area:: [ Colors' t Materials MIMI Architecture r R P ernents AS .Ta a. /S£, �i.�i!uIV14f- dcTe� 7a rd e b ' . . ' : ., x eoi R.1 . P or io-r r� . S A3 -Planning Co Won., G Un b Community bev Dept 2 r i Initials '� y Vase No. - Exhibit With Conditions n cvrainq RegUe.. 'id B First American'Titi" . `m n RECORDING REQUESTED BY: Fidelity National Title Company `r. Escrow No. 140119 -LRC Title order No. 2156839 !(�,_ When Recorded Mail Document Uo and Tax Statement To: David A. Peters Fine: Mountain'Real'Est� a e Inc , db,at) \� Cali.for-nia-Deser-t-Coristructio.nsi 73-170 Amber Street Palm Desert, CA 92260 TRA 6;6_01 7 "b.1 E/ The undersigned grantors) declare(s) Documentary transfer tax is $18A5 ( X ] computed on full value of property conveyed, or [ ]. cpmputed on full value I s.value of,liens or encumbrances remaining at time of sale- . --city City of '4'A DOC. I8 2000-121124 63/31/21900''r®R:08A Fee:6.00 Page -1 isf 1 DocT Tax Paid R.ecarded' In off'lcial Records Coumy of Riverside Giiry L..orso Asseasoc., Gcuhty Clerk $ Recorder h i M -.I S U GAGE SIZE OA ICOR 40008 EMF misc. 7w A R L i coat/ , LONG REFUND j NCHO EXAM USE FOR A VALUABLE CONSIDERATION, receipt of u which is hereby acknowledged, Lee Wetzel, A Married Mans his Sole and Separate Property hereby GRANT(S) to Pine Mountain Rear Estate '!nc., a California corporation dba California Desert Construction the following described real property in the County of Riverside, State of California: Lot`15 n Book 164 of Santa Carmelita at Vale Unit No. .17, as shown by Map on five, in Book 19 Page(s) .19 and 20 of Maps, records of Riverside County, California DATED: March -15, 2000 STATE OF CAUFO�jv IA COUNTY OF K1 V PloiSN `' ON 3- 3 - ©� before me, personally appeared Lee Wetzel (or proved to me on the basis of satisfactory evidence) to be the person( whose n'ai-6e(�'iIS/ape-subscribed to., e within instrument -and acknowled ed ,to me that a elief el executed the1 U same his AocAhek authorized capacity(ioe, and that �by (ir signature(sr on the Instrument the person(K,. or the entity upon behalf. of ch the person(I1 acted, executed tKa instru Witness my haq+�',�lncyotXial / 4-- , Signature Lee Wetzel MAIL TAX STATEMENTS AS DIRECTED ABOVE FD -213 (Rev 7196) GRANT DEED Building Address 'O P.O. BOX 1504 78-495 CALLE TAMPICO RUB LA QUINTA, CALIFORNIA 92253 owner Mailin Address ! Ari 0e2 ✓-T Zipepz Z60 Tel.. 1740 Gy Yo Statei. 8�i Y 0 City 8 Classit—+-62. °'' J Lic. # � a90 Arch., Engr., Designer Address Tel. City/ (Zip (State Lic. # LICENSED CONTRACTOR'S DECLARATION I herebyy alfirm that I am licensed oder rovisions of Chapter 9 (commencing with Section effec of Divis on 3 urine nd fe sions Elide, and my license�in f SII �QV 7000)0 ff//� O' SIGNATU-R�E/ .LST 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, atter, improve, demolish, or repair any structure, prior to'fts 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 'arid Professions Code, or that. he is exempt therefrom, and the basis lot the alleged exemption. i 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). 0: 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, 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 contractors) licensed pursuant to the Contractor's License Law.) 17 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 C�m�n H iQ tuns rance, or a certiffied,cS 71 opyPthewo Se 800, Labor Code.) Policy No. Compan %7 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 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 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 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 aliplicant Date Mailing Address .City, State, Zip P�ca- t S APPLICATION ONLY BUILDING: TYPE'CONST. 1 V �`�' OCC. GRP. A.P. Number 77_S ,a8 -3-o o c Legal Description Lam47&A.i631 doo,�19 Arg H-eA0 Project Description 14eW 40M Q Sq. Ft. "o),. No. Size Stories Add ❑ Alter ❑ T Imateo valuation No. Dw. Units Repair ❑ Demolition ❑ vewc ,00- PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing INSIDE S.M.I. Grading Date_PeirrvirMil(i Driveway Enc. Infrastructure Q� Validation:` TOTAL ZSO. 0`J REMARKS :p� 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 DATES INSIDE Issued by: Date_PeirrvirMil(i Validated by: Q� Validation:` WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Certificate,of Occupancy City: of La., _Quinta - Buiding anal Safet De -ad. Y p This Certificate issued pursuant to, .the requirements of Section 109 of the Uniform, Building Code, certifying that, at the time of issuance, .this,stru'cture was in compliancewith the various ordinances of the City repdating bui/ding construction or use. For the following: BUILDING ADDRESS: _52-6.60 AV, NIDA RUB10 Use Classification: SFD Bldg. 'Permit No.: 0012-179 Occupancy Group:' R 3 Type of Construction: VN Land Use Zone: RC . Owner of Building: PINE MTN..REAL ESTATE Address:. dba CA DESERT�CONSTRUCTION City: PALM" ESERT,CA_ 92260 By: STEVE TRAXEL Date: 10-04-01 Building Official POST IN A CONSPICUOUS PLACE ..s =H