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0104-104 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of - Ciapter 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 f� � Date U 12", Signature of Contractor ��� - r�r�' • �"�'�-•-�-•—•- v`` 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'f 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. (fin) 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 Policy No. . MEMPT (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;rl"sJiall forthwith comply with those provisi ns. JJr `TI Applicant --_ t 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 Buildi for a permit subject to the conditions and restrictions set f on his 11 application. ADDRESS �ry jAM, ¢ gY 1Y� p Tet I, .a.sl •110 Mfr4%A!,b.'Gtlfe'�.�.. 4.2%.6 O f g !. •' e.'r3 ,f �, - :EN 1. Each person upon whose behalf this application is made & e son at whose request and for whose benefit work is performed under urs ant to any permit issued as a result of this applicaton agrees to, & s I , in mni�R & hold harmless the City of La Quinta, its officers, agents a emp yees. 2. Any permit issued as a result of this application becomes ull and void if work is not commenced within 180 days from date .,f iss nce c TRAM C4 14ST11rYa1O'l ION 117800 3F permit, or cessation of work for 180 days will subject permit t cancellation. IFIP I certify that I have read this application and state that the above In orm 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. Signature (Owner/Agent)b_-•-- 1 Date 4- _: -• �►� BUILDING PERMIT PERMIT# DATE VALUATION LOT 01&4-•104 TRACT ~r .•7 � ' r- _.._ ��f3�,.'�.2�J 22 - F3:f�l 01 Lx3`� JOB SITE .. ....++" 5 ADDRESS �ry jAM, ¢ gY 1Y� p Tet I, .a.sl •110 Mfr4%A!,b.'Gtlfe'�.�.. 4.2%.6 O f g !. •' e.'r3 ,f �, - :EN OWNER CONTRACTOR /DESIGNER (NEER JAC'Idlr-i i°���.'.I MEEIG COVE,13FIV LLC C014t r°.�tii'ar10N DRSIGN S1>'MMS WC PO BOX. 6718 P. O. BOX. 628 i,<fa QOWA CA 92253 uk ()V:f 4 r.4, CA 92,253 3 (160)7 1"3593 CBLfk 5830 v, s. USE OF PERMIT S.K) v PXRMIT UGIE`s NOT IAfCI.S1Ti)E BLOCK 'WAF..d.M001-JS.d~A OR TRAM C4 14ST11rYa1O'l ION 117800 3F P0RMPATIO 40.00 SF S F'1'. '6V0013 K, HCF. 200.00 LF 0A1 ACIL? 493.09 31r Vb".1VV1X=D O0E9T OF, C'ON&MU ON =411195.20 ME DT4i'OMT 10I-000-439.318 �2�4,4t4 COWITCRUCTION IE1, 101-000-418-000 PLAN CRL 1~ FEE 101-000-4-39-318 S$36.16 PAkC1WHCAL Pft 101-000-421-000 $62.00 &=MCAL< FEE 101.000-420-000 $120,94 Pz,.UMBINO FEE 101-000.419-000 $122.1.75 STROM MOTION D'M7.,� .1110D '101-000-241-000 516.89 11.EZAt.M140 FrX 1 U4 -0DO-4,23,000 $20.00 :u3pwrtj, ipm impAC'E Vyx SMIQ07.00 ' .F41SEPLJN 101-CA)0-4 1-385 $fQO.fJ6 F 3 rOl..AL. C0N KUC01'10N AM P;.AW 0MCK V4,570.64 2 0 2001 jX2, 1;W -PAID F "3 4250.00 F LA QUINTA ANCE DEPT RECEIPT DATE BY DATE FINALED INSPECTOR r .r INSPECTION RECORD k OPERATION DATE INSPECTOR' OPERATION DATE i INSPECTOR . BUILDING APPROVALS MECHANICAL APPROVALS Set BacksA_� Underground Ducts [ Forms& Footings /i��f/'�' Ducts Slab Grade < Return Air Steel Combustion Air i Roof Deck .O( Exhaust Fans O.K. to Wraps. F.A.U. [ Framing s Compressor Insulation 0(rj Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls I Party Wall Insulation Condensate Lines { Party Wall Firewall j Exterior Lath—'t c9 $Z i Drywall - Int. Lath 8.r .O L S -T ; i { Final I Final POOLS - SPAS BLOCKWALL APPROVALS Steel [ Set Backs Electric Bond Footings Main Drain j Bond Beam Approval to Cover ; Equipment Location i Underground Electric Underground Pibg. Test 1 Final Gas Piping 1 PLUMBING APPROVALS Gas Test [ Electric Final I Waste Lines%13— �( -. rel ` Heater Final [ Water Piping cJ Plumbing Final I Plumbing Top Out Equipment Enclosure { Shower Pans O.K. for Finish Plaster { Sewer Lateral Pool Cover { Sewer Connection ..� �j - O( ` ' Encapsulation [ Gas Piping i Gas Test (yD_l Q l S�Tc I. Appliances I Final 1 COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring 4 Low Voltage Wiring i Fixtures Main Service Sub Panels r Exterior Receptacles G.F.I. 1 Smoke Detectors Temp. Use of Power i 1 Final Utility Notice (Perm) P.O. BOX 1504 APPLICATI ONLY Building ' ^ 78-495 CALLE TAMPICO �S Address _0 �!Ta f� . �( ,� LA QUINTA, CALIFORNIA 92253 P . Owner uaeiie Mailing Address jJ�x City I Zip ITel. A ress ©. �CK 1tv2 State Lic. & Classif. Arch., Engr., Designer Address Tel.. :4--+1- 4--+1 LDING: TYPE'CONST. OCC. GRP, A.P. Number ---7- 9- -?> Legal Description (-C>—r12/_� 1-4( UQrT Project Description Lic. # Sq. Ft. � No. No. Dw. ize SStories Units el. City IZip I State Lic. # j LICENSED�CONTRACTORIS DECLARATION 1 herh.1.1firm that I am Ifcensedzugder provisions(of Chapter 9 (common Ing wJth Section 7000).6( Dflvis 33rof tt i Busine�ss��jana P?o/fe�ssi�,n '�jode/ nd my licens 'J'V fdl�f)orf a and effect. 1 isi �f.�lt/{ f Ss' �,JV�+u // �l�t// I hereby 'affirm that I am exempt from the Contractor's License Law for the following reason: /Sec. 7031. S, 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 (8500). f.: 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.) 1'1 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 contractor(s) 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 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. (E100) 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 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. 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. New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT Plan Chk. Dep. AMOUNT Plan Chk. Bal. `" -9, 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 DATE INSPECTOR Issued by: Date Permit Validated bv:_ Signature of a0plicant Date Mailing Address Validation: City, State, Zip WHITE = FINANCE YELLOW = APPLICANT PINK PINK = BUILDING DIVISION .P- .e Notice: Document Cannot Be Duplicated Date 4/18/01 No. 21905 Desert Sands ,Unified School District_ 47-950' bu' hieTalms_ Road .j La Qu nfa, CA 92.253 766-7.714515 CERTIFICATE°OE- COMPL• IANCE 'Jurisdiction owner NameJack McKenzie Desert Cove Dev. LLC No. 52-840 Street 'Avenida = Rubio: City La Quinta zip 92253 Tract # BL 171 U 17 Lot # 22 APN # 773-313-006 La Quinta Permit # 0104-104 .Square Footage Log # Study Area 1,788 Type of Development Single Family Residence No. of Units 1 Comments Cashier's Check for the amount°of $10;4.07.85.* R I , At the present time, the Desert Sands Unified School _,D'istrict?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 on paying school fees ai 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 1,788 or $ 3,665.40the 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/ PFF Bank & Trust - Lisa Bailey Telephone Name on the check " By Dr. Doris Wilson Superintendent Fee collected /exempted`by Paula Ruiz r Signature Payment Receive Check No Received $3,665.40 520999739 VOTICE: Pursuant 6t 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 run from -the date on which the building or installation permit for this project is'sssued of on.which they are paid to.fhe District(s) or to another public entity authorized to :olleet them on the DisVict('s)(s') behalf, whichever is earlier. Collector: Attach a copy of county or city plan check appliication%orm*to district copy for all waivers. Embossed Original- Building_Dept./Applicant Copy- App licant%Receipt`• `Copy - Accounting RC DISTRICT - PLANNING REVIEW FORM This form is to be used by CDD staff for review of single family dwellings in the RC (Cove Residential) District, in order to deterniine the applicability., of compatibility issues or need to require the filing of Master .. Design Guidelines by the applicant. Ji shall.b6 transmitted -to the Building and Safety De fantment as your correction list. Please attach idditional ex'lanations'as"necessty. _rA SS\NO lap APPLICANT Construction Design n Systems., I SITE ADDRESS 52-840 Avenida. Rubio APN 773 313 QU-6 'BIN NO.: L CA LEGAL: . LOT. ZI BLIOCK. 171 UNIT NO.: 2001-442 17 S.C.@V.L.Q. CHECKED BY: Greg. Trousdell DATE: Inform the assigned Building.plan checker upon. you . r lassigrinient to this case.' The CDD Executive Secretary maintains a log booktotrack application -§,and. assigncasenumbers. /Zf REQUIRED ITEM Y N COMMENUCORRECTION Compatibility Review Case logged and number assighe'd Verify legal and APN information A ado, Consistent with MDG on file (a"pplicable ale MDG filing iequired (5 filings since 9/3/98) - Consistency with street/surrounditig 'area: X,"0, 4AT00-- Colors,. C 6 aterial.8 C3 WSW _00. A hitecture`,Gan"` Other Requirements: 6 C #5, ESCAbw .INSTRUCTIONS: . TO: CHICAGO TITLr COMPANY, licensed by the.California Department of Insurance 72-980 FRED WARING DRIVE SUITE B•, PALM DESERT, CALIFORNIA 92260 y (760)56873627 Fax (760)341-8296 Escrow No. 17014125 - E88 Escrow Officer JACKIE FELDMAN Date February 21, 2001 On or before the TIME LIMIT DATE of March 1.2001 2. 4• : ALAN R. POLLOCK, AS TRUSTEE, Seller (s), herein wil[hand you a Grant Deed conveying the property described 5• herein to vestee' named below; 3. 7• JOHN M. MCKENZIE, A MARRIED MAN AS HIS SOLE AND SEPARATE PROPERTY, buyer (s). herein; B. 9• hand(s) you herewith $500.00 0. 1. will hand you prior to.date of close of escrow 2. $53,500.00 3• TO COMPLETE A TOTAL PURCHASE PRICE OF $54,000.00 4. 17. which yob -are Instructed to use when you can obtain a Owners Policy, is d by Fidelity Title .Company which Policy 18•. of Title Insurance will contain the insuring clauses, exceptions, excl ns, provisions and stipulations customarily 19. contained in the printed provisions of -such form with liability not ss than $54,000.00 describing the land in the City 20. of LA QUINTA; County of RIVERSIDE, State of California, des abed as: 52�gp �' '-2. commonly known -as: VACANT LAND/,APN77.3'313-005�AN0 0 6, LA QUINTA; CALIFORNIA 92253 (Escrow holder is 23• not re to'verify sam 24. �` \ (� ,is 25. :�: � 27i�. OU 21 AND'22 BLOCK.171 F SANTA CARMELITA AT•VALE LA QUINTA,. UNIT N0: 17, AS PER MAP' RECORDED 26 IN_BOOK 19, PAGES 19 AND 0 OF MAPS, IN THE OFFICE_ OF THE.000NTY..RECORDER OF SAID COUNTY 2 28. howing the FEE to sald land -vested in: JOHN M..MCKENZIE, A MARRIED MAN A&HIS SOLE AND 29. S ROPERTY (exact vestirig shall be determined prior to; close of escrow; without further approval from 30. Seller) 31. 32. SUBJECTTO: 33. 34. 1. Real Property General and special taxes for current fiscal year in which this escrow closes, and subsequent years, . 35. including reassessments if any and including any!special•district levies or personal property taxes, payment for which 36. are included therein and collected therewith and improvement bond assessments, when applicable. 37. ' 38. 2. The Lien of Supplemental Taxes,', if. any,. assessed pursuant to the provisions of Chapter 3.5 (commencing with 39. Section 75) of the Revenue:and Taxation Code of the-State.of California. - 40. 4 1 • 3. Bonds and/or assessments now alien; if any, to. be paid current by Seller; payments not.yet due to be assumed 42. by�Buyer. 43. 44• 4. Covenants, Conditions, restrictions, reservations, easements,., rights and rights of way. of record, if any; and the 'S exception of..reservatlonsof water, oil, .gas minerals, carbons, Hydrocarbons or -kindred substances .on or under said 46. land, now of record, if any. 47. 48. 50. 5 VESTING- - The exact manner of buyer'vesting.ls.to be provided "es scrow holder by buyer prior to the close of 52 escrow. Such notification Into be In wnting; and upon receipt of'same :escrow holderas authorized to Insert the . •3• vesting Into each pertinent. document as re quired.ln:rw .this transacontlwithout fl irthar an►i►ni/ ,l nf call' � m• . LOWN. April 9, 2001 Ms. Nickie J. Gormley City of La Quinta,,B ' uilding Departmien't 78-495 Calle Tampico P.O. Box 150.4 La Quinta, CA 92253 RE: Construction Design Systems]nc. Dear Nickie: Please be advised that the following pl' b`hs,shaVb been; previously approved for use in the Cove area of La Qbinta by,the Planning Commission'. TM firmat p"I e following o f"Co ;n.ations:�struction Design Systems, Inc. ih wirfg' has my permission to use the. plansI oc 1. Plan BA -1: 52860.AVenida. Rubio 2. Plan Malibu.1: 9-528- DiAvqnida`ijt 3. Plan -Malibu 534,45 'EisenhowerW 4. Plan BA -1: 52940 Eisenhowerri ' If you have any other -questions, please 'call mi .1. e at 760/564-1866. LEN, I 'TU RES, INC. A.P. Lench,. President APL.vI �OvOd > so-& Pienning Cotnriftuion am -no.. .01cltico P Inifill' ILI _Cils4lw 0 -00 -mm Exhibit A P. O. BOX 4,50.'ILAQUINTA t c.-ALI'FOKNIA *-92263-;0450 760/5644866 FAX 564w2627 M� a t „?tti¢i.4 y5tvx:'rr" "�# %..t...... �K-...w- +�.:,--.W.+r—' �,,.ra.+•Yr� �... r,..: y�1' ` �+, ter, ��;.�', ra :. ...r.^...�'S' =( 7v •' 4. '..•�-.'.. 'w 'I mar _ ... _ ,... a;..' - ' , - J Sicidden Engineer n - , ',�'a. ., s. •,� ..� r .4, 6782 StWOO Ave., Sults E, Buena Park, Ck60621 (562) 864.4121 ('7'14) 523-6862 Fax (Y14) 523.1369 7. 38:725 60and Ln„ Suite Q', Palm:Desert,•CA 92211 ' (760)7724 93 Fax (760y 772-3895 Date Y= .h 'rte 1 ti ,r t _ �MEMO' {. -Join Nd+a1R/�G r L��- ,�,i FIELD , Project'Name x� Site`Ad6ss �,1� l;�,,� • T : Job phone �': t Work D6fi �4,Z -'Test Swml iary ! F"tinge IhSpectetF fest bry 7 Motet % Relative 'Ref, Max Moist I No: Location Eley. Danai ty %t Co action mp P of % ' Az i ' r Fie ech 8uppr, or Agent 24 hour notlas requested to schedule Meld Tschniolan, Thank you for the opportunity to be of service. ._._.....-.._....�...._....�..u..��.._._..._._.__.t:��n......:.:�t�1.;.'..:.�....s�..,.....»._...._......_._.._�..�:Y..z.-•? -- - - -.-_�t'r.,....,...oaa..�:.._._.�.�r-.-.N:..v-a..,._.M.._..___t'v._.. .._^. _.._.. -cccyC art� ca to fOaT S i► J E" Cit of:La nra, J Sditai,n and SaafetF. Dreja= }merit= ti , This Certifca M issued pursuant to:, the -`requirements of-Section 709 of "the Uniform `Bui/ding Code, y: certifyong Ghat, at the tame of issuance, this. structure},was an comp/lance with .the various yordinancesr'` s of the Cit• ire Matin bui/din construction ortuse . For 'the fo/%wind Y 9 9 9' g, _.. "'.BU�OL®ING ADDRESS ,a52=840°AVENIDA�RU;BIO Bldg %f?ermit' No 0104 104 ' Use Classification: SFD - '"` � " - '- Occupa '6v Group: R-3 - Type of Construction VN �,; Land `Use Zone RC Owner of,f3uilding: JACK. IVIcKENZ1E.DESERT COVE_ Address:.. P.O`.~BOX628. a DEV LLC e .. . -.1 - vYl-J CK'.s1v u ,. egiw. n'.Ail•ti ✓..' Y r.Y- .F a rj..SliY' _ i .. ... _ - M-.. -p,. .. r .: i: City: LA- QUINTA, CA.— 922.53 , By: STEVE TRAXEL Date: ,10-11-01 Building Official