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0004-008 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of -Qhapter 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 z /1/ !! / B cis l/c ��, Signature of Contractor t 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 Seo�tan 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 FUND No. 7,29.00 U141T 0004433 (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 subjectto the workers' compenption provisions of Section 3700 of the Labor Cod ,II shall forthwith comply with those�rovisions. pafe r' 1 t 1 _ / Applica�nf U� �✓ j� ro 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 f6r.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 abo�ve;mentioned property for inspection purposes. Si arS ture (Owner/Agent) � f'� �� V�� J Date BUILDING PERMIT PERMTJ/ DATE,,,/ / VALUATION LOT 0004-008 TRACT ( h < $91.423M i0 12 BLY. 177 U8 JOB SITE f V e,,, ADDRES APN OWNER CONTRACTOR / DESIGNER / ENGINEER STA12.i,.•1GFPiMAiMAG13bOIn WILT XAM RUSSELL ROGERS PQBOX 3 578 56900 =IS.SON _3T : 1 LAQMTA CA X2253 w T1MIMAZ CA •92214, - Q60}399-1200 C..r31.0, 1954 USE OF PERMIT S1NOI Y, FANMY DWEIXINO SP7)-PER11I`T DOES 140T 114CLUDE SLOCrINALL OR POOL \ ..•K• —4 TRACT CONSTRUCTION 1,465.00 SF PORCWPATIO 90.00 Sr t~AR.AGWCARPORT 438.00 SF 5 FT. Wool) FENCE 200.00 LF EFrIMATED COW OF CON917RUMON PERurr FEE guActuRy CONSTRUCTION FEE 101.000-418.000 $603,50 PLAN CHECK YEE 101.000-439-318 $303.03 MECHANICAL 1FUZ 101.000.421.000 $33.50 ELECTRICAL FF 9 101-000-420-000 $123.94 PLUMBING FEE .101.000.419-000 $116.75 STRONG MOTION FEE - RFSID 101-000-2x31-000 $5.14 O ADINCI FEE 101.000.423-000 $20.00 DEVELOPER IMPACT FRF, $1,907.00 PRECISE E Pi AN 101.000-441-345 $100.00 FEE DEPOSIT 101-000-439-318 •$mom , RM -TOTAL C01iWRUCT.(0 AND PLAN Ci:1rXX $3,438.88 L1~0 PRE -PAM FEW) -$250.00 YOTAY I''EMAW.PEXS7 UENOW 1 RECEIPT DATE B� T FIN D 0 INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE I INSPECTOR BUILDING Set Backs APPROVALS _ MECHANICAL APPROVALS Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck -470 Exhaust Fans O.K to Wrap _4X0 F.A.U. Framing S' 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 — y Final Final BLOCK Ll A PROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings — ly —e:00 I 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 S — I — S r Encapsulation Gas Piping Gas Test Appliances _ Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Law Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G. F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: 8_ 4 Q .63 2 P.O. BOX 1504 A 1 78-495 CALLE TAMPICO PPLI TIO ON Building LA QUINTA, CALIFORNIA 92253 Address Owner + J ` i.t6NT MINACIMCkit- ioc,_ BUILDING: TYPE'CONST. OCC. GRP. Mailing Address ,(] , 1�`. �' A.P. Number -7 7 — n52 City;) Zip Tel. ��LM wpm-� � � � � - Legal Description /�5' _ _ Contractor Project Description fi� v A7 Address •'�'� � ] 17 ip ITe�, • i ?� V State Lic. & Classif. f,�q Z City Lic. ff Arch., Engr., Designer LE NC tvs 1 r.,+J , < Rot) d�dr— A+'`- �/ ` pess Tel. G+t 21l�IZ��S,3 (State �la �- �t"f4. Lic. It LICENSED CONTRACTOR'S DECLARATION I hereby affirJnahal I am licensed under provisions of Chapter 9 (commencing with Section 7000)-of>Diion If of the Business and Professions Code, and my license is in full force and effect. A /� XSIGNATURE' �+�.+ ----.+.•DATE' OWNER -BUILDER DECLARATION _thereby affirm that I am exempt from the Contractor's License Law for.the following reason: (Sec. 7031.5,Bustness 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-Frb-visions 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 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. ISec. 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.) 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 if the permit is for one hundred dollars ($100) 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 r f/ - hereby affirm that there is a construction lending agency forthe 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 aQplicant Date Mailing Address City, State, Zip Sq. Ft. I q_V li No. No. Dw. Size Stories Units NewA -- Add ❑ Alter ❑ Repair ❑ Demolition ❑ _3 -1/5-" L 5.� -,/ - F417 o . stimated Valuation PERMIT 2 /C/�•' AMOUNT Plan Chk. Dep. 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 DATE INSPECTOR Issued•by: Date Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION w Notice: Document Cannot Be Duplicated Date 4/6/00 No. 20255 Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE Jurisdiction Owner NameWilliatn Russell Rogers No. 53-245 Street Avenida Rubio City La Quinta zip 92253 APN # 774-042-024 Permit # Log # Study Area Tract # BLK 177 U8 Lot # 12 Square Footage 1465 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 1,465 or $ 3,003.25 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/William Rogers telephoie Name on the check ell By Dr. Doris Wilson. ,. Superintendent �•' �' tiF , Fee collected /exempted,by Mary Ann L. Borja Payment Received $003.25 Check No. '216230 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 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 RECORDING REQUESTED BY: AND WHEN RECORDED, MAIL TO: Starlight Management, .Inc. P.O. Box 3579 Palm Desert, CA 92261 r. ASSESSOR'S PARCEL NO.' 774-042-024 TITLE ORDER NO.: co?yI of Docurnent ftecos!1 0i�� Ldp' ori final• An �,prdiLiBf� �� g GARY L. Of" county Awarder FORNIA d vEli:SIDE CQW! cAu THis SPADE FoR AECORMRS USE ONLY The undersigned Grantor(s) declare(s) that the DOCUMENT TRANSFER TAX IS: $ 23.65 County City ESCROWNO,! 19547-004 xx computed on the full value of the interest of property conveyed, or —. computed on the full value less the value of liens or encumbrances v remaining thereon at the time of sale GRANTDEED -- OR transfer is EXEMPT from tax for the following reason: FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Henry C, Griswold as trustde of the Henry C. Griswold living Trust established pursuant to that certain document entitled "Declaration of Trust" dated June 19, 1995, and executed by hereby GRANT(S) to Henry C. Griswold as Trustor and Trustee Starlight Management, Inc. a Nevada Corp. all that real property situated In the City of La Quinta County of Riverside , State of California, described as: LOT 12 IN BLOCK 177 OF SANTA CARMELITA AT VALE LA QUINTA, UNIT NO: 1B AS SHOWN BY MAP ON FILE IN BOOK 19 PAGES 311 OP MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA Dated February 09, 2000 STATE OF CALIFORNIA, r COUNTY OF Riverside } ss. On March 1b, 2000 , before me Cindy Burgin i , Notary Public,ppersonally appeared HENRY C. GRISWOLD, TRUSTEE Henry Griswold; -trustee personally known to me (or proved to me on the basis of —dQ 906.00 CINDY BURGIN satisfactory evidence) to be the person(s) whose name*cePntN ;1,1808!33 n is/4w subscribed to the within instrument and acknowledged •r+TARY A.s:-C-CAUrCRN!A -� wNI�T�SIC'F. to me that he/sba/#tey executed the same in his/heFfthair 16A 61-.MAOW Goun'T'v °' authorized capaclty(los), and that by his/he 4ftir signature(q) on the instrument the person(a), or the entity upon behalf of which the person(e) act , executed the instrument. WITNESS my hand d1al seal. Signature 09 MAIL TAX STATEMENTS T pisAfAA 10r dilclel notary seal) SAME AS ABOVE - NAME AMMS CITY. STAIE 4 ZAP 12 1 19 I '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 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 STARLIGHT MANAGEMENT SITE ADDRESS 537245 Avenida .Rubio APN 774 042 - - 024' -,BIN NO.; � CASE NO.: 2000-208 LEGAL: LOT 12 BLOCK '177 UNIT 18 S.'C.@V.L.Q. CHECKED BY: Fred Baker DATE: • F _ 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. r REQUIRED ITEM Y N COMMENT/CORRECTION Compatibility Review, Case fogged and :number assigned Verify legal and APN information` A EXHIBIT PROVED BY COMMUNITY DEVELOPMENT D FPT DATE -- 5a Consistent with MDG on file (as applicable CA E NO MDG filing required (5 filings since 9/3/98) - Consistency with street/surrounding area: Colors r Materials Architecture f ' Other Requirements: Q, Certificate of Oacup,ancy City of LaQuinta Building and Safety -Dep* artment 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 ADDRESS: 53-245 AVENIDA RUBIO Use Classification: SFD Bldg. Permit No.: 0004-008 Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC Owner of Building: STARLIGHT MANAGEMENT Building Official Address: P.O. BOX 3578 . City: LA QUINTA, CA 92253 By: STEVE TRAXEL . Date: 09-27-00 POST IN A CONSPICUOUS PLACE