0210-055 (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
�DProfessionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
634981
.,,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
t WORKER'S COMPENSATION DECLARATION
1•, 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.
1-(' ) 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 S,rA 1' 1,1 }!la Policy No. 154V07-0.3
(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 ifs ,should become
subject to the workers' compensatiom;provisions of Section 3,700 of the Labor
Code, I shall forthwith comply with those, provisions.;��
eaate: Y Applicants
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 haFmless 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; representativeslof this City to enter upon
ihe•above-mentioned property for irispection purposes.
Signature (Owner/Agent) ` Date `
- _4 N4
BUILDING PERMIT PERMIT#
DATE VALUATION LOT r�xay zis TRACT
JOB SITE
ADDRESS 'M-414 AV.a M11A.RUBIO
APN
fi''1-22M5••/i 1.0
OWNER
CONTRACTOR / DESIGNER / EN INEER
7%.I0? SE
c..OR.O RL0..ON 8MCJC"1'9,ON
1'.4:5 SINA1'; AAV
PASADENA CA 91104
LA qu9N l. .. CA 92233
C/60)564-46.041• 01AI 226
USE OF PERMIT
S0 -D - V66SQY`X'.-LM140. NO* titakule
.01ock'W-411, Fonc..% Poli Q1'!lpa, .4 aqt' m pniytii; k
tepheA fur Od'SyLii4V t;iyp1?JrIF.h fiwn tho NJ& •i1'�Gf;s
TRACT CONSTRUCTION 21766.00 8F
POR.tr:FiliP.Pr,TIO 283.01) SF
(1.(ildAWYCA1IORT 459,00 SF
i�.gi3i1.,�•!AI COW OF 7. oN.'rdk��'TG`7l0i''�'
.IQ�®��t A0
►]�;T�yr�;���++•• �r�q[T �?•c•f•����t /�
.C.r•c't.4�' irl" F hcYw•. fda.7.Yvll.�e'AARY .
i.�% trs1'F r�'1�11 "s1'. 101,000-41 8-000 't0.oil
&'i.AN CHECK FEE -:318 M.71
W. . DEPOSIT 101-000-4,39-318 4251MO
Mff',or•HANICAL, YZE '1014)00 -421 $11100
ELKIRiC.A.t F&E 101-000-420-000 $161,94
PA:,illul 1.01CI FEZ 101-000-419-000 $t6?.ZS
MONO MO 1011 "WR - MID 101-.000.7A 1.0300 916.30
ORADn'40 FEE 1011.000-423-000 $15.010
DI?MOP6: R IMP.A(,T RE
PRECISE Pk,AX 101-000-44.1-34.3 $100.434
we
t .N:..
.. •�A
WV-MMYY.y
SM-TOTALANDj7.p Kb4CiaLCK
T-4,570.25
ppCWWL�lAI••SX
$*/(
D !p eta P 11 PKFING D• ; OW
$41120 15
MAR 05 2003
CITY OF LA QUINTA
RECE121 11 BY t
DATE FINALED
INSPECTOg�
4.
9 .
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
--,v S"
Underground Ducts
Forms & Footings
_�
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
. Q _
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Insulation
_
_ -
t722_
Compressor
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 =_-101,U-�
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
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) '7
COMMENTS: /n /
40 r c'
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered paiios/walkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living; sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the fdllowing reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in'the amount of $2.14X 2,766 S.F. or $5,919.24 have been paid for 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/Wells Fargo - Ish Coronal Check No. 0208602495
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected
Signature
Sharon McGilvrey
$5,919.24
Payment Recd
$C:00
Over/Under
NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is eartier.
I
NOTICE: This�Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
Sent By:.OFFICE DEPOT #835;
6267925800 ;
Sep=7-02 4:49PM; Page 3/3
" ESD REPOLI(; IIILZ UW
83/08/2000 es:eeR Fa.:e-oe
Page t of t Elan T Tax Paid
RECORDING REQUESTED BY:
Recorded in offidi•al Reeorde
- ' Fidefity National Title Company
County of Riverside
Gary L. or■o
! Escrow No. ,41335-CBj
.A R L
/ n
`(
Assessor, , County Clerk i Recorder
Title Order No.
LCM
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•
When Recorded Mail Do:ocument
�� (Z.A5 rO
and Tax Statement
Mr. and Mrs. Mario W. Sewell,
1245 Sinaloa
Pasadena, CA 911.04
M j S U
FAfi� + 612E OA
0170
K=Cfl 816 ' M
.A R L
Cour
LCM
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GRANT DEED
The undersigned grantor(s) declare(s)
Documentary transfer tax is $".00' KP
( X l computed on full value of property conveyed, or
( I computed on full value less value of liens or encumbrances remaining at time of stele,
F
( l Unincorporated Area City of La Quints
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknoiNledged. Richard G. Diener and Marjorie W.
Diener, Co -Trustees of the Declaration of Trust dated June 19, 1984
hereby GRANT(S) to Mario W. Sewell and.Sarldra S, Sewell, Husband and Wife as 'joint. tenants
the following described real property in the City of La Quints
County of Riverside, State of California:
Lots .14 and 15, Block 264 of Santa Carmelita at Vale. La Quinta, Unit #24, Page 19, Page 45 of Maps, in the Office
of the County Recorder of said County.
DATED: February, 10, 2000
STATE OF CALIF RNIARichard G: Diener and Marjorie W. Diener, Co -Trustees
COUNTY OF Ae4 �&u of the D n of Trust dated June 19, 1984
ONb 11 2�'a — before me,,,
a4 (Apersonally appeared ey:
AI r,e, 1) Richar G. Diener, Trustee
CT
for proved to me on,the basis By:—. .
of satisfe ory evidence) to be the persons) whose . Marjorie W.toner; Trustee
name(s) ere subscribed to the Within instrument and r
acknowledgeg to me that .t4/oe/they executed the
same in tJs r/their authorized capacity(iss), and that
by r/their signature(s) on the instrument' -he
person(s), of - the entity upon behalf of which the LEAH H. NfALON
person(s),, acted, executed the instrument. COMM. #tt:�3542 v
WTAW PUBLIC - CALIFORNIA'
Witliess my handd official seal Los Ahohmcwm
A�. liyCwm. ExpiresJUmeB, 2003 •
Signature ,
_ MAIL TAX STATEMENTS AS DIRECTED ABOVE -
FD -213 (Rev 7/96) GRANT DEED
Wov • 26 - 2003 3 :15PM
UQQC DIN_ G BM ESTED BY•
Mario 'and Sandta_Sew-qII
1245 Sinaloa '
MAE
IL TAX TATM ( TTS TO,
nO A1,0
sPACE ABOVE THIS LINE POR RECOROER'S USE
APN: 774-235-010 and 774-235-011
THE UNDERSIGNED GRANTOR(S) DECLARES)
DOCUMENTARY TRANSFER TAX IS $
No:. 0084 P • 1
GRANT DEED
❑ Computed on full value of property conveyed, or
❑ Computed on full value less value of liens or ancurr•brances remaining at time of sale.
❑ Unincorporated area a City of La Quinta, •AND
FOR VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
Mario and Sandra Sewell
hereby GRANT(S) to,
Mario and Sandra Sewell
the following described real property in the County of Riversides, State of Califorria:
Lots 14 and 15 in Block 264, Santa Carmelita at Vale La Quinta, Unit No. 24, as per Map recorded
in Book 19, Pages 44-45 of Maps, in the office of the Ccunty Recorder of Riverside County.
This deed reflects Parcel Merger 2002-399, as approved by the City of La Guinta.
l 03 03. `
Dated
M09R,ri2 5
�Si(g4nature(s)
PARCEL MERGER No.g
LOT LINE ADJUSTMENT No.
APPROVED BY CITY OF LA OUINTA
�0 -1U E ELOPMENT DEPARTMENT
;Y. DATED
(The above area is for official notary seal and/or acknowledgrient. Attach if apace is I:mited)
MY . 26. 2003, 3 :15PM
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
b'OSS.O .... iS"n'/-yVpi!/�it�gt.',
State of California
County of t'/ P� s'•
N c . 0 0 8 4 P - 2
On Rn A2 j a0(k3 before me,Z,F Acs /taryPublic
DateName and Tql> of oKcar(e.g., •,rens, )
personally appeared
Name($) of Synege) -
❑
personal,, known to me
A proved t) me on the basis cf satisfactory
evidence
EWULWA MAC>i9.
OmndWM 014
No[ty Pubic - Cdthxnio
los ma" County
11i�r�n E,�#a• Oec t t,�t
to be the persoro whose nam-Ts/are
subscribed to the within instrument and
acknowledg 3d to me that he/she/Eley executed
the sam in �kheir authorized'
capaci ies and that by 'tti�#t�ecltheir
signatur on the instrument the. persoro
the entity upon behalf of -which the persor s�
acted, executed the instrument.
WITNES /hand offs ' s
Plaoe Notary Seal Abov¢ Slgnature of Notary Pubao
OPTIONAL —
Though the Information below is not required by law, it may prove vatu.?bfe to persons relying on the document
and could prevent fraudulent removal and reattachrnent of alis form to another document.
Description of Attached p9currient
'Mle or Type of Document: Q
Document Date; I'lumberof Pages: 7
Signer(s) Other Than Named Above:
Capacity(iss) Claimed bye Si ner
Signer's Name:Ile
Individual
f ❑ Corporate Officer — Title(s): by of thlanb here.
❑ Partner — ❑ Limited ❑ General
O Attorney in Fact
❑ Trustee
l ❑ Guardian or Conservator
❑ Other.
r
Signer Is Representing:
0 7998 National Notary Aasoclauon • e350 t>o Soto Ave., P.O. Box 2402 - Chat:wofth, CA 91 9112 6 62 . gwYa,nadonalrotary.o
Pion. No. 5907 , Rmrwr. Can 7o9•Pm¢ 1500.979.6627
Nov • 26 2003 3 16P 6.0084,•—P 3----�
Certificate of Penalty of Perjury- JCllegible Notax'-J Seal.
Declaration
(�overnzx��ant code 2,7361.7)
I certify midcr the penalty ox perjury that the notary seal on the docuratnt to
which this statement is attached reads as follows:
Name of Notary-_ , - y� ,
Comzn.ission Number-
Date Commission Expires
Date and Place of Notary Execution �� ���T A
�I
Signature of Verson Making this I) ation
Firm Nazoe (if any)
t r.Nov.26_2003 3 1 6P
No -0084 _ P .4
Legal Description of Merged Parte
LOTS 14 AND 15 IN BLOCK 264 SANTA CAF;MELITA.AT LA QUINTA,
UNIT NO. 24 IN THE CITY.OF LA QUINTA, COUNTY OF RIVERSIDE,
STATE OF CALIFORNIA, AS SHOWN BY MAP ON FILE IN TELE BOOK
19., PAGES 44-45 OF MAPS, IN THE.OFFICE OF THE COUNTY
RECORDER..
PARCEL MERGE=R No, 2'
LOT LINE ADJUSTMENT No..
APPROVED BY CITY OF LA QUINTA
COFj
DPARTMENTB DATE 1
E=11G7�
EXHIBIT A
CERTIFICATEOF-PAR-CEL MERGER N041
Record Owners
Existing Parcels
i ssessor Parcel Numbars
MARIO SEWELL
774-2-':'5-010-1
SANDRA SEWELL
774,2": 5-011 -2
Legal Description of Merged Parte
LOTS 14 AND 15 IN BLOCK 264 SANTA CAF;MELITA.AT LA QUINTA,
UNIT NO. 24 IN THE CITY.OF LA QUINTA, COUNTY OF RIVERSIDE,
STATE OF CALIFORNIA, AS SHOWN BY MAP ON FILE IN TELE BOOK
19., PAGES 44-45 OF MAPS, IN THE.OFFICE OF THE COUNTY
RECORDER..
PARCEL MERGE=R No, 2'
LOT LINE ADJUSTMENT No..
APPROVED BY CITY OF LA QUINTA
COFj
DPARTMENTB DATE 1
E=11G7�
Nov•26. 2003„ 3:16PM N.) 0084 P•.5
PARCEI MERGER No. •
LOT LINE ADJUSTMENT No.--------------
APPRO ED BY CITY OF LA QUINTA
f�O ? ry UNIT
WMENT DEPARTMENT
..
EXHIBIT B
F
CERTIFICATE'OF PARCEL MERGER NOx�
DEPARTMENT USE ONLY
ReCord wwner This Certiticatt3 of Parcel Merger No. is
Address hereby approve Cl,
Map Prepared By By
Address • Tdle
Area/Dlstrtct Date
Nov , 26. 2003. 3-: 16PM _ a5 ' NF)*. 0084 p . 6
,
SITE'PLA'N* ...__
CE.HTlFICATEOFPARCEL MERGER N.O. � _
PARCEL MERGER No. QZ �35
LOT LINE ADJUSTMENT No,
• .,, ,;... �. ,ter pv .� -
CITY OF LA OUINTA
ZELCJPMENT-DEPl
TME
DATE N
J,
Geta
Record Owner t't b"''--�"r-��
Address
Map Prepared By I.._ g•ta h 4A f:�r4T—
Pl.
ax's)
Scale - ��. GQti inT0.�rgZs3
A8$essofs Pen:el No.
on
I
R
This must bb In red h) be a
"CERTIFIED COPY"
document to which this certiitceta
Khed is cartif id to be a full, R ��
and corract copy of tho orlglnel Otjl� SFR
D and of record in my office
COUNTY RECORDER
ly of Mwmido, State of California
4 S `` OFOR��p
i 2Onef9 `- L
Certffloatlon must be In red to tre a
"CERTIFIED COPY"
This must bb In red h) be a
"CERTIFIED COPY"
document to which this certiitceta
Khed is cartif id to be a full, R ��
and corract copy of tho orlglnel Otjl� SFR
D and of record in my office
COUNTY RECORDER
ly of Mwmido, State of California
4 S `` OFOR��p
i 2Onef9 `- L
Certffloatlon must be In red to tre a
"CERTIFIED COPY"
CONCORDE CONSULTING GROUP, INC.
ENGINEEERING & CONSTRUCTION .MANAG IMENT
3505 CAMINO DEL RIO SOUTH, # 350
SAN DIEGO, CA 92108
P'H: '(619) 516-3377 FAX: (619) 516-3383
MEMORANDUM/FAX COVER SHEET
TO: FROM:
CORONEL CONSTRUCTION KRIPA
COMPANY: DATE:
05/15/03
FAX NUMBER: TOTAL NO. OF PAGES INCLUDING COVERT
PHONE NUMBER: SENDER'S REFERENCE NUMBER:
YOUR REFERENCE NUMBER:
RE: SEWEL.L — 54480 RUBIO, LQ
y
X URGENT X FOR REVIEW X PLEASE COMMENT X PLEASE REPLY ❑ ELEASE RECYCLE
notes/Comments
THIS NOTE IS TO CONFIRM THAT BASED ON THE SITE OBSERVATION, .1 HE FRAMING
ON THE REFERENCED PROJECT IS , IN GENERAL CONFORMANCE WITH
CONSTRUCTION DOCUMENTS AND DESIGN INTENT FX'C,EP T AS 0 o're'D t3E c ow
PLEASE CALL IF YOU HAVE ANY QUESTIONS
THANKS
Q�
KRIPANARAYANAN / � V41
Cjl QI.aCC AP QEB1 HT la�l.
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T R tj S5 cv aoo 2t c o r_•+fcScQs M tSsk, � s,vo--4
,
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�) PRov"as @ N. s1oE o..cS
PLM c- Z W I Wb 1. A e' G a••r� �•�l oc 6 x @ k V d wr
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e , ,ice ..� VJ 11 LV 1 �♦. ^• I V JJVYYGC.IG ' ' r YJl/ uk
REPORT OF FIELD COMPACTION TESTS °�•t
r--=RAEP'dRTO U J CUENT; rU x-1 •/�
OATL I (::. I D'3 PROJECT:
SOIL ID # I
NUCLEAR GAUGE INFORMATION AND
C 1USAATION
DAILY STANDARD
COUNTS
CAUaRATtON NUMBERS VARIATION, PERCENT. •I•
FROM SMESTS
GA4GE ADJUSTMENT
-A VARLATION FROM
LAST USE
CAUCE YY X CAMPBELL
MOLSTURE:
MOLSTVRj-!- MOMTURE:
MOIST;VRE
I D-
MODEL NO_ ��. V
DENSt'T`•';
DENSrtY: DENSITY:
DENSr-Y: -
SOIL ID # I
VISUAL CLASSIFICATION OF SOIL
MAX. DRY DE-N$17Y, PCF
OPTIMUM MOISTURE, 9/6 -, j
VIA,
I D-
COMPACTION
REQUIREMENTS, %
MOISTURE
REQUIREMENTS,
GENERAL LOCATION:
I (/L-' i pA-
TECKNICL4N:
�.aMEJci : 1 �I w ERuaL
WET/DRY
DENSITY,
PCF
PERCENT
COYIPACTION
I
COMMENTS I
I
TEST
NO
READING
QUOTI_NT/
PCF
SOIL
ID N0,
TEST
DEPTH. -IN
ELEVATION
OF TEST
MOISTURE
CONTENT,
8'
G
�,
i
1 •----A
D-
cLo. G
I
f � Z)
j!1 _. -
1
M-
zJ
I D-
TECKNICL4N:
�.aMEJci : 1 �I w ERuaL
T RESULTS COM%RY WITH SPECIFICATlOKS
Z .. FILL
0.- COMPACT70N PE7LCTA6E DOTS NOT COMPLY MRT11 SI'£tt>•lCAT10KS
d
C R41- OF PREV=5 TES I• '
a . SUHSASS
O - MOLSTVIALF W EXCESS OF SP£CIRCAT10N5
11 t. 911
j!1 _. -
1
M-
zJ
I D-
TECKNICL4N:
�.aMEJci : 1 �I w ERuaL
T RESULTS COM%RY WITH SPECIFICATlOKS
Z .. FILL
0.- COMPACT70N PE7LCTA6E DOTS NOT COMPLY MRT11 SI'£tt>•lCAT10KS
1- XCOURSE
C R41- OF PREV=5 TES I• '
a . SUHSASS
O - MOLSTVIALF W EXCESS OF SP£CIRCAT10N5
5 SOtt-CDAVC.r
E- MOtZ' RE SaOw SP£CMQ AT]ONS
8 - OTNER
** TOTAL PAGE.01 **
Certificate of Occupancy
��
,
I Lim
Building&TSafet` 'De artment
of9 Y p
z
1
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, 'this structure was in compliance with the
provisions .of the Building Code and .the. various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: `54-480 "ENIDA RUBIO '
-Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0210-055
Occupancy- Group: R-3 Type of Construction: VN Land Use Zone: RC
Owner of Building: MARIO SEWELL Address: 1245 SINALOA AVE.
City, ST, ZIP: PASADENA,. CA 91104
'
By: KIRK KIRKLAND a
` !
d Date: 09-18-2003
G
Building Official ..
6
•• POST• IN A CONSPICUOUS PLACE