9911-026 (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# 291723
y ) t
Lic.'Class Exp. Date
&]
Date fiV Signature of Contractor'`-�•P�� '�
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 (Ser.. 7044, Rusiness & 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 `
Dai AQ/ `t Signature of Owner . t:' t`a: ✓ .00 _ 1
I '
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:
Carriery 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 Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: I/ Applicant
i
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.
Signature (Owner/Agent)``
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BUILDING PERMIT
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DATE ! VALUATION LOT
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SITE
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APN
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OWNER
CONTRACTOR DESIGNER ENGINEER
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
/
Underground Ducts
Forms & Footings
.O
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
- �.�_ 9
Exhaust Fans
O.K. to Wrap
�'� _� s%L
F.A.U.
FramingCompressor
Insulation
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
7
_
Final
Final3Za
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Hacks
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
Plumbing Top Out
_ �7
Heater Final
Plumbing Final
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
3/
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) V v ,
Buildings/ 5
Address 3 -
"G__°W'K w Bldg De.4
owner {i 1 RGA
Mailing
Addressrrt
City
4� "f1 Q I Zip
Contractor
Q 012, ice
P.O. BOA 1504 APP IC 1 N O LY
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 ayY�s
BUILDING: TYPE'CONST.O''.
A.P. Number 'J,7 °`* r 0
00 Legal Description " z � oy tT out
Project Description`� q% i
A,',' r... L�1 Z' 1 1`1%_7 I tk,
City Zip Tel..,
State Lic. f I City
& Classif. .. Lic. #
Arch., Engr.,
Designer
Address Tel.
City I Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 oi'the Business and Professions Code, and my license is in full force and
effect.__44 ... 2���
SIGNATURE / �,',� DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior fo'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).
I.: 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. It, 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 contractors) licensed pursuant to the Contractor's License Law.)
i? 1 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. ❑ 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: It, 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 it 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 applicant Date
Mailing Address
City, State, Zip
Sq. Ft. No. No. Dv`v. -
Size j ° Stories Units
New 4A Add ❑ Alter ❑ Repair ❑ Demolition ❑
PERMIT
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 'rom Center Line
Side Setback from RToperty Line
FINAL DATE INSFECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Date 11/10/99
No. 19594
Owner NameStarlight Management, Inc.
APN # 774-052-009
Jurisdiction La Quinta
-Permit Permit # 9911-026 "
No. 53-180 Street Avenida Ramirez Log #
City La Quinta zip 92253 study Arra
Tract # B219,U21 Lot # 16 Square Footage 1421
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
1.93 X 1,421. or $ 2,742.53 the property listed above and tharbui. ding.
permits and/or Certificates of Occupancy for this square footage in this proposed project may.aow be issued
,tea, i r
Fees Paid By ccNIB/James H. Daughtry. Telephone 399-120;0
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green . Payment Received $2,742.53
Check No. 202552
Signature
E: Pursuant of Asse ly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
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
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/Receipf Copy - Accounting
I
NOV. 2.1999 9:22AM
,
RECORDING REQUESTED BY:
COMMONWEALTH LAND TITLE
99.9164KC 6006982
COMMONWEALTH
COMPANY
WHUNL L � R E NTS1�tE ND'
LARRY STAARLIG SHIELDS
INC.
P.O. BOX 134
LA QUINTA, CALIFORNIA 92253
NO. 204 P. 1/1
e -s
SPACE ABOVE THISLINE FOR RECORDER'S USE
GRANT DEED
The undersigned grantor(s) declare(s):
Documentary transfer tax is $15.90
(XXX) Computed on full value of property conveyed, or
( Computed on full value less liens and encumbrances remaining at time of sale.
( Unincorporated area: ( ) City of , and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
JACK COHN and SOPHIE COHN, TRUSTEES OF THE COHN TRUST DATED MARCH 15, 1989
hereby GRANT(S)to STARLIGHT MAMMENT, INC., a Nevada Corporation
the real property in the City of LA QUINTA, County of Riverside, State of California,
described as:
Lot 16, Block 219, Unit No. 21, Tract Santa Carmelita at Vale La Quinta, as per map
recorded in Book 20, Page(s) 22 inclusive of maps, in the office of the County Recorder
of said County.
Dated September 15, 1999
State of California
County of RIVERSIDE } S.S.
On SEPTEMBER 21, 1999
before me, CHRISTINA BOIVIN, NOTARY PUBLIC
, personally appeared
,TACK COHN AND SOPHIE COHN
(or proved to me on
the basis of satisfactory evidence) to be
the person(s) whose name(s) isl<iD subscribed
to the within instrument and acknowledged to
me that he/she the executed the same in
his/her hei utnion(s),
ed capacity(ies), and
that by i er/ signature (s) on the
instrument the pe or the entity upon
behalf of which the person(s) acted, executed
the instrument.
WITNESS my h d 1�
Signature
MAIL TAX STATEMENTS TO: SAME AS ABOVE
a2y.9 ��
J COHN, ti -RUST -2s'
SOPHYE COHN, TRUSTEE
CHRISTINA 80IVIN
Canmissian # 1146795
Notary Public - Cglilorni0 f
Rlvenidft County t
My Carom. Expires Jul 14, 2001
(This area for official notarial seal)
1P.,
iMl i)
}
RC
DIS
ri - Pl rini vi Form
This formis to be used by CDD staff .for review of single family dwellings in the RC JCove
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 .
Building 8+ Safety as your correction:. list. `Please attach adl explanations as necessary.
APPLICANT:
W. R. Rogers �C . 5��� Flo o
PROJECT
ADDRESS: 53-180 Avenida Ramirez
APN:... 774-052-009.
16 219 UNIT, . 21 . S.C. @ V.L.Q.
LEGAL: LOT ,BLOCK - _
CVD BY: l Greg Trousdell.. `
CASE N0.
BIN NO: 99-156 ..CHECK -DATE:
Inform, the assigned Building plan checker :upon..you.r assignment to -his case. The CDD
Executive Sec�efary. maintains a log book to track applications and assign case numbers.
The zoning code, architectural and landscaping manuals, and/or assigned inspector should
be consulted where 'uncertainties arise. The completed checklist shall ,be maintained in the
• Building & Safety address file..( ` I��
Certificate of. Occupancy
City...of La* Qdint'a-
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 ADDRESS: 53-180 AVENIDA RAMERIZ
Use Classification: SFD Bldg. Permit No.: 9911-026
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC
Owner of Building:. STARLIGHT MANAGEMENT INC. Address: P.O. BOX 3578
City: PALM DESERT, CA 92261
_ By: STEVE TRAXEL
Date: ' 03-30-00
Building Official
POST IN A CONSPICUOUS PLACE