0101-247 (SFD)JC/)
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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 Cpde; and my License is in full force and effect.
License Lic. Class Exp. Date- ,
Date Signature of Contraeto'�
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.
�.)e I have and will maintain workers' compensation insurance, as required by
S I on 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.
(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 Califo ria, and agree that If, I should become
subject to the workers' compensgboQ.provi�,q.�?'8-0} al �i'37 '0 of the Labor
Code, I shall,fo,r,th-Oith comply lb those provision ( r
Date: f, .t kpplicant'o.`s... 1
yr
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 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 law,�relating to the building
consttruction, and hereby authorize representati�es\tdf this City to enter upon
the'above-mentioned progaxty}for°�s�fiorvp}f POSEL
f ( � r 1
Signature (Owner/Agent T^'}i i1 %I' � Date � ( �'' r'
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0.101-247 TRACT
04K*n0c X913 050,510
JOB SITE
APN
ADDRESS
52-30 ,A.WP1q"E,0A :arkh!nWA,S
773-2* -016
OWNER
CONTRACTOR/DESIGNER/ENGINEER
in1'.17 -E w A`�CC :�'RIU'Iei' Y
x./xS 0-11e, LEE PIKEV'r.i gi
231 E AU-05��a`'3DW.) BLVD POTA X457
3.3680 LICK) ROAD
CA. 9.2508
1N%t"1��'.EE C -A 92584
(,9091612.5889 C`705,10
USE O,7yFryryPERMIT
Fp►Qpqyy 9W pytio
e; x(98 VI•.A.1 M.ASTZW):.P£':RM!T D03TS NOT INi"Lf. IX4
A
DD
AP
6 2001
_
7f3�A CT C.OhlSTIZUCt''I014 1,501.00 ap
PORCH)PA.'i 1C) 5a.90 S
.5 P7, WOOD FIRINCE 2ft()A LF Cl1Y
OF LA OUINTA
"D2 koz AG:t,i it SFS I
INANCE DEPT
'USK" .TNf:All cobs 01F r1QNfirrrZ1.'��' rX0,N
01 •'000.439.318 4250100
l,'4': N S,`i�,:�iw�'f'£U1`Y .YVE 1 ��Y-d'!0c" I 8_000
'LAN C�tl�4:`9 FSE 101-,0004, 94-318 $'513,45
N4 I i 101-000-421-000 $60.00
91A .'C' 5 E"S7.CAL FIJI 101-000-420-000 3131.30
��iJPe��RlklE:9 �;�)�• 1 C'a'6 -fit€�ti.�'d �-0r00 �i 1 x.75
STRONG FEE -SEROW 101 -000-241 -000 $9,:1
(3f")NO PEL 101-000-423-000 $30100
V,V9E L0. -K,` iMPACT FE -9
Ib'Txl?Zis"It+KJkM 101-ao�i �ab•1 ��5 �ifa�s.sf�►
'IA�'s I�,�.?1?dt�1:;',1!ss
' •-Sa.50,00
*
`J.�AL C.1 Tfflff.�.'~"...yIES dna OX NO
RECEIPT
DATE %
BY
D E INAL D
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Slab Grade
_
_ � Z� (�
Underground Ducts
Ducts
Return Air
Steel
Roof Deck
_
4��
`j
Combustion Air
Exhaust Fans
F.A.U.
0. K. to Wrap
Framing
Insulation
1—
Q;p (
_ 7• j, . (
��
't
Compressor
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
D�
_
��
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
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/�/
__
_
Heater Final
Plumbing Final
Plumbing Top Out
l (( r
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Gas Piping
Gas Test
q=( �Q(
j 7
Encapsulation
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit 6GG
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) 8 -//A� S
rM^;rt.Y}`�'^'+�Y..";�J+:,^�4s-�.At`1-'.."6"'j.3c^• :'wq'x..,+Fid=.'�+'�•R�;1„��,.a--.t�=-�*xrF^�6t'^,;r'a.1-rn'v- '^k�w-a4ri �,. *.�?r �„^*"kv ic.. -w». .. +, .-.-�.-....-..;. `-L'J4-}�
ems e sem
P.O. BOX 1504
�� 78-495 CALLE TAMPICO APPLICATION ONLY- ((
�r Building 5 m LA QUINTA, CALIFORNIA 92253
Address ,ides
y Owner ��-- �/
('4 GVi (L' 1 ;?i ':C 5
mail ng
Address p� 1 i3 s• �t5 2-31 1C, A J 5 s
City Zip
v (ci f; Ar5 fiP �I25"U c�-�a39
Contractor
Address
City
1 State Lic.
& Classif.
Arch., Engr.,
Designer
Address
`/-
City
f
1. t BUILDING: TYPE'CONST. OCC. GRP.
4 � 1 ['" S
A.P. Number ?7> 95 0 ►!p
/ I Legal Description tom{ �a I Ie 103 M O 10/0-7 -7 `i �"P ""� �u'•' � //
900 la5-� az ..____ ___-
j�f Project Description
/t . �.�"18 BA - G
Tel.
City
Lic. # Sq. Ft. No. No. Dw.
Size Isol Stories Units
Tel.
ZipIState
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
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,Business and Professions Code: Any city or county which requires a
permit to construct, alter, 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 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 ($500).
l: 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.)
11, 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
doesnot 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.)
f! I am exempt under Sec. B. 8 P.C. for this reason
i
Dater ' ) 1 Owner Wf%K t /1 f CN 1 TC S
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 ($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 TOAPPLICANT: 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
1 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 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 sof this city to enter the above.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
WHITE = FINANCE
56 Add ❑ Alter ❑ Repair ❑ Demolition ❑
PERMIT
` �� _ AMOUNT^
Plan Chk. Dep.
.,. , e r'' /, 411
Plan Chk. Bal.
Const.
v
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
* ReaarSetback from Rear Prop. Line
My, Side Street Setback from Center Line
`=' "m . - Side Setback from Property Line
oryNAL DATE— JINSPECTOR
Issued by UU`PAate Permit
Validated by:
Validation: �}
YELLOW = APPLICANT PINK = BUILDING DIVISION
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document'Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 4/4/01 APN # 773-275-016
No. 21847 Jurisdiction La Quinta
Owner NameW.R. Enterprises
No. 52-395 Street Avenida Bermudas
city La Quinta
Tract # Lot #
Type of Development Single Family Residence
Comments
Zip 92253
Permit # 0 10 1-247
Log #
Study Area
Square Footage 1501
No. of Units 1
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 1,501 or $ 3,077.05 the property listed above and that building
i
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued '
Fees Paid By CASH - Ed Whitson
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exe . pted by Annette Barlow
��
Signature
Payment Received
Check No.
Telephone.
$3,077.05
VOTICE: Pursuant of Assembly 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
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
:ollect 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/Receipt Copy - Accounting
c
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 W/R ENTERPRISES
SITE ADDRESS 52-39.5 Avenida Bermudas
APN 773- 275 -
LEGAL: LOT 6
CHECKED BY:
016 ' BIN NO.: FC, CASENO.: 2000-405
BLOCK 103 UNIT S.C.@V.L.Q.
Fred Baker
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.
REQUIRED ITEM
Y
N
COMMENT/CORRECTION
Compatibility Review
Case logged and number assigned
Verify legal and APN information
Consistent with MDG on file (as.applicable
MDG filing required (5 filings since 9/3/98)
Consistency with street/surrounding area:
Colors
Materials
Architecture
Other Requirements: .� <�Z`b\
TO: American Title Company
American Title Insurance Company
Escrow Division
74333 Highway 111, Suite 102
Palm Desert, CA 92260
(760)773-2177 Fax(760)773-2819
SALE ESCROW INSTRUCTIONS
Date: January 22, 2001
Escrow Officer: JON M. LIZARRAGA
Escrow Number: 01 -1534 -JL
AMERICAN TITLE COMPANY CONDUCTS ESCROW BUSINESS UNDER LICENSE IDENTIFICATION NO. 371
ISSUED BY THE CALIFORNIA DEPARTMENT OF INSURANCE.
W/R ENTERPRISE, (hereinafter known as Buyer) agree to purchase from JAMES J. PATTON M.D. AND EILEEN
PATTON, (hereinafter known as Seller) the real property setforth herein per the terms, conditions, consideration and
instructions hereinafter stated. The Seller and Buyer herein shall deliver these signed escrow instructions to First American
Title Company, (hereinafter known as Escrow Holder), within 7 calendar days after receipt of same.
Terms of Transaction
Buyer has deposited to escrow by Personal Check the sum of
Buyer will deposit, prior to close of escrow, the sum of
To Complete the Total Consideration of
1,000.00
23,000.00
24,000.00
Furthermore, i will execute and deliver any instruments and/or funds which this escrow requires to show title as called for, all
of which you are instructed to use on or before February 21, 2001, provided you hold a Policy of Title insurance with the
usual title company's exceptions, with a liability of not less than $24,000.00, covering property in the City of LA QUINTA,
County of Riverside, State of California, described as follows:
Lot 6 Block 103 of Santa Carmelita at Vale La Quinta unit No. 11, as shown by map on file in Book 18, Page 75, Records
of Riverside County California.
COMMONLY KNOWN AS: UNIMPROVED LAND, LA QUINTA, CA 92253
SHOWING TITLE VESTED IN: W/R ENTERPRISE ( complete vesting to be determined in writing prior to the close of
escrow. )
SUBJECT TO:
(1) General and Special County and City (if any) Taxes for the current fiscal year, not due or delinquent, including any special
levies, payments for which are included therein and collected therewith.
(2) Lien of Supplemental Taxes, if any, assessed pursuant to the provisions of Chapter 3.5 (commencing with Section 75) of
the Revenue and Taxation Code of the State of California.
(3) Covenants, Conditions and Restrictions, reservations easements for public utilities, districts, water companies, alleys and
streets, rights and rights of way of record, if any; also exceptions of oil, gas, minerals and hydrocarbons, and/or lease, if
any, without the right of surface entry.
INSTRUCTIONS TO ESCROW:
DEPOSIT RECEIPT: The Deposit Receipt dated JANUARY 19, 2001 is hereby acknowledged to be made a part of this
agreement and the Buyer and Seller agree to be bound by the terms and conditions contained thereon.
PRELIMINARY TITLE REPORT: Escrow Holder is instructed to order a copy of the Preliminary Title Report and, if any,
covenants, conditions, and restrictions. Upon receipt, forward same to Buyer who will then have 10 days from receipt of same
in which to approve or disapprove in writing. Absence of written notification by Buyer(s) of disapproval within specified time
shall be deemed Buyer's approval of all documents and deposit of final closing funds by Buyer shall satisfy this condition in
full.
FIRE INSURANCE: Buyer to obtain new fire insurance outside of escrow and will pay premium for same direct to their
agent. Escrow Holder is not to be concerned with the new fire insurance through this escrow.
PROPERTY DISCLOSURE REPORT: Seller to provide a Property Disclosure Report for subject property and hereby
authorizes Escrow Holder to pay for same at the close of escrow from proceeds due Seller herein.
ADDITIONAL INSTRUCTIONS ATTACHED HERETO AND MADE A PART HEREOF
hfy initials below represent my agreement and acknowledgment of the foregoing.
Seller Initials: — _ Buyer Initials:
Page 1
Y::
i-112,(:)Py
Certificate of Occupancy
City of La Quinta
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:
Use Classification SFD
Occupancy Group: R 3
52-395 AVENIDA BERMUDAS
Type of Construction: VN
Owner of Building: W/R ENTERPRISES
-d'wt
Building Official
Bldg. Permit No.: 0101-247
Land Use Zone: RC,
Address: 231-E. ALESSANDRO BLVD #457
City: RIVERSIDE, CA 92508
By: STEVE TRAXEL
Date: 08-27-01
POST IN A CONSPICUOUS PLACE