0208-001 (SFD)H
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LICENSED CONTRACTOR DECLARATION
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. I`
License # Lic. Class Date
Date �Slgnature 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).
O 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 forworkers'
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:
Carrier KATE 1``1.FND Policy No. 009J I
(This section need not be completed if the permit valuE
( ) I certify that in the performance of'the work for v
shall not employ any person in an
,,yrmanner.,so as
workers' compensation laws of C fifornia, a d agre
subject to the workers' compensation provis ons of a
Code, I shall. forthwith.comply with t "pro isions.r
Date: ! L . I .'- t> i _ Applicant i .� i 1v�s'. •'
is for $100.00 or less).
I thi"ermit is issued,
ecofne subject to the
at III should become
on 700 of the Labor
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 Saf®ty
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 appiicaton 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 w)tff all City, andState layrs relating to the building:
construction, and hereby uthorize repres tativesrof this City to enter upon
the above-mentioned
prop rty, forinspectio .purposes. s
Signature (Owner/Agent) t •F= {', '�"' Date I
BUILDING PERMIT PERMIT#
€'
DATE VALUATION LOT TRACT
JOB SITE
APN
ADDRESS 7 P -.I06 4`f9f�i�.�.3.bE.' X5: 01.
OWNER
CONTRACTOR /DESIGNER / EN INFER
11.04 DVA Y02
761 Of) t:°dvXIAT?KI., tdU .
1,Ac;Zt.T11I A CA. 922S11
LriQUIMI-Y, -CA PZ2 .'3
CUM- 181,19
USE OF PERMIT
m4dm. r,A:INInL., Y- Dwe.uN- o 1f '
SFO,, Lt: T10. PE22MJT DO.E3 VDI' iitiicu D17 ''IXA.31 "hI.P L.FaS, F-0,00 SIPA
OR 1DR315P`WAY APPROAC K
V ACT 001,11 i'RUCTION ;.'moo UY
P IRCFI PAVO 916.0 Xf'
9: s.7MtN1.0 00V OF 4 41:TAP.L.7ZUC-17ON
235,046_ 50
±i'.�:�d��:l: Ir+`,��N� S%f.,7.a�►'AIh;,1;y5i
CONSTRUCTION FrEg 101,000 -418 -WO $ I,1 I g, So
Pt,,KN Clies:)T. 3rt't`s 101-000-439-318 xd-01.ci
KFi(' D POUi'f 1011 000-439-24W -$750.90
MLL' P'iKNICAL PEE 101 -00&,4 1
Ell"FIt"`)'W"Al;.its1? 101 ��vf4,tt2
PLO iJUX 101-000-419-000
nt,own RfiCYrjoi-$ I.[K • Raw 101.-t' -000-241 -0,00 $1.3,14
ORA1)1N0 Mf-ls _00 $18100
lkutT 114 131JELIG PLACES - R101 I::'7u-000-44.5.000 $�SS.ti3
3
, 003'1' 1l f . Iot. kI�C',TIf`X AN"D %.Iyy�7�!.,?.'I C�"Y1W _vtw`:
) 3..1 +'Ts.i9
•y
.t.:l �i qi I' RF-.'P`'�SlTi.1.� YL0''_3
476000
tL
R 2002 rA1,J tXW)MTIFEES 1.)1M!, NNW
CITY OF LA QUINTA
FINANCE DEPT
_ 1
RECEIPT
DATE
BY
DAT7 F NALED
IINSPE
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Q
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
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
Final
Final - Q
SLOCKWALL APPROVALS
P®®LS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
I I
Gas Piping
(LAMBING 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
•. p
Appliances
Final
Final
UtilityNotice (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 -42-42
Final
Utility Notice (Perm)
COMMENTS:
P.O. BOX 1'504
,din 77-06 Pq Z)6L S0(18-495 CALLS TAMPICO
cress ��� LA QUINTA, CALIFORNIA 92253
(,Na� -
Address -
C'ty Zi Tel.
4r�� �Z��"
Contracto
�17�(C
State si f.
8� 7 /
Classif.
Arch., En
Designer�G v
State
Lica #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 6 (commencing with Section
7000) of Divieiom3 of the Business and Professions Code, and my license is in ful[force and
effect.
SIGNATIIpE DATE
OWNER•SUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License .Law forthe, following
reason: (Sec. 7031.5.8uslness and Professions Code: Any city or county' whkfi. requires a
permit ;to, construct, ager, improve, demolish. or repair any structure, prior to ,ss issuance also
requires, the applicant for such permit to Mea signed statement that he Is licensed pursuant to
the provisions of the Contractors License Law, Chapter 9 (commencing with Sectlon, 7000) of
Division 3 of the. Business and Professions Coda or that. he is exempt therefrom, and the boats
for the aaeged sxemplion. Any violation of Section 7091.5 by 'any . epp/banf for a perms
'subjects Mie opplk:entto a civil penalty of not more than 6ve,hundred dollars (fb00).
17 l; as owner of the property, or my'e_,mployeas with wages as their sole compensation, will
do the -work, and thestructureIs not intended or offered for sale.. fsec., 7044, Bulmoss and
Professions Code: The Conhactor's License t.'aw does not apply to an, owner of property who
builds or improves thereon and who does suofi work himself or through his own employees,
-provided that such improvementsare not intended or offered for sale. If, however, the buldIng
Lir Improvement is sok/ within one, year o1' compte0on, tris owner -budder wX have the burden
,, of proving that he did not build or improve for 'Me'purpose of sate.)
c 1'1 1' 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 b6Ws of improves .thereon, and wlio contracts for
such projects with a contractor($) frcensed pursuant to the Contractor's License Law.)
17 1 am exempt under Sec. -B, & PC. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION,
I hereby affirm that I have a certificate of consent to sell -insure, or a certificate of
Worker's Compensation Insurance, ora.cartifiedcopy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
(7 Copy is filed with'the city. ❑ Certified copy.1s hereby furnished.
CERTIFICATE OF'EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need notbe compfated h the pemdt is. for one hundred dollars ($100) valuation
or less.)
I certify-that'in the performance of,thp work, for which this permit Isdssued, 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 makbg this. Certificate of Exemption you should become
suoject to the Nbrkers' Compensation provisionsof the Labor Code, you must lorfhwith
comply with such provisions of this permit shail 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 psrmit Is issued. (Sec. 9097. CNN Code.)
Lender's Name
Lender's Address
This is abuilding permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 150 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
02,0 e- 0 0/
APPLICATION ONLY
TYPrCONST. OCC. GRP.
Number
f- aacct� � rJ Q
it Description ?CRY-/��4
Ict Description r i.
WHITE to FINANCE YELLOW a APPLICANT PINK = BUILDING DIVISION
Sq. Ft. �f-� Qr �.tNo. / No.
Size C//'fir/ lorries Units
New X Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep:.
Plan Chk. Bal.
Const.
Mach.
Electrical
Plumbing
S.M.I.
Grading
_
Driveway Enc.
Infrastructure
eo,T
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 to FINANCE YELLOW a APPLICANT PINK = BUILDING DIVISION
.---so-ht 4: DAVID FISHER CONST:; 760 564 '5629,• Sep -15-02 2:24PM; Page 1/3
DOC a 2601-667694
12/07/7661 ea: nil: Fee: 1T.00
RRCORMG REQUEff m byIANpTlllfr-t 0. Pa60 1 of 3 Dee T Tax Paid
R d.d I Arra
AND WHEN RECORDED MAIL'ro:
DAVID PHILIP FISHER
PMCIL,LA ANNETTE FISHER
P.O. BOX 1772
LA QVINTA, CA 92253,
� rU3►o�
W. n elal Records
County of RAvermade
O&ry L, Or"
A■06800r, COWRY Clerk 3 Reearder
$ V A08 •... 01� PCOR NOL+OR'
A.P.N.: TRA : Q "t9�� Or&r No.:--
•�.•RI
�jN: -r' •��6..��r, PARTNERSHIP GRANT DEED
TSE UbtD9010t4M GR4VMR(s) DECLARI`s(aj`"C. AT TWUMEN-17ARY T'RANSFRR TAXIS: couNTY.$165.00 12- t
! 1 computad on full value of ,openly conveyed, or
unpincorrppor� arca-,uj X j Cp ty ofliens
1L AA QUIN encumbrances
an �aining at time of sale. AK
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
JIM DAN D, LLC. A CALIF. LTD. LIAB. CO.
organized under the laws of the State;of CALIFORNIA
hereby GRANT(S) to DAVID PEMUP FISHER and PRISCILLA ANNETTE FISHER, Husband and Wife as Joint
Tenants
the following described' property in the City of LA QUINTA, County of Riverside State of California;
Lot 10 of Tract 28409, In the City of LA QUINTA, County of Riverside, as Per map recorded in Book 2%, Page(F)
81 THROUGH 84, Inclusive of Mhwdlanvous Maps, in the Office of the County Recorder of said County.
PARTNERSHIP GRANT DEED CONTINUED ON NEXT PAGE
Mail Tax Stalawnts to: SAME AS ABOVE or Address Noted Below
- - }Sent.By,� DAVID FISHER CONST;
a
760 564 5629; Sep -15-02 2:24PM; Page 2/3
PARTN'MHIP GRANT DEED - CONTINUED
JIM DAN D, LLC. A CALIF. LTD. I1AB. CO.
Date: Anil 26.2001
Pm0n3ftY kcmm 0 me (Or proved to Im on dw buia of ajn
and wkn wfeAWiv mo dixtt etshw%q exemted theFume
the parsom(a) or the emitY upon behalf of whlc h tho ptx *iyr,
my hand And oiru:iw mml.
1"
Slgnahup
�ncruura uwc u %jJ-mmpt,
:jibed m the widtin imuument
rismiuro(s) on tie imnmm
r.
ilAy CNANCY
Cornm1.don # 119,17
41
NoRly pum - cdoti
b
y�Wveaoiny
II�� I� VIII Inl ���I 12/ 2of 4
R�si R nRR
6 CITY OF LA QUINTA
Q UILDING & SAFETY DEPARTMENT
°F a O 777-7012
Sw INSPECTION REQUEST LINE ;
y i 777-7153
O er DAVID FISHER
SIMR ONSTRUCTION
i
Permit 0208-001
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS
77-106 CASA DEL SOL
SFD - LOTIO. PERMIT DOES NOT INCLUDE
i BLOCK WALLS, POOL/ SPA OR DRIVEWAY
APPROACH.
TYPE OF'INSPECTION DATE INSP.
ELECTRICAL
DO NOT POUR CONCRETE U TIL BOVE IGN
ROOF NAIL / PRE -ROOF
OKAY TO WRAP
FRAMING COMBINATION
I- ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL
INSULATION
COVER NO WORK UNTIL ABOVE SIGNED
INTERIOR GYP. BD. DRYWALL
EXTERIOR LATH
LY :-- GAS TEST .
61f -lov—
SEPTIC ABANDONMENT
i SEWER CONNECTION0-5
SEPTIC / GREASE INTERCEPTOR .
MASONRY INSPECTIONS
FOOTINGS /'STEEL
BOND BEAM. {
POOL/ SPA/ WATER FEATURE. INSPECTIONS
PRE-GUNITE /SETBACKS
U/G PLUMBING
I U/G AS
U/G ELECTRICAL
I PRE -PLASTER ALARMS / BARRIERS
FINAL INSPECTIONS
vrnm I ICG AG nGOAAA\Imm n^%A/CM I / A I ry --w. '
j PUBLIi
COMM
FINAL
NITY DEVELOPMENT DEPT. It It
JOB COMPLETED
r
Sent By: Dave Fisher Construction, Inc.; 760=564-5629; Nov -7-02 3:43PM!;.
-- ..-W'.0VA 4.q 2 WTLEIN CO
FLORES DE MONTANAS
HOMEOWNERS ASSOCIATION
November 4. 2002
City of Le Quinta
78-495 Calle Tampico
Department of Building & •Safety
Attention: R. Kirk Kirkland, Senior Building Inspector
Re:Lot #10, track 28409 - Flores De Montanas
Dear Mr. Kirkland:
Page 1 /1
PAGE 02/02
At a recent Board of Directors meeting held November 1, 2002, plans for construction
on lot 10, track .28409 were presented to the Board ,of Directors and the Architectural
Committee., along with, a model rendering and landscape plans.
After thorough review, the Board of Directors unanimously approved the plans for Dave
Fisher to erect his residence on the aforementioned Io(. This approval has no
stipulations, other than, those required by the City and all pn)per permits, and'insurance
etc, be provided by the homeowner to satisfy the City's requirements.
If we may be of further assistance to you, please do not hesitate the undersigned,
Very truly yours, .
FLORES DE MONTANAS HOMEOWNERS ASSOCIATION
BY: SARTLEIN S COMPANY INC,, MANAGING.AGENT
qQ65- .
Patrick O. Riley
Vice President
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road °
BERMUDA DUNES' r
Date 11/8/02 La Quinta, CA 92253 U1 RANCHO INDIAN WELLS WE LLS CJ
� �.
No. 23838 (760) 771-8515 d� ° aU NT �y
%VV p SY
Owner M/M David Fisher APN # 773-030-01.3
Address P:O. Box 1772 Jurisdiction La Quinta
City La Quinta Zip 92253 'Permit #
Tract # 28409 Study Area
Type Single Family Residence No. of Units 1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 77106 Casa Del Sol
Unit 2
Unit 3
Unit 4
Unit 5
Comments Refund $190.46 for overpayment..
3789 Unit 6
U07
Uhit.8
Unit,9
Unit°70
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports; covered patiostwalkways, 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 exampt from paying school fees at this time due to the following 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 $2.14 X 3,789 S.F. or $8,108.46 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/Bank of American - David Fisher .Check No, 2013260088
Name on the check Telephone
/Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Monica Guillen $8,298,92 I90.46
Payment Recd Over/Under
Signature Y11
4144
NOTICE: Pursuant to Government Code -Section 66020(d)(1), this will serve to notify -you that the 90-day'approvai 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 DistrictCs) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original- Building Department7Applicant Copy - Applicant/Reoeipt Copy - Accounting
Building & Safety Department
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: 77-106 CASA DEL SOL
Use classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3
Owner of Building: DAVID FISHER.
Building Official
Type of Construction: VN
INACO
Building Permit No.: 0208-001
Land Use Zone: RL
Address: P.O. BOX 1772
City, ST, ZIP: LA QUINTA, CA 92263
By: KIRK KIRKLAND
Date: December 16, 2003