9511-053 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm 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. 533670 13 0/30/96
Ucense #_ Lic. Class Exp. Date
Date i rye SignatureofContractori�
OWNER -BUILDER DECLARATION }
I hereby affirm 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). x
1, as owner of the, property, am owuqvory 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 Signatureof 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 3706 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 Policy No.
(This sectiopjD"L4gtfbejcgmpleted if the permit valuatioi(Igkfo_r;$1ffl,. 0 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 prove Ions.
bate: / ..-/-7 plicant. ✓,�..e
Warning: Failure to secure Workers' Compensation coverage is unlawful and shall
subject an employer to criminal penalties .and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706.
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his application. .
1. Each person "upon whose behalf this application is made & each person at
whose request and, for whose benefit work is performed under. or pursuant to
any permit issued as a result of this application agrees to, & shall, indemnify -t'•
& hold harmless the City of Indian Wells, its officers, agents and employees. f}`
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
i
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon the
above-mentioned property for inspection purposes.
Signature', (Owner/Agent).. yam. - r .,- -1 Date
ALC
BUILDING PERMIT
PERMIT'
�lSl.,-@6:a3
DATE 12 RI./9:�
VALUATION `.IL".D:t+,$ �.`,
LOT ,
TRACT 1AIIN.1.1.UE_
JOB SITE ADDRESS
541-625 CAL.L9 QU110
APN
769464-005
OWNER
CONTRACTOR
SUNROSE COR-PORA'C'ION
IMICI-IAE1. `V & TRACY TJVIri t.
72-1150 SOMERA R!),
43-750 CARMEL CIRCLE
I)AI.M DESERT CA 92260
1A QUINT- A. CA 92253
(6.19)346-2840 CBLtt 1137
(619)346,-28-40 -
DESIGNER(ENGINEER s
USE OF PEd MB[NC.1LL FAMULY DWLILLING
SFD Permit lndudes 96 S.f. ofp.dio in the ficmt yrutl, 1401.£ of 5' Id,.la, mid 90116f V M911 gakien.
block. cyal Permit doesnot include retaining wails and/or Pool.
FEE DESCRIPTION
FEES
TRACT CONST1?UCTfON 2.443.00 SF
POZt.CI49.1ArIO 96.00 19F
f. 3ARAOFICARPOR.T 728.00 _�F
4 FT, VAIX 140.001F
4 F" i', WAI JZ. 90.001>F
EST LARA'ITED COST OF CONSTRUCTION
153,481..50
VERMIT FEE ,81IMMi4,RY
PLAN CHE?G'I,'. FEE 1014100-439-318 $7709.66
CONSTRUCTION f IM 101-00(11-418-000 $853.00
MECHANICAL I' !k, 501-M0421-060 $72.50
ELEC'I'RI'C:AL FEE 1."0.1-000-420-000 $172.57
PLUMBING 101-000-419-000 $1.64,tt0
STONE MUfION F M, -'RESU) 100-000-241000 526.01
GRAD0410 Fm 101.000-423.000 520.00
" RNiFRAw`iTRUCTURF, FE..E 2254VO-443-342 $3„305.78
PREC1.SEr PLAN Wf-000-441-,345 $ZS.Of1
ARI' 4\1 PEiI3t 1C PLACES - RE?Si1. 701-000-253-000 �Ist1.13
'"kms OE. POSIT-$75(i.fi0
1 'WsU8- IAL CONSTRUCTION AND PLAN CRECK
GESS PRE -PAID BEES
$5,478.65
-$ 50.00
OTAJ,1'ERl<UT F.1N.,E$ DUE NOW
$8,224.65
DEC 12
j� 1995
J fill
Sy
RECEIPT
DATE"°`�1
BY
DATE FINALED
INSPECTOR
r -
YY'
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
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 Wali Firewall
Exterior Lath
Drywall - Int. Lath
6 AOL
Final
Final 2 h
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
3
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 _ G
Utility Notice (Perm)
COMMENTS: /j
`iL�i'L G,�1�� !�!�'L yi1>JCJ ��%QOt'ndi✓/��
//f/�
z Pesti;44
2 —fA5;5 P.O. BOX 1504APPLh�AT10N ONLY
Building 78-105 CALLE ESTADO
Address �D— Zai ,+��!/� QUI/ ® LA QUINTA, CALIFORNIA 92253
Owner��
7
—
4Ve BUILDING: TYPE CONST. DCC. GRP.
Mailing
Address q3 — 75-0 6 � VieA.P. Number 76Y _ o6y - no4�, m
CZip Tel. .3y Legal Description
Uv
Contractor w _ Project Description
Address
City
?fie/.;,3u6
Zip
�ZZ
Tel
I
State Lic.
City
& Classif. 6"
Lic. #
Sq. Ft.
Size 2 y3
No. No. Dw.
Stories Units
Arch., Engr.,
Designer
New Add ❑
Alter ❑ Repair ❑ Demolition p
Address
Tel.
City
Zip
State
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.
n
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,ausiness 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 provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Estimated Valuation
PERMIT
AMOUNT
IL
Plan Chk. Dep.
2Sa. 1
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).
1-: 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
Plan Chk. Bal.
Const.
Mech.
-
Electrical
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.)
Plumbing
I 1 I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the proiect. (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
S.M,I,
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
17 1 am exempt under Sec. B. 8 P.C. for this reason
Grading
Driveway Enc.
Date Owner
Infrastructure
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
17 Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
REMARKS
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 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.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
ZONE:
BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
,Minimum Setback Distances:
DATE
Issued by:
Validated by:
Front Setback frQn,Centkr Line
Rear Setback froin R' r Pro.p. Line
Side Street SetfiEc� nom Center Line
�,// —
Side Setback on P opert�ge�.
'r v
Qr I:LISP -�'f,OR
vv
Date ���J'mit
� //
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 AddressFINAL
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 building
construction, and hereby authorize representatives poi this city to enter the
e above-
mentioned property for inspection purposes.
Signature of applicant —Date—
ate
Mailing
Mailing Address
Validation:
City, State, Zip
BUILDING DIVISION
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. @ $
2ND FL, S0. FT. @
POR. SO. FT. @
GAR. SO. FT. @
CARP. SO. FT. @
WALL SO. FT. @
SO. FT. @
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ IIA c
SEWAGE DISPOSAL
_
SO.FT.GAR @ 3/<c
HOUSE SEWER
REMARKS:
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
_
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 12/11/95 APN # 769-064-005-1
No. 13950 Jurisdiction La Quinta
Owner Name Sunrose Corporation Permit #
No. 50-625 Street Calle Quito Log #
city La Quinta zip 92253 Study Area 125
Tract # Lot # Square Footage 2443
Type of Development . Single Family Residence
Comments
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 1.72 x 2,443 or $ 4,201.96
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 Mike Tuvell
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Ellen Patino
Signature
Telephone 346=2840
Payment Received' $4201.96
Check No. 747
Collector: Attach a copy of county or city plan check application form to districtcopy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
R 0 DIN!',, REQUESTED BY:
' • b
AND WHEN RECORDED MAIL TO:
NAME
r MICHAEL W. &.TRACY M. TUVELL
STREET 850 Somera Rd.
ADDRESS Palm Desert, Ca. 92260
CITY
STATE
ZIP L RECORM4 REQUESTED 8Y
FIDELITY NATIONAL TITLE INSURANCE CO.
219358
RECEIVED FOR RECORD
AT 8:00 O'CLOCK
PAID
Doc. Transfer Tax
FRANK K. JO,'-INSON
RIv. Co. Retarder
THIS SPACE FOR RECORDER'S USE ONLY:
JUL -7 1995
Reoaded in 011111" Records
a Mwelde camw a or"
�C, Recorder
Fees t
1'e-� OZn The undersi -ntor(s) declare(s) that the DOCUMENTARY TRANSFER
ASSESSOR'S PARCEL NO: 769-064-005-1
TAX IS: 6.20 _
County $ City
TITLE ORDER NO: 256037 _ com uted-'on"the full value of the interest of property conveyed, or
computed on the full value less the vane of liens or encumbrances
ESCROW NO: 958265JF remaining thereon at the time 'of sale
ei
09'1 nsfer is exempt from tax for the following reason:
GRANT DEED
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
Grantor/Seller
M JEAN PIERRE IRIART, a married man who acquired title as JEAN PIERRE IRhART, a single man
O hereby GRANT(S) to
Grantee/Buyer
Y/ MICHAEL W. TUVELL .AN&° TRACY M..:'TUY.ELL r ,HUSBAND AND" WIFE ASJOINT TENANTS
all that real property situated in the.; C1 ty of La QU1 nta County of Riverside State of California,
(name of city or unincorporated area)
described as:.
Lot 51 of Unit #5, of'Desert Club Tract, as per map recorded in Boole 21, pages 61-62
of maps, official records of Riverside County. '
---Dated June
STATE OF CALIFORNIA )
COUNTY OF ) ss
On �o _ before me
personally appeared
personally known to me (or proved to me on the basis of
satisfactory evidence) to be the person(s) whose name(s)
is/are subscribed to the within instrument, and acknowledged
to me that he/she/they executed the same In his/her/their
authorized capacity(ies), and that by his/her/their signature(s)
on the instrument the person(s) or the entity upon behalf of
which the person(s) acted, executed the instrument.
WITNESS my hand and official seal.
Signature M Le� -'e.
MAIL TAX ,
STATEMENTS TO:
JEAN PIERRE IRIART
DIANNA R.
COMR-111:
SAN
9M16YDIANNA R. MA ft
COMM. * 10SM74
Notary Public — Colllo Ma
SAN BERNARDINO COUNIV
Comm. Expires JAN 29, 3999 '
(This area for official notary,seal)
FPS/00-51 1993 .THIS FORM FURNISHED COURTESY OF ORANGE COAST TITLE COMPANIES