0202-011 (AR)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 # Lic. Class Exp. Date
h
/Date-' '' ' `p 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
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:
Carrier 1A010N INS C01 Policy No. VIC;11.361* 7
(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, Itshall forthwith comply with those provisions.
Date r<'.' <�� _ Applicant s 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.
I t
Signature (Owner/Agent) Date' c=
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
43: ,04.200 $4,11.1676.210 0 24 601
JOB SITE
APN
ADDRESS f T r 6 s7 57A7 pTFs
'/:+•�5lil� a,�'.h;it?,I.! Y.frlA.a S.L
Li''A-'@':iX.••Yl 7.i
OWNER
CONTRACTOR/DESIGNER/EN (NEER
X I T & gUillim 1:3IM; IG,
EC7W•1iRDO CO NWUC1101 "
19870M,NO Vw UXy
79.9.20MTADTCiVL1
I.,AQUINI,A C:-4 5/14-233
LAQT. 7l rfA CA 9:753
`760)775.1933 CISIA 3212
USE OF PERMIT
3tF51DYW ADl"5'T'1:1:t?W
499 SF,iNTTAC HFD CIURST PICU E tl'tgP AI PR(NFD
CUSTOM CO)4STRUCTION 49101) BY
PCIRCH/X.+.AT.10 14S.00 S*F
6 71', xN'.AIA, 000 11F
5 i,'!'. WOOD F"%MCE h1.0it R F
0*8STRUC"•THM IMP, 1X11-000-416.000 $302.50
PLAN CHECK FEE. 101>.(}.{1(1..435!-318 $20.67
MEV,HAINICAL FEE '101.000.421.000 $39,SO
E111 lllrp .=, P7?F1 $39.9.7
PLU ISPING FEE, 101.000.419.000 $32.30
STRONG W.1071014 FER a PEST 7 101-000-241-000 $4.13
1111 ADtIWO FEE 101-000.423 -001) $15.0 t
CtA3.11,T.Ct1f"i:10N.) I'LAAi CHECK
3.2,3
1.:F�.'I4a
$0.00
.._.a '':1'�;!�. �;�� �'1'"�fe'Isl�`F' �r'.4�'1��51?'l•].1a �€F.�'�k�
4t�;2�
r"
Ili L
s
�BY
,RECEIPT
DATE %
A//
_
-�--___
DATE FIN
--Ca2.
SPEC O ,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
O.K. to Wrap
Exhaust Fans
F.A.U.
Framing 0 Z &,za
Compressor
00
Insulation p
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath fyj�
Drywall - Int. Lath
Final A _
BLOCKWALL APPROVAL
/Final��
steel
1001)—
POOLS - SPAS
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 sd
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)
COMMENTS:
C
Bin #
City Of L QClinta
�Buiidinget,Safet Diyisionr
Permit # P.O. Box 1504,:78-495 Calle Tampico
La Quints, CA 92253 -. (760) 777-7012
0 Buildmg�Permit'Application and Tracking Sheet
Project Address: ?g g% �Fi4A� ; ALl O%mer's Name:_.X�) (/� too
A. P. Number:
Address: X �, g7 f C �hl. VA L�
Legal Description:
City. ST; Zip: X N
Contractor: X gqg E9J
Telephone: Xr
Address:
_
Project Description: _
iCpa�� �
City. ST. Zip;>(
^O �5..... �J
Telephone: hon
e
P x
•.
State Lic. # : X,
.:Citv'Lic. #:
7 L '
Arch.. Engr.• Designer:S
Cit%'. ST. Zip: I �;
Tele h e:'
on 5 5
P 5
3 . �
Construction i �..
tonT� e Occupancy:
.P c .
P
i #
StateLic.
ProJ' ec t typee (circle eone): Add'n Alter Repair Demo
Name of Contact Person: X
Sq. Ft.: g'
# Stories: # Units:
Telephone # of Contact Person:
Estimated Value ofProject: is
2y ° APPLICANT: DOINOT WRITE BELOW T14'' LINE
tt
Submittal
Req'd;.
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check•submitted
Item
Amount
Structural Coles.
Reviewed, ready for corrections
'.a!'
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
pN PI
Title 24 Calcs.
Plansicked u
p up,,- OL
.i OTi
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, readv forcorrections/issue
Electrical
Subcontactor List
Called Contact;Person
Plumbing
Grant Deed
Plans picked up
:S.NI•I•
H.O.A. Approval
Plans resubmitted.
Grading
IN HOUSE:-
'rd Review, reedv for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A•I.P•P•
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
12-1(o
/�DD i77' ,-, ro
STS v� 11/1 4 7-0
T—LY
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Qirita, CA:92253..
Document Cannot Be.Duplicated 760-77145i5,.
j
CERTIFICATE OY COMPLIANCE
Date 2/4/02 APN #' 761461073
No. 22897• Jurisdiction La Quinta
Owner NameSusan $ellig Permit #
N0.79870. Street. Pecan Dalley Log #
City La Quinta Zip -92253 Study Area
Tract # Lot # • SquareTootage 498`
Type of Development Residential Addition No. of Units 1
Comments
At the present time, the Desert Sands Unified School District! does ''not., collect fees .on garages/caiports, 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:
Residential Addition; 500- Sq Feet or Less
EXEMPT
This certifies that school facility fees imposedpursuant to ' 'Gove nment Code 53080 in the amount of
0.00 X 498 "or $ 0.00 the,property1isted'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 Exempt - Bob Edwards Telephone 760-775-7933
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Nicola Wong, Exempt
_ Check No.
Signature
NOTICE: Pursuant to Assembly Bill 3081 {CHAP 549 STA. S.'1 96) 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 o Ilation permit for this proted'issssued of on whicli'.they are paid to the Disiict(s) or to another public entity authorized to
tolled them on the District(s)(s) behalf, whichever is earlier.
Collector: Attach it 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
-7 970
01/19/2002 18:53 510736176e J01-41 9. SUSAN BELLIG PAGE 03
OLD REPUB'dClITLE Co.
AND WHEN IkscWW&D jiAil- VKdfi QM AND,' UNLM,
OrHanwifig !MOWN sALOW. MAIL TAX " JITATIthitNTS TO:
NAME[ jobn N. 6 Susan Belli*�,
evocal 4404. Nor R;I�dge Road
An"ges Danville, CA.' ,,94506.
sr' Ill :L
Title Order N0.9.653MO.... Ewft'-, N.140.9.7 ..........
AF
rhis 10oea F& Rece -Um
THE UNDERSIGNED GRANT61Rfs') 0Ed*RE(,)
DOCUMENTARY TRANSFER -TAX is4—A'29 - 00,
C.— —--vnincoipar�atcd zr�& )Qcy or Li "Q sI
pjkrc,,t 7 Al -i6A 9; L-0 73.
,E Computed an full value OLPMpeftyconveyed, ur
E3*cvniputid on ruit v&IUc!IM,:VIlue,0rf lierii.cr cot: rsnces renuinin; at time of sale, and
FOR A VALUABLE CONSIDERATION, re ivhjch is hereby acknowledged,
RIFAEL R. MAUNITZ AND MARY J. XWOWITZ.
hereby GIRANT(.5) to
JOHN W.*. BELLIPAND SU,SAF? BELLIG
husband and,mife, as community
property,
the following described real pNperty. in the City df.L'* Quints
county of RiveTsid.a swte of Californiz:
Complete legal
gal description as�
..par Exhibit "A"&ttachad,,hcreto and
made a part hereof.by this refekence.
Property: known ap:-'719-870'Pecan Valleyj,la Quinta,.CA.- 92253
Dated April
Mae,
STATE OF CALIFORNI
COUNTY OF
On Apvil21, 1 993
Nn tAjzy PuAlic
Rif Ael' R.: Hirk6sei&L4jid
mu
wwoar.o/ w Nv uw yvw.ge� oowNo uaqu� is uu uuuprn uou w uJV .,��` SK. RVrH A. FURS
within Instrument and acknaw e t t he/shWUW executed %;•- , i . ^ Natcry Pub4c-CUftmia
lho same in hmWw er/lhOr a empae and that by hWha/"f = '. ; „ QVeRSCE COUNTY
algnsture(e) an the instru the pe a), th lily upon behalf n- ✓ t:arnmisslon Ex0es
of which the paraon(s)- tad, ni. AAN 30, 1994
WITNE69 my ttan ofFdsdP
Signature
FOR NOTARY SEAL' OR STAMP
MAIL TAX STATEMENTS TO PARTY SHOWN ON FOLLOWING LINE; If NO PARTY 80 SHOWN, MAIL AS DIRECTED ABOVE
Nome Street Addrae City k 8ba
CTO•t•t01 tB•s+t
01/19/2002 18:53 51V7 61760 JOK) :, SUSAN' BELL. PAGE a4
EXHIBIT '°A
U0986
SAID LANQ,IS SITUATED IN,*i COUNTY',OF iiIVERSlDE;STATE OF CALI:FQRNIA, ANA IS DESCRIBED
AS FOLLOWS:
A CONDOMINIUM'-COMPRISED OF,
IA) AN IJ DIVIDED 1/1. HINTEREST-IN AND TOR V15EO,LOT 6,OF TPI�►CY NO. 24801, IN-THE CITY
OF LA QUINTA;'COUN'%Y,OF RI EASDDE, SY TE OP14ALIF.ORNIA; AS PER k1/4P RECO tDED JN g00K
213, PAGEl8176 THROUGH,) t NCLU IV }9F AMAFS; IN„TILE OFFiCE`OF:T:4E Co,UAI.TY•'RE�OROER OF
SAIO'COtJNTY, AS DESCRIRED:IN `pEEO BIfFCORDED.'JUNE 8;1 X80 AS'INSTWUti�EtVT N0.20613.
EXCEPT UNI S:6k9Q TkR000H 8-508 IPfCLUSlV�, A5 SMQV1fN ON THE CONDOMINIUM PLAN
RECORDED- JULY. 3,19911 AS'INSTRUMEN�'IU® '248381, OFFICtAd. RECORDS
(8) UNIT E500 AS SHOWN ON THL.CONDCM'V4i'f PLAN'REC®RDPD JULY 3 193VAS INSTRUMENT
NO. 248381 OF OFFICIjt AkCiRDS::.
ALSO EXCEPT AND RiSERVING,TOT-HEGRANTOR-ALLO.IL•ANDG
T,D. AS,CY®AOC1 e0N AND OTMEt
MINEAAt. RIQHT'S kw$0:00 FEET StNEATH hIE SURFAC9
OF SATO' LA[VD, WITHOUT RIGHT OF
SURFACE ENTRY.
r
G '
i1%:61'101 21,
Novacaber 90'2001
GC.. ....� .
pGA WEST II RESIDENVftAL ASSOCIATION. INC.
P.0, BOX 1252; LA'QMTA, CA 92253
(760) ?76-5I60 FAX (760) 776.5111
Jobst and Susan Balks
4444 Doi Ridge Rodd
Daavillet CA 94306
�( 79-870 h= Valley, L21 Qui'nta,: CA 42ZS3 '
ArohiteChirai Change • (3 js6ouse Addition
DcarMr. � Mrs. Setlig: .
The Board of Dii=wrs, at its.Hovember 2,206 i;m0e?iztg, reviewed the ;,`"tioiiss outtined iA a tetter dated
90ptamber'f 1, 2001 from South Wast Gottoepts: Ttie Board"tppsti>.+od Alseraate A'`as depleted lathe
atiaohed d*rem and as outlined in rdece toedamter, whicis_mites;
•
The distance from titre tacit to the Dunham's (794160 Pecan Va11ey) patio deck has been it>Greand
ft mt 32' to 46'.
TUm are two 8' high walls between the tout tlnd 3h® Dtlttliesn's psti0 rvhi ,Will block sound
trsut;sstissila>L. > .
• The emit location will,have ap additional well,to shield it ftom the golf course.
• This lockda wavides minimm to`na impab4 ou boib pivpetties a cit is oom*seiemly located out of
view wid A a landdsaPod area.
Ravi'ew by the Committee is attly flat general Cosham- ttce with the It is the.
r4s Onsibtlity of ti mur to fully-undtarnl etsand=sonform bio the arc hltet Lural gii "ices criteria whather
or stot,all daPlateizC ice, meted diatirtg r®Yuw iihe`ownet's k tc; oaftlity to field verify a}J
kstl4 conditions. Tha'Cortim tict3's decision with rgat to prgjoctadeaigttiw�ell.be fitisJ. ASM infer to
to AxhiteMmI Rules for ail eequiied Ii6lnitteli.
The Landscape-CommitW, 6o described in our April td" 1@ttet,.Shcl'h� the flal{owing C011C8MS'
6 kioraeas im"not an the plant palette aced havebe'eit removed from thr M TI cornmu Lily. Plan
make another seleetio.0fsastt the Assoctation's 4rove4ik p�leQte.
�,.
a Tbesa !a 6n abuaoastse af%anual'co' 6 on yaur plans Thi attn 'IC6' for is used'at the tips-ofboo
Daly isi6 slioald not be intez�pettaed vrit2t clsiubs: 'Plemes ssmoe the enriiiel color ie ihoso areas
M&
doat
rnttet thane ciittieia
please 06AW Javier. Contreras uVe' visorfor Vall'jr G&tdenin; Seavtce ac?dU��99=1844 and Carol ufler.
rho Assodasion Adaas�cr;. preen to any' biiigatiou snoditlrat�o is assaiated, nth rlus ct,artge. 1)atnsg� to clan
land piing, i.e., skirt ,trees, lowers >itid"tort is the tespo�tbility of the Co>itiac�or; The lussdsceping
m>sstbe brought back toils ori;i�ia} conditiatt •wheat rho pr�ecs�is cotnpletod. .
11/26/2001 21:45 5107361760
John and Susan Bellig
NovetIAM S. 2001
Pap Two.
JOHN & OU:1N k�ELL1U
rALIr- VLJ
Approvals given by the Architectural Committee are good for only si, rmnths from the daw on the
approval letter. After ftt time a tww opplicadon must be submitted.
Upon, completion Of your projc m pleas. oomplete and return The Notice of Completion of Architectural
Chatty.
If you have any addibond questions or COMM P1oM do not hesitate to contact Carol Fuller, Astec-iat;tm
Mat Wr, at 760/776.5100, Ext. 20.
SisttMly,
PGA, WEST 11 RESIDENTIAL ASSOCIATION
. Por the Hoard of DirWors
Carol Puller
Association Manarr
ca: Board of Directors
Unit mile