0005-022 (SFD)0 -I 1 kF'115?�LICENSED CONTRACTOR DECLARATION
it hereby affirm under penalty ofperjury that I, a— licensed under provisions of „
wChapter9 (commencing with Section' -7000) of Division 3 of the Business and'>r
Professionals'Code, and my License is in full force and effect -= `
.' License# ' `Lic.Class Exp.'Date
Nair�r �r
W9). Ir,.f.;.4 ` + �� 12n112(
,'Date= ry Signature'offContractor` 4,1 f`
T' OWNER -BUILDER DECLARATION
1 hereby.affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
g (y) 1,'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)., ,
O t as owner :of the' property, am exclusively contracting with licensed
�y ct.
ontractors to construct the project (Sec. 7044, Business & Professionals
S;O 1 am exempt under Section B&P.C. for this reason
1 �l'.r
'Date Signature of Owner
:WORKER'S COMPENSATION DECLARATION
vl hereby, affirm 'under penalty of perjury. one' of the following declarations:
a,
r� 3,( ) .1 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.
A I.haGe and will maintain workers' compensation insurance, as required by
, $e tion � 3700'of the Labor Code, for the performance of the work for which this
'permdis Issued `My�workers',compensation insurance carrier & policy no. are:
Carrier ' Policy No.
, FU
ETATR ND 229.00-002("714
(This section need not be completed if the permit valuation is for $100.00 or less).
i)yl certify that in the performance of the work for which this permit is issued,
r�: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
,': Zbtect to the workers' compensation provisions �of Section 3700 of the Labor
t Code,' l shall forthwith comply with those provisions.
Date ? Applicant �'� /
y Warning Faifu a to secure Workers' ompensat'.n coverage is unlawful and
' shall subtect an employer to'criminal penalties and civil fines up to $100,000, in
n,.addition'to the cost of compensation, -damages as provided for in Section 3706
,I of the Labor Code interest and attorney's fees.
�IMPORTANT,Applieation is hereby made to the Director of Building and Safety
Yfor� a�permit-subject to the _conditions and restrictions set forth on his
i application
t 1 Each person upon whose behalf this application is made & each person at:
- t', whose request and for whose benefit work is performed under or pursuant to
;aanyIpermit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
t< ; 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 ofssuch
rpermit;` or cessation'of,work for 180 days will subject permit to cancellation. .
1r 1 Y
;I certify that I have read this application and state that the above information is
Mcorrect.'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 fonspection pur
' poses.
Signature (Owner/Agent),/¢ ji'' "' Date % `
-I910a
ri...- ---s;r3�rEt-0•e"µPERMIT#/,'i�+•• �.�
. G! er �s'rh•+`!A'r„ `�•.acR+r r'•
. ;;.. BUILDING PrERMIT. r. . rlip •St{:,,a ,�r1,„��4�4
.r• L , •t•. ' �r =1y. .�{:.2, 7�'•n t x;.��l74DV+„'iJLf” :.�. {i l,I"S'r '(•f .Y �i�..,
DATE , ,VALUATION d �1�p��p LOT ?. ,r a: TRACT.'. ” t
•ty'006i 735 .70
!N , • is 46 1 "' tri , "''• s � � ) �) ?v�kf
JOB SITE , APN
ADDRESS
'1€l-•'7'&� P17�1r� x , 763 CN30 0116 � 4
OWNER CONTRACTOR / DESIGNER / ENGINEER
)&SIPERO PROPS rens ulc 9tr2`t VISTA DEVELOPMENT C0RLP> -,�
P, 0, BOX 1144 77899 W01
LA c�UJN',rA c� 92253 PALM I)Ir.'3�Rr C� 92260
(760)772-2626 = CBL4 s ;4393: ,
USE OF PERMIT
;{ ,
• b Y ."aY '1'T't�F�
S1A7CiI.L F1'' DiiVR,d.1N0
SFD•PEIT DON.S'Nar fNCLUDR BLOCS: bV.AJA" S OR POO
RML
•t ..�. c .•�>, FG
i
. .;•M1��� 4Lt r i.A� .
CUSTOM CONSTRUCTION 4806,00 S 1r�i^�� .
PORCH/PATIO 1,395.00 sF `1 ., Nil ,,
CfARA EIC,ARPOR`I'(SFj 17,844,80
r r4
PL
ESIXUATt-D COST OF cO.I�i:�"ra�ucrlO.�r��1,�3'.�.7�
PLIOWFEE GUAbMiAR �• a T ��.( y r�3� I ���•• Y,
CONSTRUCTION FEE 101.00044184000 $24001 00 i;
PLAIN CHECK FEE 101-000-239.318
rL9 DEP081T 101000.439.318 $2,00000,;
ARECIiA1+lICALFI?L 101-000 -421-000 $179.0
ELECTRICAL FEE 101-000.4!20-000 $30347
PLUMBING MEE 101-000-419-000
STRONG MOTION FEE- RDID 101.000-7AI-000 $4839 s �,• �'�°� �,
GRADINO FEE 101-000-423-000 ; '. $20 06:x:
DEVELOPER IMPACT FEE $1,5 .00
ART IN PUBLIC PLACES`, IMSI1: 701-0300-255-000 :$721041, � �• i` ;� �-
R4 bg b •. 'sem rtlr.. _ r
{OLTP, -TOTAL CO$F'TRTJC TTOAI' AP313 pT SAT`C 'E: { . ; e i%
` AFS PT:t:EaPAID FM' s's i il>Jo
_{��. A� �•
+SiVp3y %mmICA.yp$6 B095�.
4
'�pq y�"p}(/ - l�y3J � ! r r<. � " trFc•,t .� y^+'f9`��it`�'�� ;a � y�-,x
�% i 0 0 ' : � � � •+ �� S GJ y'r ,� t� � y J.>aMt� �4t}t.���- y�v�l�jpy�y�'1' j�
- • Ft .v , sa, ..j'ti1 s, �+vi^.,r{ ^r4y jN�f�..iir6,!`T�T �i L� ���,
' '- ' %.t 1,..;i1 �p`p.�'`' ,a�i•1{t1K�� '�'���'��,`���f,..}}y`?l'+'p
RECEIPT DATEil $Y ; .! DATE FINALED {Yts�sI �INw�SPEr#CTO�Ry
1W S/C1iW'%C
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
d U.S
Underground Ducts
Forms & Footings
_
Ducts
Slab Grade
V_S�
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
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
CSU
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
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)
P.O. BOX 1504 APPLICATION ONLY
Building/ �� 78-495 CALLE TAMPICO
Address J LA QUINTA, CALIFORNIA 92253
Owner
"lcS Z �-.
BUILDING: TYPE'CONST. OCC./GRP.
Mailin
Addressv ! yG A.P. Number �%1 v//7
tyZip Tel.
? - — Legal Description -
Intraetor /,. - Project DescriptionT-
� . I r- e, JA r> , i r �
CityLZ1_-P/_1a/)_S
Tel
�t)"� __77_;Z2 -;16a-6
State Lic. � City �/ %
& Classif. / Lic. # Sq. Ft. No.
No. No. Dw.
Size UUU Units
Arch., Engr.,+
Designer t /y New C�- Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address % l ` 1' Tel.
r%A LSI/ Lic.Stat#CCAS `�3
!LICENSED CONTRACTOR'S DECLARATION -
I hereby alfirm that -I arm licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of.Ure Bus' ess.and Professi9yyy�s Code, and my license is in full force and
effect. �. / 7 1 A c—,a.,,.� ,�'' / 7 e n r)
•t /V/ OWNER-BUILDER'DECLARATION
I hereby affirm that I am exempt rom 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 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 thealleged exemption. Any violation of Section 7031:5 by 'any applicant for a permit
subjects the applicant to a civil.penally of not more than five hundred dollars ($500).
C', 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
ofproving that he did not build or improve for the purpose of sale.)
Il I, asowner 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 contractor(s) licensed pursuant to the Contractor's License Law.)
1-1 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
.I,herebyaffirm 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
opy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM,
WORKERS' COMPENSATION INSURANCE
(This section need not be completed itthepermit 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 IOwner
NOTICE TO APPLICANT: 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
Ihereby 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
ame 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.
1 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
imated Valuation
I PERMIT AMOUNT.
Plan Chk. Dep
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Driveway Enc.
Infrastructure
r
W
TOTAL
REMARKS
• � l 1
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line't
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 = FINANCE YELLOW = APPLICANT PINK =BUILDING DIVISION
r
7
T
3
Desert Sands. Unified School District',.
47-950 Dune Palms Road
Notice: LaQil:iita,.CA 92253
•
Document Cannot Be -Duplicated 7G.0-77,1-8515 ' .
CERTIFICATE OF COMPLIANCE...
Date 8/31/00 APN# 769-600-016
No. 20957 Jurisdiction'
_ "La- Quinta
Owner NameNispero Properties'LLC Permit#0005-022
No. 78=785. Street Pina Log #
City La Quinta Zip 92253, Study Area '
Tract# Lot,#.. .Square Footage ',.I" .
Type of Development SFR'Mitigation :. No. of Units 1
Comments STD is in the Citws c5806 sq. ft.
4 •
At the present time, .the Desert Sands t[Jiiiticd School Drstnctr�loes not collect'•_ fees on ,garages/carports, covered
patios/walkways, residential additions under 500 sgivare feet, detaohed'acce,s'sory stiirctures or replacement mobilehomes.
r..:
It has been determined the above-named owner is exempt t 6hf-paying school fees atthis time due to the following reason:
Under M><tigation Agreement
EXEMPTION:NOT APPLICABLE
This certifies that school facility fees'imposed pursuant to Government Code; 53080, in the amount of
628.00 X 1 or $ 628.00 the propg4,1isted above anii'tlia't building .
permits and/or. Certificates of Occupant}T for: this square footage in,this•proposed'projectmav, new be issued
r,.
Fees P.aid'By CC / 1st Bank /Rob Capetz
1C$16. hon
760=772-2526
Name on the check
By Dr. Doris Wilson "�•
l
Superintendent
Fee collected/exempted by Annette Barlow Payment Received $628.00
r — wCheck No. 56616
Signature
f
TICE: Pursuant of Assembly Bi11.3081 (CHAP 549, STATS. 1996) this w 11 serve to:notify you that the 90•day'approvalperiod inwhich you may protest the fees or other payment ider tified
ove will begin to run from the date on which the building or installation permit for'this project is sssued or on whichthey are paid t`o the District(s) or to another public entity authorized to
lled them on the District('s)(s') behalf, whichever is earlier. - - -
Collector: Attach a copy of county or city plarrcheck 1)lication form to district copy for allwaivers.
Embossed Original- Building Dept./Applicant Copy- Applicant/Receipt Copy - Accounting
-�— .' h. .ate •Y�T� ' ?'
�• x.o- So- � a t -n� �� i
07
PAIRWAY
Orderivo• ��� r gt;est�d 9� RECEIVED F01fR
F:" "' ': escrow No. First Amnrit:an Title C AT O:OOMA
e Loan No. ornpany ,a;
EPAID FEB 28 WIIBN RECORDED MAIL T0:Mr. Robert H111 nsfer Tax ,,78-855 lima .rr -•�La Qu1nta, CA 92253 Re00rder
MAIL TAX STATEMENTS TO:
Spacea e this line for Rec er's a
DOCUMENTARY TRANSFER TAX 3�21 4LS
- -.Computed on -die consideration or value of property{
q " _ `- eomeyed.OR
SAMBAS ABOVE -
�Con"ted on the consideration or value less lime or
ertemnbrances remaining at time of sale
THE UNDERSIGNED GRANTOR ' [`
Signature of Declarant or Agent determining lex•Firm Nnme�.
TRA 020.03 - I 8
NT DEED
- GRA
x - ,
4`FaR A VALUABLE CONSIDERATION, receipt of which is hereby acknowlcdged, } ""
N CAPITAL PACIFIC HOLDINGS, LLC, a Delaware Limited Liability Company A.
berebyGRANT(s)ro Robert M. H111 an unmarried Man.
4
r the feel property In the City of IA Quina
County of Riverside Sate of Caliromia, described as
Lot 45 Tract No. 349"4 (See Exhibit "A" Attached Hereto) -
al
Dated: January 27, 1999 -
5 if
�1 - Sate otCalitomia ) _ -
"` ) U. CAPITAL PACIFIC HOLDINGS,
County of a Delaware United liability r
✓7 _, On : h e y .: �
be me, BY: CAPITA PACIFIC HOLDINGB,IN
SrAlmlri-N- 0A t
Personally appeared a De ware on, ManagGtg Member
personally known to me (or pvo#W to me on the barb of atbhetory
4i. .
' � = evidence) to be the penon(s) whose name(s) Was subseribed to the
within instrument and acknowledged to me that he sheither executed the
I same in hWheNtheir authorized capecity(bs), and that by hWhedtheir E
signature(s) on the instrument -the person(s) of the entity upon behaltot n
+ which the person acted, executed the instrument,
r 9r.<-
;,Yl::� WITNES MY HAND AND OFF I IAL SEAL eeaaeeea..r.r�:
Si g natureOOMil�l�l1
•• yy
a
a •�
OF LA OUINTA
cFyoFoa,� BUILDING & SAFETY DEPARTMENT
® 7777012
INSWCTION REQUEST LINE
7777153
Owner NISP•RO. PROPERTIES LLC
Contrac�or"oSIUN VISTA DEVELOPMENT CORP
``� 0005-022
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
78- 755-prN7v--
DRES
l'
WALLS OR POOL
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
5 Gd
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
Q
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT -.A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
02
GROUT ❑ 4' ❑ 8'
GROUT
--
FRAMING
moi/
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGN
DRYWALL INTERIOR logl
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
Cort,
ificate of Occupancy
chy of La Quin. -.`a
8-Uilding,�and Safety Department
This'Cei `ificate issued pursuant. to the r'equirements•.of.Section .109 of the '
* F
certifying that , the fime of._ ssuancew: Uniform Bui/ding
Co -e .
t/is structure was in compliance with the_ variocis ordinances.
6 the ;City regulating ,6ui/ctl ng., construction ,or use.: For the fo/%,wing;
BUILDING wb "RESS:
78-785T11N
Us:e Classification'._ ` SFD
c
..
:Bldg. Permit No.: 0005-022
Occupancy4 Group: R3 ..Type of Construction: VNI. Land Use Zone: RL
Owner of Building: NISPERO.PROPERTIES'LLC
Building Official
Address: R.O BOX 1144
City: LA QUINTA.CA 92,253
By KIRK -KIRKLAND ,
Date: 6-5-01
3�� POST IN A CONSPICUOUS PLACE
4,
JONITANDY
37630 Medjool Ave.
Palm A Desert,, CA, -92211
'Office (760) '772-7192
�SPECIAL INSPECTION7- , Fax j (760) 772=7193
Pager (760) "776-3338
REGISTERED' INSPECTOR'S WEEKLY�REPORT,, tea.
TYPE OF
, ❑ REINFORCEO`CONCRETE L TRUCT. STEEL ASSEMBLY ❑ S
INSPECTION
!
O POST -TENSIONED CONCRETE ❑ASPHALT Y4�
*OTHERo
La (cr
PERFORMED
s
❑ REINFORCED MASONRY'' - # ❑'FIRE PROOFING
1.(/�►"'—'
—JOB—LCqT
REPORT SEOUENCE NO.
TYPE STRUCTURE
' " -]PERMIT
NO. a • '^' .
•}
Dq
DAY OF WEEK
MATERIAL DESCRIPTION
S
pt
ARCHITECT„r
> ti
-+
,.
�I�' -)/Q(��/ �OR
HRS. CHARGED.
V l”
�'1
��✓ .��; -"•
ENGINEER " r- - ••
,
ASSISTANTS
HRS. CHARGED
INSPECTION
,DATE
GENERAL.
CONTRACTOR
T ,, ! SUB;
L& —,A "' CONTRACTOR
f
rya
��
.. s '
1> ..� #- . � 2 "`
� • .J
y t yu t pt •. .1
COPY SENT TO,CLIENT O" ,:. a
CONTI ON NEXT PAGE'.❑ ,
PAGE OF .
� ' .., � ..'" ,� } W i I, � Y x `• V'���'..' i • 1
CERTIFICATION OF -COMPLIANCE f
t:
I HEREBY CERTIFY,THAT•I"HAVE'INSPECTED,TO•,THEDBEST,OF'MY SI ATU E-OF•REGISTERED I SPECT R
..KNOWLEDGE -ALL OF;THE ABOVE•REPORTED WORK UNLESS OTHERWISE �•
NOTED I HAVE FOUND THIS WORK TO;COMPLY .WITH THE APPROVED' l,` (�� .
PLANS. 'SPECIFICATIONS. AND APPLICABLE "SECTIONS 'OF ^THE r
GOVERNING.BUILDING LAWS. ` r' . aTE F REPORT REGISTER NUMBER
�z
I :Job Name: L O Job [�b. -1 f 99 Begin ate:
Fab. Step
`77W A L i� Fid Date: Q �v
S W Vis '(
H
A
TT DP ASTM M.P. Al FUU PM
Heat` ALSC Camber ;Filets T Filets j T (symbol) NCE �1arane
PCS E De9irr No. Tal. .Size Date (In) QC , (AOD). -EA(C4t ' (YIS)(Ctate) (Date) Rc�r1e
D
®.10=.
= NINE
cull
=11M.1-1101110011101 100110101
0 NMI
111010111
*Materials and weldzients conform to plans•and specifications and RISC, and AWS D1.1
Shipping Mark
905 SHEL
Special Deputy Insp.
� ■�
NMINMI
NMI ME
OR
®.10=.
= NINE
cull
=11M.1-1101110011101 100110101
0 NMI
111010111
*Materials and weldzients conform to plans•and specifications and RISC, and AWS D1.1
Shipping Mark
905 SHEL
Special Deputy Insp.