0304-307 (SFD)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
692234
Date
111-1d.. '' Signature nature of Contractor ✓A' �a "!
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, Rosiness & 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:
O 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:
Cartier STATE FUND Policy No. 044-02-0014319 .
(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
wo> s' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Se`ion 3700 of the Labo%
Code, I shall forthwith comply withnthose provisions. J
Date: J/- ll.'1» r.%� Applicant °���it'_.,•r1` -� �° -
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and'civil fines up to $100,000; in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on 'his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work: is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such.
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating.to the building
construction, and hereby authorize representatives of this City to. enter upon
the above-mentioned property for inspection urposes.
Signature (Owner/Agent)���''°�•-!��`' Date!'A��a�
;..1,BUILDING;..PERMIT PERM'
_ 7
DATE VALUATION LOT TRACT c
I d /V ' I'6 - - . 30651
JOB SITE
?ADDRESS -'%$:y Q�%YafA.IV+:. JOLO
APN
766-060-002
OWNER
CONTRACTOR / DESIGNER / EN (NEER
. �E.aldi'0.iC�yi al1n'Ytlr�Ad'S. d.ni..�/ .4
C1G .•...7 dIONMRI:d4.+ruY.S`E
1. �? € 'K k
965 ;t`T RTH. rMEC'OND 18VI;.
LAQiLTI1+I't.A, GA 9225?
• PL*iD G'J=r 91786
(909),V82.9965 3539
USE OF PERMIT
SN YPE:A1MIIT DOES NOT fN'Ci.UDE I?I 01, SP.A OP 3:2PJVZ'WA ti r
APPIRO#1.CK7001 CDC,
PEORCHIPATIO 490.00 SV '
C`iA AWCAR.PORT 622,00 aF
rm.. tai` gy) Com: of coI~dm>iIcrioN
297A$4.W
]''1s-' lliT Fi.Tim' SiMMMY
CONISTRUCTIOt WE 101-000-438-000 $1,332,50
PLAN CHECK PEE: 101-000-439-318 $1.092.91
FEE DEPOSIT 101.000-939-318. 41,000.00
MECtf.A1.4IC.P L FEE 101,P00-4214M-
9124TRICAL FEE'. l.Ul m(iti{ 20-UfiO �20E.19
PLUNBINID: 412% :101-000-•41:9-000:. $195.r3f1 ;
STROM) MOTttapt PEE - RE SID 101.000-241-000 119.75
ORAD1140 YEE 101-000-42,3-000 �15.U0
i7iiV:lrLOPER IMPACT FEE ��405,00
.Af.2.T IN PUBLIC PLACES • RESit 270-000-4.45.-000 ' X243.64
`e�[.T�'i-'.i?Cf'I~'r'�T.+�U�I:)'I�ZCIC'",iX�)1d'�717P�',1ri'ti�•f�
�a'�a,'Y(39.4!�
- —;153 PRE -PA 1 S
-$1,000,00
'SALYUM Yr J7XES MY, NOW
003
CITY OF LA.QUINTA .. ..
FINANCE DEPT-. - ...�,,”}-,
RECEIPT
DATE a, " f,
/.
BY
..
DATE
E FI L._._._
INSPECTOR
- 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
J
Exhaust Fans
OX to Wrap
6
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
Dryvpll - Int. Lath
Final
Final
BLOCKWAV
A PROVALS
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 APPROVAL
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
34
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:
�-
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
Date 11/6/03 La Quinta, CA 92253
No. 25171 (760) 771-8515
Owner Quarry Ranch LLC APN #
Address 1 Quarry Lane Jurisdiction
City La Quinta Zip 92253 Permit#
Tract # 30651 Study Area
Type Single Family Residence No. of Units
Lot # No. Street S.F. Lot # No.
Unit 1 16 58745 Q ry Ranch -Road .3578 Unit 6
��
Unit 2 Unit
Unit 3 Unit 8
Unit 4 Unit. 9
Unit 5 Unit 10
Comments Quarry Ranch Country Club.
�J�l�t�vs��
O
Q BERMUDA DUNES r
C/) RANCHO MIRAGE
INDIAN WELLS
PALM DESERT 'c
LA QUINTA
O INDIO
O J
766-0e.0-002
La Quinta
0304-3307
Street S.F.
At the present time, the Desert Sands Unified School District does.not collect fees on garages/carports, covered patiosMalkways; residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating • r sanitation) or replacement mobile
homes. It has. been determined that 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
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14 X 3,578 S.F. or $7,656.92 have been paid for the property listed abo\.e 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 America - Mike Reed Check No. 408277564
Name on the check Telephone 909/816`7634
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /e e p d Sh M Gilvrey Payment Recd
$7,656.92 Over Under
Sianature A 0//11
NOTICE: Pursuant to GoOemment Code ction 66020'NU.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 toreiTTrom the date on which the building or installation permit for this project is iissued, 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 District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy- Accounting
✓,/ 'IRViNG REQUESTED BY:
NationakTitle Company
�P!Es
"crow No. 5534 -CAH
e a Title Order.No. 9771087 L
When Recorded Mail Document
and Tax Statement To:
Mr. Robert E. Geddes
15452 Bayside Lane
Huntington Beach, CA 92647
A • N • • i
03/01/2002 08:00A Fee:13.00
Page.1 of 3 3oc T Tax Paid
Recorded in Official Records
County of Riverside
Gary L. Orso
Assessor, County Clerk 8 Recorder
I I
I
!III
M
$
U
PAGE
SIZE
DA
PCOR
NOCOR
SMF
"Sc,
A
R
L
COPY
LONG
REFUND
NC HG
EXAM- j
GRANT DEED
W'AL.0 A[XJVC 1111) LIIVC FUn - ...,..
ff
The undersigned g
mrantor(s) declare(s)
Docuentary transfer tax is $7,700.00
[ X ] computed on full value of property conveyed, or
[ ] computed on full value less value of liens or encumbrances remaining at time of sale,
[ ] Unincorporated Area City of La Quinta .
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
General Partnership
hereby GRANT(S) to Quarry Ranch, LLC
the following described real property in the City of La Quinta
County of Riverside, State of California:
SEE EXHIBIT ONE ATTACHED HERETO AND MADE A PART HEREOF
DATED: February 27, 2002
STATE OF CALIFORNIA
COUNTY OF Riverside
ON 2-28-02 before me,
Catherine A'. Hammons personally appeared
Richard J Meyer--------------------
------------------------------------
t
e person(s) whose
thin instrument and
they executed the
pacity(ies), and that
he instrument the
half of which the
r ment.
/;
MAIL TAX STATEMENTS AS DIRECTED ABOVE
personally known to me (oma rnvPd
�edgedto
to be th
name( to the wiacknoa fie he/
same in is _ er/their authorized ca
by is er/their signature(s) on t
person(s), or the entityTpon be
person.(s) acted, execijt�d the inst
Witness my hand "nd off'c/ial s al
Signature
La Quinta Ranch, a California
La Qui a Ra c
By: r
Richard J. Meyer, General artner
FD -213 (Rev 7/96) GRANT DEED
ti