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BRES2015-041078-495 CALLE TAMPICO�—� WORKER'S COMPENSATION DECLARATION /�0 1"N LA QUINTA, CALIFORNIA 92253 NIT�L/�DU'Pli\ ELO _ I have and will maintain a certificate of consent to self -insure for workers' and my License is in full force and effect. ILDING PERSM License Class: B License No.: 744091 of the work for which this permit is issued. APP 'L 7 N,b Application Number: BRES2015-0410 Section 3700 of the Labor Code, for the performance of the work for which this permit . Property Address: 78571 DEACON DR E CITI OF LAQUJ%TA APN: 770220007 I certify that in the performance of the work for which this permit is issued, I Application Description: TRADITION / CASSATO / 3,344 i1R'Io��tQp�e�roE Property Zoning: any structure, prior to its issuance, also requires the applicant for the permit to file a workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith Application Valuation: $295,476.50 Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division Business Applicant: SUN VISTA DEVELOPMENT CORPORATION PO BOX 1144 LA QUINTA, CA 92253 VOICE (760) 7774125 FAX (760) 777-7011 ENT INSPECTIONS (760) 777-7153 Date; 4/28/2016 Owner: SKIP & NANCY CASSATO PO BOX 1144 LA QUINTA, CA 92253 Contractor: SUN VISTA DEVELOPMENT CORPORATION P0BOX 1144 LA QUINTA, CA 92253 (760)771-4722 Llc. No.: 744091 LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter I hereby affirm under penalty of perjury one of the following declarations: 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, _ I have and will maintain a certificate of consent to self -insure for workers' and my License is in full force and effect. compensation, as provided for by Section 3700 of the Labor Code, for the performance License Class: B License No.: 744091 of the work for which this permit is issued. Z "•i _ I have and will maintain workers' compensation insurance, as required by Date_ Contractor: Section 3700 of the Labor Code, for the performance of the work for which this permit . is issued. My workers' compensation insurance carrier and policy number are: OWNER -BUILDER DECLARATION Carrier:_ Policy Number: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State I certify that in the performance of the work for which this permit is issued, I License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any shall not employ any person in any manner so as to become subject to the workers' city or county that requires a permit to construct, alter, improve, demolish, or repair compensation laws of California, and agree that, if I should become subject to the any structure, prior to its issuance, also requires the applicant for the permit to file a workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith signed statement that he or she is licensedpursuant to the provisions of the ose provisions. comply wit3.6 Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division Business _ p 6 3 of the and Professions Code) or that he or she is exempt therefrom and the' Date: Applicant: 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, ($500).: AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO I ) I, as owner of the property, or my employees with wages as their sole ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF compensation, will do the work, and the structure is not intended or offered for sale. COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not INTEREST, AND ATTORNEY'S FEES. apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements APPLICANT ACKNOWLEDGEMENT are not intended or offered for sale. If, however, the building or improvement is sold IMPORTANT: Application is hereby made to the Building Official for a permit subject to within one year of completion, the owner -builder will have the burden of proving that the conditions and restrictions set forth on this application. he or she did not build or improve for the purpose of sale.). 1. Each person upon whose behalf this application is made, each person at whose I 11, as owner of the property, am exclusively contracting with licensed contractors request and for whose benefit work is performed under or pursuant to any permit .to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' issued as a result of this application , the owner, and the applicant, each agrees to, and State License Law does not apply to an owner of property who builds or improves shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and thereon, and who contracts for the projects with a contractor(s) licensed pursuant to employees for any act or omission related to the work being performed under or the Contractors' State License Law.). following issuance of this permit. (� I am exempt under Sec. . B.&P.C. for this reason . 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. Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency'for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's 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 upon the above-mentio ed property for inspection purposes. Date: V11,6 Signature (Applicant or Agent) DESCRIPTION FINANCIAL INFORMATION ACCOUNT QTY AMOUNT' PAID PAID DATE ART IN PUBLIC PLACES - RESIDENTIAL 270-0000-43201 0 $238.69 $238.69 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE Total Paid for ART IN PUBLIC PLACES - AIPP: $238.69 $238.69 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $12.00 $12.00 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $12.00 $12.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - CIVIC CENTER 252-0000-43200 0 $942.00 $942.00 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - COMMUNITY CENTERS 254-0000-43200 0 $129.00 $129.00 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE DESCRIPTION ACCOUNT QTY AMOUNT PAID 'PAID DATE DIF -FIRE PROTECTION 257-0000-43200 0 $433.00 $433.00 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - LIBRARIES 253-0000-43200 0 $344.00 $344.00 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - PARK MAINTENANCE 256-0000-43200 0 $40.00 $40.00 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - PARKS/REC 251-0000-43200 0 $2,048.00 $2,048.00 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - STREET MAINTENANCE 255-0000-43200 0 $116.00 $116.00 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - TRANSPORTATION 250-0000-43200 0 $2,842.00 $2,842.00 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT I CHECK' R15091 70001 RSE Total Paid for DIF - SINGLE FAMILY DWELLING: $6,894.00 $6,894.00 DESCRIPTION ACCOUNT QTY AMOUNT 'PAID PAID DATE TEMP POWER SERVICE 101-0000-42403 0 $24.17 $24.17 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE DESCRIPTION ACCOUNT., QTY AMOUNT PAID PAID DATE TEMP POWER SERVICE PC 101-0000-42600 0 $16.92 $16.92 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE Total Paid for ELECTRICAL: $41.09 $41.09 DESCRIPTION ACCOUNT + QTY AMOUNT PAID PAID DATE RESIDENTIAL, EA ADDITION 1,000SF 101-0000-42403 0 $49.32 $49.32 4/27/16 PAID BY METHOD' RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 . 70001 RSE. DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RESIDENTIAL, EA ADDITION 1,000SF, PC 101-0000-42600 0 $20.32 $20.32 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RESIDENTIAL, FIRST 1,000SF 101-0000-42403 0 $145.03 $145.03 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RESIDENTIAL, FIRST 1,000SF, PC 101-0000-42600 0 $47.86 $47.86 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE Total Paid for ELECTRICAL - NEW CONSTRUCTION: $262.53 $262.53 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RESIDENTIAL PRECISE GRADING - CUSTOM HOME LOT >7KSF 101-0000-42408 0 $36.26 $36.26 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RESIDENTIAL PRECISE GRADING - CUSTOM HOME LOT>7KSF PC . 101-000042600 0 $181.29 $181.29 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE Total Paid for GRADING: $217.55 $217.55 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE CONDENSER/COMPRESSOR 101-0000-42402 0 $145.04 $145.04 4/27/16 0AID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE CONDENSER/COMPRESSOR PC 101-0000-42600 0 $96.68 $96.68 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY " SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE EXHAUST HOOD 101-0000-42402 0 $12.09 $12.09 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE DESCRIPTION • ACCOUNT QTY AMOUNT PAID PAID DATE EXHAUST HOOD PC 101-0000-42600 0 $4.83 $4.83 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT. CHECK R15091 70001 RSE DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE FURNACE 101-0000-42402 0 $145.04 $145.04 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE FURNACE PC 101-0000-42600 0 $96.68 $96.68 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY " SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE VENT FAN 101-0000-42402 0 $108.81 $108.81 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE VENT FAN PC 101-0000-42600 0 $43.47 $43.47 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 ,70001 RSE Total Paid for MECHANICAL: $652.64 $652.64 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE MULTI -SPECIES RESIDENTIAL 0-8 UNITS - 2015 UPDATE 101-0000-20310 0 $1,301.00 $1,301.00 • 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE Total Paid for -MULTI -SPECIES RESIDENTIAL: $1,301.00 $1,301.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE NEW CONSTRUCTION PERMIT 101-0000-42400 0 $200.00 $200.00 10/22/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R10233 15255 SKH DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE NEW CONSTRUCTION PERMIT 101-0000-42400 0 $435.33 $435.33 4/27/16 PAID_BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE -Total Paid for NEW CONSTRUCTION PERMIT: $635.33 $635.33 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE NEW CONSTRUCTION PLAN CHECK 101-0000-42600 0 $1,300.00 $1,300.00 10/22/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R10233 15255 SKH DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE NEW CONSTRUCTION PLAN CHECK 101-0000-02600 0 $55.64 $55.64 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE Total Paid for NEW CONSTRUCTION PLAN CHECK: $1,355.64 $1,355.64 DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE BACKFLOW DEVICE .101-0000-42401 0 $12.09 $12.09 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE DESCRIPTION ACCOUNT CITY AMOUNT. PAID PAID DATE BACKFLOW DEVICE PC 101-0000-42600 0 $4.83 $4.83 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE BUILDING SEWER 101-0000-42401 0 $12.09 $12.09 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE BUILDING SEWER PC 101-0000-42600 0 $12.09 $12.09 4/27/16 PAID BY METHOD RECEIPT # CHECK #. CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE FIXTURE/TRAP 101-0000-42401 0 $241.80 $241.80 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE DESCRIPTION' ACCOUNT CITY AMOUNT PAID PAID DATE FIXTURE/TRAP PC 101-0000-42600 0 $241.80 $241.80 4/27/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE GAS SYSTEM, 5+ OUTLETS 101-0000-42401 0 $36.26 $36.26 4/27/16 PAID BY METHOD - RECEIPT # CHECK # CLTD BY SUN VISTA DEVELOPMENT CORPORAT CHECK R15091 70001 RSE DESCRIPTION ACCOUNT CITY AMOUNT PAID. PAID DATE GAS SYSTEM; 5+6UTLETS PC , 101-0000-42600 0 $24.17 $24.17 4/27/16 K"` �PAIDBY x§� ` ��METtIOD�; _..E&i w vS3�'A_. _.., a ! ��v`'S" `rhrxE�``�y°"�, } RECEIPT # £�fr5:r?*'.xa :fi,.,'*s?x.. :,.: _.,< + CHECK # '�i.L,'Azi3 r CIzTD BYE SUN VISTA'DEVELOPMENT.CORPORAT CHECK;,, R15091 70001 RSE �'z�z... kd,. ykz.. �* .,. OESCRIP�T�ION:' .° k `,.• z>- ✓. Yrr"5, i�'ty -'` ._A000UNT,Y� � +�T "`k";., f '�"+N££k+f .AMOUNT :. 4y �" ?SS?5. y ',^, bAl[)PAID;DATE, WATER HEATER/VENT 101-0000-42401, 0. $24.18 ,$24.18 4/27/16 " yxtx -°. x.'X. , 4„?xMiz x , lm .' Pa ll ��, 7 Fkri= . ,."v,x' �� ffiffRECEC T #r^ -"✓ +"K.2,t_" CHE # .. k �'° CL�Tpn SUN VISTAsDEVELOPMENT CORPORAT, CHECK_ R15091 70001 RSE UESCR PTtON� �L � pCC NT t .. zn . �:.��' .d;`�z�<:��;�`�a� x 'QTY ��h�x AIVIUUNT� x., s�ay.Y �s3'.� a: P D z �P IDDr...,�.r._ WATER HEATER/VENT PC 101-0000-42600. 0 $14.50 $14.50 4/27/16 PAID BY wEtr METHOD ECEIPT#�C ECK #� CLTD BY¢ SUN VISTA DEVELOPMENTCORP.ORAT, CHECK R15091 70001 RSE r .$N aA0000NT �. �Q 7 .. AM�NT IFIX �ADATE WATER SYSTEM INST/ALT/REP 101-0000-42401 0 $12.09 $12:09 . 4/27/16 d�' = s s .. x PAID BY :.'�i y, • '�`,c '�„y r, -,&. z mss; +i +y METHOD h n CHECK,' s x S 3� �X2.ix`53+�"r'� s�„�iu5;.�cu'�.Mla'"' a Rz# R15091 ? CHECK # a 70001 � �CL'TD BY s�Q RSE SUNVISTA'DEVELOPMENT'CORPORAT _ , n, .q,.�,�x -�✓.,�h ��.""V 'h;'i,�, 's`..'4��ix x"., ” hDESCR PsT10N < yy�„.ri�c;.'a�t�'E:...�Y',`x�'+�r` ACCOUNT4gTY d.5. � iycK'�..i�%ac. ',a AMUUN.c�T��v�s� ;�e.y.2 Y:.iJt.:"ri� ',�� 9$ �; �P.AID K PAID"DAT£ WATERSYSTEM INST/ALT/REP PC 101-0000-42600 0$12.09 $12.09 4/27/16 <RECEIPT#� ,�r t"� w ;..`7 CHS CCKK# x _ ak;u: CLxTD"BY �`5waz SUN VISTA DEVELOPMENT CORPORAT CHECK ` ` . 1 R15091 70001 -RSE °Total Paid for PLLIMBING FEES: $647.99 $647.99 .x �k x DESCRI ., �� PTI�ON.°nw�ACCOT AMIWI ., , 4TAY �" M AMOUNTis J, "PAID �� .�A�DAT�E3 SMI -RESIDENTIAL ':;101-0000-20308 ;' .0 $38.41 $38.41 4/27/16 r9'an i �`.�<. <PAIUsBY `METHOD L�x"�.:di`�'a'G� x RECEIPT #� i�..`fKA`�.s CHECK # CfTDBY " SUN VISTA DEVELOPMENT CORP.ORAT ,''. "` CHECK R15091 70001 RSE Total Paid for STRONG MOTION INSTRUMENTATION SMI:$38.41 $38.41 4:�r;*ACCOl1NT «�', .°DESCRIP��€ ksw" T11 q. AM ' NT.� OU� .PAID v.s K 3 1 ATE^ SINGLE'FAMILY DETACHED 224=0000-20320 0 $1;837.44 $1,837:44 4/27/16 k: PAIS BY !p0-,,- x;.gy w METH D�� REC P £#�'x*'..... C ECK #` v+�•.`�'a`C+`d5"x��.A..r<�:, yea Y y� SUN VISTA DEVELOPMENTCORPORAT CHECK' R15091 70001 RSE Total Paid for TUMF -RESIDENTIAL: $1,837.44 $1,837.44 •A $14,134.31 Description: TRADITION / CASSATO / 3,344 SFD Type: BUILDING, RESIDENTIAL Subtype: DWELLING - SINGLE Status: ISSUED Applied: 10/22/2015 SKH FAMILY DETACHED Approved: 1/14/2016 JJO Parcel No: 770220007. Site Address: 78571 DEACON DR E LA QUINTA,CA 92253 Subdivision: TR 28470-1 Block: Lot: 7 Issued: 4/27/2016 RSE Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $295,476.50 Occupancy Type: Construction Type: Expired: 10/24/2016 RSE No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: NEW SFD THIS PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK WALLS, DRIVEWAY APPROACH, FIRE PITS, BBQS, OR FIRE PITS. HOME IS FIRE SPRINKLED PER 2013 CRC CODES. APPLICATION EXTENSION GRANTED TO October 16, 2016 PURCHASE PERMIT. jApplied to Approved Approved to Issued Printed: Thursday, April 28, 2016 12:20:03 PM 1 of 9 sysrrnis CHRONOLOGY CHRONOLOGY TYPE STAFF NAME ACTION DATE COMPLETION DATE NOTES RECEIVED AND APPROVED APPLICATION EXTENSION E-MAIL BURT HANADA 2/23/2016 2/24/2016 REQUEST FROM BILL LEDDY. SENT AN EMAIL CONFIRMATION TO BILL. PLAN CHECK COMMENTS FROM CONSULTANT JIM JOHNSON 11/12/2015 11/12/2015 RECEIVED PLAN CHECK COMMENTS FROM CONSULTANT KAY HENSEL 1/13/2016 1/13/2016 STRUC APPROVABLE 1/12/2016 RECEIVED PLAN CHECK PICKED UP MARY FASANO 11/12/2015 11/12/2015 RESUBMITTAL AT FRONT COUNTER BY STEPHANIE & RAMSES. PLAN CHECK SENT TO KAY HENSEL 1/4/2016 1/4/2016 PROCESSED WITH RAMSES - STRUC TO YOUNG DUE BACK OUTSIDE PC 1/18/2016 Printed: Thursday, April 28, 2016 12:20:03 PM 1 of 9 sysrrnis PLAN CHECK SENT TO STEPHANIE KHATAMI 10/22/2015 AMOUNT 10/22/2015 PAID DATE RECEIPT # OUTSIDE PC METHOD PAID BY CITD BY - PLAN CHECK SUBMITTAL STEPHANIE KHATAMI 10/22/2015 10/22/2015 SUN VISTA RECEIVED ART IN PUBLIC PLACES - 270-0000-43201 0 $238.69 $238.69 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE RESIDENTIAL CALL BILL LEDDY TO INFORM HIM PLANS ARE READY FOR TELEPHONE CALL JIM JOHNSON 11/12/2015 11/12/2015 CORRECTIONS CORPORAT Total Paid for ART IN PUBLIC PLACES - AIPP: $238.69 $238.69 CALLED BILL LEDDY TO INFORM HIM THE PLANS ARE READY TELEPHONE CALL JIM JOHNSON 1/14/2016 1/14/2016 TO ISSUE CONDITIONS CONDITION DATE DATE DATE CONTACT STATUS REMARKS NOTES TYPE ADDED REQUIRED SATISFIED READY TO ISSUE JIM JOHNSON 1/14/2016 4/26/2016 COMPLETE CHECKLIST CONTACTS NAME TYPE NAME ADDRESSI CITY STATE 21P PHONE FAX EMAIL APPLICANT SUN VISTA DEVELOPMENT P O BOX 1144 LA QUINTA CA 92253 (760)771-4722 CORPORATION CONTRACTOR SUN VISTA DEVELOPMENT P O BOX 1144 LA QUINTA CA 92253 (760)771-4722 CORPORATION OWNER SKIP & NANCY CASSATO PO BOX 1144 LA QUINTA CA 92253 (760)771-4722 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CITD BY SUN VISTA ART IN PUBLIC PLACES - 270-0000-43201 0 $238.69 $238.69 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE RESIDENTIAL CORPORAT Total Paid for ART IN PUBLIC PLACES - AIPP: $238.69 $238.69 Printed: Thursday, April 28, 2016 12:20:03 PM 2 of 9 J sysrenns Printed: Thursday, April 28, 2016 12:20:03 PM 3 of 9 RWYSTfMS CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID ., PAID DATE RECEIPT # CHECK # METHOD PAID -BY BY . SUN VISTA BSAS SB1473 FEE 101-0000-20306 0. $12.00 $12.00 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE CORPORAT Total Paid for BUILDING STANDARDS ADMINISTRATION $12.00 $12.00 BSA: SUN VISTA DIF - CIVIC CENTER 252-0000-43200 0 $942.00 $942.00 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE CORPORAT SUN VISTA DIF - COMMUNITY 254-0000-43200 0 $129.00 $129.00 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE CENTERS CORPORAT SUN VISTA DIF - FIRE PROTECTION 257-0000-43200 0 $433.00 $433.00 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE CORPORAT SUN VISTA DIF - LIBRARIES 253-0000-43200 0 $344.00 $344.00 4/27/16 R15091. 70001 CHECK DEVELOPMENT RSE CORPORAT SUN VISTA DIF -PARK 256-0000-43200 0 $40.00 $40.00 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE MAINTENANCE CORPORAT SUN VISTA DIF L. PARKS/REC 251-0000-43200 0 $2,048.00 $2,048.00 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE CORPORAT SUN VISTA DIF - STREET 255-0000-43200 0 $116.00 $116.00 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE MAINTENANCE CORPORAT SUN VISTA DIF -TRANSPORTATION 250-0000-43200 0 $2,842.00 $2,842.00 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE CORPORAT Total Paid for DIF -SINGLE FAMILY DWELLING: $6,894.00 $6,894.00 Printed: Thursday, April 28, 2016 12:20:03 PM 3 of 9 RWYSTfMS Printed: Thursday, April 28, 2016 12:20:03 PM 4 of 9 R sysvcMs ' CLTD DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE RECEIPT ,# CHECK # METHOD PAID BY BY SUN VISTA TEMP POWER SERVICE 101-0000-42403 0 $24.17 $24.17 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE CORPORAT SUN VISTA TEMP POWER SERVICE 101-0000-42600 0 $16.92 $16.92 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE PC CORPORAT Total Paid for ELECTRICAL: $41.09 $41.09 SUN VISTA RESIDENTIAL, EA 101-0000-42403 • 0 $49.32 $49.32 4/27/16 RlS091 70001 CHECK DEVELOPMENT RSE ADDITION 1,000SF CORPORAT SUN VISTA RESIDENTIAL, EA 101-0000-42600 0 $20.32 $20.32 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE ADDITION 1,000SF, PC CORPORAT SUN VISTA RESIDENTIAL, FIRST 101-0000-42403 0 $145.03 $145.03 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE 1,0005E CORPORAT SUN VISTA RESIDENTIAL, FIRST 101-0000-42600 0 $47.86 $47.86 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE 1,OOOSF, PC CORPORAT Total Paid for ELECTRICAL - NEW CONSTRUCTION: $262.53 $262.53 RESIDENTIAL PRECISE SUN VISTA GRADING - CUSTOM 101-0000-42408 0 $36.26 $36.26 4/27/16 RlS091 70001 CHECK DEVELOPMENT RSE HOME LOT >7KSF CORPORAT RESIDENTIAL PRECISE SUN VISTA GRADING - CUSTOM 101-0000-42600 0 $181.29 $181.29 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE HOME LOT >7KSF PC I I I I I I I I CORPORAT Total Paid for GRADING: $217.55 $217.55 SUN VISTA CONDENSER/COMPRES 101-0000-42402 0 $145.04 $145.04 4/27/16 RlS091 70001 CHECK DEVELOPMENT RSE SOR CORPORAT Printed: Thursday, April 28, 2016 12:20:03 PM 4 of 9 R sysvcMs Printed: Thursday, April 28, 2016 12:20:03 PM 5 of 9 c SYSTEMS CLTD DESCRIPTION ACCOUNT CITY AMOUNT PAID ., PAID DATE RECEIPT # CHECK # METHOD PAID BY BY SUN VISTA CONDENSER/COMPRES 101-0000-42600 0 $96.68 $96.68 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE SOR PC CORPORAT SUN VISTA EXHAUST HOOD 101-0000-42402 0 $12.09 $12.09 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE CORPORAT SUN VISTA EXHAUST HOOD PC 101-0000-42600 0 $4.83 $4.83 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE CORPORAT SUN VISTA FURNACE 101-0000-42402 0 $145.04 $145.04 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE CORPORAT SUN VISTA FURNACE PC 101-0000-42600 0 $96.68 $96.68 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE CORPORAT SUN VISTA VENT FAN 101-0000-42402 0 $108.81 $108.81 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE CORPORAT SUN VISTA VENT FAN PC 101-0000-42600 0 $43.47 $43.47 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE CORPORAT Total Paid for MECHANICAL: $652.64 $652.64 MULTI -SPECIES SUN VISTA RESIDENTIAL 0-8 UNITS 101-0000-20310 0 $1,301.00 $1,301.00 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE -2015 UPDATE CORPORAT Total Paid for MULTI -SPECIES RESIDENTIAL: $1,301.00 $1,301.00 SUN VISTA NEW CONSTRUCTION 101-0000-42400 0 $200.00 $200.00 10/22/15 R10233 15255 CHECK DEVELOPMENT SKH PERMIT CORPORAT Printed: Thursday, April 28, 2016 12:20:03 PM 5 of 9 c SYSTEMS Printed: Thursday, April 28, 2016 12:20:03 PM 6 of 9 CR SYS7Elv1S CLTD DESCRIPTION ACCOUNT QTY < AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY SUN VISTA NEW CONSTRUCTION 101-0000-42400 0 $435.33 $435.33 4/27/16 RlS091 70001 CHECK DEVELOPMENT RSE PERMIT CORPORAT . Total Paid for NEW CONSTRUCTION PERMIT: $635.33 $635.33 SUN VISTA NEW CONSTRUCTION 101-0000-42600 0 $1,300.00 $1,300.00 10/22/15 R10233 15255 CHECK DEVELOPMENT SKH PLAN CHECK CORPORAT SUN VISTA NEW CONSTRUCTION 101-0000-42600 0 $55.64 $55.64 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE PLAN CHECK CORPORAT Total Paid for NEW CONSTRUCTION PLAN CHECK: .$1,35S.64 $1,355.64 SUN VISTA BACKFLOW DEVICE 101-0000-42401 0 $12.09 $12.09 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE CORPORAT SUN VISTA BACKFLOW DEVICE PC 101-0000-42600 0 $4.83 $4.83 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE CORPORAT SUN VISTA BUILDING SEWER 101-0000-42401 0 $12.09 $12.09 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE CORPORAT SUN VISTA BUILDING SEWER PC 101-0000-42600 0 $12.09 $12.09 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE CORPORAT SUN VISTA FIXTURE/TRAP 101-0000-42401 0 $241.80 $241.80 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE CORPORAT SUN VISTA FIXTURE/TRAP PC 101-0000-42600 0 $241.80 $241.80. 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE CORPORAT Printed: Thursday, April 28, 2016 12:20:03 PM 6 of 9 CR SYS7Elv1S Printed: Thursday, April 28, 2016 12:20:03 PM 7 of 9 c SYSTEMS CLTD DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY SUN VISTA GAS SYSTEM, 5+ 101-0000-42401 0 $36.26 $36.26 4/27/16 R15091 70001 CHECK DEVELOPMENT' RSE OUTLETS CORPORAT SUN VISTA GAS SYSTEM, 5+ 101-0000-42600 0 $24.17 $24.17 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE OUTLETS PC _ CORPORAT SUN VISTA WATER HEATER/VENT 101-0000-42401 0 $24.18 $24.18 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE CORPORAT SUN VISTA WATER HEATER/VENT 101-0000-42600 0 $14.50 $14.50 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE PC CORPORAT SUN VISTA WATER SYSTEM 101-0000-42401 0 $12.09 $12.09 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE INST/ALT/REP CORPORAT SUN VISTA WATER SYSTEM 101-0000-42600 0 $12.09 $12.09 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE INST/ALT/REP PC CORPORAT Total Paid for PLUMBING FEES: $647.99 $647.99 SUN VISTA SMI - RESIDENTIAL 101-0000-20308 0 $38.41 $38.41 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE CORPORAT Total Paid for STRONG MOTION INSTRUMENTATION SMI: $38.41 $38.41 SUN VISTA SINGLE FAMILY 224-0000-20320 0 $1,837.44 $1,837.44 4/27/16 R15091 70001 CHECK DEVELOPMENT RSE DETACHED CORPORAT Total Paid for TUMF - RESIDENTIAL: $1,837.44 $1,837.44 TOTALS: $14J34.3i $14,134.31 Printed: Thursday, April 28, 2016 12:20:03 PM 7 of 9 c SYSTEMS Printed: Thursday, April 28, 2016 12:20:03 PM 8 of 9 SYSTEMS BOND INFORMATION ATTACHMENTS Attachment Type CREATED OWNER, DESCRIPTION PATHNAME SUBDIR ETRAKIT ENABLED NOTES REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED REVIEWS STATUS REMARKS BURT HANADA Vista.pdf Vista.pdf DATE DOC 11/12/2015 JIM JOHNSON 78-571 DEACON DR. BUILDING 10/22/2015 11/13/2015 11/12/2015 REVISIONS REQUIRED EAST.docx IST BLDG NS (3 WK) DOC 11/12/2015 JIM JOHNSON SCHOOL FEES BRES2015- SCHOOL FEES BRES2015- BUCKET 0410.pdf 0410.pdf 1ST BLDG STR (3 YOUNG 10/22/2015 11/13/2015 11/10/2015 REVISIONS REQUIRED WK) ENGINEERING* JOHN THOMPSON STRUCTURAL STRUCTURAL 0 2ND BLDG NS (2 JIM JOHNSON 1/4/2016 1/18/2016 1/14/2016 APPROVED WK) IST REVIEW - NEW CITY DOC 11/10/2015 KATHRYN SAMUELS 2ND BLDG STR (2 JOHN 1/4/2016 1/18/2016 1/12/2016 READY FOR APPROVAL STRUC TO YOUNG - DUE BACK 1/18/2016 WK) THOMPSON 1ST REVIEW - 1ST PW GREEN AMY YU 1/27/2016 2/3/2016 2/2/2016 READY FOR APPROVAL BRES 2015-0410 KS SHEET (1st).doc Printed: Thursday, April 28, 2016 12:20:03 PM 8 of 9 SYSTEMS BOND INFORMATION ATTACHMENTS Attachment Type CREATED OWNER, DESCRIPTION PATHNAME SUBDIR ETRAKIT ENABLED Permit Extensions - Sun Permit Extensions - Sun DOC 2/24/2016 BURT HANADA Vista.pdf Vista.pdf 0 DOC 11/12/2015 JIM JOHNSON 78-571 DEACON DR. 78-571 DEACON DR. 0 EAST.docx EAST.docx DOC 11/12/2015 JIM JOHNSON SCHOOL FEES BRES2015- SCHOOL FEES BRES2015- 0 0410.pdf 0410.pdf 2ND REVIEW - 2ND REVIEW - DOC 1/12/2016 JOHN THOMPSON STRUCTURAL STRUCTURAL 0 TRANSMITTAL.pdf TRANSMITTAL.pdf IST REVIEW - NEW CITY DOC 11/10/2015 KATHRYN SAMUELS STRUCTURAL TRANSMITTAL BRES 0 TRANSMITTAL 2015-0410 (ist).pdf 1ST REVIEW - DOC 11/10/2015 KATHRYN SAMUELS STRUCTURAL BRES 2015-0410 KS 0 (1st).doc COMMENTS Printed: Thursday, April 28, 2016 12:20:03 PM 8 of 9 SYSTEMS Printed: Thursday, April 28, 2016 12:20:03 PM 9 of 9 C SYS 7Eti1S ATTACHMENTS Attachment Type— +CREATED OWNER DESCRIPTION PATHNAME SUBDIR ETRAKIT ENABLED 1ST REVIEW - Soils_ Report_ Scope_ BR DOC 11/10/2015 KATHRYN SAMUELS STRUCTURAL SOILS ES 2015-0410.pdf 0 REQUIREMENTS DEBRIS MANAGEMENT DEBRIS MANAGEMENT 0 DOC 1/27/2016 STEPHANIE KHATAMI PLAN.pdf PLAN.pdf PM10 APPROVAL 0 DOC 2/9/2016 STEPHANIE KHATAMI PM10 APPROVAL 2-2-16 BRE52015-0410.pdf pdf GEO TECH UPDATE 0 DOC 2/9/2016 STEPHANIE KHATAMI GEO TECH UPDATE BRES2015-0410.pdf Printed: Thursday, April 28, 2016 12:20:03 PM 9 of 9 C SYS 7Eti1S 1 Cl/ T UT P.O. BOX 1504 Buildingq�r� ��. 78-495 CALLE TAMPICO Al Address �' LA QUINTA, CALIFORNIA 92253 ,Ay// r Mailing Address -;�7C2 �o ddress - '/7 1. -- 6o -2z5 --X73 & Classif. -71-1 �I o l / Lic. # Desigy.., /CJs ner �- :PnI 9 6. (/1_h11�,d l "p Mate q2 d 5/ Lic. # ENSED CON -DECLARATION Ihereby affir th am licens er pr isions of Chapter 9 (commencing with Section 7000) of Divisiofes o o f e B .and Prns C e, d my license is in II force d effect. �� SIGN URE DATE OWNER -BUILDER ftCLARATION I hereby affirm that I am exempt from 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 Contrac- tor'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 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 (5500). ❑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 and Profes- sions 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 of proving that he did not build or improve for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct 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.) 0 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKER'S COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to sett -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE I'this section need not be completed if the permit is for one hundred dollars (5100) 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 Workers' Compensation laws of California. Date Owner 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 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 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 1 have read this application and state that the above information is correct. "j 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 WHITE = BUILDING DEPARTMENT APPLICATION ONLY BUILDIN : TYPE CONST. OCC. GRP. A.P. Number � � 2- Legal Description G Project Description /n 1- K Sq. Ft.�� Size No._ No. Dw. Stories Units New Add Alter Repair❑ Demolition Estimated Valuation R v ; PERMIT AMOUNT Plan Chk. Dep. -UD, Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL S'D CONTACT INFORMATION NAME: PHONE: 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: YELLOW = APPLICANT PINK = FINANCE Date: 4/27/2016 No.: 16-00195-1 Owner: Cassato Address: City: Type: Single Family Residential Lot # Street No. 78571 Comments: CERTIFICATE OF COMPLIANCE 0%oleo so Desert Sands Unified School District ZOy 1t 47950 Dune Palms Road y ERANCItO MtI�R�A�GE o La Qunita, CA 92253 I;PDMDWELLS, 'WMLA '. 0 (760)771-8515o� Email: Jurisdiction: La Quinta Tract #: Street Name Sq. Feet APN Permit No. Deacon Dr East 3344 770-220-007 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 (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 exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fess imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $3.36 X 3344 S.F. or $11,235.84 . have been paid for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in the proposed project may now be issued. Fees Paid By: cc/Bill Leddy Bank Name/Recipient of Certificate Check No.: 1327045 Telephone: Funding: Residential By Dr. Gary Rutherford Superintendent ' Fee Collected/ Exempted by: ^,�haro Mc ilvrey , Amount Due: $: 1235.84' Original Payments) Rec'd: - $0.00 New Payment R c'd: $-11,235.84 Lver/ tinder: $0:00 NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve ton ti 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 ilding 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 District('s) behalf, whichever is earlier. Notice to Building Department: THIS DOCUMENT VALID ONLY IF IMPRINTED WITH EMBOSSED SEAL. r Lawyers Title RECORDING REQUESTED BY Lawyers Title - IE AND WHEN RECORDED MAIL TO:t'+U# Nancy J. Cassato DOC # 2015-0211878 05/21/2015 08:00 AM Fees: $41.00 Page 1 of 3 Recorded in Official Records County of Riverside Peter Aldana Assessor -County Clerk -Recorder "This document was electronically submitted to the County of Riverside for recording" Receipted by: LIJONES APN': 770-220-007-5 - -'" Escrow No: PDL13384-LT139-CM Title No: 615693660 V 141993'ca p Space above this line for Recorder's use -f (LA Q LO -M INTERSPOUSAL INDIVIDUAL GRANT DEED Individual Grant Deed (Excluded from Reappraisal Under Proposition 13) THE UNDERSIGNED GRANTOR(s) DECLARE(s) Documentary Transfer Tax is $ Q= (THERE IS NO CONSIDERATION FOR THIS TRANSFER.) This Is an INTERSPOUSAL TRANSFER and not a change in ownership under Sec. 63 of the Revenue and Taxation Code and Grantor(s) has (have) checked the applicable exclusion from appraisal: o A creation, transfer, or iermination, solely between spouses, of any co-owners interest. GRANTOR(S):: ' .. ` . - ,:; .: - :: " rhis conve ance establishes sole Victor C. Cassato, husband of Grantee herein and separate property of a spouse hereby GRANT(S) to R $ T 11911." ' Nancy J. Cassato, a married woman as her sole and separate property the following described real property in the City of La Quinta County of Riverside, State of CALIFORNIA: For legal description of the real property herein, see Exhibit A attached hereto and made a part hereof. Dated: Mav 7 2015 Victor C. Cassato A notary public or other officer completing this certificate verifies only the Identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. STATE OF ) COUNTY OF CQt )SS. On _ (1 \ 56 ` t 9- before me. Notary Public, personally appeared U \ (—' k -0C U CC,CSS Q)rtj , who 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. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature (, �R Mail tax statements to Return address as shown above an Hirt • IMAf>t11 yl► onffilww now A* K NN