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12-0194 (DSF)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Tiht 4 4.0" Applicant: Architect or Engineer: 1pit BUILDING & SAFETY DEPARTMENT BUILDING PERMIT -------------------------------------------------- LICENSED CONTRACTOR'S 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 Class: B ense No.: 762889 ntractor: / OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she 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).: (_) 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 Professions Code: The Contractors' State License Law does not 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 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 or she did not build or improve for the purpose of sale.). 1 _ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.l. 1 ) I am exempt under Sec. , B.&P.C. for this reason 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 ISec. 3097, Civ. C.). Lender's Name: Pip Lender's Address: LQPERMIT Owner: LYLE & SHARON WAGGONER PO BOX 3000 #475 JACKSON, WY 83002 Contractor: FEDDERLY & ASSOCIATES 38747 NOPALES ROAD PALM DESERT, CA 92211 (760)773-5205 Lic. No.: 762889 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3/05/12 D) �! i,,!AR 0 -_ 2012 ----------------------------------------------- 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 Y 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 and policy number are: Carrier EVEREST INS Policy Number 760000440081 I certify that, in the performance of the work for which this permit is issued, 1 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 C II hall ply provisions. at, 514 1 plicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1$100,0001• IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this 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, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 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 county ordinances and state laws relating to building construction, and hereby authorize representatives of this cco2ounty t enter upon the above-mentioned prope y for in sp do urposes. te: 7 ignature (Applicant Application Number: 12 - 0000 0194_:= Property Address: 55490 ROYAL ST GEORGE APN: 767-522-002- - Application description: DEMO - COMML/OTHER Property Zoning:' LOW DENSITY RESIDENTIAL Application valuation: 0 . Tiht 4 4.0" Applicant: Architect or Engineer: 1pit BUILDING & SAFETY DEPARTMENT BUILDING PERMIT -------------------------------------------------- LICENSED CONTRACTOR'S 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 Class: B ense No.: 762889 ntractor: / OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she 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).: (_) 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 Professions Code: The Contractors' State License Law does not 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 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 or she did not build or improve for the purpose of sale.). 1 _ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.l. 1 ) I am exempt under Sec. , B.&P.C. for this reason 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 ISec. 3097, Civ. C.). Lender's Name: Pip Lender's Address: LQPERMIT Owner: LYLE & SHARON WAGGONER PO BOX 3000 #475 JACKSON, WY 83002 Contractor: FEDDERLY & ASSOCIATES 38747 NOPALES ROAD PALM DESERT, CA 92211 (760)773-5205 Lic. No.: 762889 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3/05/12 D) �! i,,!AR 0 -_ 2012 ----------------------------------------------- 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 Y 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 and policy number are: Carrier EVEREST INS Policy Number 760000440081 I certify that, in the performance of the work for which this permit is issued, 1 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 C II hall ply provisions. at, 514 1 plicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1$100,0001• IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this 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, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 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 county ordinances and state laws relating to building construction, and hereby authorize representatives of this cco2ounty t enter upon the above-mentioned prope y for in sp do urposes. te: 7 ignature (Applicant Application Number . . . . . 12-00000194 Permit . . DEMO PERMIT Additional desc . Permit Fee 45.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 9/01/12 Qty Unit Charge Per Extension BASE FEE 45.00 --------------------------------------------------------------•-------------- Special Notes and Comments DEMO KITCHEN & PORTION OF FAMILY ROOM DUE TO FIRE DAMAGE. INCLUDES CASE WORK, FLOORING, DRYWALL & ANY DECORATIVE FINISHES AFFECTED BY FIRE. 2010 CODES. Fee summary Charged Paid Credited ------------------------------------- Due ---------- Permit Fee Total 45.00 .00 ---------- .00 45.00 Plan Check Total .00 .00 .00 .00 Grand Total 45.00 .00 .00 45.00 LQPERMIT Bin # City of La Quinta Building 8F Safety Division Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # QP.O. Project Address: 55490 Royal St . George Owner's Name: Lyle & Sharon Waggoner A. P. Number: 7.67-522-002-9 Address: PO BOX 3000 #475 Legal Description: Lot 16 MB 2 8 5/ 0 6 5 TR2 9 3 4 8 -1 City, ST, Zip: JACKSON WY 83002 Contractor: Lance FedderlTelephone: Y Address: 38-747 Nopa l e s Road Project Description: VLA o City, ST, Zip: La Quinta CA 92211 10 T - ele Telephone: 7 - p 3 5205 . State Lic. #: 762889 City Lic. #: 9 9 9 71 Arch., Engr., Designer: Lance Fedderly Address: 38-747 Nopales Road` ronoN O r— YLWA City,ST,Zip: La Quinta CA 92211 7 - - Tele h ne. 6 0 7 7 3 5 2 0 5 P0 .. . Construction Type: Occupancy: SFR ic. # % 6 2 889 St e L' P roJ'e ct type (circle one):: New Add' n Alter Repair emo Name of Contact Person: Robin Lever Sq. Ft.: # Stories: 1 # Units: 1 Telephone # of Contact Person: 7 6 0 - 7 7 3 - 5 2 0 5 ext . 10 7 Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted 3�i Item Amount Structural Cafes. Reviewed, ready for corrections Plan Check Deposit Truss Cafes. Called Contact Person Plan Check Balance Title 24 Cafes. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2nd Review, ready for correctio /iss re ,Sj1Z.Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '"' Review, ready 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 2-28-12 To Whom It May Concern: Please accept this letter as authorization for Fedderly and Company to demo our property at 55490 Royal St. George in preparation to rebuild the fire damaged home. Thank you, Lyle Waggoner Sharon Waggoner AREA-,' EN.) �Z�Zrt� e1 e1Z�Z�Z%i� 78080 Calle Amigo, Suite 102 Telephone (760) 771-9993 La Quinta, CA 92253 Fax (760) 771-9998 Cell (760)808-9146 FIELD OBSERVATION REPORT February 22, 2012 Fedderly and Associates 38-747 Nopales Rd. Palm Desert, CA. 92211 Re.: Waggoner Residence at 55409 Royal St. George, La Quinta, Ca. 92253 To Whom It May Concern: On January 10, 2012 We performed a preliminary inspection of the above referenced property. It is our opinion that all damaged by fire and fire department and non- salvageable structural elements such as stud, posts, beams, trusses and roof sheathing should be replace at the family room and rear of the foyer and living room. This does not account for the code upgrade requirements that the City of La Quinta may require. Please contact me if you have any questions. Sincerely Reza Asgharpour, P.E. F..icld Obsertation .l.,caer for Waggoner R sidcncet.hire Damage for Itzsa3,ircc}. a� M-rAMWA PGA WEST FAIRWAYS ASSOCIATION March 1, 2012 Lyle and Sharon Waggoner PO BOX 3000 4475 Jackson, WY 83002 Re: Architectural Application — 55-490 Royal St. George Dear Lyle and Sharon Waggoner: The Architectural Committee has reviewed your request for exterior repairs to your residence. I am pleased to inform you that the Architectural Committee has approved your application subject to the receipt of both adjacent neighbor forms as well as the receipt of the necessary deposits. Enclosed is Exhibit C — the Compliance Review Request form. Please complete this form after the work is completed and return it by mail or fax to the address below so the completed project can be inspected. If you have any questions, please contact Cassie Gertz, Operations Manager at 760-776-5100 Ext. 345 or email: Cassie.Gertz(@ManaEementtrust.com. Sincerely, For the Architectural Committee P1 --A WEST Fairways Association JeMc nald, CCAM, PCAM A o iati Manager Enclosure: Exhibit C — Compliance Review Request cc: Lot File Architectural Committee Post Office Box 1690 • La Quinta, California 92247 - Phone (760) 776-5100 • Fax (760) 776-5111 VIS 1 L�+(VLV I.LV V 1 . Orange Coast Title AND WHEN RECORDED MAIL TO: Ly1,.e:W. Waggoner Sharon A. Waggoner P.O.'Bo.x 30000 #475 Jackson WY 83.002 Order No.: 1228447-10 Escrow No.: 11054 A.P.N.:767-522-002-9 TMIS IS To CFR7'IF1• TI-IA•r T1•I1S IS A'rRI;E ANIS CORRECT' Cory OF -rtil. ORIGINAL I I[REOF 13y - _0C S'--E.gSoyt EtiCROµ; INC'. SPACE ABOVE THIS LINE IS FOR RECORDER'S USE GRANT DEED THE UNDERSIGNED GRANTOR(S) DECLARE(S) DOCUMENTARY TRANSFER TAX IS $ 1,677.50 [ X ] computed on full value of property conveyed, or [ ] computed on full'yalue less value of liens or encumbrances remaining at time of sale. [ ] unincorporated area [ X ] City of La Quinta FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, George Steven Kooshian, an unmarried man hereby GRANT(S) to Lyle W. Waggoner and Sharon A. Waggoner, Trustees of the Lyle W. Waggoner and Sharon A. Waggoner InterVivos Revocable Trust Agreement dated August 11, 1981 and any amendments -thereto the following described real property in the County of Riverside, State of California See EXHIBIT "A" attached hereto and made a part hereof Dated: March 14, 2011 4 STATE OF CAL ORNIA COUNTY OF ;_,(.A)­0L.�'C�� } SS. Onit before e, e L pej.�onally appeared George Steven Kooshian, By: Ronald Viramontes, Attorney In Fact 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 by his/ her/ their. LINDA MARTINEZ signature (s) on the instrument the person (s), or the Commission # 1768268 entity upon behalf of which the person (s) acted, Nola ry Public - California executed the instrument. Riverside county My Comm. Explies sep 16, 2011 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., Diaz (This area for official notary seal) MAIL TAX STATEMENTS AS DIRECTED ABOVE