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0105-148 (SFD)LICENSED CONTRACTOR DECLARATION ' I h6reby affirm under penalty of perjury that I am licensed under provisions of l,hapter 9 (commencing with Section 7000) of Division 3 of the Business and N W Professionals Code, and my License is in full force and effect. O =) M' License # Lic.-Class Exp. Date r- d .OZr to �'� . J V to UJa z Date e - f Signature of Contractor . i 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 (5 Z• � I hereby affirm under penalty of perjury one of the following declarations: Lo < O ( ) I have and will maintain a certificate of consent to self -insure for workers' X W L- compensation, as provided for by Section 3700 of the Labor Code, for the Oro J Q performance of the work for which this permit is issued. Q C) 1 have and will maintain workers' compensation insurance, as required by p Q Section 3700 of the Labor Code, for the performance of the work for which this � Z permit is issued. My workers' compensation insurance carrier & policy no. are: Cartier Policy No. cb O STATE COMP ITNO PFJ' l5424S V-00 Q (This section need not be completed if the permit valuation is for $100.00 or less). J () 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 3 subject�to the workers' compensatiOn/p�/royisions of Section 3700 of the Labor Code, I sh ll fo`tthvJith comply with 6se�rgvisions . Date: _. 1 I' ' Applicant t C _� v . 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 CS7 of the Labor Code, interest and attorney's fees. Or 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 per whose request and for whose benefit work is performed under or pursu any permit issued as a result of this applicaton agrees to, & shall, indI & hold harmless the City of La Quinta, its officers, agents and empl 2. Any permit issued as a result of this application becomes null and work is not commenced within 180 days from date of issuance ofperrhit, or cessation of work for 180 days will subject permit to cancel1 certify that I have read this application and state that the above informacorrect. I agree to comply with all City, and State laws relating to the bconstruction, and hereby authoyize representatives of this City to enter the above-mentioned property`for"58pection�purposes. /S19 nature (Owner/Agent) f Date � � !1 ' PERMIT # ; BUILDING PERMIT ; DATE VALUATION LOT TRACT p ry 181 TI JOB SITE APN ADDRESS ; 6 -''mak 9,40TIAX0 OWNER CONTRACTOR / DESIGNER / ENGINEER RMst7"!, 71TWEE't-Sf7Ti` 11w M: J:.tE, i,%.LO."Mihai." l+t;oiz*n;.r%.rElm�!"•.,3t-)u Tt£V S°3 1: 11)1,tlTJ_9'FWf1 f'N_T 17.5564- COUMMY O[.i3T3 DTD 4113 77.564-ACOUiIRY CLUB DR 01.13 P.t'tsT:Ald DE STM CA 92211 :FALL E: ESU Y S:>A 92211 ' (760)408-3493 C Lft 6133 ' USE OF PERMIT SYD • ?'F',Jt;MIT DO&9 NOT 1,14C'tjiJDF 81.fDC K WALiAPUOt, OP., DRIV'IEWAY APPROACH, TRACT CONS'k RUCT1014 1,501.00 8F PORC•IS,"PAQ'JO 3&00 SP 5 FT. WOOD PTINCE 7100100 LF GARAGE S!r .tv STE" EJ l/09 l.Jr' (,'0 81L7P.U6. WW. .✓'w;iQl�►T4Ye.R'F' . CONSTRUCTION FEE 101.000.418.000 $612;so PLFnW CHWK F&?, 101-000-439-318 ?�1LCILF�1�fiJG'A1FEE 101-0004,11.000 $60.00 I,LECT..WC YFt 101-000-420-006 $131.30 PLUMSTOO FEE 101.000.4.19.000 $110175 STRONO MO` 1014 FEE u R 11) 101.000-241-000 0.31 GI&DJWG M 101-000-423.000 120.00 DEVFL0PM IMPACT FEE $1,997,N PRWMSE PL&I-4 101.000.441-345 $1G0.00 , rpt::lrti POIS1T' 101-000-439-318 9�sp.ia0 Jk3-:f° A .0=1,71) (21109 AM PL49 C:tUKC1C S3,464,31 2001 1XPRE PAID ItEFS -1,5250,00 `( 1 1 LA OUINj A ',; •,,. C1� pF EPS C N ANC( RECEIPT I DATE DATE FINALED I INSPECTOR INSPECTION RECORD I OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings _ _ (% �� _ -�� Underground Ducts Ducts Slab Grade Return Air Steel Combustion Air Roof Deck 3 Q Exhaust Fans O.K. to Wrap �30 . O 1 _ F.A.U. Framing =� _ OIL ( Compressor Insulation 0 —7, p t 54 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 Pibg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines. / � 1 �� �y— %J Heater Final Water Pipingr4 �[ / Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection 7 p/ 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 d S� Final ! 3�6 Utility Notice (Perm) . Q sr PP 7-A A Building -7D' 700 Address Nw, S GJ Mailing Address Pca. �oX City Contra 'U S aS City i' 4 P.O. BOX 1504 APPLICATION ONLY 78-495 CALLE TAMPICO 2p LA QUINTA, CALIFORNIA 92253 (02.3 Gig otA& Zip 'Tel. Zip State Lic.„A City & Classif. -7''e �r/ p V 1 Lic. # Designer Address City State Lic. # C22 BUILDING: TYPE'CONST. OCC. GRP. > 7 A.P. Number 641rA��1 ”?211 !-.. — ):: IN' I — ---Legal Description la 0 _1101 ( /e ub IA- 4VLJF . r -L 1► 1� Project Description )" S 1✓ a LICENSED CONTRACTOR'S DECLARATION I hereby affirm t , t I am Ilcensed under provisions of Chapter 9 (commencing vpith Se tion 7ef000)t f Divisio , f the BLsiness and Professions and my license is i frill f r and M C� 1ntLA.TURE 1 DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 703 1.5, 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 thathe 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: 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, 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 soldwithin 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.) 1'1 1, as owner 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.) 1'7 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION: I hereby affirm 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 r7 Copy is filed with the city. ❑ Certified copy is hereby,furnished. ., CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit 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. w Date_Owner NOTICE TO APPLICANT., 0, afteA making 'this Certificate of ExemptiorrWyou 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 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. I agree to comply with all city and county ordinances and state,laws relating to building construction, and hereby authorize representatives -of this city toenter the above- mentioned property for inspection purposes. Signature of aQplicant --Date— 'Mailing ate'Mailing Address City, State, Zip REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line 'p° 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 Sq. Ft. Size /5io f No. No. No. Dw. / Units NewA Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT `A AMOUNT Plan Chk. Dep. Plan Chk. Bal. d Const. Mech. Electrical Plumb! S.M.I. GradinLr Drivew Infrastlure I4 .g w TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line 'p° 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 CITY OF LA QUINTA BUILDING & SAFETY DEPARTMENT 7n -7o1 z INSPECTION REQUEST LINE 777-7153 Owner Contractor Permit Number POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGNA,LL APPLICABLE SPACES JOB ADDRESS i/v TYPE OF INSPECTION ATE INSP. FOUNDATION & SETBACK FOOTING STEEL If MAIN GROUND SYSTEM GROUND PLUMBING PRE-GUNITE DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED CONCRETE SLAB L JOISTS & GIRDERS ELECTRICAL GROUND WORK •.y DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC ROUGH PLUMBING ROUGH GAS & GAS TEST AV HEATING & VENT - A/C FIREPLACE ROOF 7 - BOND BEAM -W O.K. TO WRAP - 30 GROUT 0 4' D 8' FRAMING �. INSULATION PRE -ROOF COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED DRYWALL INTERIOR EXTERIOR LATH POOL PRE PLASTER POOL FENCE & GATE SEWER SEPTIC TANK FINALS ELECTRICAL PLUMBING FINAL GAS TEST HEATING - A/C HOUSE NUMBERS JOB COMPLETED E C. - TEMP POWER ABOVE APPROVALS DO NOT INCLUDE RIGHT TO TURN ON UTILITIES OR OCCUPY BUILDING Notice: Document Cannot Be Duplicated Date 5/11/01 No. 22003 Desert Sands Unified School District '47-950 Dune Palms Road I;a `Qwnta,'CX 92253'' ` 760-771--8515 CERTIFICATE OF COMPLIANCE APN # 646-312-031 Jurisdiction La Quints Owner NameNorthwest=Southwest_Development Permit #0105-148 No. 78-700 Street Saguaro u. City La -Quinta zip 92253 Tract # Lot # 81 Square Footage Type of Development Single- Family, Residence Comments :Log # Study'Area 1501' No. of Units 1 r 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 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: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code. 53080,- in the amount of 2.05 X 1,501 or $ 3;077.05 ,a the property listed above and that,building t, permits and/or Certificates of Occupancy for this square,footage in this proposed project may nov<be issued Fees Paid By CC/1st Bank - Richard ScottTelepdro»e Name ,on the check By Dr. Doris Wilson . Superintendent Fee,collected /exempted by Annette Barlow -Payment Received $3,077:05 Check No. 58713_ Signature NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549; 'STATS! --1 996) this will serve to notify you,that the 90 -day, approval period m Which youmay protest the fees or other payment identified above will begin to run from the date on which the building or installafion permit for this profectis sssued:&on which they are paid to th'e,District(s) onto another public entity authorized to collect them on the DistrictCs)(s') behalf, whichever;is earlier. qt Collector: Attach a 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 . j.. RECORDING REQUESTED BY: OPANGE COAST TITTLE COMPANY AND WHEN RECORDED, MAIL TO: Northwest/Southwest Development,lnc P.O. Box 2371 Gearhart, OR 97138 ASSESSOR'S PARCEL NO.: 646-312-020/03 "]ie+! 024 a-4 TITLE ORDER NO.: R-1754.01-2 ESCROW NO.: 4831 -DS GRANT DEED 090516 RECEIVED FOR RECORD AT 8:OOAM MAR - 5 1999 RIn OWN fUoords TraRss!er Tax Ae0D1b°r RIv. Co. Recorder. r —? s i THIS SPACE FOR RECORDER'S USE ONLY I Ate The .itndersigned:Grantor(s) declare that the DOCUMENT TRANSFER TAX:, $ 29:70' ounty $ City xx computed on. the full value of the interest of property conveyed, or computed on the full value less the value of liens or encumbrances remaining thereon at the time of sale. OR transfer is EXEMPT from tax for the following reason: FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, William A. Betterley and ,Evelyn B: Betterley, Trustees of the Betterley Trust dated January 17, 1992 hereby GRANT(S) to Northwest/Southwest Develppment,lnc ; an Oregan Corporation all that real property situated in the City of La Quinta County. of Riverside, State of California, described as: Lot 70 ad 81 of esertClub Manor, Tract No. 1, as per -plat recorded in Book 22, Page 53 of Maps, Records of Riverside County'a St f California. Dated February 3, 1999 STATE OF CALIFQRNIAAO William A. Betterley, T us ee Evelyn B: Betterley, Trustee personally known to me (or proved to me on the basis'.of satisfactory' evidence) to be the person(s) whose name(s) is/are subscribed to ttie.within instrument and acknowledged to me that he/she/tfiey executed the' same., in his/her/their.. JANICI: C. WOIINE " authorized capacity(ies), and that by his/her/their signature(s).on the instrument behalf the acted executed m /,� t i.,; COmm. g 1136203 N the person(s), or the entity upon of�which person(s) ( •e.. " : NOTARY` PUBLIC• CALIFORNIA the instrument.San WITNESS h�Rd official seal. '� -,' Bernardino County `+ my end - . My C=in: Expires May 11' Signature MAIL TAX STATEMENTS TO: (This area for official notary seal) Northwest/Southwest Development,lnc - P.O. Box 2371,Gearhart,- OR 97138 Certificate o*f Occupancy City of La' Quinta Suilding.,and Sa§,f,,.,et De -arti-nent�QF°`` This Certificate issued pursuant. to the: requirements of Section 109 of the. Uniform Bui/ding, Code, certifying' tha.t,� at the time of issuance, this structure was incompce .with; the .various ordinances of the City -regulating building construction nor use. For. the fo/%wing: BUILDING': ADDRESS: 78-700'SAGUAR0,. Use Classification: SFO Bldg:-.-- P6ri-hit No.: 0105-148 Occupancy' Group:.. R' 3 Type of Construction: VN - Land Use Zone: RM Owner of Building: NORTHWEST -SOUTHWEST DEV. _7"&_04n Building Official Address: 7:7-564 -A COUNTRY CLUB DR. #1 T3 City:.PALM DESERT,_ CA .922,1,1 , By: STEVE TRAXEL Date: 10-30-01 POST IN A CONSPICUOUS PLACE