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9907-109 (SFD)LICENSED CONTRACTOR DECLARATION hereby affirm under penalty of perjury that I am:licensed under provisions of Chanter 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 126552 C, 10 Coo U . 68/- 1linof D to ,>>'•{ f Signature of f 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 io 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: ( )' 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, foe the performance of the work for which this permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier Policy No. "T'ATE k'S.7ND (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 workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisio s. 'Date:// e%.9S Applicant, 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 purposes, /Signature (Owner/Agent).✓ _ %%�,, ' Date 1// BUILDING PERMIT PERMIT¢ ° DATE - VALUATION LOT ! TRACTJOB ` v) �y� � ry' ` SITE ADDRESS a0491 5 C.raLLE PAWN APN ��i°J-$9Qi {}1�rd OWNER CONTRACTOR/DESIGNER/ENGINEER LA OUYA1-,`1 CA 92251 WF ,10 (-'A 00)342-.3'318 03 617 USE OF PERMIT ; Gia C"Dld. r -NO f3LCW Wi�LL S OR, PcvOL..�l+f�.iaS`I iO't4'S iCf1t k"� f'�f # 1%L17 UAC: §30-4.5 F(W1 1'trQf1,K WYOkff Pl.JUk11T, @ALAN C::f•1.VXK FIX REC1U 0) 7SQ/a F C:2R:1 ULi'.4PLE dSSUIO(C.E. TRAC1'C0N3T.R.1JC'r1VN %1- P0RC1WPJkT30 w3l:,tjFf SF:' i31t,F�ACi}�aC:�A►�F'Ct6t'1' `7+?�.�:i .�i�'' mkF�turm COST Or CO3Na tUC I1K)N fix 101.0'.K)A18-000 s� 3,t4Eo i�Y.. A:t3 t."1 fi;t`::C ► Y'_E. 1111 -0 0-4:$9A 18 101-000-439-31, lvtL6 :HA:NTC'Al.FEE i,Ul40-421-000 $25,50 i l^f� f'R.FC 11J.,1�J i0i • C%4.20 -l100 S��T,Ss.t4 a 9x1, r Ptat[3gRdG 67 FV. ! (1 ! •- tf1)-d91 t8-f�(i(, j. f�l.,2,5 O-4423.000 ( .AaU4 , HE 101 -WO -423-000 LW11F').tJ3 ER. 3 JP1 AC I.- IFE A ART Ski PI It.:IC t�L. AaS'1:5 -1iV 7"1,011.400: 2'` 5-000 8 v52. g TM1 H.STIt:e Krl(.)N �'1v 3 1101 -WO -423-00 39191100 Kt.fB-T(_YrAl, CC)?+�fS'i'1�:i �(�`'�'f.0 N ANI".) PLAN CHECK `;x.992.25 .. LESS k'Rf::-1TAID 17EES 4250.0 • _ ... &•GJ f."AL I. -VE 16i3'U'f;' F:E98 DUE NOW �a�J RECEIPT DATE BY% DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms / ,// t/� t Underground Ducts Ducts & Footings _ (9 r Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap, �j.�—�,¢� S% F.A.U. Framing /Compressor 5 Insulation ! Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs 4 Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection —ZZ©- Cz, V.7 Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility. Notice (Perm) `��fi''t.,..'i•-=':��~iS+.y:/'..:`ir,.t^n.�,s�w'I�de%�-�$�,�:'+�+.r� M�19�1�"�'' �v3�"�-„�..,u/„�.`P"ra�,`",,,v"� �0 7-1 P.O. BOX 1504APP KATION LY +�/ b ( "4-1 Building // 78-495 CALLE TAMPICO /� Andress 50 ei CA [.d � CW` UINTA, CALIFORNIA 92253 Owner 0 J C �✓ _ _ - Mailing r� BUILDING: TYPE'CONST. OCC. GRP. Address / `Q f � � � -�� � 4 e (,a ,[�%�,, /� A.P. Number n City /7I wit 0 Zlp`7 'K3 T� �” L �^ � L� Legal Description Contractor I Q/A / /> Project Description/ f-zG1 tIA i� 14 ty 1 e A ) t _ jZip State Lic. City & Classif. -7./1"7/if-7 Lic. # Arch., Engr., ) Designer ��Ih Address Tel. �f. 'd? 1�69v --/71— Z. City/ IZip C�3 I State Lic. # q1 02— LICENSED CONTRACTOR'S DECLARATION I herebyf.irm.that.l,am licensed uncle p visions of Chapter 9 (commencing wit - Section oP wision 3 of the 8' sines andel Prof Bions Code, and my license is In ful f9rc and —SIGNATURE OWNER -BUILDER DEC AT RION I hereby, affir. tf1 t I am exempt from the Contractor's License Law for the following reason: (Sec. 70`8'I`.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 the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty or not more than five hundred dollars ($500). I: 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 of proving that he did not build or improve for the purpose of sale.) I'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 contractors) licensed pursuant to the Contractor'SILicense Law.) i 7 I am exempt under Sec.B. 8 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 171 Copy is filed with the city. ❑ Certified copy is hereby furnished. \, CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed it the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thF 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 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 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 the above. mentioned property for inspection purposes. Signature of applican Mailing Address_ City, State, Zip_ WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Sq. Ft. Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. tet"! �} .- C -7-n Plan Chk. Bal. Cbnst. Mech. Electrical Plumbing !t; • `` S.M.I.Tact Grading Driveway Enc. Infrastructure J 11 016— 19 19 Ut LA e TOTAL REMARKS x1 ' 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: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION ��Z 9 Zl 9- - Notice: Document Cannot Be Duplicated Date 8/23/99 Desert'San'ds Unified Sch6o - U'Pistrict 47-950 Dun' e Phlins Road La Quint.A"..CA'92253 766-1.71'8515 CERTIFICATE OF' COMPLIANCE No. 19230 Jurisdiction Owner NameBCK Investment Group No. 50-695 Street Calle Paloma City La Quinta zip 92253 a APN #. 769-064-009 La Quinta Permit #9907-109 Log # Study Area Tract # Lot # Square Footage 3,279 Type of Development Single Family Residence:. No. of Units Comments At the present time, the Desert Sands Unified School - District' does not collect fees on garages/carports, covered patios/walkways, residential additions -under 500 squarie feet, detached accessory structures or replacement mobilehornes. It has been determined the above-named owner is exempt frompaymg 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 1.93 X 3,279 or $ 6,328.47 the property lis'ted:above and thai,.building' permits and/or Certificates of Occupancy for this squar6 footAgedn this proposed project may now be i§suied,-, -Z Fees Paid By CCB of A/ Jay S. Gary Telephone`77*0�,-8869 Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Sylvia Carrasco Payment Received •$6;3,28'.47' Check No. 2016566132 Signature LLur,_) '6eriod in wlii6, you�may protest the fees or other payment identified NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the Wday approvall OT" above will begin to run from the date on which the building or installation permit for this projeq.is sss66d,or onwhich ihej ani paid.to'the District(s) or to another public entity authorized to co".. collect them on the District('s)(s') behalf, whichever is earlier. F Collector: Attach a copy'of county or city plan check application form to district copy for all wail Embossed Original- Building Dept./Applicant Copy- Applicant/Receipt Copy - Accounting UTuI drain I ECHN for- , . !sf,'v .'5P;�a., �..�»'wr r t,.--•srr Ww.;n •,.. ..r, ,. 4 FOUNDATION ENGINEERS AND MATERIALS LABS PROJECT:rx PROJECT NO,: CLIENT: BRANCH OFFICE: B .D TECHNICIAN -DAILY REPORT CONTRACTOR/CLIENT REPRESENTATIVE CONTRACTOR'S REP: ON SITE: � �'�� ��: 3�►ti OWNER'S REP. ON SITE: TIME IN: -/ �-�-• TIME OUT: �: �.:,� r� q �.� ;r.,.,- STANDBY TIME: LUNCH/BREAKS/ETC.. ..� .... MILEAGE: BILLABLE ,TIME: �-o PROGRESS (AREAS WORKED, COMPLETED,ETC.)i . �.� M SofA.. =.`� :fin j '+� �c.CJWI` -r ------------------ OBSERVATIONS ._ _. ,. r"4'�,�.tia»:.+ws.,'«, .,n»n.•K!.�vecl - .. ..;.tea_. _. � � 't Y.. �/,. +rh ��ri'Sf6fli':`e s �+� ,r p`r f :t+. -'! ... .. t1 rA• .•= NON - PERSON ON- PERSON NOTIFIED SIGNATURE: 'J��oay s�/�}-c..csrgc•� DATE: 9� SIGNATURE OF TECHNICIAN: L40 pE Z �.i U-HLAND / .. E0TECHNK%AL-7r ;, ey . j Y 4 r : r. FOUNDATION ENGINEERS AND MATERIALS LABS PROJECT: �<<S":'°.f'^'a�cs. �c- PROJECT NO.: /0 9 9 2(ot0 k: CLIENT: BRANCH OFFICE: T,E:CHNICI'AN. All LY,REP0RT �CO`N:TRACT.OR/CLIENT:`REPRESENTATIVE. CONTRACTOR`S`'REP; 'O.N SITE: L OWNER'S REP. ON SITE: — TIME IN: T: rv� �0 y STANDBY TIME: LUNCH%BREAKS%ETC - , :ULEAGE—.-- `BILLABLE TIME: 'PROKG`RES.S '_'(AREAVWORKED_. C040 iET6ETC) 3 ,{� ter- r. fi> ;q, � ;�..r.: x :.,'�,�,.1._,a' „�•, '.iT= !""' "*ly};LG`;`� �, f�:,.,�:t' '.:t.-nk� Y :.. �* .Eawr "y,,.�, +�. s + .• . �71G-�'� ���` % t .'!J Z- �r�- S,.#Q Ill t.� r ��.L���� .r. .. `4 .►Z� ,;,. Z 0 OBSERVATIONS =��+L L''���•�XPiE'=�"i�''C%b'/!/didGJf%0��;..:1/�/�lLr ;�.L✓/4S''l�O�/� .�P y �� Ito L't.4�.r-i-.. r .. NONL-CONFORMANCE AREAS: PERSON. NOTIFIED: SIGN TURE: 6101 AV,AL AR LE �J DATE: CJ2'-��-ozD SIGNATURE OF TECHNICIAN: two Oder --N?, Escrow No. Loan No. WHEN RECORDED MAIL TO: Georgina Clarke P 0 Box 1490 La Quinta, CA 92253 DOCUMENTARY TRANSFER TAX $ ...... :........................ ........................ ...... Computed on the consideration or value of property conveyed; OR ...... Computed on the consideration or value less liens or encumbrances remaining at time of sale. SPACE'ABOVE THIS LINE FOR RECORDER'S USE Signature of,Declarant or Agent determining tax — Firm Name GRANT DEED FOR A VALUABLE CONSIDERATION,. receipt,'of which is hereby, acknowledged, GEORGINA CLARKE, an unmarried woman hereby GRANT(S) to B.C.K. INVESTMENT GROUP, INC., a Nevada corporation" the real property in the City of La Quinta County of Riverside State of California, described as APN(S):,.769-063-006, 0 009: SEE ATTACHED EXHIBIT "A", hereby made;. -a part of: Dated August 5, 1999 } STATE OF CALIFORNIA }ss. COUNTY OF } On before me, personally appeared personally known to me(or proved yto, me on the.basis of .satisfactory ;. evidence) to be the'person(s) whose name(') is/are subscnbed'to the within:., instrument and acknowledged to me`,that he/she/they.executed'the same' in his/her/their authorizetl'oac,ty(ies) • arid 'thbsigna pa.^at y. his/her he ture(s) on the instrument the,person(s)`or the.entity�upon behalf -of which. . the person(s) acted, executed the instrument. WITNESS my hand and official -seal. Signature I MAIL TAX STATEMENTS TO - (This area for official notarial seal) 1002(1/94) BOB HOFFMAN , Structural Engineer 25 Aug 1999 Re: Residence at 50-695 Calle Paloma Court Please be advised that the design of prefabricated roof tosses are in accordance vvith the intent of the completed structure. fESS/p 14 JK a A 3/r" ' 11 aC/ ��1V`"Iil�� Six Alfaro Drive, -Rancho Mirage 92270 - 4758 Tel / Fax (760) 569 - 2967 ( Note the change ) t Z8-495 CALLS TAMPICO1 LA QUINTA, 6A.92i53 (760)-777-7075; r- APPLICATION FLOOD PLA'IW`IJEVELOPMENT PERMIT . BU ,LDI SIT )CATION FLOOD _ZONE AO' "7 -DE . E COMMUNITY PANELNMBR O [ Ic , 1�5er til Clu ; �'r. S Z(- 7L'6`00'709 0605 B, Map Revised: 8/19/1991 APPLICANT INFORMATION SECTI0 . APPLICANT NAME APPLICANT ADDRESS Y IMAILING•ADDRESSNOTTHE BUILDING „ - �! DAYTIME TELEPHONENO: INSTRUCTIONS 1. A Flood Plain Development°Permit is required by LQMC-Section 8.11 04.0(A) . The -Applicant should complete the Applicant Information portion of this,'application and submit -it to the Engmeenng De, partment. along witFi� the required documentation noted here -on 'at the same'time.the Precise Grading'Plan issubmitted to the Building' and Safety Department for plan checking.. `S 2. Documentation required priorrto receiving clearance.for'Building Permit issuance • Copy of the proposed 'Precise:. -Grading Plan for re•view;and approval containing all information required by the checklist shown.on the'back" of -this application. 3. Documentation required priorto receiving Flood Plain DevelopmentrPermlt approval. Note„this .appr'oval occurs ' after the dwelling is constructed, but before the Buildingi , -Safety Department performs•its Final -Inspection. • Submit a completed FEMA"Elevation Certificate' form to the Engineering Department. The Precise Grading Plan submitted for this application' has been, 1 All requirements have�`been satisfied. This Flood Plain Development Permit is approved.. ' reviewed and found to contain all data required,to satisfy the requirements of LQMC'8.11 The. proposed':dwellingis eligible to receive,a building permit.upon s-atisfying Building &"-Safety Department requirements. ��C i w•� 12- A onl A H0RIZED URE DTE La Quinta Engineering Department _ AUTHORIZED SIGNATURE DATE La'Quinia Engineering,Dapartment,, Po90 Feiro Engineering, Inc. Civil Engineering- Land Surveying P. O. Box 12980 Palm Desert, Ca. 92255 (760) 346-8015 FAX (760) 346-2548 City of La Quinta 78-495 Calle Tampico La Quinta, Ca. 92253 ATTN: Building Er Safety RE: Lot. 3, LLA 91-150 Calle Paloma APN: 769-063-009 Ci �Iy 4 JAN 10 RECD BUiL®iN;�4 11. V r ,Jan. 5, 2000 This letter will serve to state that we have field checked the elevations for the above project and found them to be as follows: High: FF = 40.87 Pad = 40.3 eSof EsSIO � All �`�� ®FFA 0 No. C-24176 '�' EXP..t2l311a1 :. �T9 -C-1 IL., Low: Plan: 40.81 40.80 40.3 40.3 Sincerely, James D. Feiro, President RCE 24176 U