9903-192 (SFD)N_ LU
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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division -3 of the Business and
Professionals Code, and my License is in full force and effect..
License # Lic. Class Exp. Date
/ate Signature. of Contractor yr •` ,� /Y
.4 A
OWNER-BUILDER DECLARATION
I hereby affirm under penaity•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).
O •lam exempt under Section B&RC. for this reason
Date Signature..of Owner .
WORKER'S COMPENSATION DECLARATION,
hereby affirm under penalty of perjury one'of th_e following declarations:
O I have. and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section. 3700 of the Labor Code, for the
performance of the work for which.this permit is issued.
(,) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Cartier Policy No.
t�i�tir.-ARE' lN.S.
(This, section need not be completed if the permit valuation is for $100.00 or less).
O I cedify'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
Col shall forthwith comply with those provisions.
,late:.!_ Applicant /`` �4v 1
Warning; Failure to secure Worke s Compensation coverage is unlawful and
shall subject;an employerto criminal penalties and civil fines up to $100;000,• in
Addition tothe costtof'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 requestand 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
,spermit, or cessation of work for 180 days will subject permit to cancellation.
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
t,fihe ab ve=mentioned property for inspection purposes. l
gnature (Owner/Agent) II Date '• i �' - Cj
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BUILDING PERMIT PERMIT#
.4-1�2
DALE VALUATION LOT TRACT
l 'VI8199g 872u 4Yd: 11 1 28ri70-'
JOB SITE
APN
ADDRESS
52-470 DEL C:LVW RIVE'
76"9-f42-fiifi2,
OWNER
CONTRACTOR/DESIGNER/ENGINEER
NIR & 114RS.IAY SHOLMAN
DE WP1 Cis' C:ONSTRV_n()Tl Fh1t;
I'ALkf ilt:'SERT CA, 927tvCi
67t�ti't'?7a. 176,1 C6t.,f# I4 4
USE OF PERMIT
AN43LE hA.11 ILi' i i1N1 1 %,lf�t%i
S I) - .i{i`;i 1.1O, 11K 'W AU,60k 1 o'VQL. (,`U1vii'1..1i4t4t 'f: W1114 ki iki..L.1'i:lUEkAL
STATEr LAIN&, iNCLULII'NCS'f`M 1-_NL)A' NQhKFA) SP C:IV,3 AC"I' OF 1973 (16
U.S.C. § 1.-991., ET SaC).) IF AI)PtACMLE,, tS [tf!QUIWA.►.
(""U3TON't t:OIN, fFRU. F10N 5.5(M.00 SF
t ORIC'13/PA'1'iCs 1,3.1:3.00 5f'
t:}AkAUiJt:Aft!'Uitt' I��Sli,ifil SF'
1'S3''Qt'+'>1ATED fY:D� m' Of C'rQ")11'STIaF.tOWYN
472,034-50
1'ERIWIT ft"�`I,.;4,: SLif1'i1i/i/ARV
CON3,1VICIrK)IN FEE 101-000-418-t10f? $1,940.00
ut.AN 0fr(l. ►:I 17 1011410)-439-_ W
F11.711-: ;!-: DEPOSIT 1011, 00 ?- -139,313 �I,rttii►.tt.�
INtCCJfAtdie ,VL FFT `S149.- i
d-r9..EK110 „rli 59''416.14
i"+I,iiAlriIZVCQ F`I+:1{ t 0 1 •ftftft-419-100
ai',ONG Ni POrrioN 1/t.?t; - Ri:N10 !01-.000 '41-000
6KAOINt:3 OX 101-(si`)i11-123•r00
lNFKA.v,Tii0,A3+Ht+:01E 221:8-t)(1U• 1:r -.342 s6mlA) 0o
Aral IN t�t)t3t.ic' IaI: tir( ;-Rt?�rf,:',(II-rsttU-'��•.I'tfKt K+131.'1a
'9 f13.'li-1I`M_. (''l_K-,,i'!''4I Ki "Ctf1Rl .aAID ►'l.,r3 (C. li[ .'
LESS Af1,E-11.AJ1:1 E t:i `;
IOTAI, iA1JE iV0W'
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1
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
OPERATION
DATE.
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
4 Xo Y17
Ducts-
uctsSlab
SlabGrade
Return Air
Steel
Combustion Air
Roof Deck
e . c(. Q
Exhaust Fans
O.K toWrap
o- >l` - Q 57
F.A.U.
Framing
_ $ - p
Compressor
Insulation
Vents
Fireplace P.L. Ajio
Ar.4. g
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
/Y — 5z,-
_
Final
Final
`2-S C%� s
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
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
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COLI MENTS-
-TaetF rs oK C�.v w.� �f�rs6►
* -ZD -Y? S 7
t4f1,0&c c ?_¢*1!4
S7-
STELECTRICAL
Final S
Utility Notice (Gas)
ELECTRICALAPPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G F.I•
Smoke Detectors
Temp. Use of Power
zoo
Final
Utility Notice (Perm) _ft
Desert Sands Unified School District
47-950 Dune, Palms Road
Notice: La. Quinta, CA 92253
Document. Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 3/17/99
No. 18463
Owner NameM/M Jay Shulman
No. 52470 street Del' Gato Drive
City La Quinta
Tract # Lot #
APN # 769-1.62-002
Jurisdiction La Quinta
Permit #
Log #
Zip 92253 Study Area
Square. Footage :5504
Type of Development Siiigle Family -Residence No. of Units 1
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 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
1.03 X 5,504 or $ 10,622.72 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
Fees Paid By cc/PD National Bank/DeWitte Telephone
Name on the:check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Adriana Gauto. Payment Received $10,622.72
Check No. 74713 -
Signature.
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 11996 this will serve to notify you thattthe.90-day"approval period in whidt'you may protest the fees or other payment identified
above willibegin to run:from,the date on which the building orinstalleGon parmit for this projed'Is assued or on which they are paid to the District(s) or to another.public entity authorized to
tolled them on the Districtfs)(s) behalf, whichever is earlier.
Collector: Attach,a copy, of county or cityplan check application form to district.copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
r
k
MWR-12-1999' 15:3E
I~scrcur No.1022
Loan No. tiecording Requesreu oy
WHEN REGI�IAIL'
O�b[DnT
6!e Insurance Company
s Mr. Mrs-. Jay S..Shulman,
P.O. Box 4898
Incline village, NV ,89450
MAIL TAX ST.
TO:
r� F.01
123�G6CEIVED FOR RECO
AT 8A0 ANI
APR — 11998
PAID
Doc, Transfer Tatem
Sk Co. Reoatder �►I
UMMIS me:for Recorders Usc Fm 8
DOCUMLNTARY TRANSFER TAX S_ L510
_'KC Co -
mputed,on the consideration o value of property'
Conveyed: OR
SAME. AS ABq' E _ - Computed oaths eonWeradorror vah,e less licm-or
encumbrences,remaining at time :ofWe
TheVAderd r
Signature of Declamt.or Agent determining tax -Firm Name
APN 769-162-002
TRA,GRANT DEED
FOR A VALUABLE CONSIDERATION, receipt of which is hereby adawwledged,
TRADITION CLUB.ASSOCIATES LLC,. a Delaware limited'6bilily company
hereby GRANT(S) to jay S:. Shulman and Louise Shulman, as Trustees under the
Shulman 1987 Revocable Trust Agreement dared October 20, 1987.
the real property in the City of La Quinta
County of Riverside
State•ofCalifornia, described as
Lot I_'Tract 28470-2 (See E-chibit "A" Attached.Hereto)
Dated: February 21; -1998
State of California )
County of
O b ro
�G
personally appealed / /
personally known tome
evide to be the pemson(s) whose name(s) islaM-91 ed to the
within instrument and aclatowledged to me that hGkh&%%W executed the
same in LisThefteir authorized capadty(wv),'and that by hisPheridjair
sigmture(SYom the.ittsmmmeot die person(s) or the entity upon behalf of
whieh.the person acted. executed the instru
WITNESS MY HAND AND OFFICIAL AL
a
BY: v
ITS: EXEC VE VICE PRESIDENT
, Ao�lLOW
Signature ',, �. ` GO ftft 01IV410
C Ne41►A+b1e CddtM
smaimcm*
*I* Coma &0nft6 2L=
(TW3 area for official notarial seal)
MAR -12-1999 15:40
P.01
12322
EXHIBIT "A"
Lot 1 of Tract No. 28470-2, as. shown by map on file in book 266 pages 57 through
60 of maps, Records, of Riverside County, California_
THIS DEED IS MADE AND ACCEPTED SUBJECT TO THE FOLLOWING:
i) Nondelinquent real estate ,taxes and assessments_
2) All matters of record, including without limitation, that certain Declaration of
Covenants, Conditions and. Restrictions and Reservations of Easements for the
Tradition Community. recorded as Instrument No. 262677 of Official records of
Riverside County.. California, which is incorporated by reference herein as if fully
set forth herein and any amendments or supplementary declarations thereto (the
"Declaration"). The Declaration includes; among other matters, certain architectural
and development guidelines and restrictions which will apply to the construction of
a residence on the above described lot.
TOTAL P.01
Certificate of Occupancy
City of'La Q U-inta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section. 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with -the various ordinances
of the City regulating building construction of use. For the following.-
BUILDING
ollowing:
BUILDING ADDRESS: 52470 DEL GATO DRIVE
Use Classification: SFD Bldg. Permit No.: 9903-192
Occupancy Group: R 3 Type of Construction:, VN Land Use Zone: RL
Owner of Building: MR & MRS JAY SHULMAN Address:
By: STEVE TRAXEL
Date: 04-25-00
POST IN A CONSPICUOUS PLACE
JON TANDY
ol Ave.
Sep '? r Pafi� Desert, l CA 92211
A,,, „ fC;ffice (760) 772-7192
I� �� 61", Fax (760) 772-7193.
oiiae, r (760) 776-3338
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE
O' POST TENSIONED CONCRETE
❑ REINFORCED MASONRY
O. STRUCT. STEEL ASSEMBLY
O ASPHALT
❑ FIRE PROOFING
❑
❑ OTHER
JOB LOCATION-
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REPORT' SEOUENCE NO.
TYPE OF STRUCTURE5q
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ARCHIT
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MRS. CHARGED
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INSPECTION
DATE
GENERAL Ttv
CONTRACTOR
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COPY SENT TO CLIENT O
CONTINUED ON. NEXT PAGE ❑
PAGE'
OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL,OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED: 'I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS.' AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS'.
SIG TURE. OF RE . TERED INSPECTOR �r
6I 179
DATE bF REPORT REGISTER NUMBER
JON TANDY
,� 37630 M'edjool Ave.
Jv� 0 - Pala Desert, CA 92211
DECD Office
SFax.
tiff
�ftger
REGISTERED INSPECTOR'S WEEKLY REPORT
(760) 772-71.92
(760) 772-7193
(760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED: CONCRETE ❑ STRUCT., STEEL ASSEMBLY ❑.
❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB COCA %-n9 ^ -
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DAY OF WEEK
MATERIAL DESCRIPTIO_
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PAGE Oi
CERTIFICATION OF COMPLIANCE.
I HEREBY CERTIFY THAT I HAVE INSPECTED, TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS' OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS„ SPECIFICATIONS. AND APPLICABLE` SECTIONS OF THE
GOVERNING BUILDING LAWS.
SI NAT RE' OF .REGISTE D INSPECTOR
D E OF RE RT REGISTER, NUMBER,
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REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑' STRUCT. STEEL ASSEMBLYq
❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCATION
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60V
Palm Desert, CA 92211
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Office (760) 772-7192
HRS, CHARGED
rFax (760) 772-7193
ENGINEER 1
Pager (760) 776-3338
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑' STRUCT. STEEL ASSEMBLYq
❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCATION
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COPY SENT TO CLIENT
CONTINOED.OWNEXT PAGE ❑
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT :I HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE -ABOVE REPORTED WORK'UNLESS OTHERWISE
NOTED. I.HAVE FOUND THIS°WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS, AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS:
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' • ' • Fax (760) 772-7193
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TYPE. OF
INSPECTION'
PERFORMED
O REINFORCED CONCRETE
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❑ REINFORCED MASONRY
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PAGE OF
CERTIFICATION OF COMPLIANCE
f HEREBY CERTIFY THAT I ,HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESSATHERWISE
NOTED. I HAVE FOUND THIS.WORK TO'.COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
SIGNATURE OF REGISTERED IN CTOR
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DAI% IPF REPORT REGISTER NUMBER
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APR 3 odm� Desert, CA 9221.1
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(/#Ic2bffice (760) 772-7192
AN J Fax (7.60) 772-7193
`""-Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY ❑
❑ POST TENSIONED CONCRETE ❑ ASPHALT O.OTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOC��_ O �v � f /� �V
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TYPE O,L-.- E AUCMA-0 ��'
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CON _ UED ON NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I, HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE.FOUNDTHIS'WORK TO COMPLY'WITH THE APPROVED
PLANS, SPECIFICATIONS, AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
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A E OF RMPORT REGISTER NUMBER
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Bean Date:
Job Natoe: y (1c_rN► Job No. Fab. shop W f� ,A�� Enci Date:
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905 SHEL
11 5431 LA JOLLA BLVD., LA JOLLA, CA 94037 TEL: (619) 459-5665
October 31, 1999
Attention: Building. Department
Subject: Shulman Residence
Regarding: Final Framing Inspection
Per the contractor's request, Mr. MelirdadHernmati S.E. from our office visited the site,on Oct. 8,1999
and inspected all=roof framing, nailing, holdowns an&shearwalls and made few corrections.
Base on. our visual observationand the picture were taken from the corrected framing items, the
framing has been completed substantially in conformance with the approved plan and our
recommendations.
��.GFES�G
M.S.A. & Associates Inc. C
dr-
Mehrdad. Hemmati S.E.
�Exp. 1
TAUCTO
OF CAL