0305-303 (SFD)W1
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.
Licensee #irLiicc�. ,Class Exp. Date
�yt / f
/� ) ,!
.Date 7� � r/ ,Signature of Contractor- 1 � -�•'t--
OWNER-BUILDERZDECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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, 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
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, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier STATE FUND Policy No. 1641664-0e
(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 l should become
subject to the workers' compensation provisions of-•Section;3700 of the Labor
Code, I s all f rthwith comply with'those provisions.'
/Date: ! tJ •�> An licantt. l , •1/ /lam . -'^
Warning: Failure to secure W •rkers' Compensation coverage is unlawful and
shi h 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, indemnity
& 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'fes
work is not commenced within 180 days from date of issuance of su�
permit, or cessation of work for 180 days will subject permit to cancellatio D
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- 4,Al7 �
BUILDINGTERMIT PERMIT
DATE VALUATION � - = LOT 0305"30.3 TRACT
09AM21K $i14• 54,1.85. 0_ 102 28867
JOB SITE
ADDRESS.�D.3 �t , oxro Diaw
APN
770-.`�7Ii-00,
OWNER
CONTRACTOR / DESIGNER /ENGINEER
ADAM plT
0•
lLaMOMECfA YFZAALMA1MMAw
PALM DFISERr CA 92260
(760)568-1712 0311#4 23511
USE OF PERMIT
MHOI ? FAMILY DWEII-MG
SPD.1;/". CLUDE.5 W.f LLa/rOOIJDiZI.VL VAI'APPROACIi/COMP?, ANC F, W1
ALL FEDERAL &STATE T AWS, 31`di'1,'UDiHO THE F'KDAI+iGEI)-!s"D SUPEM9 .
ACT OF 19'All V APPLICABLF, IS I:P,.;4tt11}tF`C3.
CUSTOM C'ONST1tUCTE014 x,416.00 3F
POFct: 0P.ATIO 831.00 SP'
"WEiCARPORT l,aaj,00 v
IM1M1.9,TID C10S"}'-f OF CONS' 11R"t3Cl°iox
454JIV15-'
COMIRUC°T1O;,i FEE 101-000.416.000 S1a332,0
PLAN CHECK IEE 101-0010-434-318 $1,577.37
FEE DE.14091T 101.000-439.318 -S.1,000,00
Ib6Ef,"HANICA 1, IFU 101-000-421-000 #303.Ot)
ALEC IOCA1. FET/ 101"000-420-000 S291n
PLUMBING Fid 101-000 4.14-000 $230.25
STRONG MOTION FEK RtZID ,101-000<241-0010 $43.42
OItA'.l. INO FEE 101-000-423-UOC) $15-00
DEV13LOPFR IMPACT F&E $x,40 r,00
ART ltd PUBLIC: PL,AC9S - 111431rX10-000-445-000 $635.46
S1(3B.40'tA.i C-O)"Mm%7l."I1f.iN Paw (Miloc3s'7,2:3"r.7,'i
LF -180 PRE-PAn)FES
41,0000
"t01'AL:PkT0= FUSIJPNOW
M^''
RECEIPT FiiYt'
, 2
DATE9-9-
BY /
DATE FINALED
INSPEC OR
`"l - !_ T }
- 7i- o -
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Q Q
Underground Ducts
Fors & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Q
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing,
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
L
Drywall - Int. Lath��
_
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
i0l.
Underground Electric
Underground Pibg. 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
0. K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
.'Appliances
:Final
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 _.2—o&
Final
Utility Notice (Perm)
.COMMENTS:
� (J�►nr8q�.,e: -{�
f� s'i1.-ems
�'d(1lp (�n"�`� I�
w
Date 8/13/03
No. 24818
Owner Adam Oates
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
APN #
4�J�FlED��o
Q BERMUDA DUNES
RANCHO MIRAGE CJ
{� INDIAN WELLS
d� PALM DESERT y
LA OUINTA
Q INDIO y�
A
770-370-003
Address
53570 Del Gato Drive
Jurisdiction La Quinta
City
La Quinta Zip 92253
Permit #
Tract #
28867
Study Area
Type
Single Family Residence
No. of Units 1
Lot # No. Street S.F.
Unit 1 102 53570 Del Gato Drive 5416 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments
Lot # No. Street S.F.
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 fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14 X 5,416 S.F. or $11,590.24 have been paid for 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/Pacific Western Bank - Tami Salzer Check No. 241298
Name on the check Telephone
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharon McGilvrey
Signature
Funding Residential
Payment Recd
$11,590.24 Over/Under
NOTICE: Pursuant to Government Code Section 66020(d)(1), this Will serve to notify 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 building 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: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
05/29/03 THU 08:52 FAX 909 890 0192 FNT
01ALiTY NA'I'IONAI,'I I FLE ('l),N9PANIr
iii DIVISION m.PAR*rmF:NI'
RECORDING REQUESTED SY;
- Fidelity National Title Company
EGUOW Nv. 6452 -CAH
TWO order No�;,^CA���� .313
When Recorded Mail Document
and Tax Statement To:
Mr. Adam Oates
GRANT D
fu� bav -o r�
The undersigned grantors) declarels)
Documentary transfer tax Is 4852.50
I X ) computed on full value of property conveyed, or
I 1 computed on full value less value of liens or enc
I I Unincorporated Area ' City of La Quinta
FOR A VALUABLE CONSIDERATION, receipt of which is her
A Delaware Limited Liability Company
hereby GRANTIS) to Adam Oates , an unmarried mani.
Q) 003
DOG M 20MM-000672
01/02/2003 98:00A Fee:3e.ee
Page I of 4 goo T Tex Paid
Recorded in Official Records
County of Riverside
Gary L. Oreo
Assewwr, County Clark i Recorder
111101111111101
vAL Po� I _ um I c► I rca I wo-om ( w 1 mu.
7rM6C ADVVC rnw carve rvn ncwntxn a vie
a� U
4
T`
remaining at time of sale, LW
acknowledged, Tradition Club Associates, LLC,
the following described real property in the City of La Quint
County Of, State of California:
Lot 102 of Tract No 28867, in the City of La Ouinta, as sho n by Map on file in Book 276, Pages 69 through 78
Of Maps, in the Office of the Country Recorder of Riverside ounty, California.
DATED: December 4, 2002
STATE OF CALIFO NIA
COUNTY.OF���i
j�� 9. before me,
• ]� ,�_ pemonelly appeared
personally known to me (OF wave" me-eolhe*etis
at to be the persons} whose
name*is/aro subscribed to the within instrument and
acknowledged to me that he/e� executed the
same in his1herhheir authorized capacitykt), and that
by hisAO.ePftlteir signaturelel on the instrument the
person(s}, or the entity upon behalf of which the
person(e) acted, executed the instrument.
Witness my h d official s
Signature--:�
c
, LLC, A Delaware Limited
David ChaprraV, Managing Member
CHRISTINA
RISTfNA RE$' }}
mmisrlon 0 , Rrj b
Nota Publi, ,mb
Mi�fltrfl crr i.� r ,fly
f1b242oo6
MAIL TAX STATEMENTS �S DIRECTED ABOVE
RISTINA J. DORS
Co Isslot, `oo IPIS
NO10 V YT1iQ
Rive •• . • .Y
htlrC:arrxr� Fv020.2035
FD -213 illev 7196) GRANT D ED
' r
jo-prop: Lot, 102 of Tract 29867 - P V:2003 00000672 ,I 05/29/2003 08:51 AM. 1 of 4
05/29/03 THU 08:52 FAX 909 890 0192 FNT
CALIFORNIA ALL-PURPOSE ,ACKNOVYLEDGMENT
State of California
c J
County of �C�l ss.
On /,'nom , before me St�i7�t
Data Nglao ono T100 of oelCl7 (e.g.. 'Ja Doer. Notary Publl
personally appeared Q��� C.�/!A'arxR.r!
- Nomo(sI of 91Qnerley ..�••�. ... -.—_
llfpersonally known to me
I I :proved to me on the basis of satisfactory
evidence
CHRAIINA J. OORS
coyff ! ion11Pl"1
NoWr loft - Cvafarlta
IKvw*b Cpunitt
pINQ�tleiiabmi
Place Notary Seal Abo-
to be the person(&) whose nameH isMfe
subscribed to the within instrument and
acknowledged to me that he/y'heEthW executed
the same in hisilgepAkel authorized
capacity(ies;, and that by hislAaW4e4
signature* on the instrument the person(, or
the entity upon behalf of which the person(s)-
acted,
ersons}acted, executed the instrument.
tN{iTfJ my hand � ficial s I,
9ipnRltlte e4 t ublic ....—��._..
OPTIONAL
Though the Information below is not required by law, It may prove valuable to persons relying on the document
and could prevent freudulant removal and reattachment of this form to another document.
Description of AttaChed Document
Title or Type of Document -
Document Date; L2 -:.her'_ _ Number of Pages: _.....+ %
Signer(s) Other Than Named Above;
Capacity(ies) Cla•rned by Signer/�
Signer's Name:Q iilzx
I Individual f� �.•� •
I✓ / ��/ ,✓o/ r 1 t: ne n1 �In Pnlb,•
Corporate Ofticer — Title(s):
Partner —! : limited C.I General
Attorney in Fact
I Trustee
Guardian or Conservator
Signer Is Representing:!(_[T�l��%
rA 1999 NaaonH Nolnry Aaa:7uan.9750 De Sao Aw , P.O Bo. 7e02-Cnunwaerh f:A gl]vb xret • wry n.:lp.Jinolery.t�q Roe. w M07 RMra.,: CJI t„ 4 VI t ,(m 101. IN'!
I
1@004
I IIIA 11111111111111111.1111111111111111111111111111111 et; Qe 2oof14 en
i
jo prop: Lot 102 of Tract 28867 - RV:2003 00000672 1 05/29/2003 08:51 AM 2 of 4
05/29/03 THU 08:53 FAX 909 890 0192 FNT 1j005
EXHIBIT "A"
LOT1 OF TRACT NO, 28867, IN THE CITY OF LA QUTNTA, AS SHOWN BY
MAP ON FILE IN BOOK 276 PAGES 69 THROUGH 78, INCLUSIVE OF MAPS,
RECORDS OF RIVERSIDE COUNTY, CALIFORNIA.
THIS CONVEYANCE IS MADE AND ACCEPTED AND SAID PROPERTY IS
HEREBY MADE SUBJECT TO THOSE CERTAIN COVENANTS, CONDITIONS
AND RESTRICTIONS CONTAINED IN THAT CERTAIN DECI.,ARATION OF
RESTRICTIONS RECORDED JULY 25, 1997 AS INSTRUMENT NO. 262677,
RERECORDED AUGUST 15, 1997 AS INSTRUMENT NO. 292176 AND MODIFIED
MARCH 17, 1999 AS INSTRUMENT N0. 110219 ALL OF OFFICIAL RECORDS OF
RIVERSIDE COUNTY ALL OF WHICH BY THIS REFERENCE ARE HEREBY "
INCORPORATED AND MADE A PART HEREOF AS THOUGH FULLY SET
FORTH HEREIN
1111111 IIIII! 1111 Illlli 111111 III 1111111 Il hili IIII SII eI of ea�e�
W62/290 �
e
o prop: Lot 102 of Tract 28867 - RV:2003 00000672 05/29/2003 08:51 AAAI 3 of'4
05/29/03 THU 08:54 FAX 909 890 0192
FNT
2 006
Under the provisions of Government Cude 27361.7, I certify under the penalg- of
perjury that the notary seal on the document to which this statement is attached
reads as follows:
Name of Notary: LID �,5T1 I'IC4 �: , 1� S
Commission #:
County where bond is filed:
Date Commission Expires:
Place of Execution:
Date:
Signature: -C-
2803-808672
o prop: Lot 102 of Tract 28867 - RV:2003 00000672 05/29/2003 08:51 AIM 4 of
.......................................................................................................................................................................................
APR --22-2004 THU 0412 PM Go r d o nRo s s FAX N0, 7603417631 P. 03/03
LOUNG 1VGIIVE'ERYNG SERVICES
97204 WgdeaL Ur., Palm lksat C&- 92211 (760) 364.3770 (760) 340.3719
January 21, 20"
Tom Hartung
Building Official
City of La Quinta
Re: Oates Racidenee- S3-S7D Dato Dft La 0"1 ft CA
Dear Tom,
We have performed structural observation with regards to the framing for the above referenced project
and find it to be in general conformance with the approved structural plans. However the following lrem
needs to be addressed;
• Need to provide DSCd drag connection between drag truss and shearwall 07,
• Missing MST72 strap at shesrWall #4, A35 shear transfer clips have been used in lieu of strap,
this is acceptable.
This structural observation docs not relieve thg City in any way from perfornung their standard structural
Inspections nor is it in lieu of any code required special inspeotions. The structural obmvation
performed should not be ocnstrued as a detailed suuculral inspection but as a structural observation for
gneral conformance as per CBC 1702,220.
If you have any questions please call.
Sin ely
Je oung S.&
x ra.iT�la�FJT�N3 �A11�1�` STLS09E09L 9E t60 000Z/ZUTO
3