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07-1574 (DSF)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: Applicant: ce 07-00001574 76915 AVENIDA FERNANDO 658-240-028- - - DEMO - SINGLE FAMILY LOW DENSITY RESIDENTIAL 0 T,ityl 44Quixtu, Architect or Engineer: aIP LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of d P �rofessionals Code, and my License is in full force and effect. License Class: BLicense No.: 862034 [e: ractor. 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 ($5001.: 1 _ 1 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 I, 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.). . 1 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 (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: LQPERMIT Owner: CASSANDRA DOTZLER 19438 BURGUNDY WAY SARATOGA, CA 95070 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/29/07 ------------------ 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 and policy number are: Carrier EXEMPT Policy Number EXEMPT 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 Mre become subject to the workers' compensation provisions of Section 3700 of the Labor I s forthwith comply with those provisions. ate: t2§_y7 can 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 ($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. 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 sta t a ove information is correct. I agree to comply with all city and county ordinances and sta laws relating to building 'ruction, and hereby authorize representatives of this cotrnty to enter upon th ove-mentioned property f inspe�li n purposes. /t_3ate//C-2W ature (App�ant or Ag 100, � MAY 2 g 2007 Contractor: POWERS CONSTRUCTION LA Cif OF ®�•%Iid—Te4 42191 SANDY BAY ROAD '--.FINANgE o pt BERMUDA DUNES, CA 92203 (760)772-5207 Lic. No.: 862034 ------------------ 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 and policy number are: Carrier EXEMPT Policy Number EXEMPT 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 Mre become subject to the workers' compensation provisions of Section 3700 of the Labor I s forthwith comply with those provisions. ate: t2§_y7 can 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 ($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. 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 sta t a ove information is correct. I agree to comply with all city and county ordinances and sta laws relating to building 'ruction, and hereby authorize representatives of this cotrnty to enter upon th ove-mentioned property f inspe�li n purposes. /t_3ate//C-2W ature (App�ant or Ag 100, Application Number . . . . . .07-00001574 Permit . . . DEMO PERMIT Additional desc . Permit Fee . . . . 45.00 Plan Check.Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 11/25/07 , Qty Unit Charge Per Extension BASE FEE 45.00 ---------------------------------------------------------------------------- Special Notes and Comments DEMO INTERIOR DRY WALL IN LIVING ROOM, KITCHEN, DINING ROOM BAR & GUEST BATHROOM IN PREPARATION FOR FUTURE PERMITTED REMODEL 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 8i Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address:' -7 6 R f SOwner's Name: A. P. Number: Address: Legal Description: City, ST, Zip: 14. Contractor: LAI -C ? Telephone: Address: �D Project Description: City, ST, Zip: ZZ N 4J �. Telephone: _ /N State Lic. # 04 Q City Lic. #: I a Arch., Engr., Designer: Address: (f Ai.(' City, ST, Zip: Z Telephone: 0- ZS— O State Lic. #: Name of Contact Person: Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING. PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Energy Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading, plan 2°" Review, ready for corrections/issue 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 171 Total Permit Fees RECORDING REQUESTED BY: Fidelity National title Company Escrow No. 5811-M13 Title Order No- 33247910-04 When Recorded Mall Document and tax Statement to: Frederick J. Dotzler 19438 Burgundy Way Saratoga, CA 95070 Doc 0Aa6/204 a Q Pe? -00�I►36 page 1 of 3 Doe T Tela paid Recorded in Official ka'ards County of Riverside Gary L. Oreo Assessor, County C141 ' Recorder �� 11�1 IIID III �� IIIA ILII IIII I Illlll 111111 1111 III M IS V PAGE Sly OA PCOR NOCOR SMF MISC. :S A R L L COPY LONG RFFUNb flCHG MM FIV n. VJV-916-7%J-VLV VLV-%JVC7 �..•v�....v.� ••... .•n .�.•..��..��. GRANT DEED The undersigned gratitor(s) declareisl Documentary transfer tax Is $8130.00 1 { X l computed on full value of property conveyed, or �($ { I computed on full value_ less value of liens or encumbrances remaining at time of sale, [ i Unincorporated Area City of La Quinta FOR A VALUABLE CONSIDERATION. receipt of which is hereby acknowledged, James C. Navratil dnd Hildy J. Navratil, Husband and Wife ae Joint Tenants hereby GRANT(S)to Fredrick J. Dotzler and Cassandra L. Dotzler, Trustees of THE DOTZLER FAMILY TRUST, UDT dated August 9, 2001.. the following described reel property in the City of La Duinta County of Riverside, State of California: SEE EXHIBIT ONE ATTACHED HERETO AND MADE A PART HEREOF DATED: March 17, 2004 • ;V. w • • �� : L _ �.�_before me, Pers Ily appeared .Y� !Kildy J. atil r personally known tome I to be the person(s) whose names) is/are subscribed to the within instrument and acknowledged to me that he�ahe/they executed the same in h401wr/their authorized capacity(ies), and that by Ws*opMveir signature(s) on the instrument the personis), or the entity upon behalf of which the person(s) acted, executed the instrument. Witness my hand an official seal, Signature RAY E. IARIBEE Attorney at I.aw Notary Public, State of Ohio, W, , •unty My Commission Has No Fxpil . -jate. Section 141.03 R.C. MAIL TAX STATEMENTS AS DIRECTED ABOVE FD -213 (Rev 7196) GRANT DEED 281-3 NAO'd 031-1 Will* onoN 00-01 1Z9l1Z110911-01 6510 10, 6Z AVW MAV 29 '07 07:53 TO -17607724627 FROM -De Novo Ventures T-752 P.01/01 F-781