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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.
_s : License # Lic. Class Exp. Date
- 671203 13
Date gnature of Contractor
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
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.
(YY) I have and will maintain workers' compensation insurance, as required by
Sebtion 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 Policy No. yy'' '
C -1'A'14: .FIJI [) yy 1.!'145"/f4)M;
(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
Cede, I shall forthwith comply with t(ho�see�p(obisions'. r� j
)/'? Applicant''
Date: i',• i %1%
e- i/"Cr / < it
Warning: Failure to secure Worker'! '! Compensation coverage is unlawful and
shall subject an employer toyciminal 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.
VSignature (Owner/Amen Z'5'1 / ate
PERMIT# CONTROL#
BUILDING PERMIT
');Y,iA-itl6
DATE VALUATION c.c LOT TRACT 7 918
JOBSITEtAPN
24" CITATION COURT
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENG EER '
A1111S.'MWS 1).F. F1181I117111
ANDIR'HMI PI1iRCH Ct RIVI1;ATIO'.`.1
PALM DESERT CA 92261
(7(if1'1:t4f-?22S CI1L.il 3(331
A
USE OF PERMIT
SFID
'rt
TIRRt�� IT WLti NOT iAh^.1,1MR, ill.CJ4.'rti• WAILLS Ok 1�t�(N..
I
C.i3.riiCis+:1 tiiitiSl3'ttt� "ICON 5,898M SF
'Ixi.i i't .00%
-�
i.trlki�1i1t1l.'r1}it�f4tk'1' 't ik).4.1U Str "FIT i�p
F LSA Qu .
V' ti l Ej'vi;ti•1 ED C'ON fl OF C€?NS 1 UJ IMON
433,1x,)7.43011
f: {.)�15'122.i1t:'C'141t�` �'#:"1: I�i-tilHl-�Tlii•4ii�1 S';.t�)1.1>Li
PI, AN 0iV(,-K 1-44}7 tf►t_{tij(1-�Iie),iiSi ti +`li 4S
i'171�1:1!t3Si1' IOfI-O1U-•l3)-3I8-$1,1}Iip.tX7
r a
NAF1,'1fANiCikL hiis: t0.1•WO-4214" Slft?.Si1
FiJ4f'klr,A!. Ff-'h 101-0I)0-420-000
P1,!Wit iINO 1, t, e3(t ! 25275
'1 ttUr4t MOTION 11t- - RIESIV 10t-i?C3fJ- •'rt -00 $4 8 J;rf
0.RAI;NNO P1:13 101 -WY -431-000 $20.00)
I1JFf2ANI'll?I ,'1'tfk,: trf E 2',15-r)00-443-342 16•000►")
)NRR IN tai rt11,1E.' Vf,Ar'GR - fit-Ylff_; 7(1,-§}ftft�,54-t1Qf) $97f .t2
`I I-11-srAl. (','C)NKrR1 J(:1'1ON AND PLAN rlrrCK
$11 M -7
„1INS OR -1'111111%IsF;�;
'4' 1'0f?0,01l
't•tlUAl, PERMIT140M f)UF NM
xI%.m,17
RECEIPT
DATE
BY '
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
1 MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts to
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
,Q - - d .�—
F.A.U.
Framing
Compressor
Insulatio Ap1[t
p
Vents
Fireplace P.L. a
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
L %
Exterior Lath
Drywall - Int. Lath
- 00- -
.�,.�
Final
Final
BLOCKWALL AP ROVALS
POOLS - SPAS
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
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
- S -
Appliances
Final
Final
Utility Notice (Gas) fj /41fA��
ELECTRICAL APPROVAL
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)
COMMENTS: /
141xx
�
«A�✓96l%��Y�l�.:�9 �vj° liter: wA�rs�%p
Ave F.uyi�✓CE�N� >d Ldrrfde.
Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 6/10/98
No. 17169
Owner NameFisher, Mr.
No. 52-160 Street Citation
City La Quinta
Tract #
Lot #
APN # 769-162-001
Jurisdiction La Quinta
Permit #
Log #
Zip 92253 Study Area
Square Footage 5898
Type of Development Single 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
1.93 X 5,898 or $ 11,383.14 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 Cashiers Check/Palm Desert National Bank
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Peggy Reyes
Signature Qmm "
Telephone'
Payment Received 14-1383",14
1,383':14 _
Check No. 73397
40TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) 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 sssued or on which they are paid to the District(s) or to another public entity authorized to
:ollecl them on the District('s)(s') behalf, whichever is earlier.
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
r
Payment Received 14-1383",14
1,383':14 _
Check No. 73397
40TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) 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 sssued or on which they are paid to the District(s) or to another public entity authorized to
:ollecl them on the District('s)(s') behalf, whichever is earlier.
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
r
4
Q0
i
'Recon hng Requested
Inst Arraerlratl Title kwat
Order No. 2084041—EL
Escrow No. 3840—Tc
Loan No.
WHEN RECORDED MAIL TO:
D. F AND SUE FISHER
9513 PINYON TRAIL
LTITLE TON, CO 80124
TAX STATEMENTS TO:
SAME AS ABOVE
E
IDsfer Tax
Recorder
Space above this line
463695
RECEIVED FOR RECORD /
AT 8:00 O'CLOCK
DEC 18 1997
Reamdod in O&W Reomds
m �/
r" C-011*. caNtwnm
Recorder
Fees S�
DOCUMENTARY TRANSFER TAX $ 2- -0 0 /
(X Computed on the consideration or va oflproperty
conveyed; OR
Computed on the consideration or value less liens or
encumbrances remaining at time of sale
The Undersigned Grantor
Signature of Declarant or Agent determining tax -Firm Name
APN: 769-162-001
TRA: 020-015 GRANT DEED
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
TRADITION CLUB ASSOCIATES LLC, a Delaware limited liability company
hereby GRANT(S) to D. F. Fisher and Sue L. Fisher, husband and wife as joint tenants.
the real property in the City of La Quinta
County of Riverside..., State of Califomia, described as.
Lot 41 Tract 28470-1 (See Exhibit "A" Attached Hereto)
Dated: l 'jV &.,,bAs, /7 /Ti7 /}
State of California )
ss.
County of
On Yj 6'1J.[4><._ 41&&f 7/y 97 before me,
T�✓YIe /771//.0'r
personally appeared QgMn J.- /Ug aa—A-,
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 the
within instrument and acknowledged to me that he/she/they executed the
same in his/her/their authorized capacity(ies), and that by his/her/their
signature(s) on the instrument the person(s) or the entity upon behalf of
which the person acted, executed the instrument.
WITNESS MY HAND AND OFFICIAL SEAL
TRADITIO C ASSOCIATES LL
a Delaw re ted liabil' co' ny
By:
By:
Its:
e9&vnvCF vice a,¢&ioe*JT'
IF
TERRIE MILLER
Comm #1128852 r1
• of NOTARY PUBLIC CALIFORNIAyI
- RIVERSIDE COUNTY 0
„op . Comm Exp. Mgrth 6 2001
(This area for official notarial seal)
TANDY
�.37630 Medjool Ave.
~�
OCT 1 4 RECTPalm Desert, CA 92211
8U,,L,, Office (760) 772-7192
SPECIAL INSPECTION SERVICE�
�rd_+.Fa>x (760) 772-7193
Pager (760) 776-3338
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF
INSPECTION
PERFORMED
I
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
❑
❑ OTHER
JOB LOCATION
( coLA QV��.. LDS
REPORT SEQUENCE NO.
Tv QF STRUCTURE 11
G r�Iil�, A
PERMIT NO.
DATE I n
Yg
DAY OF WEEK
MATERIAL DESCRIPTION
ARCHITECT n ' 1
INSPECTOR
MRS. CHARGED
ENGINEER �S
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
L SUB
GENECONTRACTOR A tAC Qj PC W -9-C-_. CONTRACTOR -5; e- -L-3 A C -
i
F ol P64 -y -Es it
07
O Cj% N eG c1- oy\ (/ATE
t-1-op wex�vcwc'
COPY SENT TO CLIENT ❑ 1 qQkNTINUED ON NEXT PAGE ❑ 1 PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY SIG ATUR OF REGIS RED INSPECTO /
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE �j (
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED O �� /� a �J
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THEy
GOVERNING BUILDING LAWS. DAT OF R PORT REGISTER NUMBER
All
- Certificate of Occupancy
•
'--^ _
ot
�W
•
TPKABPO¢A7ID �4 .
19Q
G� OF"I9w� Building Y p & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating, building
construction and/or use.
BUILDING ADDRESS: 52-160 CITATION COURT
Use classification: SFD Building Permit No.: 9804-103
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: MR. & MRS. FISHER Address: 52-160 CITATION COURT
City, ST, ZIP: LA QUINTA CA 92253
By: DANNY CRAWFORD
Date: OCTOBER -13-1999
Building Official
POST IN A CONSPICUOUS PLACE
ca), OF I�I ► JON TANDY
DEG37630 Medjool Ave.
8 Rfftalm Desert, CA 92211
Sul LG,rOffice' (760) 772-7192
SP-ECIAL INSPECTION "`APEax, (760) . 772-7193
Pager (760) 776-3338
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE O ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
❑
❑ OTHER
JOB LOCATION
11
.6� UT,
L- ��` n
REPORT SEQUENCE N0.
TYPE OF STRUCTURE
PERMIT NO.
DATE
DAY OF WEEK
MATERIAL DESCRIPTION �. ]
ARCHITECT
INSP CTOR
=, -77
HRS. CHARGED—
HARGEDT-77
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION GENERAL
DATE CONTRACTOR
SUB A �tTzFe
CONTRACTOR f't J
is a
obs�Q� a��En
Of E; 4, 51'r
Xx A44 /0
10,17 s oel
_ox
COPY SENT TO CLIENT ❑
CONTINUED ON NEXT PAGE ❑
PAGE
OF
CERTIFICATION OF COMPLIANCE