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61
LICENSED CONTRACTOR DECLARATION
I hfeby 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
f
Date ��`" y��.o Signature of Contractor -~+ y
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.
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 2T.ATF? FUND Policy No. !
(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 provisions.
ate: LIZ .7 /, 3 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 informati n is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby-authb�ize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) r � Date 17� /� a
PERMIT PERMIT#
_BUILDING
DATE - VALUATION LOT OaY&-072 TRACT
15 20470.2
JOB SITE
ADDRESS 522-'7$8 C XAgKr r
.;OVF770-190-07
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
DUN.IMM FINA11 . W,, T.LC
ALPHA,. OMEGA (NEWMA AUHA OTrS3:�K A C
42=829 C:C;OK X1.1
42-829 COOf. ±�1CA4
PALMDESERT CA 92260
:PALM,, DESERT CA 9260
(,760)568.1712 CM10 2357
USE OF PERMIT
HINC LE PAWL Y DWWA IG
5589 8,F. SFD PERMITDOW NOT f:3C LUDE BLDCK IXALI, :PCIOUSPA
OIL DbUVEWA'9` APPROACH
CUSTOM CONSTRUCTION MKID0 0$
POltrrHIPA110 ") .010 SIP
0AT3AMUCARPORT 1.,omoo SP
E.MW TED cols"11 OF, C 041119I;'Idi.J6OrION
466AW—V
'1?ERN(3CrFRE SUAMI RY
CONSTKOCTI0iiT ME 101 -W10 -416 -WO 91,424,00 '
PLAN CHECK FEE 101-000-439418 $1,555.39 .
1+M, DEPOSIT 101.000439.318-$1,0woo .
IeiIW„ HAXICA1,FEF. 101.-000-421-000 $144.00
ELECTRICAL PER 101 -000-420-OM, $290.92
PLU M B010 FEE 101-000,419-000 $384, CD
S`CRONx`1 MOTION FBF - RESID 101.000-241.000 $46, 4
01RA.L)INCf FXX lolt.0E10,423-00I3 $1100
OWEWPER I NIPACTFEE 4405.00
PRECISE PL.AIi 101-000-42'4 -30 $100.40
ART T'!( PUBLIC FLACM - RESII 270.000-445e,000 $666,06
81'JB-V')'d AL• C0NMRTJr_'ff0N AND MUM Ck1F? K
$7,1:31.01
.0 R%q,,0 Pj7 rb'-PAM "I�'�
41. .000.00
X'3!t:1;MT lelr0 MY ff0W
$6,433.0
NOV 19 2003
y
CITv oil: LA tsf:�TA '
IFIlRA4lCIE DEPT.
RECEIPT
DATEr
BY
DATE DIALED
INSPECT R
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
:INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
-
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
- p
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
- Q
Final
Final
BLOCKWALL APPROVALS
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 Unes
_ ( _
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure:.
Shower Pans
OX 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
Final
Utility Notice (Perm)
COMMENTS'
�1
� (Z -- L l - .v 3
Building
Address
Owner
P.O. BOX 1504 APPLICATION ONLY
78-495 CALLE TAMPICO
,SET C� Ufa, OUINTA, CALIFORNIA 92253
Address Ccx>t ? -,
City` Zip Tel.
Address /
17-260
State Lic.Z.L�i�I,v� City
& Classif. Lic. k b -3 J `l
Arch., Engr.,
Designer
Address Tel
L-i.Z
City Zip State
�rfZZ_6-d Lic. a
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,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 thathe 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 ($500).
(: 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 's
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 I, asowner of the property, am exclusively contracting with licensed contractors to con -
Strutt the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of properly who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
I'] I am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
Ihereby affirm that 1 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
F1 Copy is filed with the city. Cl Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg 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: 11, 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
1hereby 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.
1 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 sof this city to enter the above-
mentioned property for inspection purposes.
Signature of aQplicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number rI I 'c>1�� Cil � J
Legal Description �� 1� ���L 7_qLi10-a
Project Descriptions,-NA,�c (0.2� A- stG��'
Cis �1�r�� ' '=mild t., ) Z�LG CELSi-'l
Sq. Ft. r —
Size
New Add ❑
A)
No. No. Dw.
Stories ` Units
Alter ❑ Repair ❑ Demolition ❑
>timated Valuation
U ( o c) C
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
--,rJJJC
n-,
Infrastructure
L!r `
-
TOTAL
REMARKS
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
i efl�'6t-. NA���'3y'1IO AL TIT;Lh,ETCGMP-,&NY
U"BDI,;R_ECORDING REQUESTED BY:
Fidelity National Title Company
Escrow No. 6692 -CAP
Title Order No.
When Recorded Mail Document
and Tax Statement To:
Alpha Omega Communications
73-960 Hwy 111 Suite 6
Palm Desert, CA 92260
DOC = 2003-023331
01/13/2003 08:00A Fee:10.00
Page 1 of 2 Doc T Tax Paid
Recorded in Official Records
County of Riverslde
Gary L. Orso
Assessor, County clerk a Recorder
1111111111111111111111111111111111111111111111111111111
M S U
PAGE SQE
DA
POOR
NOCOR
SMF
NSC.
�
R I L
4I
I
COPY
LONG
REFUND
NCHG
EJ.
APN: �1''U rte/ IV �D� 1 "� GRANT DEED SPACE ABOVE THIS LINE FOR RECORDER'S USE
I O/D
The undersigned grantor(s) declare(s)
Documentary transfer tax is $550.00
[ X ] computed on full value of property conveyed, or S�
[ l computed on full value less value of liens or encumbrances remaining at time of sale,
[ ] Unincorporated Area City of La Quinta
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Alpha Omega, a California
Corporation
hereby GRANT(S) to Dutfield Financial, LLC
the following described real property in the City of La Quinta
County of Riverside, State of California:
Lot 15 of Tract 28470-2 in the County of Riverside, State of California in Book 276, Pages 69 through 78 as per
map recorded in said County.
DATED: November 21, 2002
STATE OF CALIF RNIA
COUNTY OF \,l2�-S iC�e
ON O before me,
ME,rsonally appeared
personally known to me
) to be the person(s) whose
name(s 's`/ re subscribed to the within instrument and
acknowled ed to me tha�she/they executed the
same i he their authorized capacity(ies), and that
by hi /her/t eir signat s) on the instrument the
person , or the e - w upon b alf of which the
person(s) acted, exed the i, trument.
Witness my harA and,6fifici@,seal.
Sign
Alp , California corporation
By:
vs out, President
CATREPME A. K ms'- "
Gornml5�aw � 13d�
-Co�Y
FIDELITY NATID41 TITLE INSURANCE COMPANY
HAS BY REQUEST AS
AN ACCO .,: `.`C';, I iuii ONLY A10 HAS NOT EXAMINED
IT FOR RE( uLkRIiY AND SUFFICIENCY OR AS TO ITS
EFFECT UPON THE Ti i L E TU AsvY REAL PROPERTY
THAT MM 0E UESi :,-:0 I .::..E: -
MAIL TAX STATEMENTS AS DIRECTED ABOVE
FD -213 (Rev 7/96) GRANT DEED
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 (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 5,589 S.F. or $11,960.46 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/Bank of America - Leith Regan Check No. 2015970416
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exemptey S ron Gllvrey Payment Recd Over
$11,960.46 over/under
Signature c ��
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 DistrictCs) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
��
Ce.r.tificale of Occ�u ancy
0 oP
04
F Building Safety pp. nt.
-D 'artme
14
This Certific ate is issued pursuant to the requirements of Section 109 of the Wifornia Buildin 9
'that,,*
Code.' certifying at the � time ." of I issuance, . this structure was compliance with e
Y s in th
provisions of the Building Code and the, various ordinances of the City regulating building
construction. and4dr use.
BUILDING ADDRESS: 52-788 CLARET COVE
Use. classification: SFQ Building Permit No.: 0309m072
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: DUTFIELD FINANCIAL ,LLC Address: -42-829 COOK ST #104
City, ST, ZIP: PALMDESERT CA 92261
By: KIRK KIRKLAND
Date: 124-04
Building Officia-r
lit
POST IN A CONSPICUOUS PLACE
PROM SUMMIT STRUCTURAL ENGINEERS PHONE NO. : 268 325 8149 Apr. 11 2003 02:54PM P1
S
Summit STructural Engineering ! l y
P.O. Box 813
270 Ndrth Main Street
Donnelly, ID 83615
(866) 862-8148
(208) 32.5-8148
' Fax (208) 325-8149
April"7, 2603'
Sun Vista Development, Inc.
P.O. SOX 9:144
La Quintai�'CA 92253
Attn: Rob Capet2
Subject: Structural Observation
Bos Residence.
Lot 15t;�7a The Tradition
La Quinta, CA
s0- 7F8
Dear Rob,
Per your superintendent Bill's request, we visited the subject job site on April 3, 2003, to
perform a structural .observation. While we were at the job site, we found several
omissions and deviations from the plans. Most of the missing items were,,
ere install®d while
we were at the job site. The remaining items were written on a list and described to Bill.
These items were installed the following day and at that time we found the structure to be
in general compliance with the structural design concept.
if you have any questions, please give me a call.
Yours truly,
SUMMIT STRUCTURAL ENGINEERING
161: 0054193
Ej
Benjamin Herbst, P,E. qL1?131M
SH
g:Wy poevments120o2NobfilesslSv-179\179_fiMdl(wtt).d"
Residential. Commercial, Industrial. Lend Development
05/13/2004 12:11 7603605719 YOUNG ENGINEERING SE PAGE 02
r
YOUNG ENGINEERING SERVICES ;
— - - 77.804 Wildcat brivc Suitc-C. Palm Desai CA 92211 Phonc: (760) 360-5770 Fax; (760) 360-5719
V.
May 13, 2004
Tom Hartung
Building & Safety
La Quints, CA 92253
Re: Lot 15, 52-788 Claret Cove, La Ouinta, CA 92253
Dear Tom,
We have reviewed the framing for the above referenced project and find it to be in general
conformance with'the approved structural plans.
If you have any questions please call.
Sincerely,
Jeffrey Bronz Young, S.E.
2
3%Y