9912-225 (SFD)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
480121 B 0220 C36 (19/it)120
1 ,
Date?! !; 5✓4 Signature of Contractor;:"
f
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 offeree(/for
sale (Sec. 7044, Business & Professionals Code). , r 1
( ) 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 j
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 workeis'
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:
Carrier01 , r : ` Policy No. 2_19411M=0%
(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.
Date/,''/?4s '''1 Applicants
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 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) ent%'��-��
9 ( 9 ..^.)7
BUILDING PERMIT PERMIT#
�� f VALUATION . „��,819,30 LOT 16 TRACT 8.332, 1 7
DATE ISL lAtfJJ )
JOB SITE 51,930 AVICNIDA JUAREZ
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER I
\t Ss1J SKr i ! 4 1,6
a`✓tillde...—,
\ 1. IL !� ♦ t!! 1'V i
78-921 iti./'PJrW,7A l' BAY
I3ERINTUDA OUNE,S C --,A 92.261
g60)'415"7106 CA1110 1526
USE OF PERMIT
SINGLE FAMILY DWELLING
,
SFD - P011 fliii LlO,iSs &07 1 -NC i l.f E BLOCK Weu.L OR POOL PLAN C1466%.
!•it;1lt'!'.t4JN ter ! i;i:lii+.f.)(1f.,1�:1) i �R%a #'Y1R MUL f 1T°I,,H. iSs? t11:f`illl.. U!''u'ANe,43
PLAN `!"i PF.
TRACT C ONSTWIXTICYN 1.496.03 SF
PORCi APATIO 33,00 SF
5 FT. WOOD' ENCE . 00.00 l
v
I4 T + A1i~D COST OFC01 ; 1v€gr
91's 9.30
1'EKIWI i FEE SUMMARY
C-rJN.9,rwwn0,N F& 10.1-000-418-000
TIT .AK 04 ,C K FV101-0M-419-(3118 S1277.3.f8
TR
i��sCf 1[ 1te ii.J�t. ■"Arils .f � 9 ^ U V V"�.� i"V W 9'l!S: •N
ELF-C'TI CAL FEE 101-000-42(1.000 $1301 48
LUt4i1i1fOF"J , 101-000-417-000
STRCYNO MMION FEE R SIJ ) 0! 4WP-241-t)(!t!
GRADING foul1 101-000-4.23-000 $20.00
DEWI.OPM, 1!`V1��AC i' i L 4 �i,'3Gy.11U
PRECISE IALAN 101-0011-441.-345 �.10U.9CT
ME PFA1 8Fr 101 -CM -439-318 A%250.00
STJT3-';itlff.A .C;QN4MVCmJI ION AND PIAN C:1- ECK.
$3.,070.04
LESS PRE -PAID FEES
4250.00
WFAL PERMIT FEE .5 DUE NOW
52,82,9.04
RECEIPTDATE
e
BY i�oINSPECTOR
1
W
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_///
Underground Ducts
Forms & Footings
5,/
Ducts
Slab Grade
/
Return Air
Steel
Combustion Air
Roof Deck
_5f
Exhaust Fans
O.K to Wrap
Q •n S7
F.A.U.
Framing
..Ito 5-f
Compressor
Insulation
? , S
Vents
Fireplace P.L.
J
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
-O
Drywall - Int. Lath
• O
Final
Final
_
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs a
Electric Bond
Footings
Main Drain
Bond Beam
7
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
/
Electric Final
Waste Lines
Water Piping
�L� �
3
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
3 - IS - oa ST
Encapsulation
Gas Piping,
Gas Test
-
Appliances .
`
Final
COMMENTS:
,4r as
Final
Utility Notice (Gas)
ELECTRIC
APPROVALS
Temp. Power Pole S ,0
Underground Conduit
Rough Wiring
Low Voltage Wiring
Futures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
67(
Utility Notice (Perm)
P.O. BOX 1504 APPLOTION ONL
Building 78-495 CALLE TAMPICO
Address r • �3 a dG JuA aCZ LA QUINTA, CALIFORNIA 92253 Ch'`
Owner ,
li.)S IAk_i/6-f...
Mailing
Address (�
City f
p Tel.
e V.
LDING: TYPE"CONST. ._ OCC. GRP.
A.P. Number i '7 _3 " / S S- - 0o 5
Legal Description 1, l 7.3 L F 7 2 fy/ 13 N 4-10 S-1 �
Project Description '3F7 N I
12 i "r foP+Ty��
State Lic. t & Classif. �,cSq. Ft. !?
Arch., Engr.,
Size / S oL)
Designer ��
Address Tel.
3-6,110 IL-l4A,�, et► kik 1 71)
Cit Zi State
1 } Y! P
t 4L.la, ]ESC-tI i I C'1i3+`�/,,n I Lic.#
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Divisipn 3 of the Busin oss a d Professions Code, and
effect. my li ns rfs in full farce and
✓"
112
SIGNATURE DTE
+6WNER-BUILDER 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 that. he 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).
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, 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 is 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-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
1'7 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I herebyaffirm that I 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
r7 Copy is filed with the city. ❑ 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 (E100) valuation
or less.)
I certify that in the performance of thq 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: If, 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
I hereby 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
ddress
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.
I certify that 1 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 -of this city to enter the above-
mentioned property for inspection purposes.
Signature of a0plicant Date
Mailing Address
City, State, Zip
in l ve
No. No. Dw.
Stories s Units
New)( Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
1
Plan Chk. Dep. GGp•""
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
.r
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Lipp.,
Side Street Setback from Center e
Side Setback from Property Line A,j
FINAL DATE INSPECTOR JoA .3 �C
; �
' r�l
Issued by: Date -Permit- r G A J
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Date 1/3/00
No. 19862
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Owner NameFelipe Fregoso & Luis Herta
No. 51-930 Street Avenida Juarez
City La Quinta
Tract #
Type of Development
Comments
Lot #
APN # 773-155-009
Jurisdiction La Quinta
Permit #
Log #
zip 92053 Study Area
Square Footage 1496
Single Family Residence No. of Units 1
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 1,496 or $ 2,887.28 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now,be'issuedj'j
Fees Paid By CC/Bank of America/Felipe Fregoso Telephone ,
Name on the check^
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Ellen Patino Payment Received $2,887.28
Check No. 2002569240
Signature &�W
NOTICE: 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
collect 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
OPaL.A Q il r ,
�+/AY7A
�Uk v9 RECO
RC District - Planning Review Form UILL � �
This form is to be usedby CDD staff for review of single family dwellings in the RC (Cove
Residential) District, in order to determine the applicabitity of compatibility issues or need
to require the filing 'of Master Design Guidelines by the applicant. It shall be transmitted to .
Building & Safety as your correction list. Please attach additional explanations as necessary.
APPLICANT: DGH Development Corp.
PROJECT
ADDRESS: 51-930 Avenida Juarez
APN: 773-155-009:.
LEGAL: LOT 16 , BLOCK 32 . , UNIT S.C. @ V.L.Q.
CK'D Bl(:
Grea Trousdel]
Case logged and number assigned .
Verify legal and APN information
BIN NO:.
v CASE NO.
' 9.9-101
CHECK -DATE:
Inform the assigned Building plan checker upon your assignment to this case. The CDD
Executive 'Secretary maintains a log book to track applications and assign case numbers.
REQUIRED ITEM
Y N I COMMENT/CORRECTwu
Case logged and number assigned .
Verify legal and APN information
1
QUI
Consistent with MDG on file las applicable)
i
MDG filing required (5 + filings since 9/3/98)
N�
Consistericy-with-street/surrounding area:.
. Colors
Materials
Architecture
OTHE REQUIREMENTS:
A L.%a CSL_ r t
U
The Toning code, architectural and landscaping manuals, and/or assigned inspector should
be consulted where uncertainties arise. The completed' checklist shall bemaintained.in the
Building '& Safety address file. , ,klil
tie
.Lr j
I
CI.TA Standard Coverage Policy of Title Insurance
Fidelity National Title Insurance Company
A STOCK COMPANY
NUMBER
NUMBER 27-01-90 3 7 0 9 4 8
CLTA STANDARD COVERAGE POLICY OF TITLE INSURANCE
SUBJECT TO THE EXCLUSIONS FROM COVERAGE, THE EXCEPTIONS FROM COVERAGE
CONTAINED IN SCHEDULE B AND THE CONDITIONS AND STIPULATIONS, FIDELITYNATIONAL
TH7LE INSURANCE COMPANY a California corporation, herein called the Company, insures, as of
Date of Policy shown in Schedule A, _against loss or -damage, not exceeding the Amount of Insurance
stated in Schedule A, sustained or incurred by the insured by reason of:
1. Title to the estate or interest described in Schedule A being vested other than as stated therein; .
2. Any defect in or lien or encumbrance on the title;
3. Unmarketability of the title;
4. Lack of a right of access to and from the land;
and, in addition, as to an insured lender only:
5. The invalidity or unenforceability of the lien of the insured mortgage upon the title;
6. The priority of any lien or encumbrance over the lien of the insured mortgage, said mortgage being
shown in Schedule •B in the order of its priority;
7. The invalidity or unenforceability of any assignment of the insured mortgage, provided the
assignment is shown in Schedule B, or the failure of the assignment shown in Schedule B to vest
title to the insured mortgage in the named insured assignee free and. clear of all liens.
The Company will also pay. the costs, attorneys' fees and expenses incurred in defense of the title or the
lien of the insured mortgage, as insured, but only to the extentprovided in the Conditions and Stipulations.
IN WITNESS WHEREOF, FIDELITY NATIONAL TITLE INSURANCE COMPANY has caused this Policy
to be signed and sealed by its duly authorized officers as of Date of Policy shown in Schedule A.
Fidelity National Titl® Insurance Company
BY
�//
..'SEALS
+: President
ATTEST
Countersigned:
Authorized Signature Secretary
FORM 27-01-90
Reprinted (2197)
California Land Title Association
Standard Coverage Policy Form - 1990
i
SCHEDULE A
Order Number: 514117 - Policy No.: 27-01-90 370948
Amount of Insurance: -
$ 8,500.00
Premium: $ 395.00
f
Date of Policy: January 28, 1999 at 08:00 a.m.
1. Name of Insured:
Felipe D. Fregoso and Luis Huerta
2. The estate or interest in the land described herein and which is covered by this policy is:
A Fee
3. Title to the estate or interest in the land is vested in:
Felipe D. Fregoso, a married man and Luis Huerta, a single man, as tenants in common; subject
to the community property interest of the spouse of Felipe D. Fregoso
4. The land referred to in this policy is situated in the city of La Quinta, County of Riverside, State
of California, and is described, as follows:
SEE EXHIBIT "ONE" ATTACHED HERETO AND MADE A PART HEREOF
THIS POLICY VALID ONLY IF SCHEDULE B IS ATTACHED
J
ii'
Certificate of Occupancy
City of La Quinta
Building and Safety Department
11
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 or use. For the following:
BUILDING ADDRESS: 5
Use Classification: SFD
Occupancy Group: R 3 Type of Constructio
s
Owner of Building: FELIPE FREGOSO & LUIS HERTA
1-930 AVENIDA JUAREZ
n:
VN
Bldg. Permit No.: 9912-225
Land Use Zone: RC
Address:
City:
By: STEVE TRAXEL
Date: 09-24-01
Building Official
POST "IN A CONSPICUOUS PLACE