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0106-045 (SFD)LICENSED CONTRACTOR DECLARATION I herby 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 Date 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: Carrier 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 workeJ S compens�a,SrorY'provision of Section 3700 of the Labor Code, I sh II forth 'fh comply Rh thos fp�rov�ision'�s:- Date: of fADDIi>; nt -"Wairningc Failure to secdrQ_„Ko•fWrar- ompensation 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 works 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 Jaws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for-irispectio. purpose's. �3 Signature low ner/Agee)"C�'�� Date 4 BUILDING PERMIT PERMIT# DATE j elf VALUATION LOT�,efjr Arm TRACT BLK. 276 JOB SITE ` '^' """`— APN ADDRESS OWNER CONTRACTOR/DESIGNER/EN (NEER DRAt3 j:1�#'ifi`I:9IN 13 C3G �� Testi A) B(,,)X 51 7 X) Dox 5 V LA Q11MA C A, 92253 1A CaVIMITA C4A 92253 C160)409.5422 C'BIA 2387 USE OFPERMIT 8114011 XV FTyLJqWY&3S10 srol-PrA>3?vkadar TcIrm iLCCWASs OR"Crox,OR. I'Af VWXY APPROACH, grNCH M1J.M. 6dJPIL-)-98 y/EE[ TRACT (K.MS3'1'RUCTJOIN I.,vao up 5 FT. WOOD MACY LF PRPAUTM SUMMARY CC`31+1'STRUC ION Pal 10.1-000-418-000 W.L.50 PLAN CHECK ig i 101-000.439-•318 �'?'!;� �►'I:Pt;:i;11!"I' 3 t�1 � 1A£�� ,93�vn� elJlit.Ci �elGFslf,F' � 10°-000-x•25-0010 giba.a74 101-00"19-0013 SUMMI MOTION FFk.. REST) :.01.OW-241 pi. oo 2 mut1 +O17 iy„l3YI*lCI'1 1r =' T 61-000.423.01 0 X20.00 P1,001312i PLA.14 101-000-441-245 .14 e D ”, %�.,�pi.y0l1 3,7Lt-I•Y' 1VSAL C�JLtlRS�RX`�«�.J i,.,t„& 'NM S�V. r++ CITY OF LA QUINTA RECEIPT DATEBY 'r .1'`/<<r DATE FINALED INSPECTOR _ .. 9- r; INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings �i % Underground Ducts Ducts - Slab Grade Return Air Steel Roof Deck / `p q• c $ Combustion Air Exhaust Fans O.K. to Wrap -(--dl 7 F.A:U. Framing Compressor Insulation Fireplace P.L. SLS . ( Vents Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wail Firewall Exterior Lath Drywall - Int. Lath 5� r Final Final _aZ2 v POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines��/©_/ 7 Heater Final Plumbing Final Water Piping Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection//p/ Encapsulation Gas Piping Gas Test l ` Appliances Final COMMENTS: �/�% vii% 14 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) VA _� CITY OF LA QUINTA � Y BUILDING & SAFETY DEPARTMENT `yov�• o� m-7012 INSPECTION REQUEST LINE 777-7153 Owner Contractor Permit Number POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES JOB ADDRESS 57e/ #9e2 -LZ` TYPE OF INSPECTION 9ATE INSP. FOUNDATION 8 SETBACK FOOTING STEEL MAIN GROUND SYSTEM GROUND PLUMBING PRE-GUNITE DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED CONCRETE SLAB JOISTS S GIRDERS ELECTRICAL GROUND WORK DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC ROUGH PLUMBING ROUGH GAS 8 GAS TEST HEATING 8 VENT -A/C FIREPLACE ROOF .- BOND BEAM O.K. TO WRAP GROUT 0 4' O 8' FRAMING !� — INSULATION S PRE -ROOF COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED DRYWALL INTERIOR EXTERIOR LATH POOL PRE PLASTER POOL FENCE 8 GATE SEWER SEPTIC TANK FINALS ELECTRICAL PLUMBING FINAL GAS TEST HEATING - A/C HOUSE NUMBERS JOB COMPLETED TEMP POWER ABOVE APPROVALS -DO NOT INCLUDE RIGHT TO TURN ON UTILITIES OR OCCUPY BUILDING Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 8/28/01 No.. 22423 Jurisdiction Owner NameBrauckmann, Inc. No. 54-820 Street Avenida Juarez City La Quinta zip 92253 Tract # BLK 276 Lot # 22 Type of Development Single Family Residence Comments r APN # 774-266-003 La Quinta Permit #0106-045 Log # Study Area Square Footage 1846 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 2.05 X 1,846 or $ 3,784.30 . 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. a Fees Paid By OC / Wells Fargo & Co. - Mike Brauckmann Telephone Name on the check» By Dr. Doris Wilson Superintendent ' Fee collected /exempted by Annette Barlow " 6;� Signature Z Payment Received Check No $3,784.30 7377002958 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 ibove 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 ;ollect 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 AY -21-01 14:34 FROM:FORESITE ESCROW INC. t RECORDING REQUESs°ED BY Chicago Title AND VV'; M RECORDED MAIL TO: BrauCkrn=10C. P.O. Box 517 La Quinta, CA 92253 A.P.N.: 774-266-003-1 TKA. #: 020015 ID:619 773 9269 PACE 2/2 Space Above Phis Line for Recorder's Use Only Order No.: 017056931 Escrow No.: 2-33747 GRANT DEED S ab s . SlW- . THE UNDERSIGNED GRANTOR(s) DBCLARB(s) TRAT DOCUMENTARY TRANSFER TAX IS: COUNTY $33.00 ( X ) computed on full value of pr erty conveyed, or [[ ]]J computed on full value less value of liens or encumbrances remaining at time of sale, unincorporated area; [ X l City of La Quinta , and FOR A VA LIABLE CONSIDERATION,'Receipt of which is hereby acknowledged, Danny Dusan. Spasojevic, a Married Man hereby GRAItT(S) to Br-auckmann Inc., a Cali.formia Corporation the following described property in the City of La Quinta, County of Riverside State of California; Lot 12, Block 276 of Santa Camtuelita at Vale La Quinta, Unit #25, as per map recorded in Book 0, Page(s) 50 of Maps in the Office of the County Recorder of said County. . f Daos1 Du aso'evic, b ub' a evic by!Y=4�1 �factg y J Y L1 J _ Document Date: „ May 14.2001 1 1 e STATE OF CA,L ORNIA )SS COUNTY OF e } On / "2-0d before-- persoually ed j& j 5PYA personally known to me r v to be the person(s) whose nam(S) is/ao&mbatribed to the wilin insovmemr and acknoedged to me thu to/sheAwr exeenred the same in+ja/hcrAwir authorized capacity(ies) and that by4h /her/&ert signaturerume s) oA the instnt the persons) or thezp6ty,ujon behotlf' offi7tbe person(s) ached, executers the iusaurnent. f This area for official notarial seal. ...�� L.:A NE FL—OA—M-1 L Ali F FLOAN (258837 Y.. Cc• gym. # 1258837 ray 4ar.��; ; ua�ic cauFaaatA {� st NGTaeYPURIC-CAURAN1A w �.. IfYtW08 Couatr Riverside County My `a �T• Ezpire: Ayre 23; 2004 '� a �y Cc�n. Exsurot Apra 2a, 2094 Wail Tax Statements to: SAME AS ABOVE or Address Noted Below 4 4 Certificate of Occupancy City of La Quinta 13uilding and Safety Department 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: 54-820 AVENIDA JUAREZ Use Classification: SINGLE FAMILY DWELLING Occupancy Group: R-3, U-1 Type of Construction: Owner of Building: BRAUCKMANN INC Building Official VN Bldg. Permit No.: 0106=045 Land Use Zone: RC Address: PO BOX 517 City: LA QUINTA CA 92253 By: KIRK KIRKLAND Date: 02/22/2002 POST IN A CONSPICUOUS PLACE