0209-160 (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
599..49A
Date Signature of Contractor �',` ��! r '� :'•°�'��s
,r
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 STA'Fi?# FUND Policy No. GoJ-its-b�21�)'i
(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: Applicant `
X." ." / l 7:.,. f ,
' 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
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 upoJi
the above-mentioned property for inspection purposes. r
�'A.
rSignature (Owner/Agent) Date ---
ate . 3
'
PERMIT #
PERMIT;,_,
.BUILDING
DATE VALUATION4}f ,z LOT a TRACT
JOB ADDRESS !4-99170 A�'a'Y�',F�IPA a�7A.RF �
APN
OWNER`
CONTRACTOR /DESIGNER /EN 1NEEER
•yvT+✓T1� 6S9E KAGG7ER,
GAiVYR A), CONSR.IETiI
P.M.M. i1r"I1r tiT 99,6
ItiANC--140 j 4s 4:,1t 922,70
USE OF PERMIT
sNi3°IZ,17AMU Y DWIRLIMP
—NS
4AFLf . 1, 4.J L 4.3, -&YS IVAi , PJ%Jil a JMtff1, AIN\.a+,1i, t? tit'".
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T]�ACT CONSTRUC:TION 7'1moD S.?
Pt PICIl`iiP.P.`P1,0 343. W 11
O.Mt.M.)FIG:»ARPORT 492.41113E
CONSTRUCTION FRE 101. -WO-41 8�IXXO
PLAN CHR-rYEB? ,:W+!•'-43+9-318 8�i}ci,`k1
FRE INWOM"Al
N3T".7C;.M�.A{. fICgA:iq,�tT{Lt'� 2111-3��y350-422••♦��i001�°��'•.6S
Yt3 9
rI,SDIsfDI3F:'sC1 >fl;. i C-% 000.4119-00(:4 $11160)o
P IS - TB.esm ;( 01 oiio-;' 4.1 M�o
s71'-�'Pt��oklo 1y�t((OT
�.1,164
y., rrl..�!!2
v1lYi.rw 7�y��2' .li - SSfT-`,00-47,'- 00 .ry]IC,`tlf?
DFIVEI.t;JPER, IMPACT FSS,
PRECISH, Plit. N 109 -0005 4141-345
SUB , CONt.T'p, (M'101 AM) i-iL�AWICITFTE�t.��C.'yyK
APR 28 2003
CITY OF LA QUINTA
FINANCE DEPT.
RECEIPT
DATE '`�
BYfli
DAT INA
INSPE T R
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
G
Ducts
Slab Grade
Return Air
Steel
3
Combustion Air
Roof Deck
14,
Exhaust Fans
O.IC to Wrap
F.A.U.
Framing
0113
Compressor
Insulations
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
d 3
Drywall - Int. Lath
Q
Final
Final14L4 Z WAPOOLS
BLOCKWALL APPROVALS
- 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
Seaver Lateral
Pool Cover
Sewer Connection
—
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole , p
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:
Lot #, No. Street S.F. Lot # No. Street S.F.
Unit 1 31 54990 Avenida Juarez 2110 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments $21.40 balance due paid in cash.'
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, 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 $2.14X 2,110 S.F. or $4,515.40 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/Canyon National Bank - Vickey Pawley Check No. 14119
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
5
Fee collected /exempted by Sharon MCGilvrey $4,494.00
�. Payment Recd Over/Under
Signature r
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 District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
Recording Requested By
REr� First American Title Company.
ORDER# 530614 /Esc#608484=PB
APN .774-266-026
WHEN RECORDED MAIL TO
Name
Street
Address
City
State
Zip
r Suzie Waggoner
Bill Waggoner
P. 0. Box 816
Palm Desert, CA 92261
_j
0&0— M
DOC sit 2002-236310
05/03/2002 08:00A Fee:40.00
Page I of 2 Doc T Tax Paid
Recorded in Official Records
County of Riverside
Gary L. Orso
Assessor, County Clerk 8 Recorder
1111111111111111111111111111111111111111111111111111111
ooe
MmeMMMmammmmumNEEMMMMMMMMMMIMMMMMMM
Grant Deed
The undersigned grantor(s) declare(s):
Documentary transfer tax is $
( X) computed on full value of property conveyed, or
( ) computed on full value less value of liens and encumbrances remaining at time of sale.
( ) Unincorporated area: ( ) City of ..................... � , t.......0 2v1�....... ............................................ ....
,.........
( ) Realty riot sold.
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
Enzo G: Provenza, Successor TTEE, of the Louise L. Good Trust established
February 26, 1992
hereby GRANT(S) to Bill Waggoner and Suzie Waggoner, Husband and Wife
as Joint Tenants
that property in Riverside County, State of California, described as: LEGAL.
DESCRIPTION ATTACHED HEREIN AND MADE A PART HEREOF AS EXHIBIT "A"
Mail Tax Statements to Grantee at address above
Date
March 15, 2002
STATE OF CALIF NIA .
COUNTY
,OOF' C- &__ .�
On � - '� — 0� before me, the
unders ned, a Notary,�ub to and for said State, personally appeared
O�i'Ic9 �l �.�Z�Q//��/ila�
personally !mown 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 be/she/they executed the same in
his/her/their authorized capacity(ies), and that by his/her/tlieir signature(s) on
the instrument the person(s), or the entity upon behalf of which the person(s)
acted, executed the instrument.
WITNESS 4nind and official s I.
Signature
Name
(typed or printed)
FTGIS•140 8/94 .
e PEGGY BAUMGARDNER
V), COMM. #1280014 n
fY NOTARY PUBLIC -CALIFORNIA A
U RIVERSIDE. COUNTY to
My Comm. Exp, Nov. 8, 2004
MAIL TAX STATEMENTS AS DIRECTED ABOVE
(This area for official notarial seal)
� o
i
r
Legal Description
Lot 13 and the S6uth Half of Lot 14, Block 276, of Santa Carmelita at
Vale La Quinta, Unit 25,. as per: -,.map recorded in Book 19, Page 51 of
Maps, Records of Riverside County,{California.
i .
I
2002-236310
II IIIIII VIII VIII IIIIII III IIIIIII III VIII IIII IIII
@5/03/2092
2Q 00R
� VIII
Certificate of Occupancy
a
4
ILAM
5�
OF�ti Building & 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: 54-990 AVENIDA JUAREZ
Use classification: SFD Building Permit No.: 0209-160
Occupancy Group: R-3, U-1 Type of Construction: VN Land Use Zone: RC
Owner of Building: BILL & SUZIE WAGGONER Address: P.O. BOX 816
City, ST, ZIP: PALM DESERT CA 92260
By: KIRK KIRKLAND
Date: 11-17-2003
Bui ding Official
POST IN A CONSPICUOUS PLACE
Jun 17 03 11:54a GCM 760 779-1516 p.2
06/17/2003 11:28 7603457315 EARTH SYS -EMS PAGE 112/Ub
EarW-Sys# .
.� Southwest 79-811P Country Club Drive
Nam& Dunes ..CA92201
(760)345.1586
(800).92.4.7015
FAX (760) 345-7315
r
lune 5, 2003 File No.: 09234-01
03=06-724
General Construction Management
71-301. Highway -1 11, Suite 8,
Rancho Mirage, California 92270
Attention: . Mr. Gary Covel
Project:. 54-,990 Atienida•.J*arez-
La Quibta, California
Subject: Report.of Field. Density Testing,
Nouse Pad
On June..2,.2003,.a.represmtatiue.of..our..firm .perforrned density -tests --at. the above referenced,
project. Tests were performed at random locations in accordance with ASTM. D 2922-81,
.Method A -or. 3; and ASTM. D-301.7-WNuclear- Density Test Procedure: Tuts werc-pc.rFormed
as per authorization of Mr. Gary Covel..
The estimated locations of the tests are presented on the atu ched plan with their results being
summarized_on-the.attached test nepog sheet. A total of Iden,-ity testgwercperformed.
Tcst. results. indicate- ihat..a..rWnimum. of 90"la'relative- compaction: hag beets obtainer within - the,
areas tested..
The maximum.. density. and optimum. rmoistuxe. are determined- in- lle. laborator=y in- accordance
with ASTM D 1557-91, Method A, B or C.
Test results arc as follows:
Soil Description USCS Maximum Dpwi y optimum Moisture
Brvwrr silty Sand;
fine to coarse grained Sm 120.5.pef...
DISCUSSION:
I. The -project is. located .aL54-990LAvenida Juarez in -the City of La-Qt1►ltta; California,.
2. Prior to our arrival, the building. pad had been graded.
3. The purpose of testing was to observe compliance with 1.he minimum requirements of the
City of -La
Jun 17 03 11:54a GCM
06/17/2003 11:28 7603457315 EARTH SYS"EMS
June 5, 2003. _.2. _.
LIMITATIONS
760 779-1516 p.3
PAGE. b3/ b5
Pilc-No.: 09234 t: t.
03-06.7- -J4
The test.results.summaraaed-in-this seporf present the moi*tore-and • density -only -at-thc-• ocm ons
and depths tested on the specified dates. The summarized field and laboratory tests were
performed-im eeordanee-with enginceringpriTreiplcs general),r-accepted at this time and .iocati6n,
No opinion .is expressed as to the uniformity of the material or compaction. No guaranty or
warranty of -the conttaetar's work is macfie or implied. The test locations are approximate and'
were determined by pacing and sighting from prominent field features. In our work,_we have
relied on topographic and surveying information provided by ethers.
With. any..manufactured. product. ..Ome.-are stat.iAkal..vmiations in -4t,*. uniformity- andirr -the\
accuracy of tests used to treasure its quality. As compared with other manufactured products,
field -construction usualtypresems-large-statttticai'vanatwns* iii itg uniformity and accuracy of test-
results used to measure its quality. Thus, even with very careful observation and. testing, it
cannot -be said'that alt'parts of ft product comply with tile"joh requIremeiits although the degree
of certainty is greater with full-time observation and testing. than it is with testing..only.
Therefore, our opinion based on testing the work means tha: there is only a statistically based
probability. that the densities obtained comply. w.ith.thc.joh.recFriretts,
This report is issued with the understanding that it is the responsibility of the owner, or of
his.. representatiti+c•..ta.wmime• that. thin. repent: is --O& Hitted--to- the.. appropri3te--gover"i»g'
agencies.
if there.are..any.ques6onsplease. do. not -hesitate .to.contact. this of -e.
Respectfully. submitted,.
EARTH SYSTEMS SOUTHWEST
tDO
Phillip D. Clanton
Supervisory Technician.
Cbmpacti.on/pdc/csh/kcj
Distribution:.. 4/.General Constr w4jor (�artager
1/RC File
2BD-File
EARTH SYSTEMS SOUTHWEST
Reviewed b QROFESSJOti
w • C011234
Craig. S.. }4j EXP. W31 /as �
CE 3823
Jun 17 03 11:55a GCM 760 779-1516 p.4
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REPORT.OF RELATWE C(3MPACT ON&>.
JOB NAME: 54-990 Avenida. Juarez FILE NO:: 092344k
LOCATION: La Quinta, California
h
RC.PORT NO: 03.06.724
Test No
Date Tested
Description Elevation
%Moisture Dry Density
Relative
V l VA f
Maximum
In Place In Place
Compaction
Den4ity
1
06/02/03
Per Plan FPG
3A 1.10.2
91
120.5
2
06/02/03---
- -Pcr :Plan FPG..
s :2 113.9
94
12O.S
3
06/02/03
Per Plan FPG
1.5 111.9
92
120.5
FPG = Finish Pa.d. Grade
June 5, 2003
EARTH SYSTEMS SOUTHWEST
Jun 17 03-11:55a
06i17/2003 11:28
I
GCM 760 779-1516 P.5
7603457315 EARTH SYSTEMS PAGE 05/05
Estimated Test Location
r •
COMPACTION MAP
Job Name: 54-990 Avenida Juarez
FitLx-*N&.,.- QM4 lUT'
A&L EMWW.BYBWns-..
Southwest.