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0007-307 (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 �+ ,date 4t '°/ Signature of Contracto2`'-*' OWNER -BUILDER DECLARATION t 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). ( ) 1; 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 I 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 subjecPto the workers' compensation laws of California, and agree that. if I shouldbecome subject to the workers' compensation provisions of Section.3700%of the Labor Code, I shall forthwith comply with those provisions. ,x *' , k5l! '' Date: :..Applicant f � �• , .. .F�:••"'+%`'°"fit i s* Warning: Failure to secure Wor rs' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fine's 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. u 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 i whose request and for whose benefit work is performed under or pursuant any permit issued as a result of this applicaton agrees to, & shall, indemnE & hold harmless the,.City of La,Quinta, its officers, agents and e I ees. 2. Any permit issued as a result of this application becomes null vif 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 lawsrelating to the building construction, and hereby authorize representative`s of this;City to enter upon the above-mentioned propertytfor inspection purposes..- f Signature (Owner/Agent),;9 " '� -•' - � Date"i-12, " b BUILDING PERMIT PERdrW 'o r� DATE VALUATION LOT ssd=i� TRACT t6"�w3 d'Ck 2f)PIT 1"2.5 JOB SITE APN ADDRESS OWNER CONTRACTOR / DESIGNER / ENGINEER .`ay�ra•Cro'�F'�•�L.��+3'�Ej�p�3 1ry�/��3•yp p(( y��Ci--rii(��•.�•(�f7'�,tL` .3 f s 5. 0.LR.kr�Ji.Ti..l. [�&`LAM IYR +� '�, 3? 3VV Y,L•ei.1. 4WI �11'•:12d, 0-1•.[4 +1'WXT&AND PAUV18 CA. 92276 `};:HOT SHAD PAL S C.A. 9ZV6 (7f*)343.1134 CUR '573 USE OF PERMIT 3W 2RAUT PDXS NOT MUCIDED HLOCKWA W 'tG?2-ORiiFEW,R.i" ,1 PORCbi/T.PnrY•IO 134.00 S 0ATIAOWC.+°i13.1 OWt 0011 9,996.00 5 're, WOOD FENCE 2001001 Ily ELl11RAJ.VA,f.Avf1JKD l •i#p',rr R"!.%` LmODd.i'.SINT✓ 4r�J1,9,O.t`i W+'b?9tW.+V4 11TUR ARPOW 101 -000-439-31 U UK 09 G:iJ'AiS•31Rf:!CTION WE 101-00"18-000 $391.0 f:'6. VIN CHICK PUS 101-000-439-318 9-318 1481, 4 kUdlr'GaHAWICA:f,. PLIZ 101-000-421-000 $33. A RLECT;RIC A1, ftR 101 w000-420.000 $1.0,46 PLUM."40 FFXI $110.7-5 I t'RONO NIOM-N FEE, • RfeJaD 1. 01.000.241.000 $8.60 - ORA-T)WO FF. R, 9 0i _(X10-423-000 $30,00 'P -I CWP FEE �" 10'1-000.441.-349 yid i?3Y'l•` 1..• Ct:9Nh";iA11(f),ION AbID PLAN CURCK 2 2001 un ,371.5 :r...41r; PRt-FAM F -RES 4,250.00 U� I'M. T.U. D'UR, NOW i > i RECEIPT DATE r , t JJr BY DATE FINALED INSPECTOR J INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings �3�Q /f `j l Underground Ducts Ducts Slab Grade Return Air Steel Combustion Air Roof Deck 0. K. to Wrap Framing Insulation Fireplace P.L. ttt - ( �- t 1 5 ` Exhaust Fans F.A.U. Compressor Vents Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final — �O S� Final 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 Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Water Piping .` _� Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection (�i z� —,�( 4!.':) Encapsulation Gas Piping Gas Test _ Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service r Sub Panels Exterior Rgceptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) ', Z Building � 3 ` C' � O Address b T4tyl 4 4 " P.O. BOX 1504 78-495 CALLE TAMPICO OUINTA, CALIFORNIA 92253 Mailing Address City I Q Zip Tel. �_ O � �`� 36 ►gaol �i5�s7 l---UKJ_ooQ1Sf I Address �\ 55 CA �Lti Cii-o �ZAU �V 14 N�J"1-2.5(0 I )1 1 State Lic.: City & Classif.`gIiI, a 'Z cj Lic. # Arch., Engr., p� Designer �1, Kt ,`Y\ t -W j)0 Z Add ess�O x a g F' (p � 2 0 Z 0 q�CityZip State t x,�FY�i�CA ZZ 40 Lic. # 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 1 DATE OWNER -BUILDER DECLARATION I hereby, affirm that I am exempt from the Contractors License Lawfor the following reason: (Sec. 7031.5,8usiness 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 �fcommencing 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'flian five hundred dollars ($500). lJ 1, 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.) 1*1 1, as owner 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.) 17 I am exempt under Sec. S. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm 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 F3 Copy is filed with the city. O 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: If, alter 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 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 I have read this application and slate 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 aQplicant Date Mailing Address City, State, Zip APPLICATION ONLY , ILDING: TYPE'CONST. ODC GRP. '. Number / 73 / `-'' l J ^ ; 7i 1 Description S ?-71/ P75-,- WY Sq.Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition `000/1,to mos -mz 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 Perrrii ` Validated by: JUL 3 1 2000 Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Estimated Valuation i PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL /J 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 Perrrii ` Validated by: JUL 3 1 2000 Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 2/23/01 No. 21693 y Jurisdiction Owner NameSo-Cal Builders No. 53-800 Street Avenida Navarra city La Quinta zip 92253 APN# 774-175-003 La Quinta Permit # Tract # Lot # Square Footage Type of Development Single Family Residence Comments Log # Study Arca 1336 Ni. of Units 1 At the present time, the Desert Sands Unified School District does not collect fees on garaps/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 Mfowing reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 2.05 X 1,336 or $ 2,738.80 the property listed above and that builang permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued Fees Paid B CCNalle Independent Bank - Mike Roberts ' By Y P Tele hone' 343-1134 Name on the check p�'m t By Dr. Doris Wilson Superintendent Fee collected /exempted by Ellen Patino Payment Received §A0, Check No. 239098 11 Signature IOTICE: 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 bes or other payment identified bove 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 Aug 02 00 12:49p GARY SCOTT 760-779-5134 p.1 RECORDING REQUESTED BY: i' AND WHEN RECORDED, MAIL TO: KeVin •Boasberg/Ronald Barry KEVRON DEVELOPMENT CORP. .16,200 Ventura Blvd., Ste. #302 %? f'j — /7,5 C0,5' s { Encino, -CA 91436 THIS SPACE FOR RECORDER'S USE ONLY ASSFSSOR'S PARCEL No.: 774-175-003 The undersigned Grantor(s) declare that the DOCUMENT TRANSFER TAX IS: TITLE ORDER NO.: 504889-13 $ 20,90 County $ City xx computed on the full value of the inte-est of property conveyed, or ESCROW NO.: 6207 -CW _computed on the full value .less the value of liens or encumbrances remaining thereon at the time of sale. OR transfer is EXEMPT from tax for the following reason: GRANT DEED FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Mark Von Esch an ie on Esch, Trustees Von Esch La Quinta Trust dated July 7, 1998 hereby GRA (S) to KEVRON DEVELOPMENT CORP., a iornia Corporation all that real situated in the City of La Quinta County of Riverside, State of California, described as:. Lot 20 in Block 251 of Unit 23 Santa Carmelita at Vale La Quinta, aS per map recorded in book 20 page 25 of Maps ---ia-the-O#ie ounty Recorder of Riverside County, California Dated June 21, 2000 ST^.TE OF CALIFORNIA COUNTY'OF ON ,iZAe before me s 'K2ad e/ _ Mark Von Esch, Trustee Notary Public; personally appeared �- �IIIea�C Leslie Von Esch, Trustee personally known to me (or prorad to me on the basis of satisfactory evidence) to be the person(a-whose nameW 4slare subscribed to the within instrument and ar%knowledged to me that bie they executed the same in .199715edtheir �1 auth:jrized capacity(fes and that by l�adiheir signature( on the instrument ;; c. ' COMM # 111`}418 the person( or the entity upon behalf of which the person acted, executed -� M .:.e instrument. �, NOTARNNRIC-I I�Rt11A WITNESS my hand and official sea). W • ORANGE COUNTY NH carenmion bOls UOL 4,2000 Signature -�^� �w,.�-•� �^ •• MAIL TAX STATEM . TS TO: (This area for official notary sea]) Same as above RC DISTRICT - PLANNING REVIEW FORM y This form is.to be used by CDD staff for review of single family dwellings in the RC (Cove Residential) District, in order to determine the applicability of compatibility issues or need to require the filing of Master. Design Guidelines by the applicant. It shall -be transmitted to the Building and Safety Department as your correction list. Please attach additional explanations as necessary. r APPLICANT LDR Construction, SITE ADDRESS 5:3 -800 -'Avenida Navarro G'?� - APN ffBIN NO.: CASE NO.: .2000-284 LEGAL: - LOT' . BLOCK- UNIT S.C.@V.L.Q: ' CHECKED BY: Fred Baker ' DATE: ' Inform- the assigned ,Building plan checker upon your assignment to this case. -he . CDD Executive Secretary maintains a log book to track applications and assign case numbers. y' -REQUIRED ITEM Y N COMMENUCORRECTION Compatibility Review , Case logged and number assigned Verify legal and APN information _Consistent with'MDG on file (as.applicable APP' RQVEp By MDG filing "required (5 filings since 9/3/98) CASE N0, Consistency with street/surrounding area: Colors Materials ' Architecture Other Requirements: I , Certificate of Occupancy City of La Quinta'. Building 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: .53-800 AVENIDA NAVARRO Use Classification: SFD Bldg. Permit No.: 0007-307 Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC Owner of Building: SO -CAL BUILDERS' _7_�&04n Address:- 31-300 DESERT PALM DR. City: THOUSAND PALMS, CA 92276, By: STEVE TRAXEL Date: 08-07-01 I Building Official 'POST IN A CONSPICUOUS PLACE on 121