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0306-185 (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 Signature of Contractor 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). ( �N)t 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 gate �` ' r', 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 workers' compensation provisions of Section 3700 of the Labor Code,,I shall forthwith comply with those provisions. ate' -`,y , Applicant %` ,ri<,a r`sk... ,.�.�..e I� .P 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) �- / �-� Date /_ BUILDING PERMIT PERMIT# - DATE . VAI DATION LOT'-` TRACT JOB SITE APN ADDRESS �1,i-�hi �t� .�_ f ��r'��r.�A e� !y446!� i-04 OWNER CONTRACTOR / DESIGNER / ENGINEER P101 £iUX 357V t . 00 11 i+cF nc PERMIT �lA�Gxf:N� 2+'lai��(~:ir .I:��:P�'•,.::.,T'1't7 TPA(` Cr;N,400UCT140N %gru.0 -,TIP 46.00 ^1.sf=(;I'TsD CCotro:f.'rN'��' r,.a')I�T �ti,3�:�¢�''''c`J:(�t`i ?. a.!�:►�t;�1.,tirJ CG`lrS`i'IiUM7,011 Fir 10 >'-000 413 )GO $671x" PI.A{{&..�ypc.. HPCT11': !-W".1d 1074110_01_4131:`_M L� E U'K"?,,031T 1GA"�i)t7 ^Q.'��•`�+If3-P�.7l�.t�J ME f��l^.1`S'.htf.t;,:.'•.lsY?a: 4>Ut-%?t1t1wR2'i-C��a 3:9.'3 Pl—UhIBINQ lo'FRCNG MOTION ?F5,R;t JID I01-1''V,241,€);:C'9 3t�.t1Ci DRVEWPER 11 k'i2MNSE '?,+.. A N 3 0 i. -000-44 t .' 4' 5 $100.0 t��il�rl��.�A:..��`r�r��l�.ra�c.�,��.��t.�i.�r�r,�a��`�;�.�� 1 �:;; ; t•� D €" IN IYTJ:1 MAY � �; c^..17 .qPP 2 2 2003 CITY OF LA QUINTA FINANCE DEPT" RECEIPT DATE BY t DATE FINALED INSPECTOR 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 4911, Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste LinesEYE_ Heater Final Water Piping _ Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection _ CT 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 Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) i f�'�itrGv P.O. BOX 1504 APPLICATION ONLY Building S3 p . )0 vA,2v 78-495 CALLI= CALIFORNIATAMPIO Address –0 6 �lJ LA QUINTA, ORNIA 92253 Owner — _ City, State, Zip WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE BUILDING: TYPE'CONST. A.P. Number 77,51r-0 Legal Description Project Description OCC. GRP. 0"1 Mailing Address J?� �� P� Qf C Zip Tel. Contractor &vAA&-., Address City Zip Tel.. State Lic. City & Classif. Lic. # Sq. Ft. Size Q ZO No. No. Dw. Stories Units Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel.Iwo City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION ' I hereby ffflrm 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. Estimated Value n SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason; (Sec. 7031.5.Susiness and Professions Code: Any city or county which requires a PERMIT AMOUNT permit to construct, alter, improve, demolish, or repair any structure, prior to *Its issuance also requires the applicant for such permit to lila 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 Code: The Contractor's License Law does not apply to an owner of property who Plan Chk. Dep. wi1 �, 00 Plan Chk. Bal. Const. Mech: 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 Electrical 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.) . Plumbing I'I I, 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.) I'! I am exempt under Sec. B. & P.C. for this reason S.M.1. Grading Driveway Enc. Date Owner Infrastructure p..,,;..,� ""'��•w �ttl� �• �l,��r 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.) W �� ^ n Policy No. Company Cl Copy is filed with the city. ❑ Certified copy is hereby furnished. ` TOTAL CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REMARKS (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: It, after making this Certificate of Exemption you should become subject fo rhe Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Fear Prop. Line 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.) Side Street Setback 'rom Center Line Side Setback from P'Operty Line Lender's Name FINAL DATE INSPECTOR . 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 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. Issued by: Validated by: Date Permit Signature of applicant -Date- ateMailing MailingAddress Validation: _ City, State, Zip WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE - CERTIFICATE OF COMPLIANCE v�sc Desert Sands Unified School District e 47950 Dune Palms Road zo�c�o BERMUDA DUNESCn r Date 9/16/03 La Quanta f CA 92253 HO RAN ANWE LLS LS CJ � tir INDIAN WE No. 24981 (760) 771-8515 �c}� P IA QUINTA INDIO Owner Mountain Cove Dev. Inc APN # 774-0.35-004 Address P O Box 3578 Jurisdiction Palm Desert City Palm Desert- 'Zip 92261 Permit # 0306-185 Tract # BLK204 Study Area Type Single Family Residence No. of Units 1 , Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 21 53080 Avenida Navarro 1820 Unit 6 . Unit 2 Unit 7 Unit 3 Unit Unit 4 Unit 9 Unit 5 Unit 10 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 1,820 S.F. or $3,894.80 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 Larry Shields Check No. 15683 Name on the check Telephone 760/771.1670 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Sharon MCGllvrey Payment Recd Iso.oa $3,894.80 Overllnder Signature G Y, 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, whi&ever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting CCC ft 2003-22903-7- _-R®�Or&g Requested By ez/?e/zft3 ea:eea F*e-19.69 First American Title Company RecordedPl of 3 00C. r rax Raid `� - - - • Ln otr"Cl'al Records County c/ RlVarstda Rsmeosor, ry L. Orso Co Wh49P Recorded Mall Document i INSw"rty Clark 3 Recorder and Tax Statement To: Mr. -Larry Shields P.O. Box 3578 Pa(rn Desert CA 92201 M s U PncE °A PCOR NxogC 10 XPN: 74-0 A R �v LONG -_ REFUND NCMO .EXAM! « r SRACE ABOVE THIS LINE FOR RECORDER'S USE The undersigned grantor(s) declare(s) Docunnentary transfer ta* is $198.00 'I X ) computed on 'full value of property conveyed, or j )computed on full value less value of liens or encumbrances remaining at time of sale i ] Urincdrporatgd Area City of La Quinta i V1/ FOR A. VALUABLE- CONSIDERATION, receipt of which is hereby acknowledged, Frank P� r) Griswold, Trustee of The Henry Gri$wold Living Trust dated June 1.9; 1.995 Y Successor hereby GRANTS) to mbuntain Cove Development, Inc., a California Corporation i the .fopowing described real property in the City of La Quinta County of Riverside, State of California: See - GATED: January 31, 2003 STATE OF CALIFORNIA COUNTY OF ON .. - before. me, personally appeared personally known to me (oC proved to me on the basis of satisfactory, evidence) to be the person whose name is/ake subscribed t0 the within instrument and acknowledged to me that `he/sN/thby executed the same.in h'is111er/th r authorized capacity( ', and that by his hlr;//thr signature on the instrument the LINDA A. p, person; or the entity ubon behalf of which perSbhX acted, executed the instrument. the Commission >! 1313093 a1. MAIL TAX STATEMENTS AS DIRECTED ABOVE Frank Myrl Griswold, Successor Trustee of The Henry Griswold Living Trust dated June 7 1+995 By: C J Frank Myrl Griswold,. rust a Witness mV hand and official se Signature FD -213 (Rev 719 GAG Notary Public-Cal►fomia ¢� Qrange Ceunty F�Irea Jul 13 X005 l .: �Y Com►n- ; GRANT DEED a C. Order Number: 0625-784481.,(03), Page Number: 6 LEGAL DESCRIPTION Real property in the City of La Quinta, County of Riverside, State of California, described as. follows: Lots 21, 22, 23 and 24 of Block 204, Santa Carmelita at Vale La Quinta, Unit No. 20, as per map recorded in book 19, page 38 of Maps, records of Riverside County. APN: 774-065-001-8 and 774-065-002-9 and 774-065-003-0 and 774-065-004-:1 REPORT OF FIELD COMPACTION CWPAC"M zMOaLmhougg"& IL dr mftmmmw& sots W^X. ow ODOM. PM GIMMA UWA?"& won #Sao phom" lwfia~ No po 0 06 . tow m 40M aommu A"WrAft even. ~AC"M ammum mmmmmmmffm� . @sow* @Now* CWPAC"M zMOaLmhougg"& IL dr mftmmmw& sots W^X. ow ODOM. PM GIMMA UWA?"& 4AtAll po 0 06 . osom 0 op "W com"m even. ~AC"M 4AtAll Y r 0 - ACbmpan-�- 'Can TY �- - CITY -or LA QUINTA 3 j -BUILDING & SAFETY DEPT. ' Y APPROVED FOR CONSTRUCTION 4 DATE 75 /,ST. CHARLES PLACE ' _ SUITE 11A - ; " JOB NO. 6 3� Z PALM'DESERT, CA 92260. -t PHONE: 760'-341-2.232 • FAX: 760-341-2293 NAME L"iE N c. !-4 UE51 G rel G�2 d 1VIANUFACTURING YARD:'PROJECT: LC - nuc. ' ,M P(;\,O 'ca Ll ' 55755 TYLER STREET, THERMAL, CA 92274 FAX: 760-399-.9786 N I. W—NIA—E NATIONAL INSPECTION ASSOCIATION, INC, Inspection of Prefabricated Trusses / Quality Audited by AA -583 ® S PLANTRU55Ct�aRKS ADDRESS DATE/ARRIVE/DEPART 5-P-0,3 PLATE MANUFACTURER �U:5CQn l PLANT CONTACT, �-� U ENGINEERS DES. DWG. 1199Qcl `�%iP�Seme,P Non -Scheduled In Plant Audits As Per Uniform Building Code Section 2321.3 and IBC Section 2303.4 or Newest Sectionsn, and In Accordance With Engineered Flan Specifications. CATEGORY CONFORMING NON -CONFORMING REMARKS Lumber Grade 0 , Connector Plates / I.C.B.O. 66-7 Span & Pitch 0117tr Workmanship Joint Accuracy Ce _ Bearing of Wood Joints Knots in Plate Area Split Limitation QEF Plate Placement Plate Size �d Condition of Plate Teeth Plate to Wood Tolerance In -Plant Handling D6 Bundling & Loading b j F Storage Jig & Press Adequacy Marking Legibility 0 Plant Stamp Verification How Many Stamps On S!te: C� Trusses Meet UBC & IBC Requirements E, In -Plant Q.C. Records u As Per ICBO/ES Requirements Supervisor's Signature NIA inspector's Signature 2475 Lancaster Dr. N.E. o Suite B19 503-391-1003 Office P.O. Box 17938 o Salem. Oregon 97305-7938 503-391-1007 Fax