0009-134 (SFD)LICENSED CONTRACTOR DECLARATION
' tt',raby affirm under penalty+of peryury; that Iam`licensed under provisions of ,
Chapter 9 (commencing with Sectioh 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).
( ) I, as owner of the property, am.,exclusively contractin with licensed
contractors to construct the project (See. 7044, Business Professionals
Code).. -
(.)•'I am a empt under Section % B&P C. for this reason
Date , kV Signature of Owner ��, ei err �
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 -ins, re 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).
c) I certify that in the performance of the work for which this permit is issued,
Iishall 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'.`,a
Date: . /t r f Applicant..~^
T
Warning: Failure to secure Workers -,Compensation coverag 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��pcation isLeby made to the Director of Building and Safety,`
for a' permit. subject to the con.dirtons and restrictiondfset forth on his
application. ` j /
1. Each peri6n'upon whose behalf this application is made & each person at
whose requesYend for whose"benefit work is performed unf�er or pursuant to i
any permit issGed asla result of -this applicaton agrees to,;& shall, indemnify
& hold harmfe'ss,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 c jsadtion 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. , v
Signature (Owner/Aget); ~%A*-'�-�j�1 ;j f Dato
BUILDING PERMIT PERMIT#
¢Ffy,1 t
DATE VALUATION LOT ODL19�•te3,4 TRACT
.59 1,4890.4
JOB SITE
ADDRESS
APN
50-940 NEC TARE0
772-070-W.9
OWNER
CONTRACTOR/ DESIGNER/ EN INEER
PO ,l OX
Tat `t '4CIA CA 1.73071.
.. C.'k✓U
USE OF PERMIT
9_7/,�WWE
UNCHUR FAWFIL LUNG
S1 ,?I) � PERMIT })C?I+. `TaOT 1',itdCLAIDI'& Din—CK V�". , PrlOLd'SNA
A'PE'E0.AC H DFS
ti
:}
,,13 x'
Ci,3I;`YOM CONSTI,'iLlMON10.00
JPCFE�.C:a•11��A:`rio ill, Fly
24,'M3. 20
:9; y".X" f T COST OF C: 1ONUTRIr4-.fe143K
-3; 6,33040
0
'.ki«4iF11 l .6i MI WWARY
PKA14 CHECK M 103-00"34-318 $1,270.83
FEE, D1L4 OS11'C 101-000-439-338 S1,900,90
man1,aakw:F&fr 101-W0421-000 $162..50
MZtg`n�9�`p1tVYnsL.A.�At Ly�¢lVF�F 101 .JOS/bg0-4{.92t/3�.,Oy�/C34y3 %24$.i�6y
p•
iata�„I:A+.C3.SA O PRE 1 01 -Gf{ 0-41 7-�L:00 $309.44'0
101-000-419-000
SUK)IN10 MOTION FRE, - RESID 1.01-M-241.000 s3iln
Moh!' R401'ri p, 101-000-423-000. $20.00
I;►EVEL:s.F,ER IMPACT ftg $1 t3re.ao
AR`.I' IN POBLIC: MAIM- MIM 701-000-233-000 $390.83
cx
r
SUB-.i'Cy`3AL C0149Mkts'�"atO.1+I SBM) PLAN CI',C6.
ss,f: 90.is
Y�F_13 PRINP,M ia�
41,000,00
' 'C?.Mt
rMIN1 :1'MY0 M NOW
S4,MM
JAN 26 2001,
ao'T Y v� � �C �O ° .
RECEIPT
DATE t�; !
ABX
DATE FINALED
INSPE
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
�7_ 'j,
Underground Ducts _
Forms & Footings
Slab Grade
G1
Ducts
Return Air -
Steel
t
Combustion Air
Roof Deck
X92'7-
Exhaust Fans
O.K. to Wrap
02— ..
F.A.U.
Framing
A-116, 0'Z
- —
Compressor
Insulation
3 —U 2M
- -- -
Vents (
Fireplace P.L.
Grills —�
Fireplace T.O.
Party Wall Insulation
Fans & Controls
Condensate Lines
Party Wall Firewall
Exterior Lath
_
Drywall - Int. Lath.:
ZJD
r
'
Final
Final
7B�iS=oA
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
�1�- '
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
Waste Lines
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
s
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
�� Circe
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
���/✓�� j.P5 1,2- O t
%
��
Utility Notice (Gas)
/
leg 2-1
ELECTRICAL APPROVALS
rr
Temp. Power Pole
Underground Conduit
-
Rough Wiring
Low Voltage Wiring
Fixtures 1
Main Service
-
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice
_ -
(Perm)
.I
�. OTC _ .
Building
Address t
Owner
0
Mailing�±
Address n Ifi F sc og
T4tyl 4 4 "
P.O. BOX 1504 APPLICATION ONLY
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Contractor 4 ow M�Q.a- ! �• ` �jl�.t Y /
u
Address
ity lZip
State Lic.I City
& Classif. Lic. #
Arch., Engr., I
Designer
Address Tel.
City IZip I State I
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 DATE
OWNER -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 thealleged 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 (8500).
I] I, as oner of the property, or my employees with wages as their sole compensation, will
do the wowrk, 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.)
I1
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 ofproperty who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
11 1 am exempt under Sec. B. & 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 .
n 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 ($1001 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, 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
1hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3091, 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 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 applicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number ±, /�
Legal Description �'1 (L 14135
Project Description
Ft. j 4 �D NO*
rf No. Dw
/// StoriesUnits
New V Add ❑ Alter ❑ Repair ❑ Demolition ❑
30
PERMIT �( AMOUNT
Plan Chk. Dep•
Plan Chk. Bal. r
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
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
t
INSPECTOR-- � R
FINAL DATE
�►
C ; ' _
Issued by:
Date Permit -^1
Validated by:
0i L
Validation:
w
1
WHITE = FINANCE YELLOW = APPLICANT
1
PINK = BUILDING DIVISION
iu
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 12/18/00 APN #. 772-070-009
No. 21358 Jurisdiction La Quinta .
Owner NameJOyce Ramsey Permit #
No. 50-940 Street Nectareo Log #
City La Quinta Zip .92253 Study Area
Tract # 24890-4 Lot # 59 Square Footage ' 1
Type of Development Single Family Residence No. of Units .1
Comments
4169 sq. ft. home at the Citrus in La quinta
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 NOTAPPLICABLE
E
This certifies that school facility. fees imposed pursuant to Mitigation Agreement in the amount of
628.00 X 1 or $ 628.00 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/WeUs Fargo - Ms. Ramsey Telephone 568-4819
Name on the check
By Dr. Doris Wilson .1 `
Superintendent �� ;
Fee collected /exempted by Ellen Patino Payment Received x " $62.8.06'
- l=
Check No. 06890113,59!,,
Signature 1 ,
OTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 40 -day approval period in which you may protest the fees 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
allect 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
9
Recording Requested
By DOC go 2000-400144
First AmeflcaD Title Company 10/11/2000 08:00A Fee:12.00
3 Doc T Tax Paid
A IRWAY'HOMES
Page 1 of
Recorded in Official Records
,
pq t� ,. raf�'�:C1ti'
Orde'NO. 1lliCoi'lai��i �';t t.i�t�,.`� . �' ,�'
County of Riverside
Escrow No. '�
FirstAmericar, �- !4fi?t' (•'{'j1'kl`Ai'�
Gary L. Orso
Assessor, County Clerk a Recorder
` Loan No.
WHEN RECORDED MAIL TO:
1E1 111111111011
1111111 10
I
Ms. Joyce A. Ramsey
o n Q
___
M S U PAGE SIZE DA POOR NOCOR SMF MISC.
P.O. BOX
SARATOGA,O7COA 95071
3
MAIL TAX STATEMENTS TO:
'
COPY LONG REFUND NCHG EXAM
A R L
XXComputed on the consideration or value of property
conveyed; OR
on the consideration or value less liens or
SAME AS ABOVE
_Computed
encumbrances remaining at time of sale T'
THE UNDERSIGNED GRANTOR N
Signature of Declarant or Agent determining tax -Firm Name
`- , ��tDTT• ,
� C)
�APN: � '� Z'-' o �1 � —' 9
I. TRA: 020-051
GRANT DEED
FOR A VALUABLE CONSIDERATION, receipt of
which is hereby acknowledged,
CAPITAL PACIFIC HOLDINGS, LLC, a Delaware
Limited Liability Company
hereby GRANT(S) to JOYCE RAMSEY,
an unmarried woman
\�
the real property in the City of La Quinta
State of California, described as
County of Riverside
Lot 59 Tract No. 24890-4
(See Exhibit "A" Attached Hereto)
Dated: July 21, 2000
State,of California )
ss.
*Pers6nally
) e orerme,
y L
peared
personally known to me (oRpe tome on the basis of satisfactory
evidence) to be the persons) whose name(s) is/are subscribed to the
within instrument and acknowledged to me that he/she/they executed the
same in his/her/their authorized capacity(ies), and that by pon behalf of
signature(s) on the instrument the person(s) or the entity p
which the person acted, executed the instrument.
WITNESS MY HAND AND OFFICIAL S1zAL
Signature
CAPITAL PACIFIC HOLDINGS,LLC,
a Delaware limited liability company
BY: CAPITAL PAC IC HOLDINGS,INC.,
a Delaware gp4or0n, Managing Member
Foster, Vice President
J. SCHMIDT
COMM. #1151834
NOTARY PUBW - CALFORNIA
ORANGE COUNTY
My Comm. Exp. Sept 13, 2001
(This area for official notarial seal)
I
December 20. 2000
Mrs.. Joyce Ramsey
P. O. Box 898
Saratoga, CA 95071
Re:' Citrus Course Architectural Submittal — Custom Home
50940 Nectareo, La Quinta, CA 92253
Dear Ms. Ramsey:
1 am writing on behalf of the Citrus Course Architectural Committee. The Committee
has reviewed your Submittal #2 set of plans and have spoken with your architect, Hugh
r rs. The architectural submittal for the custom
Jorgensen regarding the cedar garage doo
home is approved subject to the following conditions:
a Garage doors are not to be'metal doors and the cedar garage doors will be painted
! or stained to match the house.
CCHOA Architectural Committee is to be notified through PCM/Desert Resort
Management when your contractor has set the forms for the house foundation pad
so the Committee may inspect the footprint before the concrete is poured.
o The Ten Thousand ($10,000.00) Dollar security deposit will bear no interest and
you are not to expect to receive any more than $10,000.00 after final inspection.
Please advise when you have completed the improvements so a final inspection may be
41 conducted which will initiate the deposit refund. We appreciate your patience during the
fi architectural review process.
j Sincerely,
On beha o the Architectural Committee .
Citrus Course Homeowners Association
Jodlh?
anne Williams, Gnuna§-Asa�`ciation�Giariager
a I
CC: Hugh V. Jorgen•se&' facsimile'568-1098
568-4898 '
'ev-- zww -
Professional Community Management 1 Desert Resort Management
° f Post Office Box 4772 ,• Palm Desert, CA 92261-4772
.'; 73-550 Alessandro, Suite 5 ' • Palm Desert, California • (760) 346-1161 • FAX (760)346-9918.1
"' Z0'd 9196 £Z£ 6T9 SNJIS3a SSI;MVI ZI1
IV V 2 d REC'®
SA iz�
November 17, 2001
City of La Quints
78-495 Callc7ampico
La Quinta, California 92253-1504
Attention: Mr. Greg Buticr
Reference: Building Permit Extension for Ramsey Residence
50940 Ncctarco
Dear Sir:
I am hereby requesting an extention of my existing building permit because of
unforeseen financial delays. l anticipate immediate resumption of construction and
look forward to a successful conclusion to this project:
My sincere thanks for your helpful and immediate attention to'this matter.
Very truly yours,
Joyce Ramsey, Owner
I'd 6BS6-OSE-09L Raswea aogoC d60:90 To ST n'oW
m
m
i
to
tD
N
i
0
to
r-
9¢o CITY OF LA QUINTA SUB-CONT)3^CTOR ST
JOB ADDRESS 0b--- PERMIT NUMBER CWNE BUILDER
This foffn shall be posteci on thelob with the Building Inspect
ioCard at allcons icuors la O y persons appearirWon this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade all information requested below must be completed by applicant "On File" is not an acceptable response.
__
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Exp. Date
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