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BRES2016-011578-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: BRES2016-0115 Property Address: 78690 AVENIDA NUESTRA APN: 770172011 Application Description: BARBOSA /SINGLE FAMILY Property Zoning: Application Valuation: $274,153.90 Applicant: SOUTH WEST CONCEPTS, INC. 78115 CALLE ESTADO, SUITE 105 LA QUINTA, CA 92253 . 4 4v Qu&r(v COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT LICENSED CONTRACTOR'S 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 siness and Professions Code, and my License is in full force and effect. License Class: B. C3/0 License No.: 487584 Date:1— 1 Contractor: OWNER -BUILDER D CLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the . Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she 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).: . ( ) 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 and.Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the 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 or she did not build or improve for the purpose of sale.). (� I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' . State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ( ) I am exempt under Sec. . BAP.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/.11/2016 Owner. STEPHEN THUERINGER 633 DRY GULCH COLVILLE, WA 0 Contractor: A & M CONSTRUCTION. P 0 BOX 366 ..LA QUINTA, CA 92253 (760)564-4832'. Llc. No.: 487584 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 and policy number are: Carrier:_ Policy Number: _ _ 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 a to become subject to the workers' compensation laws of California, and agree th , if I should become subject to the workers' compensation provisions of Section 00 of the Labor Code, I shall forthwith comply with those provisions. Date: L r' V%a Applicant WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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. APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby made to the Building Official for a permit subject to the conditions and restrictions set forth on this 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 application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and employees for any act or omission related to the work being performed under or following issuance of this permit. 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 in ormation is correct. I agree to comply with all city and county ordinances and state la s relating to building construction, and hereby authorize representatives of this city t nter upon the above-mentioned property for inspection purposes. - Date: 1✓''` 11? Signature (Applicant or Agent): ' ;DESCRIPTION , " r .g,` ` r'ACCOUNT. QTY AMOUNT" PAID PAID`DATE ART IN PUBLIC PLACES - RESIDENTIAL 270-0000-43201 0• $185.38 $185.38 7/11/16 PAID BY _ ` METHOD RECEIPT # CHECK # _ , , CLTD BY A & M CONSTRUCTION CHECK R16964 12055 MFA Total Paid for ART IN PUBLIC PLACES - AIPP: $185.38 $185.38 V_ DESCRIPTION : :'' ? ACCOUNT AIIIIOUNT°s; PAID PAID:DATE BSAS SB1473 FEE 101-0000-20306 0 $11.00 $11.00 7/11/16 -: PAID..BY :g•i • x METHOD ,, : ._'RECEIPT# 's. i € CHECK # CLTD BY f A & M CONSTRUCTION CHECK R16964 12055 MFA Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $11.00 $11.00 ACCOUNT ,r$ AMOUNDESCRIPTION r r PAID PAID DATE, DIF - CIVIC CENTER 252-0000-43200 0 $942.00 $942.00 7/11/16 PAID BY - y METHOD F RECE1f�T # CHECK # tt e w ' CLTD BY6-, A & M CONSTRUCTION CHECK R16964 12055 MFA ;DESCRIPTION `_, ;ACCOUNT QTY`= AMOUNT,`K S PAID PAID DATE: DIF - COMMUNITY CENTERS 254-0000-43200 0 $129.00 $129.00 7/11/16 PAID BY, , . METHOD RECEIPT #" .. i CHECK # CLTD BY ': A & M CONSTRUCTION CHECK R16964 12055 MFA DESCRIPTION,r, r , r ": g ACCOUNT ;:; QTY,' 4AMOUNT;;; 't, PAID a PAID?DATE DIF - FIRE PROTECTION 257-0000-43200 0 $433.00 $433.00 7/11/16 PAID, BY s » "METHOD " RECEIPT # t' CHECK # CLTD BY A & M CONSTRUCTION CHECK R16964 12055 MFA C DESCR.IPTION :''3 ACCOUNT.-� ; 1 .QTY, AMOUNT. `: ; ' ' PAID =. PAID DATE` DIF - LIBRARIES 253-0000-43200 0 $344.00 $344:00 7/11/16 PAID BY -RECEIPT # CHECK # CLTD BYE A & M CONSTRUCTION CHECK R16964 12055 MFA DESCRIPTION' . ACCOUNT' QTYg AMOUNT -':�k PAID , . '•. PAID`DATE' DIF - PARK MAINTENANCE 256-0000-43200 0 $40.00 $40.00 7/11/16 ' PAID BY" METHOD."—,' k RECEIPT# CHECK # CLTD. By A & M CONSTRUCTION CHECK R16964 12055 MFA t r, DESCRIPTION ;< i` �ACCOIINT .: QTY AMOUNT=' PAID U PAID DATE DIF - PARKS/REC 251-0000-43200 0 $2,048.00 $2,048.00 7/11/16 " PAID,BY METHOD RECEIPT # .< .< CHECK # CL T.D•BY A & M CONSTRUCTION CHECK R16964 12055 MFA e —DESCRIPTION. £� � ACCOUNT F.. = r ` CITY' . AMOUNT,'`,' PAID =" -PAID. DATE DIF - STREET MAINTENANCE 255-0000-43200 0 $116.00 $116.00 7/11/16 ,'. • ;PAID BY r �- METHOD RECEIPT #zr CHECK # CLTD BY A & M CONSTRUCTION CHECK R16964 12055 MFA ` DESCRIPTION' ` r ACCOUNT AMOUNT PAID PAID. DATE' DIF - TRANSPORTATION 250-0000-43200 0 $2,842.00 $2,842.00 7/11/16 L� - PAID BY' METHOD "RECEIPT # , .' CHECK # CLTD BY A & M CONSTRUCTION CHECK' R16964 12055 MFA Total Paid for DIF - SINGLE FAMILY DWELLING: $6,894.00 $6,894.00 DESCRIPTION< , : ACCOUNT , QTY >"> #, AMOUNT - ry PAID '.PAID DATE TEMP POWER SERVICE 101-0000-42403 0 $24.17 $24.17 7/11/16 PAI D'BY * 5 .' : , is METHOD "RECEIPT #'. ' ' = ° CHECK # CLTD BY,' A & M CONSTRUCTION CHECK R16964 12055 MFA 'r. DESCRIPTION -' ` '. "'' ACCOUNT QTY AMOUNT 0?PAID PAID DATE TEMP POWER SERVICE PC 101-0000-42600 0 $16.92 $16.92 7/11/16 PAID BY = .a ` .� a+ . "':� METHOD {+ RECEIPT # _ CHECK # CLTD BY A & M CONSTRUCTION CHECK R16964 12055. MFA Total Paid for ELECTRICAL: " $41.09 $41:09' 'DESCRIPTION ' ; .. ACCOUNT QTY AMOUNT -'.PAID _ . PAID DATE RESIDENTIAL, EA ADDITION 1,000SF 101-0000-42403. 0 $61.65 $61.65 7/11/16 '. PAID BY, METHOD RECEIP .."CHECK#- CLTDBY' A & M CONSTRUCTION CHECK R16964 12055 MFA DESCRIPTION_ e ACCOUNT :4 . QTY AMOUNT. ; PAID $PAID DATE RESIDENTIAL, EA ADDITION 1,000SF, PC 101-0000-42600 0 $25.40 $25.40 7/11/16 PAID BY METHOD" ' " RECEIPT # `._' . u CHECK # CLTD BY A & M CONSTRUCTION CHECK f R16964 12055 MFA `DESCRIPTION $ '. :. ACCOUNT. :;'. qTY . AMOUNT;: PAID " F PAID. DATE; RESIDENTIAL, FIRST 1,000SF. 101-0000-42403 0 $145.03. $145.03 7/11/16 PAID.BY .' .. �7" �' METHOD ' RECEIPT # CHECK # y CLTD BY A & M CONSTRUCTION CHECK R16964 12055 MFA ..DESCRIPTION,, a ; , ACCOUNT Qw, E .AMOUNT" s. PAID'`.. PAID DATE . RESIDENTIAL, FIRST 1,000SF, PC 101-0000-42600 0 $47:86 $47.86 7/11/16 PAID BY'�', : • = METHOD g RECEIPT # `: ;" CHECK # m CLTD BY A & M CONSTRUCTION CHECK R16964 12055 MFA Total Paid for ELECTRICAL - NEW CONSTRUCTION: $279.94 $279.94 ` DESCRIPTION; , " .ACCOUNT ., QTY -' AMOUNT . "PAID PAID DATE RESIDENTIAL PRECISE GRADING - CUSTOM HOME LOT >7KSF 101-0000-42408 0 $36.26 $36.26 7/11/16 PAID.BY METHOD m, RECEIPT # CHECK # `' CLTD BY; A & M CONSTRUCTION CHECK R16964 12055 MFA `.`DESCRIPTION, .. ACCOUNT AMOUNT` ' PAID PAID DATE RESIDENTIAL PRECISE GRADING - CUSTOM HOME LOT >7KSF PC 101-0000-42600 0 $181.29 $181.29 7/11/16 PAID BY.: , "METHOD ` :� "° ' `. w.RECEIPT # �� CHECK # = � : ° '� CLTD'BY , A &M CONSTRUCTION CHECK R16964 12055 MFA Total Paid for GRADING: $217.55. $217.55 .,:_DESCRIPTION x ,• "' ACCOUNT QTY AMOUNT ` ' PAID - PAID DATE CONDENSER/COMPRESSOR 101-0000-42402 0 x$72:52 $72.52 7/11/16 PAID BY , a ..:. i -- • _,' •METHOD -_ - RECEIPT #tip s t CHECK # CLTD BY A & M CONSTRUCTION CHECK R16964 12055 MFA DESCRIPTION+ ,' ACCOUNT QTY -AMOUNT; • "µt •'+ .: . PAID PAID DATE CONDENSER/COMPRESSOR PC 101-0000-42600 0 $48.34 $48.34 7/11/16 PAID BY r ..f ', ._ METHOD ' • , RECEIPT # . ,._.. *CHECK # CLTD BY A & M CONSTRUCTION CHECK. R16964 • 12055 MFA' DESCRIPTIONS, - ACCOUNT-. `` QTY` ".' eAMOUNT `_ ��•PAID °'� PAID DATE EXHAUST HOOD 101-0000-42402 0 .$24.18 $24.18 7/11/16 PAID BY - _ ., METHOD RECEIPT #� = CHECK #-, " CLTD BY,.. A & M CONSTRUCTION CHECK R16964 12055 MFA DESCRIPTION ACCOUNT QTY ;AMOUNT ;YPAID PAID DATE, EXHAUST HOOD PC 101-0000-42600 0 $9.66 $9.66 7/11/16 ' i "• 'PAID BY RECEIPT # `_ CHECK #., r R CLTD BY A & M CONSTRUCTION CHECK R16964 12055 MFA DESCRIPTION ' ACCOUNTAMOUNT PAID PAID DATE FURNACE 101-0000-42402 0 $72.52 $72.52 7/11/16 - PAID BY " . `, : ' i METHOD ` ; ; RECEIPT # ' CHECK # CLTD A & M CONSTRUCTION CHECK R16964 12055 MFA •DESCRIPTION'.' . "ACCOUNT', QTY AMOUNT PAID. PAID_ DATE' '.. FURNACE PC 101-0000-42600 0 $48.34 $48.34 7/11/16 PAID BY g METHOD : w =RECEIPT # CHECK # ;' CLTD BY ` A & M CONSTRUCTION CHECK. R16964 12055 MFA DESCRIPTION ACCOUNT ,QTY' Ys AMOUNT". Yr. PAID • , _ PAID DATE VENT FAN 101-0000-42402 0 $120.90 $120.90 7/11/16 PAID BY METHOD "RECEIPT #, CHECK# CLTD BY A & M CONSTRUCTION CHECK R16964 12055 MFA �. DESCRIPTION ' a . ; ACCOUNT QTYµ AMOUNT - PAID PAID DATE, VENT FAN PC 101-0000-42600' 0 $48.30 $48.30 7/11/16 PAID BY § - R METHOD < RECEIPT # `a CHECK # CLTD BY, A & M CONSTRUCTION CHECK R16964 12055 MFA Total Paid for MECHANICAL: $444.76 $444.76 DESCRIPTION,,L ` ACCOUNTQTY = ' # : -AMOUNT AMOUNT E ` - PAID' PAID DATE'. MULTI-SPECIES RESIDENTIAL 0-8 UNITS - 2016 UPDATE 101-0000-20310 0 $1,327.00 $1,327.00 7/11/16 PAID BY METHOD- ' , RECEIPT # ; ` ` », . " ,CHECK # 'CLTD BY A & M CONSTRUCTION CHECK R16964 12055 MFA Total Paid for MULTI -SPECIES RESIDENTIAL: $1,327.00 $1,327.00 - - DESCRIPTION . ;, ACCOUNT, � Y QTY ". AMOUNT, PAID PAID DATE' NEW CONSTRUCTION PERMIT 101-0000-42400 0 $623.57. $623.57 7/11/16 PAID BY METHOD "` - RECEIPT # CHECK # CLTD BY " A & M CONSTRUCTION CHECK R16964 12055 MFA Total Paid for NEW CONSTRUCTION PERMIT: $623.57 $623.57 ° =DEkRIPTION 's• � a ACCOUNT' Ht TY AMOUNT �, PAID PAID DATE: NEW CONSTRUCTION PLAN CHECK 101-0000-42600 0 .$1,000.00 $1,000.00• 4/20/16 `PAID BY ' ``x: METHOD * RECEIPTL#. '- CHECK # CLTD BY CHRISTINA BARBOAS CHECK R14931 2786 SKH t. DESCRIPTION,' , ;;, ACCOUNT , QTY AMOUNT E',PA ID PAID DATE NEW CONSTRUCTION PLAN CHECK 101-0000-42600 0 $328.76 $328.76 7/11/16 PAID BY, a METHOD RECEIPT # , # CHECK # CLTD BY.:; A & M CONSTRUCTION CHECK R16964 12055 MFA Total Paid for NEW CONSTRUCTION PLAN CHECK: $1;328.76 $1,328.76 " DESCRIPTION:" " ACCOUNT ` °`a' "QTY AMOUNT s 'PAID "f' PAID „DATE BACKFLOW DEVICE 101-000042401 0 $12.09 $12.09 7/11/16 'PAID BY, ` METHOD`` ``} "'" .a r RECEIPT # CHECK # CLTD' BY" A & M CONSTRUCTION CHECK. R16964 12055 MFA "DESCRIPTION; ACCOUNT QTY Y AMOUNT _ �y'PAID PAIDDATE BACKFLOW DEVICE PC 101-0000-02600 0 $4.83% $4.83 7/11/16 PAID BY Rik , :,,' r° ,,METHOD " ` E RECEIPT #' : CHECK #, s CLTD BY,, A & M CONSTRUCTION CHECK R16964 12055 MFA DESCRIPTION " k ' AACCOLINT PAID ' "PAID DATE BUILDING SEWER 101-0000-42401 0 $12.09 $12.09 7/11/16 - < .: PAID BYE. °: ` `' `METHOD r RECEIPT # ` CHECK # CLTD By A & M CONSTRUCTION CHECK R16964 12055 MFA °t �DESCRIPTION° �, � ,. - .. _... _ _ ACCOUNT, �: Q COUN � _ � , QTYAMOUNT : - :, •PAID ',. ` 'PAID °DATE. BUILDING SEWER PC 101-000042600 0 $12.09 $12.09 7/11/16 _ z ; PAID BY `• ' '- METHOD ' -RECEIPT # a P g CHECK # CLTD BY w A & M CONSTRUCTION CHECK R16964 12055 MFA S .DESCRIPTION° x4 ACCOUNT x, QTY :AMOUNT x RAID �, PAID °DATE' . FIXTURE/TRAP 101-000042401 0 $278.07 $278.07 7/11/16 . 'PAID BY ` ti sx, r � ..: "` "METHOD � , ` "« � RECEIPT # , .- 'CHECK # , .,CLTD BYE A & M CONSTRUCTION CHECK R16964 12055 MFA 'DESCRIPTION ACCOUNT ,f QTY AMOUNT `:4 : PAID PAID DATE FIXTURE/TRAP PC 101-0000-42600 0 $278.07 $278.07 7/11/16 PAID BY, `'' METHODp" ' .RECEIPT # CHECK # > "' ;CLTD BY A & M CONSTRUCTION CHECK R16964 12055 MFA r DESCRIPTION .`; $"`:ACCOUNT QTY. ,-° AMOUNT, ° PAID PAID DATE GAS SYSTEM, 5+ OUTLETS 101-0000-42401 0 $36.26 $36.26 7/11/16 PAID BY, : • METHOD �l. RECEIPT # CHECK # CCTD'BY A & M CONSTRUCTION CHECK R16964 12055 MFA `b -DESCRIPTION :` ACCOUNT QTY AMOUNT'':: ~PAID 'PAIDr DATE GAS SYSTEM, 5+ OUTLETS PC 101-0000-42600 0 $24.17 $24.17 7/11/16 PAID BY. F .a , . p � METHOD r �� i# :' RECEIPT # - d t a CHECK # CLTD BY.' A & M CONSTRUCTION CHECK R16964 12055 MFA DESCRIPTION ACCOUNT' ;QTY, AMOUNT:, PAID PAID DATE: ROOF DRAIN 101-0000-42401 0. $72.54 $72.54 7/11/16 PAID BY �, . r ;. `^,, METHOD RECEIPT #-::: CHECK # CLTD BY'__ A & M CONSTRUCTION CHECK R16964 12055 -MFA N 'DESCRIPTION.'- : ' , ACCOUNT ' 14 AMOUNT ,;: PAID . PAID DATE ROOF DRAIN PC 101-0000-42600 0 $72.54 $72.54 7/11/16 PAID BY p `' .. .. METHOD , T"RECEIPT # r; CHECK # CLTD BY A & M CONSTRUCTION CHECK R16964 12055 MFA DESCRIPTION ~' '.ACCOUNT QTY :, AMOUNT _ PAID PAID DATE WATER HEATER/VENT 101-000042401 0 $12.09 $12.09 7/11/16 . PAID BY : _'.METHOD c RECEIPT# CHECK# -CLTD By A & M CONSTRUCTION CHECK R16964 12055 MFA 'ohs UESCRIPTION I, . ACCOUNT°s, =QTY AMOUNT. ' :PAID PAIQ'DATE'< WATER HEATER/VENT PC 101-0000-42600 0 $7.25 $7.25 7/11/16 PAID:BY , ,: ".* METHOD ` "' •` RECEIPT # CHECK # • CLTD BY A & M CONSTRUCTION CHECK R16964 12055 MFA ; DESCRIPTION < - ACCOUNT .: ` :QTY .: ,AMOUNT.... :i � PAID.DATE.' WATER SYSTEM INST/ALT/REP 101-0000-42401 0 $12.09 $12.09 7/11/16 -. PAID BY`•s >~ METHOD s :RECEIPT # .. CHECK # ;CLTD BY: A & M CONSTRUCTION CHECK R16964 12055 MFA DESCRIPTION~ G ` ACCOUNT u , QTY. ""AMOUNT>:' PAID PAID`DATE' WATER SYSTEM INST/ALT/REP PC 101-0000-42600 0 $12.09 $12.09 7/11/16 PAI D:'BY_' "METHOD_; RECEIPT # CHECK # CLTD BY M' A & M CONSTRUCTION CHECK R16964 12055 MFA Total Paid for PLUMBING FEES: $846.27 $846.27 f, DESCRIPTION `,'= r + ;, '-ACCOUNT `,;, QTY,` AMOUNT,: �- PAID PAID DATE SMI - RESIDENTIAL 101-0000-20308 0 $35.64 $35.64 7/11/16 PAID BY h METHOD $ ,w RECEIPT # :. CHECK # CLTD BY - A & M CONSTRUCTION CHECK R16964 12055 MFA Total Paid for STRONG MOTION INSTRUMENTATION SMI: $35.64 $35.64 DESCRIPTION ; .. s" . " ACCOUNT, , , . a QTY : ; AMOUNT . PAID - PAID DATE SINGLE-FAMILY DETACHED 224-0000-20320 0 $1,837.44 $1,837.44 7/11/16 ¢ PAID BY a METHOD ' =',cIE RECEIPT # CHECK # CLTD BY :r A & M CONSTRUCTION CHECK R16964 12055 MFA Total Paid for TUMF - RESIDENTIAL: $1,837.44 $1,837.44 TOTALS: Description: BARBOSA / SINGLE FAMILY Type: BUILDING, RESIDENTIAL Subtype: DWELLING - SINGLE Status: ISSUED Applied: 4/20/2016 SKH - FAMILY DETACHED Approved: 7/8/2016 JJO Parcel No: 770172011 Site Address: 78690 AVENIDA NUESTRA LA QUINTA,CA 92253 Subdivision: DESERT CLUB TR UNIT 5 Block: Lot: 168 Issued: 7/11/2016 MFA Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $274,153.90 Occupancy Type: Construction Type: Expired: 1/7/2017 MFA No. Buildings: 0 No. Stories: 0 No. Unites: 0 WAITING FOR STRUC COMMENTS & PLANS TO BE RETURNED Details: NEW 4396 SQ. FT. SFD. THIS PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK WALLS, DRIVEWAY APPROACH, FIRE PIT, BBQ OR WATER FEATURES. HOME IS FIRE SPRINKLED PER 2013 CRC CODES. i E; 79 3 y , Applied to Approved Approved to Issued Printed: Monday, July 11, 2016 12:06:56 PM 1 of 7 SYSTEti1S ADDITIONAL CHRONOLOGY -CHRONOLOGY TYPE • '_ ., `STAFF,NAME ACTION DATECOMPLETION DATE r NOTES NOTE JIM JOHNSON 5/11/2016 5/13/2016 WAITING FOR STRUC COMMENTS & PLANS TO BE RETURNED NOTE MARY FASANO 7/7/2016 .7/7/2016 RECEIVED PLANS FROM YOUNG. APPROVABLE PENDING • TRUSS GENERAL CONFORMANCE PLAN CHECK COMMENTS r FROM CONSULTANT JIM JOHNSON 5/13/2016 5/13/2016 RECEIVED PLAN CHECK COMMENTS FROM CONSULTANT KAY HENSEL 7/8/2016 7/8/2016 STRUC APPROVABLE WITH CONDITIONS 7/7/2016 RECEIVED PLAN CHECK PICKED UP RAMSES SEVILLA 5/13/2016. 5/13/2016 NIETO PICK UP PLANS PLAN CHECK SENT TO STEPHANIE KHATAMI 4/20/2016 4/21/2016 OUTSIDE PC Printed: Monday, July 11, 2016 12:06:56 PM 1 of 7 SYSTEti1S PLAN CHECK SUBMITTAL RAMSES SEVILLA: 6/24/2016 • 6/24/2016 RECEIVED Y DESCRIPTION ACCOUNT QTY AMOUNT PLAN CHECK -SUBMITTAL STEPHANIE KHATAMI 4/20/2016 PAID BY 4/21/2016 z' RECEIVED , BY ART IN PUBLIC PLACES - 270-0000-43201 0 $185.38 $185.38 7/11/16 TELEPHONE CALL JIM JOHNSON 5/13/2016 RESIDENTIAL 5/13/2016 CALLED SOUTHWEST CONCEPTS TO INFORM THEM THE CONSTRUCTION Total Paid for ART IN PUBLIC PLACES - AIPR: $185.38. $185.38 PLANS ARE READY FOR CORRECTIONS TELEPHONE CALL JIM JOHNSON 7/8/2016 0' $11.00 7/8/2016 7/11/16 CALLED STEVE TO INFORM HIM THE PLANS ARE APPROVED 12055 CHECK MFA NEED SCHOOL FEES CONDITIONS CONSTRUCTION ,CONDITION DATE DATE DATE CONTACT x _Y STATUS REMARKS.- NOTES TYPE ADDED_: REQUIREb SATISFIED . READY TO ISSUE JIM JOHNSON 7/8/2016 COMPLETE NEED SCHOOL FEES CHECKLIST CONTACTS NAME TYPE ;, ' NAME ' *— " ADDRES51 CITY . STATE ZIP ;; PH ONE: FAX` ' 9 EMAIL' APPLICANT SOUTH WEST -CONCEPTS, INC. 78115 CALLE ESTADO, LA QUINTA CA 92253 (760)S§.4-4832 steve@swconcepts.co SUITE 105 m CONTRACTOR A & M CONSTRUCTION P 0 BOX 366 LA QUINTA CA 92253 (760)5.64-4832 OWNER • STEPHEN THUERINGER 633 DRY GULCH COLVILLE WA 0 (760)564-4832 Printed: Monday, July 11, 201612:06:56 PM 2 of 7 SYSTEMS FINANCIAL •• • Y DESCRIPTION ACCOUNT QTY AMOUNT PAID . PAID DATE ,RECEIPT #� CHECK'# METHOD PAID BY z' , BY ART IN PUBLIC PLACES - 270-0000-43201 0 $185.38 $185.38 7/11/16 R16964 12055 CHECK A & M MFA RESIDENTIAL CONSTRUCTION Total Paid for ART IN PUBLIC PLACES - AIPR: $185.38. $185.38 BSAS SB1473 FEE 101-0000-20306 0' $11.00 $11.00 7/11/16 R16964 12055 CHECK MFA CONSTRUCTION Total Paid for BUILDING STANDARDS ADMINISTRATION $11.00 $11.00 BSA: Printed: Monday, July 11, 201612:06:56 PM 2 of 7 SYSTEMS Permit Details PERMIT NUMBER, BRES201'6 oils' City of La Quinta :: �,... •_�`.. "_" :_...,:,..tea..._:. � ,.' 77 -+ .. DESCRIPTION '' .. ACCOUNT >4, QTY �. ` - 4Y. AMOUNT . '. .F ePAID - �...r�'+�'�^ -PAID DATE` - . . RECEIPT ,# CHECK # r: METHOD . . '. Y .- . •'« F z r .'CLTD, „ <_ A & M DIF - CIVIC CENTER 252-0000-43200 0 $942.00. $942.00 7/11/16 R16964 12055 CHECK MFA CONSTRUCTION DIF - COMMUNITY 254-0000-43200 0. $129.00 $129.00 7/11/16 R16964 12055 CHECK A&M MFA - .CENTERS CONSTRUCTION DIF = FIRE PROTECTION 257-0000-43200 0 $433.00 $433.00 7/11/16 R16964 12055 CHECK MFA CONSTRUCTION DIF -LIBRARIES 253-0000-43200 0, $344.00 $344.00 7/11/16 R16964 12055 CHECK MFA CONSTRUCTION DIF - PARK 256-0000-43200 0 $40.00 $40.00 7/11/16 .1116964 12055 CHECK A & M MFA 'MAINTENANCE CONSTRUCTION DIF - PARKS/REC 251-0000-43200 0 $2,048.00 $2,048.00 7/11/16 R16964* 12055 - CHECK A & M MFA CONSTRUCTION DIF -STREET 255-0000-432000 $116.00 $116.00 7/11/16 R16964 12055 CHECK A & M MFA MAINTENANCE CONSTRUCTION DIF - TRANSPORTATION y 250-0000-43200 0 $2,842.00 $2,842.00 7/11/16 - R16964 12055 - CHECK MFA .. CONSTRUCTION Total Paid for DIF - SINGLE FAMILY DWELLING: $6,894.00 $6,894.00 TEMP POWER SERVICE 101-0000-42403 0 $24.17 $24.17 7/11/16 -1116964 12055 CHECK A & M MFA CONSTRUCTION TEMP POWER SERVICEA 101-0000-42600 0 $16.92- $16.92 ..7/11/16 1116964 1205.5 , 'CHECK & M MFA PC CONSTRUCTION Total Paid for ELECTRICAL: $41.09 $41.09 RESIDENTIAL, EA 101-0000-42403 0 $61.65 $61.65 7/11/16 R16964 12055 CHECK A & M MFA ADDITION 1,000SF CONSTRUCTION RESIDENTIAL, EA 101-0000-42600 0 $25.40 $25.40 7/11/16 R16964 12055 CHECK A & M MFA ADDITION 1,000SF, PC CONSTRUCTION RESIDENTIAL, FIRST 101-0000-42403 0 $145.03 $145.03 7/11/16 R16964 12055 CHECK A & M MFA 1,0005E CONSTRUCTION s Printed: Monday, July 11, 2016 12:06:56 PM 3 of 7 SrsrTEMS ca;. :. :t, `ACCOUNT � ` t• C - �:_ -77777 �"e!erw--�' DESCRIPTION DESCRIPTION z CITY , AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD, -PAID BY " BY -RESIDENTIAL, FIRST 101-0000-42600 0 $47.86 $47.86 7/11/16 R16964 12055 CHECK & M MFA 1,000SF, PC CONSTRUCTION Total Paid for ELECTRICAL - NEW CONSTRUCTION: $279.94 $279.94 RESIDENTIAL PRECISE GRADING - CUSTOM 101-0000-42408 0 $36.26 $36.26 7/11/16 R16964 120-c5 CHECK 'MFA HOME LOT>7KSF CONSTRUCTION RESIDENTIAL PRECISE GRADING - CUSTOM 101-0000-42600 0 $181.29 $181.29 7/11/16 R16964 12055 CHECK MFA HOME LOT >7KSF PC CONSTRUCTION Total Paid for GRADING: $217.55 $217.55 CONDENSER/COMPRES A & M 101-0000-42402 0 $72.52 $72.52 7/11/16 R16964 12055 CHECK MFA' SOR CONSTRUCTION CONDENSER/COMPRES A & M 101-0000-42600 0 $48.34 $48.34 7/11/16 R16964 12055 CHECK MFA SOR PC o CONSTRUCTION EXHAUST HOOD 101-0000-42402 0 $24.18 $24.18' 7/11/16 R16964 ` 12055 CHECK MFA CONSTRUCTION EXHAUST HOOD PC 101-0000-42600 0 $9.66 $9.66 7/11/16 R16964 12055 CHECK A 8c M MFA CONSTRUCTION FURNACE 101-0000-42402 0 $72.52 $72.52 7/11/16 R16964 12055 CHECK MFA CONSTRUCTION FURNACE PC. 101-0000-42600 0 $48.34 $48.34 7/11/16 R16964 12055 CHECK MFA CONSTRUCTION VENT FAN 101-0000-42402 0 $120.90 $120.90 7/11/16 R16964. 120$5 CHECK MFA CONSTRUCTION VENT FAN PC 101-0000-42600 0 $48.30 $48.30 7/11/16 R16964 12055 CHECK MFA CONSTRUCTION Total Paid for MECHANICAL: $444.76 $444.76 Printed: Monday, July 11, 2016 12:06:56 PM 4 of 7 C SYSTCMS Printed: Monday, July 11, 2016 12:06:56 PM 5 of 7 ' SYSTEti1S ACCOUNT' ; CITY AMOUNT PAID S----•-i----7— PAI DATE, ,CLTI :REC E - -- HECK �---.... METHOD , PAID BY� r A E � , BY MULTI -SPECIES A & M RESIDENTIAL 0-8 UNITS 101-0000-20310 0• $1,327.00 $1,327.00 7/11/16 R16964 12055 CHECK MFA CONSTRUCTION - 2016 UPDATE Total Paid for MULTI -SPECIES RESIDENTIAL: $1,327.00 '$1,327.00 NEW CONSTRUCTION 101-0000-42400 0 $623.57 $623.57 7/11/16 R16964'. 12055 CHECK A & M MFA PERMIT CONSTRUCTION -Total Paid for NEW CONSTRUCTION PERMIT: $623.57 $623.57 NEW CONSTRUCTION 101-0000-42600 0 $1,000.00 $1,000.00 4/20/16 R14931 2786 CHECK CHRISTINA BARBOAS SKH_ PLAN CHECK _ NEW CONSTRUCTION 101-0000-42600 01 $328.76 $328.76 7/11/16 R16964 12055 CHECK. A & M MFA PLAN CHECK. CONSTRUCTION Total Paid for NEW CONSTRUCTION PLAN CHECK: $1,328.76 .$1,328.76 BACKFLOW DEVICE 101-0000-42401 .0 $12.09 $12.09 7/11/16 R16964: 12055 CHECK MFA CONSTRUCTION BACKFLOW DEVICE PC 101-0000-42600 0 / $4.83 $4.83 7/11/16 R16964 12055 ~CHECK A & M MFA CONSTRUCTION, BUILDING SEWER 101-0000-42401 0 $12.09 $12.09 7/11/16 R16964 12055 CHECK - A & M MFA CONSTRUCTION BUILDING SEWER PC 101-0000-42600 0 $12.09 $12.09 7/11/16 R16964 12055 CHECK A & M MFA CONSTRUCTION FIXTURE/TRAP 101-0000-42401 0 $278.07 $278.07 7/11/16 R16964 12055 CHECK A & M MFA CONSTRUCTION FIXTURE/TRAP PC 101-0000-42600 0 '$278.07 $278.07 7/11/16 R16964 12055 CHECK MFA CONSTRUCTION GAS SYSTEM, 5+ 101-0000-42401 0 $36.26 $36.26 7/11/16, R16964 12055 CHECK A & M MFA - OUTLETS CONSTRUCTION GAS SYSTEM, S+A 101-0000-42600 0 $24.17 $24.17 7/11/16 R16964 12055 CHECK & M MFA OUTLETS PC CONSTRUCTION Printed: Monday, July 11, 2016 12:06:56 PM 5 of 7 ' SYSTEti1S 7!7 - DESCRIPTION ' ACCOUNT QTY AMOUNT . PAID PAID DATE RECEIPT.#` CHECK # METHOD PAID}BY" LTD_. x " BY ROOF DRAIN 101-0000-42401 0 372.51t $72.54 7/11/16 R16964 12055 CHECK A&M & M MFA CONSTRUCTION ROOF DRAIN PC 101-0000-42600 0 $72.54 $72.54 7/11/16 R16964 12035 CHECK MFA CONSTRUCTION WATER HEATER/VENT 101-0000-42401 0, $12.09 $12.09 7/11/16 R16964 120.55 CHECK- MFA CONSTRUCTION. WATER HEATER/VENT 101-0000-42600 0 $7.25 $7.25 7/11/16 R16964 12055 CHECK A & M MFA PC CONSTRUCTION WATER SYSTEM 101-0000-42401 0. $12.09 $12.09 7/11/16 R16964 12055 CHECK A & M MFA - INST/ALT/REP CONSTRUCTION WATER SYSTEM 101-0000-42600 0 $12.09 $12.09 7/11/16 R16964 12055 CHECK A & M MFA INST/ALT/REP PC CONSTRUCTION Total Paid for PLUMBING FEES: $846.27 $846.27 SMI - RESIDENTIAL 101-0000-20308 0 $35.64 $35.64 7/11/16 1116964 ' 12055 CHEC KCONST MFA UCTION. Total Paid for STRONG MOTION INSTRUMENTATION SMI: $35.64 $35.64 SINGLE FAMILY 224-0000-20320 0 $1,837.44 $1,837.44 7/11/16 1116964 12 055 CHECK A & M MFA DETACHED CONSTRUCTION Total Paid for TUMF = RESIDENTIAL: $1,837.44 $1,837.44 TOTALS: $14,072.40 40 INSPECTIONS PARENT PROJECTS REVIEWS RETURNED' f " REVIEW.TYPE REVIEWER.'; SENT DATE" DUE.DATE STATUS REMARKS NOTES _ • ., DATE d ._ . . IST BLDG NS (3 WK) JIM JOHNSON 4/20/2016 5/11/2016 5/5/2016 REVISIONS REQUIRED 1ST BLDG STR (3 JOHN" 4/20/2016 5/11/2016 5/11/2016 REVISIONS REQUIRED WK) THOMPSON Printed: Monday, July 11, 2016 12:06:56 PM 6 of 7 SYSTEMS 1ST PLANNING (2 CARLOS 4/20/2016 5/4/2016 5/2/2016 READY FOR APPROVAL WK) FLORES OWNER .: „< " . DESCRIPTION PATHNAME SUBDIR • ETRAKIT ENABLED 2ND BLDG NS (2 JIM JOHNSON 6/24/2016 7/11/2016 7/8/2016 APPROVED DOC 7/7/2016 WK) STRUCTURAL STRUCTURAL 0 2ND BLDG STIR (2 BROW 6/24/2016 7/11/2016 7/7/2016 READY FOR APPROVAL JIM JOHNSON 78-690 AVENIDA WK) YOUNG I I- CONDITION NUESTRA.docx NUESTRA.docx Printed: Monday, July 11, 2016 12:06:56 PM 7 of 7. SYS TEtitS Attachment Type CREATED '. OWNER .: „< " . DESCRIPTION PATHNAME SUBDIR • ETRAKIT ENABLED 2ND CHECK - 2ND CHECK - DOC 7/7/2016 BRONZ YOUNG STRUCTURAL STRUCTURAL 0 TRANSMITTAL.pdf TRANSMITTAL.pdf DOC 5/5/2016 JIM JOHNSON 78-690 AVENIDA 78-690 AVENIDA 0 NUESTRA.docx NUESTRA.docx DOC 7/8/2016 JIM JOHNSON -. TRUSS LETTER BRES2016 TRUSS LETTER BRES2016 - 0 -0115.pdf -0115.pdf DOC 7/8/2016 JIM JOHNSON SCHOOL FEES BRES2016- SCHOOL FEES BRES2016- .:;. 0 0115.pdf 0115.pdf 1ST CHECK - 1ST CHECK - DOC 5/11/2016 JOHN THOMPSON STRUCTURAL STRUCTURAL 0 COMMENTS.doc COMMENTS.doc 1ST CHECK - ' 1ST CHECK - DOC 5/11/2016 JOHN THOMPSON STRUCTURAL STRUCTURAL 0- '0- TRANSMITTAL.pdf TRANSMITTAL.pdf TRANSMITTAL.pdf DOC 5/11/2016 JOHN THOMPSON Soils_Report_Scope_BR Soils_Report_Scope_BR ' = 0 - ES 2016-0115.pdf ES 2016-0115.pdf - Printed: Monday, July 11, 2016 12:06:56 PM 7 of 7. SYS TEtitS Building 7 Address Mailing s� Address ,7 RO. BOX 1504 PPLICATION ONLY LTAMPIO��L5;�MeUINTA,CALLFORNIA 92253 CityZip Tel. p&�s .- . Contra to {�/t c n �!' �p r Address f�PIP , &VI 10� & Classif. r Lic. # Arch., Engr., 1 o Designer `�r�sll dAur-_`6l.a �nn ' Xdli4 i'_ 70 'LICENSED -7`tLic. CO LA N 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 Contrac- tor'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). OI, 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 and Profes- sions 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 w!thin 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). O I, as owner of the property, am exclusively contracting with licensed contractors to construct 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.) O 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKER'S 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 O 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 the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to 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 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 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 1l WHITE = BUILDING DEPARTMENT BUILDING: TYPE CON T. OC P. C. GR A.P. Number 77 17- ell Legal Description Project Description g :A, ir of Size No. No. Dw. Stories Units New _ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL CONTACT INFORMATION NAME: PHONE: 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: — Validated by: Validation: YELLOW = APPLICANT Date Permit PINK = FINANCE Date: 7/11/2016 No.: 16-00263-1 Owner: Barbosa CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road 4ha nita, CA 92253 11 60)771-8515 Email: Address: Jurisdiction: La Quinta City: A Tract #: Type: Single Family Resid �� u 1 +=�; �P�� f''ENT Lot # Street No. Street Name Sq. Feet APN 78690 AVenida Nuestra 4396 770-127-011 Comments: JN�fIEo S cyo 0 BERMVDADUNES "RANC/tOMIRAGE G 1;'� w� ogwEEuttsT•, y oouu ��yy pUNdDIO� y° Permit No. 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 fess imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $3.36 X 4396 S.F. or $14,770.56 have been paid for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in the proposed project may now be issued. Fees Paid By: CC/Bank of Southern California - Rick Morris Bank Name/Recipient of Certificate By Dr. Gary Rutherford Superintendent Fee Collected/ Exempted by: Sh Check No.: 209283 Telephone: 760-774-8225 Funding: Residential Amount Due: $14,770.56 Original Pay6i&ht(s) Reed: \ $0.00 1 New Payment Recd: �%+$�,770.56 r Gir ,,JjUnder: $0.00 NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify yo(th 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 to Building Department: THIS DOCUMENT VALID ONLY IF IMPRINTED WITH EMBOSSED SEAL. 71 �. Branch :025,User,;:.ICRE,- Lawyers Title RECORDING REQUESTED BY: ProNet Partners, Inc., DBA Sun Gold' Escrow Order No. 615696782 Escrow No. 10554 -CC Parcel No. 770-172-011-0 AND WHEN RECORDED MAIL TO: MICHAEL B YOUNG AND CRISTINA BARBOSA, TRUSTEES OF THE BARBOSA YOUNG REVOCABLE TRUST DATED JUNE 17, 2005 3,5,--) e) $ r y . rn&At r' papas -r'X 75z25 Continent: DOC # 2015-0447588 10/09/2015 01:31 PM Fees: $21.00 Page 1 of 3 Recorded in Official Records County of Riverside Peter Aldana Assessor -County Clerk -Recorder "This document was electronically submitted to the County of Riverside for recording" Receipled by: TERESA #134 Station Id :SWCN �Q -r,� -2 6 O I 1 r SPACE ABOVE THIS LINE FOR RECORDER'S USE GRANT DEED THE UNDERSIGNED GRANTOR(S) DECLARE(S) THAT DOCUMENTARY TRANSFER TAX IS $179.85 and CITY S ® computed on full value of property conveyed, or ❑ computed on full valueless liens or encumbrances remaining at the time of sale. ❑ unincorporated area: ® City of La Quints, and FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, VICKY J RIGBY, a single woman hereby GRANT(S) to Michael B Young and Cristina Barbosa, Trustees of the Barbosa Young Revocable Trust dated June 17, 2005 the following described real property in the County of Riverside, State of California: , SEE EXHIBIT "A" ATTACHED HERETO AND MADE A PART HEREOF More commonly known as: 1 Avenida Nuestra, La QWnta, CA 92253 i Date October 6, 2015 It VICKY J FOGVY } A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document- STATE ocumentSTATE OF CARNIA t=AW�{c COUNTY OF �h�rol 40✓� } S.S. On O `�bCQ. ITh I o1OLS beforeme, NiCbkllt " tMAOQ W:) anb�[C personally appeared VICKY J RIGBY- who proved to me on the basis of satisfactory evidence to be a personof whose name(s) is/afe subscribed to the within k strument and acknowledged to we that Wshe/t1)iy executed the same in hi4/her/tWir authorized capacity(ids), and that by his/her/thlir signature(y) on the instrument the person(s), or the entity upon behalf of which the person(A acted, executed the instrument I certify under PENALTY OF PERJURY under the laws of the State of Cwtiforme-that the foregoing paragraph is true and correct C OFFKXAL STAMP WITNESS my hand and official seal. PL5 NOTARY PUBLIC - OREGON Signature OiCA@ NmitzWL' (Seal) OOMLOSSION NO. 940194 trt /COMMISSION EXPIRES JUNE 24, 2019 i Mail Tax Statement to: SAME AS ABOVE or Address Noted Bdow 7 RIVERSIDE,CA Pace I of 3 Printed on 7/1/2016 8:50:42 AM Document: DD 2015.447588 Branch :025.User,:.1CRE• Comment: Station Id :SWCN. GOVERNMENT CODE 27361.7 DOC #2015-0447588 Page 2 of 3 I CERTIFY UNDER PENALTY OF PERJURY THAT THE NOTARY SEAL ON THE DOCUMENT TO WHICH THIS STATEMENT IS ATTACHED READS AS FOLLOWS: NAME OF NOTARY: Nicole Suratos Yepes COMMISSION NO: 940194 PLACE OF EXECUTION: Oregon DATE COMMISSION EXPIRES: 6-24-19 MANUFACTURER/VENDER NO: N/A SIGNATURE: LQ DATE: O' q - Diane Livingsto RI VERSIDE.CA Page 2 of 3 Printed on 7/1/2016 8:0:42 ANI DOCUment: DD 2015.447588 Branch :035.UsePJCRG• Comment: Station Id :SWC\ EXHIBIT "A" DOC #2015-0447588 Page 3 of 3 i THE LAND REFERRED TO HEREIN IS SITUATED IN THE COUNTY OF RIVERSIDE, STATE OF CALIFORNIA, AND IS DESCRIBED AS FOLLOWS: LOT 168 OF DESERT CLUB TRACT, UNIT NO. 5, IN THE CITY OF LA QUINTA, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA, AS PER MAP RECORDED IN BOOK 21, PAGES 61 AND 62, OF MAPS, IN THE OFFICE OF THE COUNTY RECORDER OF SAID COUNTY. ASSESSOR'S PARCEL NUMBER: 770-172-011-0 RIVLRSIDG.CA Page 3 of Printed on 7/1/2016 8:50:42 ANI Document: DD 2015.447588 78-495 CALLE TAMPICO LA QUINTA, CA 92253 (760) 777-7075 APPLICATION FLOOD PLAIN DEVELOPMENT PERMIT BUILDING SITELOCATIONFLOOD ZONE 'AD" - DEPTH 1 74 - GQO .r¢vty/.L4 W1M7X 4,, .q2 -2--s3 COMMUNITY.- PANEL NUMBER 1,Or 1(2,7PE W CG.v8 7"Zr (W/T' No. 060709 0005 B Map Revised: 8/19/1991 APPLICANT INFORMATION SECTION APPLICANT NAME APPLICANT Sit -XON jeH&I 4f�WW & .seX\/1(:43 ADDRESS 1030 GArLLE SOMAWA/ � (MAILING ADDRESS, NOT THE BUILDING SITE) -NC46"&VM CA 9Z2*73 DAYTIME TELEPHONE NO. C9�q) 3�(p .r 2/000 x INSTRUCTIONS 1. A Flood Plain Development Permit is required by LQMC Section 8.11.040(A). The Applicant should complete the Applicant Information portion of this application and submit it to the Engineering Department along with the required documentation noted hereon at the same time the Precise Grading Plan is submitted to the Building and Safety Department for plan checking. 2. Documentation required for STEP 1 OF 2 APPROVAL prior to receiving clearance for Building Permit issuance • Copy of the proposed Precise.Grading Plan for review and approval containing all information required by the checklist shown on the back of this application. 3. Documentation required for STEP 2 OF 2 APPROVAL prior to receiving Flood Plain Development Permit approval. Note, this approval occurs after forms for the lowest habitable floor are set and before the Building & Safety Department authorizes foundation construction. • Submit a completed FEMA "Elevation Certificate" form to the Engineering Department. . • Submit 95% relative density soils compaction certification to the Engineering Department. STEP 1 OF 2 APPROVAL The Precise Grading Plan submitted for this application has been STEP 2 OF 2 APPROVAL All requirements have been satisfied. This Flood Plain reviewed and found to contain all data required to satisfy the Development Permit is approved. requirements of LQMC 8.11 The proposed dwelling is eligible to receive a building permit upon satisfying all other Building & Safety Department requirements. AUTHORIZED SIGNATURE DATE AUTHORIZED SIGNATURE DATE La Quinta Engineering Department La Quinta Engineering Deparilm�O-41a rlLt:: upcn atep z approval, original goes In --t•l000 rlaln Uevelopment rermir tile; copy goes tq 4Wplicant f p � N F090 REV -2 FILE E�iiRig P