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9907-063 (SFD)LICENSED CONTRACTOR DECLARATION 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 291728 B 0,3/31/20% ate _' I% 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 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. „ ( ., l 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. VWT FUND (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,ptoyi(sions.-r Qate:9/ %lam( Applican ;..fe/e_4-*.�fy%as 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 'above-mentioned property for in ection, purposes. Signature (Owner/Agent) 1; ✓�� ` Date BUILDING PERMIT PERMITS";16+1 DATE VALUATION 596,323.70 LOT I I TRACT 131,KA U2 JOB SITE51-4175 C.'ALLN ILOILO ADDRESS APN OWNER CONTRACTOR / DESIGNER / ENGINEER 1,N (; UTATfA. PAR 'f"+i 'Dl ER WILLfAM IKUSS€:LL ROCERS 51.370 .A.VENIUA BERMUDAS 56900 JACKSON ST i',A QUI 1 A CA. 92253 '17-f1 RIVIAL C;A. 92274 (760)399-12M C 8L4 5449 USE OF PERMIT S11"NOLF FAMILY DWELL -190 _ Sig .) (YN i, X004 iT D0138 NOT I1VNC U -DE BLWK WALL 042 OL. P01ZCiir PATIO - 1.1 Loo STS O.1VtA.(y;i;JCA12:6 QXT 480.00,"W S IT . Oi► (X)D FE NC 6 ;210.00 LF ESTIMATE -11) CM OF CONST I-WICT!0N. 3613213.719 Pf.`$2MIT FE, E, SUit9:.N.,IR1V CONS' RUCTION FF,t3 101-000.4184= $581.00 pi. NK CMROZ r. IT, 1014)00-0)!# $ 493.8£ NZYal.l XICALi'1?"f x;01•-v00A.2f-000 553.$I1 JUri ; i'M AL FEE 101.-000420.00 - $126,6:3 (9LiJ 11 ll`1ir k 101-000-419,QW $133,50 STRIO tWx - MOT10W FW - u41ST1) 11!13 -A,M, 241 ruu+ GRADING t"f E..01 -00.0.423 -OW) S"Z0.00 NFRAMUCT FM 2; 5-00a-a.3.•'�Aaa PREC tSE :PLAN 101-000-441-345 lS25,09 �T-F 101-000-41Q-118 "4 • p SUB RYIA.L CON,"LI(MON A,14f) PLAN CHECK $3,332,90 LESS PRE-PAWFEES _$1250,00 PYT.ALPERTWIYT FEE'S 0 U NOW RECEIPT_- .� DATE p"��( BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs zUnderground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck $ Exhaust Fans 0. K. to Wrap F.A.U. Framing —12, - O Compressor Insulation 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 BLOCKWALL APPROVALS POOLS - 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 Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test „pp Appliances G -O O Final 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. i Final Utility Notice (Perm))Z L O COMMENTS: P.O. BOX 1504 APPLICATION ONLY Building tt 78-495 CALLE TAMPICO Address i '°"�� i 1 Si. C! �LF9 LA QUINTA, CALIFORNIA 92253 AddressC %"61 p AVC QX9rA fad W,5i, City Zip Tel. 1.4 0U1071-) 1 IR;a cn 15*4 q -S��u (Al � M Address se. 90i Zip Tel- �tw �� U State Lic. I City & Classif.2 q t t P-9 Lic. # Arch., Engr., Designer '..rt-4,ct4 Address Tel. City Zip State LA OJ107A I dt%,7<:? I Lic.# LICENSED CONTRACTOR'S DECLARATICN I hereby affirm that I a�censed under provisions of Chapter 9 Commencing with Section 7000) of Division 3 of{tbe Business and Prof salons Code, and my license is in full force and effect. /--,* F (2.447 � y� - 4y' /�" 7 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 Te is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencng with Section 7000) of Division 3 of the Business and Professions Code, or that. he is exempr therefrom, and the basis for thealleged exemption. Any violation of Section 7031.5 Dy ery applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollar ($500). I- I, as owner of the property, or my employees with wages as thei- 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 -boder 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 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 Date Owner WORKERS' COMPENSATION DECLARATICN I hereby affirm that I have a certificate of consent to self-iisure, 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 ($100) valuation or less.) _t I certify that in the performance of this work. for which this pemit is issued, I shall not 'ie 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. P 1; 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 ddress This is a building permit when properly filled out, signed and vahtlated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that 1 have read this application and state that the above information is correct. tagree 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 Mailing Add City, State, TYPE"CONST. OCC. GRP. A.P. Number -76413 - 1144. -4'-'b Legal Description LOT R Project Description Zr srazr fr VA11"P "x..r Sq. Ft. No. No. DIN. Size Stories ( Units New Nit Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from C r n Rear Setback from Rer Side Street Setback from Center Line Side Setback from Pr ope y Id"no D99J1J�`� FINAL DATE INSPECTOR � "UV Issued by: Dat twilit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Notice: Document Cannot Be Duplicated Date 8/13/99 No. 19177 Owner NameLa Quinta Partners Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE APN # 769-114-023 Jurisdiction La Quinta No. 51-475 Street Calle Iloilo City La Quinta zip 92253 Permit #9907-063 Log # Study Area Tract # BLK4 U2 Lot # 11 Square Footage 1,358 Type of Development Single Family Residence Comments t No. of Units 1 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 NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.93 X 1,358 or $ 2,620.94 the property listed above and that,buAirig permits and/or Certificates of Occupancy for this square footage in this proposed project may now be'issued rr. Fees Paid By ccNIB/Thomas Buffin Te.' hone 5_64-8470 Name on the check -r, i-� ^► By Dr. Doris Wilson Superintendent y . �.. �,.•^ Fee collected /exempted by Juanita Green Payment Received $2,621.00 Check No. 195302 Signature INOTICE: Pursuant of Asmbly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identifiedabove will begin to run fr6fn 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 collect 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 ..CjI un -24. 1999.10:13AM-'ANPOWER BROKERS RECORDING REQUESTED BY: CHICAGP TITLE COMPANY COMPANY 99.87 KC 97056039 WH L%R jMAP. D. LA QUINTA PARTNERS P.O. BOAC 134 LA QUINTA, CA 92253 r No.3332 P. 1 r 221982 M ' S U PAGE Gi£ CA PCan t+ocon s�V weC. A R L Cour taw R6fvw "CHO E)WA GRANT DSD.' DSO -Dib The undersigned-grantor(s) declare(a): Dncumentary transfer tax i3 $9.35 (XXX) Computed on full value of property conveyed, or Computed..on_ rull,. aloe less. llerts an 4encumbrances remaining at time of sale. O { ) Unincorporated"are8 "'(` ) "G`ity bf" and FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, NANCY M. KROENER, TRUSTEE OF THE NANCY M. KROENER LIVING TRUST'�T 7/1198 hereby GRANT(S) to William Thomas Buffia, an urmarried-sian DSA LA QUINTA PARTNERS, 4 the real property in the City of LA QUINTA, County of Riverside, State of California, described as: Desert Club Tract in the city of Lot 11 of Block 4, Unit No. 2,/ La Quint&, as per map recorded in Book 20, Page(s) 6 inclusive of maps, in the office of the County Recorder of said County. Dated April 28, 1999 Cdunty of� y�G P ? S.S. On 9 before r i�udl/: r personally appeared personally known to me (or e) to be the person* whose name(k) &&re subscribed to the within instrument and acknowledged to me that ireeh teary executed the same in h4e/ er he+L authorized capacity(4es), and that by iris er Q ce4r signature ('9) on the instrument the person(b}, or the entity upon behalf of which the person(b) acted, executed the instrument. WITNESS my hid and officiaseal. Signature ZI MAIL TAX STATE TO: snag As ABovs r NANCY Pq RROSNER, TRUSTEE OF THE ANCY M. KRQENER LIVING TRUST MT 7/1/98 MARY E. BUTTS COMM #1104977 rr NOTARY P1 SM • CAUFORrno. ORANGE COUNTYgo,� My Corn. EvnI dune 4 2002 (This area for official notarial seal) ,Pool COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY ASSESSOR'S PARCEL NUMBER�� q - IN - oa. -� DEPARTMENT OF ENVIRONMENTAL HEALTH ` f Aar PERMIT APPLICATION FOR "A SUBSURFACE SEWAGE DISPOSAL SYSTEM APPLICANT. Submit this form with four copies of a SCALED plot plan (1-20 SCALE) drawn to County specifications as indicated on the attached check list. A non-refundable filing fee is required when the application is submitted. Check must be made payable to the, County of Riverside. Approval of this applica- tion shall remain valid for a period not to exceed one year from date of payment. 07-22-99 16: `,17= LMS # CHIS $214.. 00 Agent, Contractor, Contact Person Address City State Zip Telephone Owner " Address City State Zip Telephone Q Z'4 OW41rd %" .:v�- . 7a dl-" d mok.. AIA;� , sPus j� fir! A7w Z Job Property Address City Zip .57 • 74" l 1Z ll a 1,,L 4 *1-4a)'141* elk - �1 Z%�.� 3 W Lot Size Water Agency/Well Use of Permit, P/P., SUP PUP? etc. Legal Description CD r w r �-Dwelling,<MH Site Prep., etc. Signature of Appfganto ty Date CHECK BOX IF REQUIRED If any box is checked, this application shall be considered rejected until ❑ Detailed Contour Plot Plans Required (1 to 5 foot interval) ) the information is provided and the fee paid. Resubmittals later than 90 days after date noted below may require repayment of fees. ❑ Staff Specialist Lot Inspection Required m ❑ Holding Tank Agreements Completed Thomas Bros. Page Grid Z 0 ❑ Certification of Existing S.D. System Required ❑ Date Lot Inspection Completed: Initials U ❑ WOCB Clearance Requiredill W (Attach for DOH -SAN -007, Santa Ana Region Only) Remarks: ¢ . CD 3- ❑� Soils Percolation Report Required ❑ Maintenance Booklet Provided , ❑ Special Feasibility Boring Report Required L)Final Inspection by Department of Environmental Health is required. F i ❑ Rereview bquired Initials Date Please call 24 hours PRIOR to inspection. , ,d y .EJ i C/42 / Soils Percolation Boring Report by .t� Lic/Project # Date Soils Map Page Soil Type u.."StK Approved By Date a No of Systems Type of System(s) No. Dwelling Units (1) Septic Tank Soil Rate Grease/Sand )[ding Tank ❑ Replaceman' Bedrooms, Fixture Units Grease Intcp/Lint Trap ew ❑ Addition,' F Existing,.": �`] t 1 7 JJ Gal. t Gal . . Sq. Ft. Total Linear Sidewall Allowance Bottom Area Ft. ~ Leach Bed sq. ft. of Bottom Area ft. rock/ ;'f sq. ft. running ft. Install Lines) �ong Oft: wide -with ^' Inlet Tested Deptfi (3 NA min. inches rock below drainlines or U Ti Proposed. Bottom Tested Depth K Z Leach lines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Inlet (BI) Seepage Pit Maximum Other: Applicable �} r Total Depth' Allooweablle pth U, LU N/A Overburden Factor ❑ 5' Cg/6' p TD- Well Review Approved: Date: Well Drilling Permit # ..^e"Y SIGNATURE Grading Plan Approved: Date: slUNATURE Sewer Verification Approved: Date: Plan Check Only Approved: ` Date: REMARKS: j F.. c; .r �^ i a r M'^�• rre H f,rs . %.�Lr �i•p . This application is APP OVED/AENIED for the category checked in SECTION B FOR OFFICE USE ONLY above, regarding the design of a subsurface disposal system as indicated on the acompanied plot plan, using the requirements set forth in SECTION above. A build- ,.r %�, � _ ` 0 O g permit is necessaryfor the installation of the above -designed system. No con- Revenue code_ a Fee $ (� struction Is permitted In the required reserved 100% expansion area. r �( asg� (1) Septic Tank, must be 100' minimum from any wells. Check # _ . �- (2) Leach lines must be 100' minimum from any wells, including expansion area. Date -e2'2-99Initial 0 (3) Sewer lines must be 50' minimum from any wells. R T • f � (4) Seepage pits must be 150' minimum from any wells, including expansion area. LU i 1 i Signature of Health Official llt Date DEH -SAN -122 (Rev 9/98) Distribution: WHITE—Office File; YELLOW—Applicant; PINK—Bldg. Dept. GOLDENROL—Plans/Records Certificate of Occupancy. City of La Quintatwow. � 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: 51-475 CALLE ILOILO Use Classification: SFD Bldg. Permit No.: 9907-063 Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RM Owner of Building: LA QUINTA PARTNERS Building Official Address: 51-370 AVENIDA BERMUDAS City: LA QUINTA, CA 92253 By: STEVE TRAXEL Date: 03-08-00 I POST IN A CONSPICUOUS PLACE