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07-1113 (SFD)4 P.O. BOX 1504 (1�/ 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application. Number: 07-00001113 Property Address: 53517 VIA BELLAGIO APN: 772-510-047- - - Application description: DWELLING - SINGLE FAMILY DETACHED Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 390587 Applicant: Architect or Engineer: --------------------------------------------------- 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 Business and Professionals Code, and my License is in full force and effect. License Class: B license No.: 533670 Date: Contractor, OWNER -BUILDER DECLARATION 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).: ( 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, 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.). 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.). ( 1 I am exempt under Sec. , B.&P.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 Address: LQPERMIT Owner: D SEDONA HOMES, INC. 49-950 JEFFERSON.ST #730 INDIO, CA 92201 Contractor: SUNROSE CORPORATION 49950 JEFFERSON, #130-134 INDIO, CA 92201 (760)347-0089 Lic. No.: 533670 VOICE (760) 77777012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 9/07 111A_ p 3 2001 ---------------------------------- ------- WORKER'S COMPENSATION' DECLARATION I hereby affirm under penalty of perjury one of the following declaration's: _ 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 EXEMPT Policy Number EXEMPT _ 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. Date: '-0 Applicant: WARNING: FAILURE TO SEC WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO 0 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 Director of Building and Safety 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 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 county to enter upon the above-mentioned property for inspection purposes. bate: _ 0-0 Signature (Applicant or Agent): Application Number . . . . . 07-00001113 ------ Structure Information 4,500SF DWELLING/V-NR/RES-3/CLASS A -FR. ----- Other struct info CODE EDITION 2001/2005 #,BEDROOMS 4.00 FIRE SPRINKLERS NO GARAGE SQ FTG 765.00 PATIO SQ FTG 887.00 NUMBER OF UNITS 1.00 1ST FLOOR SQUARE FOOTAGE 3725.00 ----------------------------------------------------------------------------- 2ND FLOOR SQUARE FOOTAGE 775.00 Permit . . . BUILDING PERMIT Additional desc . Permit.Fee' 1658.00 Plan Check Fee 1077.70 Issue Date Valuation 390587 Expiration Date 12/26/07 Qty Unit Charge Per Extension BASE FEE '639.50 291.00 3.5000 ------------------------------------------------------------- THOU BLDG 100;001-500,000 -------- 1018.50 Permit ELEC-NEW RESIDENTIAL Additional desc . Permit Fee . . . . 187.80 Plan Check Fee 46.95 Issue Date . . . . Valuation 0 Expiration Date 12/26/07 Qty Unit .Charge Per Extension BASE FEE 15.00 4500..00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 157.50 765.00 .0200 ---------------------------------------------------------------------------- ELEC GARAGE OR NON-RESIDENTIAL 15.30 Permit . . . GRADING PERMIT Additional desc . Permit Fee . . . . 15.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . .0 Expiration Date 12/26/07 Qty Unit:Charge Per Extension ----------------------------------------------------------------------.------ BASE FEE 15.00 Permit MECHANICAL Additional desc . Permit Fee . . . . 202.00 Plan Check Fee 50.50 LQPERDIIT Application Number Permit . . . Issue Date Expiration Date . 07-00001113' MECHANICAL Valuation 12/26/07 p Qty Unit Charge Per Extension Extension BASE FEE 15.00 25.00 BASE FEE 15.00 6.00 9.0000 EA MECH FURNACE <=100K 54.00 1.00 4.5000 EA MECH VENT INST/ DUCT ALT 4.50 3.00 9.0000 EA MECH B/C <=3HP/100K BTU 27.00 3.00 16.5000 EA MECH B/C•>3-15HP/>100K-500KBTU 49.50 7.00 6.5000 EA MECH VENT FAN 45.50 1.00 ----------------------=------=---------------------------------------------- 6.5000 EA MECH EXHAUST HOOD 6.50 Permit Additional desc . Permit Fee Issue Date . . . . Expiration Date . PLUMBING ' 224.25 12/26/07 Plan Check Fee . . 56.06 Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 25.00 6.0000 EA PLB FIXTURE. 150.00 .1.00 15.0000 EA PLB BUILDING SEWER 15..0.0. 1.00' .7.5000 EA PLB WATER HEATER/VENT .7.50 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 -1.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM 9.00 13.00 .7500 EA PLB GAS PIPE >=5 9.75 1.00. 15.0000 EA PLB GAS METER 15.00 Special Notes and Comments 4,500SF DWELLING/V-NR/RES-3/CLASS A -FR. 2001 CBC, CMC, CPC, 2004 CEC, 2005 ENERGY. THIS'PERMIT DOES NOT INCLUDE BLOCKWALLS, POOL AND SPA OR DRIVEWAY APPROACH. June 29, 2007 12:16:42 PM AORTEGA ------------------------------------------------------------------=--------- Other Fees . . . ART IN PUBLIC PLACES RES 476.46 DIF COMMUNITY CENTERS -RES 74.00 DIF CIVIC CENTER - RES 995.00 ENERGY REVIEW FEE 107.77 DIF FIRE PROTECTION -RES 140.00 DIF LIBRARIES - RES 355.00 DIF PARK MAINT.FAC.- RES 22.00 DIF PARKS/REC = RES 892.00 STRONG MOTION (SMI) - RES 39.05 DIF STREET MAINT FAC -RES 67.00 LQPEPNIIT Application Number . . . . . 07-00001113 - ---------------------- Other Fees . . . ------------ . . . . -------------------------- DIF TRANSPORTATION '-.RES --------------- 1930.0.0 Fee summary Charged ---------- Paid ---------- Credited ---------- __7 Due ------- ----------------- Permit Fee Total 2287.05 .00 .00 2287.05 Plan Check Total 1231.21 5100.00 .00 731.21 -Other Fee Total 5098.28 .00 .00 5098.28 Grand Total 8616.54 500.00 .00 8116.54 LQPERA1IT Building S11 Address S3' L'm 'V" Ad— \-4o VL Tihf at 44" i97-///3 P.O. BOX 1504 APPLICATION ONLY 78-495 CALLE TAMPICO n LA QUINTA, CALIFORNIA 92253 Address 44 cll V f - 730 citl. Zip I1 Z Z1p ZO1 1e q7-' �I I 41 -9 S0 Cit Zip Tel. 2�b �/ 3`(7--33ll State Lic. City & Classif.3-3 -70 Lic. Arch., Engr., Designer -LIZ `S 1 35-0 Qa_�>��- Qit, -711 Y I Z City Zip State LC, -k-e I'Z2S _� Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) o I ion f the Business and Professions Code, and my license is in full force and effect. _ 1 SIGNA 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 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 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 im- provement 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). ❑ 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.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORK'ER'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 WHITE = BUILDING DEPARTMENT BUILDING: TYPE CONST. 000. GRP. A.P. Number Legal Description Project Description % S 3 — S r , 1C. &k t C1 CJ 4 a 1 \. - ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: YELLOW = APPLICANT PINK = FINANCE Sq. Ft. Size 00 No. Z No. Dw. Stories Units New I' Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT. Plan Chk. Dep. 0 Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure fft APR j " f CITY OF LA QUIlb TA TOTAL FINAN REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: YELLOW = APPLICANT PINK = FINANCE �Coaclieff Valley Unified School District 83-733 Avenue 55, Thermal, CA 92274 X760) 398-5909 — Fax (760) 398-1224 Project Name: Owner's Name: Project Address: Sedona Homes, Inc. Sedona Homes, Inc. This Box For District Use Only DEVELOPER FEES PAID AREA: AMOUNT LEVEL ONE AMOUNT: LEVEL TWO AMOUNT: MITIGATION AMOUNT: COhIM/IND. AMOUNT: DATE: RECEIPT: CHECK N: INITIALS: CERTIFICATE OF COMPLIANCE (California Education Code 17620) 53-517 Via Bellagio, La Quinta Project Description: 1 SFD APN: 777-170-004 Tract #: Lot # Type of Development: Residential xx Commercial Total Square Feet of Building Area: 4500 sq. ft. Date: 064W/07 Phone No. 760-773-6633 Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement under penalty of perjury and further represents that he/she is authorized to sign on behalf of the owner/developer. Dated: 0628/07 Signature: SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE) Education Code Gov. Code Project 17620 65995 Approval Number of Sq.Ft. 4500 sq ft Amount per Sq.Ft. S 3.91 per sq. ft. Amount Collected S 17,595.00 By: Carey M. Carlson, Asst. Supt., Business Services Agreement Existing Prior to 1/1/87 C. Certificate issued by: Maria L. Angulo, Facilities Secretary Signature: Not Subject to Fee Requirement NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND'STATEMENT OF AEIJS Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that thisvDistrict proviV(I) a written notice to the project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of these Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall serve to advise you that the 9b -day protest*period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of any other requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether payable at this time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This Certificate of Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School District, and up to three (3) such extensions may be granted. At such time as this Certificate expires, if a building permit has not been issued for the project that is the subject of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance. I I m%klucs dcti ilc; ruulicaic of compliancc lixm tahleSTO IISI...doc 1/16/03 T �.. ' '..NEW CENTURY TITLE COMPANY RECORDING REQUESTED BY: New C ry Title Company - Riverside Title O NO.: 2372952 ESCROW NO.: 33070022 -FW AND WHEN RECORDED MAIL TO: Sedona Homes, Inc. 49-950 Jefferson Street #130-134 Indio, CA 92201 .'t.3-� -�)952--)/= .... //I 1 v- -+VtA . 020 DOC # 2007-0063185 01/26/2007 08:00A Fee:10.00 Page 1 of 2 Doc 'T Tax Paid Recorded.in Official Records County of Riverside Larry W. Ward Assessor, County Clerk & Recorder 11111111111111111111111111111111111111111111111 IN S R I U PAGE SIZE DA MISC LONG RFD I COPY l 2- M M A L 465 426 C NCOR SMF NCHG EX AM GRANT DEED THE UNDERSIGNED GRANTORS) DECLARES) that documentary transfer tax is $797.50 (County) $.00 (City) ( X ) computed on full value of property conveyed, or ( ) computed on full value less liens or encumbrances remaining at time of sale ( X ) City of La Quinta FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Gary L. Forster and Christina H. Forster, husband and wife as joint tenants hereby GRANT(S) to Sedona Homes, Inc., a California. Corporation the following described real property in the City of La Quinta, County of Riverside, State of California: SEE EXHIBIT "A'. ATTACHED HERETO AND MADE A PART HEREOF and commonly known as: 53517 Via Bellagio / Lot 316, La Quinta, CA 92253 Dated: uary 22, 2007 Gary L. Forst STATE OF C ct l iDr�/ COUNTY of 1 Uer Si J ONCIYiLIfa f U L 2, z �J _ BEFORE me 1 1 istina H. Forster + f (nere Insert name ano title of tfk officer) personally appeared GYU %f�:lt�: fQ. ChriSfipc {I I-DrtiIYl/ personally known to me (or prov d to me on the basis of satisfactory evidence) to be the person(s) 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 his/her/their signatures .on the instrument the person(s) or the entity upon behalf of which the persons) acted, executed the instrument. WITNESS my hand ar30 �fficial seal. Signature Z/' FRANCES M. WOELKE Commisalon # 1624448 -� Notory "Ic - Coliforrdo RNerslde County 'W comm. Expires Nov 24, (This area for official notary seal) Grant Deed - Individual (290) 12-05 MAIL TAX STATEMENTS AS DIRECTED ABOVE f