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04-6665 (SFD)BUILDING & SAFETY DEPARTMENT 504 `;' (760).777-7012 _LE TAMPICO FAX (760) 777-7011 CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT pGar ,zo 04-00006.6.6.5 Date 1/25/05 resumber ropeAdds . . . . . . 53408 VIA BELLAGIO A 772-510-070- - - Application description DWELLING - SINGLE FAMILY DETACHED Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation419089 • t • 4 Owner ,Contractor ---------------------- --� , `:-------------=-------'--- .. , JOHN CAPETZ SUN VISTA DEVELOPMENT CORPORAT P.O. BOX 1144 P.O. BOX 1144 LA QUINTA. CA 92253 LA QUINTA CA 92247 (760) 771-4722 WCC: STATE FUND WC: 17054604 01/01/05 CSLB: 744091 12/31/05 CCC: B ------ Structure Information 4184 SQ. FT. SFD ------ Construction.Type . . . TYPE V - NON RATED Occupancy Type . . . . . . DWELLG/LODGING/LONG <=10 Flood Zone. . . . . . . . . NON -AO FLOOD ZONE Other struct info . . . . . CODE EDITION 2001 CBC # BEDROOMS 3.00 FIRE SPRINKLERS NO GARAGE SQ FTG 846.00 * PATIO, SQ FTG 1042: 00 ' NUMBE'OF UNITS 1Y. 00 1ST FLOOR SQUARE FOOTAGE 4184.00 2ND FLOOR SQUARE FOOTAGE 626.00 ------------------------------ ------------------------ -------------- -Permit BUILDING PERMIT Additional desc Permit Fee . . . . 1759.50 Plan Check Fee 1143.68 Issue Date . . . . Valuation 419089 Qty Unit Charge Per Extension BASE FEE 639.50 320.00 3.5000 THOU BLDG 100,001-500,000 1120.00 ----------------------------------------------------------------- Permit ELEC-NEW RESIDENTIAL ------------ Additional desc Permit Fee . . . . 219.19 Plan Check Fee 54.80 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE' FEE .15!. 00 4810.00 .0350 ELEC'NEW'RES'.- 1 OR 2 FAMILY 168.35 1042.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 20.84 P.O. BOX 1504 • VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: O r— 6 bfjCS Applicant: La Applicant's Mailing Address: Date: y`"' / — a S Architect or Engineer: Architect or Engineer's Address: Lic. No.. HUILDING PERMIT DECLARATIONS 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 Licenseris i ull force and effect. 7 License Classss License No. DateJ4/— Contractor )J / r OWNER43UILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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).): U 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 propertywho builds or improves thereon, and who does the work himself or herself or 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.). U I, as owner of the property, am exclusively contracting with ticensed 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.). U I am exempt under Sec. , BA P.C. for this reason Date Owner WORKERS' 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 ,=;Tey My workers'ensation insurance carrier and gd'cy number a ,,�/ Cartier Policy NumberS'``-'— I certify that, in the–perforfinance of the work for which this permit is issued, I shall n t 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. I Date _ _0 " Applicant 5U."i l I 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. 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 APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safely 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, indemnity and hold harmless the City of La Ouinta, 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 dale 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 ent n the above -me boned property for inspection purposes. Datil ` o / Signature (Applicant or A ): i Page 2 Application Number 04-00006665 Date 1/25/05 Qty Unit Charge Per Extension 1.00 15.0000 EA ELEC TEMPORARY POWER POLE 15.00 -------------------'----------------7---------------------------------------- Permit GRADING PERMIT Additional desc . . Permit -Fee. . 15.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per u Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Permit . . . MECHANICAL Additional desc Permit Fee . . . . 145.50 Plan Check Fee 36.38 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 4.00 9.0000 EA MECH FURNACE <=100K 36.00 4.00 9.0000 EA MECH B/C <=3HP/100K BTU 36.00 .8.00 6.5000 EA MECH VENT FAN 52.00 1.00 6.5000 EA MECH EXHAUST HOOD J. 6.50 ----------------------------------------------------------_-`----------------- Permit PLUMBING Additional desc . . Permit Fee . . . . 231.75 Plan Check Fee.. 57.94 Issue Date . . . . 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 15.00 2.00 7.5000 EA PLB WATER HEATER/VENT 15.00 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 .• , 4810 SQ. FT. SFD THIS PERMIT DOES NOT INCLUDE POOL, SPA BLOCK WALLS OR DRIVEWAY APPROACH. 11/3/04 8:05:20 AM JJOHNSON ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ART IN PUBLIC PLACES -RES 547.72 Page 3 Application.Number . . . . . 04-00006665 Date 1/25/05 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER - RES 366:00 ENERGY REVIEW FEE 114.37 DIF FIRE PROTECTION -RES 97.00 GRADING PLAN CHECK FEE .00 DIF LIBRARIES - RES 225.00 DIF PARK MAINT FAC - RES 5.00 DIF PARKS/REC - RES 502.00 STRONG MOTION (SMI) - RES.. 41.90 DIF STREET MAINT FAC -RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fee summary ----------------- Charged ---------- Paid Credited Due Permit Fee Total 2370.94 ------------------------------ .00 .00 2370.94 Plan Check Total 1292.80 500.00. .00 792.80 Other Fee Total 3108.99 .00 .00 3108.99 Grand Total 6772.73 500.00 :00 6272.73 4 Building � 3-10 b 9 Address *111)wner Mailing It Address Fl1D oX City Zi� �q QVI�� Contrar.tor �1;0 T4hf / 4 4 a" 1_�$ P.O. BOX 1504 APPLICATI0646 495 Vrp- F_ / ^ &NTA, CALIFORNIA9 © �- INTA, CAIFORNI92253 ;IZ Tel. 253 170-771 17Z BUILDING: TYPE CONSST. OCC. GFIR A.P. Number :2I/-�0 - S-10— O r / ? Legal Description /fit ✓ ` �c'-t 2IlEM ` 2— Project Description � I� f k tn -e C— l' _ 9,4viv , 4v -v- z W. 3 _e c, wcn, city,1 Zip a�225 3 Tel. 77 I 4- - Z PL ' State Lic.+ City -3, S Ft.No. & Classif. `7 y ��� l Lic. # 5- 31 3 Ste 1910 Sto Designer 2 �i1 V'�L► I l,C�-fig AddresTel s 1 ' R'JIAt"ki20 &13`i x5v {' Cityl ��� Zpa� State G^ Ia�IQ G G� Lic. # l t3 LICENSED CO RACTOR'S DECLARATION I hereby affir at I a icensad u er rovisions of Chapter 9 (commencing with Section 70001 of Di 'Ion 3 of t usiness d P fessions y license is i ful Ace and effect. U SIGNATURE ATE OWNER-BUILDVR DECLARATION I hereby aff' that I am exempt from the Contractor's License Law for the following reason: (Sec. 7 1.5, 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 WORKER'S COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation, n Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Pol'cy o. Company Copy is filed with the city. ❑ Certified copy is hereby furnished. K 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 /s No. Dw. New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ OULL� Estimated Valuation PERMIT AMOUNT -90 Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing r S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS frr h! Irk i :► r � r ZONE: BY: 1 ' "yLU _ 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 14��-339 WHEN RECORDED MAIL TO: Mr. & Mrs. John M. Capetz 3011 Segovia Way Carlsbad, CA 92009 MAIL TAX STATEMENT TO: SAME AS ABOVE ®® 02/14/2003 010 Fax Paid Page 1 of 4 Doc T tax Recorded in Official Records City of Riverside Gary L. Orso pressor , City Clerk & Recorder II I I q -7Y -7303 0 DOCUMENT TRANSFER TAX $ o� �-� . S XX Computed on the consideration or value of property conveyed; OR Computed on the consideration or value less liens or encumbrances remaining at the time of sale. 0-6-37- Ow- -6a7- (l9 T sw of Declarant or Agent determining tax — Firm. Name � EED Lof 33 FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, ND LA QUINTA PARTNERS, LLC, a Delaware limited liability company ("Grantor"), hereby GRANT(S) to _JOHN M. CAPETZ AND DEBBIE CAPETZ, HUSBAND AND WIFE AS JOINT TENANTS ("Grantee"), the real property located in the City of La Quinta, County of Riverside, State of California, described as: See Legal Description attached hereto and incorporated herein as Exhibit "A". SUBJECT TO all matters of record 'including, without limitation, the covenants and agreements described in Exhibit "A" attached hereto. Dated: January 20, 2003 i-LA/627969.1 ND LA QUINTA PARTNERS, LLC, a Delaware limited liability company By: Nationwide Realty Investors, Ltd., an Ohio limited liability company its managing m er By:AJoph , . Arenson ed Representative STATE OF California ) ss. COUNTY OF Riverside On a'IAArID 2003, before me, the undersigned, a notary public in and for said State, personally appeared Joseph L. Arenson (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity(ies), and that by his signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS MY HAND AND OFFICIAL SEAL. Signature Q. {$FAT•] KATHRYN L. HUNTER Commission fl 1382692 4 Notary PutdiC - Cardomia Riverside County PMyC0ffMEVkesNov1,2006f 1-LA/627969.1 1 fall)] 1161111 Mil Bili eusau ■m 0611001 if ..,.......... - - -- . -- . lQ40 1JL9Y b "A" Leal Description Parcel No. 1: Lot 339 (the "Lot") of Amended Tract No. 29894-2 as shown on a Subdivision Map (the "Map") recorded on December 12, 2002, in Book 327, Pages 56 to inclusive, of Maps, in the Office of the Riverside County Recorder. EXCEPTING AND RESERVING THEREFROM TO GRANTOR, and its successors, assigns, invitees, licensees and employees, together with the right to grant and transfer all or a portion of the same, all easements and rights for access, ingress, egress, encroachment, maintenance, drainage, support, and for other purposes over the Association Maintenance Areas and other portion of the Lot, reserved to Grantor in the following instruments: 1. The Amended and Restated Declaration of Covenants, Conditions and Restrictions and Reservation of Easements for The Hideaway Owners Association (as amended or supplemented, the "Declaration"), recorded on December 13, 2002, as Instrument No. 2002- 745X938, of Official Records of Riverside County, California (the "Oficial Records"); FURTHER RESERVING THEREFROM, the right to enter the Lot for a term of twelve (12) months following the recordation of this Grant Deed, to complete and repair any improvements or landscaping located thereon as determined necessary by Grantor, in its sole discretion, in order to comply with requirements for the recordation of the Final Tract Map, the grading of said Tract and/or in compliance with the requirements of applicable governmental agencies. Such entry by Grantor shall be preceded by reasonable notice to Grantee before such entry. If this reservation of right -of entry is not complied with by Grantee, Grantor may enforce this right of entry in a court of law. Grantee shall be responsible for all damages arising out of said breach including attorneys' fees and court costs. This reservation of right of entry shall automatically expire twelve (12) months from the recordation of this Grant Deed. Parcel No. 2: Nonexclusive easements for access, ingress, egress, drainage, maintenance, repairs and for other purposes, all as described in the Declaration. SUBJECT TO: Nondelinquent general, special and supplemental real property taxes and assessments. 2. All other covenants, conditions, restrictions, reservations, easements, rights and rights-of-way of record including, without limitation, the Declaration and the Map for Tract No. 29894-2. 1111111111111111111111l11111IIII IllilliIII 11111 IIII Illi 9t © 3�of 4 c99F 1-LA1627969.1 3 Grantee, by acceptance and recordation of this Grant Deed, hereby (a) accepts and approves all of the foregoing in this Grant Deed, (b) grants to Grantor and The Hideaway Owners Association such powers and rights as are set forth in the Declaration ,and (c) accepts, covenants and agrees to be bound by and assume performance of all of the applicable provisions and requirements set forth in the Declaration, including Section 13.15 establishing the procedure for resolving disputes with Grantor, and the notice, which provisions and requirements are acknowledged to be reasonable and incorporated herein by this reference thereto. This grant is conditioned upon the performance of such provisions and requirements as are to be performed by Grantee under the Declaration. The restrictions on use and occupancy of the Lot are set forth in the Declaration to which this Grant Deed is specifically and expressly made subject. GRANTEE HEREBY ACCEPTS AND APPROVES THE FOREGOING, granting unto Grantor and The Hideaway Owners Ms9ciation such powers and rights which are set forth in the Declaration defined above, on 63 2003. STATE OF ) ss. COUNTY OF,��ti) On / , 2003, before me, the undersigned, a notary public in and for said State, personally appeared,%In M• Md &-Oe zpersonally known to me.(er ) to be the person(s) whose name(s) /are subscribed to the within instrument and acknowledged to me that-he/she/they executed the same in histher/their authorized capacity(ies), and that by-hisAier/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS MY HAND AND V9 CHRISTINA J. DORES Cor► ynimsson # 1291875 MulaW PubGc - Cal 143 Ever.Ode County Fila== LIDWMF4�� F12/14/2@83 98 00A 11111111111111111111111111111111111111111111111111111 4 of 4 1-LA/627969.1 4