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04-7329 (SFD)s, P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number:04'-00'0-07329 Property Address: 53472—VIA BELLAGIO APN: 772-510-068- - Application description: DWELLING - SIN A Property Zoning: LOW DENS ES T Application valuation: 451 /\ Applicant: T`ti uw , t 4.4 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT ILY DETACHED AL Engineer: c. No.: OOR SQUARE FOOT 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 Lice No.: 744091 ens bai Vie; . C-115; `'5f ontra� ctor: �A,� nom` 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).: (_) 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..lf,'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 contractdr(s) licensed pursuant to the Contractors' State License Law.). 1 _ 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: LQPERA11T g i VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/24/05 Owner: ROBERT HILL 53-472 VIA BELLAGIO LA QUINTA, CA 92253 Contractor: SUN VISTA DEVELOPMENT CORPORAT P.O. BOX 1144 LA QUINTA, CA 92247 (760)771-4722 Lic. No.: 744091 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 HRH INS Policy Number 17054605 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 / �/r�3700 of the Labor Code, I shall �forthwith comply with those provisions. ,;Dbte: O JP_05 Applicant:_ WARNING: FAILURE TOS— ECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (51 00,000). 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. Application Number . . . . . 04-00007329 Permit . . . BUILDING PERMIT Additional "desc . Permit Fee 1742.00 Plan Check Fee 1132.30' Issue Date . . . . Valuation . . . . 414515 Expiration Date 11/20/05 Qty- Unit Charge Per. Extension BASE FEE 639.50 315.00 3.5000 ---------------------------------------------------------------------------- THOU BLDG 100,001-500,000 1102.50 Permit . . . ELEC-NEW RESIDENTIAL Additional desc . Permit Fee . . . . 214.58 Plan Check Fee 53.65 Issue Date Valuation . . . 0 Expiration Date.. 11/20/05 Qty Unit Charge Per Extension BASE FEE 15.00 4824.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 168.84 787.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 15.74 1.00 15.0000 ---------------------------------------------------------------------------- EA ELEC TEMPORARY POWER POLE 15.00 Permit . . . GRADING PERMIT Additional-desc . Permit Fee . . . . 15.00 Plan Check Fee .00 Issue Date Valuation 0 Expiration Date 11/20/05 Qty Unit Charge . Per Extension ----------------------------------------------------- BASE FEE' ---------------------- 15.00 Permit MECHANICAL . Additional desc . Permit Fee . . 157.00 Plan Check Fee 39.25 Issue Date Valuation 0 Expiration Date 11/20/05 Qty Unit Charge Per Extension _ BASE FEE 15.00 5.00 9.0000 EA MECH FURNACE <=100K 45.00 5.00. 9.0000 EA MECH B/C <=3HP/100K BTU 45.00 7.00 6.5000 EA MECH VENT FAN 45.50 1.00 6.5000 -------------------------------------------- EA MECH EXHAUST HOOD -----------------------------•--- 6.50 LQPERDIIT ' 4 Application Number . . . 04-00007329 f • Permit . . PLUMBING • Additional desc - Permit Fee 216.00 Plan Check Fee 54.00 Issue Date Valuation 0 'Expiration Date 11/20/05 Qty Unit Charge, Per Extension, BASE FEE 15.00 20.00 6.0000 EA PLB FIXTURE 120.00 1.00 15.0000 EA PLB BUILDING SEWER 15.00 •2.00 6.0000 EA PLB ROOF DRAIN• 12.00 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 16.00 7500 EA PLB GAS PIPE >=5 12.00 1.00 15.0000 EA PLB GAS METER 15.00 , ----------------------------------------------------------------------------' Special Notes and Comments 4824 SQ. FT. SFD. THIS PERMIT DOES NOT INCLUDE POOL, & SPA BLOCK WALLS OR DRIVEWAY APPROACH.April 27, 2005 10:29:50 AM JJOHNSON ---------------------------------------------------------------------------- other Fees . . . . . . . . . ART,IN PUBLIC PLACES -RES 536.28 DIF COMMUNITY CENTERS -RES. 97.00 DIF CIVIC CENTER - RES 366.00 ENERGY REVIEW FEE 226.46 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 41.45 DIF STREET MAINT FAC -RES 15:00 DIF TRANSPORTATION - RES 1098.00 Fee summary Charged Paid Credited Due Permit• Fee Total 2344.58. .00 .00 2344.58 Plan Check Total 1279.20 500.00 .00 779.20 Other Fee Total 3209.19 00 .00 3209.19 Grand.Total 6832.97 500.00 .00 6332.97 LQPERDIIT - P.O. BOX 1504 Building �j �7 2 IV /J, fj EL.444tf0- 78-495 CALLE TAMPICO Ar11HrP.CC LA QUINTA, CALIFORNIA 92253 Mailing 'P, f /L/ Address ' �Jn�- ��f�� 401 J • & Classif. syn 7 Lic. # 539 Ad ess Tel. rt1ZO 7J"11 o' -Tr v�� tua - S06 ;j14z,;0 State tyL,v Lic. # 6-%9a) 6 LICENSED CONTRACTOR'S DECLARATION I hereby affirm th licensed under Prov' ions of Chapter 9 (commencing with Sectioy 7000) of Dii , of th Businese�nd Pr1of ons de, and my license is in full force ayfc effect. \ , , 1 7 " OWrN -BWLD7 DEla ARATIONii hereby affirm that I am empt from t eCoactor's License Law for the (lowing rn: (Sec. 7031.5, Business and Professions Ce: Any city or county which quires a m to construct, alter, improve, demolish, or repany structure, prior to its is ancealso uire the applicant for such permit to file a signetatement that he is licens pursuant to tprov 'ons of the Contractor's License Law, Char 9 (commencing with S Ilion 7000) of ision 3 /the Business and Professions Code, ort he is exempt therelro ,and the basis the aIle d exemption. Any violation o/Section 70.5 by any applicant !or permit subjects tapplican o a civil penalty o/not more than /ive dred dollars ($500), as owner the property, or my employees withges as their sole mpensation, will do twork, and th structure is not intended or offeredr sale. (Sec. 704 , Business and Profes- s Code: The ontractor's License Law does noply to an own o! property who builds proves there and who does such work himser through his wn employees, provided tsuch improve nts are not intended or oilerer sale. I!, h Wever, the building or imvement is sold ' hin one year of completion, owner-bu' er will have the burden o/ ving that he did n build or improve for the purpe o! sale, as owner of the pr erty, am exclusively contrag with ' ensed contractors to construct tproject. (Sec. 7044, usiness and Professions e: T Contractor's License Law does apply to an owner o! operty who builds or impes ereon, and who contracts for such ects with a contractor licensed pursuant to thtractor's License Law)am exempt under Sec. B. & P.C. fis reason Date Owner I hereby affirm that I have a cert' Compensation Insurance, or a certifi Policy Comp r4ZC2py is filed with the city. ❑ (This section need not be or less). I certify that in the pi employ any person in any California. Date Ownei NOTICE TO APPLICANT subject to the WorkerV i comoly with such Droidsio led if the ice of thi so as to 1 1 ATION DECLARATION consent to self -insure, or a certificate of Worker's thereof. (Sec. 3800, Labor Code.) copy is hereby furnished. EXEMPTION FROM JSATION INSURANCE rmit is for one hundred dollars ($100) valuation ok for which this permit is issued, I shall not e subject to Workers' Compensation Laws of after making this Certi ' ate o/ Exemption you should become mpensation provisions the labor Code, you must forthwith or this permit shall be de ed revoked. CONSTRUCTION LENDING ENCY /ureofapplicant by affi that there is a construction lending age y for the performance of the work for this p rmit is issued. (Sec. 3097, Civil Code.) LenNa LenAd ass is building permit when properly filled out, signed an validated, and is subject to exp' work thereunder is suspended for 180 days. ' that I have read this application and state that the ab vis information is correct. I acomply with all city and county ordinances and state ws relating to building conion, and hereby authorize representatives of this city to en r the above-mentioned grofor inspection purposes. Sigof applicantddress CA State, Zip WHITE = BUILDING DEPARTMENT APPLICATION ONLY BUILDING: TYPE CONST—cOCC. GRP. A.P. Number2J�� —' O (9 9 Legal Description ,� z� � 3 3 T Tr 1-Gt ag�y a Project Description Sj* � -m �- ��"`'L .O� Sq. Ft. V/Q Size / U No. No. Dw. / Stories Units New J Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. r-� - Grading Driveway Enc. ` I� Infrastructure TOTAL REMARKS ZONE: BY.. Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: YELLOW = APPLICANT PINK = FINANCE Coachella Valley United School District P.O. Boz 847, Thermal, CA 92274 `(760) 398-5909 — Fax (760) 398-1224 Project Name: This Box For District Use Only DEVELOPER FEES PAID AREA AMOUNT LEVEL ONE AMOUNT: LEVEL TWO AMOUNT: MITIGATION AMOUNT: COMMIM. AMOUNT: DATE: RECEIPT: CHECK #: INITIALS: CERTIFICATE OF COMPLIANCE (California Education Code 17620) Date June 14, 2005 Owner's Name: Robert Hill (760) 7714722 Project Address: 53472 Bellagio, La Quinta, CA 92253 Project Description: 1 Dwelling Unit APN: 772-510-025 Tract #: Type of Development: Residential XX Commercial Total Square Feet of Building Area: 4,824 Sq.Ft. Lot #'s: Industrial 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 au orized to sign behalf of the owner/developer. Dated: - June 14, 2005 Signature: sssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssss 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 17620 Gov. Code 65995 Project Agreement Existing Approval Prior to 1/1/87 Note: Number of Sq.Ft. Amount per Sq.Ft. Amount Collected 4,824 Sq.Ft. 2.88 $ $13,893.12 Building Permit Application Completed: Yes/No By: Carey M. Carlson, Asst. Supt., Business Services Certificate issued by: Elsa F. Esqueda, Facilities Analyst Signature: Not Subject to Fee Requirement NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) 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 90 -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. Welmydocs/devfees/certificate of compliance form tables.doc 1/16/03 T Af33 �- i+ jX,VV'4 jp_.'F:N N'T �,` a -f d—k' 'Sj Aj, k d f 7 i'r 'L lT 2i ('moi Vi • 14 AA i N V/I1EN RECORDED MAIL TO: al (. "(A(5 . �b(06(L a iI >_a 0,L),1n40_ i ew gas -53 MAIL TAX STATEMENT TO: SAME AS ABOVE G q M30 i DOC a 2003-101815 02/13/2003 08:00A Fee:36.00 Page 1 of 4 Doc T Tax Paid Recorded in Official Records County of Riverside Gary L. Orso Assessor, County Clerk d Recorder 111111111111111111111111111111111111111111 N1 If 1111 M S U PAGE SIZE DA POOR NOCOR I SMF I MIsC. 1 � A R L COPY LONG REFUND NCHG I E W `1111) J1.lQll1V1 1\Lr4V1 LLV1 J LLJIJ V1LL�'� DOCUMENT TRANSFER TAX $��,'��1-� XX Computed on the consideration or value of property conveyed; OR JB Computed on the consideration or value less liens or encumbrances remaining at the time of sale. Signature of Declarant or Agent determining tax – Firm Name T19_50-, . (068 gyp;, 00-051P GRANT DEED FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, ND LA QUINTA PARTNERS, LLC, a Delaware limited liability company ("Grantor"), hereby GRANT(S)togohert Hill and Michelle Hill, 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 s: 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 5 -3 - V7 e -,Z V16- 6e� 1-LA/627969.1 I ND LA QUINTA PARTNERS, LLC, a Delaware limited liability company By: Nationwide Realty Investors, Ltd., an Ohio limited liability company its managing,me er Jos ep EL. Arenson Authorized Representative STATE OF California. ) ss. COUNTY OF Riverside ) 0n �av u �1 , 2003, before me, the undersigned, a notary public in and for said State, personally appeared Joseph L. Arenson pef senally letaw t44.ma (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. SJ I _ KATHRYN L. HUNTER Signature y�l [SEAL] Commission # 1382692 Z r Z Notary Public -California ; Y, EXHIBIT "A" Legal Description Parcel No. 1: Lot 337 (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 88, 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- 7459319 )f Official Records of Riverside County, California (the "Official 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. 1-LAl627969.1