05-5515 (SFD)r�
4 4 "
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 9/12/06
Application Number: 05-00005515 Owner:
Property Address: 53677 VIA BELLAGIO CHASE
APN: 772-510-052- - 53-677 VIA BELLAGIO
Application description: DWELLING - SINGLE FAMILY DETACHED LA QUINTA; CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 372699
D n Q
Contractor:
Applicant: Architect or Engineer: ALPHA OMEGA COMMUNICATIO C
42829 COOK STREET SUITE SEP 12 1006
PALM DESERT, CA 92211
(760) 568-1712 CITY OF LA
Lic. No.: OOR SQUARE FOOT Lic. No.: 820066 QUINTA
CIG�A&r -M. —�
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 Professionals Code, and my License is in full force and effect.
Lic 1 Class. B License No.: 820066
Dat / Contract y -
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. 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.).
1 _ I 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.).
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
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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 AON RISK Policy Number 1488491
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 me subject to the workers' compensation provisions of Section
3700 of the Labor C I forthwith comply with those provisions.
DApplican
glm
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 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 nstruction, and hereby authorize representatives
of � uryyy enter upon the above-mentioned "ro inspection purposes.
Dat ! " ignature (Applicant or Agent
Application Number . . . . . 05-00005515
Permit
. . .
BUILDING PERMIT
Additional
desc .
Permit Fee
. . . .
1595.00
Plan Check Fee
1036.75
Issue Date
. . . .
Valuation
372699
Expiration
Date.
.2/07/07
Qty Unit Charge
Per
Extension
BASE
FEE.
639.50
..273.00
----------------------------------------------------------------------------
3.5000
THOU BLDG
100,001-500,000
955.50
Permit
ELEC=NEW RESIDENTIAL
Additional
.desc :. .
Permit Fee
. . . .
199.31
Plan Check Fee
_ 49.83
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date
2/07/07
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
4 4246.00
.0350
ELEC
NEW RES - 1 OR 2 FAMILY
148.61
i 1035.00
.0200
ELEC
GARAGE OR NON-RESIDENTIAL
20.70
! 1.00
---------------------------------------------------
15.0000
EA ELEC
TEMPORARY POWER POLE
-------------------------
15.00
Permit
. . .
GRADING -PERMIT
Additional
desc .
Permit Fee
. . . .
1.5.00
Plan Check Fee
.00
- - Issue Date
Valuation . . . .
0
Expiration
Date
2/07/07
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
Permit
MECHANICAL
Additional
desc .
Permit Fee
172.50
Plan Check Fee
43.13
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date
2/07/07
- Qty Unit Charge
Per
Extension
BASE
FEE
15.00
2.00
9.0000
EA MECH
FURNACE <=100K
18.00
3.00.
11.0000
EA MECH
FURNACE >100K
33:00
2.00
9.0000
EA MECH
B/C <=3HP/100K BTU
18.00
3.00
16.5000
EA MECH
B/C >3-15HP/>100K-500KBTU
49.50
5.00
6.5000
EA MECH
VENT FAN
32.50
LQPERAIIT
Application Number .
. . . . 05-00005515
Permit . . . . . .
MECHANICAL
Qty Unit Charge
Per
Extension
1.00 6.5000
----------------------------------------------------------------------------
EA MECH EXHAUST HOOD
6.50
Permit
PLUMBING
Additional desc .
Permit Fee
255.75 Plan Check Fee
63.94
Issue Date . . . .
_ Valuation . . .
. 0
Expiration Date
2/07/07
Qty Unit Charge
Per
Extension
BASE FEE
15.00
27.00 6.0000
EA PLB FIXTURE
162._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
13.00 .7500
EA PLB GAS PIPE >=5
9.75
1.00 15.0000
i-------------------------------
EA PLB GAS METER
15.00
-----------------------------
Special Notes and .Comments
------------
-
4246 SQ. FT. SFD THIS
PERMIT DOES NOT
INCLUDE POOL & SPA BLOCK WALLS OR
DRIVEWAY APPROACH.August 11, 2006
-- 4:33:54 PM jjohnson
-
-----------------------------------------------------------.-------------
Other Fees . . . . .
. . .. . ART IN PUBLIC PLACES -RES
431.74
DIF COMMUNITY CENTERS -RES
74.00
DIF CIVIC CENTER - RES
480.00
ENERGY REVIEW FEE
103.68
'
DIF FIRE PROTECTION -RES
140.00
GRADING PLAN CHECK FEE
.00
DIF LIBRARIES - RES
355.00 -�
-"
DIF PARK MAINT FAC - RES
22.00
DIF PARKS/REC.'- RES
892.00
'
STRONG MOTION (SMI) - RES
37.26
DIF STREET MAINT FAC -RES
67.00
DIF TRANSPORTATION - RES
1666.00
Fee summary Charged
Paid Credited
Due
Permit Fee Total
2237.56 .00 .00
2237.56
Plan Check Total
1193:65 500.00 .00
693.65
Other.Fee Total
4268.68 .00 .00
4268.68
Grand Total
7699.89 500.00 .00
7199.89
LQPERA11T
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P.O. BOX 1504 APPLICATION ONLY
(AIIa 1 078-495 CALLE TAMPICO
A
Lp<QUINTA, CALIFORNIA 92253
�j CNBC UICDING: TYPE CONST 0CC. GRP.
A.P. Number =►- S 10—
T^__ ,r,_ t,,4-11Legal Description w� 32)
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State Lic.�p,�� City
& Classif. Lr S 2-00 lo � Lic. # 02-3S7
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LICENSED CONTRACTOR'S DECLARATION
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 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).
O 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
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. ❑ 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
Project Description
L CITY OF u+
Size Ft Ss✓'T Stories ��CE
New CU/ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
AMOUNT
Grading
Driveway Enc.
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:
WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE
Coachella Valley Unified School District
83-733 Avenue 55, Thermal, CA 92274
(760) 398-5909 — Fax (760) 398-1224
Project Name: Ch sa e
This Box For District Use Only
DEVELOPER FEES PAID
AREA:
AMOUNT '
LEVEL ONE AMOUNT:
LEVEL TWO AMOUNT:
MITIGATION AMOUNT:
COMWIND. AMOUNT:
DATE:
RECEEPT:
CHECK #:
INITIALS
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Owner's Name: Gordonross/Chase
Project Address: 53677 Via Bellagio La Quinta, CA
Project Description:
APN: 772-510-052-5
1 SFD
Tract #:
Type of Development: Residential Xx Commercial
Total Square Feet of Building Area: 4246sq. ft.
Date: 08/24/06 .
Phone No. 760-565-1712
Lot #
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 tojsign on behalf of the owner/developer.
Dated: 08/18/06
Signature:
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE'PROJECT HAVE -BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
9
Education Code Gov. Code Project Agreement Existing Not Subject to Fee
17620 65995 Approval Prior to 1/1/87 Requirement
Number of Sq.Ft. 4246 sq. ft.
Amount per Sq.Ft. $ 0.00 3. -15 -
Amount
. -15 -
Amount Collected $ 15,992.50
Building Permit Application Completed: Yes/No
By: Carey M. Carlson, Asst. Supt., Business Services
Certificate issued by: Maria L. Angulo, Facilities Secretary Signature:
NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES ANIJ STATEM$NT OF FEtt
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.
[.I:-mtciu��rdev ;;e:> certiticate csf'ccrai;iialtc, f?rrn taGles:C�? l"SL.�)?� 1/16/03 T
Apr 12 05 09:54a Goble Properties Plstn.
A, l
NEIN CEN'T'URY TITLE COMPANY
RECORDING REQUESTED BY:
r'.Century Title Company -Riverside Title
'ORDER NO.: 2351414
ESCROW NO.: 33041782 -SP
AND WHEN RECORDED MAIL TO:
Roy Goble
Patrlcla.Goble
7923 Sawgrass Court
Pleasanton, CA 94588
7 2-5-7 os -2 -s--
C->
!`-
v
r GRANT DEED
THE UNDERSIGNED GRANTOR(S) RECLARE(S) that documentary transfer tax is $605.00 (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
(925)485-9251 p.2
DOC a 2004--1012485
12/22/2004 08:00A Fee:10.00
Page 1 of 2 Doc T Tax Paid
Reeoded
Coun in Official Records
County of Riveraide
Gary L, orso
Assessor, County Clerk $ Recorder
1111111111111111111111111111 ILII 11111, 11111,11-111, 111,
Ini
FOR A VALUABLE CONSIDERATION, receipt of which Is hereby acknowledged, Brent Platt, an unmarried man
and Virginia A. D'Addario, an unmarried woman, as joint tenants
hereby GRANT(S) to Ernest L. Goble and Patricia D. Goble, Co-I`Fustees of the Goble
Family Revocalle Trust
the following described real property in the City of La Quinta, County of Riverside, State of California:
Please see attached Exhibit "A"
Dated: December 10, 2004
STATE OF CALIFORNIA
COUNTY OF,
Onz (4j , before me
Personally appeared -� v�L c�•
r
`Person Ir -known -tome' (or proved to me on the,basis of satisfactory
gvidence) to be the person�f��vhose names),15K/9rg subscribed to the
within Instrument and acknovAdged to me that haAhe/they executed the
same in hlsjfterjtheir authorized capacityfes , and that by glsfher/their
slgnature(s) on the Instrument the personW or the entity upon behalf of
which the person(s) acted, executed the Instrument.
WITNESS -my hand dd Mciallsse�all,,,
Signature
Grant Deed - Individual (290) 10-04
MAIL TAX STATEMENTS AS DIRECTED ABOVE
V
STACEY M. DEAN
Commission # 1438222
Notary Public. California
Riverside County
My Comm, Expires Sep 8, 2007
(This arca for official notary seal)
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PAGE
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LOND
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FOR A VALUABLE CONSIDERATION, receipt of which Is hereby acknowledged, Brent Platt, an unmarried man
and Virginia A. D'Addario, an unmarried woman, as joint tenants
hereby GRANT(S) to Ernest L. Goble and Patricia D. Goble, Co-I`Fustees of the Goble
Family Revocalle Trust
the following described real property in the City of La Quinta, County of Riverside, State of California:
Please see attached Exhibit "A"
Dated: December 10, 2004
STATE OF CALIFORNIA
COUNTY OF,
Onz (4j , before me
Personally appeared -� v�L c�•
r
`Person Ir -known -tome' (or proved to me on the,basis of satisfactory
gvidence) to be the person�f��vhose names),15K/9rg subscribed to the
within Instrument and acknovAdged to me that haAhe/they executed the
same in hlsjfterjtheir authorized capacityfes , and that by glsfher/their
slgnature(s) on the Instrument the personW or the entity upon behalf of
which the person(s) acted, executed the Instrument.
WITNESS -my hand dd Mciallsse�all,,,
Signature
Grant Deed - Individual (290) 10-04
MAIL TAX STATEMENTS AS DIRECTED ABOVE
V
STACEY M. DEAN
Commission # 1438222
Notary Public. California
Riverside County
My Comm, Expires Sep 8, 2007
(This arca for official notary seal)
j
r
,- Certificate of Occupancy
S
oF T9� Building & Safet Department
Y, p
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this. structure was in compliance. -with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use. L
BUILDING ADDRESS: 53-677 VIA BELLAGIO
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 05-5515
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
y
Owrier of Building: CHASE Address: 53-677 VIA BELLAGIO
y •
City, ST, ZIP: LA QUINTA, CA 92253
-By: STEVE TRAXEL
-
Date: November 20, 2007
Building Official
POST IN A CONSPICUOUS PLACE
A_
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