0202-123 (SFD)= -, ='",`^^ Z . �."~
LICENSED CONTRACTOR DECLARATION
�11*1 hereby.aff irm under penalty of perjury that |,mnlicensed under provisions of
Chapter (commencing with Section 7000> of Division omfthe Bvain000 and
Professionals Code.and myuoemooioinmnmmeffect.
License ' uv.o/000 Exp. Date
6-0
Signaturem
OWNER -BUILDER DECLARATION , .
| hereby affirm under penalty o/perjury that |amexempt from' the Contractor's
License Law for the following reason: ~'
( ) 1; as owner ufthe property, o, my employees with wages as their sole
compensation, will Uothe work, and the structure ionot intended oroffered for
sale (Gou.7o*4.ouoi9oas,mProfessionals Coue).^
( ) |, as. owner of the property, am, exclusively Contracting with licensed
vommvmm x,'oonstmm the project (Gov. 70*4.avonma u^Pmmvomna|u
Code). I `
( ) | mn exempt under Section �ouPC. for this reason
Date Signature of Owner,
/
`
WORKER'S COMPENSATION
/ ^ . . �
| hereby affirm under penalty of perjury one of the following declarations:
()| have and will maintain acertificate oxconsent mself-insure for workers'
compensation, as pmwuou for uy Section' 3700 or the Labor Code,, for the
performance o,the work for which this permit ioissued.
( have mnU*wmmaintain workers' compensation insurance, oarequired by -
Section 3700 of the Labor Code, for the performance of the wm,x for which this
permit is issued. My workers' compensation insurance oanio, & policy no. are:.
Cartier.' Policy No
SIAT X F��D � D46'014010426
(Thissection need not be completed if the permit valuation is for $n0o.0Oor leoo):
() |oortify that in the performance o/the work for which this permit is issued,
| shall not employ any person many manner masmbecome subject mthe
wmmam' compensation |owo o/ California,and, agree that i/ | should »000mo
subject to the workers' compensation pFyisions o Seption 370-0 f, the Labor
Wa ' rnirig: Failure to secure WoFkers' 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
` o/the Labor Code, invomst^ndattorney's fees.
IMPORTANT Application iohereby made mthe Director oxBuilding and Safety `
for o permit subject to the conditions and momndona set forth on his
uppnvo,ivn'
1.Each person upon whose behalf this application iomade ueach person sn
whose request and for whose uono,itwork ioperformed under o,pursuant to
any permit issued 000result urthis op�nvamnagrees to, mshall, indemnity
m hn|6 harmless the City of Lo Quinta, its officers, agents and employees.
2. Any permit issued as result ofthio application becomes null and void if
is not commenced within 180 uoya from date of issuance of such
ponnit, or cessation ufwork for 18odays will subject permit mcancellation.
| certify that |xovoread this application and state that the above information io
correct. | agree tocomply with all City, and State laws relating tothe building �
construction, and hereby authorize representi City monte,upon �
the.obnvo'memion*n
,,Signature (Ownoo�
'
,
'
BUILDING PERMIT
DATE VALUATION LOT TRACT
17 131XI 50
JOB SITE
,ADDRESS 52--") AVVYWA. MASCO.
APN
773-295-004
OWNER
CONTRACTOR DESIGNER ENGINEER
CA 9250
RIVERMN-1 CA .'§iSOR
USE OF PERMIT
APPROACH, 03 COM
CONSTRUCTION OF
<fj�RAGFJC_AAP0RT 544100 8F.-
COMPRUCT) N FLY, 1011-000-413-000 *65150
PEP DEPOSIT 101-00-4.3q,-318 _325010
MMIANIClA111W 9 101-060-421-000 $62.00
ELECT WCAL F OF, 101-000-420-000 $116.89
MAD1140 101-000-413-000
PRECISE '101-000-44.1-345
ITIM PRU-PAM FEES
425(100
ACT M11 8,M_11 NOW
XV77hll
44
�ECEIPT
DATE
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
(� _
Exhaust Fans
O.K. to Wrap
I� v
F.A.U.
Framing
- _ p
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
o -
POOLS - SPAS
BLOCKWALL APPROVALS
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
tel`
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Server Lateral
Pool Cover
Sewer Connection
�
lZ o2L p i•
Encapsulation
Gas Piping
Gas Test
_
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Futures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
uf�Cv
P.O. BOX 1504
Building 78-495 CALLE TAMPICO APPLICATION ONLY
Address 7 CC LA QUINTA, CALIFORNIA 92253
.,.... �u-\ft l
Mailing
Address j�Q 6 0 ;"Jp
City_ _
4�<c
Zip f
2---0—,7—
Tel.
y
Contractor
;54"
Address
City
Zip
Tel.
State Lic.
& Classif. ✓ P/4�/C�
City
Lic. #t -42
Arch., Engr.,
Designer
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACT
,,?R'S DECLARATION
I hereD m fiirm that I alicensed 0 de Droviions of Chapter 9 (commencing with Section
OOOj ffDivision�,13 of t(If -S s s a ofes°sions Code, and my license is in full force and
site
SIGNATUREw 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 thealleged 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 (5500).
I'll 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, 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 -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
I 11, 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 cordracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
1-1 1 am exempt under Sec_ B. 8 P.C. for this s reason\
Date///Z
Date% 5 /I\ Owner 4( AI ^�A �7 If
WORKERS' 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
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.)
I certify that in the performance of ing work fo�.liich t.bts permit is issued, I shall not
employ, any per on in any mahne so as to be efp�hubja/yyei'to�the Workers' Compensation,
Laws I �C�I�Owns it If" 4� v 4 kf.L. v
Date i/ G y
NOTICE TOrAPPLICANT: If, alter 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
Ihereby 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 1 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 sof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE'CONST.� OCC. GRP.
A.P. Number ?�'%`��' Uy Lf
Legal Description lA% 2 �� o /5-0
Project Description
Sq. Ft. No. No. Dw.
Size n� �n Stories Units
New Add ❑ Alter ❑ Repair ❑ Demolition ❑
oat
Estimated Valuation
e
PERMIT AMOUNT
Plan Chk. Dep. r L
Plan Chk. Bal.
Const. r; "
Mech.
Electrical
Plumbing )
S.M.I.
Grading
Drivewa Enc.
Infra uctum.,
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 = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515 ,
CERTIFICATE OF COMPLIANCE
Date, 3/6/02' APN # 773-295-004
No. 23017 Jurisdiction La Quinta
Owner NameW/R Enterprises Permit #0202-123
No. 52540 Street Avenida Velasco Log #
City La Quinta Zip 92253 Study Area
Tract # BLK150 Lot # 21 Square Footage 1666. `
Type of Development Single -Family Residence No. of Units
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 replacer9ent 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 unposed pursuant to ° Government Code 53080 in the amount of
2.14 X 1,666, or $ 3,565.24 the property listed above and that building
permits and/or Certificates of Occupancy for "'square footage in this proposed project may now be issued
Fees•Paid By CC East West Bank - Ed Whitson- 'Telephone 909/779-6000
Name on the check'
By Dr. Doris Wilson
Superintendent -
Fee collected /exempted by Crystal Scott . ; Payment Received '$3;565.24
Check No. 23.41214 9
Signature
Pursuant to Assembly 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 identified
[.NOTI.61E�
bovwill begin to run from 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
`';• merican Title Insurance Company
Escrow Division
72393 Highway 111, Suite B
Palm Desert, CA 92260
60 773-3776 Fax (760) 773-3228 .
(7 )
SUPPLEMENTAL INSTRUCTIONS 0SUCT
AGREEMENT AND JOOVNTRSNS
TO: American Title Escrow
Date: November 149 2001
Escrow Officer: Sharon D. Elkins
Escrow Number: 01 -2225 -SE
AMERICAN TITLE ESCROW CONDUCTS ESCROW
OF NSUIINNCEUNDER LICENSE IDENTIFICATION NO
ISSUED BY THE CALIFORNIA DEPARTIENT
LLC,
W/R Enterprises a General Part lerhi (setforththerer e roper the Buyer)
consideration and si strut ons��
(hereinafter known as Seller) the reaproperty ,
hereinafter slated. The Seller and Buyer herein shall deliver these signed escrow instructions to American Title Escrow, `
(hereinafter known as Escrow Holder).
371
Terms of Transaction
$ 2,000.00
Buyer has handed Broker, for deposit to escrow, the sum of- $ 61,000.00
Buyer will deposit, prior to close of escrow, the sum of
$ 63,000.00
To Complete the Total Consideration of
his escrow
s to show title as called for, all
Furthermore, I will execute and deliver any instJanuars and/11, 200 n provhdedich tyou hold a Polucyeof Title tsurance with the usual
of which you are instructed to use on or before Y
title company's 'exceptions, with a liability of not less. than $63,000.00, covering property in the City of La Quinta, County o
Riverside , State of California, described as follows:__
e-' `� .. U No. 16, Block .150, as per map recorded in Book 18, Page(s) 99
Lots 20 and 21 of Santa Carmelita at Vale La Quinta, __ -
of Maps, iri the Office of the County Recorder of `said Cou__ty.
COMMONLY KNOWN AS: Vacant Lots - APN: 773^295-004100.5, La Quinta, CA 92253
SHOWING TITLE VESTED IN: W/R Enterprises, a General Partnership or assignee
SUBJECT TO:
(1) General and Special County and City (if any) Taxes for the current fiscal year, not due or delinquent, including any special
levies, payments for which are included therein and collected therewith.
(2) Lien of Supplemental Taxes, if any, assessed pursuant to the provisions of Chapter 3.5 (commencing with Section 75) of
the Revenue and Taxation Code of the State of California.
(3) Covenants, Conditions and Restrictions, reservations easements for public utilities,neralstand h drocarbo sricts, water Panandlor�leasef
streets, rights and rights of way of record, if any; also exceptions of oil, g Y
any, without the right of surface entry.
INSTRUCTIONS TO ESCROW: on
ALL CASH TRANSACTION This i`aaan "All Cash" tran
to Seller twrition ten verification d no tof sufficientcing will be sfunds dto closeethisb,transactiont,
Buyer shall, within 5 days from acceptance, provide _
Seller may cancel this Agreement in writing within 5 days after (1) receipt of the verification, if Seller reasonably disapproves
e verification expires, if Buyer fails. to provide it.
it, or (2) the time to provide th
CLOSING COSTS: Seller herein agrees to pay all Seller's usual costs and charges in this transaction which may include, but
QU
JA� 31 SIV '
714
eCC��.� � ,IRFCO
RC DISTRICT -PLANNING REVIEW FORIVh �G�i�� ;
This form is to be used by CDD staff for review of single family dwellings in the RC (Cove
Residential) District per Section 9.50.090 of the Zoning Code. Its purpose is to determine:
1) that the proposed house design does not duplicate the same architectural style of any
house within 200 feet of the applicant, and/or 2) if there is a need for the applicant to file for
Master Design Guidelines. If the applicant does need to file a Master Design Guideline, please
transmitted this information to the Building and Safety Department as part of your correction
list. Please attach additional explanations as necessary.
OR
APPLICANT Shevitski Construction
SITE ADDRESS. 52-540 Avenida Velasco
APN 773- 295 - 004 CASE NO.:
2002-616
LEGAL: LOTBLOCK < UNIT S.C.@V.L.Q.
CHECK AND APPROVED BY: Greg Trousdell DATE:
Inform the assigned Building plan checker upon your assignment to this case. The CDD
Executive Secretary maintains
log book to rack applications and assign case numbers.
REQUIRED ITEM
Y
N
COMMENT/CORRECTION
Verify legal and APN information
Consistent with MDG on file (as
applicablein
PA #
MDG filing required (5 filings since
9/3/98)
D
Architectural variety within 200 fee�oc�f d
the sur ou ing area: �it
ft�l G
MaICA.��
1 D W+
Architectura esign res"
l� Go
9 ./�
Vett
Otto
s
Other Requirements:
0.� f
-�
F