0202-116 (SFD)LICENSED CONTRACTOR 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 # Lic. Class Exp. Date
622376 B 06/30/2(
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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 & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors .to construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section , B&P.C. for this reason
Date Signature of Owner
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 & policy no. are:
Carrier STATE FUND Policy No. 046-01-0010426
(This section need not be completed if the permit valuation is for $100.00 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 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: Applicant
Warning: Failure to secure Workers' 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
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
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 applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
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 State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)\ Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0202-116 TRACT
$93,576.20 20 BLK150
JOB SITE APN
ADDRESS 52-560 AVENMA VELASCO 773-295-005
OWNER CONTRACTOR/DESIGNER/EN (NEER
W/R ENTERPRISES DEREK LEE SHEVITSKI
1860 CHICAGO AVE 3= G-7 9740 RIPPLENECK DR., MORENO VALLEY
RIVERSIDE CA 92507 RIVERSIDE CA 92508
(909>485-8033 CBL4 6125
USE OF PERMIT
SINGLE FAMILY DWELLING
SFD - PERMIT DOES NOT INCLUDE BLOCK WALL, POOL OR DRIVEWAY
APPROACH. 98 CODES.75 % DISCOUNT OF PLAN CHECK FEE FOR
MULTIPLE ISSUANCE OF SAME PLAN TYPE.
. . CTRACT CONSTRUCTION 1,508.00 SF
PORCH/PATIO 96.00 SF
GARAGE/CARPORT 475.00 SF
5 FT. WOOD FENCE 130.00 LF
ESTIlVIATED COST OF CONSTRUCTION
93,576.20
PERMIT FEE SUI CU"Y
CONSTRUCTION FEE
101-000-418-000 $612.50
PLAN CHECK FEE
101-000-439-318 $127.62
FEE DEPOSIT
101.000-439-318 4250100
MECHANICAL FEE
101-000-421-000 $68.50
ELECTRICAL FEE
101-000.420-000 $110.78
PLUMBINO FEE
101-000-419-000 $110.75
STRONG MOTION FEE - RESID 101-000-241-000 $9.36
4RADINO FEE
101-000-423-000 $20.00
DEVELOPER IMPACT FEE
$1,907.00
PRECISE PLAN
101-000-441-345 $100.00
SUB -TOTAL CONSTRUCTION AND PLAN G=CK
$3,066.51
LESS PRE -PAID FEES
-$250.00
TOTAL PERNIlT FEES DUE NOW
$2,816.51
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
a
ll f?' f 3 (' f b •bT r7r f• tt
u�l'I(,iCu
P.O. BOX 1504 APPLICA ION ONLY
Building-
% /j f �� % 4 78-495 CALLE TAMPICO ,
Address7 !' �' 'r (J (/y,�U LA QUINTA, CALIFORNIA 92253 ✓
...tat, a Com%
Mailing i _
Address / Q f i (__Ul f r a c .. 4M _ s f • �i
CityJ ZiTel
Contractor , If , li j
Address
Zip I Tel.
State Lic. City
& Class i Lic. I"OlGog-z. 3 > &
Arch., Engr.,
Designer
Address Tel.
City IZip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
that I`ar0_licensed under provisions of Chapter 9 (commencing with Section
3 ofAhe Business and Pr¢fessions Code, and my license, is In full force and
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, after, 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).
t': 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 or property who
builds or improves thereon and who does such work himself or through his own employees,
Pro
vided that such improvements are not intended or offered for sale. If, however, the building
or improvement is soldwithin 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 l I, 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 contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
1-1 1 am exempt under Sec. }� ` B. BiP.0/forthis reason
late'1 �l% �... OwnerF/-7�/)"%S"(
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
(7 Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100) valuation
or less.)
I certify that hi
in the performance of thg work. for whichis-permit is issued, I shall not
employ any person in any manner s_o as to ecome sdbject o the Workers' Compensation
Laws of i California.
Date ? Owner �l s A
NOTICE TO APPLICANT: ff. her vmaking ihis Ceftificate 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
S
BUILDING: TYPE'CONST S 1z'e- OCC. GRP.
A.P. Number _Ei' 3- Zc )r "h>S,
Legal Description �,o T 2-.,0
Project Description
h� s SAAB �'S S/ �S �/�ue►�
Sq. Ft,/_52;Ip No. No. Dw.
Size IJ Stories / Units
New,,fq Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
Plan Chk. Dep. .
Plan Chk. Bal.
Const.
Mech. ,
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
f
TOTAL
REMARKS
AMOUNT
S
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 a 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# 773-295-005
t
No. 23018 Jurisdiction La Quinta r
Owner NameW/R Enterprises' Permit #0202-116
No, 52560 Street Avenida Velasco Log #
City La Quinta Zip - 92253 Study Area
Tract # BLK150 Lot # 20, Square Footage 1508
Type of Development Single Family Residence No. of Units
Comments
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 replacement mobilehomes. It
has been determined the above-named owner is exempt from paying schoo1fees at this time due to the following reason:
1,
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
2.14 X 1,508 or $ 3,227.12 the property listed above and that building
permits and/or Certificates of Occupancy for this 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 "
r
r ,
Fee collected /exempted by Crystal Scott Payment Received $3,227.12
I
t Check No.
Signature
[NoTICE: Pursuant to Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day appioval period in which you may protest the fees or other payment identified
bovewill begintorun from the date on which the building or installation permit for this project is sssued or on which they are paid to the Districts) or to another public entity authorized to
ollect 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
American Title' Insurance Company
Escrow Division
72393 Highway 111, Suite B
Palm Desert, CA 92260
(760) 773-3776 Fax (760) 773-3228
SUPPLEMENTAL INSTRUCTIONS TO THE PURCHASE
AGREEMENT AND JOINT ESCROW INSTRUCTIONS
TO: American Title Escrow
Date: November 14, 2001
Escrow Officer: Sharon D. Elkins
Escrow Number: 01 -2225 -SE
AMERICAN TITLE ESCROW CONDUCTS ESCROW BUSINESS UNDER LICENSE IDENTIFICATION NO. 371
ISSUED BY THE CALIFORNIA DEPARTMENT OF INSURANCE.
W/R Enterprises, a General Partnership, (hereinafter known .as Buyer) agree to purchase from Estates Homes, LLC,
(hereinafter known as Seller) the real property setforth herein per the terms, conditions, consideration and instructions
hereinafter stated. The Seller and Buyer herein shall deliver these signed escrow instructions to American Title Escrow,
(hereinafter known as Escrow Holder).
Terms of Transaction
Buyer has handed Broker, for deposit to escrow, the sum of $ 2,000.00
Buyer will deposit, prior to close of escrow, the sum of $ 61,000.00
To Complete the Total Consideration of $ 63,000.00 .
Furthermore, I will execute and deliver any instruments and/or funds which this escrow requires to show title as called for, all
of which you are instructed to use on or before January 11, 2002, provided you hold a Policy.of.Title insurance with the usual
title company's exceptions, with a liability of not less than $63,000:00, covering property in the City of La Quinta, County of .
Riverside , State of California, described as follows:
Lots 20 and 21 of Santa Carmelita at Vale La Quinta, Unit No. 16, Block 150_ , as per map recorded in Book 18, Pa
ge(s) 99
Office of Maps, in the Oce of the County Recorder of said County. Z—,S 86F�
0o y . = S _ _Zy�. A 1�
EP:N:-7:73-�29:5=-004/005 COMMONLY KNOWN AS: Vacant Lots -La Quinta, CA 92253 _ J
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, districts, water companies, alleys and
streets, rights and rights of way of record, if any; also exceptions of oil, gas, minerals and hydrocarbons, and/or lease, if
any, without the right of surface entry.
INSTRUCTIONS TO ESCROW:
ALL CASH TRANSACTION This is.an "All Cash" transaction and no financing will 'be secured on the subject property.
Buyer shall, within 5 days from acceptance, provide to Seller written verification of sufficient funds to close this transaction.
Seller may cancel this Agreement in writing within 5 -days after (1) -receipt of the verification,'if Seller reasonably disapproves
it, or (2) the time to provide the verification expires, if Buyer fails to provide it.
CLOSING COSTS: Seller herein agrees to pay all Seller's usual costs and charges in this transaction which may include, but
are not limited to the Owners Poliev of Title ln-nrnnre rPnnnvrvnn`rt- fPPif nnv rPrnrrtinn faa.c cNllar'c avrr^v fa. n.1
54
I F
3%
RC DISTRICT - PLANNING REVIEW FORM
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.
APPLICANT WR Enterprises— Shevitski Construction
SITE ADDRESS 52-560 Avenida Velasco
APN 773 - 295 - 004 CASE NO.: 2002-610
LEGAL: LOT 'Z-/ BLOCK UNIT S.C.@V.L.Q.
CHECK AND APPROVED BY: . Wally Nesbit DATE:
Inform the assigned Building plan checker upon your assignment to this case. The CDD
Executive Secretary maintains a log book to track applications and assign case numbers.
REQUIRED ITEM
Y
N
COMMENT/CORRECTION
Verify legal and APN information�
Pc a^rs si sw r�� s od -57
-Qj��
Consistent with MDG on file (as
applicable
;MDG filing required (5 filings since
`9/3/98)
Architectural variety within 200 feet.of
the surrounding area:
Colors
Materials
Architectural design features
Other Requirements: Approved bZ,
O Planning Commission.____....
O City Coun
o munitif
Initials
Case No.( -02
ill
Dev,
Depl.2
fte•s
o Z
1h'1�Vith Conditions /K nq-r�