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0007-157 (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 p1728 ]31W -, t7�131/2t Date Signature of Contra or —Q Q ✓' OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I amexempt 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 1`1 Signature sof 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. W;(rl 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 �`UNO Policy No. 22040 UNIT 0A0440 (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 orthw th comply with, those prove Ions. Date: 1)� Applicant A Warni g 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, indemnity & 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. ec Signature (Owner/Agent) ,,` •--- ���6 sDate BUILDING PERMIT PERMIT# . DA��������� `�'AL•UATION, LOT�ry^ `�� TRACT /ISQd].ti 14d1� 1f1:.... JOB SITE APN ADDRESS 52-9W ,AWAIMsl VFJA.'3C!0'l - 2b^.—+A. "JI OWNER CONTRACTOR/DESIGNER/EN INEER STAR.i1t' HT MA2JAC3GMiW RTC VIRIIW RUSSMf L.ROGM YO BOSS 3578 56900 JLIC=M ST PALM D t' ERT CA 92260 11MRMAL CA 92274 (16Q)19981200CUR 1954 N � USE OF PERMIT SWC3U FAMILY DW,1 MWI SW17-PE.R.MIT DOES NOT INCLAJIVE BLOCKWe11J S OR POOL r " TRACT CONSTRUMION 10397 oo sr. POACH/PATIO 46,00 SP CAftAK1MARPORT (SP) 10,174,40 s Lam. 'WOOD FENCE 200.00 LF MUTATED COST OF COPSMU CON W341M PERMIT Fn SUADURY CONST1tUCTIO14 ME 101-000.418.000 5590.00 PLAN CHECIC FEE 101-000-439-318 $493.61 MECHA141CAL VER 101.000.421.000 SAO XLECTRIC:Ai,: PU. 1©1-000-420 MOO $122.79 PLUMI3INO FEE 101.000-419«00 3 $110. P5 STRliNO MOTION F`1&kT - RESID 101-000-•241-000 $8. F3 CR.ADINO1 K 101.000-423.000 $40,00 i1E5 EIDPER IMPACT rZ1~ $1,90`7.00 PREME PTAH 101.600.441-345 $100, 00 PER DEPOLIT 101 400-4.39-318 4250.00 a - gUB-TOTAL COM"ktTlC° 014 AND PQLAW CxIC.1' $3.40,6.47 LrsS PR&PAID TUB -$250.00 TO'! KG UM11' FENS D'11E NOW 001%. 4 t' r. rte 1 s RECEIPT a� DATE (El VK DA E.EI ALED Ole INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings Slab Grade _ �F -� Underground Ducts Ducts Return Air Steel Combustion Air Roof Deck -B ( Exhaust Fans O.K. to Wrap F.A.U. Framing c - .4,o 57 Compressor Insulation — Oo Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final L � BLOCKWALL APPROVALS ,1 POOLS -SPAS 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 LinesHeater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection 7Encapsulation Gas Piping V& Cj Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL -APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G. F.1. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: COO /S_7-- Ca YJ za4 QuAt • , __�,� .SLnS�� P.O. BOX APPLICATION L 1 Building �j �(� 1 �( 57895 CALLE TAMPICO AMS Address j v t(� V ( L7°t OUINTA, CALIFORNIA 92253 Mailing 9 < 7 8 Address Cit c1cei Zip Contyac 7r,� Address 5144 State Lic. City & Classif.�20 9 V7f - I Lic. # Designer � J�I� 0,,075, -gilt. Address Tel. /1 c City Zip State . r Lic. # BUILDING: TYPE•CONST. OCC. GRP. A.P. Number LIMB -0 0 /3 1, /4'7 G) (Legal Description LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) t. of Division 3 of the Business and Professions Code, and my license is in full force and effec 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 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 ($500). I-! 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 (hat he did not build or improve for the purpose of sale.) I 1 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 contractors) licensed pursuant to the Contractor's License Law.) 0 1 am exempt under Sec. B. & P.C. for this reason Date rell Owner e / � C1 sd'/=r c WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 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 F7 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 thg 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. Date Owner NOTICE TO APPLICANT. It, 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 tilled 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 ateMailing Address City, State, Zip Project Description PAO Sq. Ft. 1:3 q Size No. ' Stories No. Dw. Units NeWN;/1 Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep.�--�— Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. r - Infrastructure '� " • ; w t' { 7 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 i Desert Sands Unified School District 47-950 Dune Palms Road ' Notice: La Quintal CA 92253 Document Cannot Be Duplicated 760-771-8515 , CERTIFICATE OF COMPLIANCE -Date 8/2/00 , +' ,;. - APN # .773-326-0 _ No. 20831 Jurisdiction La Quints •t Owner Name Starlight Management, Inc f Permit # No. 52-980- • street Avenida Velasco Log# City La Quinta Zip'• 92253. Study Area_. " Tract # Lot # Square Footage 1397 • 1. ,' Type of Development Single Family Residence No. of units 1 Comments At the present time, the •Desert Sands Unified School District does not .,collect Jees 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 school fees at this time due to the following reason: .-EXEMPTION NOT APPLICABLE' This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of ; 2.05 X . 1,397 or $ 2,863.85. 'the property listed'above, and -that bw- lid iiey ' permits and/or Certificates of Occupancy for this square footage,in this proposed project mqy now be`'issuedr' ✓ ., Xew �w, f Fees Paid By CC/Valley Independent Bank/Lar'ry Shields ee"phone`�760{w 99 1200 � ame on the check '= a L1� � v. lzt By Dr. Doris Wilson 'Superintendent Fee collected /exempted by. ,Annette Barlow Payment Received ..$2,863.85 Check No. .227231 Signature NOTICE: Pursuant of 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 above will 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. l r Embossed Original- Building Dept./Applicant Copy,- Applicant/Receipt Copy - Accounting k RC DISTRICT -PLANNING REVIEW FORM DD staff for review of single family dwellings in the RC'(Cove Resdi Hal) This form is to be used by C g Y g . � District, in order to determine the applicability of compatibility issues or need to require the filing of Master Design Guidelines by'the applicant. It shall be transmitted to the Building and Safety your correction list. Please attach additional explanations as necessary. APPLICANT SITE ADDRESS DAVID MILLER 52-9,60 Avenida Velasco . APN 7 7 3- 3 2 6- 013 BIN NO.: CASE NO.: AL: LOT 1 BLOCK 16 UNIT 1 16 CHECKED BY: Greg Trousdell DATE: 2000-224 S.C.@V.L.Q. 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 Compatibility Review Case logged and number assigned Verify legal and APN information . �C Consistent with MDG on file (as applicable MDG filing required (5 filings since 9/3/98) Consistency with street/surrounding area: Colors 01� Materials Architecture Other Requirements: ��� '21 dY f Sam DEPT -rAAEN14410 CASE ND• � � (� SALE ESCROW INSTRUCTIONSBuy!EFis GO f ;I THIS DOCUMENT WILL AFFECT YOUR LEGAL RIGHTS - READ IT CAREFULLY! (. . TO: COMMONWEALTH LA14D TITLE COMPANY Escrow No.: 9725SE �, � � 72855 Fred Waring Dr. Date: 03/08/00 1 Suite A5 Page: 1 I� Palm Desert, CA 92260 (760) 836-3726 Escrow Officer: Sharon Elkins THE ESCROW HOLbER IS COMMONWEALTH LAND TITLE COMPANY WHICH IS LICEI� li' BY THE CALIFORNIA DEPARTMENT OF INSURANCE. Buyer, or his agent!, will hand you or cause to be handed you upon signing of 1118111 ; these instructions a deposit in the amount of ...................................$ !�` 0.00 Buyer will hand yod additional funds prior to closing in the amount of..........$ !� 00 TOTAL CONSIDERATION $ 1lilm plq-00 and any additional'funds and instruments required from me to enable you to comply wit instructions, which you are to use on or before April 17, 2000, and when First Americ Co. can issue a Standard Policy of Title Insurance Owners form, with liability of $32 real property in City of La Quinta, County of Riverside, State of California viz: Commonly known as:'Vacant - APN: 773-326-012/013, La Quinta, California 92253 Lots 14 and 15 of Block 161, Santa Carmelita at Vale La Quinta, as per map recorded in Book 18, Page 99 of maps, in the office of the Riverside County Recorder. Except any reservations of record of minerals,- oil, gas, water, carbons and hydroca Showing title vested in: Starlight Management, Inc., a Nevada Corporation or Nominee Free from encumbrance except: A. Current general and special taxes for the fiscal year in which this escrow clot taxes for the ensuing year, if any, a lien not yet due or payable. B. The -lien of!supplemental taxes, if any, assessed pursuant to 'the provisions of 3.5 (commencing with Section 75) of the Revenue and Taxation Code of the Statei California. C. Special improvement assessments, if any. D. Easements, rights, rights of way, covenants, conditions, restrictions and res record. e on �o I i is of IU60A V) Y3MOHN3S/3 / S a 666? . 05, 05 vS' PS * oS PJCos vr, or oS o.V lovrL Z. ►• 9/ S oc oe o r , q C.., 4' 0 t h Ct Q ' h t•6 b � �^ . 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' .. .. . z�_ .. _ o .. �` N - O J 0 . v 4 Q 0 \ - o O , -4- • dZNdb/Y t/.7 G'O/N3A d 4- .. v�V) o o a v M c( Q ti) o�0 y, to o �o �� u f �£ c0 E L� O �O (;:)I,, �, osp h WO.� '---..... r:,L:aetrtsa.am:�..,,... .... .u..\ ".) ,. /:. "r°'__ _ . ' .. .. . z�_ .. _ o .. �` N - �• N7 ` 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, in order to determine the applicability of compatibility issues or need to require the filing of Master Design Guidelines by the applicant. It shall -be transmitted to'the Building and Safety Department as your 'correction list. Please attach additional explanations as necessary: APPLICANT w'.•` R. ROGERS ' SITE•ADDRESS 52-984 Avenida Velasco APN '773 .- '326 - BIN NO.: CASE NO.: - 2on p - Za 8 -'LEGAL' LOT. . ,' x,114- BLOCK 4 l Ce l UNIT �w f S.C.@V.L.Q. ,CHECKED BY: • Les l ie Mour iguand 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. x REQUIRED ITEM -Y N COMMENT/CORRECTION-, Compatibility Review a Case logged and number assigned . Verify legal and APN information < � �-�• , die, / ✓"v `` - `{'�/ �/.=�r =. s�-�- -.�: ,.- 77 Consistent with MDG on file (as applicable MDG filing required (5 filings since 9/3/98)" . Consistency with streeVsurrounding area: Colors - +• ,` `� ; _ • � , Materials , Ira' ' itecture I Exhibit M ft. ..f 0 Wfth C"ditioru .,....... Certificate of Occupancy City of La. Qu'inta. Safety.®epartmHufildih'--and This. Certificate. issued pursuant to the requirements of Section 109 of the Uniform Building - Code, . certifying -that,' at the time of issuance, this structure was.in.comp/iance with the various ordinances of the City regulating. building construction or use. For the following: BUILDING ADDRESS: 5.2-980 AVENI.DA VELASCO Use Classification: SFD.' Bldg. Permit No.: 0007-157 Occupancy Group:.. R 3 Type.of Construction: VN. 'Land Use Zone: RC Owner of.Building: STARLIGHT.MANAGEMENT. INC. Address: P.O. BOX 3578 City: PALM DESERT, CA 92260 By: STEVE TRAXEL .l^ez- Date: 12-18-00 Building Official .POST IN A CONSPICUOUS PLACE