9812-069 (SFD)LICENSED CONTRACTOR DECLARATION
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_ y 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.
Oate Signature of *Contractor
OWNER -BUILDER DECLARATION
I herebV affirm under penalty of perjury that I am eiempt from the Contractor's
Li6ense Law for the following reaso�V 41�
1, as owner of the property,,or my employees with wages as their sole
compensation, will do the work, and the structure is not, interided or offered for
sale (Sec. 7044,- Business & Professionals Code).
1, as owner of the property, am�ex Alsively contracting with licensed
contractors. to construct the project (.�ec'7044, Business & Professionals
Code).
().|pmexempt uncleSonxon_______ ouPo.for this reason
___+�____
oote of Owner
.' .
WORKER'S COMPENSATION DECLARATION
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|
he'perjury one o[ following declarations:
(" ): , I have and will maintain a certificate 6f donsent 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.
SkI have and will maintain workers' compensation insurance, as required by
tion 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 Policy No.
(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 no.t 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
C6de, I shall forthwith comply with tho6Wprovisions. oolo��
Ddte� -1- .1, 219 Applicant -
/Warning: Failure to secure Worke;�s' Compensatidecoverage is unlawful and
shall subject an employer,t(:rcriminal penalties an' d" - 6vil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section.3706
of the Labor Code, inter�,�i and attorney's fees.
IMPORTANT Application is �ho�uymauommoo�oom,mav�mganuGa��
m,.a pennhoub�o m �o conditions and restrictions set forth on �
application.
1.Each pomon'uponwhose behalf this application iomade ueach porsvn,ou
whose request and for whose benefit work ioperformed under orpursuant m
any permit issued aooresult v/this oppnuatonagrees to, & shall, indemnity
`& hold harmless the City ofLaOuinto. its officers, agents and employees.
��.Any permit issued ooaresult o/this application becomes null and void i,
'wmm is not commenced within 180 uuxu from date of issuance of such
pormx.orooaoaoiono/wm,kfo,1oodoyowiUou�o��
po,mi��oanoonouon.
certify that | have read this application and state that the above information io
correct., | agree mcomply with all City, and State |mwo relating mthe building
oonitmouon, and hereby authorize taxi of this City to enter upon �
mrmonUonedpmpo for `
`
sinmn w
"p,x)no���nn
Date
IF
PERMIT #
BUIL DING PERMIT- m.2_oo
,
DATE VALUATION S 1.19,L4.1 .1 5LOT 1453 TRACT L_X�5
JOB SITE
APN 769444-006
OWNER
CONTRACTOR / DESIGNER / ENGINEER
PORUX 13297
PO BOX 132877
USE OF PERMIT
TRACT CON'STRUCTION1
PORCIAIJOAMO 42.60 8F
BLOCK WALL 0"TILIT) 5,3W.25
ESTIALWE 1) COST 0111? CONSTRUMION
1301811.05
CONS!'f REJUVION,F.Efi 1014)00,4t8-000 S748.00
MECHANICAL FIT' 101-000421-000 160.00
F-W.C'MICAL WE 101-000-420-000 $148.59
NJIMR040 F6F, 101-000-410-000 S116-00
CRAUING FEE 101 -OW -423-000
1NFRAJSTkVC1'URF FEE 225-W)443-342 $2,811,33
ART IN PUBLIC PLACJES - RESIC 701 -0 0-25.5-00,9 $77.03
TOTAL PERMIT PC&% DUE. NOW
$4.019.27
N
DATE
BY 4
DATE FINALED
INSPECTOR
_ _�_n~_, ____________
£'9
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
C
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck—
— ,
Exhaust Fans
O.K. to Wrap
g S 7
F.A.U.
Framing
$
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
t
Drywall - Int. Lath
Final
Final
—
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 I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines ,
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
—(_ (<
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
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.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
4 .... •f�U' is 1.C", ^ ..Yv.,. l"„ A�� T''+n.r ��1� �v..+r�..y, �f .�...--r...I` V/' ,y -,w ,� t
P.O. BOX 1504 APPLICATION ONLY
Building%Q n h/t: 78-495 CALLS TAMPICO
Address / U 7� �c7�r',5 LA QUINTA, CALIFORNIA 92253
Mailing
Address _ ` � cf
J t '
City — I Zip ITel.
Address
—1<4
.DING: TYPE'CONST. OCC. GRP.
Number 70/
,I Description
tct Description -D
State Lic.City —
& Classif. ^ 1"f Lic. # Sq. Ft.
Arch., Engr., Size
Designer Phew
rr
Address I Tel. /j
CityI Zip I State I
Lic. #
I hereby affirm that I am Ilceng d under provisibns=ofrChsp`te1s�J (comma
7000) of Division 3 of the Busin s .an8`plofessioh53Cod6r an y license
effect /! i
/'/OWNER -BUILDER DECLARATION
I hereby affirm that I m exempt from the Contractor's License Law for the following
reason: (Sec. 70316,By iness 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 appfican y%r such permit to rile 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 or 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).
L: 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.)
1'1 1, 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
doesnot 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. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION,`�'''lf'%
I hereby affirm that I have a certificate oY"consent to selsi sylh`" e,Oracertificate of
Worker's Compensation Insurance, or a certifiedcopythereof.6, , 0, Labor Code.)
Policy No. Compan�r �-�~'�
n Copy is filed with the city. O Certif ed copy is hereby fu fished.
CERTIFICATE^OF/EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be complefedJfI the permit is for one hundred dollars (E100) 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. 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
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%rof,lhls city to enter the above-
mentioned property for 2V�
^7Signature of applicantDat �� !''
Mailing Address
City, State, Zip / t
w
No. No. Dw.
78 Stories / Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep. �o
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback from, Center Line
Rear SetbacifromyRear Prop. Line
Side Street Setback from Center Line
Sdpe Setback from Property Line
FINAL DATE
INSPECTOR
DEC
0 8 1998
ssued 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
Date 3/2/99
No. 18411
CERTIFICATE OF COMPLIANCE
Jurisdiction
Owner NameWorld Development
No. 78715 Street Avenida La Torres
City. La Quinta zip 92253
APN # 769-144-005
La Quirita
Permit #
Log #
Study Area
Tract # Lot # Square Footage 2,078
Type of Development Single Family Residence No. of Units 1
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 mobil(�hornes.
It has been determined the above-named owner is exempt from paying school fees at this time' due to the,followng
reason: - 14 +
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080E in the amount of
1.93 X 2,078 or $ 4,010.54 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 ccNalley Independent Bank/World Development Telephone '771-5571
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Adriana Gauto
Signature
Payment Received $4,010.54
Check No. 18.8280
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 dale 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
a
RECORDING REQUESTED BY:
Fidelity National Title Company
Escrow No. 1914 -CAH
Title Order No.
When Recorded Mail Document
and Tax Statement To: -
M. Attie Akram
14060 Cape Wood Lane
San Diego, CA 92128
GRANT DEED SPACE ABOVE THIS LIN
The undersigned grantor(s) declare(s)
Documentary transfer tax is $ 0.00
[ X ] computed on full value of property conveyed, or
( ] computed on full value less value of liens or encumbrances remaining at time of sale,
( ] Unincorporated Area City of La Quinta
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, World Development, Inc., a California,.
Corporation
hereby GRANT(S) to Ameri Construction, Inc., a California Corporation
the following described real property in the City of La Quinta
County of Riverside, State of California:
LOTS 162 and 163, OF DESERT CLUB TRACT NO 5, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA, AS PER MAP
RECORDED IN BOOK 21, PAGES 61 AND 62 OF MISCELLANEOUS MAPS, IN THE OFFICE OF THE COUNTY
RECORDER OF SAID COUNTY.
DATED: November 6, 1998
STATE OF CALIFORNIA
COUNTY OF
ON
Jim Snellenbercler
before me,
personally appeared
personally known to me (or proved to me on the basis
of satisfactory evidence) to be the person(s) whose
name(s) is/are subscribed to the within instrument and
acknowledged to me that he/she/they executed the
same in his/her/their authorized capacity(ies), and that
by his/her/their 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.
Signature
World Development, Inc., a California corporation
By:
Jim Snellenberger
vv�
Val -
MAIL TAX STATEMENTS AS DIRECTED ABOVE
FD -213 (Rev 9/94) GRANT DEED
ceit,, 4 4 Q"
PUBLIC.WORKS CLEARANCE LETTER
FOR
CUSTOM'HOME LOTS
Dear Builder:
Prior to issuance of a building permit, you will be required to obtain clearance from the
Public Works Department for'one, or more, of the following:
1. Verification that rough grading is complete, and the pad elevation certifications
prepared by a licensed surveyor, �r engineer, are on file in the Public Works
Department.
2. Verification that infrastructure improvements and other required tract improvements
are complete, or sufficiently advanced to warrant building permit issuance.
3. Prepare an engineered grading plan that provides for on -lot storm water retention, .
and have it checked and approved by the Public Works Department
• Tract 26524 (Estancias)
• Tract 26769 (Mountain View Estates)
4. Prepare an engineered grading plan that provides for building pad grading in
accordance with the existing soils report and tract grading plan, and have it
checked and approved by the Public'Works Department.
• Tract 28034 (South Valley Estates)
FOR INTERNAL USE BY PUBLIC WORKS DEPARTMENT
TRACT: DSS-!^ GI,V(3 tJ
LO 6
I ��l _e5�1 3 1
PUBLIC ='JS UTHORIZATIO D TE
F \PWDEPT\DOCS\FORMS\PW CLEARANCE LETTER.ss
COMMENTS:
Certificate of -Occupancy
City oFLa Quinta
V
'Building -and Safety Department OF ti
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 compliance with the various ordinances
of the City regulating building. construction or use. For the following:
BUILDING ADDRESS:. 78=71 5 ,.AVENIDA LA TORRES
Use Classification: SFD Bldg. Permit No.: 9812-069
'Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RL
Owner of Building: WORLD DEVELOPMENT, INC. Address: P.O. BOX 13287
City:, PALM DESERT, CA 92255
A
r
7`!, o By: GARY HARTMAN
_.... �b Date: 9-9-99
Building Official
POST IN A CONSPICUOUS PLACE