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0001-041 (SFD)LICENSED CONTRACTOR DECLARATION ,I herZy;affirm under penalty of perjury that I am licensed under provisions of thapter 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 f ti3.r� J3 a2f�li20i ate � 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 ownei 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 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 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 subje-t to the workers' compensation provisions of Section 3700 of the Labor Code I sh�all forthwith comply with,th"osg provisions. ,date: LVI 0 ✓ 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. /'�/v`t�..•_ Date /4e/CSU `Signature (Owner/Agent) f BUILDING PERMIT PERMIT 0001-041 DATE!j 1 VALUATION Qi ���� ► �w� LOT 79 TRACT 2W` 1J1y� 11nJOB SITO ADDRESS t .r�.i i�!A�Dii-�.SL�A��� APN OWNER CONTRACTORDESIGNER /l ENGINEER n �. CLAIM C -11 O} M31 OA.K 1:JILL 7-Cs2 C©L)N'Tti�`C J..1}FI DR. 4M LA OE INTA CA. i)2:153 i?AL&I WiSEWP CA 912111 Fdlt?�ig.5l.5�t C nix "im USE OF PERMIT - slNt:l.. 3}At41.ILA !)bV6Sl.Li.40 S—FI) - NO iALO(X WAILS 0121100%.. OOh ILIAZvCE WITH ALL FT-D.ERAL S'I'A'I'I;1.AWS,1N. LL0fN<' T1 -W } NJ_*)AIrICDkHW-) SPEC438 AG 1' O 19.73 (16 ' U.S.C. fJ 1531, Y SEQ.) W :CI'N'L;<f Ak�i� , 1S %E �UffCa: fes• trlf sJl�lYl �+iJitlJrA l�41L .l .lVl"V �,.Yi�. �l a1' . GARAU&CARPORT 1,046.00 St' ESTI NIIIA'fED COST -t 711lvC'��}'.1TRUC� 101 . CONS'1RUCTION.i 613 101--000-418-000 513934.50 r rw v=n^ 7( c! r s n Al ��r POS,ia IME- 14ANICALFEE 1171 ttt)i1-P�aI-CGU $IJSi.Sti ELEC".•It1CA1, FEE !171-13UU-42U-!?f/U $:114. W k3t,1-fVv�tNCI CIv:P l f1J-f>Ot)-d, i �i_(4(10 F 1C1�y. `� s-trw No 1%.1arION FEE^RESto 10i-011.10-24 -009 0R.#QDINO F03% 0E -V I,0Pf,--k )MNAM' FM ART ref PUui: }G Pf..47-P ; - ICPS"1701-�i100t 2.554 i r'C),N,,.oFIZV(MON AND PLAN C14 PIC PP 41.,000.00. 111Yi'iLT. pfil..001IT V8aEN 13)1)1•: NOW $6.210.85 � RECEIPT DATE BY'"' DAT�FINA�7 INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts ,a Forms & Footings _ _ _ �jf _ Ducts Slab Grade Return Air Steel Combustion Air Roof Deck — AO Exhaust Fans O.K to Wrap F.A.U. Framing Q • f . Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath 7 P 777—c" Drywall - Int. Lath — tP�F "�I cuS 7 - do Q 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 Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection OD $ Encapsulation Gas Piping Gas Test • p ( -r- Appliances _jJba1,-S2A B•►9 LL -j E - C 3 • 0 _ Final COMMENTS: Final Utility Notice �•�~tw/t✓C. "�' fo Irl' (Gas) ELECTRICAL APPROVALS Temp. Power Pole - c2v 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) 3 a 'd g ,_. , .A - ..t, � ,. r�.� -i. 'p_+�ts.��„�.^•�`R rX�e`.�::�`�'S�f,�re.,js.,,.. .�+�w.'v►- a, _a .. ..�.�r--••.yv. "a ♦.. ....`�,..+r�'1.... r•.yl-, .-, .,. '^"= . BOX 1504 C"�V I 18-495 CALLE TAMPICO APPLICATION ONLY Building :1'J G`V`� � Address LA QUINTA, CALIFORNIA 92253 Mailing y �_ ' U-� Address i() j City Zip Tel. AContractor t Addlre Is61 l Zip State Lic. City & Classif. Lic. # Arch., Engr., Designer Address Tel. ,City--�r Zip•• y State il ` } in SJl �.'� �22iP11 Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7(X70) 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, 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 trisalleged 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 that he did not build or improve for the purpose of sale.) 11 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 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.) i? 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION r• r 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 I (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 lhg 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 ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: comply with such provisions or this permit she// be deemed revoked. Front Setback from Center Line - Rear Setback from Rear Prop. Line 4V Side Street Setback from Center Line Side Setback from Property Line LDING: TYPE•CONST. OCC. GRP Number q 'I ,. }'' �LTj I Descriptionr K1l r ` _ V ay` v J rl Sq. Ft. No. No. Dw. Size Stories Units Add O Alter O Repair 0 Demolition ❑ REMARKS r .r 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 ame 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. 1 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 aQplicant Date Mailing Address City, State, Zip WHITE = FINANCE FINAL DATE NSPECTOR Issued by: Date Permit Validated by: Validation: YELLOW = APPLICANT PINK = BUILDING DIVISION 9 99 1 Estimated Valuation J PERMIT AMOUNT Plan Chk. Dep. /0 Q Q Plan Chk. Bal. 1 Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS r .r 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 ame 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. 1 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 aQplicant Date Mailing Address City, State, Zip WHITE = FINANCE FINAL DATE NSPECTOR Issued by: Date Permit Validated by: Validation: 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 1/10/00 APN # 769-180-020 No. 19890 Jurisdiction La Quinta Owner NameClive Clark' Permit # . No. 53-285. Street Troon Trail Log # City La Quinta• Zip 92253, Study Area Tract # Lot # Square Footage 5548 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 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 1.93 X 5,548. or $ 10,707.64 - the property listed above and th.aa,dtv`bil�ding l`.,', •"u Permits and/or Certificates of Occupancy for this square footage in this proposed project maariow beiissued" - i Fees Paid By CC/Wells Fargo Bank, N.A./Ken Hudson T&plioneI460-'3.45-515;414 Name on the check By Dr. Doris Wilsonz#:Yy'`r�% a �e44, Superintendent " Fee collected /exempted by Olivia Aguirre Payment Received $10,707.64 - Check No. 0689022730 Signature / '7 i1 'Gil - • NOTICE: Pursuant of Assembly Bill 3081j(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 I above will begin to run from the date on wliich 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 Distnct('s)(s') behalf, whichever is earlier. - Collector: Attach a copy of county or cityplan check application form to district copy for all waivers. Embossed Original- Building-. ept./Applicant Copy-,Applicant/Receipt Copy - Accounting. No. 2130879 ,+ , Y- ;:crow :loAeMading Requested By 281479 .oari No. First Amedcan Title Company WHEN RECORDED MAIL TO: ' `CIi a Clark ' - v , Fourth Mesa'Inc.'.. , 55531 Oak -Hill n =La Quinta, CA 92253 MAIL TAX STATEMENTS TO: M 'S U . PAGE j SIZE DA FCOR - • NOCOR ✓� MISC. A R COPY LONG REFUND ' NCHO EXAM, Computed on the consideration or value of property conveyed; OR SAME AS ABOVE Computed on the consideration or value less liens or encumbrances remaining at time of sale " The Undersigned Giantor Signature. of Declarant or Agent determining tax -Firm Name l ,TRA; , d Z� - 01 "'. GRANT DEED,- ; FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, . TRADITION CLUB ASSOCIATES LLC.; a Delaware limited liability company hereby GRANT(S) to Clive Claik, ' a single man as_"to an undivided '50% interest and - J f Fourth Mesa Inc, a Nevada Corporation as to an undivided`50% interest as Tenants in Common the real propertyin the City of La Quinta County of Riverside- "i. State of California'described as ,i. Lot 79 -,Tract 28867. (See Exhibit "A" -Attached Hereto) Dated: May 20, 1994 State of California ss. ' Coun of �� _ - :. On TRADI N CL ASSOC TES, , a Dela w re lim' d liabili ompan personally appeared: + personally known to me ,evidence)to be the person(6) whose name(o islafe subscribed to the BY: ' within instrument and acknowledged tome that hekhaAhey-executed the , same in his/herftheir-2uthorized capacity(i*, and that by. hisl mThhca- signature* on the instrument the person(e}or the entity upon behalf of ITS: 'EXECUTIVE VICE PRESIDENT , which'the`per"son acted, executed"the instrume WITNESS ND AND O LS L Signatur CWAIM A UONN : Oenw"" i 1127AW ' Corm, Sow Feb 2% 20M ' (This area for official notarial seal) Tra difio ARCHITECTURAL DESIGN REVIEW !. January 5, 2000 Mr. Greg Butler. CITY OF LA QUINTA 78-495 Calle. Tampico La Quinta, CA 92253 Re: Clark Residence Lot 79, Tract 28867, 53-285 Troon Trail Dear Greg, CITY tea- I_A 0, `I! ITA JAN 10 RECD Via First Class Mail and Facsimile Please accept this letter as approval for the above referenced residence to obtain a building permit. Conditions that apply to this submittal will be forwarded directly to the architect, Ms. Kristi Hanson. If you have any questions or need additional information, please do not hesitate to call. Sincerely, Christina J. Dores Architectural Review Coordinator /cjd pc: Kristi Hanson, Architect Ken Hudson, Builder ti. �J.�..... :� • r •�.. o .l�'i p(, �Ii .9t.�r.}{ ,L l'. P. �' l,'>f 1 T4, J..ii 1. :�-5 w6'•• _ t'G ��1.9 J �n �.`'_ 1p�Y CAMy Dowm "Rgdul7A002.pd 78505 OLD AvENuE 52 --- LA QutNra -> CA 92253-1120 -- PHONE 760/564-3355 — FAx 760/564-2356 a OF tN� PUBLIC WORKS CLEARANCE LETTER _ FOR _ ': .•':.. CUSTOM -HOME LOTS 3 Dear: Builder Vx t� y 5 - - ... 'i Com. '- - � ' •.-.. �Z. '.- v?'� t. . Prior to issuanceofa 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 " w prepared icy a licensed surveyor,, or, engineer, are on file in the Public Works Department.:. x 4 y2 Z. :Verification that infrastructure improvements -and other'required tract improvements -yy are complete, or sufficiently advanced to warrant building permit�issuance .3. Prepare an engineered grading plan that provides for. on lot stone water retention, -and have it checked and approved by the Public Works Department # x= • Tract 26524 (Estancias) Fs` • Tract 26769 (Mountain View Estates) 4. Prepare an engineered grading plan that provides -for--building pad grading accordance with the existing soils report and tract gr"ading . "plan, and have it w checked and approved by the Public Works Department. • Tract 28034 (South Valley Estates) 3 tiz f ct 1 Szck,� a' FOR INTERNAL USE BY PUBLIC WORKS DEPARTMENT' TRACT: F:IPWDEPTIDOCSIFORMSIPW. CLEARANCE LERERss /A, DATE C17), JON TANDY °tet, 37630 Medjool Ave., %A o Palm Desert, CA 92211 RFCD Office (760) 772-7192 SPECIAL INSPECTION SERVICE Fax (760) 772-7193 REGISTERED INSPECTOR'S WEEKLY REPORT 04rz;EPger (760) 776-3338 TYPE OF INSPECTION PERFORMED ❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY ❑ ❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER ❑ REINFORCED MASONRY ❑ FIRE PROOFING JOB€L ` � � ��`a� r ,� :Tov cm REPORT SEQUENCE NO. TY -PEE F ST_'R11�11RE` "" `�' """`Y` ""F'�"`'* J Ic PERMIT NO. D E� DAY OF WEEK MATERIAL DESCRI TIO 6 a/',^ �-�� ARCHITECT _ INSPECTOR HRS.CHARGED lHRS.CHARGED ` 1 ENGINEER ASSISTANTS INSPECTION GENERAL , SUB &I T� DATE CONTRACTOR C CONTRACTOR ul63111O erlGa- D �S C�►2, i ccar oA Civ L f (•aaA i tj l9• CIo",,-p COPY SENT TO CLIENT ❑ CONTINUED ON NEXT PAGE ❑ PAGE OF CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY. KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE GOVERNING BUILDING LAWS. SIGNATURE OF REGIS ED INSPECTOR 6 " Zz�g _a ( g 17�S DA E OF REPORT REGISTER NUMBER