0308-044 (RER)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
�I.)i�i'���v � ��fw / � ✓�j 1 fl,�' �.!� Ilr�4J.
gate /-' i I --U %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 (deb -.o7044,. Business & Professionals
Code).
O I am exempt under Section B&P.C. for this reason
9 ,
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the, following declarations:
O
:1 -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.-
( A. 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:
Cartier Policy No.
111"ATE, FUND
el
(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-1 should become
subject to the workers' compensation provisions of'Sed'tion 3700 of the Labor �
Code,':'T`sIiall,forthwith comply with thoseprovisions. ' �f
'Date: / :'7. r Applicant
Warning:
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the.cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is. made & each'person at
whose request and for whose benefit`work is performed under or pursuant,to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void:if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is -
correct. I•agree to comply with all City, and State laws_ relating to the building
construction, and hereby authorize'.�epresentatives of this City to enter "upon
the above-mentioned property 0,1' pection purposes.
Signature (Owner/Agent) ! • !r `� Date
H
PERMIT#
BUILDING PERMIT
• .ia+
DATE VALUATION LOT •I� TRACT
JOB SITE
:ADDRESS
APN
54-01-9 Sift.'::$l=.'31++`�iIN .1..1'x:2.:.:
'i7ai RE7S-`:I:aS�
OWNER
CONTRACTOR / DESIGNER / EN (NEER
�`.}.#`�'�.��.�. ��� i'.£.�Ih�1�,.`��'r'i.)�ii�l�,�L 1�.-�
�.,C.r..�'�.P.}.'��.li�' 3� �.�?�. • - '
N0iD;i{i*iT CY 1.1
Lk giJ)NTA' CA 92.25.3
1'�'r'i-Q:ANA MSM C.A,. 92260
(if f 0 7.13-9024 G"1:)Lii 390
USE OF PERMIT
i�r7:+.I ik�R. NBetit . l t iT1'1iCli,:0iL I.li/IT�F'.G11Y7 �3hId'I'a XM EXTrtlfi',iO:o-:.
MULAC, PERAPPR6V-911 PLA11I1
P(Y,,)L MUM VYIA W,
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,
PIVR.W 1,71.2 SOMMAP -
EL'WiVICAL FLYZ -- ?OC)L 101.606--42C-iltii) d5.Q0
1Q1 f30!) X49-319 �d6t,tG
�:.t'�tYfF'��#.f14`:at®:i31xR� .. 1l,Ijafl'Ti0•�Ti`4-biKi fl.�0
.qS�,',PRO1.4�fS1Ip�?OTIfe3N 020., • XLSiD ? 61 00�$12100-
a�rw$�.1-/0.00
� � .1'.01
'.00()
ME1'.0 d/��g7y7, -000
i�.h,:r.+•.. n' A.'r..�i:�Ca1: L'F+D:. � Lla_000•'+C•20-000
••#'l.,[.ihhi�IY3�31;�fski .:i0�'<(?i'IU�x���td�t3 � ��i,fltJ
', , _' •
C�.TCIJa,C'�T�'12d1Y'LFTt3J
2.J. 4 .:'jam
SFP 171003
k
ni
City oft - A
RE CEIPT Fit," r BY' �� DAT F A INSP
R
8 ��
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
VF.A.U.
Framing
Compressor
InsulationILI
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWAL
A PROVALS
steel
Set Backs
Electric Bond Of
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
Encapsulation Z
Gas Piping
Gas Test
Appliances
Final
COMOENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring "
Low Voltage Wiring
Fbdures I
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
03/16/2005 20:09 7605648601
STEWART TITLE -Riverside
RECORDING REQUESTED BY
WHEN RECORDED MAIL TO
AND MAIL TAX STATEMENTS TO
NAME Mr*' .Randy C. Bills
'ADDRESS 54-4.25 Ave>n;Lda Martinez
CITY La Quinta
STATE & ZIP CA 02253,' .
GRANT DEED
FSCROW NO. 3010925BM APN NO. 762-150-008
TITLE ORDER NO: 518268285 TRA: 021::
THE UNDERSIGNED GRANTOR(s) DECLARE(S)' CITY TAX $
DOCUMENTARY TRANSFER TAX
X computed on full value of property conveyed, or eem�uted on full value less value of liens or en-.�mbrances remaining at time o sae,
❑ Unincorporated area: X City of LA QUINTA, and
R C BILLS PAGE 01
DOG !till 2004-08SM 141 -
10i26/2004 0a:00A Fee:36.00
page 1 of 4 Doc T Tax Paid
Recorded in Official Records
County of Riverside
Gary L. Orso
Assescnor, County Clerk 8 Racarder
.� � IIIIIIIIDIIIA111111IIIIIIIIIIIIIIII
I MINI III hl VIII
..M ffR
SP.E OA DCOR NOCDR s1AFMISC.
A COPY LONO REFUND NCHO EXAM
i
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
BELLA OCEANA, LIMITED PARTNERSHIP, A CALIFORNIA LIMITED PARTNERSHIP
hereby GRANT(s) to LEGACY HOME CALIFORNIA, LLC, A LIMITED LIABILITY COMPANY
the following described real property in the County of RIVERSIDE State of California: OF
LOT 15, OF TRACT N0, RIVERSIDE
D SHOWNB BY
FOR COMPLETE LEGAL-IDESCRIPTIO SEEP ON. FILE IN BOOK 27A PAGE(S) 42 THR UG 44, CEXHIBIT,`W'
MAPS, RECORDS OF RIVERSIDE COON ,
ATTACHED HERETO AND MADE A PART HEREOF.
SELLA OCE1014A LIMITED PARTNERSHIP
A CALIFORNIA LIMITED PARTNERSHIP
STEVE HELL.'i3ERG, LLC, A CALIFORNIA
LIMITED LIAi61LTY COMPANY, GENERAL
PARTNER 011: BELLA OCEANA LIMITED
PARTNERSH:iP, A CALIFORNIA LIMITED
PARTNERSHI I'P
I'(
Dated BY:. STE IEN HELLBERG, MANAGER OF
STEVE HEI. L,BERG, LLC, A CALIFORNIA
�� LIMITED LIABILITY COMPANY
rLk
STATE OF•
COUNTY
On L ` C�a bafbre me,
e 7.
(here insert nam® and title of the officer), personally appeared ,
personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose Harr Io(s) WareLOer s eir sl bed''to'the within instrument
and acknowledged to that helshemey executed the same in hls/herkhelr authorized capacity(les), and t#tel py hisMerltheir sig, J'on the instrument
the parson(s), or the entity upon behalf of which the person(s) acted, executed the instrument
WITNESS my hand and official seal. `_ - ;
Signature
NOTARY PUBLIC FON SOUTH CAROLINA
YI► commission exph'es August 13, 2001 ow,raEm.Doc
DOCUMEWPROMOEDL%YSTEWARTME,OFCALIFORNW,INC, .�
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
78-194 Elenbrook Ct.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE
❑ POST TENSIONED CONCRETE
❑ REINFORCED MASONRY
❑ STRUCT. STEEL ASSEMBLY
❑ ASPHALT
❑ FIRE PROOFING
❑
HER
JOB LOCATION /
i/�
} (� N'�
REPORT SEQUENCE N0.
TYPE OF STRUCTURE
/
PERMIT 110.
DA3E
DAY OF WEEK
MATERIAL DESCRIPTION
ARCHITECT
INSPE
HRS. CHARGED
h
1Y
ENGINEER �
ASSISTANTS
HRS. CHARGED
INSPECTION__[6/s
GENERAL _- _ — 11�. _SUBS„ .y ., _ . frc-
DATE CANTRACTOR . �, . 4L i2 �4 1. CONTRACTOR 1
d.`.
�'GNG� hI G;
LAI-,
S
f.
COPY SENT TO CLIENT O
CON HUED N NEXT PAGE O
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.
IGNA U EY F REGISTERE PEC'TTOR�( �
DATE F REPO T 3 REGISTER_NUUMBER