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0108-195 (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 Date? . �� Signature Of Contrac�to� r .,.. 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 i 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 S;46 3700 of the Labor Code, for the performance of the work for which this ipermit 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 subject to the workers' compensation provisions of Section 3700, of the Labor Code, I shall fortbwith comply with.those provisions. ,fDate:;i,..t,!� ",-, Applicant,w � Warning: Failure to secure'Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. x 1. Each person upon whose behalf this application is made &.each pers©n at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall; indemnify & hold harmless the City of La Quinta, its officers, agents and employees y.'+ 2. Any permit issued as a result of this application becomes null and void ih, work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building . construction, and hereby authorize representatives of this City to enter upon the above mentioned property for inspectiort purposes. > `, 'r Date Signature . (Owner/Agent)«, h -r , " .- PERMIT# ?- BUILDING -PERMIT DATE 1 VALUATION LOT.- 1 'f� TRACT Y./-•%'1!tri 9a1 1 R AT 17C1 .. :JOB SITE APN ADDRESS I ,77����ryj yy�D���yy /p�, egg �y ryy p� y ¢ry • 52-350 to NJ4'4eE'�dDA 8'J!:9AtIX 0 'n3 -24a.005 OWNER CONTRACTOR'/ DESIGNER / EN (NEER 1w$x M'UDA.VJNFB Ch 92261 BY-PaAMA%1:Yamn CA. 92251. (760):.3,W-8706 MIA 1526 USE OF PERMIT SPO n LCYr 18 OLK, 9?. PERMIT T WES XOT T1ilC:l,t= B1A)C.K WA1r1 ; POW9frA OR DRlV9WATAPPROA.4' K 75% PUN CHMIK .MR.RMiJMON 'Fom.1 1JA-nF; Opp a hAge PLAN TYPFI. '1 R APT :COMSTRUC TRYA 1,sxoo 3F POMI. PATIO 24,00 SP 440A SF YE- Rtmff ME SUMMARY VIOMSTRUCTICro FFE 7 01 000_41 0-000 9608,00 PLIAR Offze°dC .i71F, 101_000-439-311 8 $125.97 i�.,1�,99POSIT 101-000-439-318 -8250,00 M.W!'.i`AA11CA,1..1 101-000-421-000 ES'.,Efi:'� i� lt.AL FM 101-000.420.000 $10.06 P1..UMBWO'IFFA 101 _0110••el•'i 9-000 $126.50 ��`PlZ.OM MOT101i F10,0 • 11:V.OW 101.000-241-0W GRAY INO M. 101-000.423-000 $MOO , . ... I: �E+''EWIM ltiSizJWT I+'.EE *11907-00 P11XViH1+1:. PLAN 101-000-441-343 �t1Q0.0if .qUB ° t)TM, C.1rJ1.o5UfiRU�'.�'dC123AN!) PLAM CHECK $3,062.05 b i '.CO2.6'dL.CLMI MG DV.F&i NOW [nFr % 2001 �1 CrIYOFLAQUI A RECEIPT DATED / DATE FINALED ATE INSPECTOR �" i INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs - U2 _ �/ Underground Ducts Forms & Footings �r Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap�O Framing U �� �j 2L/G_ F.A.U. Compressor Insulation ��� 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 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 I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines ' /�/Z' Heater Final Water Piping Plumbing Final PlumbingTo Out p Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Sewer Connection _ /% p?/ �j 4.` Pool Cover Encapsulation Gas Piping Gas Test/L i It zm Fs Appliances `` Final Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APP OVALS 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) -( �•ii%'�iiff�r-�"' tj`{ /a 0 ��,�� 4 P.O. BOX 1504 APPLICATION ONLY \G� Building y 2 - list) v f . 1(%78-495 CALLE TAMPICO Address LA QUINTA, CALIFORNIA 92253 O Owner 0 7 �' �' BUILDING: TYPE'CONSA` I`7 OCC. GRP. Mailing V 1'�'� r1 Address A.P. Number I I ^ a 6 � - 0o _i— / City I Zip ITel. Contractor Zip State Lic. I City & Classif. J Vo - Z Lic. # Arch., Engr., Designer Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under,,provisions of Chapter 9 (commencing.with Seci'ion 7(X70) -of Division 3 of lheeBusiness an(rProfessions Code. and-mv license_isin-fulbforce and O OWNER -BUILDER DECLARATION ' I hereby affirm that I am exempt from the Contractors 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 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 live hundred dollars ($500). lJ 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 orimprovement 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.) I 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 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. &-P.C. for this reason Date., ,.'•tai In WORKERS' COMPENSATION DECLARATION Ihereby 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 (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 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. Date Owner NOTICE TO APPLICANT: 9, 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 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 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 Description Project Description 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 Prnnertv_I IOP FINAL DATE Issued by: D; Validated by: Validation: li • Cr'4 � _ 1 ���rr_�aea■7a�� Sq. Ft.No. Size / s ,� stories No. Dw. / Units / New)9 Add ❑ Alter ❑ Repair ❑ Demolition ❑ GJ fi aa -V ,D4fl r t ? Estimated Valuation (/ S is v 0 t1 PERMIT AMOUNT Plan Chk. Dep. 5 - Plan Chk. Bal. Plan Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure 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 Prnnertv_I IOP FINAL DATE Issued by: D; Validated by: Validation: li • Cr'4 � _ 1 ���rr_�aea■7a�� WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Notice: Document Cannot Be Duplicated Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE Date 12/17/01 APN # 773-263-005 No. 22767 Jurisdiction La Quinta Owner NameDGH Construction Corp. Permit # No. 52-350 Street Avenida Vallejo Log # City La Quinta Zip 92253 Study Area Tract # Lot # Square Footage 1533 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 accessorystructures or replacement rnobilehomes. 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 1,533 or $ 3,142.65 ' 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 =Palm Desert National Bank - David Heusinkveld Tele'"prone 76.0-360-8706 +. Name on the check �— By Dr. Doris Wilson jti - Superintendent Fee collected /exe ted by Annette Barlow Payment Received $3,142.65 J � Check No. 082996 Signature W OTICE: 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 bove 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 oiled them on the DistrictCs)(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 RECORDING REQUESTED BY ORANGE COAST TITLE :CO. AND WHEN RECORDED MAIL TO: DGH Development Corporation P.O. Box 2982 Palm Desert, CA 92261 A.P.N.: 773-263-005-7 TRA t{: D ,:-.,) CSO ! - .1 Or GI ®OG So 2001-262280. 08/08/2001 08:00A Fee:26.00 Paps 1 of 1 Doe T Tax Paid Recorded in Official Records County of Riverside Gary L. Orso Assessor, County Clerk d Recorder` M $ U PAGE SIZE DA PCOR NOCOR SMF MISC COPY I LONG REFUND I NCNG I EXAM ANT DEED THE UNDERSIGNED GRANTOR(,) DECLARE(s) THAT DOCUMENTARY TRANSFER TAX IS: COUNTY $23.65 [ computed on full value of [( property conveyed, or computed on full value 1 ss dalue'or liens or encumbrances remaining at time of sale, unincorporated area; City of _La Ouinta , and r FOR A VALUABLE CONSIDERATION; Receipt of which is hereby acknowledged, Dolores O. Cline hereby GRANT(S) to DGH Development Corporation, a California corporation. the following described property in the City of La Quinta, County of Riverside State of California; .�4: Lot 18, Block 83 of Santa Carmelita at Vale La Quiota Unit No. 10, as per map thereof recorded in the office of the recorder of Riverside County, Page 70 of Book 18 of Maps. Vv 5 Dolores . Cline Document Date: Avril 24, 2001 STATE OF CALIFORNIA O )SS COUNTY OF �J On A4 --Y — before me, 1"t I SJ I t ✓ytk, 1 V6 Ttt ►^7' . ��� �/ L personally appeared_���5� f personally known to me (or proved to me on the basis of satisfactory evidence) to.be he 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 hisiher/d�eir 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 sOD _ This area for official notarial sea] MIKE SOLIMAN Comm. # 1171996 tp inNOTARY PUBLIC • CALIFORNIA V' a ' IPMy,Comm. County of Orange Expires Feb. t, 2002 Mail Tax Statements to: SAME AS ABOVE or Address Noted Below i 0 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`2GO feovof-the applicant; and/or 2) if there is a need for -the -applicant to file for Master Design Guidelines. ]f the applicant does need to file a Master Des.ign Guideline, ,please transmitted this information to the Building and Safety Department as part of your correction list. Please attach additional explanations as necessary. APPLICANT DGH DEVELOPMENT CORP. SITE ADDRESS 52-350 Avenida Vallejo APN 773 - 263 - 005 CASE NO.: 2001-541 LEGAL: LOT BLOCK UNIT S.C.@V.L.Q. CHECK AND APPROVED BY: Michele Ramho DATE: a 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 )( Consistent with MDG on file (as applicable MDG filing required (5 filings since 9/3/98) X Architectural variety within 200 feet of the -surrounding area: Colors Materials Architectural design features 0� C RO`��0�'� L 0� Other Requirements: GPS '<Clertifica.- Yte ®f OcC- Y��anc } Citvof �a00i"nta, Building and. Safety Department I 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: 52-350 AVENIDA VALLEJO Use Classification: SFD Bldg. Permit No..: 01,08-195. Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC Owner of, Building: DGWDEVELOPMENT CORP. Address:-- 78=921 'RUNAWAY- BAY City: BERMUDA DUNES,' 'CA 92261 By: RICHARD KIRKLAND' ;44Date: 03-28-02 Building Official POST IN A CONSPICUOUS PLACE • e '<Clertifica.- Yte ®f OcC- Y��anc } Citvof �a00i"nta, Building and. Safety Department I 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: 52-350 AVENIDA VALLEJO Use Classification: SFD Bldg. Permit No..: 01,08-195. Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC Owner of, Building: DGWDEVELOPMENT CORP. Address:-- 78=921 'RUNAWAY- BAY City: BERMUDA DUNES,' 'CA 92261 By: RICHARD KIRKLAND' ;44Date: 03-28-02 Building Official POST IN A CONSPICUOUS PLACE