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0011-246 (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 /4 01.a T3 c?'O 094 Signature of Contractor�f�;_. 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). ( ) 1, 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 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. (v,) -)I -have and will maintain workers' compensation insurance, as required by Sectidn 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. STATE FVNO i�^fffZ-fia�43 �t3 (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 forthwith comply with- hose provisions. , Oate: JZZ,�L-I% _ Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1 Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta; its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to Cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspectiop purposes. ,Signature (Owner/Agent��' BUILDING PERMIT PERMIT# DATE `'VALUATION LOT TRACT t q q JOB SITE APN ADDRESS SXA.S5 AV1"Pfffi)A.. VlaX.l(.VIO 7.n.-26,2-021 OWNER CONTRACTOR / DESIGNER / EN INEER 1$.CD�?' .'l;�:.�6�'t:9�YI3 l.?t�3-1.1�1�`�'""ta,�.Clk�^t�"1•{".1"C_j�°.�td� PO DOX 29112 78-921 RUNAWAY EA -Ad 1� 195.31 CA RM:fiAL'I'DADUNES Ck 5122%1 ,CR60)360-8706 10TUf 1526 USE OF PERMIT S1rt'l - P�i�.•�itki►� IT DOES NOT INCa..lJD21'Si..C7G.":fG WALL,, POOL &SPA. OR. DRIVEWAY TRACT CONSTRUCTION 41=100 fI f?0RCH/pA'F10 24.00 y y 0.ARAGRiCAIRPORT (91) 9624,09 5 sPT. WOOD ,VZHC9 475.r.B.M'YA.6lL4JC)b1}Y.S.A�B�'�ECA�Y/��.G��JY .Y�7Pio.LBJ F 92Mr4 Firm F.€U1bt6YL URlrr COh0TRi, CT)ON W,E 101 rOM418-000 $612,50 PLAN C,H, FZ w "S ��-r�Q��a��•31fa° s�a�s.�a 1y:;;mP&rf 101 -WO -439-318 U50.00 r WWAN.ICA.1.. FRS: 101-=)-421-000 $53.30 lUW'!';f1,1C,41 FES 101-0004,20-000 SIM.% PLtiMBrua 1 101.000.419-000 111035 VVRONO MOTION FZ9.4114:111) 101-000.241.000 $9.39 VHtA R40 R1r 101-000-423-000 $20.00 DEV E OPrFt IMPACT RZ PICEC1 1 PLA14 101=000-441 -345 MIB -TOTAL t�GN' C770114' AND PAY eT.1V;OIX ,152.91 LESS FRINPAID Y"I .S 4250,00 'Nit) JAN.16.2001 ; T 111 : '�;<< sDUN:rOW Y Ur LA %Awl - .SIT RECEIPT DATE BY � DATE FINALED INSPECTOR p IIK 1 IXC INSPECTION RECORD OPERATION DATE INSPECTOR BUILDING APPROVALS Set Backs Forms & Footings Final Pools - SPAS Steel Set Backs Slab Grade Electric Bond Steel Roof Deck O.K. to Wrap Framing Insulation 3. /s -a k ZOID ( _ Fireplace P.L. Bond Beam Fireplace T.O. Approval to Cover Party Wall Insulation 9. -?, p—fit 7 Equipment Location Party Wall Firewall Exterior Lath _ �� 7 DMwail - Int. Lath OPERATION DATE INSPECTOR MECHANICAL APPROVALS Underground Ducts Ducts Return Air Combustion Air Exhaust Fans F.A.U. Compressor Vents Grills Fans & Controls Condensate Lines --j COMMENTS: Final ELECTRICAL APPROVALS Temp. Power Pole Underqround Conduit Low Voltage Wiring Fixtures Final !q iac± BLOCKWALL APPROVALS Final Pools - SPAS Steel Set Backs Exterior Receptacles Electric Bond Footings Smoke Detectors Main Drain Bond Beam Approval to Cover Utility Notice (Perm) 9. -?, p—fit 7 Equipment Location Underground Electric Underground Pibg. Test Final as Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Water Piping _/ / `/ Q/ Heater Final Plumbing Final Plumbing Top Out fff Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection /_�g., p� Encapsulation Gas Piping Gas Test _ --j COMMENTS: Final ELECTRICAL APPROVALS Temp. Power Pole Underqround Conduit Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) 9. -?, p—fit 7 r• SA�� oon-ate Tihf 0 " BOX 1504 _ / 78-495 CALLE TAMPICO APPLICATION ONLY AddresBuildins S C�S' S� �� /�Cs ;r�i � OUINTA, CALIFORNIA 92253 Mailing Address 1 - 1-' , I `'7 f . L,. Lei I •-) W U Contractor _ 1j40#. W, U - State Lic. City & Classif. 4 h -b Lic. # Arch., Engr., Designer r•\ n 1. IC AaaressI el. City Zip State 01 A ' 1--� fa,,URL, Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm I at.lram licensed under provisions of Chapter 9 (commencing with Section 7000) of D1vis'onr'3 df%the Busiryss a9.d Professio" s' Code, and my license is in full force and effect.^ 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 o/ 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 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 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 contractor(s) licensed pursuant to the Contractor's License Law.) Il 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 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 r7 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 (5100) 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: ll, 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 filled out, signed and validated, and is subject to expiration if. work thereunder is suspended for 180 days. 1 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 BUILDING: TYPE'CONST. OCC. GRP. A.P. Number • / -3 ark ( .42. — r Q Legal Description Project Description 8� r Al Sq. Ft. No. No. Dw. / Size 513 � Stories Units New Add ❑ Alter ❑ Repair ❑ Demolition ❑ >timated Valuation PERMIT yOUNT AM Plan Chk. Dep. 9, r�)Jv Ci 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 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 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 1/12/01 APN # 773-262-021 No. 21507 Jurisdiction La Quinta Owner NameRobert. Teaford Permit # 0011-246 No. 52-455 Street Avenida Vallejo Log # . city La Quinta zip 92253 Study Area Tract # Lot # 10 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 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 1,533 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 - Bob Teaford r Telephone `760-360-8706 Name on the check By Dr.,Doris Wilson Superintendent Fee collected /exe ted by Annette Barlow Payment Received $3,142.65 rue Check No. 081757 Signature NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) 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('sj(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 _ 5 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 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 - Bob Teaford r Telephone `760-360-8706 Name on the check By Dr.,Doris Wilson Superintendent Fee collected /exe ted by Annette Barlow Payment Received $3,142.65 rue Check No. 081757 Signature NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) 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('sj(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 RC DISTRICT - PLANNING REVIEW FORM r 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 Dix DEVELOPMENT CORPORATION SITE ADDRESS-'. 52-455. Avenida Vallejo 021 APN 773 - 262 - 9!2'6 BIN NO.: CASE NO.: 2000-340 LEGAL: LOT —BLOCK 8Z UNIT d S.C.@V.L.Q. CHECKED BY: Wally Nesbit 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. REQUIRED ITEM Y N COMMENT/CORRECTION Compatibility Review w/A Case logged and number. assigned Verify legal and APN information �/ 6o✓1LT A'""J - }3 - 24,?_ Consistent with MDG on file (as.applicable $0"'; MDG filing required'(5 filings since 9/3/98) Consistency with street/surrounding area: Colors Materials Architecture coz S AV7— -r'*—w �bt�S p sz. y ss- d, .Z vi Gsr.�L3 ,Qs+a Tze E/W21anning 0 &A '11 1- ARproved O O tni b: DDjt-o- Gownission L.�o ity Council ommunt y Dev. Dept. ials CR - ---- e of Exhibit .._..._..-.. = AMith Conditions _...._ .._...._... FRO [ -I RECORDING REQUESTED BY ROBERT LEE TEAFORD WHEN RECORDED MAIL TO • NAUF ' ' ROBERT LEE TEAFORD MAILING 5 ADORE -15' �j _9 ILI 2i . CITY, sTAYE PALM SPRINGS, CA 92263 ZIP coo£ - PHONE 1--d0. 000 tx 2000-054599. 02/14/2000 08:000 Fee:6.00 Page I of I Recorded in•Official Records County of RivcrSide Gary L. Orso Assessor, County Clerk & Recorder•' .. I III111111111111ii1i11IIIi111111�1111i I11111111,illlilil to J IJ PhG[ :RE PF PCrjFR. r,G_CF :;ry iu2C. - r /� R L COPY LOtI : P.EF� W0 HCHC EWM GRANT D E... E P-.'_ APN:PO 7. -' 020-1 AND 73.7.62-021-8 AKA: OTS 9, 10,111 LC LA QUINTA, CA y THE UNOERSIONED GRANTOR(5) AFFIRM(S) THAT THERE LS NO TRAN,*,FrR TAX BASED ON THE FULL VALUE OF THE PROPERTY BECAUSE THERE'IS NO ($0) CONSIDERATION. FOR VALUABLE CONSIDERATION, RECEIPT OF WHICH IS ACKNOWLEDGED, I. (WE), ROBERT TEAFORD, AN UNMARRIED MAN, AS HIS SOLE AND SEPARATEPROPERTY . GRANT(S) TO: CLASSIC DESERT PROPERTIES, INC., A NEVADA CORPORATION THAT REAL PROPERTY SITUATED IN THE CITY OF LA QUINTA COUNTY OF RIVERSIDE STATE OF CALIFORNIA DESCRIBED AS: LOTS ,� AND I 1 IN BLOCK 82 OFSAN't"A C ARMELITA AT VALE LA QUINTA, UNIT _,,16 AS P'ER MAP RECORDED IN 13001 IS. PAGE 70 OF MAPS. IN T14EOFFIC.E OF "f HE COLTNTY" RECORDER OF SAID COUNTY. 'i"HIS IS A TRANSFER TO A CORPORATION. 100%OV-N'P-D BY GRANTEE R&T 62- . EXECUTED ON THE �_ DAY OF/ 'r, 2000, AT RT STATE OF CALIFORNIA COUNTY OF ORANGE _;ss .Os T On /�..�' �cGI� .'S�1 20(j0. ;before me . personally appeared ROBERT TEAFORD AND 0 r3bnally known to.ioc; -OR- -proved to me on the hasis of S ' �i t - 'doncc) io be the persons) whose names(s) Is/are "qH LIFORNIA. TEAFORD . alro ac; of y evI subscribed to the within insirumFint and acknowledged to me that helshe/they executed the same in hiMier/their authorized capacity(ies), and that by hislher/their signature(s) on the 5 JOSEPH MARQUARDT instrument the person(s), or the entity upon behalf of which the COrtlm. r 1197201 person(s) acted, executed the instrument. l� VI NOTARY PUBLIC • CALIFORNIA WITNESS MY HAND AND OFFICIAL SEAL..: , t. EA011inge ceooty My Comm. Expires Sep[. 28, 2002 � #MAI'�iSg ature TAX STATEMENTS TO: NAME: ROBERT LEE TEAFORD - STREET: 353 VIA ESCUELA, NO. 215 CITY: PALM SPRINGS, CA 92263