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0006-124 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that Iam licensed under provisions of Chapter 9 (commencing with Section 7000) of Divisicn'3 of the Business and Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date 76051 B Okitag/g /DateAo' � e gnature of Contractor r �9,J) OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the, following reason: t ( ) - 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). ( ) 11, I, as owner of the property, am exclusively contracting with dicensed 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 ofthe Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier . GOL.DgN &A01,E'IN9. Policy No. N81►C 592�iS 01 (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 forthwit omply with those provisions — DDte: l�'"'`¢ Applicant . 4` i, y - , c 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. d - 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 bove-mentioned property for inspzection purposes. � `,- ignature (Owner/Agent) Date BUILDING PERMIT -PERMIT JI OW6-12A DATE VALUATION LOT TRACT $79�M.70 21 B;&I59 JOB SITE j ADDRESS 87Q AI.=A if .%,1q JO APN 773-3244ft OWNER fc' CONTRACTOR / DESIGNER / EN (NEER PouR i1 SONS Homo, we 1F s I CUA3':D'.CRU=014I C 67 0 N, AMOV4WAW AVS, dmP 31 ]MI.MB SAN B 'ARDINO CA .92.401 SAN BVRNADINTOa CA. 92423 (909)798.5833 CEIA 5818 USE OF PERMIT MNOLF-FAIvMY17' ELIMG SPO -PERMIT DOES.NUr INCLUDE BLOCK 'WALLS OR POOL ' !xy k TRACT CONSTRUCTION 4218,00 3F PORCH/PATIO 165.00 SF �.: OAR.4�t5F�4A,�t1'C?1tT t~S.I� �J,2`it1.80 , 5 FT. WOOD IriL+NC,E -- - - -- 200.00 LF ;l mdATs6 +r oar of cowsmumon 79,1.03.3 CONSTRUCTION FLT- 101-000-418.000 %k $549.30 PLAN CHECK FEE 101-000-439-319 N $.067.35 MECHANICAL IEEE 101-000.421,-000 663,80 RE;P°,C.TRICAL PER 101-000-420-000 $115.59 PLUMBING FEE 101-000.419.000 $128.75 ST'RONO MOTION FEE - RESID 101-000-24.1-000 $7.93 GRADIING FEE 101.000-423.000 $20.00 DEVELOPER IMPACT 1IE $1,90.7.00 PRECISE PIM 101.000.441.345 $100.00 r99 DZPOSIT 101 -OW -439-318 4250.00 SU'$<'T07AL C0NMUC"TION AND PLA14 CI -W= $3,349.62 b PRE-1'ArD PEM 4250.04 TOTAL + 1'_i,RWr FSS DUE IV'OW ri,1 .i+2 fIECEIPT DATE ABY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Z7 C Underground Ducts Forms & Footings _ $ �• Ducts Slab Grade Return Air feel Combustion Air Roof Deck '—� Exhaust Fans O.K. to Wrap _ 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 - o D - Int./Lath 7 ��1II Liv5�r / Final Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs ?G Electric Bond Footings Main Drain Bond Beam Approval to Cover -,24- o 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 y p( 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) ,Q ul�cicu "r P.O. BOX 1504 APPLICATION ONLY Building�'/^ 78-495 CALLE TAMPICO ��, Address 7n VCS(. /ftp/ V LA QUINTA, CALIFORNIA 92253 Owner Mailind Address ,,5 a 7q q City Zip !' Tel. Address State Lic. I City & Classif. Lic. # Arch., Engr., Designer Address Tel. City IZip I State Lic. # LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) 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, 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 five hundred dollars ($500). F2 I, as oner of the property, or my employees with wages as their sole compensation, will do the wowrk, 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.) 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 contractors) 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 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 -� r] Copy is filed with the city. O 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: 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. ILDING: TYPE'�CyO^N�ST. �fOCC. GRP. ! '. Number tJ ! 3 `+ y/ " oo(.,- ,1 tal Description/ a7d`/s ✓vi,ew-1Sy. r Afldf?tlt�l�%r f}7tl/i(r116 Sq. Ft. Size Newt /� In �i�t�✓✓ i�R'l`'Jry�'..J/`�/�=fir No. No. Dw. C} Stories Units Add ❑ Alter ❑ Repair ❑ Demolition ❑ valuation lut0 PERMIT ` AMOUNT r1r Plan Chk. Dep. 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 CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097.Xivll Code.) �r �- Side Setback from Property Line Lender's Name Lender's Address 0 7i JJ /U/.f`114A1*1,RW, - 'Y! /tl t, ,0° 4_ :iry'/•: / This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR 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. Issued by: Date Permit 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. Validated by: Signature of aQplicant Date Mailing Address Validation: City, State, Zip 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 6/20/00 No. 20572 Jurisdiction Owner NameFour Season Homes, INC. No. 52-870, Street Avenida Vallejo City La Quinta Zip 92253 APN # 773-324-006. ' La.Quinta Permit # 0006-124 Log # Study Area Tract # BLK159 Lot # 21 Square Footage 1218 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/watkways, 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 1,218. or $ 2,496.90 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 B CC/Citizens Business Bank/Michael Stubbs ` By Telephone, 909-721-3300 Name on the check a �w By Dr. Doris Wilson Superintendent s f t#fir .�� •, _4 .�` � .. Fee collected /exempted by Mary Ann L. Borja Payment Received 6.90� p Check No. 341998 Signature NOTICE: Pursuant of Assembly Bill W81 (CRAP 548, STATS. 1998) this will serve to notify you that the 904sy 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 sesued or on which they are paid to the District(s) or to another public entity authorized to collect them on the District('s)(e) behalf, whichever Is earlier. Collector: Attach a copy of county or city plan check application form to distract copy for all waivers. Embossed Original- Building DeptJApplicant Copy - Applicant/Receipt Copy - Accounting 0 RECORDING REQUESTED BY Lnotl ryinrs TWO Go. ANV WHEN DECORDED MMI 11 1K LrELL, AND, UNLFRS OTIIFRNA F_ SHOWN OW:1W. rAMI. TAx STAYEMENIS TO. •1 FOUR SFASONS 11011ES, INC. 670 N. Arrowhead Avenue San Bernardino, CA 92402 .a ,rte 07/29/1999 087001% Fee'8.00 Page 1 of 1 Doe T Tax Palo Recorded in official Racorft County of RlverNlde Gary L. Or" Assessor, County Clark a Rai -corder 1111 Ill IIIII IIII Illi I III IIIIIIIIIIIIIII II II{{ III{II Il I MI v II PAGE 31LE Dn W6 .' A p L COPT LONGI REFUND IK11G "M GRANT DEED I No. 773-324-006-6 TINe No. 436922-23 EscroW No. 722:3-K UNDERSIGNED GRANTOP(s) DECLARE(s) DOCUMENTARY TRANSFER TAX is S 15.95 CITY TAX S JK computed on full value of property conveyed, or I'1 computed on full value loss value of Ilens or encumbrances remaining at time of sale, IJ Unincorporated areal: II(X City of La Ouinta and Z A VALUABLE CONSIDERATION, receipt of which Is hereby acknowledged, :OTHY J. BURTON , an unmarried woman Who acquired title ns Dorothy J. Burton eby GRANT(s) to FOUR SEASONS HOMES, INC., A CALIFORNIA CORPORATION following described real property In the inty of Riverside , State of Callfornla: 21, Block 159 of SANTA CARMELITA AT VALE LA QUINTA, Unit No. 16, In the Count of. •erside, State of California, as per flap recorded in Book 18, Page 99 of Maps, in the `ice of the County Recorder of said County. ed: June 17, 1999 Dorothy J. u u ate,,I WWOVIK FU)k%T>N sa. )U11ty of ..-pWy coul-ITY_ before me. �7a ` _ ixsC r �_ (here insert nom Notary Public. !rson11111)avvapQsaTed�:��Io �J_1rsonuliy known to me (or ixovt3 ori the basts, of satkfoctoy evidence) to be the person(s) whose name(s) Is/are subscribed to a wllhln Instmanent and acknowledged to me aIl that he/sho/they executed the some hi his/het/their oUthorDed r_apOelty(les). and ?f by his/hear/trlelr signature(s) on the IfTshument the person(c), or the enfily upon behalf of which the person(s) octeri. eKecula�d the =:tclA'itienf. ?NESS my hand and offkekTl seal. Catol A. Ringhiser Notary Public - State of Florida My Commission E-lras Jury 8, 2002 inature _-Qz�a-A 0 - Comma®cion No. CC.7668d6 �� , ... _ -ARN le+nl Fra, bor4re`/ v— tt - MA- Teri STATEMENI9 AS DWCIED esOYF,, i Fi ! 1 IIS Ift, 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, 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 Four Seasons Homes, enc, SITE ADDRESS 52-870 Avenida Vallejo APN 773 - 324 - 006 BINNO.: 573 CASENO.: .2000-239 LEGAL: LOT 21.'.. BLOCK. 159 UNIT .16 S.C.@V..L.Q. CHECKED BY: Greg Trousdell 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 a , Case logged and number assigned. 0 z Verify legal and APN information c Consistent with MDG on file (as applicable, w up 0 MDG filing required .(5 filings since 9/3/98) z o Consistency with street/surrounding area: Colors Materials Architecture CD MZ � Other Requirements: ?4E _ �� Ve- Go CHAR /�`21O (� �p,(A -78 X64 Q �r-A-c c� i Ot- G122�j3 LAND q,ctsitecture• Interiors, SpaceStr>uturaland Land Planning Calailations fo CI I F `'� Co PAN o k l ll� l� t T 'tc� I(� i- L Kt T�•�=o R-r�Aa�tc..� A 16 ON f- 1 t �s'CF�1T��L co PstUN NT o` - T�'� CoNs�vrlcT��W . ��c NSI-�lT4 _ G �� Lt=-.5 �..�• � u�.vc-t✓►� +� ICS Cr 35-325 Date Palm Drive, Suite 151-3- Cathedral City, CA 92234 - Phone/Fax: (760) 324-7146 Certificate -of Occupancy City of -La Quinta Building.and Safety Department 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 fol%wing: - - BUILDING ADDRESS: 52-870 AVENIDA VALLEJO Use Classification: SFD Bldg. Permit No.: 0006-124 Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC Owner of Building: FOUR SEASONS HOMES, INC. Address: 670 N. ARROWHEAD AVE. City: SAN BERNARDINO, CA 92401 ~ By: STEVE TRAXEL. ---ret, Date: 05-01-01 + Building Official ►jam POST IN A CONSPICUOUS PLACE