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9908-107 (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 � YV. /ate' ' E �, � � 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 (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. X ) 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. "Af 411D,11,4 rAxilli k, (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 suect to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forth:,wpth comply with th'os&2 owsions. ? Applicant— Warning: Failure to secure Workers' Compensation coverage. is unlawful and shall subject an employer to criminal, penalties and civil fines Sp to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize, representatives of this City to enter upon Z above-mentioned prope yy foypspection purposes. �ature (Owner/Agent) PERMIT # BUILDING PERMIT DATE VALUATION LOT TRACTJO 'TIEB ADDR S ,�.7,-i 3S d�l�•l ��d AI V,iUsfur %�,II APN OWNER CONTRACTOR/DESIGNER/ENGINEER 11101.4rs. ��:,.�a��,4,w>11034uti��:�,ta�t . tbAj X AIM( .RVIlli;'fit) AVi,.. 4i70 i�, u,,--,%,6 AVHF D AVE. USE OF PERMIT si. f.'#.(�i:�ll t ue :i S 17YEir 17ti(:1.t'"0"..k e t_G)' '!'4 Wh;,lda._:s iD�Sy+,4;ik°1Jd�ty�t�I�) ld:i,titJ ;cap �'ani-v�"tr�".�4.,t��Y�1�+,>j'.�,`'�S��r'�i.+K.P �y'f• �.pp q,g 3► /'a�e� �i} �v� —L,,� r4 Sb.�V5 ��, i Vag s yvr 4 If inLLl.ItS�A'■ �t ��fJk? �1Wit���14,�4Yl�f,i V. tY) ;iA (9L;`$°i(`►1 Y= lei nl,4l,4�9 Pr. AW 4 ?0t �Y 141111101f4t 111(1.,11#2 ^h`7 A01 _11M) r ha�'i �'tq"a(t� fF t;. t'�391"� ►�ft.i��)-+ I.� t1 j7!6 t1V 010f 11,411' L�� t RECEIPT DATE BY DATE FINALED INSPECTOR 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 ff >7 Exhaust Fans O.K to Wrap 2 _ Q F 5,T F.A.U. FramingI_Ly �� > Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath7 Drywall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam - / ( -pa 7 Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines < r Heater Final Water Piping cc Plumbing Final. Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection (—[3 — Q 57 Encapsulation Gas Piping Gas Test deo S? Appliances 6 Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole / Z - Z 7 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) COMMENTS: �i f�'f1,rGv T4tyl 4 P.O. BOX 1504_ APPLICATION ONLY Building' 78-495 CALLE TAMPICO Address 53-085 AV . Vallejo LA QUINTA, CALIFORNIA 92253 Owner Mailing Four Seasons Homes, Inc/ BUILDING: TYPE•CONST. OCC. GRP. Address P.O. Bol[ 749 A.P. Number :77 Ll- w s Z - n 16o City Zip Tel. Lr yr Bernardino 92402 909 889-0221 LegalDescriptionLru dL,LneIc at5 Lluctr ?l.:lc ?(!.�s,,�'• Contractor Project Description �Four Seasoner Homes, Inc. 67 q &R, Arrowhead Ave. City Zip Tel. San Bernardino 92401 (909)889-0221 State Lic. City & Classif. 764551 B Lic. q 5618 Sq. Ft. No. No. Dw. Arch., Engr., Size ,T / Stories Units Designer Frank A. Moreno New i Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. 52-950 Av. Mendoza (760)564-1282 City Quinta zip 92253 Lict# LICENSED CONTRACTOR'S DECLARATION I 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 Contractofs 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 1 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). l_ 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 0r 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.) 1'1 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.) 17 1 am exempt under Sec. B. 8 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..kIW�5S7i7C•AhCompany Grt_'l..ru JeA6E6• fALIt��O• f7 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 th(; 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., d, 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('O' s,rk�_L"• —r!v'.�*,avy .,d4%G• �1A-/Zt1,�f f•r" Lender's Address �% i). r:�/ `K fat-_ n- �' C s'�da 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 slate 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 �o this city to enter the above- mentioned property for inspection pur ses GG Signature of aflplicant_— 4 — Date 17 Mailing Address i;4 CZ �k,, r!"Y `? L•) 4 City, State, Zip �. Ta - r.° e �. Gi 1 k �. Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 7 '7 -7V p1 Const V 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 Name Address city & State RECORDING REQUESTED BY Lawyers 'title GU - AND WHEN RECORDED MAIL THIS DEED AND, UNLESS OTHERWISE SHOWN BELOW. MAIL TAX STATEMENTS TO: FOUR SEASONS HOMES, INC. 670 N. Arrowhead Avenue San Bernardino, CA 92402 TT -100 (Rev.1 X99) -y 4 0 2 w / DOC to 1999-235130 05/28/1999 08:00A Fee:6.00 Page 1 of 1 Doc T Tax Paid Recorded in Official Records County of Riverside Gary L. Orso Assessor, County Clerk & Recorder IIIII III II III II M $ U PAGE SIZE DA PCOR / NOCOR SMF MISC. Ili A I R IL COPY LONG REFUND NCHG EXAM GRANT DEED APN No. - 774-052-016-2 Title No. 434688-23 Escrow No. 7093-K THE UNDERSIGNED GRANTOR(s) DECLARE(s) DOCUMENTARY TRANSFER TAX is $ 15.40 CITY TAX $ 11,X computed on full value of property conveyed, or ❑ computed on full value less value of liens or encumbrances remaining at time of sale, ❑ Unincorporated area: XX City of La Quinta �I ,and FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, LOYOLA MARYMOUNT UNIVERSITY, a California NonProfit Benefit Corporation, who.acquired title as Loyola Marymount University hereby GRANT(s) to FOUR SEASONS HOMES, INC. , a California Corporation the following described real property in the County of Riverside , State of California: Lot 4 in Block 219 of SANTA CARMELITA AT'VALE.LA QUINTA, UNIT 21, as per Map recorded in Book 20, Page 22 of Maps, in the Office of the County Recorder of said County. Dated: May 5, 1999 LOYOLA MARYMOi ItSI,T1Y it a Cor is ,Corpo tion By: ✓ By: I. John Oester, Vice President State of California V County of Los Angeles ss. 1999 On May 17, before me, Wendy A. Wilson ------------------- (here Insert name) Notary Public, personally appeared John R. Oester ----------------------------7------------------ personally known to me ( to be the person*) whose name Is are subscribed to the withi Instrument and acknowledged to me all tha�h° /she/4hey executed the same irti /Gir�tk►ek authorized capacityJk), and that by hheFj4h9I signatureX on the Instrument the person, or the entity upon behalf of which the persorylfQ acted, executed the Instrument. WITNESS my hand and official seal.WENDY& WILSON Commission i 1089264 -m 4 Notary Public — Callfcrnlo Loo Angeles County a My Comm. Expires May 17.2MO Signature MAIL TAX STATEMENTS AS DIRECTED ABOVE. offlx seal within border b RC District - Plannin4 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 applicabitity of compatibility issues or need to require the filing of Master Design Guidelines by the applicant. It shall be transmitted to Building & Safety as your correction list. Please attach additional explanations as necessary. APPLICANT: FOUR SEASONS PROJECT ADDRESS: 53-085 Avenida Vallejo. APN:. 774-052-0.16 LEGAL: LOT 4 , BLOCK 219- , UNIT 21 S.C. @ V.L.Q. CK'D BY: Leslie Mouriquand BIN NO: CASE NO. 99-114 _ CHECK DATE: I`nform.'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/CORK TION ...::•., •::: .:a ..� ..: \•a: '• \ `::,;; ..+L:{`ti; max:$•:,:•:;�w.Na:•::::;•3.A�•..'::2�{'£, ''•\`\`Y.�:iv:ii:w:S4: .; •. •:: ;:<.�}Co,•: •:;:+.•:t.�:c•. C N \:• `�•:•, .c'w`.mon'.23`;v..'`•::`.\ti.::;cy2�\.,:�,\•; . ..`i^�..�; ..@\U`.v,:`.3w:£:�`•7{y+.`•�a.,�. .y ?,``}k\`'a`'Ca;�. 'r;.3 *,�,.:•:t?;2`5�.;.:C:`}p; •�..w<•h ' ., a \ ��:'•r.:� \iii.,>.;^;:a:\Y'O{ C�.i}•.� �ci..M`��'�y.:Q ?v^.�.\`•tiS•.•'.'•}':riadM�.� `T�{�\$'C:.'?\;i•; ':''n^hS 7. Case logged and number assigned -777 Verify legal and APN information Consistent with MDG on file las applicable) O� MDG filing required (5+ filings since 9/3/98) Consistericy -with street/surrounding area:. O� Colors Materials "Architecture OTHER REQUIREMENTS:' The zoning code, architectural and landscaping *manuals, and/or assigned inspector should be consulted where uncertainties arise. The completed checklist shall be maintained in the Building .& Safety address *file.