0202-110 (SFD)LICENSED CONTRACTOR DECLARATION
V hereby affirm under penalty `of perjury that, l' 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
oo -0/2C.
Date Signature of Contra c ori_ a -.
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.
I � have and will maintain workers' compensation insurance, as required by
Se tion 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:
CarrierST,t1i., E I�" D Policy No. 040-.0f-01..0426
(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 they workers' compensation ovision�Sfof,Sec Ion :3700 of the Labor
Code, I allJ/forthwith comply 0f6.,1Fiose pro1sions. I r
✓%Y`.- Applicantt-.� `t �.�`l 1e----
=— L_
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
f: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:.insp'eejgA- urposes. : €
Signature (Owne.h .p t i +-- - DA.&:h $ y
V1
BUILDING PER PERMIT#
DATE/ VALUATION '. LOT'-� TRACT
'0' l r.'x,r�r�
JOB SITE - +
APN
ADDRESS •-1.40 dVVXMDA'dALL;^ O
77441b3-007
OWNER
CONTRACTOR / DESIGNER / EN INFER
'9TifJ'1F ;F`ie'f 2�Is9?� _. _ _ _;. - - -
,� 41�<�1.� I:IWE ;�'I:f'E�FTJ'►: - _ _ - � -
1860 CITtfi:,AW,AVEe SLIM, G-7
9740 RIPPLMWX- DR, MORL0,40, 'VAJ.,LEY
CA 9 23 07
RIVERSDE CA 92508
:.
(909)9.85..8033 tCFAlff 6125
USE OF PERMIT
I v]M FA'ALi'D9yNG
.
SFT) .. PL?R 1T ,13i)LS NOT INt�'LI UDE SI.00K'WAIJ, POOL 012.1?'.3l�.2'4►'l."Jrr•AY '
h.P"�'ROA.CR 93 ¢JIASTUR MfMOV,'7.1%i�UN CHECKR.M. I3.�ISCO�fia�a_T � -R...
t.dI�.3L'k'I.t .L9 OIIR ITS CSF' i AIMIX PLAN 7Y'PX
TRACT C: NSTRUCTION
POR.MPATlc`D p" . .
CARAi'EWAR1'ORT
5 FF. WOOD aFl°,i�C)� -` ?n ��1t`1.9t� UAB,
EVIDJ M CONT CDS+: CON491 11:7I1os
109,10120
E'ER11 ,f- SM"X
MECHANICAL PEE 101-0 W-421-000 $02,00
ELECTRICAL IFF 101-000-420-000 $120.94
PIIl7MT SIO ME
ST#YOW LICITI N V.Elit u. "SID 1011-000-241-000 $.It4.S9
MMING M, .101.000.423.000 MIA
I ENIEI,.CMP, IMPACT FTX $5,9070.44
PR;Q7C`9SL� PLAN 1,01-000-441-345 V001"
MAN C11ECK 7 FIE, 101-000-439-318
CONSITIRUCTIO FEE 101.7000.418-000 Orl;ito
-
"M DFPOSI*r 101-000.4.39-318
IRM-T'IO`IAL C:fi)NI�CiiUC ITONT AND PIM CHMMI;
S3,123,51 '
LT03 PIS-k''AM FEED
4�2450,00
,. "sf'Yi d °VWf 11TES DIM NOW3
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
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
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
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
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
`'""`� ""`'�`" }�'� �• `� ,.�T„ tl'�!'�Irs,� ".P�"�.,�+'1�'�°'"s,°1�.. _ 'rd I���,J �/ t/i � '`'."'r'�..-""-"�„.-"`'Qi�l�f't';Ii�'j"`�7;'iY4'a�t�1'
140,
\J 0
' 9 P.O. BOX 1504 APPLICATION ONLY
Building oab� + / �� 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
ice;
+,
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 3/6/02 APN # , 774=053-007
No. 23014 Jurisdiction' La:.Quinta
Owner NameW/R Enterprises Permit #
No: 53-140 Street Avenida Vallejo Log #
City La Quinta Zip 92253 Study Area
Tract # BLK218 Lot # 18 Square Footage 17.88
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:
r
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
2.14 X 1,788 or•$ 3,826.32 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 East West BankEd Whitson Telephone 909/779-6000
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Crystal Scott Payment Received $3';826.32
Check No. 2341212
Signature
F
TICE: Pursuant to 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
ovewbegin 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 tolect them on the District('s)(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
SENT BY: HP LASERJET 3150; 7607732619; N6V-29-01 9:03AM; PAGE 3
10/30/2001 15:4"760-773-2019. AMERICAN TITLE /
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TO: American Title Escrow
American Title Insurance Company
Escrow Division
72393 Highway 111, Suite B
Palm Desert, CA 92260
(760) 773-3776 Fax (760) 773-3228
SALE ESCROW INSTRUCTIONS
Date: October 30, 2001
Escrow Officer: Sharon D. Elkins
Escrow Number: 01 -1986 -SE
AMERICAN TITLE ESCROW CONDUCTS ESCROW BUSINESS UNDER LICENSE IDENTIFICATION NO. 371
ISSUED BY THE CALIFORNIA DEPARTMENT OF INSURANCE.
Ed Bernardino, (hereinafter known as Buyer) agree to purchase from Jeanne Kranhold, (hereinafter known as Seller) the • reap
property setforth herein per the terms, conditions, consideration and instructions hereinafter stated. . The Seller and Buyer
herein shall deliver these signed escrow instructions to American Title Escrow, (hereinafter known as Escrow Holder).
Terms of Transaction
Buyer will deposit, prior to close of escrow, the sum of $ 60,000.00
To Complete the Total Consideration of $ 60,000.00
Said total consideration is allocated as follows: $30,000.00 per lot.
Furthermore, I will execute and deliver any instruments and/or funds which this escrow requires to show.title as called for, all
of which you are instructed to use on or before November 13, 2001, provided you hold a Policy of. Title insurance with the
usual title �xc th a liability of not less than $60,000.00, covering property in the City of La Quinta,
Co y of Riverside, tate o ifon ' , described as follows:
1: Lot 18 of Block 218 of Santa C rmelita at Vale La Quinta and as more fully described in the preliminary title
0 be issued. /
Parcel 2: Lot 24 of BLUER 6�f Santa Carmelita at Vale La Quinta and as more fully described in the preliminary title report
to be issued. 3_� y o Avc v14��� o .
74-053-007
COMMONLY KNOWN AS: APN: 773-085-001 / 7La Quinta, CA
SHOWING TITLE VESTED IN: Ed Bernardino, (Vesting to be Determined prior to Close of Escrow)
SUBJECT TO:
(1) General and Special County and City (if any) Taxes for the current fiscal year, not due or delinquent, including any special
levies, payments for which are included therein and collected therewith.
(2) Lien of Supplemental Taxes, if any, assessed pursuant to the provisions of Chapter 3.5 (commencing with Section 75) of
the Revenue and Taxation Code of the State of California.
(3) Covenants, Conditions and Restrictions, reservations easements for public utilities, districts, water companies, alleys and
streets, rights and rights of way of record, if any; also exceptions of oil, gas, minerals and hydrocarbons, and/or lease, if
any, without the right of surface entry.
INSTRUCTIONS TO ESCROW:
NO REAL ESTATE BROKER INVOLVED: As there are NO Real Estate Brokers in this transaction NO Deposit Receipt
has been executed, these instructions, therefore, constitute the only written agreement. between the parties hereto.
ALL CASH TRANSACTION This is an "All Cash" transaction and no financing will be secured on the subiect nrooertv.
Y
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 r200 feet of the applicant, and/or 2) if there is a need for the applicant to file for
Master Design Guidelines. If the applicant does need to file a Master Design Guideline, please
transmitted this information to the Building and Safety•Department as part of your correction.
list. Please attach additional explanations as necessary.
APPLICANT WR Enterprises - 'Shevitski 'Construction
SITE ADDRESS 5.3-14j/Avenida Vallejo
APN 774 - 053 - 007 CASE NO.:. 2002-612
LEGAL: LOT l -BLOCK -2(5 UNIT Z ( S.C.@V.L.Q.
CHECK AND APPROVED BY: Wally N Gh; 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
Verify legal and APN information
Consistent with MDG on file (as
applicable
I
A41,
MDG filing required (5 filings since
9/3/98)
Architectural variety' within 200 feet.of
the surrounding area:
Colors
Materials
'Architectural design features
do •
Approvedby_
Other Requirements: O Planning Comm
O City Council
Community Dev.
Initials
Case No. AC 0Z-
Exhibit
sslo
Deol.
Pae Reso #
6�2
,az