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0202-059 (SFD)LICENSED CONTRACTOR DECLARATION 11 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 /DateJ a 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. . ,,V) 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. (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 those provisions. ^'Date: +�/7 rife ? APPlicantT it��°N-.� 6a.•..�' 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. t. 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, &Ishaq, 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;inspection pbrposes. Signature (Owner/Agent) • ao -•--'Date Ey 3 «= BUILDING PERMIT PERMIT# DATE/ i VALUATION LOT ()2)rr�{:}� TRACT JOB SITE APN ADDRESS 51-3995 CA:l,,i.F K.rALMM 770--166-019 OWNER CONTRACTOR / DESIGNER / ENGINEER IN1W. SRV, CORP. 1XIET 1.)F_VZ t.:9r;iv fgNT COOP PO BX 29811A 78-921 RUNAWAY BAY 1%AM r)EV.1v:+R71 CA 92261 1aERM073A MIMES CA 92161 (iG�.�G�6r"g6L 1526 USE OF PERMIT STi9O1' PAi,&Y DWISLUNO -D 1.i�(3-4'LT"1C:iyFS�n'yMP.,S('7�'ER,E PERMIT MES NOT i SP ,�t'C:D.:IJOE, p• �jn;1�(..piy�pl'JdA, i p r , TRACT CONSTRUCTION TRUCTION 1.5313.00 BY :POR.C:HIPATIO 24.00 Sr GARAGUCAPVORT 440,110 OF P�APPR�??1CCfRAl��yy���.;�WC( Iyyt�+f*rrSUAD �A7ey 9 /� �p r q 7 �y �,��,/� qAfi pp 0.•\�N'iSTR CB.11.3E ME 1Ol^000 X418-000 PIAN C11H 1: K FSE, 101-00"39-318 5+3'14 1E10 D' P0.01T 101X000-439-313 �5ti.t►0 MEti:HANICALrM. 101-000 421-000 RI W3RACALF°2 1€►1-M- 0.42;1-(300 WON$ P1. TMB1140 1+11M 101.000 419.000 $126.:90 STRONO MOT1014 KF - PYWD i 01-000441 -000 X9,22 1ri1R.tAUIWO IFFIE 1.01.000.423.000 $20.00 CiW 9WPEf:1aWF'.k 0T FEE S1, ,06 Pi2=13F1 P1 41N 101-000-441-345 �l0U.U0 � A ��a�1t,�YK+e�-��pe�t �Vq•�7� �X+n�,,aA{� ,rn, �q �y,�1�y 7 •S p�� �T��TC�r+. ar W:1'.�i`A0.JA'.C•11:e ,iO �2,iC'!?�V6.d.,�,a ANI) 3'�J..�'1:I.V �s.,Cy1C,5....{}w.. �t /� p,� +V.���ap�B�?.K.F3d� a73 PRE -PAID �c 250100 ALALB.P.J+I.SlvSyd FQS.3;0.. 'i>U1 '.*CAH �v'=a�'.��'L�GT4' MAR O 1 1001CITYOF }< ci.11�' RECEIPT ' %! BY. � !/"y DATE'FIN` D n r� INSPECTOR V !! /. INSPECTION RECORD' OPERATION DATE INSPECTOR OPERATION ' DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings ( Ducts Slab Grade A Fl, Return Air Steel Combustion Air Roof Deck O ?/ Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation . >a _ Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath _ d� Final Final _ 0 40 POOLS - SPAS BLOCKWALL _ AP.'ROVALS 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 -2 .a Z ;iW 47 Encapsulation Gas Piping Gas Test _ Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole �Q Z 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) . �O L r - Building 1 Address Owner Mailing Address City l `J A / L;Ity State Lic. & Classif. V Arch., Engr., Designer Address -14�- o �9 P.O. BOX 1504 i ti APPl:ICATION ONLY 78-495 CALLE TAMPICO 0 QUINTA, CALIFORNIA 92253 (L J ,J ' BUILDING: TYPE'C NS y_ I . GRP. 2-- A.P. Number 0) 9 lip T`�•�-(� y �� Legal Description Lot Project Description D ri Irl 1-Y, f K1.1, 1.1' ZiD ITel. -�2_nl/U. City Lic. # City (Zip( State Lic. # 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 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 or 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 or Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner or 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.) II 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 doesnot apply to an owner or property who builds or improves (hereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) i 7 1 am exempt under Sec. B. & P.C. for this reason Date Owner 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 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 it the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of lhp 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 she be deemed revoked. Sq. Ft. Size S New ❑ Add ❑ No. No. Dw. Stories Units Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT 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, Civil Code.) Side Setback from Property Line Lender's Name Lender's Address FINAL DATE INSPECTOR 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. 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 a0plicant Date Mailing Address Validation: City, State, Zip WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION 0/Lt <-rNRZ Notice: Document Cannot Be Duplicated Date 3/1/02 No. 23001 Owner NameDGH Dev. Corp. No. city La Quinta Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE Street Calle Kalima APN # 770-166-020 Jurisdiction La Quinta Permit # 0202-297 Log # Zip 92253 Study Area Tract # BLK2DCTU Lot # 7-8 Square Footage 3066 Type of Development Single Family Residence No. of Units Comments VE: Tract Devel Family Dwelling 8 @ 51405 Calle Kalima - 1533 sq. ft. 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 2.14 X 3,066 or $ 6,561.24 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 PDNB/David Heusinkveld Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Crystal Scott Signature Payment Received Check No. Telephone $6,561.24 083270/1 40TICE: 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 ibove 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 Allect 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 I FORESITE ESCROW, INC. 41-995 BOARDWALK, SUITE G-2 PALM DESERT, CA 92211-5110 (760) 773-5333 FAX (760).773-9289 D G H DEVELOPMENT CORP DAVID HUESINKVELD 78921 RUNAWAY BAY BERMUDA DUNES, CA 92201 —lip -5 RE: apn: 770-166-019 & 020, La Quinta, CA Dear: is Date : December 10, 2001 Escrow No. : 2-34778 thcG z /j- 41/"/f We are pleased to inform you that your escrow was closed on December 7, 2001 and we enclose the following for your records: Final Closing Statement Our Check in the amount of $95.93 representing your refund. Policy of Title Insurance No. 8204149-1, to follow, issued by Orange Coast Title Company. Property Tax Information - For your information, County taxes on real property become delinquent as follows: First installment after December 10th, second installment after the following April 10th. If you do not receive a tax bill one month prior to the delinquency date, a written request for same should be made to the County Tax Collector. Your written request should include the legal description and Assessor's Parcel Number (APN) of the property. When the lender collects impound funds for payment of.taxes, the tax bill is usually sent to them. Any recorded documents which you are entitled to will be forwarded to you directly from the County Recorder's office. It has been a pleasure handling your escrow. We look forward 'to servicing your future real estate transactions. 1 Foresite Escrow, Inc.' Sydney Benoun Escrow Officer W /o S, dot) Fitch Engineers Inc. March 18, 2002 i, City of La Quinta 78 495 Calle Tampico La Quinta, California 92253 SUBJECT: 51 395 Calle Kalima (Lot 7 Blk 2 DCT #2) Gentlemen: I.1ereby certify this day that the pad elevation on the above referred to lot is set at 40.4. The approved grading plan establish6dthe elevation at 40.3. Respectfully, WM. H. FITCH R . C.� 7 ti+;. 12:,x,. ?� t Cz 3/3�/IJ' CIVIL ENGINEERING — PLANNING — SURVEYING — DESIGN P.O. BOX 4551 PALM DESERT, CA 92261 Sladden Engineering 6782 Stanton Ave., Suite E, Buena Park, CA 90621 (562) 864-4121 (714) 523-0952 Fax (714) 523-1369 39 725 Garand Ln., Suite G, Palm Dena, CA'92211 (760) 772-3893 Fax (760) 772-3895 Date REL® MEMO Job No. 5 Z2 — /YS Project Name Client: Site Address Job Phone WorX Done Test Summary / Fontings Inspected Test Location Elev. D Dry Density MOW % % Relative Compaction Ref. Max pot MoistNo. % L .. ........ Comments. az 5LLvj- 04 bci ffieech. Super. or Agent 24 hour notice requested to schedule Field Technician, Thank you for the opportunity to be of service. r al eb,-q :F;o c.o i.? jew Sladden Engineering F,1182 Stanton Ave., Suite E, Buena Park, CA 90621 (562) 864-4121 (714) 523.0952 Fax (714) 523-1369 39.725 Garand Ln., Suite G, Palm Desert, CA 92211 (760) 772-3893 Fax (760) 772-3695 Date—i_zs_ 67 Job No. �-Z2 - FIELD MEMO Project Name Giien': Sit6 Address 'q Job Phone Work Done -- Test Summary / Footings Inspected ,L,,v 1z'.ao Test No. i Location Elev. r Dry Density Moist '/:, % Pelativp Compaction Ret, Mat pci I % �'6 I Ile) t Comments eCh. Super. or Agent 24 hour notice reouested to schedule Field Technician. Thark you for the opportunity/ to be of servire. A 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 following: BUILDING ADDRESS: Use Classification: SINGLE FAMILY DWELLING Occupancy Group: R-3 Type of Construction: VN 51-395 CALLE KALIMA Owner of Building: DGH DEV. CORP. —7-'&"4-X Building Official Bldg. Permit No.: 0202-059 Land Use Zone: RM Address: P.O. BOX 2982 City: PALM DESERT, CA 92261 By: RICHARD KIRKLAND Date: 06-28-02 POST IN A CONSPICUOUS PLACE `ter ^F 4Cl" 78-495 CALLE TAMPICO LA QUINTA, CA 92253 (760) 777-7075 APPLICATION a FLOOD PLAIN DEVELOPMENT PERMIT BUILDING SITE LOCATION FLOOD ZONE 'AD"- DEPTH 1 C 4 �T COMMUNITY- PANEL NUMBER 060709 0005 B , Map Revised: 8/19/1991 APPLICANT INFORMATION SECTION APPLICANT NAME at y iQ 6- v S f n k L APPLICANT * DAYTIME TELEPHONE NO. INSTRUCTIONS 1. A Flood Plain Development Permit is required by LOW Section 8.11.040(A). The Applicant should complete the Applicant Information portion of this application and submit it to the Engineering Department along with the required documentation noted hereon at the same time the Precise Grading Plan is submitted to the Building and Safety Department for plan checking. 2. Documentation required for STEP 1 OF 2 APPROVAL prior to receiving clearance for Building Permit issuance • Copy of the proposed Precise Grading Plan for review and approval containing all information required by the checklist shown on the back of this application. 3. Documentation required for STEP 2 OF 2 APPROVAL prior to receiving Flood Plain Development Permit approval. Note, this approval occurs after forms for the lowest habitable floor are set and before the Building & Safety Department authorizes foundation construction. • Submit a completed FEMA "Elevation Certificate" form to the Engineering Department. • Submit 95% relative density soils compaction certification to the Engineering Department. STEP 1 OF 2 APPROVAL STEP 2 OF 2 APPROVAL The Precise Grading Plan submitted for this application has been All requirements have been satisfied. This Flood Plain reviewed and found to contain all data required to satisfy the Development Permit is approved. requirements of LQMC 8.11 The proposed dwelling is eligible to receive a building permit upon satisfying all other Building & Safety Department requirements. 40RIZ�D, AUTHORIZEDATURE NA RE DATE La Quinta Engineering Departlut DATE La Quinta Engineering Department rILG vpori arep c approval, original goes In -rl000 ream uevelopment rermit- tile; cppy-goe 'L� t!� Please use this Plan Check Number (PCN) on all correspondence while plans Foso REV -2 are in plan check 7i00 CHECKLIST FOR PRECISE GRADING PLANS IN "AO" FLOOD ZONE 1. Prepare Precise Grading Plan in accordance with Checklist for Precise Plans and the following additional items. 2. All elevations shall employ the NGVD-29 convention. 3. I Show and label elevation of "Highest. Adjacent Grade" next to the building I footprint. This refers to the highest existing natural grade next to the proposed building prior to constructing the elevated the building pad. 4. i Show and label the "Highest Existing Elevation on Lot" 5. Show and label the "Lowest Habitable Finished Floor Elevation". Note,. this elevation shall be at least ONE FOOT higher than the "Highest Adjacent Grade" elevation. 6. The following grading note shall appear on the plan: All fill material placed under the structure shall be compacted to ninety-five percent (95%) relative density. 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