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9710-113 (SFD)A LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of CI*.e,466-11-(9ommencing 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 7i•}}fin !3 irigsii!)7 ,/Dater/lignature of Con,ractor~ 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. (K) 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. U, Nrrn r,,4s. co, (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 shadforthith complyeitw. ose prAsi /Date: // 1pplicant� Warning: Failure to secure Workers Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines tip 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 reprgsentatives of this City to enter upon the above-mentioned propertyforinspe fon purposes. ,,jSlgnature (Owner/Ag `� / I/r Dat//Z/,, Iq Ai to — IM BUILDING PERMIT PER ITN CONTROL# j V7,11 q. 110 DATE VALUATION � -� 'i.si 0 •f - INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 3t Backs Underground Ducts Forms & Footings Ducts Slab Grade y '7 Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap -30 _J• F.A.U. Framing.. o - Q 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 i 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 z Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection .6 - Encapsulation Gas Piping Gas Test —;ZY Appliances Final Final Utility Notice (Gas) - •�� ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Law Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Pe,") COMMENTS: c D••�j, XWss e::WICAJf ' 40 1 MEMORANDUM TO: Susan Maysels, Deputy City Clerk FROM: Carolyn Walker, Executive Secretary lig" DATE: February 3, 2010 SUBJECT: Release of Model Home Deposit Security for Tract 27899, Marbella Susan: In researching the request for release of Certificate of Deposit No. 128000080, in the amount of $1,000.00, 1 have found out the following information: The two model homes were on Lots 59 (79-090 Kirsten Ct) and 60 (79-085 Kirsten Ct) in,the Marbella Development, Tentative Tract 27899. 1 have attached 'a map showing their location. The Building & Safety Department shows that these two homes received "temporary final inspections" and had Correction Notices issued on each of them. (A copy of each Correction Notice is attached). will not be able to release the Certificate of Deposit since the items on the Correction Notices were not completed and final inspections were not done. In order to release the Certificate of Deposit, Century Crowell would have to contact the Building & Safety Department to obtain applications for Special Inspections for each of these two models. The Special Inspection Fee would be $100 and would apply for each model for a total of $200.00. Upon completion of the. application for Special Inspection and final inspection and approval of the model home conversions,- we would then be able to release the CD. Should Century Crowell have any questions regarding Building and Safety's requirements, they may contact Kay Hensel, Counter Technician, at 760-777-7084 for further details. will put this file on hold until I receive the final documentation from Building and Safety. Should you have any further questions, please feel free to call me. P i(. AROLYNU.eetilslC:orrected. No licnoit CD Release.doc 5 Sunower Carolyn Walker From: Doris Benoit[dbenoit@centuryvintagehomes.com] Sent: Thursday, January 07, 2010 10:01 AM To: Susan Maysels Subject: Request #3 Attachments: Marbella $1000.pdf; Marbella CD$1000.pdf Marbella Tr.27899 Original CD #0128-000080 was issued on 9/5/97 in the amount of $1000 for the removal of the Sales Office Marbella Tr.27899 Original CD #124465 was issued on 9/5/06 in the amount of $1000 for Dust Control Security on Permit #2782 The Partnership was: Topaz Associates, LP Page 1 of 1. Doris A. Benoit Operations Secretary CENTURY CROWELL COMMUNITIES 1505 So. "D" Street, Ste.100 San Bernardino, CA 92408 Bus (909) 381-6007 X 222 Fax (909) 383-9088 2/2/2010 This Certificate EvidencesA THE CITY OF .LA QUINTA Deposit In The 1535 S D ST SUITE 200 N Of• Ce- .sate Number 1 SSN/TIN 33-0594370 D/OB ame(s) SAN BERNARDINO CA 92408— Account Number 128000080 Date 09/05/1997 In The Amount Of "ONE THOUSAND 'DOLLARS AND ZERO CENTS*" dollars $ 11000.00 ACCOUNT TYPE AND TERMS - Only the boxes that are checked and the lines that aro filled in apply. Tenn (Initial) 12 Months C3 Additions permitted in a minimum amount of S Maturity Date (First) 09 /05f 1998 JD Fixed Rate :0 Min. Balance Req. $1 a 000.00 Interest Rate (Initiao 5.340 % ❑ Variable Rate: Initial Index Rate . % Maximum Rate % Compounded. Simple - MinimumRate % Fist Adjustment Date Interest Calculated ACTUAL/365 V Adjustment Frequency No. Endorsements Required for Withdrawal 1 Rate Formula . ❑ Single Maturity KI Automatically Renewable Interest Paid. MONTHLY Tp EPENDENT BANK (a) ® By Adding It To The Account Balance - 00G1w9EE STE E (b) ❑ By Deposit To Acct. No. n BY DEFINITIONS. "We" and "ac" means the fimamial io&totiom "You" and "youe-means the depositor(s). "Certificate" means both this original instrument as well as the deposit it shows. This certificate (and the account it represents) may not be transferred or assigned without our prior written consent and is not negotiable. VARIABLE INTEREST RATE: Your deposit will earn interest at the initial interest rate stated on this certificate to the first adjustment date. Then, and on each succeeding adjustment date, the rate this certificate will earn is subject to be increased or decreased according to the formula described on this certificate. The rate will remain the same between interest adjustment dates. If the 'first adjustment date' is phrased in teems of "Index change' this means the first adjustment date and the rate adjustment frequency after the first adjustment date are not regularly scheduled. In this case, the rate this certificate will cam will be adjusted any time the "index' changes. The interest rate we will pay on this certificate will not, however, be greater than the stated maximum rate (f any) or be less than the stated -minimum rate (f any) regardless of changes in the index rate. COMPOUNDING: The compounding frequency and interest calculation method will not change during the arm of the certificate, regardless of adjustments to the interest rate, until we give reasonable notice to you of such change. ADDITIONS: If we permit you to make any additions, they will only be permitted in an amount equal to, or greater than, the minimum amount indicated. The making of additions to this certificate will not extend the maturity of all, or any portion, of the funds on deposit. Additions will cam interest from the date of deposit, and will mature at the same time as the first deposit. No additions may be made within n a days of the final maturity date. NOTICROFPEENALTY FOR EARLY WITHDRAWAL Except as mentioned below, you. cannot withdraw any principal from this account before a maturity date without our consent and we will charge a penalty. We can.only consent to an early withdrawal at the time you request it. The penalty will be an amount equal to: Othe greatest of: (1) all of the interest earned on the amount withdrawn from the most recent date of deposit or last renewal, (2) a6 the interest that could have been earned on the amount withdrawn during a period equal to one-half of the maturity period, or (3) siven days' interest on the amount withdrawn. ❑one month's interest on the amount withdrawn. Elthree months' interest on the amount withdrawn. D We will charge the penalty first against any interest then in the account, and any excess will be deducted from the amount you withdraw. FOLD RATE TIME DEPOSITS: For a fixed rate time deposit we will use the nominal (simple interest) rate in effect to calculate the amount of the applicable penalty. SINGLE MATURITY: If the single maturity box is cheered, the depositor should present this certificate promptly at maturity for payment. Interest ❑ will ® will not accrue atter maturity. AUTOMATIC RENEWALS: If the automatic renewal box is checked, this certificate will be automatically renewed after the stated maturity date stated for successive terms, each equal to the original term. The interest rate will be the same we offer on new certificates on the maturity date which have the same term, minimum balance (f any) and other features as this original certificate. The depositor nay call us on or shortly before the maturity date and we will tell the depositor what the interest rate will be for the next renewal term. The automatic renewal of this certificate may be prevented if,one of the following things happens: (1) This certificate is personally presented for payment on a maturity date or within 10 days after the maturity date; or (2) We receive written notice from the depositor before a maturity date of their intention to cash in this certificate. YOUR DEPOSIT ❑ WILL ® WILL NOT EARN INTEREST AFTER FINAL MATURITY. (Sign only when requesting withd'rawal): VARIABLE RATE TIME DEPOSIT: For any time deposit which earns a rate that may vary from time to time during the term, the interest rate we will use to calculate this interest forfeiture will be: ❑average (weighted for time) of the simple interest rates tamed on this certificate up to the date of withdrawal; ❑ simple interest rate in effect on the date that this account is opened; or, ❑ the simple interest rate in effect on the date of early withdrawal. Minimum Balance Account: If we require a minimum balance on this account, we may treat any withdrawal that reduces the balance below such minimum as a withdrawal of the entire balance and calculate the penalty accordingly. EXCEPTIONS: Federal regulations permit, or in some cases require, the waiver of the early withdrawal penalty if: (1) any account owner ties or is declared incompetent, or (2) this is an I.R.A. or Keogh account and you are at least 59% years of age or disabled at the time of the withdrawal request, or (i) this is an I.R.A. or Keogh account and the request for whhdrawal is made within seven days of establishing the account. (Me penalty in such case will be all interest earned on the amount withdrawn.) 0 1992, 1990 Bankers Systems, Inc., St. Cloud, MN (1.900-397.2341) Form VFRCDIAZ 7/22194 VARIABLE/FIXED RATE TIME CERTIFICATE OF DEPosrr /pope 1 of 1/ BUILDING DEPARTMENT CITY OF LA QUINTA . 1 OFFICE: (760) 777-7012 INSPECTION REQUESTS: (760) 777-7153 TO: C'��y reo y DATE:.3 A_ DDRESS::. .29 " 0005 �'e�s '�' � 67 CORRECTION NOTICE - INSPECTION:�''� `L ��©�� PERMIT NO.: T AT 44 rg�4- 7/n,E 2. . F�IVC/AIV To 8� Gt/�i�/GE�D sPT. 7/nlG7 �Lr'c reic i�E,es IS R7 - y O E A T 11V ✓A, ;C51D/V I N K '119 Q Inspector 0 BUILDING DEPARTMENT CITY OF LA QUINTA OFFICE: (760) 777-7012 INSPECTION REQUESTS: (760)777-7153 c TO: E U DATE: ADDRESS: �9-�90/ST,E11/ C T CORRECTION NOTICE INSPECTION: _ ���/��-1//J7oV�L PERMIT NO.: 9P/O—//,Z 4r 14 72EX DW rZ- g. 1-15 F' 'r S E d i. t 1 a4 • w ' � ,�F r .. . c STE L Inspector to � ea-ia 4W fu-rc-ta OW - uwar-w dra �'�0�n�wo ala a a a a a� o xa•ti � x �duQ _ ow ,.aSwu -.L.DV L �71NI�O � d0 .111J 66BLL •17'0211 81210N.v.LNintp'01 1'0 fina2POW 1,1 `�°i'ob� vat ►ep`-. �� i�Oj �