9710-112 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter.9 (camrgiencing 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
7i41Y,ii 13 � !(i11197
/ate I a ! lignature of Contract- or Z
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
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.
zfi lrn; I.4s. o" 71�E�1::f,'bly
(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
Geode, I shall fortwith comply with t ese'provislons.
Date: I/ 7APPlicgnt�'
Warning: Failure to secure Workers' Comp nsation 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
applicatioh. ti
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
corry,ct. I agree to comply with all City, and State laws relating to the building
cystruction, and hereby authorize representatives of this City to enter upon
t e above-mentioned property for inspection purposes. /
ignature (Owner/Agentn 1'4""•"� Date .&/- /C"
41 Le "117v
r
BUILDINGPERMIT
PERMIT#
CONTROL#
DATE / VALUATION LOT
g l.3� 5%.80
Q '
S.)
TRACT A�78
JOB SITE
APN
ADDRESS 79.090 K RIXF1124 COURT
4M-tif l-U8a
e
� Q
OWNER
CONTRACTOR / DESIGNER / ENGINEER
t EMI'L:Ii.;'!''I;C? IT1,1,C.OM.I.,IU1"11,711i5
CEN, n3ftyCl!LOVIIE
Lf, COIN I MUN I'll ES,
1335 SO. "f1- snua `E; :Tn?. U7.00
1535 80. "EJ" STRETT' .k7m. 1#.1)0
SAN MAkNA}U)INO CA 92.0.4
SAN HE RNAlklA
) CA X2409
(cO)1V(140)7
CF31.fE .140
USE OF PERMIT
.,rD - NiAld"! 1A PLAN Ilii (NIOD •i.j
-
Crt;/RCiili'KI t:,
�..tal S1:
,
tett#CrliifJ(;Ak4'L�ft'1' G:,Li
�i11 SN .
PERMIT FEE S MMAWY
C-1N:rt'i0;M'10N F'VE 101.000.41 K -(}N
57rr: !�fi
VI,AN t 1>f3 -PK 44W
:LiIXNATNHI AS. F14115 EOi.•tliiti +2�i :IQCI
M5,.50
iaXC" rR1CAL P) -Ji EGI-000-420.OW
I'LUA FI1NO iTMtOI-OW-419401
1.i2 75
51755`t?�I�7 if it Yfif11Y 3.1cC? . it,?'{li} 105-(W.LA1./)fM
_
eALAU1;1O:'M 101.000.423-000
PAID
iNFRAMI1t►+,''MRIi Fi>!i 225446-4,11-3,12
$1
ART 3N PUBLIC. PLAU!N - R000 TOf-(31.10-255-000
Qu 19 1991
..
c
of uA QUINTA
fit(t1-ic:t1'A1. (:'CEN;M'1 U,N',' ON t> N 1 PIAN C11.
$4,$75.75
LESS PRt3- IAA) FET'S
T': TAL PFRAII (T FE'TS 011441 NOW
U N7'5.74
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
T
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE TINSPECTOR
\ BUILDING
APPROVALS
MECHANICAL APPROVALS
, SacksUnderground
ge-
Ducts
jrms & Footings
e W,Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
—Q
F.A.U.
Framing
.,�o - e
Compressor
Insulation
- .1197
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
A —/7 —
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_ .Q
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
�ve�C Pita'"$
T,Bus,S <glx: B rME 2A
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) 3g-
I,¢��3E!►anmtrnei�a ee e e ��r-m
4 4129mro
MEMORANDUM
TO: Susan Maysels, Deputy City Clerk
FROM.: Carolyn Walker, Executive Secretary l V
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, I 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).
I 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.
I will put this file on hold until I receive the final documentation from Building and Safety.
Y Should you have any further questions, please feel free to call me.
1'lC AROI.YNU.eguls�,C'orrected No._Renoit CD Relc.ase.doc
0
'Sunflolker
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
Deport In The 1535 S D ST SUITE 200
Name(s)Oft SAN BERNARDINO CA 92408—
Cc. .,:ate Number 1
SSN/TINI 33-0594370
D/OB
Account Number 128000080
Date 09/05/1997
In The Amount Of **ONE THOUSAND VOILARS AND ZERO CENTS" dollars $ 11000.00
ACCOUNT TYPE AND TERM - Only the boxes that are checked and the lines that are filled in apply.
Term (Initial) 12 Months ❑Additions permitted in a minimum amount of $
Maturity Date (Furst) 09 /05/'1998 ZIF xed Rate U Min. Balance Req. $l, 000.00
Interest Rate (Initial) 5.340 % ❑ Variable Rate: Initial Index Rate % Maximum Rate %
Compounded. Simple Minimum Rate % First Adjustment Date
Interest Calculated ACTUAL/365 / Adjushnew Frequency
No. Endorsements Required for Withdrawal 1 Rate Formula
❑ Single Maturity 91 Automatically Renewable
Interest Paid MONTHLY DENT BANK
(a) ® By Adding It To The Account Balance 0 9
(b) ❑ By Deposit To Acct. No. _
BY j,
DEFINITIONS: "We" and "as" means the Ovar*30 icarib,tiDa, "You" and
"your" -means the depositor(s). "Celt ficate" 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 caro 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 name between interest adjustment dates.
If the 'first adjustment data' is phrased in terms of "Index change" this means
the first adjustment date and the rate adjustment frequency after the brat
adjustment date are not regularly scheduled. In this can, the rate this certificate
will earn 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 (if any) or be leas than the sated. minimum rate (mf
any) regardless of changes in the index rate.
COMPOUNDING: The compoemding frequency and interest calculation method
will not change during the term 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 tam interest from the date of
deposit, and will mature at the acme time as the first deposit. No additions may
be trade within ri a days of the final maturity date.
NOTICROF PENALTY FOR EARLY WITEDRAWAL
Except as mentioned below, you. cannot withdraw any principal from this
account before a maturity date without our consent and we will charge a penahY.
We can .onlyy consent to an early withdrawal at the time you request it. The
penalty will be an amount equal to:
the greatest of: (1) all of the interest earned on the amount withdrawn
from the most recent date of deposit or !last renewal, (2) all the inter
that could have been earned on the amount withdrawn during a period
equal to one-half of the maturity period, or (3) siva days' interest on the
amount withdrawn.
❑one month's interest on the amount withdrawn.
three months' interest on the amount withdrawn.
We will charge the penalty first against any interest then in the account, and any
excess will be deducted from the amount you withdraw.
FDIRD RATE TIME DEPOSITS: For a fixed rate time deposit we will use the
nomual (simple interest) rate in effect to calculate the amount of the applicable
penalty,
SINGLE MATURITY: If the single maturity box is checked, the depositor
should present this certificate promptly at maturity for payment.
Interest ❑ will ® will not accrue after maturity.
AUTOMATIC RENEWALS: If the automatic renewal box is checked, this
certificate will be automatically renewed after die 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 (if any) and other feature■ as this original cer ificate. The
depositor may call us on or shortly before the maturity date and we will tell die
depositor what the irtterest rate will be for the Doxt 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 INTEREbT AFTER
FINAL MATURITY.
(Sign only when requesting withdrewao:
VARIABLE RATE TIME DEPOSIT: For any time deposit which care a rata
that may vary from time to time during the term, the interest rate we will use to
calculate this interest forfeiture will be:
[lave -rage (weighted for tithe) 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 h opened; or,
❑ the simple interest rate in effect on the date of early withdrawal.
Mmimmn Balance Account: If we require a minimum balance on this account,
we may treat any withdrawal that reduces the balance below such rniuirmim 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 withilrviwasl penalty it:
(1) any account owner dies or is declared Incompetent, or
CZ) 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
(3) this is an I.R.A. or Keogh account and the request for withdrawal is
made within seven days of establishing the account. (The penalty in such
case will be all interest earned on the amount withdrawn.)
01982, 1900 Sv*ere Systems, Inc., St. Cloud, MN 11.600-397-23411 Form VFRCDIAZ 7/22194 VARIABLE/FIXED RATE TIME CERTIFICATE of DEPOSIT Gwre r or rl
f
•
BUILDING DEPARTMENT
.
t
CITY OF LA OUINTA
4�
OFFICE: (760) 777-7012 INSPECTION REQUESTS: (760) 777-7153
TO: _A/ rave y DATE:.3 "20 y�
�
r -00 GT
ADDRESS: /9
CORRECTION NOTICE
-
INSPECTION:0C//V/- /% OP61 PERMIT NO.. 9210-11--1
AT LATER
. FEi�IG/Nri -ra 86c R T_ T IV Cs"
E -
LEG ie/c 7-,Iig,9ees -7-b -47-
47'AT
A 7-42WVkZ510W
t;
k '
b,
v
Inspector
BUILDING DEPARTMENT
CITY OF LA QUINTA
OFFICE: (760) 777-7012 INSPECTION REQUESTS: (760)777-7153
TO: 14Ebel , (/ DATE: 3?!7
ADDRESS:
CORRECTION NOTICE
INSPECTION-_ ��N��- �/%%��L , PERMITNO.:
• i
�4r ,LAT�,e DAVE'
QF ,�lOUS�
_ O
STE G
Inspector
y ._
�• ,m -r. Nr m-r.-rw Oul
Dil D 1T14
M. NW.g1Y� IM
■
n
lo!1���
®'ion`•
•� ��
moo°s°o.,
as
`��die