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9904-041 (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 Date 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: (k) I, as owner of the property, or my employees with wages as their sole dompensation, 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 JDate "7- .; « 4, Signature of Ownerp: 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. FvtJL7 C><(.1 4111 p .(This section need not be completed if the permit valuation is for $100.00 or less): ( ) I certify that)h 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 1 should become subject td -the workers' compensation provisions of Section 3700 of the Labor Coqp� �Ishall fortliwith comply with those provisions. Date: •2•- Applicant- _ 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 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 s,.. 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 bove-mentioned property for inspection purposes. Signature (Owner/Agent)=`�� . ��' r r�.' . Date; — ' • ` 9 BUILDING PERMIT PERMIT# 9"aW1141 DATE07/021:1119.9 7/02 f��j�VALUATION $186 502.'�i� LOT 1S TRACT 2180 JOB SITE S 79 -bat! 1!' A'lJ'RsJ�.iaS110 � ROAD ADDRESS APN 646-061-017 OWNEER. CONTRACTOR /DESIGNER ENGINEER GIGp ERIT& 111,13EITk, SOLO 110 M[L A R 40 -90t 5 SAINDY C:r.ALE LAK:1 .A.P'1' C 3488'N. STODI ARD AVENUE' P.t#1. M DEF.."! CA92211 SAN 1Qkz TARDTNO CA t42405 �91i9)S'«'1-5529 C;F3T.� USE OF PERMIT Sll'daILE, FAMUf DWELIATO Sf D -1'x'}2 UT DOES 1400 INCLUDE BLOCK WALLS OR .POOL vc.1T;p•/C' (jJ.td{'A/�+'.I'� ucrioll ^�,.Q�a8.00 SF piya'c� voflailE'A1'lo - •.- Y o"o al .•. �Al2,Ad,�t;fG.flfit'�3h''.P •750,Oft S4: 11 S nINIA,TED COST Off+' ICAMRUC x 10IN' JS6,5GZA9 ERAU i 11,.x,, � SUMMARY C0N'3 I'ILtA':T1014 FL% 101-000-41$-000 5944.00 PLAN CHE-47KIMIR 15799.06 EMU)W.-OSIT 101-000-439.318 tuf1`7fi.1f.ti%MV,1iL CIsT; lot -M-421-000 ELEC:1iUCAL FM 101-400-4204J00 S20i ,38 STRONG INIO` ION FES - 2+1 ID 1.111.-00U-24,1�000 S:18.55 ORHi7aFi�'aFtIII .101-M-423-000 520.00 isNPI Al:Y!'ktif;`i°URE EIRE 22J.000-443-342 V1956.914 ART IN AI,K.1C PLACES - R STT, $216.26 SUIR-IMAJ, C€'>NSIRI UMION AN37 PJ A.N Cf iJ:C K 1M,451.25 213 W FEES ell, lteXCA.L [PpSO.�iO�I1I i ERS 011 Fr Ni/iitl $6,201.25 i f• i r/� r RECEIPT DATE BY ' DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS - MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Slab Grade _ "� _ l Ducts - Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap / _ F.A.U. Framing Z Cv _V2Compressor Insulation 1 • i Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath rc Final Final G BLOCKWALL APPROVALS Steel POOLS - SPAS 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 Encapsulation Gas Piping Gas Test Appliances Final Final alk, 1-10 Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit 1 ~ Q - Q KW�L 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 44 P.O. BOX 1504 APPLICATION ONLY Building 78-495 CALLE TAMPICO Address &A QUINTA, CALIFORNIA 92253 Owner Mailing t " RC� 4-' 505' Otto A �e ' BUILDING: TYPE'CONST. . OCC. GRP. Address � A.P. Number . _ Legal Description Contractor -5,11k�,.� A Project Description �� Address �--� City Zip Tel.. State Lic. City & Classif. Lic. # q,t No. No. Dw. Arch., Engr., Size I Stories Units Designer New Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing wlth Section t. 7000) of Division 3 of the Business and Professions Code, and my license is in full force and elec _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 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 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). 1'1' 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 orimprovement 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.) 1*7 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. Company n Copy is filed with the city. O 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 thF 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 Lender's Address This is a building permit when properly filled out, signed and validated, and is subject -lo 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. 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. Estimated PERMIT AMOUNT Plan Chk. Dep. 5c) (j C` 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 Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip I. i �� WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 Date 7/2/99 No. 18980 CERTIFICATE OF COMPLIANCE APN # 646-061-017 Jurisdiction La Quinta Owner NameGilbert & Socorro Salazar No. 79— Street Horseshoe Road ,o5o -L -'- City La Quinta d1(q4q zip 92253 Permit #9904-041 Log # Study Area Tract # 2180 Lot # 18 Square Footage 2,968 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: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.93 X 2,968 or $ 5,728.24 the property listed above and that buiidliig Permits and/or Certificates of Occupancy for this square footage in this proposed ro ci&,*y n� w be issued -, Fees Paid By cc/Provident/Gilbert C. SalazarTee - �lephon�" 771;6103 Name on the check rte: By Dr. Doris Wilson Superintendent v ~ t! ;' .R ,� ..._t, Fee collected /exempted by Signature Juanita Green Payment Received $5,728.24 Check No. 8195 NOTICE: Pursuant of A embly Bill 3081 (CHAP 549, STATS. 1996) this will serve to no you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the dale 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 collect 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 ASSESSOR'S PARCEL NUMBER Y OF RIVERSIDE HEALTH SERVICES AGENCY tTMENT OF ENVIRONMENTAL HEALTH AAIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM LICANT. Submit this form with four copies of a SCALED plot plan (1-20 SCALE) drawn to County specifications as indicated on the attached check list. Ion -refundable filing fee is required when the application is submitted. Check must be made payable to the County o�Rive Jsidt Appel -of this applic�a 37 m shall rree%main valid for a period not to exceed one year from date of payment. $M�°F« � %y Aic I A dy,IV A L -MS # C. , CHK ( Agent, Contractor, Contact Person Address City State Zip C, Telephone [ [ Owner L 1. �+~ G)C 012 ./t. r4 I A 4, -Address City State Zip 1z -. Telephone Z cR Job Property '/Address 11 7� 4VQ #04)?W3-Nuf City I q Ot/rte{. Zip U cwn Lot Sife r �/S. 3 Water Agenc a r r1.' t � � 4 Use of Permit, P/P, SUP, PUP, etc. 4 4L11GR�4 ft A Legal Description rqd f X E y.S X 130 .1/,?pwftt/ J / �W4 7 L ,4J (r Dwellin I�hSfte•Rreplretc���CJL 3 ' � J1 Signatur f Applicant( 07777-77QIt aG / - Y-" Date CHECK BOX IF REQUIRED If any box is checked; this application shall be considered rejected until ❑ Detailed Contour Plot Plans Required (1 to 5 foot interval) the information is provided and the fee paid. Resubmittals later than 90 days after date noted below may require repayment of fees. ❑ Staff Specialist Lot Inspection Required m ❑ Holding Tank Agreements Completed Z❑ Thomas Bros. Page Grid O Certification of Existing S.D. System Required U ❑ WQCB Clearance Required ❑ Date Lot Inspection Completed: Initials LU N (Attach for DOH -SAN -007, Santa Ana Region Only) Remarks: ❑ Maintenance Booklet Provided ❑ Soils Percolation Report Required ❑ Special Feasibility Boring Report Required • ❑ Rereview Required Initials Date ❑' Final Inspection by Department of Environmental Health is required. Please call 24 hours PRIOR to inspection. C/42 / Soils Percolation Boring Report by Lic/Project # Date Soils Map Page Type Soil /LIQ ✓' Approved By Date No of tystems Type of System(s) LJolding Tank ❑ Replacement No. Dwelling Unitst f j1 Bedrooms, Fixtnredlnits (1) Septic Tank Soil Rate Grease/Sand `', Grease Inp/Lint Trap ' ew ❑ Addition eE 9 3r�� �3 ii411/Ai1L]Mt /�(/�1GaL /� �, ���. , fe!— (doe, Gal. Sq. Ft. 'Bottom Area • Total Linear Ft. I Sidewall Allowance l fes. rpcckk/ sq. ft..running ft. Install Line ft. long ft. wide with Leach Bed sq. ft. of �bttom Area Inlet Tested Depth ❑ NA min. inches roc Blow drainlines or U Proposed Bottom Tested Dep Z 0 Leac lines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Inlet (BI) Seepage Pit Maximum Other: H U A livable Pp t I � Q Total Depth ! •v -Allowable Depth (� A LUN/A Overburden Factor ®p5' e' TD T V Well Review Approved: Date: Well Drilling Permit # - SIGNATURE Grading Plan Approved: Date: SIUNATURE Sewer Verification Approved: Date: Plan Check Ont Approved: Date: REMARKS: Cllr �X.rr✓ .r r����Xl�f/ Cl - �(!/ Q !/ .sty ..x�cP r� .,�� .c.3-ta%�4. �- 6M" 6t.z-r�t•er�%%��� l�I.r:1� '.I'�'� eaai�o�i f J A : � *te a. r ,� rue i' aY. 2LI, : f.Z,,,.� �. 1111141a 044. This application is APPROVED/DENIED. for„the category;-checke-_,d�SECTION B atSoxe .regarding the desig 6f-sawsubsurface disposal FOR OFFICE USE ONLY system as Indicated on,the Scompanied plot plan, using the requirements set -forth in SECTION C above. A build- -- - Ing permit is necessary for the installation of the above -designed system. No con. structlon Is permitted In the required reserved 100% expansion area. pp Revenue code / 0111 510 Fee 1 � � �• � f% 6)),Septic Tank must be , ,10Y minimum from any wellsi � U , M' ^ � ��UA i A t / Check #.- (2) Leach lines must be 100' minimum from any wells; including expansion area. Date C- ` r(-� 9 Initial F �% � (3) Sewer lines must be 50' minimum from any wells. C” �• / . � z 0_(4) Seepage pits must be 150' minimum from any wells, including expansion area. ~r , LU Signature of Health Official Date u_n- ^-44 lnu�/u.) VISl11UUL1Ul1. YYnIIC—UITIOe r'lle; YLLLUW—Appucant; FINK—bldg. Dept.; GOLDENROL-Plans/Records Westward Ho Property Owners' Association 79860 Fiesta Drive 0 La Quinta, CA 92253 • (619) 347-8351 tY�Et(d.711d' dJl ttlA1 ldt;. 1J 4L6.61YJ01/ dl '146 uArnKLAGd1Vr 4 VLM&L/anilNnJ0 Jame UC �.eautevau�in FORESITE ESCROW, INC. Lr0WSE 0963 2355. SALE `-A11-995 Boardwalk, Stlite G-2 (olf U ok street) ESCROW INSTRUCTIONS Palm Desert, CA 92160.4310 (619) 773.5333 • FAX (619) 773-9289 : ESCROW TYPE _ SALE ESCROWOFFICER PEGGY BAUMGARDNER, CSEO TO COMPLETE A TOTAL CONSIDERATION OF $ 73,000-00 I/We will hand you UPON OPENING OF ESCROW THE SUM OF $1,000.00, AND WILL DEPOSIT AN ADDITIONAL $73,000.00 PLUS BUYER'S COSTS PRIOR TO CLOSE OF ESCROW. and will deliver to you any notes, instruments and additional funds required from buyers to enable you to comply with these instructions on or prior to Nov. 7, 1993 all of which you are authorized and instructed to use and deliver provided instruments have been filed for record entitling you to procure assurance of title In the form of a Standard Policy of Title Insurance with the Issuing company's usual printed exceptions, with a liablity of $ covering property In the County of . RIVERSIDE State of California ESCROW NO. 2-16452 DATE Oct. 7, 1993 MEMO PAID OUTSIDE ESCROW $ CASH THRU ESCROW , 000 ' LOAN OF RECORD - 1 st LOAN OF RECORD - 2nd ADD'L LOANS OF RECORD NEW 1 st LOAN NEW 2nd LOAN ADD'L NEW LOANS TOTAL CONSIDERATION $ 73, 000. Records of said County described as follows: LOT 18 OF TRACT 2180, AS PER MAP RECORDED IN BOOK 41, PAGES 37, 38 AND 39 OF MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA. Property address: VACANT LOT, (not verified) showing title vested in: GILBERT C . 'SALAZAR AND SOCORRO M. SALAZAR , HUSBAND AND WIFE AS JOINT TENANTS Free from encumbrances except: (1) General and Special taxes, including any special district levies, payments for which are included therein and collected therewith, for the current fiscal year, not delinquent, including taxes for the ensuing year, if any, not yet payable. (2) Covenants, conditions, restrictions, reservations, rights, rights of way, easements and exceptions of minerals, oil, gas, water, carbons and hydrocarbons on or under said land, of record, and in deed to file, if any, affecting the use and occupancy of said property. (3) LIEN OF SUPPLEMENTAL TAXES NOT YET ASSESSED, IF ANY. THESE INSTRUCTIONS ARE CONTINUED ON ADDITIONAL INSTRUCTIONS ATTACHED HERETO AND MADE.A PART HEREOF: If above encumbrance is a purchase money trust deed,.endorse interest on noies as of date of recording deed. In event unpaid balance of trust deed(s) of record are more or less than the sum(s) set forth above, adjust difference ( N / A ) in cash ( N/A ) thru deed of trust to file ( ' N/A ) in the selling price. Prorate taxes on real property only, based on the latest tax bill in your possession or on latest available tax figures furnished by the title company as of CLOSE OF ESCROW Prorate interest on loans of record as of N/A Prorate rents a N/A based on rent statement handed you. Any rents in arrears to be disregarded in your proratil Prorate insurance as handed you as of N/A and in the event the lender requires additi! insurance to cover new loan, this is your authorization to order same and pay premium, if any, from buyer's funds. As of N / A credit seller and debit buyer the amount of impounds, if any, as disclosed by beneficiary statement from the holder of the loan of record. EACH PARTY SIGNING THESE INSTRUCTIONS HAS READ THE ADDITIONAL ESCROW CONDITIONS AND INSTRUCTIONS ON THE REVERSE SIDE HEREOF AND APPROVES, ACCEPTS, AND AGREES TO BE BOUND THEREBY AS THOUGH THE REVERSE SIDE HEREOF APPEARED OVER THEIR SIGNATURES. The undersigned hereby agrees to pay, on demand, charges for drawing, recording and notarizing all documents, charges of title company, if any, charges of lending institution, if. and the buyer's and/or borrower's customary escrow fees, necessary to complete this escrow. 9�yer's S!gnatLre�� - !� Buyer's 3.1gn,atu.a: G BERT C. SALAZ R Buyer's Signature Buyer's Signature _ SOCORRO M. SALAZAR Address 1427 BLOSSOM AVENUE, REDLANDS, CA. 92373 The foregoing terms, provisions, conditions and instructions are hereby approved and accepted in their entirety and concurred in by me. I will hand you necessary docum( and/or funds called for on my part to cause title to be shown as above, which you are authorized to deliver when you hold for my account the sum of $ PROCEEDS together with any documents, due the undersigned as described above, within the time as above provided. Pay your escrow charges, recording fees, charges for evidence of title as called for, whether or not this escrow is consummated, except those the buyer agreed to pay. You are hereby authorized to pay bol assessments, taxes and any liens or encumbrances of record, plus accrued interest, charges and bonus, it any. Pay Documentary Transfer Tax as required on Deed to property I conveying. You are also authorized to reimburse party advancing money for cost of building report. NU -LAND VENTURES, INC., A CALIFORNIA CORPORATION Seller's Signature BY* Seller's Signature By JORG CHRISTIANSEN, PRESIDENT Seller's Signature Seller's Signature Address , 43-365 TEXAS STREET, PALM DESERT, CA. 92260 ES611 12187) T4ht 4 4 Q" PUBLIC WORKS CLEARANCE LETTER p Y,,jf, FOR A�s,sD CUSTOM HOME LOTS l/►'� A� % S �L G- 77 AA/ /fir f C��'Z— / -��— A�( �v� .118 Dear Builder: 3 q 7 Gt 3 �`�`�% Prior to fssuf a n e of a building permit, you vuill be required to obtain clearance from the Public Works Department for one, or more, of the following: 1. Verification that rough grading is conplete, and the pad elevation certifications prepared by a licensed surveyor, or engineer, are on file in the Public Works Department. 2. Verification that infrastructure improvements and other required tract improvements are complete, or sufficiently advanced to warrant building permit issuance. 3. Prepare an engineered grading plan that provides for on -lot storm water retention, and have it checked and approved by the Public Works Department. • Tract 26524 (Estancias,` • Tract 26769 (Mountain View Estates) 4. Prepare an engineered grading plan that provides for building pad grading 'in accordance with the existing soils -eport and tract grading plan, and have it checked and approved by the Public Works Department. • Tract 28034 (South Val ey Estates) FOR INTERNAL USE BY PUBLIC WORKS DEPARTMENT (c,_ Zl TRACT: Gc/ LOT: e. Z5� 'PURI ICWOASAHORIZATION t DATE FAPWDEP'RDOCS\FORMS%PW CLEARANCE LETTER.ss L1 ` 1/iA I / �► . t•ur L�►L■ 7 QUI Ak"