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0111-075 (SFD)LICENSED CONTRACTOR DECLARATION � I hereby affirm under penalty of perjury that I am licensed under provisions9 , Chapter 9 (commencing with Section 70 00) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date x91 MB B IRA 1 /v bated 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. 1 ( ) 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 ),r'e"t'sd11;fT� Policy No. 23 E3a f7'tfCir�9+$2S (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 C� IJ'fornja, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor CodeVIsh II forthwith comply wifh,thos-pr visions. 1Date: ApplicaWarnailure 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 Borth op this application. 1.,Each'person upon whose behalf this application is made & each personat 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 representatives of this City to enter upon, the above-mentioned property for,inspection purposes. 4-81ignature (Owner/.4gent)� " ._;"�- ?t! � - — Dat 4Y ' BUILDING PERMIT PERMITk DATE VALUATION LOT £%i1. F'•i 7 TRACT :i ��- YJ 2 JOB SITE APN ADDRESS 5 -2.50 AVF..=A. DIAZ 773-732-(W OWNER CONTRACTOR / DESIGNER / ENGINEER 1+?ice)1WTMWCOVEJ.3EVEt,EyPM1�.,9r,Mr, IWITLWARtYSSrJ..LRflGERS pts BOX 31578 5f 900 JACY USI 61 PALm'D.1c.�m%'.1" CA 92261 'MRMATJ C.A. 9127M (MP)399-1200 (:kU 1,954 USE OF PERMIT W140'EU U FA1 ILY 1Ail'��,.uaG 3'RD a P1;Tdl IT 1:FC IKS NOT INCLUDE LifAO'CK WALL,, POOL OR 1,10VI.'e'lfAY PORCH/PATIO 1-5100 Sp 0ARAGWC ARPORT - .518,00 SF 51'1. 'WG OVI 3�1."•33C X00, QO E,T+ R?T: 101 -000, 418-000 PLAN t;,HWK FF% 101- -W01439-3 $481.01 Mil DZIPOSIT 101-000-439.318 1.k0,00 MMIC II AA+1=1.A P!'IE 101-000-•421-000 $6100 1±:L1KMatC., LFXF, 101af 00.420-000 5106101 numni mPsi 101-000-41.9-000 g14 X11 fS a'1ONO Ilt'3°4'.ION FRI? Hu`,rD 101 -000441 -MO SMS ORAD1140 Tr1f•1:: io M1a00-b42-3-000 DR 00 Vir".1,0M IMPACT FTE F SIA -71.00 PRECi.SkF, 1''i., N 101.0()0-441-345 $100.60 --4P41J-'rC.ffA .00118T1iU yTIP-M4 DPLA (W__,(1C LI KOS PRE -Pr' U) FIRM 4250,00 NOV 14.2001 CffY0FLAQU@W64 RECEIPT DATE �)e {/ BY .J DAT IN E INSPECTOR OPERATION j DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs (A7 Underground Ducts Forms & Footings Q ll_Zl/ Ducts Slab Grade ` Return Air .Steel Roof Deck O.K. to Wrap Framing Insulation -0t �L/S/� G '_ �5•'/ ��'� Combustion Air Exhaust Fans F.A.U. Compressor Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls- , Party Wall Insulation Condensate Lines Party Wall Firewall _ Exterior Lath Drywall - Int. Lath Final Finalj�U2� POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover j%gl Final Equipment Location Underground Electric Underground Plbg. Test 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 COMMENTS: Final Utility Notice (Gas) - ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voftage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) r.`ii.`1ra7ras.v*F7"�`.--r.'y-.r.c�p`.,ot♦q>L3}y.y:r.+,.- ,�-- P.O. BOX 1504 APPLICATION ONLY Buildings��4 78-495 CALLE TAMPICO Address , ;f 1 u Av i`, I n b;/-,) LA QUINTA, CALIFORNIA 92253 1III )UIQ1,-� f'^1I1*-1,- I )e x/,s..,,._ �,'7:,. Mailing Address 0 3 ,� ?XilyCity Zip Tel. f✓fEr,Yp f,�a Co`ntr'actoor ? _Ci/1.yy, I Zipy> �/ Tel. •] / X,01/1"[ l 1 � �7 31II- o - State Lic. City & Classif. Lic. q Arch., Engr.,--- / Designer //, a 1" 1j S f lei n N de 'a Address�� Tel. City Zip State y U Lic. ff LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70D0) 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. 7031.5,8usiness 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). I: 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 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 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.) 1-1 1 am exempt under Sec. B. & 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 (7 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 cartily 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 shall be deemed revoked. CONSTRUCTION LENDING AGENCY Ihereby 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 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. 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. Signature of a0plicant Date Mailing Address City, State, Zip WHITE = FINANCE BUILDING: TYPE'CONST. �5�. �) OCC. GRP. A.P. Number !% %3 • .Z t_->7- 0U-�L Legal Description /_v /%� Project Description Mech. Electrical Plumbing r: S.M.I. Sq. Ft.-ry Size 13417 No. Stories Driveway Enc. No. Dw� Units New'Q' Add ❑ Alter ❑ Repair ❑ Demolition ❑ A Vi! 'r 1 \r,511- IL- f 13 7, L -'—,- /G D/ TOTAL REMARKS S : 7-7 I i (7lr) rn- -v� 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 Side Street Setback from Center Line FINAL DAI Issued by:. Validated I Validation: YELLOW = APPLICANT rmit r PINK = BUILDING DIVISION Oct Oi 01 03:36pi JUUZ •oa RECORDING I EOUWED BY CHICAGO TITLE COMPANY AND WHEN RECORDED MAIL TO fN0UNTAxN COVE DSVEIAPMENT, INC A NOVAM CORPORATION D. 0. RON 3579 PALM DUSURT, CA 92261 L J ESLrou No. 1+os1703 POZ brdav Ma. stn-Airoe 52,no AV t 0IAZ NO. M P.2 in tthewlt Wa;elobY or certain is eaadcCOPY, 1L -ANY Eta t.'.._ --'• lsgz---._. C,..; ..,' . SPACE AUK 110{ 111E "m pttcxt me Wn ---- — ••- 71 DOCRYTRANSRBATAXIS 029.60 Q um awdarca ® City at &A OUlam [� compand ep the full odue of "lateral or pemportr wavered, w b ❑ computed ah the roll VD140 k41 the value of Neto ar eneomb"Am remlAina 41 tithe of sale, and FOR A VALUABLE CONSIDERATION, rem''pt of which is htfeby acknoWIC4. PATRICIA L. KUSICH, WHO ACQUIRED TITLE AS PATRICIA L. BAKER, 98 HER SOLS AND SEPARATE PROVERTY hereby GRANT(S); to MOUNTAIN COVV 03VELOPMENT, INC.. A NEVADA CORt?OttATION the followindcacribed real property in the Ci Ly of LA QUINTA I County of rVERS!IDE , State of California: IAT 21 IN BLOCK 9 OF %,'4TT 00. 1, SANTA CARMB;,ITA AT VALE LA QUINTA. IN THS CITY OF LA QUINTA, COUNTY OF JUVWIG=DE, STATE 09 CALIFORNIA, AS PER 14AP RECORDED IN BOOK 19, PAGE 96 OF MAPS, INTIM OPPICE OF THI COUNTY RRCORDSR OF SAID COUNTY. Dated-Septembez 11, 2001 VATR T.IP C1.A 1 f ry rrt L Coutm of,� �VLA4( 4'_A On �' A S', a Notary Pubde In tatd baforome PATR CIAO. MUSICK eppaalod ovwft r brown to and (ot wound to me on Cha bash of tmgl wwry LIMA amERY vwMen") is be 06 peksvn whM 119MI t I1104 iu Obld 10 11m .- whhln Initrumem and alm wAadgad to rm thatAt/11 GA" axacuted the COW # i3ow nem. to Wffiept#mw aodhwteed vapsa"V mf and that by b11fMr/*W PNIRJC-GISI lFOiINfA 6i,z+t6truW do the Inst ' meth the Petam(6r or the antlyr u0mm 00611 of ax YPMJRA COUNTY �+ whlch do peuon(M%cU0, mmeufed tM btltrumsM. my r Eltp m AN is, 2m vmwlmSmv hand and of tNa) *W. Ifalyra o levy ��W Qvitimms" l" Fm NOT VW aft oq gra wP K41L TALI STATMENTS TO PAR SHIOM ON FOLLOIMNO .UNE: IF 140 PARTY SO SHOWN, MAIL AS DIRECTED AaOVE SAME A8 ABOY$ rang &VA Addme fuly,1i161e !L ZIP 00+ •-0n�orova. Notice: Document Cannot Be Duplicated Date 11/9/01 No. 22663 Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE APN # 773-252-002 Jurisdiction La Quinta Owner NameMountain Cove Development, Inc. ! 1 No. 52-250 Street Avenida Diaz' I City La Quinta zip 92253 Permit #011 1=075 Log # Study Area Tract # BLK9 U1 Lot # 21 Square Footage 1347 Type of Development Comments Single Family Residence No. of Units 1 At �he 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 2.05 X 1,347 or $ 2,761.35 the property listed above and that building pe miits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued Fees Paid By CC / Canyon National Bank - Larry Shields Telephone Name on the check By Dr. Doris Wilson Superintendent Fee collected /exe pted by Annette Barlow Payment Received $2,761.35 Check No. 08090 Signature i NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) this will serve to'notify 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 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 collect them on the District('s)(s') behalf, whichever is earlier. 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 Certificate of Occupancy City of La Quinta Buildinga'nd Safety Department f 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: 52-250 AVENIDA DIAZ Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0111-075 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC Owner of Building: MOUNTAIN COVE DEVELOPMENT Building Official Address: P.O. BOX 3578 City: PALM DESERT, CA., 92261 By: RICHARD KIRKLAND Date: 2/15/02 POST IN A CONSPICUOUS PLACE