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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.Classs Exp. Date
Date,r JJ L r t /
"+Signature of,C ntra•to�
OWNER -BUILDER DECLARATION E
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
prmance 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 U3?cMPT 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 � I should become
subject to the workers' compensation.provisibns of Secti n 3700 of the Labor
Cod shall forthw'th-comply with lop,provisions.
Da--.,-- �C/t � 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.
.tt ,
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 represehtativesgof this City to enter upon
the above- mentioned,.pr6perty for inspection p�rpes. J.
Signature (Owns /r Age Zr'✓
BUILDING PERMIT PERMIT#
DATE r f VALUATION LOT 0201-2,27 TRACT
w� 6 91 U
JOB SITE
ADDRESS r%3-00.AV FPWA DTAZ
APN
12••W4
OWNER
CONTRACTOR / DESIGNER / EN (NEER
COv1.DMI10,P]AEM
� GAC-YH02 3
22.-i41.4, RIDGE WOM ROAD
47.750 KDAMQSIMIM.° 02n
(M)-.564-7820 CMAIA 02061
USE OF PERMITT�
01t�'Sa3'..EFA3+s3:IXDWF% e'NCy
1690 S.F. SJID. PERMIT DOES NOT 111CL:UDL SWCK `F1VAiJ SA"10 1, OR.
DIr.N'HAVAY APPROACH
TP -ACT CONSTRUCTION RUCTION I'aa,,00 SF
.PDRC ,VP.A`P10 71.00 Say
t'1.t,RACS]r.Jt;:A,ldl'O T 532,00 wF
951[�".C��lAM. ' CWT OFCs'C)1�i�e..ERi7%."TION
102, ,20
MMUTI'TY. HUMMARA
CONSTRUCTION FEE 101.000.419.0€ 0 $650,00
PLM4 CHECK F7%e 101-000-439-318 5511.2 i
FEE DEPOSIT 101.000-439.318 4250.90
A&ECHAN :;.R.l, FEE 101-flt'7!i-421-000 $39.00
PLL3151IDrmci FEE, 101-000-419-000 I2u.75
MONGMOTION FRE •1UID 101-000-M-000 $lo_0
ORAL YNO, FEE 103 -000-42 3-000 $i.15, 60
DFV-IW. PER IMPACT FEE rl,403.00
PI2 CtSL� P;LAII 101.4tO0-A41.345 �tll0.0i3
1M.1 YRT,,,�PAII> 100
425aoo
$°RkUMtr FEE -13 DVE0W,
�D
0, 777,.3`5
ITy OF LAQUINT
RE EIPT FINj4 ! f t
BY
INSPECT
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
S
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
—
Exhaust Fans
O.K. to Wrap
F.A.U.
FramingQ.
Q
Compressor
Insulation
d Z $
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
�Z• a r� �j
Drywall - Int. Lath
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
OIL
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
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)
COMMENTS:
I
• aT�Gv
v� 07 a �
4
P0 BOX 1504
Building
Address � V
A
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
'\I
Mailing /,(I((,
Address Z ) 4f Al K r t: t (, LI C i~jC:( 14
City
%)1 t� �1fut)
Zip J
�721�
Tel.
7 U -;J?,'S.
Contractor
Address `
�(a UC
6t% I
,City
Zip,-
Tel.
State Lic.
& Classa.�(� jL,_
City
Lic. #
Arch., Engr.,
Designer r,?S/
Address `y
Tel.
CityI Zip I State
Lic. # 2 r33
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that
la 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. _
i
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 rile 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 thathe 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).
f: 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. It, 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.)
I 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.)
Il I am exempt under Sec. B. & P.C. for this reason
Date Owner
v 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
f7 Copy is filed with the city. ❑ 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 thg 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: It, 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 it 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 sof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
5
APPLICATION ONLY
LDING: TYPE'CONST. OCC. GRP.
Number —1 -7 Lf ( i -) 60
al Description I -4D 7— BWLl 11 v Aft
ject Description
J1104L P F ;
ZONE:
BY:
Sq. Ft.No.
Size )6 ��
No. Dw.
Stories Units
Ne*Er*'_ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Estimated Valuation
Validated by:
PERMIT
AMOUNT
Plan Chk. Dep.
D
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I. •
Grading
Driveway Enc.
Infrastructure U
tl I
Jut, U! IIE
LA QUIN
NCEDEPT.
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:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Comments (4) Cashiers Checks.- 63096 - $3961.14, 63095 - $3608.04, 63097 - $3961.14 and 63094 - $3608.04
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 (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that 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
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14 X 7,074 S.F. or $15,138.36 have been paid for 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 !st Bank - Sharon Bills Check No. see above
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Crystal Scott $15,138.36(:�;l
v Payment Recd Over/Under
Signature M�_
NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
714-547-8909• May -19-02 5:52PM; Page 1/2
Sent By: CSAR;
NOTE SECURED BY DEED OF TRUST ESCROW No.: 2-35963
RE
INSTALLMENT NOTE - INTEREST ONLY
$607,500.00 PALM DESERT, CALIFORNIA APRIL 16, 2002
In installments and at the time hereiraher stated, for value received, I/We, promise to pay to
Richard L. Deman and Monique De -man, Trustees, or Successor Trustee, under Detlaration of Trust dated October
1,1981.
or order, at Palm Desert, California, or at place designated by the holder(s) hereof, the principal sum of Si:x Hundred
Seven Thousand Five Hundred And 00/100 Dollars ($607,500.00) with interest from APRIL 26, 2002 on
the amounts of principal remaining from time to time unpaid, until said principal sum is paid, at the rate of 7.50% per cent
per annum. Payable in monthly installments of INTEREST ONLY, or more, commencing on the 26TH day of each
and every month, beginning on the 26TH day of MAY 1 20 02 , and continuing thereafter until
APRIL 26, 2005 at which time the entire unpaid principal balance, together with interest due thereon,
shall become all due and payable.
This Note is subject to Section 2966 of the Civil Code, which provides that the holder of this note shall give written notice to
the trustor, or his successor in interest, of prescribed information at least 90 and not more than 150 days before any balloon
payment is due.
Payor reserves the privilege of prepaying this Note in pan or in full at any time without prepayment penalty.
In the event any payment is not paid within 10 days of the due date, Trustor shall pay to Beneficiary a LATE CHARGE of
6.00% of the payment due in addition to each payment due and unpaid.
"This Deed of Trust is given and accepted upon the express provision that should the property hereinbefore described, or any
part thereof, be conveyed or alienated by Trustor, either voluntarily or by operation of law, without Beneficiary's written
consent, then all suets secured hereby shall, at Beneficiary's option, become immediately due and payable."
S 2-0 - D AV4 0 6'Z"DIV Ccs Y.
Partial reconveyance(s) are to be issued upon payment of 537,500 per Lo . S 3.. 3 8 t� i4c• OB,oti
22
SAID LOTS TO BE. RELEASED LN A SPECIFIC ORDER AS FO O«'S: �lh�`
First phase of Lots released are Four (4) Single Lots APN 773-215-004, 774-075-007, 774-111-003 and 774-112-00?. Second
phase of Lots released are Three (3) Double Lots apn 774-073-0051006, 774-095-005/006 and 774-17;-023/024. Then all other
remaining individual lots to be released.
Each payment shall be credited. first on interest then due and the remainder on principal sum, and 'interest
cease upon the amount so credit on the said principal. Should default be made in paymeat or any installment
Shall thereupon
when due the
whole sum of principal and interest shall become immewmeiy cue at the option of the holder of this note. Principal and
interest payable in lawful money of the United States of America. Should suit be commenced to collect this note or anv
portion thereof, such sum as the Court may deem reasonable shall be added hereto as attorney's fees. This note is secured
by a Deed of Trust to El Paseo Financial, Inc., a California.Corporation as Trustee, affecting the property located at: 18
Lots Vacant Land, La Quinta, CA - See attached as per H:MBIT "A".
Patrick T: Doherty
Continued. on. Page -2
elly W Dohe .
DISTRICT - PLANNING REVIEW FORM
This form is to be used by CDD staff for review of single family dwellings in the RC'(Cove
Residential) District per Section 9.50.090 of the Zoning Code. Its purpose is to determine:
1) that the proposed house design does not duplicate the same architectural style of any
house within 200 feet of the applicant, and/or 2) if there is a need for the applicant to file for
Master Design Guidelines. If the applicant does need to file a Master Design Guideline, please
transmitted this infolmation to the Building and Safety Department as part of your correction
list. Please attach additional explanations as necessary.
APPLICANT Cove Development
SITE ADDRESS
53-600 Diaz
APN 774 _ 112 -.004
LEGAL: LOT
CASE NO.: 2002-690
21 . BLOCK
UNIT
CHECK AND APPROVED BY: Greg Trousdell DATE:
S.C.@V.L.Q.
Inform the assigned Building plan checker upon your assignment to this case. The CDD
Executive Secretary maintains a log book to track applications and assign case numbers.
REQUIRED ITEM
Y
N
COMMENT/CORRECTION
Verify legal and APN information
Consistent with MDG on file (as
applicable
MDG filing required (5 filings since
9/3/98)
Architectural variety within 200 feet of b
the surrounding area: cove
G. O Go
Gomts►�
��f
Architectural design fea0r''s
C
1s
, o g
,
.� I_A QUINTA
Goo
JUL 11 RECD
BUILDIN6 AND SAFEilf
Other Requirements:
- -- - - - --CITY OF LA QUINTA SUB-CONTRACTOR LIST '
JOB ADDRM' 4_ 2 f __i_ _ kRMIT NUMBER OWNER BUILDER
This form shall be gosted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees gre authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
FEB -28-2003 06:56 AM
CERTIFICATE OF
Firm;y L d's3a��wic�s
Street Address:
Capias to: Builder, HERS Provider
P-02
CF -4R
Plan Number
Sample Group Number
Sample Nouse Number
City/State/Zip: Zat ow/ji' _Cdr U&0
HERS RATER COMP A CE OXATEMJNT
The house was: Tested ❑ Approved as part of sample tasting, but was not tested
As the HERS rotor providing diagnostic testing and field verification, I certifythat the houses identified on this form
COM ly with the diagnostic tested compliance requirements as checked on this form.
Distribution system Is fully'ducted (I.e,, does not use building cavities as plenums or platform returns in lieu
of ducts)
(Where cloth backed, rubber adhesive .duct tape is Installed, mastic and drawbands are used in combination
with cloth backed, rubber adhesive duct tape to seal leaks at duct connections,
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic -Leakage Testing Results (Maximum 6% Duct Leakage)
Measured
Duct pressurization Test Results (CFM ® 25 Pa) values
Test Leakage Flow in CFM
If fan flow is calculated as 400cfm/ton x number of tons enter
calculated value here l
If fan flow Is measured enter measured value here
Leakage Percentage (100 x fest LeakagelFan Flow) a,
Check Box for Pass or Fall (Pass=6% or less)
❑
Pass Fail
THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent
Yes C] No Thermostatic Expansion Valve (or Commission approved
equivalent) Is installed and Access is provided for inspection
❑
Yes Is a pass
Bass Fail
C7 MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
1. a Yes Q No ACCA Manuel D Design requirements have been met
(rater has verified that actual Installation matches values in
CF•1 R and design on plan.
2. 0 Yes 0 No TXV is Installed or Fart flow has been verified. If no TXV,
A/Y
verified fan flow matches design from CF -1 R,
Measured Fan Flow =
O
Yes for both 1 and 2 is a Pass
Pass Fail
�LQ�zC
®
Sladden En ineeriru 9 9
6782 Stanton Ave., Suite A, Buena Park, CA 90621 (714) 523-0952 Fax (714) 523-1369
39-725 Garand Ln., Sulte G, Palm Desert, CA 92211 (760) 772-3893 Fax (760) 772-3895
Date
Job No. !;ZZ-aa-�
FIELD MEMO
Project Name
Site Address 1S3lcA� �U\iC- Q A�
Job Phone
Client:. i_ c '
1-3
t�
Work Done
1
I
Test Summary / Footings Inspected
Test
No.
Location
Elev.
Dry
Density
Moist
'Yo
% Relative
Compaction
Ref. Max
pcf
Moist
a
%
11t),13,12
Ic- Z
z Cr
77
IL-
.a
Comments 10 r
% C
eld Tech.
Super. or Agent
0
24 hour notice requested to schedule Field Technician. Thank you for the opportunity to be of service.
1-d 968E 2LL 09L ' -4,jasap wTed uappeTs dTT:ZT ZO SO AoN
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
53-600 AVENIDA DIAZ
Bldg. Permit No.: 0207-227
Occupancy Group: R-3 Type of Construction: VN Land Use Zone:- RC
Owner of Building: COVE DEVELOPMENT
! a�
Building Official
Address:
2214 N. RIDGEWOOD
City:
SANTA ANA, CA 92705
By:
KIRK KIRKLAND
Date:
MARCH 5. 2003
POST IN A CONSPICUOUS PLACE