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12-1467 (SFD)T4hf 4 P.O. BOX 1504 ^' VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 10/31/13 Application Number: 12-00001467 Owner: Property Address: 81150 ELSWORTH PL MR. & MRS. FILLER APN: 767-200-998-11 -330761- Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 651441 Contractor: WCE Applicant: Architect or Engineer: RAP/PAR DEVELOPMENT INC P.O. BOX 1455 PALM DESERT, CA 92261-1455 tip (760)340-4216 Lic. No.: 681590 -------------------------------------------------------------------------------------------------- LICENSED CONTRACTOR'S 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 Class: B f License No.: 681590 Date r7 contractor:. OWNER -BUILDER DECLAR I hereby affirm under penalty of perjury that I am exempt from the Contractor's Siaticense Law for the following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she 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 (5500).: 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, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the 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 or she did not build or improve for the purpose of sale.). (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). (_ 1 I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address:NJ _ LQPERniTT WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ave 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 and policy number are: Carrier STATE FUND Policy Number 9013530-2013 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 bec a subject to he rs' compensation laws of California, and agree that, if I should bec me su 'act to th work e s' ompensation provisions of Section 700 of the Labor Code,, I shall f h ith co y wit h se Provisions. Date Applicant: WARNING: FAILURE TO SECURE WORK S' COMPENSATION COVERAGE IS F1 AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HU RED THOUSAND DOLLARS ($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. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this 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 application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 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 information is. orrec I agree to comply with all city and county ordinances and state laws relating to bud ing c struction, and h eby authorize representatives of this county to'jenter / upon the above-mentioned property for nspectio urpa s. Datfe11 ✓/ Sigi lure (Applicant or Agent): I r Application Number . . . . . 12-00001467 Permit . . . BUILDING PERMIT Additional desc . . Permit Fee . . . . 2495.50 Plan Check Fee 1622.08 Issue Date . . . . Valuation . . . . 651441 Expiration Date . . 4/29/14 Qty Unit Charge Per Extension BASE FEE 2039.50 152.00 3.0000 THOU BLDG 500,001-1,000,000 456.00 ---------------------------------------------------------------------------- Permit . . . ELEC-NEW RESIDENTIAL Additional desc . . Permit Fee . . . . 660.98 Plan Check Fee . Issue Date Valuation . . . Expiration Date 4/29/14 165.25 0 Qty - Unit Charge Per Extension BASE FEE 15.00 7335.00 .0300 ELEC NEW RES - MULTI FAMILY 220.05 7335.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 256.73 7335.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 146.70 1.00 15.0000 EA ELEC TEMPORARY POWER POLE 15.00 1.00 -----==--------------------------------------------------------------------- 7.5000 EA ELEC TEMP SUB POLE 7.50 Permit . . Additional desc . Permit Fee . . . Issue Date . . . Expiration Date . GRADING PERMIT 180.00 Plan Check Fee . . .00 Valuation . . . . 0 4/29/14 Qty Unit Charge Per Extension BASE FEE 117.00 7.00 9.0000 THOU GRADING 1001-10,000 63..00 ---------------------------------------------------------------------------- Permit . . . MECHANICAL Additional desc . . Permit Fee . . . . 225.50 Plan Check Fee . Issue Date . . . . Valuation . . . . Expiration Date . . 4/29/14 Qty Unit Charge Per BASE FEE 7.00 9.0000 EA MECH FURNACE <=100K 7.00 9.0000 EA MECH B/C <=3HP/100K BTU LQPERDSIT 56.38 0 Extension 15.00 63.00 63.00 Application Number . . . . . 12-00001467 Permit . . : . . . MECHANICAL Qty Unit Charge Per Extension 12.00 6.5000 EA MECH VENT FAN 78.00 1.00 ---------------------------------------------------------------------------- 6.5000 EA MECH EXHAUST HOOD 6.50 Permit .. . . PLUMBING Additional desc . . Permit Fee . . . . 375.75 Plan Check Fee 93.94 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 4/29/14 Qty Unit Charge Per Extension BASE FEE 1.5 . 0 0 35.00 6.0000 EA PLB FIXTURE 210.00 1.00 15.0000 EA PLB BUILDING SEWER 15.00 14.00 6.0000 EA PLB ROOF DRAIN 84.00 3.00 7.5000 EA PLB WATER HEATER/VENT 22.50 1.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM 9.00 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 3.00 .7500 EA PLB GAS PIPE >=5 2.25 1.00 15.0000 EA PLB GAS METER 15.00 ---------------------------------------------------------------------------- Special Notes and Comments NEW SFD 7335 SQ. FT. WITH 1255 SQ. FT. PATIO AND 1290 SQ. FT. GARAGE THIS PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK WALLS, FIRE -PIT, WATER FEATURES, AND BBQ. October 23, 2013 8:27:29 AM JJOHNSON. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ART IN PUBLIC PLACES -RES 1128.60 BLDG STDS ADMIN (SB1473) 27.00 DIF COMMUNITY CENTERS -RES 104.00 DIF CIVIC CENTER - RES 1089.00 ENERGY REVIEW FEE 162.21 DIF FIRE PROTECTION -RES 612.00 DIF LIBRARIES - RES 334.00 DIF PARK MAINT FAC - RES 51.00 PLAN CHECK, SFD GRADING 143:00 DIF PARKS/REC - RES 1773.00 STRONG MOTION (SMI) - RES 65.14 TUMF: RESIDENTIAL 1837.44 DIF STREET MAINT FAC -RES 158.00 DIF TRANSPORTATION - RES 3592.00 Fee summary Charged Paid Credited Due LQPE"Irr Application Number --------- Permit Fee Total Plan Check Total Other Fee Total Grand Total LQPERMIT 12-00001467 3937.73 .00 .00 1937.65 1250.00 .00 11076.39 .00 .00 16951.77 1250.00 .00 3937.73 687.65 11076.39 15701.77 , 14 (01 TWT " I "- Building 78-495 C, ALLE TAMPICO APPLICATION ONLY AddressalIw Vt&otmpIGQUINT'A"C'A'L'IF'O'R"NlA92253 BUILDING: TYPE CONST. OCC. GRP. Address A.P. Number r (;d;b- City ip Tel. Legal Description n n ontractor Project Description Address City Zip Tel. State Lic. City Sq. Ft. No. No. Dw. & Classif. Lic. # Size Stories Units Arch., EngrNeAdd ❑ Alter ❑ Repair ❑ Demolition ❑ Designer .��1/1 ( Til - Arrtit P� cnaL, WX 20 City �ZipState 2� D O Lic. # c—� O LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am 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. 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). ❑ 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 and Profes- sions 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 im- provement 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, as owner of the property, am exclusively contracting with licensed contractors to construct 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) O 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKER'S 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 O 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 the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to Workers' Compensation Laws of Cakfornia. 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 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 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 applicant Date Mailing Address City, State, Zip WHITE = BUILDING DEPARTMENT l Estimated Valuation ` ^ 25 1 Coo PERMIT AMOUNT Plan Chk. Dep. oOO Plan Chk. Bal. Const. Mech. Electrical Plumbing 11 r, l.?,A 11 —11111 S.M.I. ; Ili 4--- — 111111 Grading 116 l 71117 1101 Driveway Enc'. Infrastructure ��— r;,1,q►T� 1 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 Issued by: Validated by:— Validation: YELLOW = APPLICANT INSPECTO Date Permit PINK = FINANCE POST IN A CONSPICUOUS PLACE Certificate of Occupancy Community Development Department This Certificate is issued pursuant to the requirements of Chapter 1 Section R110 of the California Residential Code, certifying that, at the time of issuance, this structure was in compliance with the provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 81-150 ELSWORTH PL Use classification: SINGLE FAMILY DWELLING Building Permit No.: 12-1467 Occupancy Group: R3 Type of Construction: VB Land Use Zone: RL Code Edition: 2010 Sprinkler Installed: YES Sprinkler Required: YES Owner of Building: JIMMY FILLER Address: 2964 SHOOK HILL PKWY City, ST, ZIP: BIRMINGHAM, AL 35223 _________ BURT HANADA _______________ By: KIRK KIRKLAND Building Official Date: DECEMBER 9, 2014 p CITY OF LA QUINTA SCS I_- _I,S (,(j C:� " '/1j(PERMIT SUB -CONTRACTOR LIST '�.. �' J ? �U�'� JOB ADDRESS O NUMBER _ OWNER r '. '.�� „BUILDER � -L—,Cl��/�� This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are 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. of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response. :>: >S ..s ::>:t >?. ' > <: :»:<lrade./:;.Clas f.ic.a ion...................:................Contractor...........:.....:.: >»' » <..... :; :: :>:>:;»: <:; '> ?`: `: ..:...................... `':> .:. a.............Cit. St te..C..ontractor:..s..Ucense :::.....................................Wor.kers.Co <> <' <» ? <»>'.`:» > <> <? <> ":' > >i:::> ::`: ;<::>;::> ` :' :>i :>` ::><;<<:i' >i::> ;;>; > < :<'.> ,' <[> ' < a ati n Insurance........................... .. _..mp.ns o 'i > > > <: >4 ; :::::u :s>;>a'.;: ;?Licei Y ..B sin ss.. s' [' '•> e.......... ComPanY Name Classification License . Date Carrier Name Policy Number Exp. Date License Number Exp. Date _ (e.g. A, B, C-8) , (xxxxxx) (xx/xx/xx) . (e. . State Fund, CalCom ) 9 P (Format Varies) (xx/xx/xx) (xxxx) (xx/xx/xx) _ '��f J L—A '� ^ � /.r � / C S l y� 50 � Y 20/C 7 6 L ONCRETE:; ;::::;81cst ::. I U�1/ 0I1T 0 t' ` .. /T G on, f—s� ZL � I� PCUI � Nc7/ cna L C ST.....L.,ICS;�).;::<;.; ��JQr�J �n lna6�/► C� i G`��C�� '�r''� �CC �� Nc/�/citi (v i��d�-� 1, G / 4�e�s^ l 7S`i''%: G •- . r '.:PLUMB ::: C s3 7 F 71 i C� V ET. META.. C'ERAM I:C; l Q °c �I r w C I Y c -I Coachella Valley Unified School District 83-733 Avenue 55, Thermal, CA 92274 (760) 398-5909 — Fax (760) 3984224 This Box For District Use Only DEVELOPER FEES PAID AREA: AMOUNT LEVEL ONE AMOUNT: LEVEL TWO AMOUNT: MITIGATION AMOUNT: COMMAND. AMOUNT: DATE: RECEIPT: CHECK 8: INITIALS CERTIFICATE OF COMPLIANCE (California Education Code 17620) Project Name: Madison Clu Date: October 31, 2013 Owner's Name: Mr. & Mrs. Filler Phone No. Project Address: 81-150 Elsworth Place Project Description: Single Family Dwelling APN: 767-200-998-11 Tract #: Type of Development: Residential XX Total Square Feet of Building Area: Commercial 7335 Lot #'s: Industrial Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement under penalty of perjury and further represents that he/she is authorized to sign on behalf of the owner/developer. Dated: October 31, 2013 Signature: **********'X•******************•********1:*********'r*************4:***1:**1:** SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE) Education Code 17620 Number of Sq.Ft. Amount per Sq.Ft. Amount Collected Gov. Code Project 65995 Approval 7335 $3.20 $23472.00 Building Permit Application Completed: Yes/No By: Elsa F. Esqueda, Director of Facilities and Maintenance Agreement Existing Not Subject to Fee Prior to 1/1/87 Requirement NN to i Pursuant to AB 181 any room additions or enclosures of 500 sq. ft. or less are exempt from developer fees. Any mobile homes being relocated within the same school district's jurisdiction are exempt from developer fees. Certificate issued by: Laurie Howard, Secretary Signature: -SCC_ NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a written notice to the project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of these Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall serve to advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of any other requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether payable at this time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This Certificate of Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School District, and up to three (3) such extensions may be granted. MV:chnydoca/devfees/certificate of compliance furni updated 3-2007 11/2010 Brook Marshall <drefacilitator@gmail.com> To: John Vuksic<JohnV@prestvuksicarchitects.com> Bcc: 11A October 15, 2013 Mr. and Mrs. Jim Filler RE: Lot 11 A at 81150 Elsworth Place Final Review Submittal Dear Mr. and Mrs. Filler: October 15. 2013 9:15 AM The Madison Club Design Review Committee (DRC) met on October 11, 2013 to discuss an email received from John Vuksic on October 9, 2013. As proposed the landscape will most likely require supplementary maintenance and more frequent plant replacement. As stated previously, the DRC strongly recommends the plant material receive modification; however, the committee will note these as courtesy comments at this time and allow the project to move forward. The project is approved to start construction; however, a Pre -Construction Meeting must be held at the lot after a Building Permit is obtained but prior to the commencement of construction. Please contact Brook Marshall at (760) 219-8057 or by email at DRCFacilitator �, gmail.com or Jeff Prevost at (760) 391-5072 with any questions or to schedule your Pre -Construction Meeting. Sincerely, Madison Club Design Review Committee cc: Prest Vuksic Par Development DRC File 10/28/2013 20:40 FAX IfflM PYNATWALn=0I%VAW Ft MRDING RBQQUERM BY A%rffiWff1L TOt Jimmy Fillerand Carol Fillor cam- o2v�(rp- ORDRR NO.: 72533ti380 lbmw No. L"WIM-905 Parcel No. 21UM ddl Rl 002 DOC # 2012-0062029 02/10/2012 08:00 AM Fees: $21.00 Page. l of 3 Doc T Taos Paid Recorded In Oficlal Records County of Riverside Larry W. Ward. Assessor, County Clerk $ Recorder "This document was electronically submitted to the County of Riverside for recording" Recelpted by: SOOMEZ GRANT D THE UNDERSION13D GRANTOR(s) DEICI.ARB(s)cumentary Transier Tax is $ �3 C 10 unincorporated area Vmnputed on fou value of interest or IPmpwty coil em, or the city of La Qatute E3 fall value less value of lens or encumbrances remaining at the time of Sale FOR A VALUABLE CONSIDERMION, recoipt of which IS WMbY Acknowledged, CRE IJ CA LLA, s Delaware lfn*W NnbfBty wmpaey . hereby GRANT(s) to Jhmrgr Biller and Carol POW, husband ural wilt =Joint tenant% with rights of survivorship the following real property in the County of Riverside, State of Califbmts: legal description attach Dated: ftb= 3, 2012 SEE EXHIBIT A cm LI liability STATS OFt'AL RMA COUNI'YOF } SS: On before me. Sle&oLt v0 lak,[ i a Notary Public, pas rally appeared who prpW to me on the basis of satfshotory evidence to be the porson(aMmse namrfs) is/t0aaubsorlbed to do within fnsuumem and wknowlodpd to me that heldttAWaxecded the some In !ddW)jb* authorized capaclool) and that by hWWom* all natum(On the inetnunent the peraoq(etJ. or the entity upon behalf of which the personWacted, executed the instrument. I oathy under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph to true and cuffed. WITNESS my, haNY42 official Seal. 5TEPMANtE J0 TAKANAtit Slgasurre - 'Con alabn • 1911W Notary Public - CaWerals Los Anpelea County F4 -D -,Uv -Conan. Eafte More M4 hp i of 2 was 10/28/2013 20:41 FAX 0003 Title No. '11-125130MWA--TC Locate No. CJIWW72 0972-0051-0725139380 LEGAL DESCRIPTION EXHIBIT "A" THE LAND REFERRED TO HEREIN BELOW IS STRIATED IN THE CITY OF LAN QUINTA, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA AND IS DESCRIBED AS FOLLOWS: PARCEL Is Lot 11 of Tract No. 33076-1, in the ffty-of La Quanta, as shown by Map on fila In Book 388, Page(s) S7 through 79, Inclusive of Maps; In the Office of the County Recorder of Riverside County, Californla. PARCEL 2o Nonexclusive easements for access,'Ingress, agress, drainage, maintenance, repairs and fbr other purposes, all as described In the Declaration. APN: 767-670-007-2 2 n1r►MANWRapat"-NOMM(iuvro6)