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05-4145 (SFD)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: 11/04/05 Application Number: 05-00004145 Owner: Property Address: 53080 AVENIDA VILLA BUILDING HORIZONS APN: 774-064-003-21 -000000- _ 42600 COOK ST #120 Application description: DWELLING - SINGLE FAMILY DETACHED PALM DESERT, CA 92211 Property Zoning: COVE RESIDENTIAL Application valuation: 107330 Contractor: Applicant: Architect or Engineer.__ _ z BUILDING HORIZONS 42600 COOK STREET, #120 - PALM DESERT, CA 92211 (760)340-4748 Lic. No.: OOR SQUARE FOOT Lic. No.: 812160 ,v(A ------------------------------------------------------------------------------------------------- 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 Busine and Professionals Code, and my License is in full force and effect. License Cl ss: 13 License No.: 812160 Date: Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury I am exempt from the Contractor's State License 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 ($500).: (_ 11, 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.). (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the prnject (Sec. 7044, Business and Professions Code: The Cuntractors' 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.). (_) 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 LQPERMIT 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 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 0003523-2004 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 thee` orkers' compensation provisions of Section 337700 of the Labor Co all forthwit m¢ly with those provisions. Date: UIW�p Applicant: WARNING: FAILURE TO SECURE E ' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMI NALTIES AND CIVIL FINES UP TO ONE HUNDRED 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 above information is correct. J.agree to comply with all city and county ordinances and state laws relating to buil onstruction, and he authorize representatives of this c my o ant on the above-mentioned pro t r inspection pu as. Date: [I Signature (Applicant or Agent): Application Number . . . . . 05-00004145 Permit BUILDING PERMIT Additional desc . Permit Fee . . . . 667.50 Plan Check Fee 433.88 Issue Date . . . . Valuation . . . . 107330 Expiration Date . . 5/03/06 Qty Unit Charge Per Extension BASE FEE 639.50 8.00 ---------------------------------------------------------------------------- 3.5000 THOU BLDG 100,001-500,000 28.00 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 59.00 Plan Check Fee 14.75 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 5/03/06 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 9.0000 EA MECH B/C <=3HP/100K BTU 9.00 3.00 6.5000 EA MECH VENT FAN 19.50 1.00 ------------------------------------------- 6.5000 EA MECH EXHAUST HOOD -------------------------------- 6.50 Permit . . . ELEC-NEW RESIDENTIAL Additional desc . Permit Fee . . . . 97.66 Plan Check Fee 24.42 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 5/03/06 Qty Unit Charge Per Extension BASE FEE 15.00 1665.00 .03.50 ELEC NEW RES - 1 OR 2 FAMILY 58.28 469.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 9.38 1.00 ---------------------------------------------------------------------------- 15.0000 EA ELEC TEMPORARY POWER POLE• 15.00 Permit . . . . . PLUMBING Additional desc ... I'i rmiL Fee %5 . UU Issue Date . . . . Expiration Date . . 5/03/06 Qty Unit Charge Per BASE FEE 1.00 6.0000 EA PLB FIXTURE LQPERHIIT Plan Check Fee . . 18.75 Valuation . . . . 0 Extension 1.5.00 6.00 Application Number . . . . . 05-00004145 . Permit . . . . . PLUMBING Qty Unit Charge Per Extension 1.00 15.0000 EA PLB BUILDING SEWER 15.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM 9.00 6.00 .7500.EA PLB GAS PIPE >=5 4.50 1.00 15.0000 ---------------------------------------------------------------------------- EA PLB GAS METER 15.00 Permit GRADING PERMIT Additional desc . Permit Fee 15.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 5/03/06 Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments 1665 SF. SFD PERMIT DOES NOT INCLUDE BLOCK WALL, POOL/SPA OR DRIVEWAY APPROACH ---------------------------------------------------------------------------- Other Fees . . . . . . . ART IN PUBLIC PLACES -RES 20.00 DIF COMMUNITY CENTERS -RES 74.00 DIF CIVIC CENTER - RES 480.00 ENERGY REVIEW FEE 43.39 DIF FIRE PROTECTION -RES 140.00 DIF LIBRARIES - RES 355.00 DIF PARK MAINT FAC - RES 22.00 DIF PARKS/REC - RES 892.00 STRONG MOTION (SMI) - RES 10.73 DIF STREET MAINT FAC -RES 67.00 DIF TRANSPORTATION - RES 1666.00 Fee summary Charged ---------- Paid Credited -----------------------=------ Due ----------------- • Permit Fee Total 914.16 .00 .00 914.16 Plan Check Total 491.80 250.00 .00 241.80 bluer Fee 'roral 3'/'/U .12 .00 .00 3770.12 Grand Total 5176.08 250.00 .00 4926.08 LQPERDIIT I 4 f �/'O�A Po. Box 1504 APPLICATION ONLY Md ^ O.� O / 78-495 CALLE TAMPICO Addess ) v� ` QUINTA, CALIFORNIA 92253 Mailing Address City Corior / V1 Address (` %Z0VJ5 BUILDING: TYPE CONST. OCC. GRP. ra.. _ A.P. Number -724— 09y " 003 Tel. Legal Description � / 2 / 3 � �� s Project Description Zip & Classif. �' 2 ` 6 D In. # Designer Tel. Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under= of Chapter 9 (commencing with Section 000) of Division 3 of the Business and Professions Code, and my license is in full force and OWNER -BUILDER DECLARATION I reby affirm that I am exempt from the Contractor's License Law for the owing reason: SeC. 7031.5, Business end Professions Code: Any city or county whic equires a permit to amtruct, alter, improve, demolish, or repair any structure, prior to its suance also requires th applicant for such permit to file a signed statement that he is lice ed pursuant to the provisio of the Contractor's License Law, Chapter 9 (commencing wi Section 7000) of D''wsion 3 o!a Business and Professions Code, or that he is exempt the from, and the basis for the alleged emption. Any violation of Section 7031.5 by any applic t for a permit subjects the applicant to civil penalty of not more than live hundred dollars 500). ❑ I, as owner of t property, or my employees with wages as th ' sole compensation, will do the work, and the s cture is not intended or offered fat sale. ( c. 7044, Business and Profes- sions Code., The Co ctor's License Law does not apply t n owner of property who builds or improves thereon a who'does such work himself or t ough his own employees, provided that such Improvemen are not Intended -or offered ! sale. If, however, the building or im- provement is sold with'' one year of c mpletion, t owner -builder will have the burden of proving that he did not bu or improve or the p osa of sale). 0 I, as owner of the prope am exclu ely c tracting with licensed contractors to construct the project. (Sec. 7044, Busl ss and rot ions Code: The Contractor's License Law does not apply to an owner of pro pe wh' bu s or improves thereon, and who contracts for such projects with a contractor(s) tic se' rsuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason WOR ER'S COM ENSATION DECLARATION 1 hereby affirm that I h e a certificate consent to self -insure, or a certificate of Worker's Compensa10M rance, r a certified cop hereof. (Sec. 3800, Labor Code.) Policy No.Company ❑ Copwith a city. ❑ Certified c y is hereby furnished. CERTIFICATE OF EXE TION FROM WORKERS' COMPENSATI INSURANCE (This sectin t be completed if the permit is 10 one hundred dollars ($100) valuation or less). I certifa performance of the work for whi this Permit is issued, I shall not employ anin any manner so as to become subject Workers' Compensation Laws of California. DateOwner NOTICE TCANT.. If, after making this Certificate of Ex ption you should become subject tokers' Compensation Provisions of the Labor ode, you must forthwith comply witrovisions or this permit shall be deemed revoke CONSTRUCTION LENDING AGENCY I here y affirm that there is a construction lending agency for the pe\ehe once the work for which is permit is issued. (Sec. 3097, Civil Code.) Lender' Name Lender' Address T is is a building permit when properly filled out, signed and validaubject toexpir tion if work thereunder is suspended for 180 days. certify that I have read this application and state that the above Iorrect.I roe to comply with all city and county ordinances and state lawsb ildingc struction, and hereby authorize representatives of this city to enter en nedoperty for inspection purposes. Signature of applicant Mailing Address City, State, Zip WHITE = BUILDING DEPARTMENT Sq. Ft. nn No. No. Dw. SIZe .,C Stories Ilnits New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Valuation PERMIT AMOU T Plan Chk. Dep. SO Plan Chk. Bal. Const. Mech. Electrical Plumbing S.W. 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: Validated by:_ Validation: YELLOW = APPLICANT [rate Permit PINK = FINANCE At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered *ios/walkways, residential additions under 5 00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile ho mes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the -ollowing reason: EXEMPT This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $0.00 X 1,665 S.F. or $0.00 have been paid for the property listed atove and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By Exempt - Todd Berg Check No. Name on the check Telephone 340-4748 Funding Commercial By Dr. Doris Wilson Superintendent >, Fee collected /exempted by Sharon MCGilvrey Payment Recd ` Over/Urider_' Signature NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval pe7iod in which you may protest the fees o r 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 thdse amounts are paid to the District(s) or to another public entity authorized to collect them on the DistrictCs) behalf whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original -Building Department/Applicant Copy -Applicant/Receipt Copy -Accounting CERTIFICATE OF COMPLIANCE SIF Desert Sands Unified School District 4�J�', o 47950 Dune Palms Road BERMUDA DUNES r Date 11/14/05 La Quinta, CA 92253 to RANCHO MIRAGE (� INDIANWELLS 27855 (760) 771-8515 �P LMDESERT A GUINTyA7yNo. �INDIO � 0 Owner Building Horizons- Boys & Girls Club of C Valley APN # 774-064-003 Address 42-600 Cook Street, #120 Jurisdiction La Quinta city Palm Desert Zip 92211 Permit # Tract # Study Area Type Commercial No. of Units 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 53080 Avenida Villa 1665 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered *ios/walkways, residential additions under 5 00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile ho mes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the -ollowing reason: EXEMPT This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $0.00 X 1,665 S.F. or $0.00 have been paid for the property listed atove and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By Exempt - Todd Berg Check No. Name on the check Telephone 340-4748 Funding Commercial By Dr. Doris Wilson Superintendent >, Fee collected /exempted by Sharon MCGilvrey Payment Recd ` Over/Urider_' Signature NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval pe7iod in which you may protest the fees o r 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 thdse amounts are paid to the District(s) or to another public entity authorized to collect them on the DistrictCs) behalf whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original -Building Department/Applicant Copy -Applicant/Receipt Copy -Accounting 10 09/16/2005 ,10:15, 7603406388 �:drding Requested By' r t American Jitle Company When Recorded Mail Document and Tax Statement To: Mr. Dole Wissman 42600 Cook Street, #120 Palm Desert, CA 92211 `t„�� mnmiv I *"The undersigned grantors) declare(s) Documentary transfer tax Is S 145.20 4r1*A.� ( X ) computed on full value of property conveyed, or [ ) (;-t � computed on full value less value of liens or encumbrances remaining at time of sale, l Unincorporated Area City of La Quinte BUILDING HORIZONS PAGE 02 >>ieaisee= ea:sea x Q 0i 0 Page t of Z Qeo T Tax Paid Recorded In offlola/ Reoo�de ca+nty of Riverside Gary L. oreo Aseeseer, ICounty Clark Recorder 1 I (j/0 FOR A VALUAISIX CONSIDERATION, recdpt of which Is hereby acknowledged, Frank Myrl Griswold, Successor Trustee of The Henry Griswold Living Trust dated June 19, 1995 hereby GRANT(S) to Building Horizons, Inc., a California Corporation - the following described reel property In the City of La Quinta County of Riverside, State of California: 1'S Lots 20, 21, end 22, Block 205 of Santa Carmelite at Vale La Quinta, Unit #20, as per map recorded In Book 19, Page 38 of Maps, in the Office of the County Recorder of said County. DATED: October 14, 2002 STATE OF CALIFORNIA COUNTY OF ON before me, personally appeared 1% nNm4k L►vtb personally known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name( is/bp subscribed to the within instrument and acknowledged to me that he/N/thly executed the same in his/Rv/thhlr authorized capacity(iN, and that by his/RWtftr signature(Ift on the instrument the personN, or the entity upon behalf of which the personk acted, executed the instrument. Witness my hand and official seal, Frank Myrl Griswold, Successor Trustee of The Henry Griswold Living Trust dated June 19, 96 40 Frank Myrl Griswold, Tr tee LINDAA. GAGNON Cornmisaion * 1313093 Notary Public - California Orange County My COMM EsPi,-es Jul 13, 2005 MAIL TAX STATEMENTS AS DIRECTED A90VE FD -213 (Rev 7/96) GRANT DEED Wr edel�.■e.�em©� (j/0 FOR A VALUAISIX CONSIDERATION, recdpt of which Is hereby acknowledged, Frank Myrl Griswold, Successor Trustee of The Henry Griswold Living Trust dated June 19, 1995 hereby GRANT(S) to Building Horizons, Inc., a California Corporation - the following described reel property In the City of La Quinta County of Riverside, State of California: 1'S Lots 20, 21, end 22, Block 205 of Santa Carmelite at Vale La Quinta, Unit #20, as per map recorded In Book 19, Page 38 of Maps, in the Office of the County Recorder of said County. DATED: October 14, 2002 STATE OF CALIFORNIA COUNTY OF ON before me, personally appeared 1% nNm4k L►vtb personally known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name( is/bp subscribed to the within instrument and acknowledged to me that he/N/thly executed the same in his/Rv/thhlr authorized capacity(iN, and that by his/RWtftr signature(Ift on the instrument the personN, or the entity upon behalf of which the personk acted, executed the instrument. Witness my hand and official seal, Frank Myrl Griswold, Successor Trustee of The Henry Griswold Living Trust dated June 19, 96 40 Frank Myrl Griswold, Tr tee LINDAA. GAGNON Cornmisaion * 1313093 Notary Public - California Orange County My COMM EsPi,-es Jul 13, 2005 MAIL TAX STATEMENTS AS DIRECTED A90VE FD -213 (Rev 7/96) GRANT DEED r.. 12/12/2005 08:36, 7603415794 PSI PAGE 02 �+ ® In�Urn' fion , /r�� b Build On D - North East Cotner M- I n- D- M- + p- , TECHNICIAN: Glenn Meek Jr. ti COMMENTS: I = FILL MATERIAL A, TEST RESULTS COMPLY WITH SPECIFICATIONS 2 = BACKFILL. 8 - COMPACTION PERCENTAGE DOES NOT COMPLY WITH SPECINCATIONS 3 = BASE COURSE C = RETEST OF PREVIOUS TEST 4 = SUBBASE D = MOISTURE IN EXCESS OF SPECIFICATIONS 5 = SOIL CEMENT E = MOISTURE BELOW SPECIFICATIONS 6 = OTNIER Professional Service Industries, Ine. - 42.240 Green Way, Suite C- Palm 0e8e4, CA 92211 - Pion 76054%5790 • Fax 7601341.5794 YKVI; ivK ivirvmivx^i iv,4 _ s SOIL ID i# VISUAL CLASSIFICATION OF SOIL MAX. DRY DENSITY, PCP OPTIMUM MOISTURE, % FCOWACTIO74 Otey Course ! ine Sandy Soil 129.5 9.0° o REQU1REhiBNTS, A101$TURE RFQU,ReMENTs. 90.0% GETIERAL LOCATION: Nouse Pad SOIL TEST MOISTURE WET DRY TEST ID DEPTH, ELEVATION CONTENT, DENSITY prNS1TY PERCENT FQUOTIENT N0. RT-ADING / PCF NO IN OF TEST % ?CF PCF COMPACTION COMMENTS M- 1 129.9. 120.1 92.71/c 4A D South West Cotler M- F126.0 2 g.1% 116.6 90.0% 4A D - North East Cotner M- I n- D- M- + p- , TECHNICIAN: Glenn Meek Jr. ti COMMENTS: I = FILL MATERIAL A, TEST RESULTS COMPLY WITH SPECIFICATIONS 2 = BACKFILL. 8 - COMPACTION PERCENTAGE DOES NOT COMPLY WITH SPECINCATIONS 3 = BASE COURSE C = RETEST OF PREVIOUS TEST 4 = SUBBASE D = MOISTURE IN EXCESS OF SPECIFICATIONS 5 = SOIL CEMENT E = MOISTURE BELOW SPECIFICATIONS 6 = OTNIER Professional Service Industries, Ine. - 42.240 Green Way, Suite C- Palm 0e8e4, CA 92211 - Pion 76054%5790 • Fax 7601341.5794 12/12/2005 08:36 ti - 7603415794 PSI PAGE 03 Fes" do for=tion oT® Build Dec E,wnreejing • consuming • Tesom Report of Moisture Density Relationship of SOL ASTM D 1.557 Tested For: Building Horizons Test Data Visual Classification: Grey Course -Fine Sandy Soil Sample S,)urcc: Qneite Test Results Maximum Dry Density: 129.5 lbs/ft' optimum Moisture Content: 9.0 % Specific Gravity: 2.65 (estimate) i M Date: 2.:'06/05 Project: 073-50448 53080 Avenida Villa LA Quinta, Ca. Report. No.: I Lab Report No.: 46.3 Lab Tech.: 610111 Remarks: To �c Used in House Pad Moisture Density Relationship of Soil ASTM D1557 I 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14,0 Moisture Content (%} `c. Respectfully Submized, D =Onal ser/' 1 strias, Inc. Rick Ford Branch Manager R$PORT5 i,9AY NOT BE RF.ARODUCED. CXCEPT rN Fln.l., WirNOUT Wit MEN PERMISSION BY PROMSIDNAI.3RR'JICE WDUSTIMS. INC. Proles9ional Service Industries, Inc. • 42.240 Green way, Sulte C • Palm Desert, CA 92211 • Phone 70of341-5790 • Fax 750!34t-5794 Certificate of Occupancy J G OF Building Y & Safety Department y This Certificate is issued pursuant to the requirements of Section 109 of the California Building 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: 53-080 AVENIDA VILLA Use classification: SINGLE FAMILY DWELLING Building Permit No.: 05-4145 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC Owner of Building: BUILDING HORIZONS Address: 42-600 COOK ST. #120 City, ST, ZIP: PALM DESERT, CA. 92211 By: STEVE TRAXEL —�� Date: 06-20-2006 Building Official POST IN A CONSPICUOUS PLACE l' P.O. BOX 1504 APPLICATION ONLY Building�� 78-495 CALLE TAMPICO Address�� O 4 v� " � �� OUINTA, CALIFORNIA 92253 (V,'LOr-75 Mailing 1% Address tAZ _ non I.W�L�� • �� 1p R� 340 ->4 -?w9 ress & Classif. Q ► ') / / n I Lic. # Designer Address Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 000) of Division 3 of the Business and Professions Code, and my license is in full force and OWNER -BUILDER DECLARATION I t�by affirm that I am exempt from the Contractor's License Law for the owing reason: Sec. 7031.5, Business and Professions Code: Any city or county whit equires a permit to onstruct\d'dn alter, improve, demolish, or repair any structure, prior to its ' suance also requires thlicant for such permit [o file a signed statement that he is lice ed pursuant to the provisi! the Contractor's License Law, Chapter 9 (commencing wl Section 7000) of Division 3 Business and Professions Code, or that he is exempt the from, and the basis for the alleemption. Any violation of Section 7031.5 by any apph' a t for a permit subjects the appliccivil penalty o! not more than five hundred dollars F5500). O I, as owt property, or my employees with wages as th i sole compensation, will do the work, ae s cture isnot intended or offered for sale. ( c. 7044, Business and Profes- sions CodCo actor's License Law does not apply t n owner of property who builds or improveeon a who does such work himself or t ough his own employees, provided that such vement are not intended or offered ! sale. ll, however, the building or im- provementld with' one year of completion, t owner -builder will have the burden of proving thid not bu I or improve or the p ose of sale). ❑ I, as owner of the propert am exclu vely c trading with licensed contractors to construct the project. (Sec. 7044, Busi ss and ro! ions Code: The Contractor's License Law does not apply to an owner of prope wh bu' s or improves thereon, and who contracts for such projects with a contractor(s) tic se • rsuaW to the Contractor's License Law) ❑ 1 am exempt under Sec. B. & P.C. for this reason 1 hereby affirm that I t Compensation Insurance, Policy No. ❑ Copy is filed with a city. ❑ Certified co y is hereby furnished. IIIIII'CERTIFICATE OF EXpTION FROM WORKERS' COMPENSATION INSURANCE I be completed if the permit is to} one hundred dollars ($100) valuation e performance of the work for whi this permit is issued, I shall not any manner so as to become subject Workers' Compensation Laws of (ER'S COMPENSATION DECLARATION a certificate consent to self -insure, or a certificate of Worker's a certified copy hereof. (Sec. 3800, Labor Code.) - Company (This section need or less). I certify that it employ any perso) California. Date Owner NOTICE TO AP LICANT.• If, alter making this Certificate of subject to the orkers' Compensation provisions of the t comply with s h provisions or this permit shall be deemed i you should become you must forthwith CONSTRUCTION LENDING AGENCY I here � y affirm that there is a construction lending agency for the perto ance of the work for which is permit is issued. (Sec. 3097, Civil Code.) /expir Name Address is a building permit when properly filled out, signed and validated, and i subject to n if work thereunder is suspended for 180 days. ify that I have read this application and state that the above information is orrect. o comply with all city and county ordinances and state laws relating tob ilding tion, and hereby authorize representatives of this city to enter the above -men ned for inspection purposes. of applicant Date Mailing Ad City, State, BUILDING: TYPE CONST. SVIA OCC. GRP. A.P. Number % 7m — ® y ` 003 Legal Description IZITL 2]/� Q LK 2-0 Project Description �/ �-✓ ZONE: BY: Minimum Setback Distances: Front Setback Rear Setbact Side Street Se Side SetbacH ' FINAL DATE_ Issued by: Validated by: Validation: Date Permit WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE Sq. Ft.' , No. Size Stories No. Dw. Units New ❑ Add ❑ Alter •:1 Repair ❑ Demolition ❑ 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 Rear Setbact Side Street Se Side SetbacH ' FINAL DATE_ Issued by: Validated by: Validation: Date Permit WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE