9709-136 (SFD)LICENSED CONTRACTOR DECLARATION
f hereby affirm under penalty of perjury that I am licensed under provisions of
Obapter 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
o4 341 y`7 -- f ,% X1199
Date) Signature of ContractoF�
i OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury�that l 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.
(� 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.
(This section e d nootNbe completed. if the permit valuation I1196735 frr 0.00 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 if I should become
Subject to the workers' compensation' -provisions of Section 3700. of th°e Labor
Code, I shall forthwith comply with those provisions: %%
Date: Al /1 f /7 ? Applicant k I : ^sem •; / /f t
Warning Failure to secure Workers' 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 certifythat 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
t e above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
BUILDINGPERMIT PERMIT# CONTROL# -
DATE VALUATION LOT 9709-136 TRACT
61,157
IQ/721 '7 $90.1120.30 4 BW V LQ5
JOB SITE
APN
ADDRESS
51-825 AVENIDA HERRERA
773-1.72-016
OWNER
CONTRACTOR / DESIGNER / ENGINEER
BUILDING HORZONS
JOE StTKO CONSTRUCTION
42600 CWK. ST .TI'E 110
PALM DESEwr CA 92211
BE A4UDA DUNES CA 92201
(760)360-6 t 18 CBL#F .'3002
USE OF PERMIT
Sl -D - PERMIT DOES NOT INCLUDE, BLOCK WALLS OR POOL. PLM
CHECK PORTION OFFETS :REDUCED 75% FOR MLJLTIP1.F ISSUANCE or, ,
q Amy- Pr AM nw
TRACT CONSTRUCTION 1,4467.00 SF
PO CWPATIO 66.00 Sr
GARAO&CARPORT 489.00 SF
EYT['Mr?►TED C081' Ole` CONSTRUCTION
PER AIff FEE SUMMARY
CONSTRUC11014 FH, 101-000-41(1-000 $599.00
PLAN CHECK FEE 101-000-439-3.1& $126.65
FEE DEPOSIT 4230.00
M9 HANICAL FEE 101-000-421 <000 $60.00
ELEZ17R1CAL FEE, 101-000-420-000 $1.24.63
PLUMBING FEE 101-000-413-000 $128.75
STRONG MOTION FEE - RESI.D 101-000.241-000 $9.01
OP.AD:1NO f 1{'il (3ti0-423 $20.00
fNFR.AVrRUCTURE FEE 2Z5 -WO -443-342 $2,007,96
PRECISE PLAN ha41-000441.345 $25:00
f
Pt;
SUB-T((T kL CONSrRUC7'tON AND PLAN CHECK
$3,101.00
OCT. 2 1997. LESS P.{U--P.AID FEES
.4250.00
`I'OTAt., IPEZAi1T 1FEVS I)UF NU4v
$2,851.00
C IS 0 9= s I NITA
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
I
w %,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
_
Return Air
Steel
A
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
%
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace 131.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
I
Equipment Enclosure
Shower Pans
t
O.K. for Finish Plaster
Sewer lateralZ
Pool Cover
Sewer Connection
r %
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APP RO ALS
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 j` -g
' w 1•. .r .� '�� .. -' ^ •t 4" • c.r �:..+5,. t'�"' IL �'. �.yr.'-�s+pr�-n3'� .+� n..'.%.�. w� ?>r-.. „, :•�a',.j ", �:'tr�-.y:�.-��-../.r'��_ • ''t-
7_6? Ave t'Oe—a&eA P.O. BOX 1504 APPLICATION ONLY
Building /�� UINT CALLE CALIFORNIATAMPIO
Address ✓� LA QUINTA, ORNIA 92253
Owner
Mailing '
Address
city, Zip Tel.
Contractor �' Q
57/
Aaaress
5'7. SPS //v
City Zip y Tel y+
State Lic. 'J 9y Cittyj
& Classif. �s 7 7J �/L Lic. #
Arch., Engr.,
Designer _-ZoN�
Iss
flr Tel �L
C'C�,q IZIp / (State
''' / Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed underdprA�risions o C1�aptgT 9 (commencing with Section
71X10) of ivisiorP3"o the Business nd Pr assions o e, Gd my license is in full force and
effect. /l/
NAT R T DATE
NER-BUILDER DECLARATION
I hereby ifir hat I am exempt from the Contractor's License Law for the following
reason: (Sec.�P 1.5.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-,' I, as owner of the property, or my employees with wages as their sole compensation, will
d0 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 •ere 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 'hat he did not build or improve for the purpose of sale.)
Vl 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.)
0 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 Co, ns EM
.Ins rance, or a ce ted co t ereo Sec. 3800, Labor Code.)
P A�
Policy �N9r r � �� Company !�
ty�c:opy 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 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: 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 sof this city to enter the above.
mentioned property for inspection purposes.
Signature of a0plicant Date
Mailing Address
City, State, Zip
BUILDING: TYP.E�'fCO�NST.-5r OCC. GRP. 't
A.P. Number / / 3/%'
Legal Description 40(—' ,i
Project Description /47" W44,9 4,09- 4X V /WPI— GW
�4
Sq. Ft.)'6 No.
A
Size 7 Stories
Newt Add ❑ Alter ❑
/ No. Dw.
Units
IEstimated Valuation /�� 9
A1711. v Y
Repair ❑ Demolition ❑
PERMIT AMOUNT
Plan Chk. Dep. ,;2 5 61 .��
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 A
Side!Setback from Propert
VAA
FINAL DATE INSPECTO
Issued by: Date c±r__rEeL. 97
Validated by:
Validation: GIIY O- F C I IINTA
ft
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
V 4
�%FIED
O
Z 'r
—0
h BERMUDA DUNES r
r RANCHO MIRAGE 0
6 INDIAN WELLS y
PALM DESERT b
•� LA OUINTA
0 INDIO
Desert Sands Unified School District
47-950 Dune Palms Road • La Quinta. California 92253 • (760) 777-4200
October 14, 1996
To Whom It May Concern:
Desert Sands Unified School District hereby waives the payment of Developer Fees for the
Building Horizons Project located at:
51-805 Avenida Herrera 51-825 Avenida Herrera ,
La Quinta, CA 92253 La Quinta, CA 92253 4
and
73-378 Royal Palm Dr. 73-386 Royal Palm Dr.
Palm Desert, CA 92260 Palm Desert, CA 92260
If you have any question and/or concerns, please don't hesitate to contact me at (760) 771-8515.
Sincerely,
Peggy Reyes, Director
Facilities Services
RECORDING REOUESTED BY
=; CHICAGO TITLI COMPAA'Y
AND WHEN REVORUL) MAIL 7Y)
f
Building HorizonA
�* P.O. BOx 1440
La Quinta, Ca 92253
194989
C
RECEI
AT
:L
JUN - 9 i997
rkam.w non
of 16�M" �
L Fees
ticrow No. �eie004 --st3
-Order W.-7-amooi
APACE PAM rM UNE FON UE
GRANT DEED Tse oz
lleeeeeer• oel �;
773-17Z
THE UNDERSIGNED GRANTOR(S) DMAWS)
DOCUMENrARy 71 AMMRTAX IS NONE -CORRECTION DEED
® WdMaMorated area ❑ Chy d
® MMputed 0n the futl valve or the inteteat 0r property conveyed, or is
❑ ooasfil xl on the &D value leu the valve of IMM of eW ebranaa remaining at tiff of ale, and t?
FOR A VALUABLE CONSIDERATION,reoeiPt of which is hereby ackn ed,
BUILDING HORIZONS, INC., A CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION, WHO
ACQUIRED TITLE AS BUILDING HORIZONS, A CALIFORNIA CORPORATION
hereby GRANT(S) to
BUILDING He.ORIZONS, INC., A CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION
the following deunbed rent property in the
County Of RIVERSIDE , State of Cltlifornia:
LOT 4, BLACK 60 OF UNIT 5 OF BANTA CARMELITA AT _VALE LA QUINTA UNIT NO. 5, IN THE CM. -
OF, LA QUINTA, AS SHOWN BY MAP ON FILE IN BOOR Is. PAGE 63,,,0E -MAPS, RECORDS OF..
-1P1vnSIDz MURTY. -- _
Dated May 27, 1997
STATEOF CALIFORNIA
COUNTY OF RIVERSIDE } SS.
On– MAY 30 --1997
MARIE T. JONES/NOTARY PUBLIC
A Notary Public In and for aald County and Stab, PenonalIy aPPeared
BETTY WILLIAMS AND j. DUCATTE
Porsonal►y known to me (a Proved to me on to Wale of &esjW&Mfy
win e) to be ft Pemon(s) whose nano(s) jl/are aubeorlbed to the
within Inatrumant and acknowledged 11O n* that /may ex a uts the
Sarna In *I their authorized capacMypea), and ghat by.*k&ar/tMlr
a+pr,aturG(S) on the Irlatrun»nt Nle person(a), or the ermy upon bow of
which the Person (a) aimed, exearbd the Instrument.
WITNESS my hand and o"I al asal.
pne urs of ry
MAUL TAX 111TATEMENT8 TO SHOWN PPI FOLLOiWIN(>I UNE:
MME t SBx
CWmM1 / Iwo
NOWY Ape —Odame
@a** � bv6" AIN x M
FOR NOTARY SEAL OR ffAMP
IF NO PARTY SO SHOWN, MAIL AS DIRECTED ABOVE
nta, Ca 92253
W1 -10/181"" w�. FWAU.MW chy, stab & ZIP
JCM Inspections
39725 Garand Lane Suite G
Palm Desert, CA 92211
Phone: 760-345-5554 • Fax: 760-772-3895
Project Name:
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Project No:
"'
Date:
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Project Addre!! ..� j
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Architect:
Structural Engineer:;
p n(1%s S • \4
Location of Samples:
Welding Process / Electrodes:
— �'•�
Slump (inches): Supplier:
Time Sampled: Mix Design:
Welders:
Time in Mixer: Specified Strength:
Water Added @ Jobsite: Admixture:
Concrete Temperature: Truck #:
Ambient Air Temperature: Field I.D. Marking:
Description of Work Inspected:
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N N
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JCM Inspections
39725 Garand Lane Suite G
Palm Desert, CA 92211
Phone: 760-345-5554 • Fax: 760-772-3895
Project Name:
Project No:
Date:
4-3-16
Project Address:
Wow
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t
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Architect:
Structural Engineer:
Location of Samples:
r
Welding Process / Electrodes:
Slump (inches): Su plief
Time Sampled:
Mix Design:
Welders:
Time in Mixer: Specified Strength:
Water Added @ Jobsite:
Admixture:
Concrete Temperature:
Truck #:
Ambient Air Temperature:
Field I.D. Marking:
Description of Work Inspected:
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Copy 2 Proijec, SuperintendeCopy 3 Governing Agency
WESTERN INSULATION, INC.
4211 Latham Street, Riverside, California 92501
(909( 686-8760
(909) 686-8786 Fax
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE
CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24, STATE OF
CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT/ PHASE: BOYS AND GIRLS CLUB OF TRACT #:
COACHELLA VALLEY
LOT#:
SITE ADDRESS: 51-825 AVENIDA HERRERA, LA QUINTA, CA
-----------------------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 5 1/2" R -VALUE: R-21
CEILINGS : BATTS BLOW
MANUFACTURER: GREENSTONE IND. THICKNESS: 10.3" R -VALUE: R-38
GENERAL CONTRACTOR: BUILDING HORIZONS
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC
LICENSE NUMBER: 481278
BY:
TITLE: Product4n Man ler
DATE: JUNE12, 1998
q
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:
51-825 AVENIDA HERRERA
Use Classification:
SINGLE FAMILY DWELLING
Bldg. Permit No.:
9709-136
Occupancy Group:
R-3 Type of Construction:
VN Land Use Zone:
RC
Owner of Building: BUILDING HORIZONS
Building Official
Address: 42-600 COOK ST STE 110
City: PALM DESERT, CA., 92211
By: DANIEL P. CRAWFORD JR.
Date: 8/21/98
POST IN A CONSPICUOUS PLACE