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LICENSED CONTRACTOR DECLARATION~ V .
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. 69_�
-
License # Lic. Class ` Exp.,Date
47a21ei i'r . , 7
/Date
f� Signature of Contractor ' ( i
%i ,V (✓
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.
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 •TrA."i'ls[dORD Policy No. I:+J037
(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+if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I sha(� ll,forttpwith comply with thoseiprovisions�/ ,
V/Date: V ' 4 i Applicant -
le
r r
Warning: Failure to secure Workers'i0ompensation coverage i� 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 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,�elating to the building
construction, and hereby• authorize representatives)of this City to enter upon
the above-mentioned property for, inspection purposes.
Signature (Owner/Agent) / j l A Date
BUILDINGPERMIT PERMIT# � CONTROL# "
DATE VALUATION . ;.4f1 LOT TRACT
JOB SITE
5.A-965 AI�1t�ER1RA
APN
73--17 2-0':
ADDRESS
'
OWNER
CONTRACTOR/DESIGNER/ENGINEER
42••x+110 CCO 1, �;T 1 IIIET SU E _1.10
P.O.DRr't<NVliR 40310"
-flmm on"s .IVI", 0
IN0110 C',A 91.202
1110.1160
(6194.5/34-4175 MA, 3517
v,
USE OF PERMIT
1f3t:s�.�I h',dlfud.ii,lf .i�W}a'9.f•,E.NiiJ
.,
',S*T)A-t~+E12.[v JT U K;i;tTOF� i 1921:fR OF .9 0ARDNP`N WALL" AMl'1'LO"f+i.i'1I: f-vRMITS,1.6- 0Ct owriumlo
tiiA.i�FtCSG�C:t!l�POt2'i n,5ti Ot► �1%
"''
4 F f. WAI.A. 192,00 U.",
F';�§`i'1iMATED COST OF CI�f'�1�M1 CTION
104,051.40
-pi t-mp n'T F -1m,
(',*0Nq'1 RkU'','Tf0N F 0T, . . 101, -OM -412w (1f 0 S6.5_00)
PLAN c ,''"v .3,1•11: 101-{t00-439-'318 $54146:32
MM -LA L<WE 101,-000-•.j?1-000
M
1�'.I CMR11 L FEi� .OI�tK)0-�i'?{1,{liJC} $1'3;.27
—I O_
PL'UNIGINt.'a a 1414•ili3i3.41 -C4iQ °�"I2i.5ti
G>
Slftywl M(7.1'iON.Ffi'li - R.1i311? 1.01-000.241.-000
Q0 AJX1g0.F'F 101,000-421,000 S2f1:0i)
Q W
rnn.��S`!'1ZIJ'C""!''fllifil�'1::)s 17�.�ty-M13r�12 S2,.tf".�i"�
cn
1PR:I CiSEPLMN
AWF W PUBLIC PLl3CB8 - W_ISW 101-0611-315-000
C.0
vi111-1-T4rkd' LC0.1VS1LwT.3l.+'3 .0N, AN' 1.) PLAN CiJMS.9.
$_,832,63
LESS. 1?R -PAID .151-liS
42SO.00
TOTAL jP CR,IM 1,.1 F EVi D 1,,! LOW
RECEIPT
DATE
BY�� �`��� p
T 11 .
DATE FINALED
INSPECTOR
INSPECTION RECORD.
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Stab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap.
FI.A.U.
Framing
V_ —III
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
steel.
POOLS - SPAS
Set Backs
Electric Bond
Footings AXA10
Main Drain
Bond Beam
Approval to Cover.
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APP OVALS
Gas Test
Electric Final
3 —
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low.Vottage. Wiring
Fixtures
Main Service
Sub:Paneis' .
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
n. Final
Utility Notice (Perm)
COMMENTS:
W f,
Building
Address
Owner
-D-96S
Address —T —LSV C 06--r- `> i
4 4 " %68-686.
P.O. BOX 1504 APPLICATION ONLY
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
w C_
S tliV
CitZip Tel.
PAUM
Contractor
Address `t
{ `moi /P� Lc AVE
City L� �2Zj 3 Tel.
Zlp `
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer vJ�/�✓ '+.aCJ � "�►
Address P -D „} Tel.4
CitZi State
YPALM ��� . p Lic. #
LICENSED CONTRAC�t R'S DECLARATION
I hereby affirm that'f• am license' under provi$ ons of Chapter 9 (commencing with Section
7000) of D'vision 3 of tfie Basin Profe si ns C e, and my license is in full force and
effect. ( N ggLubd.C,/
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. 1!, 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.)
I 11, 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 properly 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 am exempt under Sec. B. 8 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
r] 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: I!, 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
ateMailing Address
City, State, Zip
BUILDING DIVISION
JILDING: TYPE CONST. tJOCC. GRP.
P. Number 1'72-02-
Legal Description
Project Description 4SFt>
Sq. Ft.
Size
New C!
mated
c� Stories Units
Add ❑
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
Alter ❑ Repair ❑ Demolition ❑
2
AMOUNT
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 t_e=it
Validated by:
. U) Validation: nrr� .___
CONSTRUCTION ESTIMATE
NO, ELECTRICAL FEES
NO. PLUMBING FEES
A.C. UNIT
1ST FL. SO. FT. @ $
UNITS
ROUGH PLUMB.
2ND FL. SQ. FT.
HEATING (ROUGH)
YARD SPKLR SYSTEM
POR. SQ. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @+
POWER OUTLET
ROOF DRAINS
GAS (ROUGH)
METER LOOP
DRAINAGE PIPING
CAR P. SD. FT. 0
REINF. STEEL
GAS (FINAL)
WALL SQ. FT. @
DRINKING FOUNTAIN
SO. FT. @
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
LUMBER GR.
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
VENTILATION
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11A c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING R AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
-
REMARKS:
VENTILATION
----
--
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
.FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
,,%FIEO
io c
-o
N BERMUDA DUNES r
RANCHO MIRAGE
INDIAN WELLS H
PALM DESERT
PLA OUINTA �a
,p INDIO )�
Desert Sands Unified -School District
82-879 Highway 111 - Indio, California 92201-5678 - (619) 775=3500 - FAX# (619) 775-3543
BOARD OF EDUCATION
Gilbert L Anderson
Tun A. Godecke
Jim Koedylter
Mut Moms
Amy Swan -Draper
To Whom It May Concern:
Facilities/Acquisitions/Construction
September 9, 1996
Desert Sands Unified School District hereby waives the payment of Developer Fees for
the Building Horizons Project located at:
51-975 Avenida Herrera
La Quinta, CA 92253
and
51-965 Avenida Herrera
La Quinta, CA 92253
If you have any question and/or concerns, please don't hesitate to contact me at (619)
775-3500, ext. 5272.
Sincerely,
Peggy Reyes, Manager III
Facilities/Acquisition/Construction
RECORDING REQUESTED BY:
Fidelity National Title Company
Escrow No. 1 -MP
Title Order No. 8576
When Recorded Mail Document
and Tax Statement To:
13UItDING HORIZONS
P.O. BOX 10320
INDIO, CA 92202
(Certified to be a true and Correct
Copy of (
Recorded moi?
AAs Instrument No.
.Of Official Records of
�o4nty,- Catitarcua
IDELITY NAT. IGNAL TITLE,
GRANT DEED SPACE ABOVE THIS LINE FOR RECORDER'S
The undersigned grantor(s) declare(s)
Documentary transfer tax is $ 15.95
f X ) computed on full value of property conveyed, or
computed on full value less value of liens or encumbrances remaining at time of sale,
( X ) Unincorporated Area City of
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Laura E. Root trustee and successor
trustee of The Root Family Living Trust, which trust was executed November 22, 1991, who acquired title as Everett
M. Root and Laura E. Root Co -Trustees of the Root Family Living Trust, which trust was executed November 22, 1991.
hereby GRANT(S) to BUILDING HORIZONS, INC., A CALIFORNIA NONPROFIT PUBLIC
BENEFIT CORPORATION
the following described real property in the County of Riverside, State of California:
Lot 11 of Block 60 Santa Carmelita, Unit No. 5 as per Map recorded in the Office of the County Recorder of Riverside
County at Page 63 of Book 18 of Maps.
DATED: June 28, 1996
STATE OF CA IFORNI
COUNTY OF
ON V L before me,
( I -5W E personally appeared
/_ A -u �2 4 r✓ oT
- rmonalLyknown to me 12LpLoved to me on the basis
of satisfactory evidence) to be the person(s) whose
names) ire subscribed to the within instrument and
acknowledged to me that he/they executed the
same in his /their authorized capacity(ies), and that
by his/ 1�f their signature(s) on the instrument the
person(s), or the entity upon behalf of which the
person(s) acted, Wcuted the_Lnstrument.
Witness my ha d of gal eal
r-
Signatur
2-
The Root Family Living Trust, which trust was executed
November 22, 1991 /
By: �e Q A k1ft-A
Laura E. Root, successor Trustee and Trustee
tMg RM ANNA
• �•' � No+ay r„b�o -, t�aitraria
UX ANOA9 COLM
Mr C—; ewv« Ara 241"9
MAIL TAX STATEMENTS AS DIRECTED ABOVE
FD -213 (Rev 91941 GnANT DEED
STRUCTURAL AND CIVIL ENGINEERING
DENISE R."POELTLER, INC..
134661 Highway 111 .o Suite G o Palm Desert; California 92260
3 September. 1996
STEPHENr,JONES, General Contractor
P._ O. Drawer 4656
Palm4Desert; CA 922.61
RE -BUILDING HORIZONS
51-965 Avenida Herrera
51-975 Avenida" Herrera.
Dear Mr. Jones;
I have reviewed the-,dead°and live loads used f.or the design.
of gang -nail wood trusses provided by SPATE&,FABRICATORS-, and
found'them' in substantial conformance with my'o'rigina1 design
loads.
Respectfully submitted,
Denise R. Poeltler
R . 33446;
DRP/ lm wo` POI�r�Fyp,
W.O. #96-178 a`' No, 39446
CC: Stephen Jones.
Ezp.6- -�
(619) 779-0405 0 FAX (619f 779-1317