9608-087 (SFD)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 f., Lic. Class Exp. Date,,
4fJ216 is f f�1ryt
to f-'� Signature of Contractor+7,%� X /I
., f V, J -
OWNER -BU ILDER'DECLARATION
I hereby affirm under penalty of perjurQhat 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 Sianature 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.
( II 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 iT'lal`fvT�t1'1viJ Policy No. L1ti73h
(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 Irshould become
subject to the workers' compensation', provisions of Section 3700 of the Labor
Cdde, I shall forthwith comply with hose provisions./ '
Date: r'r e " • :i I _ Applicant--
Warning:
pplicant Warning: Failure to secure Woiikers' 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.
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 representatives of this City to enter upon
,the above-mentioned property for inspection purposes.
i
<sSinature (Owner/Agent) �, Date
BUILDING PERMIT PERM'T,fy� CONTROL#
DATE 9/1"16 1 "16 VALUATION 5101184.7.20 LOT TRACT 4120
JOB SITE Si-`. 7S AV ll'aiHIA atEkilill i
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
f'cJ1I,IMtP :11109 ; .1"iS,1",;✓.
T( 1: S,, COT()R1'
,12-60 CCK)K. N'REE.i`Si-iITE 110
P,G. DRAWER 102.0
1'f1LM DEISM.', Cc
INDIO CA 9x2022
836.-1 i 60
(619)% 44175 4175 (13L# 3,517
USE OF PERMIT
3 ( i ( y (51�9f y y
N"Ildcil.rl. !'fl �'1L1e� 13 VV J:�eI I!'CO
n
SLS I;f�ML'1:2t�i1'L' INC,t:fJIJLH �t�il�t` e�E' t' ��iL�,13�?N WALL. ALL>I'1'3e�3�tA1. F�t+lie�ii'C`� `.C1�.131; �ii'L',t1NLif�
GARA0FiC1VR,,Pr,q.f` 439.M SI"
41' r. WALL 44 00 'L
1;+,US'iTMA`4'.ED COST OF CO1ISTRU "flTIONv
400,:147,24)
t'E3t1V€ T FRE SUMNIARY
CC, NSTIRIfr,`s!0N 17EM '1x01-Wl 438-000 00
PLAN G lEIC K 4"I'MI, 110149)6-439-315 13.35.3.1
tali., wipoC 3%'i .$250.00
' ME-CHANTICA.L F03 10.1«00 l-421-()(10 $53.50
c.0
1 fi'f"'rtLlC7/!1. f�.FC; .J01-000-470-000
(,1"0mAi�'NoME 1.01.000-419-000 11.13.30
C,
'1VNCrW-10,140Nf*EE.-11E.h) 1.01.-000-241-W 1,0.08
«itAlylNt! F' ;E3 L01 -U( 4'223 aC>,1 $ 8A0
Q CL
fNFRA TRf, Y71' 000 '.1, F9 22540-443-342 V,2147.63cin
#".RVCISU IILf.V4 4(11-000-14.1.3,49 123.itU
ART IN V013O.0 flLAICS - RIi8%L' 70i -000-:1"55-M0 $211.4
SUB-T(WA'L CONS1 RUt,"IION AND PLAN C1`11 CK
LESS PRE -PAID V 1~rS
-Sz50.01)
•:4 QFAL PERMIT FEES l2tJEe NOW.
�S3i�41�,24
A
RECEIPT
DATE
BY.; (�
-4F�La MAA V g
DATE FINALED
INSPECTOR
1
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel,
Combustion Air
Roof Deck
Q
Exhaust Fans
O.K. to.Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
steel
POOLS! -SPAS
Set Backs
Electric Bond
Footings //
S'
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg, Test
Final
Gas Piping
PLUMBING' APPROVA S
Gas Test
Electric Final
--01 7..
Waste Lines
/:/Zm
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 APP OVALS
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:
4
f P.O. BOX 1504 APPLICATION ONLY
Building 7 7&105 CALLE ESTADO
Address ( ( fes' AU�J) LA QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. :�EtJlll OCC.GRP.
Mailing /` 1
Address- (.b U CQoa� '5r,— S + t O A.P. Number % `2
Cit Zip Tel.
Legal Description
Contractor S I ..a �„� Project Description
7- 11cc.o 32E fAv
Address
/ A/� �9.5� -PA2� AU
S
City Zip 97
7
j Tel. / i_4t _
State Lic. City '�7
& Classif. Lic. #
Designer �(-vZ> t
Address Iv -465(. Tel. 34
City , Zip State
f11t.AA fkSW ajZZ�I Lic.#
- 9 (commencing with Section
my license' m full force nd
� - l4-�i
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 703 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 or not more than five hundred dollars ($500).
17 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. If, 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 i 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 or property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
I I I am exempt under Sec. B. 8 P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
Ihereby 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
n Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(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 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 shalt 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
BUILDING DIVISION
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 j�o�
�1
Validated by:
Validation:
1 By ,/Z�i
Ft. 1 '
Siz
Size �
Stories
Stories Unitss
t
New), Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
�Zj, 049
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
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by: Date j�o�
�1
Validated by:
Validation:
1 By ,/Z�i
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FE?q
IST FL. SO. FT. $
UNITS
HEATING (ROUGH)
2ND FL. SO. FT. @
FORMS
YARD SPKLR SYSTEM �)
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. @
GAS (ROUGH)
METER LOOP
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
GAS (FINAL),
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. @
GROUT
WATER HEATER
WALL SO. FT. @
FINAL INSP.
DRINKING FOUNTAIN
SO. FT. @
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
LATHING
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1Y. c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/4c
HOUSE SEWER
FINISH GRADING
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 & 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.
FFNf:F FINAI
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
CORDING REQUESTED BY:
fidelity National Title Company
Escrow No. 2 -Mr
Title Order No. (1577
When Recorded Mail Document
and Tax Statement To:
BUILDING HORIZONS
P.O. BOX 10320
INDIO, CA 92202
Certified to e a true and correct
copy ofn"'�
Recorded 19
As Instrument No. 5 �(5 32
of Official Records of
County, Californ'
by_
LIDELITY NATIONAL TITLE CO.
GRANT DEED SPACE ABOVE THIS LINE FOR RECORDER'S USE
The undersigned grantors) declares)
Documentary transfer tax is $ 16. 50
1 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, James C. Belknap, Jr., Trustee of
the James Belknap Separate Trust dated May 5, 1992
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 12 in Block 60 of Santa Carmelita at Vale La Quinta, Unit 5 as per Map recorded in Book 18, Page 63 of Maps,
Records of Riverside County, California.
DATED: June 28, 1996
STATE OF CALIF RNJA
COUNTY OF L--fT//Y/,
,/. �i '.'i.'/tel/� .�.�.if�lL�,�w�. • .before me—
appeared
personally known to me (or proved to me on the basis
of satisfactory evidence) to be the person(s) whose
name(s) is/are subscribed to the within instrument and
acknowledged to me that he/she/they executed the
same in his/her/their authorized capacity(ies), and that
by his/her/their signature(s) on the instrument the
person(s), or the entity upon behalf of which the
person(s) acted, executed the instrument.
Witness my hand and official seat.
���
Signature C�iul1�
Jami s C. Belknap, Jr., Trustee.of the James Belknap
Separ to Trus daRed May 5, 1992
13.
James . Belknap, Jlt, Trustee ( k
JACALENE AMA SCOTT
-
Corn Won 1 106W7
7-101ary Pubtlf — Coliternto ..
RIVEWADE COUNTY
My Comm. E,cplrse Ju173. 19W
MAIL TAX STATEMENTS AS DIRECTED ABOVE
FD -213 (Rev 9/94) GRANT DEED
w
"XtfIEp
_
—0
N BERMUDA DUNES r
RANCHO MIRAGE
INDIAN WELLS N
PALM DESERT a
J LA OUINTA
'Jp INDIO
Desert Sands Unified -School District
82-879 Highway 111 • Indio, Califomia 92201-5678 - (619) 775-3500 - FAX# (619) 775-3543
BOARD OF EDUCATION
Gilbert L Anderson
Tina A. Go&cke
Tim Koedyker
Mut Monica
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
ullpe J
STRUCTURAL AND CIVIL ENGINEERING
DENISE R. POELTLER, INC.
73.661 Highway 111 .e Suite G ® Palm Desert, California 92260
3 September 1996
STEPHEN JONES, General Contractor
P. 0. Drawer 4656
Palm Desert., CA 92261'
RE: BUILDING HORIZONS
51-965 Avenida Herrera
51-975 Avenida'Herrera
Dear Mr. .Jones:
I have reviewed the dead arid'live loads used for the design
of gang -nail wood trusses provided by SPATES FABRICATORS, and
found -them in substantial conformance with my original. -design
loads.
Respectfully submitted,
Denise.R. Poeltler
R.C.E. 33446
DRP/ lrn
W.O. #96-178
CC: Stephen Jones
(619) 779-0405 0 FAX (619) 779-1317