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0010-225 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penall,, erjyry that I am licensed under provisions of CIMS/* Chapter 9 (commencing wit, Se 'Jon 7060) of Division 3 of the Business 'and Professionals Code, and my Lice �e is In full force and effect. License # Lic. Class Exp. Date "Date Signatur&of Contractor 1.— 0 OWNER -BUILDER DECLARATION U.1 LU I hereby affirm under penalty of perjury that I aryi,exempt from the Contra6tor's License Law for the following reason: Z 1, 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 ol sale (Sec. 7044, Business & Professionals Code). ( ) 1, as owner of the property, am exclusively contracting with dicensed, contractors to construct the project (Sec. 7044, Business &,,Professionals co I am exempt under Section —, B&P.C. for this reason LO 04 Date Signature of Owner WORKER'S COMPENSATION DECLARATIOW 1 hereby affirm under penalty of perjury one of the followin declarations: Lo It 0 1 have and will maintain a certificate of consent to self -insure for workers' X LIJ U_� compensation, as provided for by Section 3700 of the Labor Code, for the 0 _J _J performance of the work for which this permit is issued. 0 1 have and will maintain workers' compensation insurance, as required by d SeCtion 3700 of the Labor Code, for the performance of the work for which this LO p6rmit is issued. My workers' compensation insurance carrier & policy no. ar . e: Z Carrier Policy No. < (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 shall fort�,,with comply with those proviCions. "'Warning: Failure to secure Workers' Compensation coverage. is unlawful and shall subject an employer to criminal penalties and civil fines up to $1 - 00,000, 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 1. Each person upon whose behalf this application is made & each person MO. whose request and for whose benefit work is performed under or pursuant t6i any permit issued as a result of this applicaton agrees to, & shall, indemnify A 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 ins ion purposes. PERMIT # BUILDING PERMIT DATE YALUATION LOT. 001iD_1)2#J TRACT JOB SITE APN ADDR OWNER. CONTRACTOR ,V_AN­.MNAXr)7X0 CA 92407. 49AR BERNADWO CA 92423-0! YSE OF PERMIT TRACT CONSTRUCTION 112000 SF PORCHAPAVO 165.08 UP 5 Fr, WOOD YRNCE 200.60 LY SP M-104STRAXTIMI WE 101-000-418-000 WPM IM CHANICAL'ME, 101-000-A21-000 XLIXTRIQAL "EF, 101 -OW -420 -WO PMUMM0 PER 101-000-419-000 STROW40 h90TILYN FEF - =2D 101 -W" 0-2A 1 -000 RIAINNS 0 FEE 101-000-423-000 kMZ DEPOSIT 101-000-439-318 ID IMEALFERKU FUES MY- NOW $*, "'An OCT 3 0 2000' V17 LA QUINT INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms& Footings _ _ _ _ �y1 ff/B� Under round Ducts Ducts Slab Grade ` Return Air Steel Combustion Air Roof Deck �7 L /J.�1 l 7 Exhaust Fans O.K. to Wrap L F.A.U. Framing /_ _ �L `/�'� Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs G 3.6 4 l 'g� —� _ �-� Electric Bond Footings Main Drain Bond Beam /! 3�p g Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines _ _ _ ©y/` Heater Final Water Piping �d9 Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection S 7 Encapsulation Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS 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) Building Address 1 f'ry Owner JCA f f Y ; �.. 5t> A)5 Mailing Address P "7A/ 4 City Zip ;N ?0, A ,►�f 4'2`�UZ Contractor Address City zip T4ht 4 4 Qum& J\ v P.O. BOX 1504 78-495 CALLE TAMPICO APPL ATION ON Y� LA QUINTA, CALIFORNIA 92253 �vvJ BUILDING: TYPE'CONST. CC. GRP. A.P. Number _% 73 -1 Legal Description / 1 State Lic.City & Classif. -79Q Lic. #t 4 Q Arch., Engr., Designer P Plf Address Tel. 9 0 A0. M E• A)Do-,�4 740 6</ l2R 2 City Zip State e.n. g2.aS3 Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division °df th usineU and Prof�sions Code, and my license is in full force and effec/I I" , ; � f X.[rs.("IttY" ��->/(j"-D10 SIGNATURE ''3 DATE OWNER -BUILDER DECLARATION I hereby affirm that 1 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 thealleged 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). t 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. 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 of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law.) 11 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 (7 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 lhp 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 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. 1 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 allplicant Date Mailing Address City, State, Zip Project Description Sq. Ft.No. Size C_ t/ , No. Dw. Stories Units New„ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT h AMOUNT Plan Chk. Dep. �' . ' " .-._cif -- ��- Plan Chk. Bal. E 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 Lirie FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Desert Sands Unified School District 47=950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF -COMPLIANCE Date 10/30/00 No. 21151 Owner NameFour Seasons Homes No, 52-930 CityLa Quinta Tract # Street Avenida Herrera Lot # 17 APN # 773-325-010 Jurisdiction La Ouinta zip 92253 Permit # Log # Study Area Square Footage 1218 Type of Development Single Family Residence No. of Units 1 Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It has been determined the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 2.05 X 1,218 or $ 2,496.90 the property listed above and,that'building permits and/or Certificates of Occupancy for this square footage in this proposed project may now lib issued Fees Paid By CC / Citizens Business Bank / Michael Stubbs Telephone Name on the check By Dr. Doris Wilson , Superintendent Fee collected /exe ted by Annette Barlow Signature vvv"� 5!L �ro Payment Received $2,496.90 Check No. 375609 10TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified bove will begin to run from the date on which the building or installation permit for this, project is sssued or on which they are paid to the District(s) or to another public entity authorized to ollect them on the Distdct('s)(s') behalf, whichever is earlier. Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting 1 RC DISTRICT - PLANNING REVIEW FORM This form is to be used by CDD staff for review of single family dwellings in the RC (Cove Residential) District, in order to determine the applicability of compatibility issues or need to require the filing of Master Design Guidelines by the applicant. It shall be transmitted to the Building and Safety Department as your correction list. Please attach additional explanations as necessary. APPLICANT PSI BUILDERS SITE ADDRESS 52-930 .Avenida Herrera APN 773 - 325 - 01`,0 * BIN NO.: CASE NO.: 2000-331 LEGAL: LOT 17 BLOCK UNIT S.C.@V.L.Q. CHECKED BY: Stan Sawa DATE: Inform the assigned Building plan checker upon your assignment to this case. The CDD Executive Secretary maintains a log book to track applications and assign case numbers. REQUIRED ITEM Y N COMMENT/CORRECTION Compatibility Review Case logged and number assigned Verify legal and APN information Consistent with MDG on file (as.applicable . MDG filing required (5 filings since 9/3/98) Consistency with street/surrounding area: ` Colors Materials Architecture Other Requirements: YV ayiC- ,DLI b l B � 1x+v� usz�, • C.Inav�ti2 Lmi7 why M����b . Cil -9dr .4-�'bUCA Ab ly3t )e <<�-�PM17J�. ��� t�I� tavv"m TAlo Co. RECORDING REQUESTED BY AND WHEN RECORDED MAIL THIS DEED AND, UNLESS OTHERWISE SHOWN BELOW, MAIL TAX STATEMENTS TO: Name FOUR SEASONS HOMES, INC. 670 N. Arrowhead Avenue Address San Bernardino, CA 92402 city & State -'ice 0210 TT -100 (Rev. 1/99) APN No. 773-325-010-2 DOC a 1999—a7sa l6 08/23/1999 08:00A Fee:9.00 Page 1 of 2 Doc 'T Tax Paid Recorded in Official Records County of Riverside Gary L. Orso Assessor, County Clerk 8 Recorder 11111111111111111111111111111111111111111111111111 I I I M S U PAGE SIZE DA POOR NOCOR SMF MISC. A R L COPY I LONG REFUND I NCHG EXAM GRANT DEED Title No. 436933-23 Escrow No. 7227-K THE UNDERSIGNED GRANTOR(s) DECLARE(s) DOCUMENTARY TRANSFER TAX is $ /5. �V CITY TAX $ XX computed on full value of property conveyed, or ❑ computed on full value less value of liens or encumbrances remaining at time of sale, • Unincorporated area: 19 City of La Ouinta Y1 FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, DRAGO C. VINSKI and MIRA-VINSKI, husband and wife hereby GRANT(s) to FOUR SEASONS HOMES, INC., a California Corporation v the following described real property in the County of Riverside , State of California: ,and ,Lot 17 of Block 160 of SANTA CARMELITA AT'VALE LA OUINTA, Unit No. 16, in the City of La Ouinta, County of Rivexside,'State of California, as per Map recorded in Book 18, page 99 of Maps, in the Office of the County Recorder of Riverside County, California. Dated: June 18, 1999 Drago C. V ski Mira Vinski State of California 1 S5. County of wt s htv.Gi v teS t On I eicl before me, A"+ems F, Ilk x e -s A A (here Insert name) Notary Public, personally appeared personally known to me (or prov4d 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 all that he/she/they executed the same in his/her/their authorized capacity(les), 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 seal. Signature MAIL TAX STATEMENTS AS DIRECTED ABOVE. Andrew B. r'ccr.K3:,t- I' t: Comm. 1;1 ;;.',010'3 V ?,.7 • NOTARY PUBLIC CALIFORHVY� • ~ LOS ANGELES COUNTY (� Comm, Exp. April 6, 2001' + affix seal within bnrdAr CHARLES D. GARLAND C11 Architecture, Interiors, Space and Land Planning Structural Calculations 24 October 2000 City of La Quinta Department of Building and Safety 78-495 Calle Tampico La Quinta, CA 92253 Project: Single Family Residence for': Four Seasons Homes The Rose Plan "A"& "B" 52-930 Herrera and 52-940. Herrera La Quinta, California Re: Review of Truss Manufacturer's calculations To Whom It May Concern, { I have been supplied with a copy of the truss manufacturers calculations prepared by Spates Fabricators Of thermal, California, for the project noted above. Upon review of these calculations I find them to be in substantial conformance with the design intent of the construction documents. If you have any other comments or questions regarding this or any other matter pertaining to the project noted above please do not hesitate in contacting me. Sincerely, N Charles D. Garland, Architect EXP 3-1 35-325 Date Palm Drive, Suite 151-J - Cathedral City, CA 92234 - Phone/Fax: (760) 324-7146 d 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: 52-930 AVENIDA HERRERA Use Classification:. SFD Bldg. Permit No.: 0010-225 Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC Owner of Building: FOUR SEASONS HOMES, f a'+w► Building Official Address: P.O. BOX 749 City: SAN BERNARDINO, CA 92402 . By:, STEVE TRAXEL Date: 07-18-01 POST IN A CONSPICUOUS PLACE