9601-064 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm 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 19 full force and effect. '475,138 8 5/31N7
License # Lia Class "I Exp Date
Date Signatureof Contractor
OWNER -BUILDER DECLARATION
I hereby affirm 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, aria 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 STA Cts r UIND Policy No. 076245295
(This section need not be completed if the permit valuation is for $100.00 or less).
() I,, ertify that in the performance of the work for which this permit is issued,
I shall of 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 theorkers' compensation provisions of Section 3700 of the Labor
Code, I shall fdrthwith comply with,those p(&Nsions.. .,
Date: / /2 Applicant �s
/ v
Warning: Failure to secure Workers' Compensation coverage is unlawful and shall
subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance_of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information isl
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this -City to enter upon the
above-mentioned property for inspection,purposes.
Signature (Owner/Agent)1� l Cr=—�h'" Date�/Z,
ALC x
BUILDING
PERMIT
PERMIT4512,064
DATE 1/..11.16
VALUATION
LOT 4$
TRACT 1 ..,
JOB SITE ADDRESS 78-810 1,11k'CA
APN 76944W014
OWNER
CONTRACTOR
•
SCM'(' 111 & IU-.114LEEN DAL EC3.0
721-285 E t1,1'.HA.IWDR.
419505 VIA AibII1,�4'AU
RANCHO MIRAGE CA 9227th
L.A QU IN'.j 1k Cil 32253
(619)569-4491 C H Lill 4044
DESIGNER/ENGINEER
USE OF PERMITj%i+iiil,,.f„ FA -MIL UWGL-4-d-Ki
)Jem)A dtvs .rw%t incl de b1i>FIS mivtl or pool.
FEE DESCRIPTION
FEES
CUSTOM CONS'TTWIC i ION 3,200.00 LF
laORCHWA'IIO 240,00 SP
GARAf0:F.1 IMPtDRT 7510,00 SF
$ '� o ►#fi: 3 C 0 11 OF CON3'1RUCf10NI
267,172.00
E.lx 1)0C 0`SIT 4250.00
PLAN tE:1f"CK IME 101.000_439-315 $1,002.04
-�
CA:NST.tWC'T'ION FEE 101-000.41$-000 $1,2'µ''T.;O
WECHANIC.Ai rM. 1,01-000-42j.-000 $92.00
FJ, TX- ,rRICAL F ME 101 -OW -420-000 Sit 1.50
PLLTi!H.:]!It`'rFEE 101-QOQ 39•t?OJ $11,66.00
5'IOidG MOTION FEE - PJMD 1010-000-2414100 526.72
CTR ADI NO FF8 401-000-425-0010 S20.pf3
JNM\STRUCrIX8 M 2254000-443-342 $5.939.55
..,11ti R'F :IN :PURL IC PLA.CES - R1 SID '701-000-255 OW $41.7.93
i
;il. B 1VI AL CONSTRLJC,"11ON AND PLAN CHECK
$91131.24
LESS PRE -PAID FEES
4250.0(1
1 T011AL PElttYr FEES DUE10O W
$8,81.24
,/qAI
1'99
y 6
RECEIPT
f
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs 9::�
Underground Ducts
Forms & Footings /
Ducts
Slab Grade (
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing .– V. T6(fiC
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 TPF
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 yr
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 Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
s�c4vITY OF LA QUINTA.
NorBr� ING & SAFETY DEPARTMENT
777-7012
v �� �PECTION REQUEST LINE
c,�PaG 777-7153
Owner SCOTT & KATHLEEN DALECIO
JOBE ION
Contractor 9601-064
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MZT SIGN ALL APPLICABLE SPACES
/5-5.1u LAMA
JOB ADDRESS
SFD Permit does not include block walls or pool.
ELECTRICAL GROUNDWORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
` ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST '
i HEATING & VENT - A/C 42
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
i GROUT ❑ 4' ❑ 8'
FRAMING —
If INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNE
j DRYWALL INTERIOR
I EXTERIOR LATH
4(1
POOL PRE PLASTER
L ENCE & GATE
SEWEIV-SEPTIC TANK
� FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
j HEATING -A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
A
. • . _ .. ROVE APPROVALS DO NOT INCLUDE RIGHT TO
1/95 TURN ON UTILITIES OR OCCUPY BUILDING
Desert Sands Unified School District
Notice 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201619-775-3500
CERTIFICATE OF COMPLIANCE
Bate 1/11/96
No. 14035
Owner Name Mr. & Mrs. Scott Dalecio
No. 78810 Street Lima
City La Quints
APN # 769-600-014
Jurisdiction La Quinta
Permit #
Zip 92253
Log #
Study Arca 116
Tract # 24890 Lot # 42 Square Footage 3200
Type of Development Single Family Residence No. of Units I
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 mbbilehomes. 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 1.73 X 3,200 or $ 5,504.00
the property listed above and that building permits and/or Certificates of Occupancy for
this square footage in this proposed project may now be issued.
Fees Paid B , .. {
y cc/First Ra.nlc/Tithe Daiecio � Telephone'
Name on the check
By Dolores A. Ballesteros `= r
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $5,504.00
Check No. 3"x310
Signature "
Collector: ,attach a copy of county or city pian check application form to district copy for all waivers.
Embossed Original- BuiidinR DeAt./AI)plica.nt CoUV - Applicant/Receipt Conv - Accounting
NOV 30 195 11:18AM JM PETERS•COMPANY
A Dlvlslon
@,Cp,
The Citrus Homeowners Associal ion
Architectural Review Committee Action
November 30, 1995
Re: Lot 42- Dalecio Residence
Dear Mr. and Ms. Dalecio,
-Please be advised that The Citrus Homeowners
specifications prepared by Ed Diaz, labeled "Dal
on Lot 42 of the Citrus development.
Si cerely,
Gary Chroniste
Association President
ARC Committee President
r
4100 MacArthur Blvd„ 5uito 200
P.O. Sox 7150 r .
Newport Beach
California 92658-7150
(714) 622-8400 CONSTRUCTION PAX; 0114) 622-8411
P.1/1
Association hereby approved plans and
ecio Residence". This home will be built
Capital Pacific Holdings, Inc.
A publicly Mdcd company
listed on the American Stock
Exchattgo AMLVSymbol-"CPH"
1
01/11/96 11:44 FAX
I
"FAIR14AY HOMES"
'Order No.•
Escrow No.
Loan,' .
WHEN RECORDED MAIL TO:
Mr. Scott Daiecio
48505 Via Amistad
La Quinta, CA 92253
MAIL TAX STATEMENTS TO:
SAME AS ABOvE
16 002
rldo-�'
SPACE ABOVE THIS LIN@ FOR RECORDER'S
DOCUMENTARY TRANSFER TAX $
X. Computed on the eonelderatlon or value of vroporly conveyed: OR
...... Computed on the consideration or value loss liens or encumbrances
remaining at time of sale.
Tffr, IM)
Signature, o' OOdarent or Agent eierm ni.g tax _ tnn af.0
GRANT DEED
FOR A VALUABLE CONSIDERATION, receipt of which Is hereby acknowledged,
CAPITAL PACIFIC HOLDINGS, INC,, A Delaware Corporation, doing business in California
as J.M. PETERS COMPANY, INC.
hereby GRANT(S) to
SCOTT M. DALECIO and KATHLEEN S. DALECIO, husband and wife
as joint tenants
the real property in the City of LA QUINTA
County of RIVERSIDE , State of California, described as
SEE EXHIBIT "A" ATTACIIED IILIZCI'0
(TRACT NO. 24890-4)
ASSESSORS PARCEL NUMBER:
Dated November 10 2995
STATE OF CALIFQ_nNIA }
COUNTY OFP� Iss.
On r'17 C715— be(pre me.
personally appeared
��-r
personally known to meor Droved to mC On Ilio basis of saelglaCtOry
evidence) to be the persons) whose 1nnic(s) is/nre suhBCribod to the wllllln
InSlrument 3 -id acknowle(Iged jr) Ile Ilial 110511 1mly eseeuleddhe s.lnle
in hlsiherrlheir l uthorized r-ip;ipily(•es), and that by ht9/her/their zidna-
ture(s) on file Inslrumn-nl Ihll I)qe ,qn(!) cit 111n Orality tll)nll 1361alf of which
the DefGon(s) ac imi. exCCUI('tl Ill;! inslrumCnl.
WITNESS my 110 d :4nd ollii,. sral.
Sienna,;•=- -`
CAPITAL PACIFIC HOLDINGS, INC., a Delaware
corporation, inn business in California
BY: /
Crai o er, Vice President
BY:
9CHMIDT
ID=. emus
fb xv pwe - Calltomla p
CnikNGE COUNTY
CLO
Coma. Exp. sop'. 13. loll
(111....11-- Int . ,.1 11, u:, n.0
t.
a
1
01/11/86 11:44 FAX
EXHIBIT "A•
ALL THAT CERTAIN LAND SITUATED IN THE STATE OF CALIFORNIA, COUNTY OF RIVERSIDE
CITY OF LA QUINTA, AND IS DESCRIBED AS FOLLOWS:
PARCEL 1:
LOT 42 , OF TRACT NO. 24890-4, AS SHOWN ON A MAP FILED IN BOOK 218 PAGES 1
THROUGH 9 INCLUSIVE OF MISCELLANEOUS MAPS, RECORDS OF RIVERSIDE COUNTY,
CALIFORNIA.
ALSO EXCEPTING AND RESERVING THEREFROM, FOR THE BENEFIT OF THE
.I.M. PETERS COMPANY, INCORPORATED A -NEVADA CORPORATION, ("DECLARANT")
ITS SUCCESSORS AND ASSIGNS, TOGETHER WITH THE RIGHT TO GRANT AND TRANSFER ALL
OR A PORTION OF THE SAME, AS -FOLLOWS:
A. THE FIGHT TO PLACE ON, UNDER OR ACROSS THE PROPERTY, TRANSMISSION LINES
AND OTHER FACILITIES FOR A COMMUNITY ANTENNA OR CABLE TELEVISION SYSTEM AND
THEREAFTER TO OWN AND CONVEY SUCH LINES AND FACILITIES, 'AND THE RIGHT TO ENTER
UPON THE PROPERTY TO SERVICE, MAINTAIN, REPAIR, RECONSTRUCT AND REPLACE SAID
LINES AND FACILITIES,. PROVIDED, HOWEVER, THAT THE EXERCISE OF SUCH RIGHTS
SHALL -NOT UNREASONABLY INTERFERE WITH GRANTEE'S REASONABLE USE AND ENJOYMENT
OF THE PROPERTY.
B. NON-EXCLUSIVE EASEMENTS OF INGRESS, EGRESS, UTILITIES, DRAINAGE, AND FOR
OTHER PURPOSES, AND EASEMENTS AND RIGHTS AS RESERVED TO DECLARANT AS DEFINED
AND DESCRIBED IN THE "MASTER DECLARATION" HEREINAFTER DESCRIBED, AS
SUPPLEMENTED AND AMENDED. -
RESERVING THEREFROM UNTO LANDMARK LAND COMPANY OF CALIFORNIA, INC., ITS LEGAL
REPRESENTATIVES, SUCCESSORS AND ASSIGNS, ALL WATER, MINERALS, OIL, GAS,
PETROLEUM, OTHER HYDROCARBON SUBSTANCES AND ALL GEOTHERMAL ENERGY SOURCES IN
OR UNDER OR WHICH MAY BE PRODUCED FROM THE LAND WHICH UNDERLIES A PLANE
PARALLEL TO AND FIVE HUNDRED (500) FEET BELOW THE PRESENT SURFACE TO THE LAND
TO WHICH LANDMARK LAND COMPANY OF CALIFORNIA, INC., HAS ANY RIGHT, TITLE OR
INTEREST. SUCH RESERVATION SPECIFICALLY RESERVES TO LANDMARK LAND COMPANY OF
CALIFORNIA, INC. THE RIGHTS OF PROSPECTING, EXPLORATION, DEVELOPMENT,
PRODUCTION, EXTRACTION, AND TAKING OF SAID MINERALS, OIL, GAS, - PETROLEUM,
HYDROCARBON SUBSTANCES, WATER, AND GEOTHERMAL ENERGY (AND/OR ITS SOURCES) FROM
THE LAND BY MEANS OF MINES, WELLS, DERRICKS, AND/OR OTHER EQUIPMENT FROM
SURFACE. LOCATIONS ON ADJOINING OR NEIGHBORING LAND OR LYING OUTSIDE OF THE
LAND; PROVIDED, HOWEVER, THAT THE OWNER OF SUCH MINERALS, OIL, "GAS, PETROLEUM,
HYDROCARBON SUBSTANCES, WATER, AND GEOTHERMAL ENERGY (AND/OR ITS SOURCES), AS
ABOVE SET FORTH, SHALL HAVE NO RIGHT TO ENTER UPON THE SURFACE OF THE LAND NOR
TO USE THE LAND OR ANY PORTION THEREOF ABOVE SAID PLANE PARALLEL TO AND FIVE
HUNDRED (550) FEET BELOW THE PRESENT SURFACE OF THE LAND FOR ANY PURPOSE
WHATSOEVER.
0 003
01/11/96 11:44 FAX
PARCEL 2:
NON-EXCLUSIVE EASEKENTS'FOR INGRESS, EGRESS, UTILITIES, DRAINAGE AND FOR OTHER
PURPOSES, ALL AS DESCRIBED IN THE DECLARATION OF COVENANTS, CONDITIONS AND
�•._ RESTRICTIONS FOR THE CITRUS COURSE HOMWWNER5 ASSOCIATION ("MASTER
DECLARATION") RECORDED NOVEMBER -6,.1990 AS INSTRUMENT N0. 406990.
SUBJECT TO:
I. NONDELINQUENT REAL PROPERTY. TAXES AND ALL NONDELINQUENT UNPAID GENERAL
AND SPECIAL ASSESSMENTS;
2. COVENANTS, CONDITIONS, -RESTRICTIONS, BASEMENTS, RESERVATIONS,
DEDICATIONS, RIGHTS AND RIGHTS-OF-WAY OF RECORD OR APPARENT INCLUDING WITHOUT
LIMITATION, THE MASTER DECLARATION, AND SUPPLEMENTARY DECLARATIONS AND ANY
AMENDMENTS THERETO, DESCRIBED ABOVE.
CS
16 004