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9903-102 (SFD)LICENSED CONTRACTOR DECLARATION *l.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 Pr6fessionals Code, and my License is in full force and effect. -License ti Lic. Class Exp. Date% - bate. Signature of C6nt'ractor -01NNER7BUILDER DECLARATION " - yff 4 irm under penalty of perjury. that [.am exempt from the Contractor's License Law for the following reason: as -owner of the property, or my employees. with wages, as their sole compensation, will do.thb work, and. the structure is not intended or, offered for sale (Sec. .7044, Business & Professionals Code). (*i,) 1,;aslowner of the property, am exclusiv6ly contracting with licensed contractors to' _�tke' projecf'(Sec. 7044, Business & Professionals construct Code).:: am exempt under'Section B&P.C. for this reason Dates .Siqnature,of Owner -WORKER'SICOMPENSATION DECLARATION' I hereby -affirm under penalty of perjury , qne`'&, the following declarations: )!I have;and will maintain a certificatd 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. C ), I have a . nd*.will 'maintain Workers' compensation insurance',las required by Section 3760 -6f the Labo'r Code, for the performance of the work for Which this permit* i6'issu'ed My;Woirkers' corripensation insurance carrier & policy'no. are: Carver Policy No. e . : �. . TT (This�section need not becornpleted if thepermitvaluation is for $100.00 or less). I certify that in the the work f performance of h or which,this permit is issued, I'shall any,p@rson- in any"man'ner so as to become subject to the workerslwc6rripensation laws of California, and agree that if I should become subject lo -the, workers' compensation provisions of Secti6n'3700 of the Labor Code: I'shall forthwith comply with those provisions. Date ' Applicant—' Warning: Failure to Secure Workers' Compensation coverage is unlawful and shall subject -an e M" ployer.to criminal penalties and civil fines up.to $100,000, in ldditio�n t6`thii cost of compb n-Sation, damages . as provided for in Section 3706 of theLabor Code, interest and attorney's fees.. IMPORTANT. Application is.hereby .made to the 'Director of Building and Safety ifoi',�a`,perrnit Subject to, the conditions and restrictions set forth on his app'licition., !'Each person upon whose behalf this application is made & each person at ,--:wh6s6request and for whose benefit work is performed under,or pursuant to y.Any permit issued as a result of,tk.i.s'applicaton agrees to, & shall, indernnify 4, -hold% harmless the City of La Quinta, its -officers;. agents and employees. %;.2. -Any permit issued as a result of this applicatioribedomes null and void if work -is "not commenced within 1.80 days from date of. issuance of such `peiyrIit,,or,cessation of work for 1.80 days Will subject permit to cancellation. l,certify that I have read this application and state that the above information is correct: I agree. to comply N'Ith all City, and State laws relating to the building bonstruction-, and hereby authorize representatives of this City to enter upon the ab6ve-nientioned property f6r inspection purposes. V F Signatdre (Owner/Agent)' . f4 Date 1 4; , ­ �, PERMIT # BUILDING PERMIT 6 DATE t VALUATION S17_�Z,426.1(1 LOT 209 TRACT JOB SITE ADDRESS'' 47480 VIA C01U)0VX APN 64X106-030 OWNER CONTRACTOR DESIGNER ENGINEER X41CHA1.`L,J3ERG-R,1 CQNS7R.U(W_110N NMICKAR),aERGINTCONSMUCT1011 72929'SKYWAPD WAY 'MZ9 SKYWARD WAY PALMIL)ESEXV CA. 922610 PALM DESEAT CA 92260 C" I,.4# 4217 USE OF PERMIT IitJ U rANOLVEWPUNG. SFQ PEN&[,FT 130t.3 NOT DICLUDI't"BLOCK MULS 41-A Pool'. T 4OINVIVUC-310114 flop-01/pATIO 236.00 vW ENT]"MATED COST OF CONS "ARUC13,01N 172-1426.10 P U(M-1 11 P1)11 S, TJ WMI AIRY CO NISTRUCM0 . N FFX J01 -0004M-000 p1,.A,14 r 19 S,757:59 FIRM DEIVO' $]T I ("I _000439�11 S WIECRANICAL FfE 1:01 -Ochi -gill -000 $99.50 ELECTRICAL ME 701-000-420-000 S194.89 numInNo t?mm $177,25 ZONG!'00TtON FEtz, ftt= S17.24 STP ORAT)ING-170 10 1_000_,12,j 2.25-000-443-342 AN ZC S UB -TT MAL. C0N,'31'RiJCION JVW) Y1, Qf-H, I Is P2Z.E-PA-10 FEES 47-50,00 ''T OX AL PERMIrfFEE .S.DUE NM RECEIPT DATE BY, DATE FINALED INSPECTOR, F M 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 Exhaust Fans O.K. to Wrap Framing o -. T• F.A.U. - Compressor Insulation r f S—/ Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath 7-�/- �/ S �• 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 I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final 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 Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G. F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS' ' P.O. BOX 1504 Buildingcc11-7 2 78-495 CALLE TAMPICO Address4-7 ' 7Eb I 049-00upt.- pt. LA QUINTA, CALIFORNIA 92253 Owner, t L e" BUILDING: TYPE"CONST. Address �/o 2—?9 City Zip 1Z2(.) Tel. Q ,, t1.&� &2 -q05-8 Contractor' j /' M-1CU" P I E. 0-5., �. :;�T AJC Address 72 -C 2� SSC r CIV y...... Zip Tel. C 05 & Classif. qt. 19 Lic. n Arcn., tngr.,`� �� t Designer ac ,A Address V Tel. 3 60 -025.0 City Zip State Lic. N LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (comment' g with Section 7000) of Division 3 of the Bus' 76nd Professions Code, and my license is n full 6rce and GNAT / ...w.. DATE OWNER -BU ILDE :EtC ARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec. 7031.5%siness and Professions Code: Any city or county which requires a permit to construct, after, improve, demolish, or repair any structure, prior to 'its issuance also requires the applicant for such permit to rile 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, Bussness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improvesthereon 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.) i 7 I am exempt under Sec. 8. 8 P G�',for this reason Date owner a '�'� 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 n 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 wolk�for which this permit is issued, I shall not employ nyaperson in any manner so as to M.ubje t to the Workers' Compensation Laws o California. Date f Owner NOFCE TO APPLICANT: If, alter making this Certificate o/ a tptlon you shou3'b7rt'ome•- subject to the Workers' Compensation provisions of the Labors ode, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a constructiop lending agency for the performance of the work for which this permit is issued. (Sec. 3 J7, Civil Code.) Lender's Name /.tom. !�_ Lender's Address ry v k4PK",W`,- 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 Number `H03 -fid 2 -- APPLICATION APPLICATION ONLY OCC. GRP. Description :t Description . 44 7 -S4 0 l)i A- V, ) Q` Q_ Sq. Ft. No. Size 2 Stori New sI Add ❑ Lt3ti-% r' T. L�-7-S 78 VVI No. Dw. Units Alter ❑ , Repair ❑ Demolition ❑ PERMIT AMOUNT Plan Chk. Dep. 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 hear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line 0%e FINAL DATE INSPECTOR k Issued by: Date Permit Validated miit Validated by: 9�tr+F9�'ff � 9 &00# Validation: v WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVI�S��� OF I A QUIN � ib is t, 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 3/29/99 x APN #' 643-100=030 No. 18506 Jurisdiction La Quinta Owner NameMichael Bergin t, Permit # No. 47380 Street Via Cordova Log # City La Quinta zip 92253. Study Area , Tract # Lot # Square Footage ' 2,835 Type of Development Single Family Residence No. of Units .1 . Comments a . At the present time, the Desert Sands Unified School District does not'collect fees on garages/carportscovered 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,''>,: ~ { 7 5 This certifies that school facility fees imposed pursuant to Government Code 53080 in the a""mount Gf 1.93 X 2,835 or $ 5,471.55 the property, listed above and that build g permits and/or Certificates of Occupancy for this square footage in this proposed project may now be. issued Fees Paid By cc/VIB/M. Bergin Telephone 862-9058 • Name on the check By Dr. Doris Wilson Superintendent ; Fee collected /exempted Adriana Gauto Payment Received $5,471.55 Check No. 192431 Signature NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90-day approval perid in which you may protest the fees or other payment identified 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 collect them on the Dislrict('s)(s') behalf, whichever is earlier. c .. 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 S . r l . RECORDING REQUESTED BY AND WPkN'CORDEDyN1AIL'THIS DEED AND, UNLESS , OTHES 0WL'OW, MAIL TAX STATEMENT TO: . NAME L.A. q%))fj-M 0 tAC#' Z3 STREET 304413 2ANICy o V/6To %2,D ADDRESS ♦ i �� `ITV, STATE 6 ZIP CODE '92 " TITLE ORDER NO. 4 "� ESCROW NO. E APPROVED BY COMMUNITY DEVELOPMENT DEPT BY Al lVC56. r DATE ..1. L_9-- EXHIBIT vfl;-) CASE NO. `�- 9 9- 3....°��..._. �...... CE ABOVE DOCUMENTARY TRANSFER TAX $ - ❑ computed on full valuetof property conveyed, or GRANT DEED ❑ computed on full value: less liens and encumbrances remaining at time of sale. Signature of Declarant or Agent )etermining Tax Firm Name ' FOR. VALUABLE. CONSIDERATION, receipt of which is acknowledged, I (We), La Quinta Beach 2'3, -LLC •'+.i. a Limited Liability Company ' (NAME OF GRANTORIS)) grant to Lee rl a cke INAME OF GRANTEE'S)) ;.all that Teal property situated in the City of La Oulrita (or in an unincorporated area of) Riverside county, California described as follows (insert legal description): (NAME OF COUNTY) (STATE) 4that portion of land in Lot B which is overlaid by-.. the reconfigured shape of LotA pursuant to LLA 99 - 30o approved by`the•City,of La Quin a. The, reconfigured. lots are described in Exhibits A and B attached hereto and made.a part hereof. t NOTE: This grant deed perfects the intent of ]Lot Line Adjustment as approved 3tiw Ct of La Qunta. ---- -___ Assessor's parcel No. 33 Executed on March 8 1999 ; at . San Juan Capistrano, California " (CITY AND STATE) STATE OF California COUNTY OF Orange before me,LCk14A6_ 9. CAIM, n4dr p PLL b11C. ` INAME/TITLE.i.e.•JANE DOE. NOTARY PUBLI . personallyappeared�, personallyknown tome (or proved to me on the basis ofsates actory evide 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 seal. IFTTTU► R SCOFIEW Commission # 1176668 • _ i . -s Notary Public - Cardamia , } Orange county W (SIGNATURE OF NOTA 1 • (SEAL) '•'1 comm. Eliclom April 2ry002 MAIL TAX STATEMENTS TO: Before you use this form, fill in all blanks, and make whatever changes are appropriate and necessaryy to your particular transaction. Consult a lawyer if you doubt the form's fitness for your purpose. and use. Ny t o -lo makes no representation or warranty, express or implied, with respect to the merchantability or fitness of this form for an intended use or purpose. WOLCOGRANT E FORM 719 -Rev. COT (price class 30) , IIIIIII��IIII (III (III II III (III GRANT DEED ©1994 WOLCOTTS FORMS, INC. CAPACITY CLAIMED BY SIGNER(S) ❑INDIVIDUAL(S) ❑CORPORATE OFFICER(S) (TITLES) ❑PARTNER(S) ❑ LIMITED ❑ GENERAL ❑ATTORNEY IN FACT OTRUSTEE(S) ❑GUARDIAN/CONSERVATOR ❑OTHER: SIGNER IS REPRESENTING: (Name of Person(s) or Entitylies) a ` • PUBLIC•WORKS CLEARANCE LETTER FOR Q CUSTOM HOME LOTS , Dear Builder: Prior to issuance of a building permit, you will be required to obtain clearance from the Public Works Department for, one, or more, of the followirng: _—.1. Verification that rough grading is complete, and tie pad elevation certifications . prepared by a licensed surveyor, or engineer, are on file in the Public Works Department._c� Y Verification'that infrastructure improvements and other required tract improvements are complete, or sufficiently advanced to warrant building permit issuance. 3. , Prepare an engineered grading plan.that provides for on -lot storm water retention,. and have it checked and approved by the Public Works Department . • Tract 26524 (Estancias) • Tract 26769 (Mountain View Estates; 4. Prepare an engineered grading plan that' provides for building pad grading in accordance with the existing soils report and tract grading plan, and have it checked and approved by the Public Works Department. • Tract 28034 (South Valley Estates) FOR INTERNAL USE BY PUBLIC WORKS DEPARTMENT COMMENTS: TRACT: 2(o 152 LOT: 2,09 LIC WORKS AU�HORIZATION ' I ' 1 DATE L F:IPWDEP_RDOCSXFORMSIPW CLEARANCE LETTER.ss �A Ktk-UNUIPAO Nt6)ULbILU BY "Lawyers 'Tale C. AND WHEN RECORDED NAIL TO Nome Lee Glaske Address ,. 47295'Via 'Rav,enna S*a+e La QU nt:a,% CA 92253 ,rr-too (Rev.4194) n -«z '0-C> '�L c.jZ'Yzv NO COR FILED 380'59 RECEIVED FOR RECORD AT 8:OOAM SEP -8 1998, e Dau&W t I�600lde rr SPACE ABOVE THIS LINE FOR RECORDER'S USE D/I GRANT DEED �......�... _ APN No. tp-3-\C7G-U3fJ . Title No. Escrow No. AR THE UNDERSIGNED GRANTOR(s) DECLARE(s) DOCUMENTARY TRANSFER TAX is $ 159. SO CITY TAX S Cl computed on full value of property conveyed, or •computed on full value less value of liens or encumbrances remaining ot'time of sale, O Unincorporated area: X City of LA Q.0 I N T A and FOR A VALUABLE CONSIDERATION, receipt'of which Is hereby acknowledged,, WILMA-LA QUINTA L.i., A DELAWARE LIMITED PARTNERSHIP hereby GRANT(s) to LEE GLASRE, a' married man As his sole and separate property i I the following described real property In the County of RIVERSIDE State of California: SEE EXHIBIT "A " ATTACHED Dated:Aug. 13, /99g WILMA-LA QUINTA L.P. A DELAWARE LIMITED PARTNERSHIP BY: CENTRUM PORT PAVILION LTD., A DELAWARE CORPORATION, AS GENERAL PARTNER BY: WILMA SOUTH MANAGEMENT CORP.,. A GEORGIA CORPORt),;)yON, ITS ATTORNEY State ofrmaaNa FLpt'ril4. Lh -4ef le S 0 - 'Q-,:R9h4, - SS. County of Lt ✓'v - On P11149 before me, the lindersigned (here insert name) Notary Public, personally appeared personally know- me me (or proved to me on the basis of satisfactory evidence) to be ;the person(s) whose nome(s) is/are subscribed to the within instrument and 6cknowledged to me all that he/she/they executed the same in his/her/their authorized capocity(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 seal. y. .RHONDALYNN 0. 0 ODWIN .'. MT COMMI8810N / CC 840914 ^1f� a Do, -1pX6: June 8 4001 am"d ihru Hoary PuNig Updgw tpra Signotur 1 — omx seal wrMin border, EXHIBIT "A., PARCEL 1 t LOTS 209 &-236 of TRACT 26152, IN THE CITY OF LA QUINTA, COUNTY OF'RI;UERSIDE., STATE OF CALIFORNIA AS SHOWN.BY MAP ON FILE IN BOOK 227 PAGES 77 THROUGH 85,:;INCLUSIVE OF MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA, AND AMENDED BY. RESOLUTION NO.: 91-108 RECORDED MARCH 26, 1992 AS INSTRUMENT NO. 105T76 OF OFFICIAL,RECORDS OF RIVERSIDE COUNTY, CALIFORNIA'; EXCEPTING THEREFROM ALL OIL, GAS, AND OTHER HYDROCARSON'.:'SUBSTANCESa LYING WITHIN AND UNDER THAT PORTION OF SAID LAND,.LY"ING BELOW A DEPTH OF 500 FEET, MEASURED z .VERTICALLY FROM THE SURFACE OF SAID LAND'OR INTO THAT PORTION OF THE SUBSURFACE THEREOF, LYING BELOW A DEPTH OF 500 FEET, MEASURED VERTICALLY FROM,,SAID SURFACE, AS RESERVED IN DEED RECORDED AUGUST 4, 1993 AS INSTRUMENT NO. 303830 OF`OFF,ICIAL RECORDS OF RIVERSIDE COUNTY, CALIFORNIA; ..PARCEL .2 NON-EXCLUSVIE EASEMENT FOR INGRESS, EGRESS, USE AND ENJOYMENT OF THE COMMON AREA" AS DEFINED IN THE DECLARATION OF CONDITIONS, COVENANTS -AND "RESTRICTIONS RECORDED NOVEMBER 27, 1991 AS INSTRUMENT NO. 415112 OF OFFICIAL RECORDS ,OF RIVERSIDE ..COUNTY, CALIFORNIA. 23� 1 z(5 r' �a J*��� �-y T�d� 6 1 9 7 7 1 2 1 4 0 r u SEP-22-.96..TUE 15:04;GIBSONGRUUP r, July 2, 1998 TO: Mr. Michael Bergin. Bergin Construction, Inc. 72929 Skyward Way. r Palm Desert, California 92260 From: Rich Lane Architectural Committee Lake La Quinta Homeowners' Association The tectural Committee met on July 1, 1998.evaluated-and approved your proposed, Pl R d 4. We wish you well with your project, ' One member of-thethe committee expressed concern regarding amount of bathroom glassblock planned for one corner of the residence. However, no recommendation was provided except the suggestion to use non -observable see-tlhxough block. Once construction begins please make every effort at dust abatement watering and reduction of the amount of the trash accumulating at the site. Please make trash bins for, each site: We currently have a builder who ignores these responsibilities and will soon force the homed Am rs to take action. Sincerely, Rich Za e Certifi C-1, ato ofOcc'upancy,, O Cit of La Quinta y• BUHding. and. Safety Department oF - 5 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: - 47-380 VIA. -CARD' VA Use Classification: SFD_ Bldg. Permit No.: 9903-1.02 Occupancy Group. R 3 Type of Construction:VN Land Use Zone: RL Owner of Building: MICHAEL BERGIN CONSTRUCTION Address: 72-929 SKYWARD WAY City: PALM DESERT CA 92260 By: STEVE TRAXEL Date: 11-4-99 Building Official POST IN A CONSPICUOUS PLACE