9704-143 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury *that I am licensed under provisions of
Ghapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
5y ' 1311..8
`Date '=7Signature of Contractor
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 Policy No.
UNICA-RI, INS, CO SA501156141'79 -
(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, aincPaggree toat if I hguld become
of�
subject to the workers' a mpensation f j i i Etiorf of
the Labor
/Code, I shall - rthv cmply with those , IIS
71
Date: ' /Applicant
Warning: Failure to secure WorkerpCompensation 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 statetthat t e9bove information is
correct. I agree to comply with all City, and Sta Ce law relating to the building
construction, and hereby authorize�ep��it {{five�/ofp�lthhils ',tyto enter upon
the>above-mentioned property fo ispec i PO
nature (Owner/Agent) ®�� '"�' Date 815211
r
PERMIT # CONTROL #
BUILDING PERMIT 97414143 5263
DATE /-��7 VALUATION 5141-515,911LOT 143 TRACT 261152
JOB SITE
ADDRESS 1►
47-750VIFLU}tKINIC'E '
APN 683-116-00
OWNER
CONTRACTOR / DESIGNER /ENGINEER
4An1yylC'S4 r0N{,-V 7'
rAi9DAN" uCOMPANY
1$707BROOK,FdOF.,LOW IK. 91'E. 208
1570.BN(.K:)K.fi0LL0W O.F%iir".F.,SUM 108
`ANNA. ANA. CA 02705
SANTA ANA CA 92705
(714}251-9151 CM.0 4485
USE OF PERMIT
,iFfj - PLAN 1
DEAN t"FfWX F IFS CtF Fatfl,'#it 1 BY 79'a FOX MULTIPLY, 133U OF ,,AMM
1'1,AN TYPI1
TFC W,'J' C 0N3 iZtK 1014 G, ,7,00 S11,(iI
1"AtCPJlI 110 5601) )F
0rjUtA0 FJCARfrtaRT 60f7.C) S1
MSTIAMTED C;tl�'sT OF CONI TRUCT1GAN
141,575.90
'C�1Yt�F'k.1J�'t"It71,1'[1iF 101.<i F4341Ft-OtMF V96. -it)
R:21'01031'1' -� 'Sd►.tlf1
M't:t;TtAN AL Ck.Cs ;.Cl.i��iOG-a2}-taxi S`JFs,S(7
EI.W27TRICAL1"RR 101 -000420 -WO 5167.70
t'1 }t14f�3r►+1Cs .); . 1(3i.(}�31!� �K1t) $1.61 "S
S'11314ri MO°TIOR 117 - RESID 101,-000-241.000 k14,.16
0(bXi)1N0, 6D, .3- 101-000-42.3-000
TN]1 A8T'RtJCTtJk1? M 2i5-fFOO-443-:41 53.168.70
AKT }N 1'1.15 MAG KN(714,; . R1?S!,' 700-000.255-(l(Ft) $103.94
U13-TOJ' 1, COMM tK,`1 ON rA:ND T7T.,.AN CRECK
�4,E*Riv.04
LESS PR PINK) Ff.X'S
-$2.50.00 -..
'1'WCAL i'EFk141':IT #+'F;1! S i)UF; NOW
�4,43i1.(iS
CEIPT,,, ✓
"/l 'i!
DATE/'+"
BY
�',
DATE FINALED
INSPECTOR
i
�.��
'
/n 1
INSPECTION RECORD
OPERATION
DATE -
INSPECTOR
OPERATION
DATE
INSPECTOR
UILDING APPROVALS
MECHANICAL APPROVALS
et acks
Underground Ducts
Forms & Footigge
Ducts
'
Return Air
Steel
Combustion Air
Roof Deck
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 Wall Firewall
Exterior Lath
Drywall - Int. Lath
Af
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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 LinesqZZ4 YO
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
S
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Server Connection
Encapsulation
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)IV
P.
Building/� , / /— 78-105
Address 7 � C.�' V /G Flo f -o, rC-LA OUINTA
Owner l /
rG ON 041. y d CIO n-1:) 4 It y
Mailing- 7 c
Addres/5 / js,a�/moomoo J—
�, .2,0&
City4�//�j} Zip 0?,j Tel ` e [
Contractor / �Oh. 7G
CG..4 cy
Aririracc
_�> CA "v. C
ty lZip Tel..
O. BOX 1504 APPLICATION ONLY
CALLE ESTADO
CALIFORNIA 92253
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer 4 /H9 ✓/%� iW f ��ji{rtate;7vt C_
A,ddddress r Tel..
/ // .. Sv�1n doh ef 760 3201-?11
City/ (' Zip State
��/hCl J/�:It^�� a' Lic.#
CIICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER-BUI W pRl DECLARATION
I hereby affirm that I am exempt fromsthe Contractor's License Law for the following
reason: (Sec. 7031;5;B`siness arfLd,�4Professions Code: Any city or county which requires a
permit to construct, atter, ;Aprov'e, 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). .
1 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
orimprovement 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.)
IA 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 contractor(s). licensed pursuant to the Contractor's License Law.)
17.1 am exempt under Sec. B. & 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
0 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: 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.
r t,
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-
memioned property for inspection purposes.
Signature of applicant Date
Mailing Address -
City, State, Zip
BUILDING DIVISION
BUILDING: TYPE CONST. OCC. GRP.
I
A.P. Number
r
Legal Description
Project Description
Sq. Ft.No.' No. Dw.
Size 7 Stories Units
New ❑ iAdd ❑ „ A'Iter u:' `� Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
o - AMOUNT
ZONE: BY:
Minimum Setback Distances:
Front Setbacc from Center Line
Rear Setback from Rear Prop. Line
r.
Side Street Setback from Center Line
}`Setback from Property Line
FINAL DATE
I i�7 —INSPECTOR
Issued by: APR 2 9 19"` Date Permit
Validated bv*
,I-
Validation:
t
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
A.C. UNIT
1ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SO. FT. @ $
SO. FT, @
UNITS
YARD SPKLR SYSTEM'
HEATING (ROUGH)
SO. FT..(v MOBILEHOME SVC. BAR SINK
FORMS
SQ. FT. @ POWER OUTLET ROOF DRAINS
ROUGH WIRING
S0. FT. @ DRAINAGE PIPING
ROCKSTORAGE
SO. FT. @ DRINKING FOUNTAIN
GAS (ROUGH)
SO. FT. @ URINAL
HEATING (FINAL)
VALUATION $ WATER PIPING
REINF. STEEL
NOTE: Not to be used as property tax valuation
TEMP. POLE
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
FINAL INSP.
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
_$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FRAMING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
FIRE ZONE ROOFING
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1'A c
SEWAGE DISPOSAL
MESH
SO.FT.GAR @ 3/4c
HOUSE SEWER
INSULATION/SOUND
GAS PIPING
FINISH GRADING
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
ROCKSTORAGE
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 SIGNATURESIINITIALS
GARDEN WALL FINAL
' Desert Sands Unified School District -k "
N60ce:82-879 Highway 111 ,
- • • Indio, Document Cannot TBe Duplicated InA 92201
dio
, CC5-3500 t
CERTIFICATE OF COMPLIANCE' x -
Date' 6/6/97 APN 9 643-110-001,
No. 15611 Jurisdiction La Quinta
Owner NameCanady & Company Permit #
No, 47-750 Street Via Florence ' '-Log #
City La Qtiinta Zip 92253 Study Area .123
Tract # Lot # Square,Footage 2377
,Type of Development Single. Family Residence No. of Units 1
f
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 r✓placement mobilehoriles.
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
1.84 X 2,377 ` or $ 4,373.68 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 By Cashier's Check Pacific National Bank/
Telephone (714) 751-9151 ,
^ Name on the check
By. Dr. Carol McGrew
Administrator in Charge
Fee collected /exempted by Peggy Reyes • Payment Received ;4;373'.68
F; IN
Check No. 67528 "
Signature.:}_
NOTICE: 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 Fotesf the fees or other payment identified
above 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 Districl('s)(s') behalf, whichever is earlier.
a.,vucaLUI. h►aaa•u a 1-Upy V1 UUMILy V1 Clly P1411 CIMCK il(Jp11CM1011 corm to ulstrlct copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt• Copy -Accounting"
MAR -18-97 12:00 FROM:FORESITE ESCROW
INC. 1D:619 773 9268 PACE 5/6
AND WMEN RECOQMD MAIL i0
r+ome Canada y and Co.
1570 Brookho110W Drive
C,itre, Suite 298
wore Santa Ana, CA 92705
TT- 100 ray... vow 0 SPACE ABOVE THIS UNE ADA RECORDERS USE
GRANT DEEB
APN No. Title No.EscrOw No. 2-22095
THE UNDERSIGNED GRANTOR(s) DECLARE(s)
DOCUMENTARY TRANSFER TAX is S 231.'00 CITY 1AX S
O Computed on full value of property Conveyed, or
O computed on full value less value of liens or encumbrances rernoining at time of sale.
O Unincorporated area: ON City of LA QUI NTA and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
WILMA-LA QUINTA L.P., A DELAWARE LIMITED PARTNERSHIP
hereby GRANT(s) to CANADAY AND COMPANY, .a California Corporation
the following described real property in the
County of RIVERSIDE State of California:
SEE EXHIBIT "A ATTACHED WILMA-LA QUIN"A L:P..A DELAWARE
LIMITED PARTNERSHIP
BY: CENTRUM PORT PAVILION LTD.,
A DELAWARE CORPORATION, AS GENERAL
Dated: PARTNER
BY.: WILMA SOU=H MANAGEMENT.CORP.,
A GEORGIA CORFORA ON, ITS ATTORNEY
IN FACI
Stoteotembj&Cn4t.LeS D. Graham
County of lrl�L. } SS.
on t�l°t7 bet«e me: /,,
/� n/ (here insert name) Notory Public.
petsonouy oopeored (_Gyp ✓!'&
pemonaUy known to me (or proved to me on the boss of sotisloctory evidence) to be'the
person(s) whose narrte(s) afore subscribeC to
Me within instrument and acknowieoged to me ou that he/she/they executed the some in hisfher.'irieir outhor¢ed c opaciiy(ies), and
trot Oy his/her%their signature(s) on the instrument the person(s), or the entity upon beW of wtich the person($) octed, executed the
cutnrment.
WITNESS my hand and officio► sed. "`�. RHONDALYNK D. WODWIN
COMMOM 0 CC 2=3
tomes: � a3. tear
augur T= NM. wale L%owwfto
Srgnoture �LVftic(,ChJ �✓ +'•LL'/.i,(Ji�•:�
r
._ orrx ®a �mvr, ocXde,
�2) - G43 3 00 bJ
13 - G+a3 nook
MAR -16-97 12:01 FROM=FORESITE ESCROW INC. ID:619 773 9269
Exhibit "A"
PACE 6/6
Parcell:
Lots 103 and 113 of Tract 26152, in the City of La Quina, County of Riverside, State of California, as per map recorded in
Book 227, pages 77 through 85 inclusive of maps, in the office of the County recorder of said Counry and amended by
Resolution No. 91-108, recorded March 26, 1992, as Instrument No. 105176 of Official Reecrds.
EXCEPTING therefrom all oil, gas and other hydrocarbons substances lying within and under that portion of said land, lying
below a depth of 500 feet, measured 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 official records. '
PARCEL 2:
A nonexclusive casement 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,
PARCEL 3:
A temporary nonexclusive easement appurtenant to Parcel 1 for pedestrian and vehicular access, ingress and egress over that
certain real property more particularly' described in Exhibit 1 which is anached hereto and incorporated herein by this
reference. The temporary easement granted in this Parcel No. 3 shall automatically terminate and be of ao further force or
effect upon annexation of the Lots describe on Parcel No_ 1 ander the Declaration of streets pnviding vehicular and pedestrian
access to Parcell herein and the transfer of fee title to or an easement over said streets to the lake La Quinta Homeowners
Association, a California nonprofit corporation ("Association') for.aceess and use purposes pursuant to the Declaration. Upon
the termination of the temporary easement granted pursuant to this Parcel No. 3. access to Panel l of the Property shall be
pursuant to the nonexclusive easements granted pursuant to Parcel No. 2 above.
RESERYING THEREFROM UNTO GRANTOR, is successive owners and assigns, together with the right to grant and
transfer all or a portion of same as follows:
A. All water rights or interest in water rights that may be within, under or on the property, whether such water rights are
riparian, overlying. appropriative, percolating. prescriptive or contractual; provided however. that the reservation made herein
shall not reserve to or for the benefit of Grantor any right to enter upon the surface of the Property in the exercise of such
rights, together with the right and power to use or utilize on any other property owned or leased by Grantor any and all water
rights or interest in water rights no matter how acquired by Grantor.
B. Easements over the property for the construction. installation and waintenaace of electric, .gas, telephone, water, sewer,
private street, landscaping. trail and drainage facilities, provided that the construction and installation of such facilities shall
not unreasonably interfere with Grantee's development or use of the Property.
SUB,iECT TO:
1. Taxes and None Assessments: Nondelinquent general, special and supplemental real "property taxes and assessments;
2. Restrictions of Recoird: All covenants, conditions, restrictions, reservations, dedications, easements, enalmbrances, rights
and rights of way of record.
3. Assignment of beclarant Rights: Effective upon recordation of this Deed, Grantor assigns to Grantee with respect to the
property, all of Grantor's rights, exemptions and entitlements as "Declarant' under the Declaration and any amendments or
annexation documents recorded in connection therewith, including without limitation, all exemptions from Association,
Architectural and other review and approval; development rights, entitlements and access over all portions of the Rancho La
Quina development for purposes of constructions, development and sale of residences within the Property;- and all voting
rights of Declarant with respect to the property. Upon recordationof this Deed, Grawce,shall have the same rights with
respect to the oroverty udder the Declaration as Grantor orior to the dare of recordation of ibis Deed.
x
HOAK &SHAH. ASSOCIATES,
CONSULTING, 'ENGINEERS
3920 E. Coronado Street, Suite 203, Anaheim, ` CA. 92807 ' -
Phone: (714),632-186.5 Fax: (714) 632-1314
May .19, 1997
City of La Quinta
Department of Building & Safety
•78495-Calle'Tampico ,
-La'Qu,inta, Ca. 92253
RE: 47-750 Via Florence (LOT 113 -Plan -1 Gable)
La Quinta, Ca. 92253
To Whom It May Concern:
We have reviewed the truss drawings and calculations by Truss Works @
P.O.Box 626, Thousand Palms, Ca.,92276 for the above referenced project
and find them' -in substantial conformance with the structural framing
plan and design.
DQRpFESSIoly.
.Respectfully �`�� �1�1C E
- ' Hoak:_.& Shak Associates , Inc .
Q -37
rn
C.�. No.34803
Lawrence W- Hoak,• P . E .
President�-
s�gTFC V 1
r