9704-144 (SFD)` LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensedunder provisions of
F- Chapter 9 (commencing with Sdction*7000) of Division.3 of the Business and
T W ' ; Professionals Code, and my License..is in full force and effect.
O :D M,y License # Lic. Class Exp: Dale
r\ Q
W /+
% 4 d
Z r- /Date � Signature ofContractor� y.�. w
0
CO OWNER=BUILDER DECLARATION' ,
u1 ,Lu I hereby affirm under penalty of perjury that I.am exempt from the Contractor's
~ d 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
sale (Sec. 7044, Business & Professionals Code).
(') 1, 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
bN . 'I . .
'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•workem'
" 6ompensation, 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'oy
Section 3700 of the Labor Code, for'the performance of the work for. which this
permit is issued.'My workers' coriper'sation irisurance carrier,&,policy no. are:
Carrier Policy No.
I.IN:(G•'.i1�*t1g i�J'S G't� ', ,;; .. , .. • �5k35t71 i,9s�:14.I7ft '-: '..
(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 beco� a subject to. the
workers' compensation laws of California, and agre ' that I should become
s'bject to the' workers' compensation prodilioRsS a doh 3700 of the L boi!
ode,1 hal ` it comply with thoserav�s'en
ate: _A Applicant ��
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 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.l 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 authoriz re p,. r sentatw hof this. City to enter upon
the above-mentioned property for msjS cfi Moses.
Si natureO/wnerA ent
( )
f
PERMIT # CONTROL #
BUILDING PERMIT
9704-1445.264
DATE VALUATIONX�,:.i.► LOT. TRACTt;l.s
DRESS %-ii`SVIA V1,100 CC
APN-y311.(E�
OWNER
CONTRACTOR / DESIGNER / ENGINEER • a
` t r�jll'e�:iJ+►a1' a f "L�9;tl!?�E,a°4f�
Cts-lt? DAY 4 ; C..i'}Y;��'.�d`iNfY
1 OR, .. $snv. 2W
1570 MdO iP0401 J 0W DRIVE, SUM -208
QIIX 927135
SANTA ANA.. .. 'CA 92705
"
(71A}75l���1S.1 6: E I„ 4-4 5
.
USE OF PERMIT
81,1).- PL AN I;
. MCC CONSTRUU l.iaj 6p' � •t}V e.H
..
jxakE'`C•lit3xi`'tty 56_x€! Sia
O ARAE,EIC AI2;4'e°7W.f 600.00 SF
' C°OS O C �P+3.�'�:$�RJ�' i lt�i�t
-1414575.90
ay��+ p i. y �}e; {py A I3?y�°i""'.t'�iL�r�`I`.1+,d3
PrO
c�:Pt,w't'I2UC't',te>N'i 7?t • 1t3.1<o00��11?S-Q{aG $7f 6I%
s
1'f AN' CMI r;t � rtz 1(11: OUO-. z9 3:.t,�t CirJ;2!
4250.00
M!'�P. HANICA k'1ES,. .''- ' 1..):1,CJiifj-421 �0 S".50
Fash t °I`MLtC �i 1~ t, E
Pi, L1.MJ1tt4O_113P $1,611215
,..
Sa 1'C, ioL1 t%IJ'.I,[ f`l A .f:I 121.!'iil� 101:-000441-000 $14,16
��r;taaaiNs� 1'ii�. •, 1:U1-i►►Ufi-4�3 fiat► .. �2t�.ix)
f_N141i�,S'E`Fd'UCT0 it E,Li 2: �5 O(1(1-AtEz-3�1 `. �?,j.c :7fi
hiT".!N ^ioC�5-tUL:: STfl3:5'4
+Eil?i=141"�i?,CC1�a�!'l�tic,%1t7A1 �1s�� 1'[:�NN 0� .J.EG?�
1"'Ess :1p 6 R,k .C1 FE E, >
41250,flfj
C!`,1'ri:>X..]F'8 [t{9�'1'@ 1' 1r a t1`5..1V()1it
5A,!D 19.96
ECEIPT
DATE
BY ; y r i ' y'dATE
FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING AP
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel V2
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
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings OP
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
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
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)
- • � �� • I�.PPLICATION.ONLY •. ...
P O BOX 1504
Building 7 ��y t �' T'/ 78-105 CALLE ESTADO
Address / y !G� % orr'" f C LA QUINTA, CALIFORNIA 92253
Owner
�G h 4 t_N/4,to, d co.;7"a u N
Mailing 70 /6`UfAddress 1:5
City
Su h � ���. zl 17d ITel. Wel 7S7 713-/
Contractor .
Ctih4d4„/ i.rarb.�M�
Address
C-- /
City IZip I Tel.
State Lic. City
& Classif. I I I Lic. #
Arch.; Engr.,
Designer as M �fJr/sa f til /7 �6v�J
Address / ! Tel.
760 3d0/2//
City l r Zip State c ' y
A ! M 'h yl %.� (p� Lic. # i /
LICENSED 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 -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5, 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 of 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.)
t'1 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.)
7 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
❑ 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 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.
BUILDING: TYPE CONST,.. . OCC. GRP.
A.P. Number y
Legal Description
Project Description
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
ZONE: BY:
Sq. Ft.No.
Size o?3-77
No. Dw.
Stories Units
New ❑ Add O
Alte, ❑ Repair ❑ Demolition ❑
F.
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
ide Street Setback from Center Line
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.)
ide Setback from Property Line
Lender's Name
`jp
Estimated Valuation
FINAL DATE INSPECTOR
PERMIT
�.�JO Op AMOUNT
i`
Plan Chk. Dep.
_ ev � .—
Plan Chk. Bal.
ry
Const.
Mech.
Validated by ►�
Electrical
Plumbing
Va Nation:
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances:
Front Setback from Center Line
F.
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
ide Street Setback from Center Line
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.)
ide Setback from Property Line
Lender's Name
`jp
Lender's Address
FINAL DATE INSPECTOR
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.
Qi r-•: -
p�P •^ '
I certify that I have read this application and state that the above information is correct. I
Issued 6`y” Gate Permit
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.
Validated by ►�
Signature of applicant Date
Mailing Address
Va Nation:
City, State, Zip
BUILDING DIVISION
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING F
9q
IST FL. SO. FT. @ $
2ND FC. • SQ. FT.
POR. SQ. FT. ,
GAR. SO. FT.
CAR P. SQ. FT. G??
WALL SQ. FT.
SO. FT.
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE:.Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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. F7. c
BATH TUB
SQ. FT. p c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ IVa c
SEWAGE DISPOSAL
HOUSE SEWER
REMARKS:
ZR
GAS PIPING
PERMIT FEE
Ff
P
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.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 APPJEQUIP.
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
Notice ,. 827879 Highway,111
M Indio, CA 92201
= Document Cannot Be Duplicated 619-775-3500
' CERTIFICATE OF COMPLIANCE s
Date 6/6/97. APl`i# . 643-130-061',
No. 15610' - Jurisdiction La Quit to
.
Owner NameCanady &Company Permit #9704-144 .
No. 78-885" Street Via Florence ~. Log'#
` City La,Quinta Zip '92253 Study Area 123
Tract # .' Lot# Square Footage 2377 +
• _ Type of Development Single Family ResidenceNo. of Units
Comments
At the present time, ythe Desert, Sands,'Unified School District does not' collect fees on garages/carport's, 'covered,
patios/walkways, residential additions under. 500, square feet;"detached accessory structures o- replacement mobilehomes.
It has been determined the above-named: owner is exempt from paying school fees at thin time `due to the following t
reason: I F
EXEMPTION NOT APPLICABLE f
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 ane that •bu i ld ing
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) 75179,151 '
• Name on the check '
By Dr. Carol McGrew
Administrator in'Charge�
,
-Fee collected /exempted by Peggy Reyes Payment Received:` ' .''$4;373 68r
' Check No. 67528 n ;
Signature
r
ICE: Pursuant of Assembly Bill 3061 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 day approvalperiod in which'youiriay polest'lhe fees or other payment idenled'
e will begin to run from the date on which the building or installation permit fol this project is sssued or on which they are paid to the Districts) or to another public entity authorized tod them on the District('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, _-I' Applicant/Receipt Copy: Accounting
MAI,B-97 12:00 FROM:FORESITE ESCROW INC.
AND WKN MCOROCD h1An t0
name Canaday and Co.
"," 1570 Bro0kh0110M Drive
ID:619 7739263
PACE S/6
care, Suite 298
state Santa Ana, CA 92705
TT -100 caw. p SPACE ABOVE THrS UNE FOR RECORDER'S t1SE
GRANT DEED
APN No. Title No. Escrow No. 2-22095
THE UNDERSIGNED GRANTOR(s) DECLARE(s)
DOCUMENTARY TRANSFER TAX is S 231.00 CITY TAX S
O computed on full value of property Conveyed, or
O computed on fug value less value of liens or encumbrances remaining at time of sale.
O Unincorporated area: L)U City,of LA QUINTA , 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 QUINTA L.P. A DELAWARE
LIMITED. PARTNERSHIP
BY:, CENTRUM PORT PAVILION LTD.,
A DELAWARE CORPORATION, AS -GENERAL
Dated: PARTNER
BY: WILMA SOUTH MANAGEMENT CORP.,
A GEORGIA CORPORA ON, ITS ATTORNEY
StoleotGnttOmaj2, FIV12- 1DA 1>C11arles D. Craham
County of 1J [.L VA L. 1
before me. h (here insert name) Notary Pubic.
personwy oppeored
personoUy known to me (o(proved to me on the basis of sotisfoctoryevidence) to be the pewr•Qs) whose ncnWs) is/are subscribed to
true win -in instrument and ocknowieaged to me oU that he/she/they executed th® some in siker/tt,eir outh=ed copocity m), and
that by his/her/their signatures) on the.irW(ument the person(s), or the entity upon beholf of wtKh the per"(s) octed, executed the,
instrumenl.
WITNESS my hand and offi iol seat.•-'•. PAONOALr<!8r D. DOOOM .
`E►�i' M1' WZ"SSi011 i OC 290213
pr ; t7�ftiES: AA9 tl, tf)$f
Sisrwt�re _ L��h-/ �✓� i'•f.L'��Ii/..'v
r
aax ced ..antis oaae+
�P�- G43�300b)
MAR -016-97 12:`01 FROM:FORESITE ESCROW INC
ID:619 773 9269
Exhibit "A"
Parcel l:
Lots 103 and 113 of Tract 26152, in the City of La Quinta. Cotinty 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 County and. amended by
Resolution No. 91-108, recorded March 26, 1992, as Instrument No. 105176 of Official Rexrds.
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, pleasured vertically from said surface. as nxerved.in deed recorded August 4, 1993, as instrument
no. 303830 official records.
PARCEL 2:
A nonexclusive easement for ingress, egress, M and enjoyment of the comma area as defined in the Declaration of
Conditions. Covenants, and Restrictions recorded November 27, 1991, as instrument no. 4151.12.
PARCEL 3:
A temporary nonexclusive casement appurtenant to Parcel 1 for pedestrian and vehicular access, ingress and egress over that
certain real property more panic lady described in Exhibit 1 which is attached hereto and incorporated herein by this
reference. The temporary easement granted in this Parcel No. 3 shall automatically terminaoe and be of no further force or,
effect upon annexation of the Lots describe on Parcel No. 1 under the Declaration of streets providing vehicular and pedestrian
access to Parcel 1 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 access and use purposes _lursuant to the Declaration. Upon.
the termination of the temporary easement granted pursuant to this Parcel No. 3, access to Parcel l of the Property shall be
pursuant to the nonexclusive easement granted pursuant to Parcel No. 2 above.
RESERVING THEREFROM UN'T'O 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. appropriadve, 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 Pwperty 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 bow acquired by"Grantor.
B. Easements over the property for the construction, installation and waiatmance 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.
SUBJECT TO:
1. Taxes and None Assessments: Nondelinquent general, special and supplemental real praperty taxes and assessments;
2. Restrictions of Record: All covenants, conditions. restrictions, reservations. dedications, easements, encumbrances, rights,
and rights of way of record.
3. Assiglunent of Declarant Rights: Effective upon recordation of this Deed, Grantor assigns to Grantee with respect to the
property, all of Grantor's rights, exempu6w and entitlements as 'Declarant' under the Decl1hration 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
Quinta development for purposes of constructions, development and sale of residences within the Property; and all voting
tights of Declarant with respect to the property. Upon recordation of this.Deed, Grantee shall have the same rights with
resow to the vrovertv under the Declaration as Grantor orior to the date of recordation of this Deed.