0310-095 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that l am licensed under provisions of
Chapter 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
509442. 2914710
Oatea Signature of Contracto
WGRI
�
•OWNER -BUILDER D 4 10 ��Yhe
I hereby affirm under penalty of perjury that lam exeeptt� roontractor'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 MEMPT-NEW SIM
fL Policy No.
(This. section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is. issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, an .a' relaat if I should become
subject to the workers' compen$ati 'n pp oyls7�n of Sec Ion 3700 of the Labor
Code, I s�all forthwith comply with t o§e� ,0 i io�`ii , �r
Date,a� i" ApplicAt A
Warning: Failure to secure A 'ers' Co p sation-e verage 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 Budding 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 i D
work is not commenced within 180 days from date of issuance of suc
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 i
correct. I agree to comply with all Gi�jr, and State laws relating to the building
construction, and hereby authorizer repgqese atives of this City. to enter upon
the above-mentioned prope f �r'insp rc4io p oses.
Signature (Own /t g)n .j I o Datel '
NVM
BUILDING PERMIT PERMIT#
DATE el VALUATION LOT 0310- 'S �jRACT- '
a / - U t� $►1%.20 12 14104
JOB SITE,�
ADDRESS 50.4350 NTA I�r3t N�'�i�$KA.
APN
'i7..i1r�26D, 01Z
OWNER
CONTRACTOR/DESIGNER/ENGINEER
P. MTNlyr
MARK T,)UPI IDW C' �OW8117R.t"�'CM(ON
69•9301iVIT .111. #15
69683 PIMASSANT.C:*ROVF
(76,�„1)578^49417 LM4 13822
USE OF PERMIT
SIXIO1T,1?A1vl[LY DWEL NG
69$5 SP slqb. PRAlNUT DOES NOT IN C IX DF POOL, SP.E. BLOCK WALLS OR
DitIMIT �:�,,Y API°ROACH PERMIT. 2001 GDC;.
CWTOM 1,' ONS7:'12UC:TION 6,335.00.8F
POIICHIPAT10 1,171.00 SF
,
t��'`AGIUC.ARPORT 1,190.011 SP
} �►" �dAs'i`1�°T� Con OF COr°d5MUC."ATON
:'.a v: ,%,20
>'EMMn" bfTYLP &MSTARY r
CONSTRUCTION MR, 101-000.4163-10010 $2,150.50
PLAN CHECK FUE 101-000-4"-318 $1,1W.49
FEE DEPOSIT t 101-000-439-318 -51,000.00
MECHANICAL FEE 101-0110-4.21-000 $207.50
3±.T.k OTRI€ AL FFL 101-000420-000
PLiiPABING Fls'F; 101-000.419-( 000 $2711.'75
S T RO 40 MOT109- FEE • RMID 1,01-000-241-000 S5164
CiLkL1010 PIM 101..000-423-0300 $1.5.00
DUV R1,01I .12 IMPACT M.E. ` $2,405.00
GIRT IN PYDBTAC PLACES - RUIF 1-10-060-44.5-000
N
1
P
SUB -TOTAL CONSTT?iTG" M-1 AND P �,rs C ;.K
-$8,002.15
%ESS . ?rPAW'%V_'.al
-$1,000.00
1rarAT1,PY_RMff FTINS DUE, MW
$7,0023.,S
MAR 0 9 2004
CITY OF LA QUINTA
RECEOPINAN - -�
BY <
DATE FINALED
1
INSPECTOR
I— Ii-''�.
-62
_
I' �
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
F.A.U.
F
Compressor
sulation -
Vents
i
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
j 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
Gas Test
Electric Final
Waste Lines " _
eater 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
�liances
✓
-R
r
Final
Utility Notice (Gas)
ELECTRICAL APPRO / . S
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) .
Final
COMMENTS:
Coachella Valley Unified �icnooi vistrict
P.O. Box'847; `i'hermal, CA 92274
;760) 39.8-5909 — Fax (760) 398-1224
This Box For District Use Only
T)1RVRT.0P1PR FRES PATI)
AREA:
AMOUNT
LEVEL ONE AMOUNT:
LEVEL TWO AMOUNT:
MITIGATION=AMOUNT:
COMMIIND. &MOUNT:
DATE:
RECEEPT:
CHECK N:
rNIT1ALS'
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name: Polo Estates Date: March 4, 2004
Owner's Name: A T PVInP /P hGn++.T* Phone No..
Project Address: 50-350 Vigra Mant2„;i Ta Orinra, rA
Project Description: 1 SFD
APN: 772-260—OT Tract #: 14104 Lot #'s: =
Type of Development: Residential ffi Commercial
Total Square Feet'of Building Area: 6 _ IA9 sq- ft-
Certification
r__
Industrial
Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement
under penalty of perjury and further represents that he/she is Iutltor"d to sign on behalf of t�� owner/developer.
Dated:' -3 114 119 Ll Signature:
w ,r * * * i «, * * r r ,► « * * « � r . « * ' w * * ,r * * * r ,r * r ,w r r r * * ,w • .. • • w *, r • r * * * w « * * r ,► w ,w * « r w * . * ,w
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code Gov. Code Project
17620 65995 Approval
Number of Sq.Ft. 6,385
Amount per Sq.Ft. : $ --2.24
Amount Collected $ 14, 302.40
Building Permit Application Completed: Yes/No
By: Carey M. Carlson
Asst. Supt., Business Serv.
Agreement Existing Not Subject to Fee
Prior to 1/1/87 Requirement
Note:
'110 Z.� - - - /.&-77- —,,,
Certificate issued by: E1yi ra, Mattson Signature:,_
Office Technician
NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES
Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a written notice to
the project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of
these Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall
serve to advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of
any other requirements as described in section 66026 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether
payable at this time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This
Certificate of Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School
District, and up to three (3) such extensions may be granted. At such time as.this Certificate expires, if a building permit has not been issued for the project
that is the subject of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance.
MV:c/mydocs/devfees/certificate of compliance 09/30/02
I
December 18, 2003
Mr. Patrick Mundt
69-93o Hlghway 111, Ste. #115
Rancho Mirage, CA 92270
RE:. Architectural Request
Dear Mr. Mundt:
The Architectural Committee and the Board of Directors has approved your request "
for a new residence pending the foilowing conditions:
1. Please submit a landscapeplan to the Committee for approval as soon as
possible:
Should you have any further questions, please feel free to contact the undersigned.
Dec 11 03 02:30p
'RECORDING REQUESTED BY:
COMMONWEALTH LAND TITLE COMPANY
12882JE
WHEN RECORDED KUL THIS DEED AND,
UNLESS OTHERWISE SHOWN BELOW,
MAIL TAX STATEMENTS TO:
Patrick R. Mundt
943 GAVIOTA DR.,
LAGUNA BEACH, CALIFORNIA 92561
760 202 3757 p.2
08/07/2003 08:00A Fee:30,00
Page I of 2 Doc T Tax Paid
Recorded in Official Records.
COLnty of Riverside.
Gary L. Oreo
County Clerk 8Reeorder
,,A,S61e,S,S,0,r'1ri1111�I�INIl011Ni1.
eee
==0=0
.
7YtR OCG - fUs(0D
MENRIMMMMMMM
The undersigned ,grantor(s) declares)
13 a /- 2-a
Documentary transfer tax is -
3�
ee��eeme�
Computed on full value.less liens and remaining at time of sale.
(( ))
Unincorporated area: ( ) City of
RAW
7YtR OCG - fUs(0D
The undersigned ,grantor(s) declares)
13 a /- 2-a
Documentary transfer tax is -
3�
(�) Computed on full value of property conyeyed, or
-encumbrances
Computed on full value.less liens and remaining at time of sale.
(( ))
Unincorporated area: ( ) City of
and
FORA VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
1.
Kurt G. Campbell and Bonnie May Campbell, Trustees of the Kurt G.
Campbell Revocable
Family Trust Dated 12-15-82
hereby GRANT(S) to
Patrick R: Mundt, a single man alta .
the real property in -.the City of -La Quinta, County of Riverside,
State of California,
described as:
Lot 12, Tract 14104, as per map recorded in Book 112, Page(s) 67
through 69 .inclusive of
maps, in the office o£ the County Recorder of said County. ,
Dated May 22,'2003
State of Califo
rt.Gv
County . of //!P/ //'�if= } S . S . N Campboell , ' ru,%tee ,
on ZZ, 9645
before me.,
personall�j appeared "gonnie May Camp
ell, .Tru ee .
91- /�l9, /9j� -
personally kno to me (or proved to me on
the basis of satisfactory evidence) to be
the person(s) whose names) is/are subscribed
to the within instrument and acknowledged to
J79KC
me that he/she/the� executed the swie in
sz%. COW.0a 1zsss
his/her/their authorized capacity(ies), and
o P"ALU�OMLI►�
UBL
that by his/her/their signature(s) on the ��
,cMARY
P►vORs�c�7Y 0
fV'�,88tk:'°
instrument the person(s), or the entity upon7.
c0aw.w.4. .
behalf of which the person(s) acted, executed
the instrument.
WITNESS my and an tic 1 seal.
Signature (This area for official notarial seal)
MAIL TAR ST TO
Y