9806-037 (SFD)LICENSED CONTRACTOR DECLARATION
I 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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
4419714
Datef��� �� Signature of Contracto Z, �/_/A
V -(.,4
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.
t(/) I have and will maintain workers' compensation insurance, as required by
S ction 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:
Cartier 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, and 'agree that if I should become
subject to the workers' compensation provisi Rs of Section 3700 of the Labor
,Code, I sh dforthwith comply with those p vision Sn'
Date: �� �• A �. Applicant��
Warni g allure to secure Workers' Compensation covers a 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 state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize represeDtatives of this City to enter upon
the above-mentioned property for inspectidn p poses.
/Signature (Owner/Agerif`��- ate��'==�°
t
6, ... r ,
BUILDINGPERMIT PERMIT CONTROL#
DATE VALUATION `9172,426,10 LOT 2 � TRACT '18428
o-zi> ir.
ADDRESS 47-540 IA- i3.Cr1<i C%k JOB
APN 6d3-i.z�FfH)ts
OWNER
CONTRACTOR /4DESIGNER /ENGINEER
r♦ 7y^^ U r 1 ��
1\_i+;•oil�''1A.� f�ri"��y:�� �a L.�iv �s, i.t riYi�i 4s �:
7� f
t4t�14~l;iltLA_. l'.i. i`c.w.ii1'r i.�t.�,+c�.e [ A'tiJli-iii*�
72929 SkYWA}.'..t) WAY
729"—) SKYWARD %VAY
PA1,M .6.E-sb.R:r CA 92.260
�.it.C. M DES1,11M, t''A. 9.2200
060)8312_9058 tof 11.E 4177
USE OF PERMIT
SINCYI.,I�a' f-,JkJW1A- 1)11\+1 1.1.,11jV r
SID - FERX- f`1. WE.S O'Y INCLUDE BLOCK WALLS OR V7OL,
P
flilD
`tl t.k:a
0012 1, 'ago
OF LA'l+[1.
IN
cyta�2A.Cli✓.ti,nitlDL'�1t'!' rfs3.�f0 �'
• !•EIVRLN.TI'.,P-� COST
-fL,`J GE),Io
CONS'.i'12.t31.7I0Pd.I+E t.;t)
f R,;DiYea .d.
!�ilit �ziKt+fll°nf.1�.1si, l01.-iJQQ-d.2 �-•Ci00 a!sti_sl1
iW1 F 4 i1�ft Al # 1*� f,0t-111)042.0-000 $1,9489
Pi 111141! 11 hk'1 rl;rl1(} 1 -!)11th 1 l-ff(it? f 1 i F
3TR()T4r _N1011CX4 1111., kEN113 101-000--24.1 004) ~ t
AJkAT<:TtMG .CEL 101-000-423-000
1Iv_H0`tMXt.f( 11.)121: F'}i!^ d 22:5-000-443-3}Q $ ,iiu?3,4ab
n "•t• Int PTfir,1e' F+1,.Ar. `! _ R► fT 70f 4"-? 5,;-w
SJ.)Pt C)TA L COIN M ( .* KIN AN P P:t,c* N
c!)
TZ!34K; PRE341WD FEES
_V%) 00
TC)'il Al, t'FUNII l FKEN 00VN0W
s:9.':►i)100
S• T'
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
AV
Underground Ducts
Forms & Footings
a
Ducts
:Slab Grade
Return Air
Steel
Roof Deck
_
:��(— Q 9 ,�
Combustion Air
Exhaust Fans
OX to Wrap
— / -
F.A.U.
Framing
Compressor
Vents
Insulation _
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_
/1l
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
/_
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
L/�
Encapsulation
Gas Piping
Gas Test
¢ Q Q
Appliances
Final
COMMENTS:
RRP 47 AOdle S'iS/W 4190e Jr 1114f
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
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
t
Final —` �� --
Utility Notice (Perm) 4. --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 10/5/981 APN #. 643-120-008
No. 17842 Jurisdiction La Quinta
Owner NameMichael Bergin Construction, Inc. Permit # x
No, 47-540 Street Via Montessa Log #
City La Quinta Zip 92253 StLdy Area
Tract # Lot # Square Footage -2,335
Type of Development Single Family Residence j No. of Units '1
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.-eplacement mobilehomes.
It has been determined the above-named owner is exempt from paying school fees at this time due to the following
reason:
x '
EXEMPTION NOT APPLICABLE
This certifies that school facility• fees imposed pursuant to• Government Code 53080 in the amount of
1.93 X 2,835 or, $a5 471.55di r `
the property listed above andttsa+ buteldmg
permits and/or Certificates of Occupancy for this square footage in this proposed projeec vmaynoWbe'yssued'1. y, .
Fees Paid By CC/1st Bank/Michael Bergin.on 8629058 A
' Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green- Payment Received '35,471.55
Check No. 47697
Signature
NOTICE: Pursuant of Asse Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may pretest the fees or other payment identified
above will begin to run from dale on which the building or installation permit for this project is sssued or on which they are paid to the District(s) oo to another public entity authorized to
collect them on the District(' (s') behalf, whichever is earlier. -
Collector: Attach a copy of county or city plan check application form to district copy for all vraivers.
Embossed Original- Building Dept./Applicant' Copy - Applicant/Receipt Copy - Accounting
— r EP. 18. 1999 3: 34PM LIBERTY . ESCROW INC NO. 173 ;' P.3/5
RECORDING [REQUESTED By.
AND N011EN RECORDED MAIL TO
Nom® Lei Glaske
cs a
SPACIE ABOVE THIS LAVE FOR XCORDER'S USE
GRANT DEED
APN No.
NO -
Title No, E$CfOW NO- .
THE UNDERSIGNED GRANTOR(s) DECLARE(s) 159:^Sm '. CITY TAX $
DOCUtAENTARY TRANSFER TAX, Is S
0 computed on .full value of property conveyed; or: -
sale.
O computed on full value less value of Ions or encumbrances. pmaining at time of and
El Unincorporated area
, ®City of LA QUINTA
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged:
WILX-A-LA QUINTA L.P., A DELAWARE LIMITED'PARTNERSHIP'
LSA •G'1i.AS1�8, a married mmas his $alk_ and separate pxOPert y i.
All
hereby GRANT(s) to ;
the following described real property In the
CoUOY Of RIVERSIDE . State, of Colifornio;
SEE ExHIBIT "A " ATTACHED..,. WILMA—LA QUINT. L. P. A DELAWARE
LIMITED. PARTNEE.SFIIP
BY. CENTRUM POET PAVILION LTD.,
A DELAWARE CORPORATION, AS_. GEN!?RAL
l�94 PARTNER
Doted; .!�, BY: WILMA SOUTH�MANAGEMENT.CORP-,
A GEORGIA CORPOR N, 11ATTCRNEY
T9 F
State of q FG p�A4
County of
(here insert name) Notary Public.
On, �f J—Lq _ before me, thts
personalty appeared
l persanotiY known too (or
acknow�Ito me an II)a edged to me all that he she/ttl Y executed the am®n hlslherf-helf authorized c poc►ty(®load o
i
the within Instrumen and
that by his/her/heir signature(s) on the Instrument the person($). or the entity upon behalf of which the person(s) eacted, executed the
Instrument.
-WITiNESS my hand and cftiolat secl. �q��+V'� ►i0N10AL NN 0. N9ppYYIN
K w� MY camMIA8IQN aC MOB14
im r, goal
W40d T" Matin PAo shwa it
$I�nOtU, .aa(f!xce0lwlif!U+corder
July 2, 1998 `
TO Mr. Michael Bergin
Bergin Construction, Inc.
72929 Skyward Way <,
Palm Desert, California 92260 '
From: Rich Lane
Architectural Committee '
' Lake La Quinta Homeowners' Association ' r
The Atectural Committee met on July 1, 1998 evaluated and approved your proposed
'
Plafqnd 4.. _
Lot 236
We wish you well with your project,
One member of the committee expressed concernregarding the amount of bathroom
glassblock planned for one corner of the residence. However, no recomar_emdation was
provided except the suggestion to use non -observable see-thxough 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 andwi11 soon
force the homed Anvers to take action. '
Sincerely, M
Rich (Cane