9806-038 (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
Date Signature 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:
Carriery S. >•`>[ Policy No.
+Yb A1't'Abe� faGr��y1� Jl.D I61
(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 proVI If's (.Section 3700 of the Labor
)Code, Isha&fhwth comply with hose p i Sf.Datel l 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 Applicatibii is Iieieby 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 repre entatives of INS City to enter upon
the above-mentioned property for inspect on , :poses.
Signature (Owner/Agent)
BUILDING PERMIT PERMI1��I,( 0314 CON/T�ROL#/�
DATEVALUATION S1.72A2%.'1 LOT 1`4.4� TRACT
[�
��% —,?/—
!!/
JOB SITE
ADDRESS Ole��\D/r�
APN l�i+�l=Y(! fjlial
.OWNER-
CONTRACTOR / DESIGNER / ENGINEER
�'if 1'1' 1ti 4a ''YAi f`( aft; a di °i 1
I"I I; l"L 1 f a,AtL�Umf C ON �.V. x.11. � V %N
t23Y:i I� xis+"E1#C U WAY
V�.j�7a� �56+.����ti`�m) i�✓F1.N'.
PE11..M lY' E."-fi. 92200
Pt14.M DIN I T t,'A 92201,)
(C'11f,ft X1197
f.
USE OF PERMIT
NINOJJ. ,' f AI411R,`Y I. VVIOAAM..
lo',D_1.1lZtltt.s• fitti3.fvvf. t. i 't,.iri t�I3L�,; i�. i18 ki> r_�L I' AN
I�(» ?5' u f (){ ISSUANC1f1SA&J✓ PLAN
�. PA I
OCT 21 1998
f'l.>i<41f11'll:i iCj 1`It.il(i >.i:+
e1A14UN(J14(,'ARJJ( AC' 783,00 6F
OF LA QUIN
✓j
'r
�Y:l•r b� '!.tl'�i� r*i1�'p' fqr a'.� ,i,t G.�'f-�8"i
+fit +'CPI►
at t .a, a..= .Y � � A �. � e::y ativ�; . dwei
f {{y� q3 yy��,, vvRRgg q aa>,e'►
t.'(>f�fy`CIt,l�r<"fI()r•)3<f� 1!)t-Olio<41�-f}f}t3 ,�+S.Ct�
f3f.AN IW, N-, W 10{-l�diti•4l� "it�i '�t�W�O
FEE 60,M) PT 1101-000439-304 4250,W
4YtECIIANICAL FlYi 101-000-121.0OU `n'3Se�rs)
171X'(1,Ri(1AL Via." 101 -0W -420 -OW 504.89
1-4 :1 101-i►m-tiIt) (Of)
0
miiRC'1%fO SI1) 10.8."1000-241-000
(IR Af�U�."EL, Iti.1W-423-000
{fti4 ±:A5'.t alit .i'fit�F,;F Ii 125AW-40-342 1ti111808.90
Fi'a,' riJ }i14Fii i ° (,tl� ti -'tr `�1t 7()1...0( cl-.255-000 Sift) ()'3
litTI ANO PfA/N (41t�,C'�1y�
E iS, 1 RE -11k` ID rTES
I'MAJ, k'11+,9d1i'i AT .VVIN ;Dl i ' NOW
�►5„33�. i�
5
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
<1_
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
. MECHANICAL APPROVALS
Set Backs v A
Underground Ducts
Forms & Footings t IDucts
Slab Grade /
Return Air
Steel
Combustion Air
_
Roof Deck �pt1j
Exhaust Fans
O.K. to Wrap ' 7/ • '
F.A.U.
Framing 7— $7
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 AP ROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines �G�
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 7—��
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) 4 /7
ELECTRICAL APPROVAL
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) % _ -
Desert Sands Unified School District
' 47-950 Dune Palms Road
Notice: 1 La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 10/5/98 ' APN # 643-120-007
No. 17843 Jurisdiction La Quinta
+-'Owner NameMichael Bergin Construction, Inc. Permit #
No. 47=570 Street Via Montessa Log #
City La Quinta zip 92253 Study Area
Tract # Lot # Square Footage 2,0035
Type of Development Single Family Residence, 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:
. ; 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 $.5,471.55 the property listed above and fiat building;
r
permits and/or Certificates of Occupancy for this square footage in this proposed project may.w), be issued ".
Fees Paid By CC/1 st Bank/Michael Bergin.. c Te!eRhone x'862-905.8
Name on the check 41
x.
,l
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Payment Received5,471.55
Check No. 47698
Signature
NOTICE: Pursuant of Asse y Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may pmtest the fees or other. payment identified
above will begin to run from a date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) m to another public entity authorized to
collect them on the Dislricl(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 - Applicant/Receipt Copy -.Accounting
-SEP. 18. 1998 3.33RM LIBERTY. ESCROW INC N01•3 P.1/5
RECORDING RlQUESTED ,by
,
AND WKN R@COrjDEO MAII TO
MarneM�C)1»4!1 $e$g D CoAstruction
Aodr�s 72929 Skyward Way s
cine -Palm Desert, CA .'9;2260
Sure
SPACE ABOVE TMIS•UNC F.OR'RECORDER'S USE:
CRANT`DEEDgns t2o - oo'j
-Escrow:No, .I
APN.No.
THE UNDERSIGNED ZRANTOR(s) DECIARE(s), CITY TAS $
u
DOCUMENTARY TRANSFER TAkiS S° •,
80 30
�. computed on full volue of property conveyed, or_
liens encumbrances remaining at time of sale, s;
D computed on full value less value. of or
anal,
G Unincorporated area; 0 City of T.A. QUINTA
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
a ,
WILMA--ILA OUINT'A L.P. ; A DELAWARE LIMITED. P'ARTN:ERSHIP :R
ISic>bael Bergin Caustruction, Inc.;, -.a California, �C-prporatioa
j
hereby GRANT(s) to
the followlig described real properly In the
f
Couniy.of . R I'VE g s I D E State of California; .
S.EE EXHIBIT. "A " ATTACRED WILMA-LA QUINT& L.P. 'A DELAWARE
LIMITED PART14ERSHIP
$Y: CENTRUM 2097 PAVILION LTD,,
A DELAWARE C6R?0RATION, AS GENERAL
PARTNER
f3,t94$
Dated: BYt WILMA SOUTa MANAGEMENT CORP.,
A GEORGIA CORPORA I ITS ATTORNEY
,*,
State 6th i�i�� . , • - as.
u ✓A(.,
County of
�Qg the der f ed {here•Insertname) NotoN Public,.
ori - before me,
personally apAeoreds__ ��--s-si+�
personally known to me (or proved to me on the basis of satisfoctary evidence) to be the person(s) vhose nome(s) b/arra subscribed to
some In hIs/nerrNbIrauthorized capacity(le5), and
itis witnln instrument and acknowledged to me oil that he/she they exeCUfb0$*
the Instrument the person(s), or the entity upon behalf of which'.he person(s) acted, executed-tne
that by hls/her/their slgnoture(s) on
Instrument.
WITNESS my hGnd and ofti iai seol,
F}{O y� D. 6400WItd
My' MM;IW[0N # = ✓ M14
EVIRS: Jane 6, 9.961
;Ate Bonded ThN "ft Po ft Undaan"
�
,Sl9natw � onuc o �d v+snin polder
•
SEP--22-98 TUE 15.:04 GIBSONGROUP 6197712140 ,P..02
July 2, 1998 ,
TO:t, Mr. Michael Bergin -
Bergin Construction, Inc. _
72929 Skyward Way
- Palm Desert, California 922.60
From: Rich Lane ,
r
Architectural Committee '
Lake La,Quinta Homeowners' Association k •
The A hitectural Committee met on July 1, 1998 evaluated and approved your proposed ~
Plan and 4,
.: Ld{ Z35
We wish you well with your project, v
One member of the committee expressed concern regarding the amount of bathroom
glassblock planned for one corner of the residence. However, no reconur.emdation was
provided except the suggestion to use non-observable see-through 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 ind Will" soon
force the homeo Amers to take action. N
Sincerely,
RZe
- if ♦ is :, k• .