BRES2016-0366LICENSED CONTRACTOR'S 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 Professions Code,
and my License is in full force and effect.
License a License No.: 655874
Dt- ate: i Contracto
OWNER -BUILDER ECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for the permit to file a
signed statement that he or she is licensed pursuant to the provisions of the
Contractor's State License Law (Chapter 9 (commencing with Section.7000) of Division -
3 of the Business and Professions Code) or that he or she 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).:
( ) I, as owner of the property, or my employees with wages as their sole k;'3 -
compensation, will do the work, and the structure is not intended or offered for sale.
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
apply to an owner of property who builds or improves thereon, and who does the work
himself.or herself through his or her own employees, provided that the 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 or she did not build or improve for the purpose of sale.).
(_) I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
( ) I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
(760)340-9800
Llc. No.: 655874
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjuryone 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 and policy number are:
Car ' EMPT Polity Number:
r 1 certify that in the performance of the work for which this permit is issued, I
s F nofemploy 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 provisions of Section 3 0 of the Labor Cod Is all forthwith
comply wit thos provisions.
Date: ' Applica
WARNING: FAILURE TO SECURE WORKER COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($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: "
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this 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 application , the owner, and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
employees for any act or omission related to the work being performed under or .
following issuance of this permit.
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 county ordinances an'd state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the.
above mentio ped p operty for inspection purposes.
Date: O Signature (Applicant or Agen :4
j
.
VOICE (760)
777-7125.
78-495 CALLE TAMPICO
7-701
LA QUINTA, CALIFORNIA 92253
DESIGN & DEVELOPMENT DEPARTMENT
INSPE NS.(760
-715.1
BUILDING PERMIT
Cr
i
Date
3/8/
o
LO
z
Application Number:
BRES2016-0366
Owner:
c
Property Address:
52983 VIA SAVONA
PAUL DEWEY
cv
APN:
777380001
PO BOX 12793
C�
C
CX.
Application Description:
HIDEAWAY/ SUNLITE / SFD 6888 SQ FT
PALM DESERT, CA.92255
®
� 0
Property Zoning:
Application Valuation:
$634,359.10
U
Applicant:
Contractor:
®
Z
ESU /FMESUNLITE
DEVELOPMENT 1
C
tri
180016TH ST
P 0 BOX 10668
p
SANTA ANA, CA 92701
PALM DESERT, CA 92255
LICENSED CONTRACTOR'S 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 Professions Code,
and my License is in full force and effect.
License a License No.: 655874
Dt- ate: i Contracto
OWNER -BUILDER ECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for the permit to file a
signed statement that he or she is licensed pursuant to the provisions of the
Contractor's State License Law (Chapter 9 (commencing with Section.7000) of Division -
3 of the Business and Professions Code) or that he or she 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).:
( ) I, as owner of the property, or my employees with wages as their sole k;'3 -
compensation, will do the work, and the structure is not intended or offered for sale.
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
apply to an owner of property who builds or improves thereon, and who does the work
himself.or herself through his or her own employees, provided that the 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 or she did not build or improve for the purpose of sale.).
(_) I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
( ) I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
(760)340-9800
Llc. No.: 655874
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjuryone 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 and policy number are:
Car ' EMPT Polity Number:
r 1 certify that in the performance of the work for which this permit is issued, I
s F nofemploy 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 provisions of Section 3 0 of the Labor Cod Is all forthwith
comply wit thos provisions.
Date: ' Applica
WARNING: FAILURE TO SECURE WORKER COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($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: "
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this 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 application , the owner, and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
employees for any act or omission related to the work being performed under or .
following issuance of this permit.
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 county ordinances an'd state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the.
above mentio ped p operty for inspection purposes.
Date: O Signature (Applicant or Agen :4
Date: 3/8/2017
Application Number:
BRES2016-0366,;
Owner:
Property Address:
52983 VIA SAVONA I
PAUL DEWEY
APN:
777380001
PO BOX 12793
Application Description:
HIDEAWAY / SUNLITE / SFD 6888 SQ FT
PALM DESERT, CA 92255
Property Zoning:
Application Valuation:
$634,359.10
Applicant:
Contractor: "
ESU /FME
SUNLITE DEVELOPMENT INC
1800 16TH ST
P O BOX 10668
SANTA ANA,, CA 92701
PALM DESERT, CA 92255. •
(760)340-9800
Llc. No:: 655874
Detail: NEW 6888 SQ. FT.
SFD THIS PERMIT DOES•NOT INCLUDE POOL,SPA, BLOCK. WALLS,
DRIVEWAY APPROACH, FIRE PIT, BBQ, OR -WATER FEATURE:
HOME IS FIRE SPRINKLED
PER 2013 CRC CODES.
FINANCIAL •• •
DESCRIPTION ACCOUNT QTY AMOUNT
ART IN PUBLIC PLACES - RESIDENTIAL
270-0000-43201 0 $1,085.90
Total Paid for ART IN PUBLIC PLACES - AIPP: $1,085.90
DESCRIPTION
ACCOUNT
QTY.
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$26.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $26.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DIF - CIVIC CENTER
252-0000-43200
0
$942.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DIF - COMMUNITY CENTERS
254-0000-43200
0
$129.00
DESCRIPTION.
ACCOUNT
QTY
AMOUNT
DIF - FIRE PROTECTION
257-0000-43200
0
$433.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DIF - LIBRARIES
253-0000-43200
0
$344.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DIF - PARK MAINTENANCE
256-0000-43200
0
$40.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DIF - PARKS/REC
251-0000-43200
0
$2,048.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DIF - STREET MAINTENANCE
255-0000-43200
0
$116.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DIF - TRANSPORTATION
250-0000-43200
0
$2,842.00
Total Paid for DIF - SINGLE FAMILY DWELLING: $6,894.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TEMP POWER SERVICE
101-0000-42403
0
$25.33
DESCRIPTION
ACCOUNT
QTY.
AMOUNT
TEMP POWER SERVICE PC
101-0000-42600
0
$17.73
Total Paid for ELECTRICAL: $43.06
,DESCRIPTION
ACCOUNT
QTY
AMOUNT
RESIDENTIAL, EA ADDITION 1,000SF
101-0000-42403
0
$103.36
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RESIDENTIAL, EA ADDITION 1,000SF, PC
101-0000-42600
0
$42.56
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RESIDENTIAL, FIRST 1,000SF
101-0000-42403
0
$152.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT .
RESIDENTIAL, FIRST 1,000SF, PC
101-0000-42600
0
$50.16
Total Paid for ELECTRICAL - NEW CONSTRUCTION: $348.08
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RESIDENTIAL PRECISE GRADING - CUSTOM HOME LOT >7KSF
101-0000-42408
0
$38.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT.
RESIDENTIAL. PRECISE GRADING - CUSTOM HOME LOT >7KSF PC,
101-0000-42600.0
l $190.00
Total Paid for GRADING: $228.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
CONDENSER/COMPRESSOR
101-0000-42402
0
$190.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
CONDENSER/COMPRESSOR PC
101-0000-42600
0
$126.65
DESCRIPTION
ACCOUNT
QTY
AMOUNT
EXHAUST HOOD
101-0000-42402
0
$25.34
DESCRIPTION
ACCOUNT
QTY
AMOUNT
EXHAUST HOOD PC
101-0000-42600
0
$10.14
DESCRIPTION
ACCOUNT
QTY
AMOUNT,
FURNACE
10170000-42402
0
$190.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FURNACEPC
101-0000-42600
0
$126.65
DESCRIPTION
ACCOUNT
QTY
AMOUNT
VENT FAN
101-0000-42402
0
$126.70
DESCRIPTION
ACCOUNT
QTY
AMOUNT ..
VENT FAN PC
101-0000-42600
0
$50.70
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WALL HEATER
101-0000 42402
0
$50.66,
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WALL HEATER PC
101-0000-42600
0
$25.34
Total Paid for MECHANICAL: $922.18
DESCRIPTION
ACCOUNT
QTY
AMOUNT
NEW CONSTRUCTION. PERMIT
101-0000-42400
0
$866.17
Total Paid for NEW CONSTRUCTION PERMIT: $866.17
DESCRIPTION
ACCOUNT
QTY
AMOUNT'
NEW CONSTRUCTION PLAN CHECK
10170000-42600
0
$1,200.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
NEW CONSTRUCTION PLAN CHECK
101-0000-42600
0
$721.10
Total Paid for NEW CONSTRUCTION PLAN CHECK: $1,921.10
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BACKFLOW DEVICE
101-0000-42401
0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BACKFLOW DEVICE PC
101-0000-42600
0
$5.07
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BUILDING SEWER
101-0000-42401
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT'
BUILDING SEWER PC
101-0000-42600
0
$17.73
.DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIXTURE/TRAP
101-0000742401
0
$392.77
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIXTURE/TRAP PC
101-0000-42600
0
$392.77
DESCRIPTION
ACCOUNT
QTY
AMOUNT
GAS SYSTEM, 5+ OUTLETS
101-0000-42401
0
$38.00
DESCRIPTION .
ACCOUNT
QTY
AMOUNT
GAS SYSTEM, 5+ OUTLETS PC
101-0000-42600
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
ROOF DRAIN
.101-0000-42401
0
$25.34
DESCRIPTION
ACCOUNT
QTY
AMOUNT
ROOF DRAIN PC
101-0000-42600
0
$25.34
DESCRIPTION
ACCOUNT `
QTY
AMOUNT
WATER HEATER/VENT
101-0000-42401
0
$25.34
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER HEATER/VENT PC
10170000-42600
0
$15.20
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER SYSTEM INST/ALT/REP
101-0000-42401
0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER SYSTEM INST/ALT/REP PC
101-0000-42600
0
$12.67
Total Paid for PLUMBING FEES: $1,026.23
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SMI - RESIDENTIAL
101-0000-20308
0
$82.47
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $82.47
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0 _
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SINGLE FAMILY DETACHED
224-0000-20320
0
$1,837.44
Total Paid for TUMF - RESIDENTIAL: $1,837.44
r
'� CV
P.O. BOX 1504
BuildingpO 78-495 CALLE TAMPICO
Address 5z 9O 3 V//T<�10/Vyf LA QUINTA, CALIFORNIA 92253
S�iYG /T� G
Mailing
Address pG &,Y l dl.&A
WA
Address
City lZip JTel.
State Lic. // .•,�•-� City I
& Classif' 77L1 Lic. #
Arch.,
Designer
Address Tel.
-7
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm tbaHem licensed un ovisions of Chapter 9 (commencing with Section 7000)
of Division 3 the siness rid P ofes ions Code, and my lic �s in toll force d effect.
SIGNATURE DATE
O R -BUILDER D LARATION
I 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
suchpermit to file a signed statement that he is licensed pursuant to the provisions of the Contrac-
tor'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).
0I, as owner of the property, or my employees with wages as their sole compensation, will do
rthe work, and the structure is not intended or offered for sale. (Sec. 7044, Business and Profes-
sions 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).
O 1, as owner of the property, am exclusively contracting with licensed contractors to construct 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 tractor's License Law)
❑ 1 am exempt under Sec. _ I . & P.C. for ttt e"ason
WORKERIS COMPENSATION DECLARATION
I hereby affirm that I hav 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 Workers' Compensation taws 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.
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-mentioned
property for inspection purposes.
Signature of applicant �� Date
Mailing Address
City, State, Zip
WHITE = BUILDING DEPARTMENT
00,
APPLICATION ONLY
BUILDING: TYPE CONSTT,OCC. GRP.'-7,/�i�
A.P. Number -7'7. 3 !30 Z
Legal Description :17:9 � g -
Project Description
Sq. Ft. /0' G41_7 No.
Newly Add ❑
No. Dw.
Alter ❑ Repair ❑ Demolition ❑
IEstimated Valuation / rI �O ,O O �,,C
PERMIT
Plan Chk. Dep.
Plan Chk. Bal,
Const.
Mech.
Electrical
Plumbing
S.M.I.
Driveway Enc.
Infrastructure
TOTAL
CONTACT INFORMATION
NAME:
PHONE:
AMOUNT
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line —
FINAL DATE
INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
YELLOW = APPLICANT PINK = FINANCE
11
Coaches' Walley Unified School District
83-733 Avenue 55, Thermal, CA 92274
(760) 398-5909 — Fax (760) 398-1224
This Box For District Use Only
DEVELOPER FEES PAID
AREA:
AMOUNT
LEVEL ONE AMOUNT:
LEVEL TWO AMOUNT: -
MITIGATION AMOUNT:
COMMAND. AMOUNT:
DATE: -
RECEIPT:
CHECK #: -
INITIALS •
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name: The Hideaway Date: February 21,.2017
Owner's Name: Sunlite Development Phone No.
Project Address: 52-983 Via Savona
Project Description: SFD
APN: 777-380-002 Tract #: Lot #'s:
Type of Development: Residential XX! Commercial Industrial
Total Square Feet of Building Area: 6888 Sq. ft.
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 authorized to sign on behalf of the owner/developer.
Dated: February 21; 2017 Signature: .
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
k*j#**####***k*##*###*
EN OR WILL BE SATISFIED IN
Education Code
Gov. Code
Project
Agreement Existing
Not Subject to Fee
17620
65995
Approval
Prior to 1/1/87
Requirement
Note:
q.Ft. b888 Pursuant to AB 181 any room additions or enclosures of 500
Number of S
Amount per Ft688 8 sq. ft. or less are exempt from developer fees. Any mobile
homes being relocated within the same school district's
Amount Collected $23970.24 jurisdiction are exempt from developer fees.
Building Permit Application Completed: Yes/No
By: Elsa F. Esqueda, Director of.Facilities and Maintenance
Certificate issued by: Laurie Howard, Secretary Signature:
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 66020 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.
IN1V:c/mydocs/devfees/eciiificate ofcomipliance form updated 3-2007 11/2010
RECORDING REQI;,.:;1LL) ur:
T
r�►G�iLTA��... Tv
AND WHEN RECOrt.,..0 Mwu 'ro:
Paul Dewsy
PO Box 12711,j
Palm Deser L , i.:; , j2255
Order No.: _910-1t. .. , ...
Escrow .No.: Fsi,,.
A.P.N.:77T3so-oot 3 1t;;•. 0:u -2o5
DOC # 2016-0449509
10/13/2016 02:06 PM Fees: $-763.00
Page 1 of 2
Recorded in Official Records
County of Riverside
Peter Aldana
Assessor -County Clerk -Recorder
"This document was electronically submitted
to the County of Riverside for recording"
Receipted'by: MARY #420
SPACE ABOVE THIS LINE IS FOR RECORDER'S
GRANT DEED
THE UNDERSIGNEu C1v\N1'0R(S) DECLARE(S)
DOCUMENTARY TRANSFER -TAX IS $ 781 . 00
[ X ] cc:. ;ted on full value of property conveyed, or
{. ) c rnputedon-full-value-lessvalue-of-ikmor-encumbrancesremaWngattil eof.sale.
X ) City of La Quinta
FOR A -VALUABLE CL f-!' ,.;DERATION; receipt of which is hereby acknowledged,
—Huntington Beacn t roporties,.11-C, a Wyoming Limited Liability Company
hereby GRANT(S)'i., -
Paul Dewey , r,_ L cd man as his sole and separate property
the foiiowtng desct;t.,,d real property in the County of Riverside, State of California
See Exhibit'A" ak.;ched hereto and made a part hereof.
Commonly knows; ,._ : :cant Lot (52983 Via Savona) , La Quinta, CA 92253
Dated: October 4,21.;16
A notary public or ur, r,i uniwr cumpieting this certificate
veriHes_cnly_the_idt_L,; ut uio individual who signed.the
document to whist .0 c oi.t, icate3 is attached, and not the
t uwwness.'accura< ;,'off vc�uJity of that document.
STATE OF CN
COUNTY OF 'r O
On / ?._ before me,
A 2 a notary public,
personally appeared i S
who proved to me on u,e basis of satisfactory evidence to be the
person(s) whose namo(s) is/;,re subscribed to the within
Instrument and ackm ::•edged to me that he/shelthey executed
the same in his/her/their authorized capaeity(les), and that by
hi.Vher/their signature(s) on the instrument the person(s), or the
entity upon behalf of which the person(s) acted, executed the
instrument
I certify under PENALTY -OF. PERJURY -under the laws of the
State of Califomia•thar,fhe foregoing par'agriapti is true;and
correct._. :�•
WITNESS my hand and official scut.
(Seal)
(This area for official notary seal)
=NTS AS DIRECTED ABOVE
Huntington Beach. Properties, LLC, a Wyoming
Limited Liability Company
} SS.: Autho ignerjZAM U IA5
JEFF SCHWARTZ
Comm.. #2075608 u,
-Notary Pubis[ •California n
i ° .. Orange County
1 `•� Comm. Expires Jul 24, 201 a