9803-134 (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 Jzp. Date
91561
JDate —� 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:
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).
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 Policy No.
U ICARE IN'S C"i� SC"3i? 1197-1.4 17
(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 wor ers' compensation provislo s oftSection 3700 of the Labor
Csode, I shall fortith comply with those pro �l ions:'
,ibate: 7 �' �pplicant �¢
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 (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
co?struction, and hereby authorize representatives of this City to enter upon
the above-mentioned property forAnspection pur. oses.
/Signature (Owner/Agent)—�
Date ,
..PERMIT#. . ,. , � CONTROL#
. I�DI�w PERMIT
NG PERMIT s 7 3
DATE .' VALUATION, LOT TRACT
SS3i3 1fj ,
-7J L �f
JOB SITE
ADDRESS 47-87iVIA,1� ..E.W.1`D+: ;�,
JAIN
, �����-Q35iB
OWNER CONTRACTOR/DESIGNER/ENGINEER
i
o (:',AntAOAY A• CONKP .rr r
157O'BR.,Of.7KtiOLLOW DIME, SUM 209 1370 i's#cstG. Ci7f..`s Q'W rjRf 'E, SUTI'i 2O8
S�aN%r� ANA, C.A. 'i4)5 .F1't�'.d'.1 Zt�l r1 t1, 12 05 .
USE OF PERMIT p
S'. < i'"iWIT r"38'z� OT.[�ifvi. UDE LL Eat ., tiyAUS 6 t 1?C3r t'
MAR 2.7 19
TRACT CONSTRUCTION 2591,00 !'l . �I' T � � �UI�T�
1X)RC1T/F Kr_1p 4.8,00 SF
C. M AGIFYCARPtiRT 6 i ►.i} # SF
0STTA1 TED G'R'ST OF C0NS' PON 153,'235.70
C014S RUC A0N'FF.3 101-000-418-'000 5828,50
PL Mckwzl K;E'er S01.16
>)rCHlic �it..F� l:U1-000-2tlt•0�) S94.SJ
'01 000- 20-000 $17SJ9
1~I .%��.-IRICAL �' 1.1.7... 101,000-4200
KUNMINC1) IEW 101 -000 -419 -NO
. 317RO?vG MCS'i.,t4 N ATE - R?, -,,11,E ! 0i -W�241-000
CttA�jt C:: 101-000-423-000
$WRASTRUC7'i;RSTT"^-% `IJ -000-4.1413,:342 $3,434.M
ART IN PLTH- LIC Pi..As:.US SK4121
C wt .:n1 i5r - 1Q C if3-=13 -31.x3 r32�),Gt�
•
1,113«?'{YMI., CQT.,TS` TRQTi"l.'1C7,\i.ANr_) PLAN CK $S,Sr;? Vic)
LESS:i�Id i-.1:t;a -$;0.00
'1'6T.f1L ;SER' NMYr ;i+'1,:Qt�,S 00 C NOW
tr
RECEIPT
DATE
BY
DATE FINALED '
INSPECTOR' ,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_
Underground Ducts
Forms & Footings, _
Slab Grade �90
Ducts
Return Air
Steel
Combustion Air
Roof Deck
_
G�0
Exhaust Fans
O.K. to Wrap
g
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
/
!L/Z�� cl
Final
POOLS -SPAS
BLOCKWALL APPROVALS
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
Neater 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)
WhWITF+ .
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
C
Final
Utility Notice (Perm)
}' � . ; a
I A,. ,. . � . .
'�� ~ :�
City:.of La Quints a" .
` :'
r
Building a Safety Division
PXI..O. Box 1504 - ..
.Permit # :.:: ': <-`:<?: `:<:?><
78-495 Calle Tampico
.
�_ La Quinta, CA 92253
Building Permit Application �and'Tracking Sheet
Project Address: 87S 44 Tp -/e 5 G -
Owner's Name: C,G h`/I At ,4 ef,o, .
A. P. Number: �p 13 OD 5�0
Address: 1 6'70 Jfj r00 K d 110 N, &,W -26J,-
Legal Description: ,
City,ST; Zip: , J4, A, /qn.c cq L
Contractor:
Co,., ,.7
Telephone: 7s s
Address: / 6 • ro
of ow r ir#�0J
LL
Project r S�. L11D7 SO
Cit) -.ST, Zip: ' SG r T4. h 4
C #4- 9a 7oS ' .
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1-, �n a10 Z 4 . .
Address / _ A 0 U x 75
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//
City. ST. Zip: _Ot'SciT /Xop J r�.." f e
Telephone: 60 �o
7 3a� �
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tru ti n T e: Occupancy: —
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t t Lic.
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Pro'ect e ctrc e o P
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Name of Contact Person: /j0 `j
4 1GCei
Sq. Ft.:p7S�/ /Tst-ri�es:
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#Units:
Telephone # of Contact Person: /p
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Estimated Value of Project:
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Notice:.
Document Cannot Be Duplicated
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 3/27/98 APN #
No. 16817 Jurisdiction La Quinta
Owner NameCanaday & Company Permit #
No. 47-875 Street Via Trieste Log #
City La Quinta Zip 92253 Study Area
Tract # Lot # Square Footage 2591
643-130-050
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 replacement 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 2,591 or,$ 5,000.63 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
Fees Paid B Cashier Check/Steve Santee }
By Telephone 7_71-96361,1,"i
Name on the check
By Dr. Doris Wilson
Superintendent �<S
Fee collected /exempted by Juanita Green Payment Received
l Check No. 01058148
Signature
NOTICE: Pursuant of Asserbbly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to anotherpublic entity authorized to
collect 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 - Applicant/Receipt "Copy - Accounting
' , eco &,k Requested gy
CHICAGO TITLE COMPANY
• AND WHEN RECORDED MAX TO
Canaday & Company
1570 Brookhollow Drive
aooesc Suite 208
cl^ a
scare Santa' Ana, CA 92705
rt- 100 (Rev. 4/94) 0
• Lo f moo.
41.9582 �.
RECEIVED FOR RECORD
R,o.Q,;�„�,r�„,u f , �.,,•_.• AT 2:00 O'CLOCK
Doc . 'r►'.;;:�„ •r: N O V 14 1997
P.'>', Reoorow n oread Reao,o,
or AtVrs,610e county. Cetbmte
Recorder
Fees $___L�__
SPACE A80VE THIS LINE FOR RECORDER'S USE
GRANT DEED
APN No. Title No. Escrow No. 01873CB
THE UNDERSIGNED GRANTOR(s) DECLARE(s)
DOCUMENTARY TRANSFER TAX is S 616.00 CITY TAX S
CS computed on full value of property conveyed, or
0 computed on full value less value of liens or encumbrances remaining at time of_sole,
G Unincorporated area: 0 City of LA QUI NTA 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:
Lots 49 through 59, inclusive, and 98, 99, 100, and 104/ofdTrac0
t 26152
SEE EXHIBIT "A " ATTACHED WILMA-LA QUINTA L.P. A DELAWARE
LIMITED PARTNERSHIP
BY: CENTRUM PORT PAVILION LTD.,
A DELAWARE CORPORATION, AS GENERAL
Dated: October 29, 1997 PARTNER
BY: WILMA SOUTH MANAGEMENT CORP.,
A GEORGIA CORPORATION, ITS ATTORNEY
ll,
State oia Glar,—
// ss.
County of Z)G,-✓!.L/ �j A /y
On - I before me, �J 1 (/ c� [ 1 I�(VOrA
(here Insert Home) Notary Public.
PersOn011y appeared_ �A /Qr/� U . (�l'GtfYl..✓l
Personally known to ma (or proved to me on the basis of sotlsfactory evidence) to be the persons) whose name(s) is/ori, subscribed to
Me within instrument and aCknawledged to me Qu that he/st\e/they exaCuted the some In his/her/thelr authorized COpOCIty(les). and
shot by his/her/their signotvre(s) on the instrument the person(s). or the entity upon behalf of which the person(s) acted, executed the
instrument.
WITNESS my hand and orficial seal.
r� AMONDALYNN D. GOODWIN
;may T MY tOM WION 0 CC M14
�s W14S: June 9, 2001
Bonded Thru NMY P01111111LXXWM ft"
Signature
offix teal wl}hin Oord&
ANV'dWOC KV0'VNV3 V40d.l 1-4,7c L : S
4IJDUC
EXHIBIT "A
Parcel 1:
Lots 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 98, 99, 100, 104, and 110 of Tract no. 26152 in the
City of La Quinta, County 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.
EXCEPTING THEREFROM all oil, gas and other hydrocarbon 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, as reserved in deed recorded August 4, 1993. as instrument no.
303.830 official records.
Parcel 2: .
A nonexclusive easement for ingress, egress, use and enjoyment of the common area as defined in the
declaration of Conditions, Covenants, and Restrictions recorded November 27, 1991 as instrument no.
415112.
TRA: 020-024
APNos: 643-130-049-6
-050-6
-051-7
-052-8
=057-3
-059-5
-055-1
-056-2
-054-0
643--140-001-3
-002-4
-003-5'
643-130-058-4
-053-9
-063-8
-047-5
7 . ZS 16 15L . V L L .l1\lbdV400 . VGVNVO HOd -J
VIVE.' I. ' S Stir ; I - : 1- 1
PARCEL 3:
419582
A temporary nonexclusive easement appurtenant to Parcel I for pedestrian and vehicular access, ingress and egress over that
certain real property more particularly 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 terminate 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 casement over said streets 'to the Lake La Quinta Homeowners
Association, a California nonprofit corporation ('Association') for access and use purposes pursuant to the Declaration. Upon
the termination of the temporary easement granted pursuant to this Parcel No. 3, access to Parcel I of the Property shall be
pursuant to the nonexclusive casements granted pursuant to Parcel No. 2 above.
RESERVING THEREFROM UNTO 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, appropriative, 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•the9surface of the Property 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 how acquired by Grantor.
B. Easements over the property for the construction, installation and maintenance 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 Assessmen : Nondelinquent general, special and supplemental real property taxes and assessments;
2. Restrictions of Record: All covenants, conditions, restrictions, reservations, dedications, easements, encumbrances, rights
and rights of way of record.
3. Assignment of Declarant Rights: Effective upon recordation of this Deed, Grantor assigns to Grantee with respect to the
property, all of Grantor's rights, exemptions and entitlements as "Declarant" under the Declaration 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
rights of Declarant with respect to the propeny. Upon recordation of this Deed, Grantee shall have the same rights with
respect to the property under the Declaration as Grantor prior to the date of recordation of this Decd.
".j ZS l6 t SL V l L ,kNV6100 AV(TV'N)V0 tvod_ vmV t.: S
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance. with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 47-875 VIA TRIESTE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9803-134
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CANADAY AND COMPANY Address: 17480 EAST 17TH ST. #106
Building Official
City: TUSTIN, CA 92780
By: STEVE TRAXEL
Date: 12-29-98
POST IN A CONSPICUOUS PLACE