0002-420 (AR)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. Dale
7064? Q B i� f; X10(
Af\Date �?` ° Signature of Contractor ()V
�"
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 Sianature 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.
(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 provisions of Secti n 3700 of the Labor
Code I sh 'll fort ` 0th comply with tl4ose� provisions. ��}�'
A�plicant M , H`��
Warnin :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, indemnity
& 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 representatives of this City to enter upon
the above-mentioned prope rty,for 6spectio purposes. ,r r
jSignature (Owner/Agent) `� DateA, APP
PERMIT #
BUILDING PERMIT
4MR-410
°�
DATE C VALUATION $15,424.20 LOT TRACT
JOB SITE
ADDRESS 77-330 VISTA ROS
APN
OWNER
CONTRACTOR / DESIGNER /ENGINEER
11'1,10N tIks" & 1 i,t�.CE1Y rTIPIPI L
°a4 I�Itf;I�n eV4,*C().t�,;
290 WOODSCDE RD
78-120 CM,LE }sS I'ADO 6206
WCIt:)i:1SIDE CA 94062
LA. QAJtiITA CA 92215A
('760)7777-7611 MA, 17141
USE OF PERMIT
ttCSi13iIv'Tl.r�.t. A.t3�1'fitu�i
t:!2i :i.!~ f��,i4.ti�1U At31),t A't,l,aiV L3Ul�tiCi t)��s�l�!t�i.. l��liV:i f�.i11; t J.lal'�I
CU vT011 COe•IS"MUCTIO aI9®;C•i, a
� 9# a 4At1 9r,ti'e.P3 �ra.b v. • COIN aawd�m al�
PJ. AN C'k#fdCiC H,01 9.61-lttjOP 3 N 3I $I 1115
C'.nFN/�51t'1f3Yirl Tj/e9NP FR9101-f/i01-418-f?(g) $1771 01
.117.1 I( IR 1-CA�r 1. C li 11.fl "'�7RV 414.01 VVFf S6193
z;114.QNG me f O'NFLE t0. Sit) 10i,�t7i3O-241-0fk 61_14
AKT IN P08.1,1C P mAiS 70.1-000-25 —0Wr 338,56
`11R- 1` rA1,f'ONS"'f'R.rtCMO;► J AND PLAN (JII.rK
LESS i lut '_ IAID FEII-18
$0.01
10"I'AJ., eERMkT R+ili',?! 4 0141 NOW
SJ29 iK
4
RECEIPT
DATE
BY'i' DATE FINALED
IN__SPECTOR
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.
Framing Y ji p
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 Jj a/
BLOCKWALL PP OVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
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
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
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
Final
Utility Notice (Perm)
COMMENTS:
"Notice:
(Document Cannot Be Duplicated
Desert Sands Unified School District
47-950 Dune Palms Road
` La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Date 2/28/00 APN # 631-082-001
No. 20.072 Jurisdiction La Quinta
Owner NameThomas &Stacey Siebel -420
a
No. 77-330 Street. • Vista•Rosa Log #
City La Quinta zip 92253
Tract # r Lot # �.' Square Footage
Type of Development Residential Addition
Comments
198 sq:' ft. addition to kitchen during original construction.
Study Area
198 -
No. of Units 1 '
"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:
••' Residential Addition 500' Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to Mitigation Agreementin the amount of
0.00 X 198 or $ 0.00 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 By N/A - Ed Wright Telephonev760�777=7611
Name on the check,
By Dr. Doris Wilson T _"
4" 1 V
Superintendent �-
Fee collected /exempted by Mary -Ann L., Borja Exemot $0.00 "' .:� •�'
Check No. N/A
Signature
F
TICE:: Pursuant of Assembly 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
ove will begin to run from the date on which the building or installation permit far this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
llect 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
1;
N,
"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:
••' Residential Addition 500' Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to Mitigation Agreementin the amount of
0.00 X 198 or $ 0.00 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 By N/A - Ed Wright Telephonev760�777=7611
Name on the check,
By Dr. Doris Wilson T _"
4" 1 V
Superintendent �-
Fee collected /exempted by Mary -Ann L., Borja Exemot $0.00 "' .:� •�'
Check No. N/A
Signature
F
TICE:: Pursuant of Assembly 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
ove will begin to run from the date on which the building or installation permit far this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
llect 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
• F - 4_ ♦ +
RECORDING REQUESTED BY
AND WHEN RECORDED MAIL THIS DEED AND, UNLESS OTHERWISE
SHOWN BELOW, MNL TAX STATEMENT TO:
Thomas & Stacey Siebel,,
"�1B 2995 Woodside Rd. • -
stree,t Woodside, CA 94062
Citia
state
ZIP
C® P Y of Document Recorded
on�:4 LI as No.
Pas not been compared with original.
LI�COUNTY RECORDER
Title Order No. Escrow No. -
t
'SPACE- ABOVE THIS LINE FOR RECORDER'S USE
T 355 Legal (2-94)
Grant Deed
THE •.UNDERSIGNED GRANTOR(s) DECLARE(s)
DOCUMENTARY TRANSFER TAX IS $
❑ unincorporated area, ❑ City of
Parcel No.
❑ computed on full value of interest or property conveyed, or.
❑ computed on full value less value of liens or encumbrances remaining at time of sale, and
FOR A VALUABLE' CONSIDERATION, - receipt of which is hereby acknowledged,
The Enclave•Mountain Estates'Homeowners Association, a -California
non profitmutual benefit corporation
hereby GRANTS) to l
Thomas M. Siebel and Stacey Siebel, husband and wife as
joint tenants
the'following described real property in the
' county of Riverside , state of California: See Exhibit A
Lot C, inclusive, of Tract No.t'25237, as shown on•a Subdivion.Map
recorded in -Book 228, Pages 95-99, inclusive of Maps in the Office of
the Riverside County Recorder..
RESERVING AND EXCEPTING UNTO GRANTOR, its successors and assigns,
together with the right to grant and.transfer all•or a portion of the
same:
A. All previously unreserved ail -rights, mineral rights, natural
gas rights and rights to all other Hydrocarbons by whatever name known
to all geothermal heat and to all products derived from any of the fore-
going (collectively, Subsurface Resourq ff'p;,. nd r
-Dated
STATE OF CALIFORNIA �.11/G'(�� l�)f } S.S.
COUNTY OF /l ,\
On
� before'me,
a Notary Public in and for said County and State, personally appeared —
r
personalty known to me (or proved to me on the basis of satisfactory ` R. H. JONES
evidence) to be the persona) whose name(* is/are subscribed to the Commission =.1 162435 Z
within instrument and acknowledged to me that heisheAl%ey executed i G-,� Notary Public - California
the same in hisfl*waheir authorized capachy(ws), and that by his/hedtheir rte', Riverside Courry
signature() on the instrument the person(q), or the enti n behalf
of which the person(9l.acted, execut instrument. Nry COMM. ExoreS Nov 22_ 2001
WITNESS my hand and off i I seal
Signature (This area for official notarial seal) .
MALI. TAX STATEMENTS TO PAR OWN ON FOLLOWING LINE; IF NO PARTY SHOWN, MAIL AS DIRECTED ABOVE
Name Street Address City & State
4 RECORDING REQUESTED BY
Thomas & Stacey Siebel
AND WHEN RECORDED MAIL THIS DEED AND, UNLESS
OTHERWISE SHOWN BELOW, MAIL TAX STATEMENT T0:
NAME Thomas & .Stacey Siebel
STMT 2995 Woodside Rd.
ADORM Woodside, Ca. 94062
clTy. STATE 6
ZIP CODE
L J
MI OADFR NO. E9CROW No.
GRANT DEED'
1W. V lV I . L
CU �� of Document Recorded
Oil 8s NO.
Has not been comparad with origlnal,
COUNTY RECORDER
DOCUMENTARY TRANSF9R TAX 6
Q computed on full value of grope conveyed. or
(� computed on full value less liens and
encumbrances remaiMiM at time of sale.
Signature of Dederem or Aldent DetermiMng Tex Flrm ams
,c:
FOR VALUABLE CONSIDERATION, receipt of which is acknowledged, I (We), �yo'mas M. Siebel and Stacey
p g INAMF or awl
Siebel, husband and wife as joint tenants
grant to Thomas M. Siebel and Staceyw
Siebel, husband and ife as joint tenants
all that real property situated in the City of INANE of ORANSEE all (or In an unincorporated area of'.
Riverside County, California described as follows (insert legal description):
(NAME OF couNW1 IgtATEI
Per attached Exhibits "AII & "8"
�j as approved by the
�
This Grant Deed reflects Parcel Merger No. if
City of La Quinta.
a
Assessor's parcel No.
Executed on ) 23 , - r9q�, at
STATE OF -/c!�YZfJdr�
COUNTY OF S/fA/ irll!'i8
On F- A.7 before me. AgLai sT;o Po -r -or r 010%
MAMinML1.*.1JAr* oo m"ART tueur� known to me
personetlyeppeared TK'aKMd; M•.Si'eQEt-+SLAC !e � pecIP-9 t�bscribed
torppeved.;& FAs to be the the within instrument and aeknowledged me that he/she he nexecuted he serrl� or tentity
autherized capacitymi; and that by his/her signetu�on the Instrument the perso
upon behalf of whfehthe parsq!!�cted, executed the instrument.
WITNESS my hand and official seal.
C:(P)
Comm
IeIONATURE OF NOTARVI I.EAU
�MCOIRM
MAIL TAX
STATEMENTS TO:
/our partleular
Before you use this form, fill In all blanks, and make wttatevar changes are appropriate and rtscesGaty to tts makes no
nala' cbtion. Go�sult a lawyer II you doubt the form's Tltee(1ass for Your purpose and use., wOl'Cl an
intontletl
representation or warranty. express or implied, with reapact to the merChantabdity Or fitness Al this form
use or purpose,
WOLCOTTS FORM 778 - Rev. 3•a4e Wice Blase 3A) I
GRANT DEED 01994 WOLCOTT$ FORMS, INC. i
111iII11111 1 illI 1Ill` 9
7 7775 39775
8
i i r1UMOVnIni I iUYoneU
7
a
6
E
CAPACITY CLAIMED BY SIGNER(S)
❑INDIVIDUALIST
000RPORATE
OFF)CER(S)
❑PARTNERI$) ❑ LIMITED
0 GENERAL
OATTOANE'r IN FACT
OTRUSTEEIS)
❑GUARDIAN/CONSERVATOR
COTHER;
SIGNER IS REPRESENTING:
INeme or Pamwi(aJ or Er111n,9611
,.° , / lam•; . F' � ' Y�. � «I ",. , y .�* f' • '.
•oM3 67 �9 B 5F
Is t
�iRh�4ty11l,'�1 `, JUL 2 r 1999
,NF CLAVE MOUNTAIN ESTATES HOMEOWNERS ASSOCIATION' "
August 26,.1999
Rc Stacey
Thomas Y Siebel
C/o Gerry Glessing
60 E. Third Ave. 9270
San Mateo, CA 904401 • - '
Re: Lots 53 & 54 / 49335 'Vista Rosa
Enclave Mountain Estates H.O.A.
Dear Mr. Mrs. Siebel: ,
The Enclave Mountain. Estates' Architectural Review, Committee has reviewed your
8119/99 submittal of drawings and -has approved .the package contingent on receipt of the
" following items: '
1) $10,000.00 Construction Deposit
2) Signed Contractual Agreement
Tote: 'Please have the builder submit the lA inspection form-when they are ready to
arrange for the setback/form inspection. a
Good luck with the construction of your nevi tome.
Sincerely, . .
°
Carol Calhoun, Property Maxtager '
For the Architectural Review Committee and
The Board of Directors
Enclave Mountain Estates H.O.A.
Cc: David A. Price Associates; 17802 Irvine Blvd., Siete 239 Tustin, CA 92680
Fax 47141832-0738
Professional Community Management./ Desert Resort Management
Post Office $ox 4772 'Palm Desert, CA 92261-4772
^3-550 Alessandro, Suite 5 ; f • ; Palm Desert, California • (760) 346-1161 FAX (760) 146-•-)918
�G3 + ?c 10 " 1 _ ,o.. _H .. J'7 i a� ti cj nDR, l.l.� l l� _ — �--7( r"
01/28/2000 00:02
NOTE:
6505928727 COMMERCIAL ENTRPPRIS PAGE 04
With proper validation
this form constitutes en CITY OF LA QUINTA
encroachment permit APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) �
OF
For the oonstruction of public or private curbs,. driveways, pavements, sidewalks, parking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision improvement Permit — Class III
DATE: A/27 /o4 Minor improvement Permit Class IV —
LOCATION OF CONSTRUCTION
(Street address or Description of Location) -
PURPOSE OF CONSTRUCTION PAD CERTIFICATION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTIONOVER EXCAVATION IFT.
RECOMPACT & CERTIFY PAD SEE ATTACHED CONDITIONS
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 8T30/99
7am-5vm
APPROXIMATE TIME OF COMPLETION 9/30
ESTIMATED CONSTRUCTION COST $ 50,000
(Including removal of all obstruction, materials, and debris, backfilling, Com-
paction and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agress,to:
Indemnify, • defend and save the City, its authorized agents, officers, representatives and. employees, harmless from and against any ares all
pamfties, liabilities or loss resulting from claims or court action and arising out of any accident,, lose or damage to persons or property
happening or occurring es -a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started.
comply wkh oil wolicabie City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as'the result of this work.
Signature of Applicant or Agent
BRISTOL CONST. 73292 LARREA PALM DESERT,CA. (760)341-4061
Name of Applicant (please print) Business Address Telephone No.
SAME SAME
BRIAN EW 14G Telephone No.
Name of Contractor and Job Foreman Business Address
5180725333
Contractor's license No. ' City Business License No,
GLAA1302258
SAFECO
Policy Number
Applicant's Insurance Company I
FEES: Subdivision Improvement Permit —Class III - °'
.Public improvements: 3% of estimated construction costs - AUG 3 -0 1999 • ,
Private Improvements: 3% of estimated construction wits 7JJ O
Minor Improvement Permit— Class IV: See attached schedule �l r K
Inspection Fee $ PERMIT VALIDATION
Permit Fee 100.00PERMIT NO. 3034
Penalty DATE APPROVED 8/27/99
Cash DepositSuretV Bond 12/31/99
if required EXPIRATION DATE
TOTAL: $ Ion nn.DATE ISSUED^�
Receipt No. By
dmi ' tratire Authority
Received by Date
Recorded by Telephone: (618) 777-7075