0201-041 (SFD)r
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9'(commen'cing 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
40883
Date Signature of Contractor
OWNER -BUILDER DECLARATION
1Oro I0 °:
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
cb`ntractors to construct the project (Sec. 7044, Business & Professionals
Code). -
( ) I am exempt under Section B&P. C. for this reason
Date, !•,I -Signature of Owner f i ? M`?
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.
Sq�I have and will maintain workers' compensation insurance, as required by
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:~
Carrier Policy No. X16-1ClL9w all
(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 Section 3700 of the Labor
Code, I shall forthwith comply with those provisions;
Date:"9 fay Applicant ,a_
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
.Eaddition 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 persor�af
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 representatives of this City to enter upon
the above -menti oned_p rope rty,for in pection purposes.
/Signature (Owner/Agent)��d '% ? �•��` "'� Date f?%
BUILDING. PERMIT PERMIT#
t 0200.0411
DATE VALUATION LOT I TRACT
Y't C+w
%ice
•a • S 1 x,72. '$4%,294.90 - 1 - - - -- - 213119 F
JOB -SITE
ADDRESS 7.15 107.5 .�:�i, 3BX.F fMg11
l
APN
'775-1704M
OWNER
CONTRACTOR / DESIGNER / ENGINEER
DELOS 0 CIRCLE LE
SourkI PONT C:OMIT.f TY -11 rI:C. N
131 wMiM LsY Y LACIR
70?-099Wa� —R.1 , 0102
t uj'd 't fls°A1' P`.l:L1' Chi 9404.0
PAIAA DE6.is" f CA. 9: 260
C160)34595521 C—SVi< 4320
USE OF PERMIT
SFD ,. I-A")TI4. PERMAI T f' OM NO'T.TtXCi...(.1t3Z, LiOCK 1.'�ALL,% PML, oR
' CUSTOM CONSTRUCTION 4,656, 00 .Sp
PO CI59l1'ATIO I,M.00 S-
GA11AWYCA.'APORT 4.,3 4 (1 Sr
.i"f17.6.#d.RlldO.yia3Y con Olt �siidVh73..l,lL/'L.l.S�kOO.�6
Yr47liSdrg+�V�
CONSTRUCTION ME 103 -000-418-00 I M.17 A
D
PIAN CHECK ME, 101-t 1-439-338 $1,399.0
RKE DEPOSIT 101-000-439-318 fi1,Q o
4
Tv MCH ANICa9 L PRE 101- WO -421-.000 $146 4
a
RI iSC: i'Ryi: Jo FRE 1.01.000 -gib 20.000 52.51, 2
4
PLUMBING PRE 1014)00-41.9-000 va§°.:S
q
MTRCA4C1.tM'C?i'IC'W FER AMID 401 -MO -,241-000
ORADY OFR -ss 101.000-423-.900 tt.cD
DEVELOPER IMPACT FEE ti' o
o
fiJt I' 344 PL7 6L.IC PLACES* ,, RMS1270-000-445-000 0515.',
4
c3o. B -.I. tidblJ,. L•O-L'it7f.7R.EX.AIOY'7 �vDTii6i1R,
1M.3 ITIS -PAID FTE
Lr.0 E
5 "Ar�L21yI1<,V00r4'.00
i i 9'�AI, ry-a � n, Tixav S 3"?1�' ,Igf.3�T,f
h 2 `10 2 L
OFLAQWR� TA
-
C Tyffy
FIRAINC )
RECEIPT
DATE j
BY" ,/
DATE OALiD
INS EC OR
./r s.. " �6. .u:
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings pop—
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
/d
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 _3
BLOCKWALL APPROVAL6
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APP OVALS
Gas Test
Electric Final
Waste Lines
1 6
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
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:
3
�, � C %'S 6/7/aZ
�ITXGO�✓ u-FJ4GTA� l H �,3�6Z ��
a
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
10/31/2(
447883 B
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 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 STATE FUND Policy No. 46-10535-01
(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 Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: 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 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 representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
Fr (,F
BUILDING PERMIT PERMIT#
0201-041
DATE VALUATION $406,294.9dOT 14 TRACT 25397
JOB SITE
APN
ADDRESS 35-775 PEBBLE BEACH
773-170-014
OWNER
CONTRACTOR / DESIGNER / EN (NEER
DELOS O CIRCLE
SOUTH POINT CONSTRUCTION
131 WAVERLY PLACE
77-899 WOLF RD. 4102
MOUNTAIN VIEW CA 9404C
PALMI DESERT CA 92260
(760)345-5521 GBL9 4320
USE OF PERMIT
SINGLE FAMILY DWELLING
SFD - LOT14. PERMIT DOES NOT INCLUDE BLOCK WALLS, POOL, OR
DRIVEWAY APPROACH,
CUSTOM CONSTRUCTION 4,656.00 SF
PORCH/PATIO 1,297.00 SF
GARAGE/CARPORT 1,344.00 SF
ESTIMATED COST OF CONSTRUCTION
406,294.
PERA/IIT FEE SUA06"Y
CONSTRUCTION FEE 101-000-418-000 $1,714.(0
PLAN CHECK FEE 101-000-439-318 $1,398.f
5
FEE DEPOSIT 101-000-439-318 -$1,000,
0
MECHANICAL FEE 101-000-421-000 $146.
0
ELECTRICAL FEE 101-000.420-000 $257.
PLUMBINO FEE 101-000-419-000 $289.
0
STRONG MOTION FEE - RESID 101-000-241-000 S40.0
OR gDINO FEE 101-000-423-000 $20.
0
DEVELOPER IMPACT FEE S1,907.0
ART IN PUBLIC PLACES - RESIE 270-000-445-000 $515.-4
SUS -TOTAL CONSTRUCTION AND PLAN CHECK
$6,289.56
LESS PRE -PAID FEI
2 _$1,000,00
TOTAL PERMIIT FEES DUE NOW
$ns,u9.56
RECEIPT
DATE
BY
DATE FINA LED
INSPECTOR
P.O. BOX 1504
Building'/1 �� 78-495 CALLE TAMPICO
55_?.p� P�b
Address ll /'7 3eACf.A QUINTA, CALIFORNIA 92253
Owner
Address
City Zlp
Contractor` \ •� —
Address
D F— L
City Zip Tel.
2z 3 S S z
State Lic. City ouV ill .0i.
& Glassif. _ Lic. #
Arch., Engr.,
Designer
Address Tel.
City (Zip ( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm 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.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
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 io construct, alter, Improve, demolish, or repair any structure, prior to *Its Issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor'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).
I'' 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, Buisness and
Professions 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.)
I 1 I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct 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 contracrorfs) licensed pursuant to the Contractor's License Law.)
I'! I am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. fSec. 3800, Labor Code.)
Policy No. Company
rl Copy is filed with the city. O 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 the Workers' Compensation
Laws 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
1 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__Dl
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 a0plicant -Date-
Mailing
ateMailing Address
City, State, Zip
APPLICATION ONLY
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number
Legal Description f ,.L i a—s% 446h.L1�r7 _yt
Project Description���-.
Sq. Ft. t�// '4— No. No. Dw.
Size 7'65.6
G 56 Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
PERMIT AMOUNT
Plan Chk. Dep. _---
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
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:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVIS104
�'W,oachella Valley Unified School District
P.O. Box 847, Thermal, CA 92274
(760) 398-5909 — Fax (760) 398-1224
This Box For District Use Only
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name: Date: March 25, 2002
Owner's Name: Delos 0 Ci rdlt Phone No. x'5€7 -
Project Address: 55-775 Pebble Beach La Qui nta PGA
Project Description: Si ngl p Family Dwellings
,CPN. 775 170 014 _—Trete: 25397
Type of Development:
Residential XX
Total Square Feet of Building Area: 4656
Lot #'s:
Industrial
14
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: 31,-;, _�—! O,�
Signature:
***********************************************************************
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code Gov. Code Project
17620 65995 Approval
Number of Sq.Ft. 4656
Amount per Sq.Ft. $ 2.16
Amount Collected $ 10,056.96
Building Permit Application Completed: Yes/No
Agreement Existing
Prior to 1/1/87
Note:
By: Foch "Tut" Pensis, Assistant Superintendent Administrative Services
Administrator in Charge
Certificate issued by: Marcella Vallidez Signature:
Facilities Clerk
TICE OF 90 DAY PERIOD FOR
F FEES AND STA
Not Subject to Fee
Requirement
.M
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. At such time as this Certificate expires, if a building permit has not been issued for the project
that is the subject of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance.
MV:c/mydocs/devfees/certificate of compliance 07/24/01
DEVELOPER FEES PAID
AREA:
AMOUNT:
RCPT #:
CK #:
CASH:
INITIALS:
DATE:
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name: Date: March 25, 2002
Owner's Name: Delos 0 Ci rdlt Phone No. x'5€7 -
Project Address: 55-775 Pebble Beach La Qui nta PGA
Project Description: Si ngl p Family Dwellings
,CPN. 775 170 014 _—Trete: 25397
Type of Development:
Residential XX
Total Square Feet of Building Area: 4656
Lot #'s:
Industrial
14
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: 31,-;, _�—! O,�
Signature:
***********************************************************************
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code Gov. Code Project
17620 65995 Approval
Number of Sq.Ft. 4656
Amount per Sq.Ft. $ 2.16
Amount Collected $ 10,056.96
Building Permit Application Completed: Yes/No
Agreement Existing
Prior to 1/1/87
Note:
By: Foch "Tut" Pensis, Assistant Superintendent Administrative Services
Administrator in Charge
Certificate issued by: Marcella Vallidez Signature:
Facilities Clerk
TICE OF 90 DAY PERIOD FOR
F FEES AND STA
Not Subject to Fee
Requirement
.M
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. At such time as this Certificate expires, if a building permit has not been issued for the project
that is the subject of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance.
MV:c/mydocs/devfees/certificate of compliance 07/24/01
FROM : MAIL N MOTION
T.,
11E{,�IdM/01 W.
AND V*QN . ntAn, tQ
Mr. and Mrs. Delos 0. Circle
171 Waverly Place
Mountain View, Ca, 94040
FAX NO. : 16509682891 Mar. 25 2002 12:38PM P2
. e25r1
JIf,3E�011'sPAR$ilNO.c 3')3.170-Dxs•i
tmAO +NO.! 207036274
ESCROW N0.., 291922-002
GRANT DEED
aaafta* me
M/12111eoe N:asa FM 1 .M
Pao 1N' 1t>MTTaa1old
0"WMd to off 16$61 ■ Amde
canal ar Mloerald
OMY L. ors.
s,tassssr, CMwty ClWk L tseer-der
IN11911
}`Mto1j7MK
r0
A , -T - ov. loir ono .'ePM nrrrr
Thr uWr_td Ommar(t) datim ONTYR.019FE0
TAX IA:
79computed an this U Vatue d the MWWOV of pro >, sty conveyed, or
— comWod an the full value lets the value d lion ; x encumbrances
re ns" thereon of the tome of We
— OR uenOw Is EXEV r ham tax for the follm l va"n:
FOR A VAIUAIKE CONSIDERATION, of vblkh Is hgleby s6r4 MedQed,
Michael A. Witt and Lima M. Witt, husband and rife
hereby GRANT(8) to
DOM O. CnCLE AND CANDACE L. CTRC1,E, buaband and r►i% as ceerlra�!!t property
80 that reel pMpwW dtuated In the City of La Quints
County d Riverside , State d Cal femta, deeerbW m:
Lot Sa of 'tract 25397 in the City of La Quints, County of !Riverside, State I:' California
reeorded in Bw',c 218, Pages 20-25 inclusive of flaps, in the office of the C )»tty Recorder
of Said county.
[*ed Mril 27 2000
STATE OF CAUMRMA, ►
7ese.etf.f0 - Nry Public, pay appeared
Mft1IAEy A. WfTT- �ANh
Lr 1:ok M. wtTT
4 Wavedt0 Irte O i the bash
encs] t0 158 it* P-(s)me a
are eu wlttlb+ OnftwnwIl and Oda' e I Ips I
to wo that NOW#" executed the ante In R'W-W/thelr
StARmlled atpscay(lee). and /tf►eh abgilature(e)
on the k1>1trUrrart parsan . or the ww" upon who of
which the persa 0 the k*bu" ere.
*Mesa my I1sr1d
t1AA1i. TAX 82T�k TO: 1j.' -r-
�� L •�
/�irC4W AW. '-r P1 Pert/
,J
Mich. Witt '
Al
Lie. M.Witt
ll
OF:ICIAL SE 1.��
.MNfil000BEP A W
MOMMY F11913 • G J 200M
WcobhosmN I t S Im C
0*00MINOWMEU Sop* t :=1
OFUNGE 001/ T f -'
eyh, r �• e y�' _
4
PGA WEST
RESIDENTIAL ASSOCIATION, INC.
August 1, 2001
Mr. Delos O. Circle
55-775 Pebble Beach
La Quinta, CA 92253
Dear Mr. Circle:
Mr. Don Adolph, Architectural Committee Member, has reviewed your plans to construct a custom
home at 55-775 Pebble Beach. Approval has been granted for construction of the residence;
however, please note the following:
1.. Keep pool equipment back against 10 ft. setback;
2. The overhead garage doors must be the roll up type;
3. No glass is allowed in the overhead garage doors;
Prior to commencing construction, please provide your contractor's name, license number
and proof of insurance (see enclosure). We will also need the signed Construction
Regulation form and a check in the amount of $10,000.00, to serve as a architectural deposit.
We reserve the right to make a final inspection of this change to make sure that it matches the
original mquest. An approval is based only on the aesthetics of your proposed plan and should not
be taken as any certification as to the construction worthiness or structural integrity of the proposed
change.
We appreciate your cooperation in submitting this request for approval., If I may be of further
assistance, please contact me at the HOA office, (760) 771-1234, Extension 15.
Sincerely,
aec
Operations Manager
cc: Architectural Committee
enclosure' (1)
R0. Box 1060, La Quinta, California 92253, Telephone 760.771-1234 FAX 760-771-5125
I/E 30dd `WdN:t Z0-9i-UVN °9i 19 UL 09L `•I '0088v 1vI1N30IS3d 183M VDd :A9 1N38
r rb
' YOUNG ENGINEERING SERVICES
• Engineering • Architecture•Surveying• Building & Safety Services
Letter of Transmittal
To: CST'{ 4 t- Date:
Project:
Attn: W. 0.:
Tel No.:. Tract No.:
We are forwarding: By Messenger By Mail Your Pickup
No. of Copies Description:
> g=m 4
Comments: T -'11s
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This Material Sent for:
Your Files Per Your Request
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47-159 Youngs Lane • Indio, CA 92201 • (760) 342-9214
Bron Young •
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:
Use Classification:
Occupancy Group:
55-775 PEBBLE BEACH
SINGLE FAMILY DWELLING Bldg. Permit No.: 0201-041
R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: DELOS O CIRCLE
Building Official
Address: 131 WAVERLY PLACE
City: MOUNTAIN VIEW, CA 94040
By: DANIEL P. CRAWFORD JR.
Date: 2/5/03
POST IN A CONSPICUOUS PLACE
REGISTERED INSPECTOR'S WEEKLY REPORT
4
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
'Office (760) 772-7192
' Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE 6-6-TRUCT. STEEL ASSEMBLY ❑
❑ POST TENSIONED CONCRETE ❑ ASPHALT /Q OTHER P
❑ REINFORCED M.ASONRY^�x❑=FIRE PROOFING
JOB LOCATION-t--c-
OCATION--.. r- ,(��REPORT
•�V t
SEQUENCE
TY P TURE �;/j
r90C Yet D
PERMIT NO. - - .�*�•"
D� � DAY OF WEEK
MATERIAL DESCRIPTION •��
ARCHITECT +.
IN HRS. CHARGED
E—) • p, s (' ��, -•'
-/\
ENGINEER
ASSISTANTS ' HRS. CHARGED
INSPECTION GENERAL� --,�C���, � - SUB ` "-
DATE CONTRACTOR `S ,P%V,`4AA- CONTRACTOR •'t,--�%�
l�/�dLC, �
,nom
(k t�J�n i pJ lid 9 tCG�
H
'� l
opt N
• •
COPY SENT TO CLIENT O
_ CONTINU ON NEXT PAGED �
PAGE OF
r
' CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE -BEST OF MY L GNATU E OF REGISTERE SPECT
S KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE i�
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED �ir/•'
PLANS.* SPECIFICATIONS. AND APPLICABLE SECTIONS, OF THE
GOVERNING BUILDING LAWS. D TE OF EPORT REGISTER NUMRFR
.. a , ` Vii_ • ..
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: -
55-775 PEBBLE BEACH
Use Classification:
SINGLE FAMILY DWELLING
Bldg. Permit No.:
0201-041
Occupancy Group:
R-3 Type of Construction:
VN Land Use Zone:
RL
Owner of Building: DELOS O CIRCLE
—7—,1., #4-t, /
Building Official
Address: 131 WAVERLY PLACE
City: MOUNTAIN VIEW, CA 94040
By: DANIEL P. CRAWFORD JR.
Date: 2/5/03
POST IN A CONSPICUOUS PLACE
JAN -28-2003 09:,34 AM
P. 04
CF -4R
'd
Pa
775 w
Aa6,
er
,C) r10 j Address Builder Name
-577 tCont
80d t Telephone Plan Number
Zr.-in eamexd
HER
Reler T lephone Sample Group Number
O
3
,4frtitying.Signatufe Date Sample, House Number
Firm; 'rcs-ae)' HERS. Provider:
Street Address: ,Ke-wd:EK�0' citylsta a/ Z4, 0(4/dla-
-296(0 t"ZIp:
Copies to- Builder. HERS Provider
HERS RATER COMPLIANCE STATEMENT
The house was: F Tested C3 Approved as part of sample testing, but was not tested
As the HERS rater providing diagnostic testing and field veirificaWn, I certify that the houses identified on this form
coy with the diagnostic tested compliance requirements as checked on this form.
eDistribution system Is fully'duetard (i.e., does not use,buildiirig cavities as plenums or platform returns in lieu
-y"Olf
duels)
Where cloth t)aeked, rubber adhesive duel tape is installed, mastic and drowband3 are usod in combination
with cloth backed, rubber adhesive duct tape to seal leeks at duct connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Measured
Duct Pressurization Test Results (CFM 25 Pa) values
Toot Leakage Flow In CFM
It tan flow is calculated as 400cfm/ton x number of tons enter
calculated value here
If fan flow is measured enter measured value here
V o/
Leakage Percentage (100 x Test Leakage/Fan Flow) V P
Check Sex for Pass oir Fall (Pass=6% or less)
Pass Fail
Lt—THERMOSTATIC EXPANSION VALVE (TXV) or Commission spor.oved eguivalcm
uryes 11 No T.h.-rmostatic Expansion Valve (Or Commission approved
equivalent) Is Installed and Access is provided for Inspection ❑
'Yes Is a pass ores Fail
0 MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
I ED Yes M No ACCA Manual D Design requirements have been met
(rater has verified that actual installation matches values in
CF -1 R and design on plan.
2. C Yes 0 No TXV is installed or Fan flow has been verified' If no TXV,
verified fan flow matches design from -C F- I R.
Measured Fan Flow
Yes for both 1 and 2 is a Pass
Q ED
Pass Fail
JAN -28-2003 09:33 AM
I
e hone
�c t= 02/y-e�i,9 3 Plan Number
Wer Telephone Semple Group Number
P.03
Prtlying:Signature.- 7 pa .Sample.Houee Number
Firm; G. ssocl es HERS Pm.vlder,..TG. �swG�fTrs _
Street Aodresg' �i �1� 4✓� I�YG�t� City/State/Zlp; ZN OLY/,? rhG 2S :3
Copies to: Builder, HERS Provider
HERS RATER COMPLIANCE STAIgMENT
The house was: PrTested ❑ Approved as part of sample testing, but was not tested
As the HERS raterrovidin diagnostic testingand field verification, I certify that the houses identified on this for
co y with the diagnostic t9a,
tested compliancerequirements as checked on this form.
Distribution system is fully'ducted (i.e., does not use building cavities as plenums or platform returns in lieu
I ducts)
where cloth backed, rubber adhesive duct tape is Installed, mastic and drawbands are used in combination
with cloth backed, rubber adhesive duct tape to seal leaks at duct connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Measured
Duct Pressurization Test Results (CFM (3 25 Pa) - values
Test Leakage Flow In CFM_
If fan flow is calculated as 400cfm/ton x number of tons enter
calculated value here a7v
If fan now is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) a.' -71
Check Box for Pass or Feil (Pass=$% or less) ❑
asS Fail
THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent
Yes ❑ No Thermostatic Expansion Valve (or Commission approved
equivalent) is installed and Access Is provided for inspection
Yes Is a pass
❑ MINIMUM RSCUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
1. 0 Yes M No ACCA Manual D Design requirements have been met
(rater has verified that actual installation matches values in
CF -1 R and design on plan.
2. D Yes ❑ No TXV is installed or Fan Flow has been verified. If no TXV,
verified fan flow matches design from CF -1 R.
Measured. Fan Flow a
Yes for both 1 and 2 is.9 Pass
Pass Fail
0 p.
Pass. Fail
JAN -28-2003 09:33 AM
V
CERTIFICATE OF FIELD
'OSTIC TESTING�
Plan Number
Sample Group Number
P. 02
F-4
'Fifying Signature DEF Sample House. Number
Firm:,T-e.-.0-oWDGie'e'C HERS; Provider:.,.TG;v=i%oc/uTrs
StreetAddross: 7W 0 ,-41Farber GLz� City/State/Zip: Zu. LAuirr 64Y
Copies to: Builder, HERS Provider
HERB RATER COMPLIANCE STATEMENT
The house was: X Tested ❑ Approved as part of sample testing, but was not tested
As the HERS rater providing diagnostic testing and Held verification, I certify that the houses identified on this form
comp+y with the diagnostic tested compliance requirements as checked on this form.
Distribution system is fully'ducted (i.e., does not use building cavities as plenums or platform returns in lieu
f ducts)
Where cloth backed, rubber adhesive duct tape is Installed, mastic and drawbands are used in combination
with cloth backed, rubber adhesive duct tape to seal leaks at duct connections.
MINIMUM REQUIREMLNYS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 0% Duct Leakage)
Measured
Duct Pressurization Test Results (CFM Q 25 Pa) values
Test Leakage Flow in CFM 0 Z
If fan flow is calculated as 400efmJton x number of tons enter 47Vcalculated value here
42- If fan flow is measured enter measured value here
Leakage Percentago (100 x Test Leakage/Fan Flow) =, , 411 If,
Check Box for Pass or Fail (Pass=e% or less) ❑
Pass Fail
t ZTHERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent
Q0 Yes ❑ No Thermostatic Expansion Valve (or Commission approved
equivalent) is installed and Access Is provided for inspection ❑
Yes Is a pass ras Fail
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
t . O Yes []No ACOA Manual D Design requirements have been met
(rater has verified that actual installation matches values In
CF -1 R and design on plan,' /
2. O Yes ❑ No TXV is installed or Fan flow has been verified, If no TXV,r
verified fan flow matches design from CF71R.
Measured Fan Flow a
Yes for both 1 and 2 is a Pass Pass Faii
JAN -28-2003 09:32 AM
Ll:I%IUI
F >FIEM)
Firm: •Y -C. P rrs pe4re!s
Stroot Address: 7&, z ...� .:GoYl CYG .e,
Copies to: Builder, HERS Provider
P.01
Builder Name
Plan Number
Sample Group Number
_Sample House Number
...HERS. Provider, J7C-.4L Aio6ala S
CityJslzte/Zip: Z41 01:4 /n. r coo,
HERS MTE8 gOMPLIANCE §IATEMENT
The house was: Tested ❑ Approved as part of sample testing, out was not tested
A$ the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form
comply with the diagnostic tested compliance requirements as checked on this form,
Distribution system is fully'ducted (i.a,, does not use building cavities as plenums or platform returns it) lieu
f ducts)
Where cloth backed, rubber adhesive duct tape is Installed, mastle and drawbands are used in combination
with cloth backed, rubber adhesive duct tape to seal leaks at duct connections.
70`MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 0% Duct Leakage)
Measured
Duct Pressurization Test Results (CFM Q 25 Pa) values
Test Leakage Flow In CFM
If fan flow is calculated as 400efmlton x number of tons enter
calculated value here 62 04>0
If fan flow Is measured enter measured value here r
Leakage Percentage (100 x Test Leakage/Fan Flow) _, a. J
Check Box for Pass or Fail (Pass=8% or less) ❑
Pass Fail
$THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent
dyes ❑ No Thermostatic Expansion Valve (of Commission approved
equivalent) is installed and Access 19 provided for Inspection
Yes is a pass
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
0 Yes 0 No ACCA Manual D Design requlrements have been met
(rater has verified that actual Installation matches values In
CF•I R and design on plan.
2 0 Yes D No TXV is Installed or Fan flow has been verified. If no TXV,
verlfled fan flow matches design from CF•1R,
Measured Fan Flow ■
Yes.,for both :t :and 2.1s a Pass
ar❑'
cs Fail
O O
Pass Fail -
Earth Systems
SA 707, 'Southwest
79-811B Country Club Drive
Bermuda Dunes, CA 92201 • (760) 345-1588
Client Name
Client Address ` l ` `) 0
CSC_)
Client Phone
FIELD DA LY
DATE
JOB NO.
PROJECT
ELEVATION
LOCATION
REFERENCE CURVE
CONTRACTOR
OWNER
WEATHER TEMP
oat AM
Oat PM
PRESENT AT SITE
TEST
NUMBER
G,i.-p �
LOT
NUMBER
ELEVATION
FIELD TESTING
REFERENCE CURVE
MOISTURE
CONTENT
DRY
DENSITY
Ibslcu. ft.
MAXIMUM
DRY
DENSITY
%
MAXIMUM
DRY
DENSITY
lbs/cu. ft.
OPTIMUM
MOISTURE
CONTENT
%
//2•
Y
/l
.e
REMARKS:'/LQ1V.A.'n(i / ? �'� i' / C f t S !U
R
LIMITATIONS: Thi
corrective action, add
report is subject to re,
f
F�
s ro,p vide information regarding the status of the field co
ting and or observations. No guarantee or warranty of the
hepp oject manager.
{`�
iuio'n'as to the need
N
T' -
CLIENT,REP/ ESfNTATIVE SIGNATURE TECIjNICIANS SIGNATURE
BD -FS -001 (12/01) //
�q' 13525j;
Earth Systems
1t� Southwest
79-811B Country Club Drive
Bermuda Dunes, CA 92201 •.(760) 345.1588
Client Name
Client Address �� _ e •�� `
,.
Client Phone "'� ✓�
FIELD DAI Y
'DATEWw
JOB NO.
rJ-
PROJECT
43 d Iv.
l
2% t�
LOCATION
MOISTURE
CONTENT
%
CONTRACTOR
OWNER
C- SUS; rj,��,..a
OPTIMUM
MOISTURE
CONTENT
WEATHER % TEMP
Oat AM
Oat PM
PRESENT AT SITE
bC .
TEST
NUMBER
�--
s e
LOT
NUMBER
ELEVATION
�-
FIELD TESTING
REFERENCE CURVE
MOISTURE
CONTENT
%
DRY
DENSITY
WCU. ft.
MAXIMUM
DRY
DENSITY
%
MAXIMUM
DRY
DENSITY
Ibsku. ft.
OPTIMUM
MOISTURE
CONTENT
/ 7
Cn
1
1
1•
REMARKS: 1 A I_ 1-1 C.y l 0\
NI
L)
GJi�,i ���•In�; 1-�t.aYlE f�) i��:c-'�1,C I fi�ltl �S ;n>(°, % pn
LIMITATIONS: This report is t provide information regarding the status of the field conditions and our opinion as to the need for
corrective action, adPralitestingand or observations. No guarantee or warranty of the contractors work is made or implied. This
report is subject to revi6w
bY the p q)ect manager.
'GLIENT REPREISENTATIVE SIGNATURE TECHNICIANS SIGNATURE
BD -FS -001 (12,01) 7 13434
0,�.,„s.+�..ti•.s}�'.rt�a-t,�.^[.'r.r-;y�l,�r,..�--'^.rwvcrwcs+wr..r�'-rte-r
a
Earth Systems
117 Southwest
79-8118 Country Club Drive
Bermuda Dunes, CA 92201 • (760) 345.1588
-•ry Q�.�r�-s-�..� �rR-•-.tr�..�,���y..'.e-.x ".�,.fX'u�-i`'id'vt�""T�+�e�vr.'e"r'°'..�"�IY�".'1
Client Name v �'
Client Address
Client Phone
FIELD DAI Y
DATE q'
JOB NO.
PROJECT
v
FIELD TESTING
REFERENCE CURVE
LOCATION }
DRY -
DENSITY
Ibs/cu. fl.
MAXIMUM
DRY
DENSITY
%
CONTRACTOR
OPTIMUM
MOISTURE
CONTENT
%
OWNER
WEATHER
TEMP
oat AM
Oat PM
PRESENT AT SITE
� I t tie.
&)
fro °
�
'10
TEST
NUMBER
LIMITATIONS:
LOT
NUMBER
ELEVATION
FIELD TESTING
REFERENCE CURVE
MOISTURE
CONTENT
%
DRY -
DENSITY
Ibs/cu. fl.
MAXIMUM
DRY
DENSITY
%
MAXIMUM
.DRY
DENSITY
Ibslcu. ft.
OPTIMUM
MOISTURE
CONTENT
%
L(
�'
1• �
0 � �
i%
�
fro °
�
'10
Joe
5v
I
s
I
J
J
e. � (� J � /' � xC �. ✓moi Pry
REMARKS: m2x 4 G e P J B LJ I CIS 5 i w / t r< 01 � �-
L-� i e L)
I)II"W-
W
LIMITATIONS: This report is to'provid linformation regarding the status of the field conditions and our opinion as to the need for
corrective action, additional � ssti g and observations. No guarantee or warranty of the contractors work is made or implied. This
report is subject to rev ew be pro ect manager.
CLIENT REPRESENTATIVE SIGNATURE TE�HC NICIANS`SiGNATURE
BD -FS -001 (12/01) i i r 12616
Earth Syst®rns,
Southwest
/79-811 B Country Club Drive
Bermuda Dunes, CA 92101 • (760) 345-1588
Client Name v , C—`
Client Address (21" L ' ` '"cam
1, •L
Client Phone C- >�
FIELD DAI Y
6
DATE
JOB NO.
PROJECT
( u1 . ! r �l�
�1! c//, .
LOCATIO
REFERENCE CURVE
CONTRACTOR _
OWNER
WEATHER TEMP
oat AM
Oat PM
PRESENT AT SITE
TEST
NUMBER
LOT
NUMBER
ELEVATION
FIELD TESTING
REFERENCE CURVE
MOISTURE
CONTENT
DRY,
DENSITY
Ibs/cu. fl.
MAXIMUM
DRY
DENSITY
%
MAXIMUM
.DRY
DENSITY
Ibslcu. fl.
OPTIMUM
MOISTURE
CONTENT
%
iD
�
lCPO.0
A
10e.3
oll
-14
REMARKS: i i�(.. I'1"9l0 o t S Jl till A 9 'O'. c 1. t D L
\ A it 1 ID 0.I,L i -,L - Se e. r I i uI rt, G
LIMITATIONS: This report is .pro/vide information regarding the status of the field conditions and our opinion as to the need for
corrective action, additional �stmg a�d or observations. No guarantee or warrantytiof the contractors work is made or implied. This
report is subject to feview . y the.manager.
CLIENT REPRESENTATIVE SIGNATURE 1: ; ,; , n ��, TECHNIC~1gNS SIGNATURE
BD -FS -001 (12/01)
NO 1261'8