15503 (SFD)444
P.O. BOX 1504 No. 1.55#3'
'Building 55-7180 Pebble Beach78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
Owner
+ David Robe "des BUILDING-. TYPE CONST. rP OCC. GRP. 115 �
Mailing
Address r! OIJ u€ 11h a ti 1i:L .1S A.P. Number 769-360 -015
' .CityZip Tel.
.vinta.. 9223 771-5500 Legal Descriptionea''s Tract 20717-2
Contractor , , ' `-SFD'
SBF Eng Contractor Project Description
Address `
City Izip
Los Ahgeles
State Lic.
& Classif. 504-883
Arch., Engr.,. , • ;
Designer:
Address
City .�" :-'; Zip
Tel.:
233.234-5681
City
Lic. #
Sq. Ft. ..No. No.,Dw.
Size 614$ Stories • Units
NewK19 Add'❑ Alter ❑ Repair ❑
ape d: does.;not .include block
9i
Demolition ❑
all f
I hereby affirm ihat,l am licensed untler pirovisions g of Chapter 9Acommenc with Section
7000) of Division 3 of the Business 'nd Prdfesslons Code,
and y license is in full force and
effect.
t / cis �-...-----'
r
• - - -
.r'_-"""`..�-•-.e.-.�^ 6
- ! 4-/ DATE
I
-SIGNATURE
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
7031.5,Business Any
x,0'3 35.2 dfl
reason: (Sec. and Professions Code: city or county which requires, a
permit to construct, atter, improve, demolish, or repair any structure,. prior to its issuance also
- I - '•
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
PERMIT - AMOUNT
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 Any Section 7031.5 by 'any for
Plan Chk. Dep. 0'0' -
alleged exemption. violation of applicant a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
,.; .".5{ •
i
Plan Chk. Bal. 1447.31
❑ 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
Const. 253
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,
- J�
2 Mech. )
�+
provided that such Improvements are not Intended or offered for sale. If, however, the building
or Improvement fs sold within one year of completion, the owner -builder will have the burden
-
Electrical 3? ��
of proving that he did not build or Improve for the purpose of sale.)
2.
p I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing 388.50
struct the project. (Sec. 7044, Business and Professions Coder The Contractor's License Law c
-
•-
does not apply to an, owner of property who builds or improves -thereon, and who contracts for
•� q,
S.M.I. 50 a-.7�! '• i
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
_
Grading '20.00
• ❑ I am exempt under Sec B. 8 P.C. for this reason'
Driveway Enc.
Date owner
Infrastructure 6000.00-.
Arts �'t1 1'1 i;aci>>9 1258..38
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. (Sec. 3800, Labor Code.)
Policy No:Company
y
Vopy is filed with the city:. ❑ Certified copy is hereby furnished.
TOTAL 1:399.43 11.749.43
CERTIFICATE OF EXEMPTION FROM
s
REMARKS
WORKERS' COMPENSATION INSURANCE
his section need not be completed If the
R p permit is for one Hundred dollars (5100) valuation
/ '
. ' of less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
- ,rr�•-.,,
- employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California
- fes• , '
Date Owner
_
NOTICE TO - APPLICANT: N, after making this Certificate of Exemption you should become'
- ZONE: ' ' ` BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances: R
Front Setback from Center Line
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND
' Side Street Setback from Center Line
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
-
HUNDRED THOUSAND DOLLARS ($IDO,000), IN ADDITION TO THE COST OF COMPENSATION,
Side Setback fromProperlyLine -
DAMAGES AS PROVIDED' FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
,
FINAL DATE INSPECTOR j
This is a building permit when properly filled out, signed and validated, and is subject to
'
expiration it work thereunder is suspended for 180 days.: c •
I certify that I have read this application. and state that the above information is'correct.
Issued by: Date Permit
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.
Validated by: ' F'
Signature of applicant —Date—
ate
Mailing
Mailing Address
Validai lon:� L i
City, State, Zip
j .'
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. Ff.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APP./EOUIP.
DRINKING FOUNTAIN
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION 3
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTE /11
FINA NS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
VENTILATION
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1'/e c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
-
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMB I
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
EATING (FINAL)
OTHER APP./EOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTE /11
FINA NS
FINAL INSP
GRADING
cu. yd.
$ plus x$
.
=$
LUMBER GR.
FRAMING
ROOFING
ri
^
REMARKS:
VENTILATION
FIRE ZONE ROOFIN
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/S UND
FINISH GRAD G
FINAL INSP TION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIl3NATURESIINITIALS
GARDEN WALL FINAL
- .1�o r�ei1- - -. : , . y
RECEDING REQUESTED BI-
Oh;..n� I l'L� COMPANY
AND WHEN RECORDED, MAIL TO:
Chang Stein
54 015 SOUTHERN HILLS
La Quinta, CA 92253.
ASSESSOR'S PARCEL NO.: 769-360-015-5
ozo o�S-
TITLE ORDER NO.: 580448
ESCROW NO.: 15396-001
GRANT DEED
PAID
Doc. Transfer Tax
FRANK K. jOHNSe N
RN. Co. Reoo d
.ulu lzj
RECEIVED FOR RECORD
AT 8:00 MOCK
APR - 3.1995
IlwrOw h�iM ��
r r' n
THIS SPACE FOR RECORDERS USE ONLY l 1,
The undersigned Grantor(s) declare(s) that the DOCUMENT TRANSFER
TAX IS:
$ 423.50 County $ City
xx computed on the full value of the Interest otp`r'aperty conveyed, or
— computed on the full value less the value of liens or encumbrances
remaining thereon at the time of sale
— OR transfer is EXEMPT from tax for the following reason:
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
Thomas A. Rosenquist and Leslie G.. Rosenquist
hereby GRANT(S) to
Chang A. Stein, a married woman as her sole and separate property
all that real property situated in the City of La,-Quinta
County of Riverside , State of California, described as:
Lot 23 of Tract 20717-2 in the City of La Quinta, County of Riverside, State of
California,as per map recorded in Book153, Pages 80 through 96 inclusive of Maps, in the
office of the County Recorder of said County.
--
Dated February 21, 1995
STATE OF GA6}F5f WK;"T\\%nqS } Thomas A. Rosenquist
COUNTY OF -I -.Ake. } ss.
On a �-\ q5 ,before me S�e�h�n;� Leslie G. Rosenquist
Cr . N , 21&o , Notary Public, personally appeared
personally known to me (or proved to me on the basis of
satisfactory evidence) to be the person(s) whose name(s)
.*are subscribed to the within instrument and acknowledged
to me that hefshe7they executed the same in hleftrer/their
authorized capacity(les), and that by hlofher/their signature(s) "OFFICIAL SEAL
on the instrument the person(s), or the entity upon behalf of STEPHENIE G. NIEHOFF .
which the person(s) acted, executed the instrument. Notary Public, Stats of IGlnois
WITNESS my hand and official seal. My Commission Expires 10/12/96
Signature
MAILTAX STATEMENTSTO: Qt,learearorofflclalnotaryaeaQ
SAME AS ABOVE -
NAME ADDRESS CITY, STATE & ZIP
COAC111101,1A VALLEY UNIFIED SCAMM, DISTIM'.1,11,
CERTIFICATE Ole(' , 0 IVIIL I'I A N
(Govel-11111C111( Code 53080)
Proje'd Nallic.:
Projecd Address: 55-780 Pebble Beach, La Quinta, CA 92236 (PGA)
Project -Owner's Nainc:__DAyj_d R()berdf--q Plimic No.: 7*71-5500__
1?1.ojcc( Description: One Dwelling
[Wilding,l),pe. (Check one): Residential (Include No. of'Dwellings)
Commercial Industrial
Trail No.: Lot No.:
(11'tnict attach Schedule, "A" ohill lots by tract, square 1,)0(agu,1161- each lot and w1al.)
Assess6i's Parcel No.: 769-360-015
(ITSCIMILlie "A" is used show Assessor's Parcel No. Cor each lot if one exists or Assessor's Parcel
No.. I01' IMI'Cefs bel -ore subdivided')
Total square I'M of Building Area. 6148 Sq.Ft.
Cci-(ification T lie persoll siglillig curtilles that the above i111,01-limholl is
Correct and makes (Ills -staleli'lew mider pelmll of, ) I., and kiltlerre 'esclik at u/she is
ill.10101UM to sign oil behall'ol.,dic 6wilel./developor.
Signature:
_
--T........---._...-
City/County ('.'er(ificadoll:
(Sign,Mure) Optional
A* if A A* A AA**A A* A A*** A***** A AAA *A A* A A**** h**A A A A A A AAA *A A
SCI -1(: 01.1 DISTRICA, lkli"OUIRVAIENTS P'ORTHE ABOVE, BEFA
OR WILL BE, SATISFIED IN M''C'MMANCT, WITH. ONE OP'THE le0L,LC),VVIN(.'V*-
(CI RCLE.ONE)
Gov. Code Gov. Co(Ie Agreement li'.xis(ing Not subject to
53080/65995 65970 prior to I/1/87 cc roquirelici(s
(AB 181, SB 1287) (SH 201) Note:
Total Nuber 0('S(I,/Ft. .6148
Amount per Sq/.Ft. 1.72
Aniomit Collected 10,574.56
Schoi►ITitle: Asst, Supexintendcilit, Admin, S
"T11C, 1101ds.Nt-e: August 11, 1995
Phone (619) 399-5137 Ext. 235
Note: AB 2926 and Sit 201 Im are caliped at $1.72 per square Foot for all residential
Construction, mid A! Foot h,". t-oll) ill (,Tri;1 1!in (h 1