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14-0914 (SFD)LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 {commencing with Section 70001 of Division 3 of the B siness and Professions Code, and my License is in full force and effect. License Class: B License No.: 838041 Contractor:O OWNER-BUILDDECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7.031.5, 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 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.). (_) 1, 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 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 Na Lender's Add 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' zompensation 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: Carrier: Policy Number: _ I certify that in the performance cf 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 tat, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. C Date: Applicant: WARNING: FAILURE TO SECURE WORKERS' CDM PENSATION 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 t5 is application. 1. Each person upon whose behalf this apAication is made, each person at whose request and for whose benefit work is performed under orpursuant 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 cf issuance of such permit, or cessation of work for 180 days will subject permit to cancallation. I certify that I have read this application and :tate 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 represen-atives of this city nter upon the above- mentioned property for inspection purposes. n C.` Dated Signature (Applicant or Agen C 78-495 CALLE TAMiPICO ` 0 D VOICE (760) 777-712S FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 1/22/2015 Application Number: SFD-14-914 Owner: Property Address: 55290 CHERRY HILLS CHRIS JEANS APN: 775170030 78-150 CALLE TAMPICO #101 Application Description: NEW SFD LA QUINTA, CA 32253 =1=3 Property Zoning: Application Valuation: $468,523.50 <-- Applicant: Contractor: 50 CZ SOUTHERN HILLS DEVELOPMENT INC SOUTHERN HILLS DEVELOPMENT INC t� 78-150 CALLE TAMPICO STE 101 ImC N 78-150 CALLE TAMPICO STE 1,1 —0 LA QUINTA, CA 92253 LA QUINTA, CA 32253 D n U1 9 (760)771-3497 ? U LIC. No.: 838041 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 {commencing with Section 70001 of Division 3 of the B siness and Professions Code, and my License is in full force and effect. License Class: B License No.: 838041 Contractor:O OWNER-BUILDDECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7.031.5, 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 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.). (_) 1, 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 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 Na Lender's Add 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' zompensation 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: Carrier: Policy Number: _ I certify that in the performance cf 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 tat, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. C Date: Applicant: WARNING: FAILURE TO SECURE WORKERS' CDM PENSATION 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 t5 is application. 1. Each person upon whose behalf this apAication is made, each person at whose request and for whose benefit work is performed under orpursuant 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 cf issuance of such permit, or cessation of work for 180 days will subject permit to cancallation. I certify that I have read this application and :tate 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 represen-atives of this city nter upon the above- mentioned property for inspection purposes. n C.` Dated Signature (Applicant or Agen Total Paid forNEW CONSTRUCTION PERMIT: $732.21 $0.00 DESCRIPTION , � � •ACCOUNT.. QTY AMOUNT PAID PAID DATE NEW CONSTRUCTION PLAN CHECK 101-0000-42600 0 $377.08 $0.00 PAID BY METHOD �': RECEIPT # CHECK'# CLTD BY Total Paid forNEW CONSTRUCTION PLAN CHECK: $377.08 $0.00 DESCRIPTION ' `, ACCOUNT QTY; AMOUNT PAID PAID DATE BACKFLOW DEVICE 101-0000-42401 0 $12.09 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY. DESCRIPTIONf ACCOUNT QTY AMOUNT PAID PAID DATE BACKFLOW DEVICE PC 101-0000-42600 0 $4.83 $0.00 PAID' BY METHOD . RECEIPT #- . CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT. = PAID PAID DATE BUILDING SEWER 101-0000-42401 0 $12.09 $0.00 PAID BY METHOD RECEIPT # _ CHECK # CLTD BY ' DESCRIPTION , ACCOUNT. QTY. 'AMOUNT PAID PAID DATE BUILDING SEWER PC 101-0000-42600 0 $12.09 $0.00 PAID.BY . ., METHOD RECEIPT,#••. CHECK # CLTD BY DESCRIPTION .. -ACCOUNT. QTY AMOUNT = PAID - PAID DATE FIXTURE/TRAP 101-0000-42401 0 $314.34 $0.00 ,PAID:B,Y, METHOD RECEIPT # CHECK # CLTD-BY DESCRIPTION ;_ - ACCOUNT CITY AMOUNT = PAID PAID DATE FIXTURE/TRAP PC 101-0000-42600 0 $314.34 $0.00 c PAID BY METHOD RECEIPT # .. CHECK # CLTD BY ' r DESCRIPTION ` .:. !,ACCOUNT ' CITY' AMOUNT " PAID " PAID DATE GAS SYSTEM, 5+ OUTLETS 101-0000-42401 0 $36.26 $0.00 PAID BY METHOD - RECEIPT # .. CHECK # - ..CLTD BY DESCRIPTION _ . t 'ACCOUNT ." CITY'. AMOUNT = PAID' 'PAID DATE GAS SYSTEM, 5+ OUTLETS PC 101-0.000-42600 0 $24.17 $0.00 r PAID BY METHOD' .. RECEIPT # CHECK # CLTD BY ;. DESCRIPTION ` ;` A000UNT ; QTY '' . 'AMOUNT PAID PAID DATE ROOF DRAIN 101-0000-42401 0 $48.36 $0.00 DESCRIPTIONY « , ACCOUNT. : QTYr AMOUNT PAID PAID DATE EVAPORATIVE COOLER 101-0000-42402 0 $12.09 $0.00 'PAID BY .: METHOD. RECEIPT#, CHECK # ' CLTD BY ' DESCRIPTION ACCOUNT QTY 'AMOUNT PAID. PAID DATE- EVAPORATIVE COOLER PC 101-0000-42600 0 $12.09 $0.00 - PAID'BY , METHOD ' RECEIPT# ' CHECK # CLTD BY DESCRIPTION. �' ACCOUNT QTY'' AMOUNT PAID; PAID DATE. EXHAUST HOOD 101-0000-42402 0 $12.09 $0.00 PAID:BY METHOD RECEIPT # CHECK #. CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT :'° ; -PAID PAID DATE EXHAUST HOOD PC 101-0000-42600 0, $4.83 $0.00 METHOD CLTD BYPAIDBY DESCRIPTION ` ." ACCOUNT QTY AMOUNT PAID PAID DATE FURNACE 101-0000-42402 0 $181.30 $0.00 PAIDBY. ,, METHOD `RECEIP.T # CHECK # : . CLTD BY ` - DESCRIPTION -' ACCOUNT QTY AMOUNT : PAID . PAID DATE FURNACE PC 101-0000-42600 0 $120.85 $0.00 PAID BY .', METHOD.., RECEIPT #.... CHECK #, CLTD BY 'DESCRIPTION. ACCOUNT QTY AMOUNT PAID PAID,DATE VENT FAN 101-0000-42402 0 $132.99 $0.00 PAID BY .... - '. • . METHOD.. RECEIPT # CHECK # CLTD BY :. DESCRIPTION ACCOUNT QTY' AMOUNT PAID. .' . PAID DATE VENT FAN PC 101-0000-42600 0 $53.13 $0.00 i;, METHOD RECEIPT # ' CHECK # CLTD BY Total Paid forMECHANICAL: $831.52 $0.00 -DESCRIPTION 'ACCOUNT .'.'' QTY,'•AMOUNT `; PAID ' :PAID DATE MULTI -SPECIES RESIDENTIAL 0-8 UNITS 101-0000-20310 0 $1,292.00 $0.00 PAID BY' METHOD . ` 'RECEIPT # .' CHECK # CLTDBY:. Total Paid for MULTI -SPECIES RESIDENTIAL $1,292.00 $0.00 :'DESCRIPTION : } :"" ACCOUNT- QTY .: AMOUNT' . PAID 'PAID DATE, NEW CONSTRUCTION PERMIT 101-0000-42400 0 $732.21 $0.00 PAID BY : METHOD.ry ° RECEIPT #.'' . CHECK-'# CLT1 BY �iZ P.O. BOX 1504 APPLICATION ONLY BuildingG 5,2� D 78-495 CALLE TAMPICO Address55-290 CN ceey 1 LLS LA QUINTA, CALIFORNIA 92253 � /g Owner g V,,2�� S J���'.j ,S' BUILDING: TYPE CONST. --94 OCC. GRP. 9-3 Mailing 4% ;Sou ooe'AN Ova/ S A.P. Number Ti 6J - 17 o - U3 o Address -78 U rile %. icc °� �D/ CI �^ Zip 9ZZS3 Tel. Legal Description 30 ?IP�KII- 2549? Contractor Project Description 0 SUT C M 641 4C. l 'Address o �E I Ica Id I Cty Zip Tel. - - fnlfl� v9i�3- State Lic. City Sq. Ft. No. No. Dw. & Classif. 8 3 80 41 Lic. # IR 7 Size$:18 rj Stories Units Arch., Engr., New)K Add C3 Alter❑ Repair❑ Demolition Designer A?4 6 63. W . acee2 Address Tel. -rfocp 22T(� YtA-�3�f 3�0,3oo�Y City Zip State aeY2- Gj2Zl.o Lic. # br CENSED C NTR TOR'S DECLARATION �Aj I hereby affirmthat I en u r p of Chapter 9 (commencing with Section 7000) of Division 3 Of the u n s an f io sAo , and my license is in full force and effect., A. a A _✓3� 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 orcounly which requires a permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to lite 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 o/ the Business and Professions Code, or that he is exempt therefrom, and the basis for the alleged exemption. Any violation o/ Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). Ell, 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 and Profes- sions Code: The Contractor's License Law does not apply to an owner o/ 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 o/ proving that he 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 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 the Contractor's License Law) ❑ 1 am exempt under Sec. B. 8 P.C. for this reason Date—Own WORKER'S 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 ❑ 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 th permit ;.�f or one hundred dollars ($100) valuation or less). I certify that in the performance of the ork for ch this permit is issued, I shall not employ any paiso in an manner so as to beco bjorkers' Compensation Laws of California. PHONE: Date v I Owner— NOTICI TO APPLICANT If, a 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. ZONE: BY: Minimum Setback Distances: 1 CONSTRUCTION LENDING AGENCY Front Setback from Center Line I hereby affirm that there is a construction lending agency for the performance of the work for Rear Setback from Rear Prop. Line which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Side Street Setback from Center Line Lender's Address Side Setback from Property Line 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. FINAL DATE INSPECTOR 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. Issued by: Signature of applicant Date Mailing Address Validated by: — City, State, Zip Validation: YELLOW = APPLICANT Estimated Valuation PERMIT Plan Chk. Dep. Plan Chk. Bal. J AMOUNT Infrastructure TOTAL F_FTcq,,D o CONTACT INFORMATION NAME: WHITE = BUILDING DEPARTMENT Date Permit PINK = FINANCE .r� Coac&HellValle Unified School District y• This Box For District Use Only 83-733 Avenue 55; Thermal, CA 92274 DEVELOPER FEES PAID (760) 398-5909 — Fax (760) 398-1224 AREA: AMOUNT - LEVELONEAMOUNT: ' LEVEL TWO AMOUNT: M ITIGATION AMOUNT: COMMAND:AMOUNT: DATE: RECEIPT: CHECK #: INITIALS CERTIFICATE OF COMPLIANCE (California Education Code 17620) Project Name: PGA West Date: December 4, 2014 Owner's Name: Chris Jeans • .Phone No. Project Address: 55-290 Cherry Hills, LaQuinta Project Description: New Single Family Dwelling / Attached Casita APN: 775-170-030 Tract #: Lot #'s: Type of Development: Residential XX! Commercial Industrial Total Square Feet of Building Area: 5185 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 / the owner/developer. Dated: December 4, 2014. 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 Agreement Existing Not Subject to Fee 17620 65995 Approval Prior to 1/1/87 Requirement • Note: Number of Sq.Ft 5185 Pursuant to AB 181,any room additions or enclosures of 500 sq. ft. or less are exempt from developer fees. Any mobile Amount per Sq:Ft. homes being relocated within the same school district's Amount Collected $628.00 jurisdiction are exempt from developer fees. Per 1986 rAgreement($628/du) Building Permit Application Completed: Yes/No By: Elsa F. Esqueda, Director of Facilities and Maintenance Certificate issued by: Laurie Howard, Secretary Signature:C�k.(/1.CSI�a 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 is 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. Mv:cflmydocs/devfees/certificate of compliance form updated.3-2007 11/2010 I IANDW00D TITLE COMPANY RECORDING REQUESTED BY: Landwood Title AND WHEN RECORDED MAIL TO: Mr. Donald Christopher Jeans 2300 Dobbins Lane Irving, TX 75063 f 31s8'q Title Order No.: 131689 TRA #: 020-025 DOC # 2013-0044447 01/29/2013 08:00 AM Fees: $21.00 Page 1 of 3 Doc T Tax Paid Recorded in Official Records County of Riverside Larry W. Ward Assessor, County Clerk & Recorder —This document was electronically submitted to the County of Riverside for recording" Receipted by: QHENSON THIS SPACE'FOR RECORDER'S USE ONLY: Escrow No.: 14-008997•GT GRANT DEED THE UNDERSIGNED GRANTOR(S) DECLARE(S) DOCUMENTARY TRANSFER TAX is $632.50 [X] computed on full value of property conveyed, or (] computed on full value less value of liens or encumbrances remaining at time of sale. [ ] Unincorporated area [X] City of La Quanta AND FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Herbert Hafif and Kay F. Hafif, Trustees of the Herbert Hafif and Kay F. Hafif Revocable Trust Dated October 4, 2010 hereby GRANT(s) to: Donald Christopher Jeans , a Single Man the real property in the City of La Quinta, County of Riverside, State of California, described as: LEGAL DESCRIPTION ATTACHED HERETO AS EXHIBIT "A" AND MADE A PART HEREOF Also Known as: 55290 Cherry Hills, La Quinta, CA 92253 AP#: 775-170-030-6 DATED January 4, 2013 STATE OF CALIFO.gNIQ Herbert Hafif and Kay F. Hafif, Trustees of the Herbert COUNTY OF CCos ii►,ay��S Hafif and KVe', fif Revocable Trust Dated October On •: 1. :.�� before me, 4, 2010- �fi i3iicIsti A NotaN PUbIIC In end.for sald:State oerseriall6•anriwarn�i s it; and the sa .ibscribed to me, tfaf h BY: F/Hi if;: al ha by .hls/her(jff�signatur44 on :the instrumenTil-ie v W•or the entity•upon behalf of'which 'the •person(s) MINDY D URESTI•BUESA , executed the instrument. Commissbn M 1989857 y_under•PENALTY OF.PEiRJURY.under the laws of the State Notary Public - CsilforMs fornia That the foregoing paragraph is true and correct. Las Ang" County :SS ; nd and oificial.seal. C Fib .17 tura (Seal) TAX ST MENTS T-0 RAR - • SHOWN BELOW; IF NO PARTY SHOWN, MAIL AS DIRECTED ABOVE: GOVERNNM NT CODE 27361.7 I certify under penalty of perjury that the Notary Seal on the document to which this statement is attached reads as follows: NAME OF THE NOTARY X, DATE COMMISSION EXPIRES COUNTY WHERE BOND IS FILED._ CO1vM S S I ON NIJMi TA -B- MANUFACTURER/VENDOR NUMB'9R . PLACE OF EXECUTION / a�� �Yt DATE _ I certify under penalty, of perjury and the laws of the State of California that the illegible portion of this document to which this statement is attached reads as follows: Date Place of Execution .. Signature ORDER NO.: 131589 All that certain lot or parcel of land lying and being situated in the City of LA QUINTA, State of California, as more particularly described as follows: LOT 30, OF TRACT 25397 AS SHOWN BY MAP ON FILE IN BOOK 218, PAGES 20 TO 25 INCLUSIVE OF MAPS IN THE OFFICE OF THE COUNTY RECORDER OF RIVERSIDE COUNTY, CALIFORNIA. Assessor's Parcel Number: 775-170-030-6 BOE -502-A (P1) REV. 11 (07-10) PRELIMINARY CHANGE OF OWNERSHIP REPORT To be completed by the transferee (buyer) prior to a transfer of subject property, In accordance with section 480.3 of the Revenue and Taxation .Code. A Preliminary Change of Ownership Report must be filed with each conveyance in the County Recorder's office for the county where the property Is located. Please answer all questions in each section, and sign and complete the certification before filing. This form may be used in all 58 California counties. If a document evidencing a change in ownership is presented to the Recorder for recordation without the concurrent filing of a Preliminary Change of Ownership Report, the Recorder may charge an additional recording fee of twenty dollars ($20). NOTICE: The property which you acquired. may be subject to supplemental assessment In an amount to be determined by the County Assessor. Supplemental assessments are not paid by the title or escrow company at close of escrow, and are not -included In' lendet Impound accounts: You may be responsible tar the current or upcoming property taxes even if you do not receive the tax bill. SELLER/TRANSFEROR Herbert Hafif and Kay F. Hafif ASSESSOR'S PARCEL NUMBER ( ) (;/f I. J. 776-170-0308 BOYER/TRANSFEREE Donald Christopher Jeans BUYER'S DAYTIME TELEPHONE NUMBER * STREET ADDRESS OR PHYSICAL LOCATION OF REAL PROPERTY when the crealb0grantor/trustor.dies; '3. tolfrorr an Irrevocable'trust for the benefli of the 55290 Cherry Hills, La Quinta, CA 92253 ( .) ;creator/grantor/trustor and/or( ).grantors/trustoes spouse j j grentorshrustor s registered domestic paMer. 4 to/from an irrevocable trustfrom•whlch'theproperty reverts to the.creator/grentor/trustorwithln 12 years. MAIL PROPERTY TAX INFORMATION TO (NAME) Thls property is subject -to a lease with a remaining lease term of 35 yeare or more Including written options. This la a transfer betweeb partiea.lnwhich proportional Interests of_ ttw transfemr(s) Mr. Donald Christopher Jeans and transferees) In each and every parcel being transferred remain exactly:the same atter the transfer: ADDRESS 2300 Dobbins Lane CITY Irving solar energy system. you checked YES- to statements C, D, or E, you may, quality for a. property tax reassessment exclusion, which may allow you to maintain your previous tax ord e. It you •checked YES to statement N, you may quallfyfor a STATE ZIPCODE TX 75063 ( )YES (v}'N0 Thla property t8 intendedas my principal residence. If YES, please'lndlcete the date of oacupenoy MO 'or intended •occupancy. DAY YEAR _ PART 1. TRANSFER INRARMATInki YES N"""0...��C - - - • wavv wnirmw all artuarmurliz. ( ) (v Z A. This transfer is solely between spouses (addition of removal of a spouse, death of a spouse, divorce settlement etc.): ( ) ( S. This transfer is solely.between domestic. partnere currently registered -with the California Secretary of State (addition orremovel of e partner, death of a partner, termination' settlement, etc.). This is:a transfer between: ( ) parents) and chlid,(ren) ( ) grandparents) and grandchild(ren). ( ) { D. Thla transaction into replace a principal residence by a -person 55 years of age or older. Within the same county? .( )YES. ( j,NO ( ) (tom' E. This transaction Is to replace a principal resldence,bya person who ls•severely disabled as defined -by Revenue and Taxation Code section 69 6 Within the'same county? ( );YES ( , ) N0 F. Thistranaaction Is onlya correctlonof the name(e) of the person(s) holding tltie to the.property (e.g., a nems change upon maniegs). If YES,; please explain: ( ) ( Vj' G. The.recorded documen crea es,• erm nates, or reconveywe lenders Interest In.the property ( ) ( vY' H. This:transaction Is recorded only as a requirement for flnancing•purposea or to create, terminate, or reconvey a security Interest (e.g., cosignerj: if YES, please explain: ( ) (;/f I. J. The recorded document substitutes a trustee.o a trust, mortgage.-O—roth-er-sTm-Ilar document. This Is a.transfer of property: 1. tolfrom a revocable trust thatrrlay be revoked by the transferor and is for -the benefit of ( )'the transferor, and/or ( ) the transferors spouse ( ) registered domestic partner. 1 to/from a trust that be revoked by the ciestorigrentor/trustor who Is also a joint tenant, and which names the otherjointtenent(s) as beneficiarlea when the crealb0grantor/trustor.dies; '3. tolfrorr an Irrevocable'trust for the benefli of the ( ) (�) ` ( .) ;creator/grantor/trustor and/or( ).grantors/trustoes spouse j j grentorshrustor s registered domestic paMer. 4 to/from an irrevocable trustfrom•whlch'theproperty reverts to the.creator/grentor/trustorwithln 12 years. (�! K Thls property is subject -to a lease with a remaining lease term of 35 yeare or more Including written options. This la a transfer betweeb partiea.lnwhich proportional Interests of_ ttw transfemr(s) and transferees) In each and every parcel being transferred remain exactly:the same atter the transfer: M. *If This Is transfer subjectto subsidized low-lnoome housing requirements with govemmentally Imposed restrictions. Thia.transfer Is to the first purchaser of a new building containing an active solar energy system. you checked YES- to statements C, D, or E, you may, quality for a. property tax reassessment exclusion, which may allow you to maintain your previous tax ord e. It you •checked YES to statement N, you may quallfyfor a propertytax new construction exclusion. A claim form must be filed and all requirements met In order to obtain any ofthese exduslona. Contact the Assessor for clalm4onm s. lease provide any other Information t at Hn e p t e Assessor un erstan the nature o t e ran er. THIS DOCUMENT IS NOT SUBJECT TO PUBLIC INSPECTION BUE-502-A (P2) REV. 11 (07-10) PART 2. OTHER TRANSFER INFORMATION Check and complete as applicable. A. Date of transfer, If other than recording date: B. transfer: ( Purchase { ) Foreclosure ( ) Gift ( ) Trade or Exchange ( ) Merger, stock or partnership acquisition (Form BOE -100-8) ( ) Contract of sale. Date of contract (. ) Inheritance. Date of death: ( ) Sale/leaseback ( ..) Creation of a lease Assignment of a lease ( ) Termination of a lease. Date lease began: Original term in years (including written opdons): Remaining term In years (Including wrlften options ( ) Other: Please explaln C. Only a partial Interest in the property was transferred? ( ) YES (v -MO If YES, indicate the percentage transferred _ % PART 3. R SE'PRICE AND TERMS OFFS -ACK Check and complete as applicable, A. Total purchase or acquisition price. Do not Include closing costs or mortgage Insurance $ fSiOya-' Down payment: $ Interest rate: % Seller -paid points or closing costs: $ Balloon payment: $ ( ) Loan carried by seller ( ) Assumption of Contractual Assessment* with a remaining balance of $ • An assessment used to finance property-spedfic improvements that constitutes a lien against the real property. B. The property was purchased: Through real estate broker. Broker name: '7A4G/ A&65v LS' Phone number:%)d -3.7o-t -✓ -7 ( ) Direct from seller ( ) From a family member ( )Other Please explain: C. Please explain any special terms, seller concessions, financing, and any other Information (e.g. buyer assumed the existing loan balance) that would assist the Assessor in the valuation of your property: PART -4; PROPERTY-kN ORMA ON.- Check.and `complete as. applicable, A. Type of property transferred ( ) Single-family residence (: ) Co-op/Own-your-own ( ) Manufactured home `(: ) Multiple -family residence. Number of units: (: ) Condominium (t-4,t)nimproved lot (: ) Other. Description: (Le., timber, mineral, wa g , eFifs tc) - (: ) Timeshare ( ) CommerciaUlndustrlal f3, ( ) YES (1460 Personal/business property, or Inoentives, are Included In the purchase price. Examples are furniture, tarn equlpment, machinery, club memberships, etc. Attach list If available. If YES, enter the value of the pereonallbusiness property: ,$ C. ( ) YES (%,WO A manufactured home Is included In the purchase price. If YES, enter the va a attributed to the manufactured home: $ ( ) YES ( 0 The manufactured home Is subject to local property tax. If NO, enter decal num er: D. ( ) YES ( u*I�O The property produces rental or other income. If YES, .the Income Is from: ( ) Lease/rent ( ) Contract ( ) Mineral rights ( ) Other: E. The condition of the property at the time of sate was: ( mood ( ) Average ( ) Fair ( ) Poor LARRY W. WARD Recorder P. O. Box 751 COUNTY OF RIVERSIDE Riverside, CA 92502-0761 ASSESSOR -COUNTY CLERK -RECORDER (951) 488-7.000 Website: wwwAversldescr.00m DOCUMENTARY TRANSFER TAX AFFIDAVIT WARNING -ANY PERSON WHO MAKES ANY MATERIAL. MISREPRESENTATION OF FACT FOR THE PURPOSE OF AVOIDING ALL OR ANY PART OF THE DOCUMENTARY TRANSFER TAX 18 GUILTY OF A MISDEMEANOR UNDER SECTION 5 OF ORDINANCE 518 OF THE COUNTY OF RIVERSIDE AND 18 SUBJECT TO PROSECUTION FOR SUCH OFFENCE. ASSESSOR'S PARCEL NO. 775-170-030-6 1 declare that the dogpmentery transfer tax for this Property Address: 55290 Cherry'Hills, Le,Qulnta, CA _92253 transaction is: $ & 3-'L• sU If this transaction is exempt.from Documentary Transfer Tax, the reason must be identified below. I CLAIM THAT THIS TRANSACTION IS EXEMPT FROM.DOCUMENTARY TRANSFER TAX BECAUSE: (The Sections listed below are taken from the Revenuwand Takeflon Code. Please check one or explain /n "O>Sftsr".) 1. Section 11911. The.document Is a lease for teini of.less,than thirty-five (35) years "(Including options).. 2. Section.11911. The. easement Is not perpetuel;.permanent, or for life:. 3. Section x1921. The lnstrument.was.given to secure a debt. 4.1 Sectlon: 41922. The conveyance, is to a govemrriental entity or political subdivlslon. 5. $ection 1'1925, The.transfer la.between Indlvlduais and a legal entity'. or legal entities, and does not change the: proportional Interests held: 8. Section 11928: The-lnetrument'is.from at rustof to a beneficlary, In lieu of foreclosure, and no additional. consideration was paid, 7.. Section 1 1928. The.grantee is the foreclosing beneficiaryand the consideration paid by the foreclosing beneficiary dries not exceed -the unpaid debt. 8. -Section 11927. The conveyance. relates to a dissolution of maniage or legal separation. 9. Sectlon 11930. The conveyance is an Inter vivos gift` or a_transfer by death, "Please be aware that Information stated on this document:may be•glven to and used by governmental agencles,,including the Internal Revenue Service. Also, certain glfts`in excess of" annual Federal gift tax exemption may trigger a Federal GiftTax: In auch,cases, the Transferor�(cidnor/grantor) maybe .requiredaofile Form 709 (Federal t3ifftax Return) with'the Internal Revenue Service. 10. ection 11930. The conveyance,is to the grentors revocable living trust. 11. X Other (Include explanatlon and authority)__ I DECLARE UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Executed this• day of or,at 7V b✓ to a ure o t ame -01 rlrM (if app ca e ajl d �h�r oohe� �ean5 Printed Name of an D 00 ��S �h@,�►4vi�► I X 7�C��o3 Address or Amant erepnone Number of Affiant (inclu-dng area c. e This form Is subJect to the California Public Records Act (Govemment Code 6280 at. seq.) Tor eco e s se: Affix PCOR Label Here ACR 521P-AS4EX0 (Rev. 11/20/10) Available In Alternative Formats PGA WEST. - RESIDENTIAL ASSOCIATION, INC. July 31, 2014 Mr. Donald Jeans 2300 Dobbins Lane Irving, TX 75063 Re: Custom Home to be built at 55-290 Cherry Hills La Ouinta, CA Page 1 of 2 Dear Mr. Jeans, The Architectural Committee has reviewed. your proposed custom home and related site development as shown on your submittals inclusive of a color board and drawings prepared by Andrzej W. Weber Architect. Sheets: Title Sheet & Sheet 2 dated 6/18/14; Gl & G2 dated 6/16/14; 3, 4, 5, 6, 7, 8, 9, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24 & 25 dated 6/18/14; T-24.1 & T-24.2 dated 6/9/14; GN, GD, S-1, S-2, SD -1, SD -2 & SD -3 dated 6/9/14; HFXl & HFX2 dated 11/1/13. The project -is acceptable in accordance with the Architectural Guidelines and the Association's CC&R's, pending receipt of City of La Quinta approved plans. The following comments and/or requirements are pertinent to the execution of this project: 1. Provide two (2) sets of City approved drawings for final acceptance. 2. Provide the HOA with a copy of the city permits for pool/spa, site walls, and driveway work. 3. The review of the mailbox is pending sub fo 4. Contact the HOA prior to starting undation to verify building setbacks, slab elevation, and site general condition provisions. 5. The HOA recommends a chain link fence with wind screen to prevent loose debris and materials from blowing into street and lake. 6. The homeowner and contractor should review the Custom Home Guidelines ,in reference to the various schedules, milestones and inspection requirements. 7. The project time period is not to exceed one year from the date of the final acceptance letter. 8. The Association is not responsible for locating easements and underground utilities on the site. Note: The lake equalizer eet Opinch Cherry Hille is located in utility ecial easementm Thand locatiipe on continuation extends into the 1 and depth of this is verified by Brad McGee. 9. The HOA acknowledges the building appendage encroachment near the garage on Cherry Hills into the 20 -feet 0 -inch Cherry Hills "equalizer pipe" easement. 54-320 Southern Hills, La Quinta, California 92253-5665, Telephone 760-771-1234 FAX 760-771-5125 Page 2 of 2 10. All exterior house and yard lighting is to be compatible with the ni.ghtscape and not cause problems for the adjacent neighbors. 11. Review site wall step down requirements for sidewalls at the rear property line and make corrections. The site wall on the vacant lot side is to be stucco finished and painted to match. 12. Provide the HOA with pool, landscape, hardscape, exterior lights plans for review. 13. The vacant lot is not to be used unless written permission is provided by the lot owner. 14. The contractor and homeowner must make provisions throughout the project for traffic control to preveht traffic disruption and accidents. The construction employee parking and vehicles must park on one side of the street. 15. The contractor is not allowed to stockpile any material, equipment or construction debris in the street. All debris must be cleaned up daily. 16. The owner and contractor must maintain a dust free construction site to avoid a rp oject stop notice. 17. The street gutters cannot be used for concrete wash out and the contractor is responsible for keeping the gutter clear and free of debris. 18. Upon completion of the project, the homeowner is required to provide a signed copy of the City of La Quinta Inspection Card, City of La Quetta Occupancy Permit and the Contractor Certification letter (enclosed). . We reserve the right to make a final inspection of this change to make sure that it matches the original request. 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 19. Cordially, y � Kel McGalliard ' Operations Manager For the Architectural Committee Enc. 1 Cc: Architectural Committee YOUNG ENGINEERING;, .. E� Letter of Transmittal . To: City of La Quinta Today's Date: - 11-25-14 78-495 Calle Tampico City Due Date: - 11=17-14 ' La Quinta, CA 92253 Project Address: - - . 55-290 Cherry Hills Attn: Kay Plan Check #: x 14-914 _ Submittal: ❑ 1s' r, ❑ 4th - -.. ❑ .2nd .. ❑ 5th ' ® 31d - ❑ Other: We are forwarding: ® By Messenger ❑ By Mail (Fed Ex or UPS) ❑ Your Pickup Includes: # Of Descriptions:. Includes: ,. # Of, Descriptions: Copies: Copies: ❑ Structural Plans ❑'. 1 Revised Structural Plans ❑ Structural Calculations ' , El 1 Revised Struct. Calcs El 1 Truss Calculations Floor El1 Revised Truss and Roof , ❑ Soils Report . ❑ Revised Soils Report ❑ 3 Structural Comment List - . El.- Approved Structural Plans ❑ 2 Redlined Structural Plans ❑ Approved. Structural Calcs ❑ Redlined Structural Calcs ❑ P Approved Truss Calcs ❑ Redlined Truss Calcs "" ❑ Approved Soils Report ❑ Redlined Soils Reports ❑ Other: .,RECFI\/PD Comments: Structural content is approvable. If you have any questions, please call. NOV 2 i014 Time =.75 HRr-.;� "tel i Lit .LA OUTNITA "_•` "UNIFY DEVEEOp . MENT This Material Sent for: - } ❑ Your Files , ® Per Your Request - : ❑ t Your Review ❑. Approval ❑ Checking u ❑ At the request of: Other: ❑ By: Kathryn Samuels . - Palm Desert Office: N. (760) 772-5107 Other : ❑ . 'r