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BRES2015-0307f. ` Illllll lllil l'll I'll m4aw ,B 78-495 CALLE TAMPICO VOICE (760) 777-7125 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 10/14/2015 Application Number: BRES2015-0307 Owner: Property Address: 81318 PEARY PL 3D GROUP APN: 767680030 6615 E P C HWY STE 260 Application Description: MADISON / SAMUELS / 7675 SFD LONG BEACH, CA 0 Property Zoning: Application Valuation: $666,311.00 Applicant: D Contractor: PETER JACOBS HOMES INC OCT 14 Z015 PETER JACOBS HOMES INC P 0 BOX 356 _ P 0 BOX 356 LA QUINTA, CA 92247 CI,Y0FLAQUINTA LA QUINTA, CA 92247 COMMUNITY DEVEIAPMENT DEPARTMENT (760)880-1761 Llc. No.: 799449 LICENSED CONTRACTOR'S 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 Professions Code, and my License is in full force and effect. License Class: B License No.: 799449 teoMftractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, 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).: (1 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.). (_) I, 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 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 thedlork for which this permit is issued. have and will maintain workers' compensation insurance, as required by Se n 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 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. Dat' e - / gMlcan WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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 this 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 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 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 county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to ter upon the above-mentioned property for inspection purposes. 49NIP--r v� •� Date: • �� / Si raatrfre`-('tYpplicant or Agent): FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE ART IN PUBLIC PLACES - RESIDENTIAL 270-0000-43201 0 $1,165.78 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for ART IN PUBLIC PLACES - AIPP: $1,165.78 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $27.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $27.00 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - CIVIC CENTER 252-0000-43200 0 $942.00 $0.00 PAID BY = METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - COMMUNITY CENTERS 254-0000-43200 0 $129.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - FIRE PROTECTION 257-0000-43200 0 $433.00 $0.00 PAID BY METHOD RECEIPT #.. CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - LIBRARIES 253-0000-43200 0 $344.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - PARK MAINTENANCE 256-0000-43200 0 $40.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - PARKS/REC 251-0000-43200 0 $2,048.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - STREET MAINTENANCE 255-0000-43200 0 $116.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - TRANSPORTATION 250-0000-43200 0 $2,842.00 $0.00 TMETH RIN Total Paidl,forblF FAMILY DWELLING: $6,894.00 $0.00 DESCRIPTION! g�Y. # - i.,i- Q @ :% wg n T, v T, Q 4AINFIR, et 'MOUNT A PAIMDATE� p. -m- -- -r 1* left. 11 0 I& 1, Nu OR, -0 K...= TEMP POWER SERVICE 101-0000-42403. 0 $24:17 $0.00 �PAIDMWZ24,2 -MIN A - ",HOE MET ug. �qwggj - C LT D BYE '2,52-N0, 92,n 0 �MCHECK10--r� Kb�7 . _3 M. 4�� tou", w NTj klL; Q Y IOUNT I I TIE ME MN &k z go -elf Nm RR Raw TEMP POWER SERVICE PC 101-0000-42403 -,0: $16.92 - $0.00 'PA R jm 141 HE - G-;�METHOD1,;,'._ .... .. R", , RECEIPT X ell � WIN VIM M X. a.N N Rllw� — 'V,"T;. M i� MK 05 f R,XHECK,#g, .,Total Paid, for.ELECTRICAL: $41.09,, $0.00 tv pgg� IPM "ACC X WON, 2 m ti,M' ,DESCRIPTION lj�' P RESIDENTIAL, EA ADDITION 1,000SF 101-0000-42403 0 `08,.64 $0.00. gim _MN W.TNIV MERM win, P, R, 'N MUP� gt PT4`4 "M IM 4. ' CHECK*,N "'g, 1�CLTDBY` am '13 r_ m T 7�1 N 0.1.11, RAN aqu R MOUNT .1 R 01 PAID 'y -DATE, " " IRI JRO �'Aldjl+%I� 0', RESIDENTIAL,.EA ADDITION 1,000SF, PC, 101-0.0.00-42600 0 $40.64 $0.00 �,Z MO." D1 114 METHOD ECEIRT1#12 Mk!. E § .7� M 1.51 Z �V RT cl ION' kJ 40 A, qkA. AMOUNT,--%�fl- B ib 1PAIMDATE, w % *E 'A RNR 4 i�A RESIDENTIAL, FIRST 1,000SF 101-0000-42403 0' $145.01, $0.00 Al PAID `BY,, 'K0 METHODS mt �g ,l jri�DES CRIP.TlO'_N,,6`w.0` ii, ON., _z ylml, XW w llkltk �PAIMDATE,; RE I RmLkill ?MMU NFE. A W.. We N�'.4-Ull"A RESIDENTIAL, FIRST 1,000SF, PC-, - 101-0000-42600 0 $47.86. $0.,06 iar `PAID `6i(MI5"M1'METHO R cEIPTl� P _q "V Z'a, Total Paid for ELECTRICAL NEW CONSTRUCTION: -.$332.'i7 $0.00 K ttou iT iv 3UNT W grpw 1�v PAID DATE; 'DESCRIPTIOWPAID Z NOR M M� , IRK'! �il,%Nl g IN y RESIDENTIAL PRECISE GRADING CUSTOM 10.1-0000-42408 O� $36,26 $0.0 0 HOME LOT >7'KSF ffl; PA I D L`BY,'��',,�. 'METHOD - - 01 3 ET NEI �MMKU ,r BY jAjt,.RECEIPT#� ,--, alp 'AW LE TrDESCRIMONl)� P RVAN,d RESIDENTIAL PRECISE GRADING -CUSTOM TOM , 0 $181.29 $0.00 HOME LOT >7KSF PC .101-0000-42600 .. ........ . ., , i; -i" M" ONMR&'M R 1jCHECK P 4' KLTD�BY IN 0 WMETHOD Z& .. P . ; Total Paid for GRAD NG.,. $217.55 $0.00 glpQ St TIONr�,'f� �iN Kp M4-1 I'll AQUK,_ K. p A[ vr, PA I ?, 0 CON DENSER[COM PRESSOR 101 -0000-42402,' $290o()8 $0.00 PAID BY METHOD RECEIPT # . CHECK # CLTD BY DESCRIPTION ACCOUNT � CITY AMOUNT: PAID PAID DATE CONDENSER/COMPRESSOR PC 101-0000-42600 0 $193.36 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT CITY 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 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE FURNACE 101-0000-42402 0 $253.82 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE FURNACE PC 101-0000-42600 0 $169.19 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE VENT FAN 101-0000-42402 0 $157.17 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION 'ACCOUNT CITY AMOUNT PAID PAID DATE VENT FAN PC 101-0000-42600 0 $62.79 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for MECHANICAL: $1,143.33 $0.00 DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE NEW CONSTRUCTION PERMIT 101-0000-42400 0 $843.09 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for NEW CONSTRUCTION PERMIT: $843.09 $0.00 DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE NEW CONSTRUCTION PLAN CHECK 101-0000-42600 0 $630.52 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT, CITY AMOUNT PAID PAID DATE NEW CONSTRUCTION PLAN CHECK 101-0000-42600 0 $1,200.00 $1,200.00 8/11/15 PAID BY METHOD RECEIPT # CHECK # R CLTD BY MICHAEL SAMUEL CHECK R8397 1108 SKH Total Paid for NEW CONSTRUCTION PLAN CHECK: $1,830.52 $1,200.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE BACKFLOW DEVICE 101-0000-42401 0 $12.09 $0.00 PAID BY ;METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION 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 $483.60 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE FIXTURE/TRAP PC 101-0000-42600 0 $483.60 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE GAS SYSTEM, 5+ OUTLETS 101-0000-42401 0 $36.26 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE GAS SYSTEM, 5+ OUTLETS PC 101-0000-42600 0 $24.17 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE ROOF DRAIN 101-0000-42401 0 $241.80 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT - QTY AMOUNT' PAID PAID DATE ROOF DRAIN PC 101-0000-42600 0 $241.80 $0.00 PAID BY METHOD - RECEIPT # CHECK # . CLTD BY DESCRIPTION ' ACCOUNTQTY AMOUNT PAID PAID DATE WATER HEATER/VENT 101-0000-42401 0 $24.18 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID '- PAID DATE WATER HEATER/VENT PC 101-0000-42600 0 $14.50 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WATER SYSTEM INST/ALT/REP 101-0000-42401 0 $12.09 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT' QTY AMOUNT. PAID PAID DATE WATER SYSTEM INST/ALT/REP PC 101-0000-42600 0 $12.09 $0.00 PAID BY METHOD . , RECEIPT # CHECK # CLTD BY Total Paid for PLUMBING FEES: $1,615.19 $0.00 DESCRIPTION ACCOUNT � QTY AMOUNT PAID PAID DATE SMI - RESIDENTIAL 101-0000-20308 0 $86.62 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for STRONG MOTION INSTRUMENTATION SMI: $86.62 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE SINGLE FAMILY DETACHED 224-0000-20320 0 $1,837.44 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for TUMF - RESIDENTIAL: $1,837.44 $0.00 TOTALS:00.00 Description: MADISON / SAMUELS / 7675 SFD Type: BUILDING, RESIDENTIAL Subtype: DWELLING -SINGLE Status: APPROVED Applied: 8/11/2015 SKH FAMILY DETACHED Approved: 10/14/2015 JJO Parcel No: 767680030 Site Address: 81318 PEARY PL LA QUINTA,CA 92253 Subdivision: TR 33076-1 Block: Lot: 68 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $666,311.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 9/1/2015 Details: 7625 SQ. FT. SFD THIS PERMIT DOES NOT INCLUDE -POOL, SPA, BLOCK WALLS, DRIVEWAY APPROACH, FIRE PIT, WATER FEATURES OR BBQS. HOME IS FIRE SPRINKLED PER 2013 CRC CODES. Printed: Wednesday, October 14, 2015 3:38:30 PM 1 of 7 OF SYSTEMS ADDITIONAL CHRONOLOGY CHRONOLOGY TYPE STAFF NAME ACTION DATE COMPLETION DATE' NOTES NOTE JIM JOHNSON 9/1/2015 9/3/2015 PLAN CHECK COMMENTS FROM CONSULTANT KAY HENSEL 10/14/2015 10/14/2015 STRUC APPROVABLE 10/13/2015 RECEIVED PLAN CHECK PICKED UP MARY FASANO 9/3/2015 9/3/2015 PLAN CHECK SENT TO MARY FASANO 9/28/2015 9/28/2015 OUTSIDE PC PLAN CHECK SUBMITTAL STEPHANIE GUMPERT 9/25/2015 .9/28/201S RECEIVED TELEPHONE CALL JIM JOHNSON 9/3/2015 9/3/2015 CALLED BROCK TO INFORM HIM PLANS ARE READY FOR CORRECTIONS TELEPHONE CALL JIM JOHNSON 10/14/2015 CALLED BROCK PAYTON TO INFORM HIM PLANS ARE READY TO ISSUE Printed: Wednesday, October 14, 2015 3:38:30 PM 1 of 7 OF SYSTEMS FINANCIAL CONTACT DATE ADDED DATE DATE REQUIRED SATISFIED CONDITIONS STATUS REMARKS NOTES CONDITION TYPE READY.TO ISSUE CHECKLIST JIM JOHNSON 10/6/2015 10/14/2015 PENDING ART IN PUBLIC PLACES - 270-0000-43201 0 $1,165.78 $0.00 RESIDENTIAL Total Paid for ART IN PUBLIC PLACES - AIPP:' $1,165.78 $0.00 BSAS SB1473 FEE 101-0000-20306 0 $27.00 $0.00 NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL APPLICANT PETER JACOBS HOMES INC $0.00 P 0 BOX 356 LA QUINTA CA 92247 DIF - COMMUNITY CONTRACTOR PETER JACOBS HOMES INC $129.00 P 0 BOX 356 LA QUINTA CA 92247 OWNER 31) GROUP 6615 E P C HWY STE 260 LONG BEACH CA 0 FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD BY ART IN PUBLIC PLACES - 270-0000-43201 0 $1,165.78 $0.00 RESIDENTIAL Total Paid for ART IN PUBLIC PLACES - AIPP:' $1,165.78 $0.00 BSAS SB1473 FEE 101-0000-20306 0 $27.00 $0.00 Total Paid for BUILDING STANDARDS ADMINISTRATION $27.00 $0.00 BSA: DIF - CIVIC CENTER 252-0000-43200 0 $942.00 $0.00 DIF - COMMUNITY 254-0000-43200 0 $129.00 $0.00 CENTERS DIF - FIRE PROTECTION 257-0000-43200 0 $433.00 $0.00 DIF - LIBRARIES 253-0000-43200 0 $344.00 $0.00 DIF - PARK 256-0000-43200 0 $40.00 $0.00 MAINTENANCE DIF - PARKS/REC 251-0000-43200 0 $2,048.00 $0.00 Printed: Wednesday, October 14, 2015 3:38:30 PM 2 of 7 (cmWsrsreMs Printed: Wednesday, October 14, 2015 3:38:30 PM 3 of 7 SYSTBtitS C DESCRIPTION ACCOUNT. QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY DIF - STREET - 255-0000-43200 0 $116.00 $0.00 MAINTENANCE DIF - TRANSPORTATION 250-0000-43200 0 $2,842.00 $0.00 Total Paid for DIF - SINGLE FAMILY DWELLING: $6,894.00 $0.00 TEMP POWER SERVICE 101-0000-42403 0 $24.17 $0.00 TEMP POWER SERVICE 101-0000-42403 0 $16.92 $0.00 PC Total Paid for ELECTRICAL: $41.09 $0.00 RESIDENTIAL, EA 101-0000-42403 0 $98.64 $0.00 ADDITION 1,OOOSF RESIDENTIAL, EA 101-0000-42600 0 $40.64 $0.00 ADDITION 1,000SF, PC RESIDENTIAL, FIRST 101-0000-42403 0 $145.03 $0.00 1,000SF RESIDENTIAL, FIRST 101-0000-42600 0 $47.86 $0.00 1,000SF, PC Total Paid for ELECTRICAL - NEW CONSTRUCTION: $332.17 $0.00 RESIDENTIAL PRECISE GRADING - CUSTOM 101-0000-42408 0 $36.26 $0.00 HOME LOT >7KSF RESIDENTIAL PRECISE GRADING - CUSTOM 101-0000-42600 0 $181.29 $0.00 HOME LOT >7KSF PC Total Paid for GRADING:. $217.55 $0.00 CONDENSER/COMPRES 101-0000-42402 0 $290.08 $0.00 SOR CONDENSER/COMPRES 101-0000-42600 0 $193.36 $0.00 SOR PC EXHAUST HOOD 101-0000-42402 0 $12.09 $0.00 Printed: Wednesday, October 14, 2015 3:38:30 PM 3 of 7 SYSTBtitS DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD BY EXHAUST HOOD PC 101-0000-42600 0 $4.83 $0.00 FURNACE 101-0000-42402 0 $253.82 $0.00 FURNACE PC 101-0000-42600 0 $169.19 $0.00 VENT FAN 101-0000-42402 0 $157.17 $0.00 VENT FAN PC 101-0000-42600 0 $62.79 $0.00 Total Paid for. MECHANICAL: $1,143.33 $0.00 NEW CONSTRUCTION PERMIT 101-0000-42400 -1 0 $843.09 $0.00 Total Paid for NEW CONSTRUCTION PERMIT: $843.09 $0.00 NEW CONSTRUCTION PLAN CHECK 101-0000-42600 0 $630.52 $0.00 NEW CONSTRUCTION PLAN CHECK 101-0000-42600 0 $1,200.00 $1,200.00 8/11/15 R8397 1108 CHECK MICHAEL SAMUEL SKH Total Paid for NEW CONSTRUCTION PLAN CHECK: $1,830.52 $1,200.00 BACKFLOW DEVICE 101-0000-42401 0 $12.09 $0.00 BACKFLOW DEVICE PC 101-0000-42600 0 $4.83 $0.00 BUILDING SEWER 101-0000-42401 0 $12.09 $0.00 BUILDING SEWER PC 101-0000-42600 0 $12.09 $0.00 FIXTURE/TRAP 101-0000-42401 0 $483.60 $0.00 FIXTURE/TRAP PC 101-0000-42600 0 $483.60 $0.00 GAS SYSTEM, 5+ OUTLETS 101-0000-42401 0 $36.26 $0.00 GAS SYSTEM, 5+ OUTLETS PC 101-0000-42600 0 $24.17 $0.00 ROOF DRAIN 101-0000-42401 0 $241.80 $0.00 ROOF DRAIN PC 101-0000-42600 0 $241.80 $0.00 Printed: Wednesday, October 14, 2015 3:38:30 PM 4 of 7 Ammpft %r SYSTEMS INSPECTIONS SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED DATE DATE RESULT REMARKS NOTES FINAL" BLD RETURNED REVIEWS REVIEW TYPE REVIEWER CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY WATER HEATER/VENT 101-0000-42401 0 $24.18 $0.00 STRUCTURAL - 2 WK WATER HEATER/VENT 8/11/2015 9/1/2015 9/2/2015 REVISIONS REQUIRED ENGINEERING 101-0000-42600 0 $14.50 $0.00 PC WATER SYSTEM 101-0000-42401 0 $12.09 $0.00 INST/ALT/REP WATER SYSTEM 101-0000-42600 0 $12.09 $0.00 INST/ALT/REP PC Total Paid for PLUMBING FEES: $1,615.19 $0.00 SMI - RESIDENTIAL 101-0000-20308 0 $86.62 $0.00 Total Paid for STRONG MOTION INSTRUMENTATION SMI: $86.62 $0.00 SINGLE FAMILY 224-0000-20320 0 $1,837.44. $0.00 DETACHED Total Paid for TUMF - RESIDENTIAL: $1,837.44 $0.00 TOTALS:•0.0• INSPECTIONS SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED DATE DATE RESULT REMARKS NOTES FINAL" BLD RETURNED Printed: Wednesday, October 14, 2015 3:38:30 PM 5 of 7 CRIff SYSTEti1S RETURNED REVIEWS REVIEW TYPE REVIEWER SENT DATE DUE DATE DATE STATUS REMARKS NOTES NON-STRUCTURAL - JIM JOHNSON 8/11/2015 8/28/2015 9/1/2015 REVISIONS REQUIRED 3 WK STRUCTURAL - 2 WK YOUNG 8/11/2015 9/1/2015 9/2/2015 REVISIONS REQUIRED ENGINEERING Printed: Wednesday, October 14, 2015 3:38:30 PM 5 of 7 CRIff SYSTEti1S 2ND BLDG NS (2 WK) JIM JOHNSON 9/25/2015 10/9/2015 10/14/2015 APPROVED 2ND BLDG STR (2 YOUNG 9/25/2015 10/9/2015 10/13/2015 READY FOR APPROVAL SUBDIR ETRAKIT ENABLED WK) ENGINEERING JIM JOHNSON 81-318 PEARY 81-318 PEARY 0 1ST PW GREEN AMY YU 9/28/2015 '10/5/2015 9/30/2015 READY FOR APPROVAL DOC 10/6/2015 SHEET SCHOOL FEES BRE S2015- SCHOOL FEES BRES2015- 0 Printed: Wednesday, October 14, 2015 3:38:30 PM 6 of 7 ' LJ .C:J SYSTEMS BOND INFORMATION ATTACHMENTS Attachment Type CREATED OWNER, DESCRIPTION PATHNAME SUBDIR ETRAKIT ENABLED DOC 8/28/2015 JIM JOHNSON 81-318 PEARY 81-318 PEARY 0 PLACE.docx PLACE.docx DOC 10/6/2015 JIM JOHNSON SCHOOL FEES BRE S2015- SCHOOL FEES BRES2015- 0 0307.pdf 0307.pdf 1ST REVIEW - NEW CITY DOC 9/2/2015 KATHRYN SAMUELS STRUCTURAL TRANSMITTAL BRES 0 TRANSMITTAL 2015-0307 (lst).pdf 1ST REVIEW - Soils_ Report_Scope_BR DOC 9/2/2015 KATHRYN SAMUELS STRUCTURAL SOIL 0 ES 2015-0307.pdf COMMENTS 1ST REVIEW - DOC 9/2/2015 KATHRYN SAMUELS STRUCTURAL BRES 2015-0307 KS 0 (ist).doc COMMENTS 2ND REVIEW - NEW CITY DOC 10/13/2015 KATHRYN SAMUELS STRUCTURAL TRANSMITTAL BRES 0 TRANSMITTAL 2015-0307 (2nd).pdf CONSTRUCTION DEBRIS CONSTRUCTION DEBRIS DOC 9/29/2015 STEPHANIE KHATAMI MANAGEMENT 09-29- MANAGEMENT 09-29- 0 15.pdf 1S.pdf DOC 9/29/2015 STEPHANIE KHATAMI HOA 09-29-15.pdf HOA 09-29-15.pdf 0 DOC 9/29/2015 STEPHANIE KHATAMI GRANT DEED 09-29- GRANT DEED 09-29- 0 15.pdf 15.pdf Printed: Wednesday, October 14, 2015 3:38:30 PM 6 of 7 ' LJ .C:J SYSTEMS Printed: Wednesday, October 14, 2015 3:38:30 PM 7 of 7 CNFW.IYSTEMS r PO. BOX 1504 APPLICATION ONLY Building�% (, —../� 78-495 CALLE TAMPICO Address D:"'` - : ��5 ��9_[--Y -��l iP� LA OUINTA, CALIFORNIA 92253 S 41M uG is Mailing Address City Tel. J'ipJL2_y ? ��v'i71� Contractor Address City Zip Tel. State Lic. 7City /, Y & Classif. r Lic. # Arch., Engr., Designere`L Address Tel. Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of CFapter 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 --ounty which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to is issuance also requires the applicant for such permit to file a signed statement that he is licensee pursuant to the provisions of the Contrac- tor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that he is exempt therefrom, anc the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permr subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ 1, 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 Nor sale. (Sec. 7044, Business and Profes- sions Code: The Contractor's License Law does not mply to an owner of property who builds or improves thereon and who does such work himself om through his own employees, provided that such improvements are not intended or offered for see. 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, as owner of the property, am exclusively contracting with licensed contractors to construct the project. (Sec. 7044, Business and Professions Code: she 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 icense Law) ❑ 1 am exempt under Sec. B. & P.C. liar this reason Date Owner 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 s hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permf is for one hundred dollars ($100) valuation or less). I certify that in the performance of the work fov which this permit is issued, I shall not employ any person In any manner so as to become subject to 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 L°NDING AGENCY I hereby affirm that there is a construction lerding agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Con.) Lender's Name Lender's Address This is a building permit when properly fill 9d out, signed and validated, and is subject to expiration if work thereunder is suspended for 1:0 days. I certify that I have read this application end 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 representelives of this city to enter the above-mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip WKITE = BUILDING DEPARTMENT BUILDING: TYPE CONST. OCC. GRP. A.P. Number 24 7 Legal Description /,7-/ Project Description SCCA 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— Issued by: Validated by: Validation: YELLOW = APPLICANT INSPECTOR Date PINK = FINANCE Sq. Ft. ?/ ,f No. Size r/ Stories / No. Dw. Units New ,4 Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL CONTACT INFORMATION NAME: PHONE: 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— Issued by: Validated by: Validation: YELLOW = APPLICANT INSPECTOR Date PINK = FINANCE Coa& lia Valley Unified School District 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 LEVEL ONE AMOUNT: LEVEL TWO AMOUNT: MITIGATION AMOUNT: COMMAND. AMOUNT: DATE: RECEIPT: CHECK N: -INITIALS CERTIFICATE OF COMPLIANCE (California Education Code 17620) Project Name: jfhe Madison Club, Date: October 13, 2015 Owner's Name: Michael Samuel Phone No. Project Address: 81-318 Peary Place, LaQuinta Project Description: New Single Family Dwelling APN: 767-680-030 Tract #:: Lot #'s: Type of Development: Residential XX Commercial Industrial Total Square Feet of Building Area: 7,625 Certification of Applicant/Owners: The person signing certifies that the above i9formation is correct and makes this statement under penalty of perjury and further represents that he/she is authorized to Sigehalql,f the owner/developer.. Dated: October 13,2015 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. 7625 Amount per Sq.Ft. $3.36 Amount Collected $25620.00 Building Permit Application Completed: Yes/No By: Elsa F. Esqueda, Director of Facilities and Maintenance Agreement Existing Not Subject to Fee Prior to 1/1/87 Requirement Note: Pursuant to AB 181 any room additions or enclosures of 500 sq. ft. or less are exempt from developer fees. Any mobile homes being relocated within the same school district's jurisdiction are exempt from developer fees. Certificate issued by: Laurie Howard, Secretary Signature: 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 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. MV:c/mydocs/devfees/certilicate of compliance form updated 3-2007. 11/2010 � 1 RECORDING REQUESTED BY First American Title Company AND WHEN RECORDED MAIL DOCUMENT TO: Michael Samuel and Alaina Samuel P.O. Box 1506 Midland, TX 79702 DOC # 2014-0296090 08/06/2014 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. MABRERA Space Above This line for Recorder's use only GRANT DEED A. P, N.: 767-680-030-3 T.R.A. No.020-161 File No.: RIW-4674091(SE) The Undersigned Grantors) oedare(s): yDOCUMENTARY TRANSFER TAX $8so,00; q:1Y TRANSFER TAX $; computed on the consideration or full value of property conveyed oR w [; computed on the consideration or full value less value of liens and/or encumbrances remaining at time of sale, [ unincorporated area; Xcity of La Quinta, and, FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, 3D Group, LLC hereby GRANTS to Michael Samuel and Alaina Samuel, husband and wife as community property, as to an undivided 50010 interest and William G. Spathelf, Trustee of the William G. Spathelf and Deborah K. Spathelf Living Trust, as to an undivided 500/o interest all as tenants in common the following described property in the City of La Quinta, County of Riverside, State of California: PARCEL NO. 1: LOT 68 (THE. "LOV)_OF TRACT- NO., 33076-1,-114 THE CITY OF LA QUINTA, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA, AS SHOWN ON'SUBDIVISION MAP (THE "MAP") RECORDED ON SEPTEMBER 7, 2005, IN BOOK 388, PAGES 57 THROUGH 79, INCLUSIVE, OF MAPS. IN THE OFFICE OF COUNTY RECORDER OF SAID COUNTY. ill �