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BRES2014-106178-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: BRES2014-1061 Property Address: 79555 N TOM FAZIO LN APN: 766032016 Application Description: 5818 SF SFD Property Zoning: Application Valuation: $518,984.70 Applicant: PIERCE CORPORATION, ANDREW 0 OUTSIDE CITY LIMITS LA QUINTA, CA 92253 VOICE (760) 777-7125 FAX (760) 777-7011 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 9/15/2014 Owner: NADER & SHIRLEY KHOSHNIYATI 19 LAGUNA DR 11 11 /V\ n LAGUNA BEACH, CA 92651 SEP 15 20114 Iii: COPAMUNCITY OF li ITY DEVE. cp 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 Clas /_ icense No.::LIC-0003031 wm& ate. % rack go OWNER -BUILDER D LARATION 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 f a permit subjects the applicant to a civil penalty of not more tlian 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.). (� 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 Name: Lender's Address: Contractor: PIERCE CORPORATION, ANDREW 0 OUTSIDE CITY LIMITS LA QUINTA, CA 92253 (760)346-3230 Llc. No.: :LIC -0003031 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 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 co ply wit those rovisions. D/ate: �� ' Appli WARNING: FAILURE TO SECURE WORKERS' COI 9PENSATION 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 gktoity to enter upon t above• /m/eroned rope/rt/yfor inspecti ri purposes. nature (Appli or Agent): DESCRIPTION ;. _, FINANCIAL INFORMATION ACCOUNT QTY AMOUNT ... PAID PAID DATE ART IN PUBLIC PLACES - RESIDENTIAL 270-0000-43201 0 $797.46 $797.46 9/15/14 PAID BY' METHOD RECEIPT # CHECK # ' _ CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE Total Paid forART IN PUBLIC PLACES - AIPP: $797.46 $797.46 DESCRIPTION ACCOUNT" ' QTY AMOUNT PAID,'t PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $21.00 $21.00 9/15/14 PAID BY METHOD RECEIPT # CHECK # {LTO BY " PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE Total Paid for BUILDING STANDARDS ADMINISTRATION BSA $21.00 $21.00 DESCRIPTION -' ACCOUNT QTY $ AMOUNT PAID, PAID DATE DIF - CIVIC CENTER 252-0000-43200 0 $942.00 $942.00 9/15/14 PAID BY METHOD'". RECEIPT # CHECK # CLTD BY „ PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE DESCRIPTION ' ` ACCOUNT' •QTY AMOUNT . ° PAID• PAID DATE DIF - COMMUNITY CENTERS 254-0000-43200 0 $129.00 $129.00 9/15/14 PAID BY . METHOD. RECEIPT # CHECK # CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - FIRE PROTECTION 257-0000-43200 0 $433.00 $433.00 9/15/14 PAID BY METHOD RECEIPT # CHECK # CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE DESCRIPTION— ACCOUNTQTl( AMOUNT PAID, PAID DATE DIF - LIBRARIES 253-0000-43200 0 $344.00 $344.00 9/15/14 PAID BY METHOD RECEIPT # < CHECK # CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE 'DESCRIPTION '' ACCOUNT CITY AMOUNT.:. PAID PAID DATE DIF - PARK MAINTENANCE 256-0000-43200 0 $40.00 $40.00 9/15/14 PAID BY 'METHOD RECEIPT# CHECK # ;`' .. CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE DESCRIPTION ACCOUNT,,; QTY AMOUNT PAID PAID DATE DIF - PARKS/REC 251-0000-43200 0 $2,048.00 $2,048.00 9/15/14 PAID BY METHOD RECEIPT# CHECK # CLTD BY, PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - STREET MAINTENANCE 255-0000-43200 0. $116.00 $116.00 9/15/14 PAID BY METHOD RECEIPT #, CHECK # CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF -TRANSPORTATION 250-0000-43200 0 $2,842.00 $2,842.00 9/15/14 PAID BY METHOD RECEIPT #... CHECK # CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE Total Paid for DIF - SINGLE FAMILY DWELLING: $6,894.00 $6,894.00 DESCRIPTION ACCOUNT QTY AMOUNT, PAID PAID.DATE' TEMP POWER SERVICE 101-0000-42403 0 $23.83 $23.83 9/15/14 PAID BY METHOD RECEIPT #CHECK # CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE DESCRIPTION.' ACCOUNT .., QTY AMOUNT PAID PAID DATE TEMP POWER SERVICE PC 101-0000-42403 0 $16.68 $16.68 9/15/14 '.PAID BY . METHOD RECEIPT .# CHECK # CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE Total Paid forELECTRICAL: $40.51 $40.51 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RESIDENTIAL, EA ADDITION 1,000SF 101-0000-42403 0 $72.96 $72.96 9/15/14 PAID BY :....: METHOD .:.. RECEIPT .#, CHECK # CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RESIDENTIAL, EA ADDITION 1,000SF, PC 101-0000-42600 0 $30.06 $30.06 9/15/14 PAID BY METHOD RECEIPT# CHECK # CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE DESCRIPTION ACCOUNT _ QTY AMOUNT PAID PAID DATE RESIDENTIAL, FIRST 1,000SF 101-0000-42403 0 $143.00 $143.00 9/15/14 PAID BY : METHOD RECEIPT # CHECK # CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE DESCRIPTION , , : ACCOUNT _ QTY AMOUNT PAID PAID DATE. RESIDENTIAL, FIRST 1,000SF, PC 101-0000-42600 0 $47.19 $47.19 9/15/14 PAID BY METHOD'`: RECEIPT#° CHECK # , CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE Total Paid forELECTRICAL - NEW CONSTRUCTION: $293.21 $293.21 DESCRIPTION : ACCOUNT .: QTY: . _ AMOUNT: PAID PAID DATE RESIDENTIAL FINISH GRADING PC 101-0000-42600 0 $143.00 $143.00 9/15/14 PAID BY METHOD RECEIPT # CHECK # CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE Total Paid forGRADING: $143.00 $143.00 DESCRIPTION ACCOUNTQTY AMOUNT PAID 4 PAID DATE CONDENSER/COMPRESSOR 101-0000-42402 0 $214.50 $214.50 9/15/14 PAID BY., METHOD ''..,RECEIPT # CHECK # GLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE CONDENSER/COMPRESSOR PC 101-0000-42600 0 $142.98 $142.98 9/15/14 PAID BY METHOD RECEIPT # , ` CHECK # CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE i A DESCRIPTION _ ACCOUNT QTY; AMOUNT PAID PAID DATE. EXHAUST HOOD 101-0000-42402 0 $23.84 $23.84 9/15/14 PAID BY i b ::A;, METHOD ; . x. RECEIPT # ' CHECK #. ' CLTD BY .. PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE DESCRIPTION '° ACCOUNT QTY AMOUNT •. PAID PAID DATE EXHAUST HOOD PC 101-0000-42600 0 $9.54 $9.54 9/15/14 PAID BY METHOD RECEIPT # CHECK # "CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE DESCRIPTION = ACCOUNT ' . _ QTY AMOUNT PAID_' PAID DATE FURNACE 101-0000-42402 0 $214.50 $214.50 9/15/14 PAID BY METHOD` RECEIPT,i CHECK # CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE DESCRIPTION- ACCOUNT QTY AMOUNT PAID. PAID DATE FURNACE PC 101-0000-42600 0 $142.98 $142.98 9/15/14 PAID.BY METHOD RECEIPT # ;CHECK # CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE DESCRIPTION ACCOUNT, QTY AMOUNT PAID PAID DATE VENT FAN 101-0000-42402 0 $83.44 $83.44 9/15/14 PAID BY METHOD .. RECEIPT # CHECK # CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE DESCRIPTION ACCOUNT QTY AMOUNT PAID' PAID DATE VENT FAN PC 101-0000-42600 0 $33.39 $33.39 9/15/14 PAID BY r,f METHOD,, RECEIPT#, CHECK # CLTD BY PIERCE CORPORATION, ANDREW CHECK 111151 39773 KHE Total Paid forMECHANICAL: $865.17 $865.17 DESCRIPTION ACCOUNT CITY, AMOUNT' F PAID PAID DATE MULTI-SPECIES RESIDENTIAL 0-8 UNITS 101-0000-20310 0 $1,292.00 $1,292.00 9/15/14 PAID BY # METHOD , . RECEIPT # . CHECK# CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE Total Paid for MULTI-SPECIES RESIDENTIAL- $1,292.00 $1,292.00 DESCRIPTION - ACCOUNT QTY_ AMOUNT PAID PAID DATE NEW CONSTRUCTION PERMIT 101-0000-42400 0 $752.07 $752.07 9/15/14 PAID BY . ` � .� , _ v •" METHOD RECEIPT # ' ; CHECK # CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE Total Paid for NEW CONSTRUCTION PERMIT: $752.07 $752.07 DESCRIPTION, ACCOUNT QTY AMOUNT PAID PAID DATE NEW CONSTRUCTION PLAN CHECK 101-0000-42600 0 $420.68 $420.68 9/15/14 lt PAID BY:` : METHOD RECEIPT # CHECK # CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE NEW CONSTRUCTION PLAN CHECK 101-0000-42600 0 $1,200.00 $1,200.00 7/18/14 PAID BY METHOD RECEIPT # CHECK # CLTD BY NADER KHOSHNIYATI CHECK R428 103 AOR Total Paid forNEW CONSTRUCTION PLAN CHECK: $1,620.68 $1,620.68 DESCRIPTION ACCOUNT" 4jr AMOUNT PAID : PAID DATE BACKFLOW DEVICE 101-0000-42401 0 $11.92 $11.92 9/15/14 PAID BY�. ':� a:: METHOD �} RECEIPT# CHECK#CLTD BY;, PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE DESCRIPTION #.' ACCOUNT . QTY AMOUNT,-'j- PAID PAID DATE' BACKFLOW DEVICE PC 101-0000-42600 .0 $4.77 $4.77 9/15/14 PAID BY a METHOD, rt `RECEIPT #, CHECK # CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE DESCRIPTION rSp: ACCOUNT QTY °``,AMOUNT': PAID PAID DATE; BUILDING SEWER 101-0000-42401 0 $11.92 $11.92 9/15/14 :PAID BY . '.. r METHOD RECEIPT # _ CHECK # CLTD BY PIERCE CORPORATION, ANDREW • CHECK. R1151 39773 KHE -DESCRIPTIONACCOUNT :: QTY . `� . 'y AMOUNT S is. PAID :'� '.:PAID DATE BUILDING SEWER PC 101-0000-42600 0 $11.92 $11.92 9/15/14 PAID BY METHOD v:M RECEIPT # CHECK # CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE DESCRIPTION ACCOUNT QTY 'AMOUNT "- PAID PAID DATE FIXTURE/TRAP 101-0000-42401 0 $286.08 $286.08 9/15/14 PAID BY METHOD" RECEIPT # CHECK #• CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE DESCRIPTION s Z` „ACCOUNT, QTY .„"..- AMOUNT ;PAID PAID DATE FIXTURE/TRAP PC 101-0000-42600 0 $286.08 $286.08 9/15/14 PAID:BY, METHOD RECEIPT # CHECK #. r ., CLTD BY . PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE DESCRIPTION. ` .-ACCOUNT ,= QTY AMOUNT' PAID PAID DATE GAS SYSTEM, 5+ OUTLETS 101-0000-42401 0 $35.75 $35.75 9/15/14 rj PAID BY ' m:' METHOD". r RECEIPT # CHECK # CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE DESCRIPTION . . • r ACCOUNT QTY.. AMOUNT :. PAID , PAID DATE GAS SYSTEM, 5+ OUTLETS PC 101-0000-42600 0 $23.83 $23.83 9/15/14 - PAID. BY r , :' , rr" m „'- METHOD , _ RECEIPT # '~ - CHECK # CLTD BY ' PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE DESCRIPTION_, ACCOUNT, QTY : ; : AMOUNT PAID PAID DATE ROOF DRAIN 101-0000-42401 0 $35.76 $35.76 9/15/14 PAID BY .K ,.' METHOD . RECEIPT #.CHECK # CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE DESCRIPTION { ACCOUNTQTY AMOUNT -:.' PAID r PAID DATE ROOF DRAIN PC 101-0000-42600 0 $35.76 $35.76 9/15/14 PAID BY^ METHOD RECEIPT. # CHECK # CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE DESCRIPTION -' " " s ACCOUNTY QTY AMOUNT 1PAID 4 PAID DATE. WATER HEATER/VENT 101-0000-42401 0 $11.92 $11.92 9/15/14 PAID BY r METHOD.: r RECEIPT # CHECK # CLTD BY PIERCE CORPORATION; ANDREW CHECK .111151 39773 KHE DESCRIPTION ACCOUNT, `' QTY AMOUNT y� ',:PAID, PAID. DATE WATER HEATER/VENT PC 101-0000-42600 0 $7.15 $7.15 9/15/14 ' PAID BY " #CHECK # -.CLTD BY:-: PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE DESCRIPTION ' ACCOUNT ,' QTY AMOUNT .` PAID PAID DATE WATER SYSTEM INST/ALT/REP 101-0000-42401 0 $11.92 $11.92 9/15/14 " PAID, BY ' . METHOD "RECEIPT # , ` CHECK # CLTD BY . PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE DESCRIPTION;; ACCOUNT ' QTY n AMOUNT; ` ; PAID F -. PAID DATE: WATER SYSTEM INST/ALT/REP PC 101-0000-42600 0 $11.92 $11.92 9/15/14 PAID BY METHOD' " RECEIPT # CHECK # :`CLTD BY' PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE Total Paid forPLUMBING FEES: $786.70 $786.70 -DESCRIPTION. 1 ,ACCOUNT QTY AMOUNT 'PAID PAID DATE.. SMI - RESIDENTIAL 101-0000-20308 0 $67.47 $67.47 9/15/14 'a PAID BY METHOD -'" RECEIPT#; `, CHECK # .. " CLTD BY PIERCE CORPORATION, ANDREW CHECK R1151 39773 KHE Total Paid forSTRONG MOTION INSTRUMENTATION SMI: $67.47 $67.47 DESCRIPTION ACCOUNT QTY' `: AMOUNT. " `. PAID PAID.DATE SINGLE FAMILY DETACHED 224-0000-20320 0 $1,837.44 $1,837.44 9/15/14 • PAID BY c METHOD RECEIPT #' ` CHECK# CLTD BY -: PIERCE CORPORATION, ANDREW CHECK R1151 39773" KHE Total Paid forTUMF - RESIDENTIAL: $1,837.44 $1,837.44 TOTALS: P.O. BOX 1504 Building " ,55 L� 78-495 CALLE TAMPICO Address %r LA OUINTA, CALIFORNIA 92253 Owner /. • 1 /__ /YI T J APPLICATION ONLY IV f1 b c A: -' S t r t CSS/f /V Mir, BUILDING: TYPE CONST. OCC. GRP. Mailing Address / A.P. Number /_4 1- & Classif Designer \ Address Ts D Tel. �l y9 - Lic. # Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirmthat 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 to construct, alter, improve, demolish, or repairanYstructure, 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 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, 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). OI, 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 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). OI, 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.) O 1 am exempt under Sec. B. & P.C. for 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 O 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 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 I 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 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 herebyKu6rize repr sentatives of this city to enter the above-mentioned property for inspection pur. 7 Signature of applicant Date- Mailing ate Mailing Address City, State, Zip WHITE = BUILDING DEPARTMENT Legal Description {- Project Description R - ' 7a 'Kc c To +>n �n� u N s1.CC CA Sq. Ft. No. Size 814 Stories No. Dw. b O t,L_ Units Nei Add ❑ Alter ❑ Repair ❑ Demolition ❑ 1�4,210.I Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. laoo, 06) Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL CONTACT INFORMATION cp NAME: PHONE: J DEVDP /A?q P�fXrf 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: Validated by: Date Permit Validation: YELLOW = APPLICANT PINK = FINANCE COMMUNITY DEVELOPMENT DEPARTMENT 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 (760) 777-7012 FAX (760) 777-7011 CERTIFICATION OF BUILDING AREA STREET ADDRESS OF JOB: 79-555 TOM FAZIO LN. APN: 766-032-016 RECEIVED DESCRIPTION OF WORK: NEW SFD SQUARE FOOTAGE: 5818 SQ. FT. OWNER'S NAME: NADER & SHIRLEY KHOSHNIYATI For questions regarding this letter, please call: City of La Quinta Permit Center (760) 777-7012 Coachella Valley Unified School District 83-733 Avenue 55 P0Box 847 Thermal, CA 92274 (760) 398-5909 Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 (760) 771=8515 SEP 1'0 2014 D.s.u.s.D. FACILITIES SERVICES ;FR 1 n you be dYlczc -7LZ)�`- Please note: This letter verifies conditioned square footage. Please call your School District to verify school fees, requirement for cashier's check or money order and hours of operation. CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road Date 9/10/14 La Quinta, CA 92253 No. 31538 (760) 771-8515 Owner Nader & Shirley Khoshniyati Address City Zip Tract # Type Single Family Residence Lot # No. Street Unit 1 79555 Tom Fazio Ln. Unit 2 Unit 3 Unit 4 Unit 5 9ERIKUDADUNES i V3 RANCHO MIRAGE b' INDIAN WELLS PALM DESERT y LA QUINTA INDIO y APN # 766-032-016 Jurisdiction La Quinta Permit # No. of Units 1 S.F. Lot # No. Street S.F. 5818 Unit 6 Unit 7 Unit 8 Unit 9 Unit 10 Comments COC created on 9/22/14 as software crashed on 8/14. Original to be mailed to Bldg Dept & copy to Gary Lohman , Andrew Pierce Corp, 44835 Deep Canyon Road, PD 92260, Gary. Loh man @andrewpierce corp.com At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that the above -named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $3.36 X 5,818 S.F. or $19,548.48 have been paid for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By CC/Union Bank - Garr Lohman Bank Name/Recipient of Certificate BY Dr. Gary Rutherford Superintendent Fee collected ilvrey Check No. 0325012375 Telephone 760-880-3228 Funding Residential Payment Recd 60.00 $19,548.48 over/Under Signature NOTICE: Pursuant to Government Code Svc r 66020(d)( 7tewhich serve to notify you that the 90-day approval period in which you may protest the fees or other payment identified above will begin to run from the the building or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another tity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID without embossed seal Embossed Original - Building Department Applicant Copy - Applicant/Receipt Copy - Accounting Recording Requested By 71, • q First American Title Company. RECORDING REQUESTED BV: .ProNet Partners, lnc.,,DBA Sun Gold Escrow Order No. 4634507 Tra: Escrow No. '10364 -CC Parcel. No. 766-032-016-1 f. AND WIIEN RECORDED MAIL TO: NADER KHOSHNNATI 19` Lagunita Dr Laguna Beach CA 92651 E FOR RECORDER'S USE GRANT DEED THE UNDERSIGNED GRANTORS) DECLARE(S) THAT DOCUMENTARY TRANSFER TAXIS 5357.50 and CITY S ® computed on full. value of property conveyed, or . computed on full value less_ liens or encumbrances remaining at the time of sale. ❑ unincorporated area: ® City .ofLa Quinta, and FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Robert T Feury, a Married Man hereby GRANT(S) to Nader Khoshniyati-Trustee of the. Nader. Khoshni.yati Family Trust the following described real property in the County of RQverside, State of California: dated 2/22/2002 SEE EXHBIT "A" ATTACHED HERETO AND MADE A PART HEREOF �t� MayC�4, �5y Robert Fury STATE OF GAl6W4W&tA Nelle is p �- ) couNTY,QF Zero en } _ On , bef re me, personal) ja��d�— �rrbereutK who proved to me on the basis of satisfactory evidence a the persons) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/shelthey executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed )lie instrument. ��onse I certify under PENALTY OF PERJURY under the laws of the State of-Gafifeniia tY hat the foregoing paragraph is true and correct. WITNESS my hand and official sea . Signatu (Seal) Mail Tax Statement ro: SAME AS ABOVE or Address Noted Below ROSAUND GUNDLING , �. NOTARY PUBLIC OF_NEVJERSEYy My Commies ion Expires October 7,, 2017 f Notary Seal Under the provisions of Government code 27361.7, 1 certify under penalty of perjury that the Notary Seal on'the document to which this statement is attached reads as follows: Name of notary: Commission dumber: �e County where Bond isfiled.:;...__.-.1W W... �_` ... ._ Date Commission Expires:._l��fJ�u PLACE OF EXECUTION: SAN BERNARDINO DATE: SIGNATURE: PRINTED NAME: Ashleigh Salters Order Number: 0625-4634507 Page Number: 7 LEGAL DESCRIPTION Real property in the City of LA QUINTA, County of RIVERSIDE, State of California, described as follows: PARCEL 1: LOT 45, AS SHOWN ON THAT CERTAIN -MAP ENTITLED TRACT NO 27728, WHICH MAP WAS FILED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF RIVERSIDE, STATE OF CALIFORNIA IN BOOK 249 OF MAPS PAGE(S) 1 TO 13. EXCEPTING ONE-HALF OF ALL OIL, GAS AND OTHER HYDROCARBON SUBSTANCES AND ALL MINERALS, WHETHER METALLIC OR NON-METALLIC WHICH MAY BE EXTRACTED OR REMOVED PROVIDED, HOWEVER, THAT THE SAID GRANTOR, HER SUCCESSORS OR ASSIGNS, SHALL NOT USE THE SURFACE OF SAID LAND OR ANY PART OF PARTS WITHIN 500 FEET OR SURFACE THEREOF AN IN THE EXERCISE OF SUCH RIGHTS SHALL NOT DISTURB THE SURFACE OF SAID LAND OR ANY IMPROVEMENTS THEREON, OR INSURE OR IMPAIR THE LATERAL OR SUBJACENT SUPPORT OF SAID LAND OF ANY IMPROVEMENT THERON, AS RESERVED IN THE DEED FROM ETHEL S. SOKOLOW, A MARRIED WOMAN, RECORDED SEPTEMBER 20, 1960 AS INSTRUMENT NO. 81986 OF OFFICIAL RECORDS OF RIVERSIDE COUNTY, CALIFORNIA; ALSO, EXCEPT THEREFROM, ALL OIL, GAS AND OTHER HYDROCARBON SUBSTANCES AND ALL MINERALS, WHETHER METALLIC OR NON-METALLIC, IN, UNDER, OR ON, OR WHICH MAY BE PRODUCED, EXTRACTED OR REMOVED, AS CONTAINED IN THE DEED RECORDED OCTOBER 15, 1951 IN BOOK 1310 PAGE 289 OF OFFICIAL RECORDS OF RIVERSIDE COUNTY, CALIFORNIA. PARCEL 2: A NON-EXCLUSIVE EASEMENTS APPURTENANT TO PARCEL 1 ABOVE, ON AND OVER THE "COMMON AREA" AS DEFINED IN THE DECLARATION FOR ACCESS, USE, OCCUPANCY, ENJOYMENT, INGRESS AND EGRESS OF THE AMENITIES LOCATED THE=REIN. THE COMMON AREA IS FOR THE USE OF OWNERS OF LOTS WHICH ARE SUBJECT TO THE DECLARATION AND IS NOT FOR THE USE OF THE GENERAL PUBLIC. APN: 766-032-016 FirstAmerican Title Page 7 of 15 THE QUARRY AT 1A QUINTA OWNERS ASSOCIATION Professionally managed by 68-950 Adelina Road !gManagement Personalized Cathedral City, CA 92234 PropertyPhone: (760) 325-9500 Fax: (760) 325-9300 June 30, 2014 MR. NADER KHOSHNIYATI Re: Approval of architectural submission for construction of residence at 79-555 Tom Fazio Lane North, The Quarry at La Quinta Homeowners Association. Dear Mr. Khoshniyati: The Board of Directors and Architectural Committee appreciate your recent submission of plans for the construction of a home in The Quarry @ La Quinta. We thank you for your patience during the review process to ensure the current structure meets the HOKs Architectural Guidelines. In this instance, the Architectural Committee and Board of Directors have approved your design with acceptance of the minor variances proposed. Congratulations! We look forward to having you as a neighbor and we welcome you to the community. Again, we appreciate your efforts in adhering to the Architectural Guidelines in the undertaking of your project by following all of the proper protocols in advance. With receipt of this letter you may move forward with your project with approval, which should also assist in guaranteeing your compliance with all City of La Quinta building statutes. Should you have any questions on this matter, please contact Community Manager Mike Livingston at Personalized, Property Management Company. Thanking you in advance for your assistance in this matter and all the best to you in your exciting endeavor. FOR THE QUARRY @ L4 QUINTA HOMEOWNERS ASSOCIATION BOARD OF DIRECTORS Sincerely, %144 sse -4"i+ Vaw Michael W. Livingston Community Manager, The Quarry at La Quinta HOA Personalized Property Management cc: Board of Directors File. RECEIVED CITY OF LA QUINTA - PUBLIC WORKS DEPARTMENT GREEN SHEET PUBLIC WORKS CLEARANCE FOR RELEASE OF BUILDING PER M�� 2 ci�l4 -_- Form updated & effective 9/25/2009 Green Sheet approvals are forwarded to the Building & Safety Department directly by Public WGWI (AvebbeWNlTST submit the Green Sheet (Public Works Clearance) Packet to the Public Works Department UNM 'r&fiyFtJ-QRWNT below are complete. Incomplete applications or applications which cannot be processed will be returned to applicant. Date: 0$ / I q / 14 Developer: Nader Khoshniyati Tract No.: 27727 Tract Name: Lot No.(s):45 Address(s): 79-555 Tom Fazio Lane North Phone Number:( ) GcLr y The following are the requirements for Public Works Clearance to authorize issuance of a building permit from the Building & Safety Department: ❖ CUSTOM HOMES: PROVIDE ITEMS #2, #3, #4, #5 & #7 BELOW TRACT HOMES: PROVIDE ITEMS #1, #2, #3 & #5 BELOW ❖ COMMERCIAL BUILDINGS/OTHER: PROVIDE ITEMS #1, #2, #3, #5 & #7 BELOW ❖ WALLS, SIGNS, OTHER: PROVIDE ITEM #6 BELOW 1. Attach Pad Elevation Certificates in compliance with the approved design elevation for building pad (maximum allowable deviation of +/-,0.1,foot). Pad Elevation Certificates must be current (within 6 months of current date). If a precise grading plan creates the pad for approval, please withhold green sheet submittal until a Pad Elevation Certificate can be provided. 2. Attach geotechnical certification of grading plan compliance including compaction reports from a licensed Soils Engineer. Recently rough graded residential developments which have a previously approved geotechnical certification are exempt from this requirement. 3. Attach recorded final map or title information/grant deed showing proposed building locations are legal lots. 4. Complete the attached <1 acre per lot or infill project Fugitive Dust Control project information form, PM10 plan & agreement or provide alternative & valid City approved PM10 plan set reference number or hard copy plan. PM10 plans for commercial & residential developments (beyond 1 lot) are submitted separately with grading plans & are subject to additional requirements. A current PM10 certification number is required. 5. Attach a copy of the rough or precise grading plan to the Public Works Department showing building location(s) for pad elevation verification. AO flood zone developments will require an approved flood plain development plan. 6. Attach supporting documentation for wall plan, monument sign, grease trap or special facility installations. 7. Complete and sign the attached water quality management plan (WQMP) exemption form, if applicable. PW approved building construction projects require`either a WQMP or a completed WQMP exemption form. - Approved maps/plans may be viewed at the following link: http://www.la-guinta.org/PlanCheck/m search.aspx I have reviewed and confirmed the requirements listed above as presented and find the improvements to be sufficiently complete for construction of the proposed buildings/structures/walls/signs on the subject lot(s). Pursuant to my findings, the above project may be released for building permit issuance. This section completed by City staff. fiA1 olc PV - Recommended by: Date: / / �J / q— eoNslSTF-7-1- *--21A4 � IQov(�if t>rt.4D/N Public Works Distribution: ( ✓) reen Sheet to Building & Safety ( -�reen Sheet to Planning DepartmeX6' e Declined7for approval for reason(s) as follow(s), please correct and resubmit: TAChecklists - Forms 8 ApplicationsWonns 8 Applications\GREEN SHEET cover & PM10 less than 1 Acre Revised 9-25-09.doc