9906-208 (SFD)LICENSED CONTRACTOR DECLARATION
U) -1 hereby affirm under penalty of perjury that I am licensed under provisions of
F— Chapter 91commencing with Section 7000) of Division 3 of the Business and
cv W Professionals Code, and my License is in full force and effect.
o =) ch License # Lic. Class Exp. Date
r-- ~ r
oZ ti Date Signature of Contractor
to O t�
J U C) OWNER -BUILDER DECLARATION
W W r` I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ License Law for the following reason:
Z_ ( ) 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 for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
cY) () I am exempt under Section
u7 B&P.C. for this reason
O C\JN Date Signature of Owner -
0)
WORKER'S COMPENSATION DECLARATION
o ZCL
I hereby affirm under penalty of perjury one of the following declarations:
r O () 1 have and will maintain a certificate of consent to self -insure for workers'
X LU LL compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q C) (K) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
;li. "v.r'.i�:,rx17a.
Q (This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: Applican
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
(y construction, and hereby authorize representatives of this City to enter upon
the above -mentioned property for inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
TE t q)11 wt 1 W)<VALUATION ^� n°.��3 LOT TRACT
SITE
A ESS j.,.yr«�4� '� 1�.tfA x49..►3r+a
APN
�. )i.-i) Z•Q�t}1
❑ ER
CONTRACTOR / DESIGNER / ENGINEER
i, i' / t
,'t_�ppirL
Sii::'..}
(.:." �440o,
1,;MAI N'S►_:1.`. ('.A 9220)
1-hit;'t'trt#*_i'(.,jfi i / •`(1; .ff 5 �;4a
USE OF PERMIT
!it•ii E'15k:Ib'IS S. i_711i�:N �VC.11 i.l^�'..,.l.11i}i lif.L�.:4t V�`t{S.Y, (1t. 1'!�.HJf_r.
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A".3li4CO!
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ftVy ro •:•n. .1 �}-r-•r- !a'•. f+;+ '�'t.3 iflb .
,) 4;
RECEIPT
DATE
BY DAT FINALED
INSPECTOR
Y 3'O
INSPECTION RECORD
OPERATION I
DATE I
INSPECTOR
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
"Set Backs
Forms & Footings
Underground Ducts
Ducts
-
$
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
O.K. to Wrap
ZO
$f
Exhaust Fans
F.R.U.
Framing
Compressor
Insulation
—6-
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
�� p
Exterior Lath I
Drywall - Int. Lath
4 o
Pq
- TIT_
Final
k
Final
POOLS - SPAS
BLOCKWALL A VA
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plhg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric final
Waste Lines
�_
Neater Final
Water Piping
7Q
s�
i Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Q -2
`aT
Encapsulation
Gas Piping
Gas Test
(
_
c
Appliances
Final -- _-•-- - �
r [}�1!i ENTf
Final
UtRy Notice Gas
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit f
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final'
Utility Notice (Perm) _
7 — 3 30 V15TA 2
r.�7 r AYL
P.O. BOX 1504 APPLICATI N ONLY
Building -� A �'� ." 78-495 CALLE TAMPICO :see
Address 1�r'• �� r.�f �', _ LA QUINTA, CALIFORNIA 92253 L�o? B�
Owner
Mailing
Address
City Zip - Tel.
Contractor 9 /
Address
`x�-t I Zko 9 47���L,�
State Lic. City
& Classif. y #
Arch., Engr., �'AL/ f� � f
Designer
Address Tel. C7 t t4
1* 19 �� �- r✓rye : , j. r:f5 19
CA Zip J r State
- Licyff7
LICENSED CONTRACTOR'S DECLARATION r
r 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
700pj of Division 3 of the Business and Professions Code, and my license is in full force and
effecI.
SIGNPTuRF -- 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 requlres a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such perm8 to Me a signed statement that he is licensed pursuant to
W. provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Ofvision 3 or the Business and Proressforrs Code, or that. he is exempt therafmm, 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 (S500).
L: I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
buikfs Of improves thereon and who does such work himself or through his own amployeas,
provided that such k7Tprovernenl5 are not intended or offered for safe. If, however, the boAdd'ng
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.)
LLi 1, as owner of the property, am exclusively contracting with licensed contractors to con.
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's license Law.)
17 I am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy Ihereof. (Sec. 3800, Labor Code.)
Policy NO. Company
FI Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This secltbn need not be complafad if the perryft is for one hurrdrad doNars f$1001 Vaktatiorl
cr )ess. y
-
I certiIy that in the performance of the workfor which this permit is issued, I shall not
employ anyon m any manner so as to become subject to the Workers' Compensation
Laws OI Callfornia-
Dale 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 Ihat the above information Is correct.
I agree to comply with all city and couniy ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter the shove-
menlioned properly for Inspection purposes.
Signature of applicant -Date-
Mailing Address
City, State, Zip
BUILDi G: TYPE'CONST. OCC. GRP.
A.P. Number...4 �-
Legal Description Z
Project Description
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep. Im , QQ
Plan Chk. Bal. r
ConSt.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setbac istances:
t Setback from Center Line
e ack from Rear Prop. Line
S et Setback from Center Line l.
ffiid�Setback from Property Line
v! �}
FINA D - J9 INSPECTOR
Issued by: Date Permit
�r� A
Validated by:
Validation:_ .
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
RECORDING REQUESTED BY C
AND WHEN RECORDED MAIL THIS DEED AND, UNLESS OTHERWISE
SHOWN BELOW, MAIL TAX STATEMENT TO:
Thomas & Stacey Siebel
"�1B 2995 Woodside Rd.
streer� Woodside, CA 94062
city a
State
zip
Title Order No.
Escrow No.
C® Py of Document Recorded
one 1 as No. 113510
Has not been compared with original.
COUNTY RECORDER;
SPACE ABOVE THIS LINE FOR RECORDER'S USE
T 355 Legal (2-94)
Grant Deed
THE UNDERSIGNED GRANTOR(s) DECLARE(s)
DOCUMENTARY TRANSFER TAX IS $
❑ unincorporated area ❑ City of
Parcel No.
❑ computed on full value of interest or property conveyed, or
❑ computed on full value less value of liens or encumbrances remaining at time of sale, and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
The Enclave Mountain Estates Homeowners Association, a California
non prrofit mutual benefit
herebyRANT(S) to
Thomas M. Sie
joint tenants ..
the following described real property in the
county of Riverside
corporation
bel and Stacey Siebel, husband and wife as
_ 1
, state of California: See Exhibit A
Lot C, inclusive, of Tract No. 25237, as shown on a Subdivion Map
recorded in Book 228, Pages 95-99, inclusive -of Maps in the Office of
the Riverside County Recorder.
RESERVING AND EXCEPTING UNTO GRANTOR, its successors and assigns,
together with the right to grant and transfer all or a portion of the
same:
A. All previously unreserved oil rights, mineral -rights, natural
gas rights and rights to all other hydrocarbons by whatever name known
to all geothermal 'neat and to -all products derived from any of the fore
going (collectively, "Subsurface Resoud
x�e;5rr] n/
Dated
STATE OF CALIFORNIA lr r f=s I (�Yl4
COUNTY OF �IVG1r� a�j� ) S.S.
On r � i3 1 before me,
Xw\; tr S
a Notary Public in and for said County and State, personally appeared
f _
personally known to me (or proved to me on the basis of satisfactory
evidence) to be the person(e) whose name() is/we subscribed to the
within instrument and acknowledged to me that heisheAhey executed
the same in histhedWeir authorized capacity(ws), and that by his/herlfheir
signature(;) on the instrument the person(Q, or the anti n behalf
of which the person(sj acted, execute &[Figinstrumer .
WITNESS my hand and o t 1 seal
Signature
R. H. JONES
Commission = 1162435
z -ay Notary Pualic - Colifomia
dlL
Riverside County
" My Comm. Expires Nov 22.2001 '
(rhis area for official notarial seal)
MAIL TAX STATEMENTS TO PARI?YAHOWN ON FOLLOWING LINE; IF NO PARTY SHOWN, MAIL AS DIRECTED ABOVE
Name Street Address City & State
RECORDING REQUESTED BY 0
Thomas & Stacey* Siebel
AND WHEN RECORDED MAIL THIS DEED AND, UNLESS
OTHERWISE SHOWN BELOW, MAIL TAX STATEMENT TO:
NAME Thomas & Stacey Siebel
2995 Woodside Rd.
AIDDRIMS Woodside, Ca. 94062
CITY, STATC b
ZIP CODE
6
TRL9 ORDER NO. ESCROW NO,
GRANT DEED
C 0 P of Document Rocord'
�ed//'
Oft 8-- No-.ir+>:-t-i
Has not been compared with original.
COUNTY RECORDER
DOCUMENTARY TFiANSF�R TAX 6
Q computad art full value of Properry conveyed, or
❑ computed on full value less liens and
encumbrances remPPOIN at time of sale.
SiBreatursr of Daganrst ar ABe"t DratermiNnO 'Fax Flrm Nerve
FOR VALUABLE CONSIDERATION, receipt of which is acknowledged, I (We), otaas M. 5iebe'AM9OFGi$1n^Aft11I3ItsCay
Siebel, husband and wife as joint tenants
grant to Thomas M. Siebel and Stacey Siebel, husband and wife as joint tenants
all that real property situated in the City of INAMI of tzAANSEE{eta (or In an unincorporated area of
Riverside County, CalifQUint
a�ttia deypribed as follows (insert legal description):
INAME M COLLNTYI iST hip]
Per attached Exhibits "At' & "B"
;;�Q�������
This Grant Deed reflects Parcel Merger No. ��� as approved by the
City of La Quinta.
Assessor's parcel No.
Executed an _ r��� , at
STATE OF ■
COUNTY OF SAW ftA7F—'Q
on ;F• i3-4 7 before me, t��-� /Vo P'/*
n+.srsr.ms+... „ra4 0o NOYAAr ruax I elVltnowntome
CL
personalty eppeerad 7i'akM6 M • S f� Rey -i s'FA� f e per,�2sEttbscrlhed
torth' within inasrurnent and acknowledged me that helshe ha nezecuted the fign' Or the n
authorized cSpacit)IRi and chat by hislherll'sbgnatu on the rnstrumertt the pars°
upon behalf of whlcn -hI3 pars rtt . cTad, executed the ins�rumant.
WITNESS my hand and official seal.
IBRJNATURE OF NOTARY)
CO�" � ► dM■
Iw�aMom Pablo
semi Ck" '�Mn3=
MAIL TAX
STATEMENTS TO:
your particular
Beare you use this form_ fill In aD pranks, and make whatevgr changes are sppropriato and i)tassa.v tro. yS mikes no
rransaJ.on. Carysult a Iewyer II you doubt the norm's 1lvr� ess for your pyrpos?q ana use.. Wdt Ian an intenled
representation or werrenty. express or Imptled. with respect to xha meec ante4,liry or 1kn@sS of this farm
use or purpose,
W0I_COTTS FORM 77a - Rev. 3•A4b iprica Blase 3A1
GRANT DEED ®2BB4 WOLCOTTS FOAMS, INC. 11111111111111111111111$7 775 39773
n1uT, l Irluin pt'n,f. r iu yPf,an
E
S
a
CAPACITY CLAIMED BY SICLNER(S)
❑INDIVIDUAL(S)
❑CORPORATE
CIFFICER(S)
❑PARTNERIS) Q LIMITED
0 GENERAL
OATTOANEV IN FACT
0TRUSTEE(S)
❑ GUARDIAN/CONSERVATOR
COTHER;
SIGNER IS REPRESENTING:
INsme or Perow(o) or Entlnpeal
Notice:
Document Cannot Be Duplicated
Date 10/12/99
No. 19435
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Owner NameThomas & Stacey Siebel
No, 77-330
City La Quinta
Tract # 25237
Street Vista Rosa
APN # 631-820-001 & 002
Jurisdiction La Ouinta
Permit #
Log #
Zip 92253 Study Area
Lot # 53 & 54 Square Footage 6619
Type of Development Single Family Residence No. of Units 1
Comments
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 or replacement mobilehomes. It
has been determined 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 Government Code 53080 in the amount of
1.93 X 6,619 or $ 12,774.67 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/PD National Bank/Bristol Construction, Inc. Telephone 346=4061
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Payment Received $12,774.67
Check No. 75445
Signature ( ��
NOTICE, Pursuant dl Assembly Bill 3081 (CHAP 549, STATS. 1996) this will 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 date on which the building or installation penult for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them on the Dlstrict('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
0 0
p )-yj 6� �
J U L 2 6 1999
F,NCLAVE MOUNTAIN ESTATES HOMEOWNERS ASSOCIATION
August 26, 1999
Thomas & Stacey Siebel
C/o Gerry Glessing
60 E . Third Ave_ 9270
San Mateo, CA 904401
Re: Lots 53 & 54 / 49335 Vista Rosa
Enclave Mountain Estates H.O.A.
Dear Mr. & Mrs. Siebel:
The Enclave Mountain Estates Architectural Review Committee has reviewed your
8119/99 submittal of drawings and has approved the package contingent on receipt of the
following items:
1) Slo,000_00 Construction Deposit
2) Signed Contractual Agreement
Note- Please have the builder submit the 1- inspection form when they are ready to
arrange for the setback/form inspection.
Good luck with the construction of your new home.
Sincerely,
Carol Calhoun, Property Manager
For the Architectural Review Committee and
The Board of Directors
Enclave Mountains Estates H.O.A.
Cc: David A. Price Associates, 17802 Irvine Blvd., Suite 239 Tustin, CA 92690
Fax 47141832-0738
Professional Community Management / Desert Resort Management
Post Office Box 4772 - Palm Desert, CA 92261-4772
:'3-550 Alessandro, Suite 5 • Palm, Desert, California • (760) 346-1161 • FAA (760) S46-9918