Loading...
04-4469 (RER) + 08512 (RER) + 001560 (SEW)54521 Avenida Alvarado IIIIIIIIIIIIIIIIIIIIIIIII 57 IE n a_ . P.O. ill6I 254004 7-449-5-CA.LLE_T.AMPIC0 CLA QEITT OF FuRNIA at 404flai BUILDING & SAFETY DEPARTMENT ;t. (760).777-7012 FAX (760) 777-7011 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number x`047.00004469+ Property Address '..-544571TAVENIDA ALVARADO APN: 774-272-013-1 -000000- Application description REMODEL - RESIDENTIAL Property Zoning COVE RESIDENTIAL Application valuation 40000 Owner Contractor Date 5/21/04 BLANCA QUINTERO OWNER 84408 MARGARITA LA QUINTA CA 92553 (909) 544-3407 Structure Information REMODEL INT. Construction Type TYPE' V - NON RATED Flood Zone NON -AO FLOOD ZONE Other struct info CODE EDITION # BEDROOMS. 2001 CBC 3.00 Permit BUILDING PERMIT Additional desc Permit Fee 349.50 Issue Date Plan Check Fee . . Valuation . . . . Qty Unit Charge Per BASE FEE 15.00 6.5000 THOU BLDG 25,001-50,000 . 1 • • 227.18 40000 Extension 252.00 97.50 Permit ELECT - ADD/ALT/REM Additional Permit Fee Issue Date desc Qty Unit Charge Per BASE FEE .7500 PER ELEC DEVICE/FIXTURE 1ST 20 12.00 24:00 .Plan'Check Fee . Valuation 6.00 0 Extension 15.00 9.00 Permit MECHANICAL Additional Permit Fee Issue Date desc Qty Unit Charge Per 24.00 Plan Check Fee.. Valuation BASE FEE 6.00 0 Extension 15.00 P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 cettitot 4 atilma BUILDING & SAFETY DEPARTMENT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Application Number:. 64 WI 7 Applicant: Applicant's Mailing Address: Date: S, 2(o Architect or Engineer: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS 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 Professionals Code, and my License is in full force and effect. License Class License No. Date Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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 Kapplicant 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 or 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.). U 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.). U I am exempt under Sec. , B.& P.C. for this reason Da�S/d lJ mer WORKERS' 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: Cartier Policy Number X% 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 Califomia, 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. 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. 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 APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety 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 county to enter upon the above-mentioned property for inspection purposes. /%.5/10/Ayiate ��� ignature (Applicant or Agent): Application Number 04-00004469 Qty Unit Charge Per 1.00 9.0000 EA MECH APPL REP/ALT/ADD Page 2 Date 5/21/04 Extension 9.00 Permit PLUMBING Additional desc Permit Fee 55.50 Plan Check Fee . Issue Date Valuation Qty Unit Charge Per 4.00 1.00 1.00 2.00 6.0000 EA 7.5000 EA 3.0000 EA 3.0000 EA BASE FEE PLB FIXTURE PLB WATER HEATER/VENT PLB WATER INST/ALT/REP PLB GAS PIPE 1-4 OUTLETS 13.88 0 Extension 15.00 24.00 7.50 3.00 6.00 Special Notes and Comments NEED GRANT DEED TO VARIFY OWNER. DIFFERENT OWNER LISTED ON RECORD. Other Fees ENERGY REVIEW FEE 22.72 Fee summary Charged Paid Credited Permit Fee Total Plan Check Total Other Fee Total Grand Total 453.00 253.06 22.72 728.78 .00 .00 .00 .00 .00 .00 .00 .00 Due 453.00 253.06 22.72 728.78 1111111111111113 58 te.—C-4c--L-t, RIVERSIDE COUNTY 'DEPARTMENT OF PUBLIC NEAJ!.THn? . DIVISION OF ENVIRONMENTAL HEALTH q'k Food Establishment ! E>ris�rns 11-45.'i7 Sewage Disposal �n�rl hr p, -yr-,/> °oO Gal. Septic Tank Trailer Park Motel, Apt., Hotel • ----V-Dwelling . 2 b� MSX Sq. Ft of Leach Line ' Commercial Building 0/4/ -C2._ ‘x _e_9____ Seepage Pit 1 % ' is -on Swimming Pool Connection to Sewer a N W0 //5 - on -site regenerating water softening devices may be 'discharged into the individual sewage dispose. /system herewith approved -without clearance from the Water Quality Control Board. C..:-sera,.ir4g-thi nstalfa.ron must be from an approved source. - All sewage disposal installation must conform with requirements of• current Uniform Plumbing Code. -Any cutting, grading, or filling in excess of four (4) feet_wili nullfy sewage disposl-approval. Approval -has' ba'en-ablame.a from .the Regional Water Quality Control Board for installation of the se. age disposal system. • s to certify that -the Riverside County Department of Public Health approves for e,, construction - installation the item(s) checked above. - Bv_ /LI- _...8----..> I=Jw' ROVA(L GRANTER BY :NT OF PUBLIC HEP FQR OHNE (1) Y TE O(F APpROVPL. • • fri . Vfi eta° RIVERSIDE COUNTY 'DEPARTMENT OF PUBLIC NEAJ!.THn? . DIVISION OF ENVIRONMENTAL HEALTH q'k Food Establishment ! E>ris�rns 11-45.'i7 Sewage Disposal �n�rl hr p, -yr-,/> °oO Gal. Septic Tank Trailer Park Motel, Apt., Hotel • ----V-Dwelling . 2 b� MSX Sq. Ft of Leach Line ' Commercial Building 0/4/ -C2._ ‘x _e_9____ Seepage Pit 1 % ' is -on Swimming Pool Connection to Sewer a N W0 //5 - on -site regenerating water softening devices may be 'discharged into the individual sewage dispose. /system herewith approved -without clearance from the Water Quality Control Board. C..:-sera,.ir4g-thi nstalfa.ron must be from an approved source. - All sewage disposal installation must conform with requirements of• current Uniform Plumbing Code. -Any cutting, grading, or filling in excess of four (4) feet_wili nullfy sewage disposl-approval. Approval -has' ba'en-ablame.a from .the Regional Water Quality Control Board for installation of the se. age disposal system. • s to certify that -the Riverside County Department of Public Health approves for e,, construction - installation the item(s) checked above. - Bv_ IIIIIIIIIIIIIIIIIIIIIlll 59 IE Contractor Owner X .jr LH ALJ 1 1V'1'H Address Job Address This form shall be posted on the job with the Building Inspection Card at all times conspicuous place. It is the responsibility of the General Contractor or the Owner/Buil. to monitor the sub -contractors that are on this list are the same persons performing • work. Any changes of this list must be approved by the City of La Quinta Department Building and Safety prior to work being performed by a changed sub -contractor. Failure comply will result in a stoppage of work and/or the voidance of building permit. v. TRADE �� SUBCONTRACTOR NAME CONTRACTOR'S LICENSE NO. WORKMAN COMP. NO. ON FILE CITY BUSINESS LICENSE NO. GRADE/ EXCAVATE PIPELINES CEMENT/ FOUNDATIONS CEMENT/WALKS & DRIVES ASPHALT FRAMING . STEEL/ STRUCTURAL MASONRY , � � PLUMBING � p �'e' v /LATHING -WY?? D y " ' ? DRYWALL (/ w V PLASTERING 4 en ' HVAC ,..5-62--79 /41 C' ELECTRICAL S-70*7, S /5/ c - ROOFING SHEET METAL FLOORS GLASS/ GLAZING INSULATION SEWAGE DISP PAINTING/ DECORATING TILE CABINETS/ INSTALLATION ORNAMENTAL METAL FENCES/ BLOCK WALLS LANDSCAPING OTHERS . Building Address 54-521 Avenida Alvarado of 4 auvad P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Owner Mailing Address Ar 1 4y Pwrr, City 5 --545 La Quints 1,J0 92253 Tel. 324-6010 Contractor Al Millar/Sons Address • AA -7.60 rit Prtve City Zip No. 08512 BUILDING: TYPE CONST. OCC. GRP. A.P. Number Legal Description Project Description Ra -roofing Catbde*ral City 92234 Tel. 328-6616 State Lic. & Classif. C.-39, 336547 City Lic. # Arch., Engr., Designer Sq. Ft. Size No. Stories No. Dw. Units New ❑ Add ❑ Alter 0 Repair 0 Demolition 0 Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Div'siion 3 of t Business and Professions Code, and my license is in full force and effect. )f.• ^>a i;/ `J !% .. _—1Le_A7J0 SIGNATURE / / "" • DATES OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec. 7031.5,Bustness and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to lila a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the 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 (5500). ❑ 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 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-bullder will have the burden of proving that he did not build or improve for the purpose of sale.) o I, 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 (0 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 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 PolicyoWy No. Comensation sUr y ,tea apg[tifi s ,(1qy theregf. (S&ec. 380 *nn©II 0, Labor e. 3fiory is filed with the city. 0 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 (5100) valuation or less.) I certify that in the performance of tho 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. Date Owner NOTICE TO APPLICANT: ll, 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 hereby authorize representatives .of this city to enter the above- mentioned property for inspection purposes. Signature of applicant_ Date Mailing Address City, State Zip Estimated Valuation $2,800.©0 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. 54-00 Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS i A 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' Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL SQ. FT. SQ. FT. so. FT. SQ. FT. SQ. FT. SO. FT. SQ FT.@ VALUATION ® $ • BONDING HEATING (ROUGH) UNITS STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING. DUCT WORK 2ND FL. ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. YARD SPKLR SYSTEM REINF. STEEL - GAS (FINAL) POR @ "� R MOBILEHOME SVC. WATER HEATER SERVICE FINAL INSP. BAR SINK GAR., ® GRADING cu yd x$ _$ POWER OUTLET LUMBER GR. FINAL INSP. ROOF DRAINS FRAMING FINAL INSP. CAR P. rep ROOFING REMARKS: DRAINAGE PIPING WALL FIRE ZONE ROOFING FIREPLACE DRINKING FOUNTAIN. SPARK ARRESTOR GAR. FIREWALL URINAL LATHING ESTIMATED CONSTRUCTION $ MESH WATER PIPING INSULATION/SOUND NOTE:Not'to be used as property tax valuation FINISH GRADING FLOOR DRAIN MECHANICAL FEES CERT. OCC. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN GARDEN WALL FINAL WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEMIPERM LAVATORY• HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER. B.T.U. SO. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 114 c SEWAGE DISPOSAL SO.FT.GAR ® 3ric HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FES ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT ' COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL - GAS (FINAL) TEMP. POLE "� R GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM• GRADING cu yd x$ _$ LUMBER GR. FINAL INSP. $ plus FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL < O_ (f U uWi II IIIIIIIIIIEIIIIIIIMI ""j OF RIVERSIDE, DEPARTMENT OF HEALTH APPLICATION FOR A SUBSURFACE DISPOSAL with three copies of a scaled plot plan drawn to county specifications filing fee of $15 is required when the application is Riverside. COUNTY PERMIT Applicant: Submit this form attached check list. A non refundable made payable to County of SYSTEM required on the submitted. Check must be Name D oTE t -A d 5PrrA A—T, o rS. 140. Mailing Address s o .- 'c S . - ' City O p) C. (tom (/i4 State r �� Zip Code gA., 36, Phone .�� e--5.-4-1~ 'Property Address 5u r„%,),rH JGAi *City or Community /_ 1 QJ,.J'fA 'Legal Description of Property (Lot, Parcel Map, Tract) f'.,�.tai, rN .41� �o? 1 v.vrt �-� V,PE <_N £tU.."J7rf *Assessors Parcel No. Water Serving Property From 1- C,,' w.!.ro Lot size . , 4 .7/r, , 7:=. % '/%. '. 8.v` Signature'of Applicant Date 'The above information must be verified from Building Application Staff Use — Do Not Write Below This Line SECTION B WQCB Clearance required Soils feasibility report required Detailed boring report required Detailed contour plot required Comments: Initial Date ' - " • cr Yes ■ No Yes ■ No 4 Yes • No Yes ■ No 11 Soils or boring report by Date Approved by Date V.', 1,,Soils Map Page Soil Type Tract File No -S ,.. Other 417 Number of Bedrooms Z Septic Tank Size (gallons) r y, .^ / " Rate Required y / /0 t Type of System New Addition Replacement il Leach line sq. ft. of bottom area trench Leach bed (sq. ft. of bottom area bed) Seepage Pit Diameter 5'❑ 6' 12'^mac Number of Pits Seepage Pit Depth B.I. ,,' Total Depth of Pit _ !' Location of System Ai.- . - _ r , _ , , - Additional Requirements r. r., , 'I S fr ' r...-- . a ,,,,. /-,,,,,,,r ,-, `, ,,...- - -A SECTION C ac y oCC) � N � • u -, _7 3 CD am o - a, Fa 3 o CD • a ..a n m to ci. o - a \ o 5 m N. m ca o 7 • 0 r, Cr0) 7• c o 0- • c 6C) C -a N - 5D co 0 ¢1 N _. in 3 7 � CD 0) O 0 `w cn . a)5 0 a - o S 7 (D b co A =0 • su 3 O 73 • W 7 O C a 7'-0 (D A� 6 -0 O - (D Receipt No Issued By f `� District: Riverside 0 Indio E- Hemet 0 Date ? Sr' DISTRIBUTION: WHITE - Office File DOH SAN 122 (Rev 10/84) YELLOW - Applicant PINK - Building Dept. GOLDENROD - Pending File Building 54_521 A j.varadn Address P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Owner Eirady Terry Mailing Address SEIM City to i.:.intd Zip - 9225 Tel. Contractor fit. Sanitation t33. Address . 50-305 Hof 131 No. 001560 BUILDING: TYPE CONST. OCC. GRP. A.P. Number Legal Description Project Description City CQ d ila Zip 92236 Tel.' • 398-5444. State Lic. & Classif. City Lic. # Arch., Engr., Designer Sq. Ft. Size • No. Stories No. Dw. Units New ❑ Add ❑ Alter 0 Repair Demolition 0 Address Tel. City Zip State Lic. # Weiltitg Repair Leach Line Failure LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensedfunder 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. • /fl Y .,% / / 1 -M!:, 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 repair any structure, 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 Contractor's License Law, Chapter 9 (commencing with Section 7000) of 'Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the 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). 0 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, Buisness and' Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, 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.) - ❑ I, 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.) • 0 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 thereof. (Sec. 3800, Labor Code.) Policy No Company 0 Copy is filed with the city. 0 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 the 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 ode.)Lender's Name Lender's Address This is a'building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. 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 enter the above- mentioned property for inspection purposes. J r Signature of applicant ` Date Mailing Address City, State Zip HARD COPY ieo.PitSh tiro Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. 10.00 Mech. Electrical Plumbing 30.00 S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS 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• Date Permit Validated by: Validation: A 1 5 3 3 6 12 40.00 CK CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL SO. FT. SO. FT. SO FT SQ. FT. SO. FT. SO. FT. SQ. FT. VALUATION @ $ STORAGE TANK FORMS UNITS ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP 2ND FL. ® REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER YARD SPKLR SYSTEM FINAL INSP. _ POR @ GRADING cu yd _$ MOBILEHOME SVC. FINAL INSP. $ plus x$ BAR SINK FINAL INSP. GAR. @ . 1/4" %t�v 74- C C••� REMARKS: VENTILATION//' POWER OUTLET FIRE ZONE ROOFING ROOF DRAINS SPARK ARRESTOR CAR P. GAR. FIREWALL LATHING MESH DRAINAGE PIPING FINISH GRADING WALL - FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS. DRINKING FOUNTAIN • ® URINAL ESTIMATED CONSTRUCTION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. @ c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID @ 11/4 c SEWAGE DISPOSAL - SQ.FT.GAR @ 3/ac HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu yd _$ LUMBER GR. FINAL INSP. $ plus x$ FRAMING FINAL INSP. ROOFING . 1/4" %t�v 74- C C••� REMARKS: VENTILATION//' FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS. GARDEN WALL FINAL Received From• Address: Account No. Service Address ❑ Meter(s) ❑ Service(s) ❑ Backflow(s) ❑ House Lateral (s) ❑ Detector Check(s) ❑ Meter Surcharge COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL Sanitation Capacity Charge ❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - Fee - ❑ Plan Check Fees Water / Sewer - Tract - ❑ Bond Payment - A.D. - Bond Assmt ❑ Customer Deposit ❑ Other Remarks: ❑Copy to: • TOTAL $ Cash Check Money Order Water Service, ! .e Cashier CVWD-438 (11189) 4, cettii/44 Quida 78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 IIIIII IIIA III 1011 IIII 68 IE TELEPHONE (760) 777-7012 FAX (760) 777-7011 OWNER / BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as "Owner/ Builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the City or County. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is 8200.00 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the State and Federal Government as an employer and you are subject to several obligations including State and Federal income tax withholding, federal social security taxes, worker's compensation insurance, disability insurance costs and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under Stare Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/Builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N. Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, CITY OF LA QUINTA DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico La Quinta, CA 92253 (760) 777-7012 FAX j(760))7777-7011 j!y/ C'4. ccP'` OWNER'S SIGNATURE/DATE .5z! 5.2 / due PROPERTY ADDRESS 04 - mei& PERMIT NUMBER(s) • Southland. • Title RECORDING R 'E.i UFSIED BY /.8/2003.5:28 PAGE 3/4 RightFax STAGRITMENEKTMUMN BLANCA BRITO QUINTERO 54525 AVENIDA ALVARADO LA QUINTA, CA. 92253 14 S u DOC t4i 2003-336774 15/19/2003 88:019 Fee:11:00 Papa 1 of 2 Doc T Tax Paid Recorded In Official Records County of Riverside Gary L. Orso Assessor, County Clerk & Recorder o 1 ii r 111 ►/YGE S E DA POOR NOW& a* MCG A l COPT LONG REFUND &GIG EXAM A.P.N.: 774-272-013-9 Order No.: 30330581-41 TRA: 020-102 GRANT DEED Escrow No.: 135116 THE UNDERSIGNED GRANTOR(s) DECLARE(s) THAT DOCUMENTARY TRANSFER TAX IS: COUNTY $121.00 ( f computed on full value of property conveyed, or E computed an full value less value of liens or encumbrances re mining at time of sale, unincorporatedarea; 11 I City of LA OUINTA , and FOR A VALUABLE CONSIDERATION, Receipt of which is hereby acknowledged, MELITON R. GARCIA, A SINGLE MAN AND GUADALUPE SALAS REYES, A SINGLE WOMAN, WHO AQC(IIRED TITLE AS MINCIXNag SALAS REYS, A SINGLE WOMAN. • GUADUAUIPE hereby GRANT(S) to BLANCA BRITO QUINTERO, A MARRIED WOMAN AS HER SOLE AND SEPARATE PROPERTY. RIVERSIDE the following described property in the City of LA QUINTA, County of Noribmonnao State of California; • LOT 1, BLOCK 269 OF SANTA CARMELITA AT VALE LA QUINTA, UNIT NO. 25, AS SHOWN BY MAP RECORDED IN BOOK 19, PAGES 50 AND 51 OF MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA. A.P.N. 714-272-013 M "(tint 'e ITON R. GARCIA iRc%4 -.Document Date: 04i 4 huh ¢€3' MAY 8. 2003 Or_ ijM4Pt Sa1 ' 3E,r f GUADALUPE SALAS REYES SCALE OF CAL WORNtA )SS COtJNTYOF SAN BERNARDINO ) DAHLIA RODRIGUEZ, NOTARY PUBLIC On MAY 8, 2003 • before me. person alt y/ appcarcd MELITON R. GARCIA AND GUADALUPE SALAS REYE$• vsq btiyregftf1 t (ur,prcyed m me on the basis of satisfactory cvidcnrx) to be the (tersun(s) whose name(s)ffiare suhscrlbsl to the within instrument and acknowledged tN me Oen 111Nr4tthhey executed the same in Ll§ jiSA/flteir authorized capac)ty()ee) and t at by$s(1y18te)r signature(s) on the Instrument tlx person(s) or the )x : all of which the person(s) acted. executed the instrument. WITNESS anti altd o I Ictal I. WPC • DAHLIA RODRIGUEZ This area for official notarial seal. DAHLIA RODRIGUEZ Commission # 1383440 Notary Pubtic - California ; San Semarchno County 4.0.4„..4.6.10v Comm. Expkes Novy, MOO Mail Tax Statements to: • SAME AS ABO1r . Address Noted Below