Loading...
0002-429 (BLDG)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of `Chaptter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date .139911.1 C iG C29 03,'31120( Date Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) 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 & Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code),, ( ) ,lam exempt under Section , B&P.0 forr this reason — .pate,Signature of Owner 1112,77 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 & policy no. are: Carrier Policy No. (This section need not be completed if the permit valuation is for $100.00 or less). (,,ey 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 •f•the Labor Code, 1 shall forthwith comply with those provisions. ✓!� ` !." ' �C ate: 's. - 2 Applicant ' 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 construction, and hereby authorize representatives of this City to enter upon theabove-mentioned property,for inspection 'purposes. ,Signature (Owner/Agent) - - /t'. Date ? —2",-)o BUILDING PERMIT PERMIT01110"29 DATE 02/21J/200 VALUATION %5.700.1 LOT TRACT JOB SITE ADDRESS ,3-790 AM4111A 10ONi Tf+;Zs imA I APN r - OWNER CONTRACTOR / DESIGNER / ENGINEER DAVIT) CAMPBELL FDIWARD9111 !EI.C'ZYK. 53-790 AVENIDA NIOYiEWMA 62.231 LAST HILIU t_'T_ L,A QlAIT1'A r'A 92233 IND110 CA 9?201 (76OW7-(1390 rrib# 322..4 USE OF PERMIT uFNERAL LsULDING i 761..E. o'(Ib k- 670F. 3'{k) - GARDFN WALL - s: RC -i O&DARD 7, L S Fr, WALL 67.00 LF STINIMED COST 0*FC0N.S11*'UC7T10N 5,700.M rVER-Nits a r 11 SuMMARV f CONNIi2IX'TlolsiVLE 101 -U()() -4th -WO Sf31.13u N(TR:1XyrAI, MNCCf'R1)C710N AND PLAIN C'T1F( "1 00 LESS PRE-RAIDRIES, $000 RECEIPT I DATE I BY' I DATE FINALED I INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck — Ga Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS - SPAS steel Set Backs Electric Bond Footings 3-7 —oo Main Drain Bond Beam Qm S-7 Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit 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) COMMENTS: / ��FIEp Z /% o H BERMUDA DUNES r RANCHO MIRAGE INDIAN WELLS H PALM DESERT a %P LA OUINTA 100 INDIO y'3 • Desert Sands Unified School District 82.879 HIGHWAY 111 • INDIO, CALIFORNIA 92201-5678 • (61% 347-8631 June 10, 1986 City of La Quinta Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 Re: Block 83, Lot 5 and 2 of 4, Gentlemen: The developer of the above referenced lot has mitigate -d i:ts impacts on our overcrowded schools by payment of the amount of $628 per unit to be applied to the cost of district educational facilities made necessary by such. new development. Sincerely, J), -t. n ....'� John D. Brooks Assistant Supe.ri.ntende.nt Business Services JDB/crm I COUNTY OF RIVERSIDE, DEPARTMENT OF HEALTH PERMIT APPLICATION FOR A SUBSURFACE DISPOSAL SYSTEM Applicant: Submit this form with three copies of a scaled plot plan drawn to county specifications required on the attached check list. A non refundable filing fee of $15 is required when the application is submitted. Check must be made payable to County of Riverside. Name - ��ed-,4F,9 .IT. t Mailing Address City State Zip Code Phone 'Propert Address .C"rdlIiF7-NMA EI y or rnroTlgFy _ t7 i'� :% 'Legal Description of Property (Lot Parcel Map, Tract) G• f AT t A�C'A/L�+,.acii-A �i2�C! 1 AT GA u,' iA 'Assessors Parcel No. Water Serving Property From Lot size � Q r ,Si- ature of Applicant Date / 'The above information must be verified from Building Application Staff Use — Do Not Write Below This Line Initial Date WQCB Clearance required Yes ❑ Nod— Soils feasibility report required Yes ❑ No Detailed boring report required Yes ❑ No Detailed contour plot required Yes ❑ No Comments: Soils or boring report by Date Approved by �� 4Q Dante �� Soils Map Page Soil Type Tract File N��f /0'er/K enof.Bedreo ..gra �A�a��1' t f Septi Tan Size (gallons) Rate Required Type of System New Addition Replacemept" Leach line sq. ft. of botto area trench Leach ed (sq. t(of bottorg area bed) Seepage Pit Diameter Sze 6 NumberofPts Seepage Pit Depth Bib. Total Depth of Pit LocationofSystem J Additional Requirement A permit is pproved/ eifor the design of a subsurface disposal system as indicated on the accompaniedplotplan using a requs set forth in Section B above. A building permit is necessary for the installation of the above ,A- designd system. iI y,A q pp , Signature of Health Official Date Receipt No. District: Riverside❑ I.ndio'❑ Hemet DISTRIBUTION: WHITE -':—Office File YELLOW - Applicant DOH SAN 122 (Rev 10/84) sued y6 '� PINK - Building Dept. --O. LDENROD -Pending File &., T -C-0 �2 Ne -U) 1500 4Ai16ro Tian N K ry ewl �'�►. �v� V APPROVAL GRANTED BY THE RTMENT OF PiJBLIC HEALTH ATiL 2voM 5 9�y,��itchALID FOR ONE (1) YEAR C�sTi�CIF FROM DATE OF APPROVAL. e%� of #hese pkno W the D"Ai W aent of vutijU Health of Riverside County does, not relieve the Yngib- ter or Architect of the responsibility for the Rnvir-�• °nr nr Arrhit�.rtnral lfpcivr'/f �� I McN I Ur DIVISION OF ENVIRONMENTAL HEALLTTf-( Food Establishment " �SoO Sewage Disposal Trailer Park Gal. Septic Tank, Motel, Apt., HotelSq. Ft. 9f Leach Lint Dwelling ' x Seepage Pit Cr ML 06PIV Commercial Building E'lST Connection'to Sewer Swimming Pool C33Fcf/t No on-site "regenerating water softening devices ay be discharged into the Individual sewage :.• system herewith approved without clearance from the Water Quality Control Board. Water supply sedyp,n,�� t �� staIIation must be from an approved source. All sewage disposal^iaflon must conform with requirements, of current Uniform Plumbing Cod. Any cutting, grading, or filling in excess of four (4) feet will nullify sewage disposal approval. Approval has been obtained from the Regional Water Quality Control Board for installation of the sr age disposal system. Tlitii�s i$ to_ certify that the Riverside County Department of Public Health approves or sv, construct'. .Zrr iir allation the item(s) checked above.���/a♦l� f� j� /////I El Z O H U W N Receipt No. District: Riverside ❑ Indio'❑ Hemet ❑ DISTRIBUTION: WHITE - Office File YELLOW - Applicant DOH SAN 122 (Rev 10/84) Issued By Date " PINK - Building Dept. GOLDENROD - Pending File COUNTY OF RIVERSIDE, DEPARTMENT OF HEALTH PERMIT APPLICATION FOR A SUBSURFACE DISPOSAL SYSTEM Applicant: Submit this form with three copies of a scaled plot plan drawn to county specifications required on the attached check list. A non refundable filing fee of $15 is required when the application is submitted. Check must be made payable to County of Riverside. Name Mailing Address City State Zip Code Phone 'Property Address *City'or,Coa muaity `Legal Description of Property (Lot, Parcel Map, Tract) 'Assessors Parcel No. Water Serving Property From Lot size signature of Applicant Date 'The above information must be verified from Building Application Staff Use — Do Not Write Below This Line Initial Date WQCB Clearance required Yes ❑ No Soils feasibility report required Yes ❑ No 6 Detailed boring report required Yes ❑ No E Detailed contour plot required Yes ❑ No h — Comments: Soils or boring report by Date Approved by Date Soils Map Page Soil Type Tract File No.�'% �'`Other Number of Bedrooms Septic Tank Size (gallons) Rate Required Type of System New Addition Replacement l" l Leach line sq. ft. of bottom area trench Leach bed (sq. ft. of bottom area bed) Seepage Pit Diameter Number of Pits _ Seepage Pit Depth B.I. Total Depth of Pit 5'�O 6' Location of System Additional Requirements , J, 'd /r A permit is_'approved/den.ied for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements set forth in Section B above. A building permit is necessary for the installation of the above designed system. Signature of Health Official Date Receipt No. District: Riverside ❑ Indio'❑ Hemet ❑ DISTRIBUTION: WHITE - Office File YELLOW - Applicant DOH SAN 122 (Rev 10/84) Issued By Date " PINK - Building Dept. GOLDENROD - Pending File —jaw" VF ENVIRONMENTAL HEALTH �Lt� -- Food Establishment Trailer Park 1K Sewage Disposal Motel, Ap Hotel SC• Gal. Septic Tank Dwelling.aQD Sq_ Ft, pf Leach line — Commercial Building � •�� ��Ete �fl� �� Commercial P x -!-•! Seepage Pit i? c,1 � t4 Alr4W Dirr_dc;� Swimming Pool Connection to Sewet r _ No on-site regeneratin a system herewith a g water softening devices may Water supply � Y be discharged into the and°riti►era► sewage.dispp�l approved without clearance from the Water Quality Control Board, x All sewage disSE sR1al�i�Os! Imtion must be from an apprnv:d s uric M� must Conform with re Uir m£r,Ps of Any cutting, yrac it q, t; ;nn ;n st cos of four (4) fceP will is f current Uniform PlurrNn Approval has been ob;ai;,cd from the Regional Water . Code. Y sewage disposal approval. age disposal system. Quality Control Board for insta Talion of the sew - O p a is to certify that Phe• Riverside County D Or installation the item(s)eparture t of Public Health a checked above. PpFcves for construction PXOPEII.t`y Mm �4�1 APPROVAL ANTED BY'THE "approval 01 these plans by the llopnrtment o1 PUbLU EF RTMENT OF PUBLIC HEALTH �UWi:h of Riverside County dues not relieve the Engia. —� IS VALID FOR ONE (1).. YEAR eer or Archir.ect of the reaporisibility for the �� FRO ? ;DATF OF APPROVAL: tete or Architectural desi¢n." EXar. Pmoeo as00H 6'x w /. L x�sT,v5 C. TW ►v Ic_ /� Cxi-ST • Od L Cakl�b2� J1A/.