9909-199 (MISC)f
LICENSED CONTRACTOR DECLARATION
I hereby affii4fwund6c`$enalty •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 # Lic. Class Exp. Date
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).
'(X) I, as owner of the property, am exclusively contracting with licensed
,contractors to construct the project (Sec. 7044, Business & Professionals
Code).,
O ham exempt under Section B&P.C. for this reason
Date G % —C I �� Signature of Owner
WORKER'S COMPENSATION jECL�ARATION `4 f
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. t
i'
(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
Codo''I shall forthwith comply with those provisions..,
Rate: f �r -L, Applicant - � / • �� , , t f � l,� r
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.
ru
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
the above-mentioned property for inspection purposes.
VSignature (Owner/Agent) '' 1 ` f f� IQate J j
l
PERMIT #
BUILDING PERMIT
9%044"
DATE "VALUATION �qq�� ��� LOT TRACT
JOB SITE
VLNII) ON'TL:ZlJiVIA
ADDRESS %%-M'--, A�.,6"l
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
COAC:.HELI.AV At, LE Y RT,C & #'A K t)I5% :
CI fr'A 01' SI R4Ju�S'!' R f: .
45-371 CLINTON S'MMN
17972 SKITARK C( CLE, STE V
),INt)13 ICA 92201
MAINE CA 42614
USE OF PERMIT
(i1Jst',RU..ANk W'.-,•
A NT,0Rt1RY l.fADU FOR 09-4 OKTC H.i1:AIFES f.'PER Tike 99-24',&- P
L'liLUKIi.ON 35100G.1101. r r
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-C AL INtSl:*t�'si.•" 10114 Wt_(XV-423-100)
V
t V
Si3M:I.UT't,LI..CONSTRfIf:('ONI fhN0)'I-AN CHrCK
ISI(W)(it)
or
RECEIPT
DATE
BY
DATE FINALED
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
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 A PROV LS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
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 Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
W
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1999 KTOEE FE TIN LA: UINTA
COACHE9.LA VALLEY RECREATION & PARK DISTRICT
...... .. .. . ... .................
.. ........ ... . .. . .. ......... .... .... ......
. ... .... . .. .............
TO: TOM HART UNG, BUILDING AND SAFETY DIRECTOR .
JERRY HERMAN, COMMUNITY DEVELOPMENT DIRECTOR.
CHRIS VOGT, PUBLIC WORKS DIRECTOR
FROM: DODIE HORVITZ, COMMUNITY SERVICES DIRECTO
DATE: AUGUST 10, 1999
SUBJECT: OKTOBERFEST FEES
The Coachella Valley Recreation and Park District's Oktoberfest `99 has received. a Community
Service Grant for City permit fees through the Community Services Department budget. Please
see attached estimated expenditures -from CVRPD; based ori last year's costs.
Please submit any required fees to the Community Services Department for payment. Should you
have any questions, please contact me at extension 7032.
cc: Laura McGalliard, Superintendent, Coachella Valley Recreation and Park District
C:\My Documents\OKTOBERFEST.wpd
1'
0i _OU
Z CU UG 1 RIC p
MEMORANDUM
TO: OM HARTUNG, BUILDING. AN ' v SAFETY. DIRECTOR I
JERRY HERMAN, COMMUNITY DEVELOPMENT DIRECTOR
CHRIS VOGT, PUBLIC WORKS DIRECTOR
FROM: DODIE HORVITZ, COMMUNITY SERVICES DIRECTO
DATE: AUGUST 10,..1999
SUBJECT: OKTOBERFEST FEES
The Coachella Valley Recreation and Park District's Oktoberfest `99 has received a Community
Service Grant for City permit fees through the Community Services Department budget. Please
see attached estimated expenditures from CVRPD, based on last year's costs' ,
Please submit any required fees to the Community Services Department for payment. Should you
have any questions, please contact me at extension 7032.
/cep s PeCec941" 7'CY2.4�t c
cc: 'Laura McGalliard, Superintendent, Coachella Valley Recreation and Park District
C:\My Documents\OKTOBERFEST.wpd
Requested Community Service Grant Expenditures
1.
City of LaQuinta Event Fees
a) Community Development Dept.
$100.00
b) Builtling & Safety Dept. —`�
.
$100:00
c) Public Works –Encroachment
$1-00.00
d) Placement of cordonsT'no parking"
$850.00'
2.
City of LaQuinta Water Truck Fees
a) $60.00/hour x 6 hours
$360.00
3.
Vacant lot soil stabilization fee
$700.00
(1998 bill plus estimated increase)
3.
Riverside County Fire Inspection Fee
a) Structure inspection fee,
$126.00
4.
Unforeseen expenses
$664.00
Total
$3,000.00
&UILD plop
4 /JVG
78-495 CALLE TAMPICO — LA OUINTA, CALIFORNIA 92253 /-VP(J$A) 777-7000
TDD (760).4, W-1227
June 4, 1998
Ms. Laura McGalliard, Superintendent
Coachella Valley Recreation and Park District
45-871 Clinton Street
Indio, California 92201
SUBJECT: TEMPORARY USE PERMIT 99-202 AND SIGN PERMIT 99-463
Dear Ms. McGalliard:
The Community_ Development Department has approved your request to hold the Oktoberfest event on
October 8-10, 1999-,' based on Section 9.210.050 of the Zoning Code,subject to attached Findings and
Conditions of Approval.
The District is responsible for paying fees as defined herein, unless deferred by adoption of the 1999-2000
Fiscal Budget on June 22, 1999.
This Department was unable to process your request to hold off-site pedestrian races until specific
information is submitted (e.g., race routes, times, etc.).
This decision may be,appealed to the Planning Commission provided the written appeal and filing fee of
$175.00 are submitted to this Department within 15 calendar days. Please contact our office if you wish to .
file an appeal and we will assist you.
If you have any questions, please contact the undersigned at 760-777-7067.
Sincerely,
RR RMAN.
TY DEVELOPMENT DIRECTOR
GUO IFZUSDELL
Associa e Planner
Enclosures
c: C_om_munity Development Director
Building and Safety Director �.
Public Works Director --
Sheriff s
irectorSheriff's Department
Code Compliance Department
Fire Marshal
Riverside County Health Department
Fy TUP2020ctFest�q
&WLING ADDRESS P.O. BOX 1504 - LA OUINTA, CALIFORNIA 92253
CONDITIONS OF APPROVAL
TEMPORARY USE PERMIT 99-202 AND SIGN PERMIT 99-463
FINDINGS:
1 The event will not be detrimental to the health, safety and general welfare of
the community in the area of the proposed event.
A. Various public agency permits are required prior to the event ensuring.
that the . event will be conducted in an acceptable manner. Health
Department permits are- required for all food and beverage vendors
serving the event, and police and fire personnel will be on _hand to assist
the organizers in providing a safe environment for vehicles and patrons.
The public roadways surrounding the project are capable of handling the
traffic. No problems are anticipated which would be. detrimental .to -the
community based on the recommended conditions.
B. This project is categorically exempt under Section 15311 .(Class,1 1(c))
of the California Environmental Quality Act (CEQA) because the outdoor
event is being conducted in , an existing park facility designed to
accommodate the daily patrons and public streets will be used to direct
traffic to designated parking areas.
C. Temporary signs directing patrons to the event will be displayed along
various public streets in the community. The .signs will be placed so that
they do not interfere with traffic safety signs or other facilities (i.e.,
traffic signals, etc.). Sign removal will occur immediately after the event
in order to guard against the signs becoming roadside debris or litter.
2. There is adequate area to conduct the event and to accommodate the
anticipated attendance.
A. 'This outdoor event is .held in an adequately designed facility which can
hold the daily patrons because various facilities will be provided such as
restrooms, food and beverages, parking, and other facilities which
provide services to those attending the daily activities. The Frances Hack
Park has existing buildings and other facilities which complement the
CONDTUP202- 34
l
planned event. The applicant is proposing on-site and off-site parking
areas to accommodate guests and employees for the event.
The following Conditions shall be completed by September 28, 1999:
1. Fire Department permits for temporary use structures (tents, stages, stands,
etc.) or any open flame devices shall be obtained prior to installation. If you
have any, questions, please contact the Riverside County Fire Department
_(Planning and Engineering) staff at 863-8886.
2. The applicant shall apply for an encroachment permit for placement of, any
temporary signs in the City's rights-of-way. Signs in the City right-of-way shall
be mounted on maximum 2 -inches by 2 -inches wood posts unless otherwise
approved by the Public Works Department. No signs shall be closer than 100 -
feet from an intersection. Temporary signs shall be posted no closer, than 5 -feet
from the edge of the paved area of any public road or street and placed a
minimum of 200 -feet from an identical sign. Signs placed on private property
shall be installed. only if authorization from the owner has been secured prior to
installation. All signs shall be placed in a manner which does not obstruct
--traffic,or street signs or other important equipment.
3.- For any disruptions of regular traffic flow on public streets, the District shall
prepare, or cause to be prepared, a traffic control plan by a qualified individual..
The District shall obtain the City Engineer's approval of the plan and obtain an
encroachment permit from the Public Works Department prior to disruption of
traffic.
4. A- notice shall be given to the existing property owners in the immediate area
informing them of the upcoming. special event and associated parking
restrictions and access routes. A copy of the written notice shall be given to
the Community. Development Department.
5. A bond or other type of guarantee acceptable to the City Engineer shall be
posted with the Public Works: Department insuring that unpaved parking lots for
the event are stabilized after the event is completed pursuant to Chapter 6.16
of the Municipal Code (Fugitive Dust Control Ordinance). The bond will be
r
CONDTUP202- 34 Page 2 of 6
• �' 4 - r . e F - S - rl.. ,+ , . � ,� ,, ice. �, C + `
.• } �_, y �• - .• '._� .. 1 - ,:.(� .. •. w.'r_��sr � is •�' l .
.released once the applicant has provided a letter from their contractor` stating•
that the stabilizer material has been installed (i.e., chemical emulsion, wild n.
flower mix with irrigation,.etc.) and City staff has made a field inspection t6 4. y
verify'compliance., A copy of the contractor's; letter shall also be submitted to
the Community Development Department -for. filing. ,
• 6. , A building permit is required f-o.r any tents`and.temporary.electric,:po-wer. Please
` y D ment-for-a-permit: The�fee-is=S 100.00'
apply to the_ Building and-Safet_
IL
The following Conditions shall be completed by October 5, 1998: _
7. All unimproved (unpaved) roadways and parking areas used in- conjunction. with
this event shall be'adequately.com.pactea, and prepared to create a hardened `
travel surface, and maintained in a manner (watered) -which will reduce dust
during use by vehicular -traffic. If the soil -composition is not -conducive to
formation of a hardened surface, an appropriate chemical binder shall be, applied
r as a remedial measure.
The following. Condition shall be completed by October. 8; 1999:`
8. Prior to start of the event, a site inspection shall be ,i-nade ,by City Building'_.
Department --staff and --the Fire Marshal ,to insure compliance with all •project -
conditions.
• : ,
General Conditions '� - l,� .Y _ , -' '� • .
9. The, outdoor 'event -is permitted to be held from, October 8,10, 1999. ' See ,the
attached .information:
.10. Noise created by ,musical entertainment shall not be .physically annoying to..
_ R , adjacent residential property owners. The applicant shall comply with noise
control "standards 'established in .'Section .9.100.210 (Noise Control) of the,
Zoning Code. Amplified, music shall not -be played past 10:00 p.m.'
11. The District is responsible for implementation and maintenance.of meas'u'res'.,
identified in the traffic control plan. The District may contract with private
vendors of the City -for needed services. The City's fee `for preparation of the` `
traffic control, drawings is $150.00. The City. can.also lease necessary traffic
CONDTUP202- 34 A �' ti Page 3 of 6
'
control devices and/or provide set up, take down, and maintenance services for
a fee commensurate with the scope of work.
12. Outdoor lighting shall be adequate to ensure customer and employee safety.
13. Portable restrooms shall be provided for patrons and vendors as required by the
Building and Safety Department. Restroom facilities to accommodate the
physically challenged shall also be provided.
14. Temporary trash receptacles shall be provided so that trash/debris can be
deposited accordingly. The site shall be left clean of any litter at the close of
the event.
.15. Riverside County Sheriff's Deputies shall be employed during the event to
provide security and traffic control supervision as determined by their agency
through prior contractual arrangements.
16. All food and beverage vendors shall obtain a City Business License.
17. The applicant shall work with Waste Management of the Desert to recycle the
aluminum cans disposed in the temporary trash receptacles during the outdoor
- -
--event-.----
18.
_event:= - 18. If ground excavation is -required, please contact .Underground Service Alert
(USA) 'at 1-800-422-4133 at least two working days prior to digging.
19. Before any cranes, forklifts, or other aerial equipment is raised, please check for
existing overhead'wires. Please note that California Title 8, Electrical Safety
Orders, specifies the closest distance that non-qualified electrical workers can
get to electrically energized conductors. Non-qualified electrical workers can get
no closer than 6 -feet from distribution lines and 10 -feet from transmission lines.
People operating boom type lifting or hoisting equipment can get no closer than
10 -feet from distribution lines and 17 -feet from transmission lines.
20. All designated private security personnel must be licensed by the State of
California and possess a current Private Security Guard license.
CONDTUP202- 34 Page 4 of 6
f
< i
21. Parking attendants shall wear bight -colored clothing and reflective vests. Flash.
lights shall be used after dusk.
22. No overnight camping at the site is permitted. Exhibitors or food vendors may
leave their vehicles or equipment at the park provided the applicant provides
overnight security.
23. Vendors who sell or serve alcoholic beverages shall.. obtain.a license from the
State of California Alcoholic Beverage Control Department. All drinks shall be
served in paper or plastic cups.
24. Parking areas that are not hard surfaced or turf, shall be sufficiently watered
daily up to the event's opening, and during, to reduce blowing dust. Any
tracked -out or other accumulation of soil material(s) onto paved areas, whether
public or private, shall be wet -swept, water flushed, or otherwise removed (no
dry -sweep methods permitted) by the end of each day, and shall be kept damp
during event operation hours until removed.
25. All public streets surrounding the event shall not be blocked or barricaded unless
prior approval has been obtained, from the City Council and Public. Works
Department. Fire lanes shall be established and/or maintained during the special
--event—.-- -
26. No parking shall occur on private property unless the District has` obtained
written authorization. All vacant.parcels surrounding the park shall be cordoned
off .(i.e., by using rope, logs .or other devices) to ensure no parking occurs unless
permitted in advance, .by the property owner(s). No parking signs shall be
posted at 50 -foot intervals. The signs shall indicate that violators are subject
to towing. The District shall assign personnel to continuously monitor each "no
parking" property during event hours to advise violators 'of .the strict
enforcement policy.
The District may contract with a private vendor or the City for placement and
maintenance of the cordons and "No Parking" signs. The City will provide this.._
service for $850.00 which does not include any additional public relations
personnel. ,
27. The maximum number of off-site directional signs is 30. On-site temporary
banners shall. not exceed. 32 square feet.
CONDTUP202- 34 Page 5 of 6
28. The District agrees to indemnify, defend and hold harmless the City of La Quinta .
in the event of any legal claim or litigation arising out of the,City's approval of
this project. The City of La Quinta shall have the right to select its defense
counsel at its sole discretion.
29. The City may impose additional conditions, or revoke this permit, � if any
problems arise during the event that needs special attention or consideration.
Page 6 6f '6
,SPECIAL INSPECTION SERVICE --,
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm, Desert, CA 92211
Office (760) 772-7192
.Fax (760) 772-7.193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE TRUCT. STEEL ASSEMBLY ❑
❑POST TENSIONED CONCRETE ASPHALT ❑ OTHER A
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCATION
REPORT SEQUENCE NO.
T"E OF STRUCTURE'
..ft
PERMIT NO.
DA E
D 1 o
DAV OF WEEK
MATERIAL DESCRIPTION
1.
�m
JvV
ARCHITECT
I SP
a
HRS. CHARGED
L; UTII
PCNA
ENGINEER
ASSISTANTS
MRS. CHARGED
INSPECTION
.DATE
GENERAL
CONTRACTOR
SUB
,CONTRACTOR"'.—
w 1 l
COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED .TO THE BEST OF W
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
IGN TURE OF REGISTERE SPE TOR
0�0DATE F REPORT REGISTER NUMBER
Fes' 3�<<F�■��1�1�
wommmammmamim
r
P.O. BOX 1504N o. 13912
Building .77-865 Monte uma 78-105 CALLE ESTADO •�
Address LA QUINTA, CALIFORNIA 92253
Ownt,roachella Valley Paris Rae i Dept* '
BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address 4587.1 Clinton A.P. Number
City Zip Tel.
India,— A .92201 -347-3484 Legal Description �'•
ContractorBe'1throom' and kitchen remodel
SaM6,:- Project Description'
Address
City Zip Tel.:
-------------------
State Lic. City
& Classif. Lic. # Sq. Ft. No :; No. Dw.
Size Stories Units-'
Designer " New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑
Address Tel.
City Zip State t
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Cade, and my license is in full force and
effect.
SIGNATURE - DATE ,
OWNER -BUILDER DECLARATION Estimated VdlllatlOfl .m �y e�ept�99
I hereby affirm that I am exempt from the Contractors License Law for the following �"•' . y �ihi�"a vt!
• 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 rile a signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions o/ the Contractor's License Law, Chapter 9, (commencing with Section 7000) o/ - -
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 /or a permit Plan Chk. Dep. -
subj�ecfs the applicant to a civil penalty o/ not more than rive hundred dollars ($500).
Lv as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure isnot intended or offered for sale. (Sec. 7044, Buisness and Const.' a "Kc
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, Mech:
provided that' such improvements are not intended or offered /or sale. If, however, the building -
or improvement is sold within one year of completion, the owner -builder will have the burden- a
of proving that he did not build or improve for the purpose of sale.) EIBCtfICdl --- 2
❑ 1, as owner of the property,'am exclusively contracting with licensed contractors to con- Plumbing
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 /or S.M.I. -
- such projects with a contractor(s) licensed pursuant to the�Contractor.'s)License Law.)yf :-
❑ 1 am exempt under Sec. B..& P.0 or this -reason J Grading
,�'/'%' ✓.� ,/ ,� Driveway Enc.
Date�spwner'"�-<��� Infrastructure
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.)
PolCompany
ic�y% o. _
C+YCopy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL =i
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is /or one hundred dollars ($100),
or less.) valuation ^
'
I certify that in the performance of thg work for which this permit is issued, I shall not 4-
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 o/ Exemption you should become ZONE:-�BY:'
'subject to the Workers' Compensation provisions o/ the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. ^�
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) Side Setback from Property Line
Lender's Name-
Lender's
ame Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
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. Issued by: Data Permit
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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. p
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. (off
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. p
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SQ. FT.
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN
SQ. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FRAMING ((_�
FLOOR DRAIN
MECHANICAL FEES
� �
P (e "6
' ` Y5
� C/ 109 /
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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 ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
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 Y j(
DERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-x$-=$
LUMBER GR.
FINAL INSP —.9 /
FRAMING ((_�
FINAL INSP.-�-ojc�
r�
ROOFING ,?�� 5 ) �
7� tel/
� �
P (e "6
' ` Y5
� C/ 109 /
C
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWAL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
44
r. P.O. BOX 1504 N o . 12694
Building 78-105 CALLE ESTADO
Address 77-865 ]hvel ?48:ntdz a LA QUINTA, CALIFORNIA.92253
Ow4r6achel,1a' .' Vally Recreation/Park Dist.
MailinBUILDING: TYPE=CONST• OCC: GRP.
Addre9s'^8%1 Clinton
A.P. Number x
CityZip• Tel.
Tg did'o' �'CA 922€}1 347--3484 Legal Description
Contractor; ' t ._ Project Description Rdstroom
Resttoot Facilities Co.
.Address
I t Wgod;Land Ave.
City Zip Tel.:
Reno, NV 83513 ('702)'74b-5.120
State Lic. City
& Classif. t 6251324 Lic. # 3121
Arch:, Engr`,
Designer
Address - Tel.
-City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
' 1 hereby affirm t at I am licensed under provisions of Chapter 9 (commencing with Section
x/7000) of DiPsiioon 31of the Business -and- Professions Code, al?d-m-yy lliicense.i_s in full force and
lreffect.1 e:.•c., ......
1.- SIGNATE
' • ,` �; OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's'License Law for•the following
Treason: (Sec. 7031.5,Business and Professions Code: Any•'city orjcounty 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 or Section 7031.5 by 'any applicant for a .permit
subjects the applicant to a civil penalty ofnot more than five hundred dollars ($500).
01 , 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 or completion, the owner -builder will have: the burden
of proving that he did not build or improve for the purpose of sale.)
O 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.)
❑ 1 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 Compensatio Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy, No. Company
❑ �py's filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
± WORKERS' COM P ENSATIO N 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,thp work for which this permit is issued, I shall not
employ any person in any manner -6c, as to become subject td the W6-rkerseC_ompensation
Laws of California. f /' % ••.
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 car ify.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
TOTAL �_Q-•
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
r b's .•
Issued by: ;>' Date Permit
Validated by:
Validation:
Sq. Ft. No.
Size - �`.�' Stories
No..Dw. °y .
..Units
New ❑ '' Add ❑' `; Alter ❑
Repair ❑' "'.Demolition ❑ w
a•
Estimated Valuation
PERMIT. -
AMOUNT
Plan.Chk. Dep.
Plan Chk. Bal.
y .
Const.
Mech.'_r
,
Electrical
Plumbing*.
.S. M. 1.
Grading`
Driveway Enc.
Infrastructure
k
TOTAL �_Q-•
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
r b's .•
Issued by: ;>' Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMVING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR'SINK
POR. SQ. FT. p
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SQ. FT.
GROUT
WATER HEATER
WALL SQ. FT. ®'
FINAL INSP.
DRINKING FOUNTAIN
SQ. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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.
SQ. FT. ® c
BATH TUB
LATHING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1'A c
SEWAGE DISPOSAL
SO.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.IEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
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 SIGNATURESIINITIALS
GARDEN WALL FINAL
PROJECT y` SHEET NO.
R.C. STR U CTU RAL J09 N0.8a�
ITEM DATE
ENGINEERING ENGINE ER
U,y�A r�ea.cJ FESS/
GO
rlm
J C 7 ^,
civiv �Q-
2.
14- C 3 Z�� _ 9�E OF Ch\ffi �
400 (-1,83)
S, L (2) (►sal ( 4.11 = 4- O v �. i- � • .
� = �•�� J +�,� 4,3t�C�l •
- = 2 • C� �-T � 3.v FT
1 (,1 to `
e
PO L '
P�3ZD
F-1 = C-3 C -t ) C'/3 L 4,-7
�� L icat)
l/ L-7 60" Fo E PA I N
• y
{ f_ r !-f.: !. . ✓'" %a � r :�/ YY' - .: .l l0 '� ...^�".�'^�} l_ P .• .•ErEy.- _ ,i�..� �?.ir�-lr�• �?�""'•_'� q � t
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r 'pit, fh'fs '-,j
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C�\I-REi+C•
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--15:2.4 IFAX 619'347'466'0�a D
OZ��PARK
A1m.e`F;t
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!
AX TRANSMISSION. 3`'
✓
DATE,TRANSMITTED:
�-. TIME:. l
tdumber of, Pges/ `inclUoing this one:
AXED
L FROM: -
,�Cre1�a 45-871 CLINTON ST.
lNDIO, CALIFORNIA
92201
r.• �, r� G (619) 347-3484
"' �f r 4 • . _ FAX (619) 3474660
;
Recreation & Park
f District
DON MARTIN
�'• DISTRICT MANAGER
,
-
'. FAXDD TO: ,
--------------
Phone Number.? 2--
r
Pax Number: Z 7 - %c)
SPECIAL. COMMENTS�OR DESCRiP`I'IOC OF DOCUMENTS:
'
,
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• ,� ��-:. T�i�rrKs� fr rvCtP� . .
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01/13/94 -1.5.24- 'FAX 619 ,347 °4660 PARK DIST _ 10002
STAT Er
P.O. gQX x90807. SaN FRANCISCO, CA 94142.0007 r
COM PEWSAt IUfy 3
I NSURAN<::t T
FUND UHTIFICATE OF WORKERS' COMPENSATION INSURANrF,
`
r t' r i• POLICY NUMBER: 7 LC.
k' r• "� } ; 't. .� t. 'CERTIPICATF FXI'MU:
45S71 CL?'
J1 r L3 it `.t-iTa '
1—
Thi. is to certify shat wa have issued a valid Workers' Culoi)ensaiion insGrance'paIir,y in a form aooroved 0y,'tne Califulnia
Insurance Cvmmissioncr to the amplovor named below for the policy geriu'J indicated. , •
21
This policy is not mbiect to cancellation by the FunJ except upon terr.dayc' adv;ne.n written notice to the erriployei? }
1^ We will also give you TEN. days' arivanre notice should this policy t,c udn.tlled prior to itc normal ?Ypiration, `
This certificate of inwrdu<e is not an insurance poliry and does not arrlend, extend ur alter the coverage afforded by ihr.
policies listetf' harein. Notwithstanding any reyvilcment, term, or condition of anv Contract or other doculueut`with
respect- to which this certificate of incurance may be issued or may pertain, the insurance afford?rf by the oolicies
tirtpsr.6bed herein Is subject to alt the terms, exclusions and conditions of such Dollcles'
PRE51DIENT' .
S_nl: ,yT aT:TL'i b` i .. :.!' Tr L�_ ,' t 0T:. cc CT:v'�
..1TTC���:l T.. .N0 F.��:�� yYikT F TN:S'\'GL:tY
t.
r r
• . 1 k'••'r'` f• ~ _ if •1 I 1• , * ' t•
rA
,EMPLOYPR
` 1 ��•NUdul iUL =
L
' '_ t
e 01/12/94 16:36 FAX 619 347 4660 CN' REC.PARK DIST
County of Riverside Department of Health
Environmental Health Services Division
3636 University Avenue
Riverside, CA 92501,
ATTN: Land Use Section
1. ..Certification of Existing Subsurface Sewage Disposal System. Date of Inspection: 1/3/94
72-865 AVE MONTEZUMA, LA QUINTA, CA 92253 C.V. RECREATION AND PARYC nTCTUTr1
(Owner's Name) --
(Legal Description and APN)
FAILURE TO PROVIDE ALL REQUIRED INFORMATION SHALL PREVENT
OWNER FROM OBTAINING ENVIRONMENTAL HEALTH SERVICES APPROVAL.
2. Show design and location (1" - 20' maximum scale) of the sewage disposal system In relation to attached
dwellings, structures, wells, etc. on required plot plan (see Item Il of memo RE: Existing Subsurface Sewage
Disposal).
3. a. I examined the existing subsurface sewage dlsposal'system at the above location on ___113/94
date -
and determined that the septic tank•capacity is -1500 gallons and that there is — sq. ft,
of leach IIna' bottom area.
b. There are leachline(s), each ft. long.
c. There are ONE seepage pit(s), each 6' in diameter, 34 ft. deep.
d. The leachbed is ----- ft. by ----- ft., total sq. ft. of ieachbed area.
4. a. Construction of septic tank (please check one of the following):
5 concrete G fiberglass
C steel
O other (explain):
b. Internal dimensions of septic (length 7' 6" ft., width7 'SL' depth s41, ft.)
c. ' Condition of tank (please answer yes or no for each question):
Yes -No
Inlet Tee present? n - ❑
Outlet Tee Present? ❑
Two compartments? ❑
Tank structure deteriorated?' 0 4
'If yes, briefly explain and Indicate appropriate correction suggested:
5. a. While pumping the tank, did effluent flow back into tank from the absorption system? O Yes O No
b. Prior to pumping, was the liquid level in the tank above the outlet tee? O Yes ONo
c. Was the area around the lids oxidized? O Yes XX No
d. Is design of system gravity feed? 3M Yes O 'No
e. Were well(s) observed on this or adphcent property? O1 Yes amo
If yes, indicate distance of well from: Septic Tank 150' MIN. ft
Leachlines ft.
Seepage Pits iM� ft
f. Distance from springs, lakes Septic Tanks _ N/A ft
and natural drainage courses: Leachlines VA
(circle appropriate item) Seepage Pits N A . ft
g. ,Sewer is within 200 ft. of system and abuts property line. O Yes RkNo
ADDITIONAL COMMENTS: THE TANK WAS PUMPED BY PERSONS UNKNOWN TO ME BEFORE my
6. It is my opinion that the system .appears to be in good working order and can be expected to function properly
with proper maintenance. R Yes O No
If there are any further questions, feet free to contact tha IrnriArcinnAri at.
1001
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