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DEMO (9911-043) + SFD (04689)53445 Avenida Madero 9911-043 04689 LICENSED CONTRACTOR 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 # Lic. Class Exp. Date 62928 i3 iY51 i Ut Date /1 0 2- rs r; Signature of Contractor OWNER -BUILDER DEC,, RATION I hereby affirm under penalty of perjury that Pam 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). () I am exempt under Section B&P.C. for this reason Date Signature of Owner 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). ( ) 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. --P)ate: /` Applicant C'1..,.'1/% Warning: Failure to secure Worker 'jCompensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. ' IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions_ set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. ignature (Owner/Agent) a ' o--% Date BUILDING PERMIT PERMIT# p DATE 9 vo4n 99VALUATION 3i LOT _ TRACTJOB . ADDRESS 53.• 4.,5 A V, + N1, 11711 AyV; dA. :J v`..,a APN OWNER CONTRACTOR/DESIGNER/ENGINEER s:rapr i aA , z;Mr, r ;,tt r tT,rrrti r.tyj : u vtr -o,I aectiitd, i. wif✓ at.a•a.. . s aa.a.. r-r r. a ii s a as _!Tie ev +3k:5`+ llil:; +' ki1Rti'J r?ti d C...t c ii«'r'T '.t % i,aS r?4 .t ; E ii its LA (, UINNT A CA 92253 FAIN D SEXT f:'d'A 92,260 (1160,)772-4' 41 CFJL# 1394 USE OF PERMIT N!3IMUCTI-CYN OA0 iFF;fl,..'i4Hq.+'f+il".. 3UMMAR k" f1 iMtC: +3 3 k iCr F&a t13—f `!ir+ P, 't ;"r s_f ; f f a• s a d P3, C; VCK RECEIPT I DATE TO#'.E$L Y'URMI Y EEE DOE'NOW 1 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 1_7--0o Exhaust Fans O.K. to Wrap _L _ go S7 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 oZ -1 —uZo Q Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS 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 COMMENTS: 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 1 Temp. Use of Power Final Utility Notice (Perm) PO. BOX 1504 Building' 78-105 CALLE ESTADO r . Address 53-445 Widero „-,.LA QUINTA, CALIFORNIA 92253 Owner lev Land , BUILDING:, TYPE CONST. OCC. GRP. Mailing Address 247- E, ^d't irAa ita Way-42- _ A.P. Number .. 74-033-020 City Zip Tel., - palm e` a;}3 G' ,Y>gil 226 3U« -IQ20 Legal Description wr Contractor , - Project Description • • • Starr Construction Address Pat€ City Zip Tel, State Ljc. Cit3 #793.4 Lic. & Classif. #_ r • _89 ,, Sq. Ft., .1410 : • No. No. Dw. .. Size Stories Units ' Arch., Engr.,- " Designer New ❑ Add ❑ • • Alter ❑ Repair ❑ Demolition ❑ Address, Tel. 428, Garage City • Zip State70$ lA flnce - Lic. # • LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under,orovisions of Chapter 9 (commencing with Section . 7000) of Division ,3 of the Bus itness acid Professions Code, my license is in full>force and,, effebt. V°&.:lfi mot a rl f CXi SIGNATURE ,Y f DATE ' OWNER-BUILDER DECLARATION Estimated Valuation T g0 I hereby affirm that I am exempt from the Contractor's License Law for the following 7:a 5 , reason: (Sec. 7031.5,Busfness 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 - PERMIT - AMOUNT.' 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 plan Chk. Dep.-n + yy[4 ' - for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit 4 i♦ `:1T "-• subjects the applicant 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 Plan Chk. Bal. t to do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. -.. +Y Professions Code: '.The Contractor's License Law does not apply to an owner of property who - 7 builds or improves thereon and who does such work himself or through his own employees, Mech. .a . v0 , provided that such improvements are not intended or offered for sale. If, however, the building -S5 ry or improvement is sold within one year of completion, the owner-builder will have the burden Electrical - 74,171 g 4 , 1 of proving that he did not build or improve for the purpose of sale.)_ - e t:f - , O I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 4{ 5 n o struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law *3G does not apply to an owner of property. who builds or improves thereon, and who contracts for • S.M.I. • - - • •.7 such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - Grading 20. ❑ 1 am exempt under Sec: B. & P.C. for this reason r Driveway Enc.. Date owner Infrastructure ,,.• » WORKERS' COMPENSATION DECLARATION f I hereby affirm that .1 have a certificate of consent to self-insu e, or a certificate of Worker's Compensation Insurance, ora certified copyAhere'of.'(Sec. 3800, Labor Code.) Policy No.—Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit Is for one hundred dollars ($100) valuation 4"`Yi d r fid 4 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. ZONE: - - BY: • subject to the Workers' Compensation provisions . of the Labor Code, you must , forthwith - z comply with such provisions or this permit shall be deemed revoked. i - Minimum Setback Distances: - `Front Setback'from Center brie `Rear .Setback frorri Rear.Prop. Line F 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.) i.Side Setback from Property Line' Lender's Name r . _. a = . . y Lender's; Address FINAL-DATE INSPECTOR ' • 'This is a buildmg permit when properly filled out signed and validated, and Is subject to 9 ^ expiration if work thereunder Is suspended for 180 days.. -, + ` ' • d ' I"certify that I'have read this application and state that the above information is correct., -Issued by. '' Date' 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. bove mentioned. property for inspection purposes: _ ,V811dated by: r - ".Signature of applicant{ t Data Mailing ' ; `• , ' Mailing Address ValldatlOn: K. r tj iCity, StateZip r — t' i ; n•i C F ' .. WHITE FINANCE PINK : APPLICANT GREEN BUILDING, GOLDENROD 'ASSESSORS OFFICE HARDCOPY- FlLi' " a .Y cS N, - ". :h..-,. 1 ,-. . -L..". r :'S . w e;`•. .o.'''.;_. , ._»_ r .r: '° • ...5{.- c:.+,. t x .!'. ,_i - ..,.r. '1 tu.. s., :.n....•.,>r1F,.. .1...2•.:.2,.`4 w: _-. .;. ... -.f. i f'ry. , .. _.. t~i .,.. ...- .: .. .' i.a.7 ?= _ .. §" . 33 <.- - :0.... sk .. ,'t •, CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SO FT (p $ UNITS SLAB GRADE 2ND FL SO FT. @ BONDING YARD SPKLR SYSTEM POR SO FT m MOBILEHOME SVC. BAR SINK GARSO. FT. iK POWER OUTLET ROOF DRAINS FOUND. REINF. GAS (ROUGH) DRAINAGE PIPING CAR P. SO FT. a OTHER APP.IEOUIP. REINF. STEEL WALL SO. FT. Q TEMP. POLE DRINKING FOUNTAIN SO. FT. (a GROUT URINAL ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE Not to be used as property tax valuation WATER SYSTEM FLOOR DRAIN MECHANICAL FEES _$ WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTOKDISHI 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 SPARK ARRESTOR SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID 1 I c SEWAGE DISPOSAL LATHING SO.FT.GAR 3/4c HOUSE SEWER MESH GAS PIPING PERMIT FEE INSULATIONISOUND 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 8 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.IEOUIP. 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 INSULATIONISOUND FINISH GRADING FINAL INSPECTION 2 CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL z O_ F- 0 U w co z O f— U w U) U) Y cr Q W cr COUNTY OF RIVERSIDE, DEPARTMENT OF HEALTH ENVIRONMENTAL HEALTH SERVICES DIVISION —77Y - PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM Applicant: Submit this form with four copies of a scaled plot plan (1-20 scale) drawn to County specifications required on the attached check list. A non-refundable filing fee of $40 is required when the application is submitted. Check must be made payable to the County of Riverside. Building Department Application Log # Name (Owner. Agent. Contractor. Etc.) /0J Mailing Address I A 1-/7 LE r,,4r/cJ c,i , -e 4, [.c)A City PM. /4j State e• 4 Zip Code 9 L Z,4 Z.-- Telephone 'Job Property Address/ , /.t f'CA Cab i y 'Legal Description of Property (Lot. PM. TR) .a4i;„ I C RQw♦.tai-r L.o /Z,43Z / cL.✓ T 'Assessor's Parcel No water Agency ' ,eii— / /,, Use of Permits l/ l f ()1L Ci T {tranning Case B Lot Srze '°' A Pd. 77 1— 033— O 2® 0 7.,Z oea,7'”' ' / a X fSfJ SFD. MH Site Preparation Etc Signature of Applicant Date 'The above information must be verified from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE E Initial Date Certification of Existing S.D. System required. ❑ Yes WOCB Clearance required. ❑ Yesd Soils feasibility report required. ❑ Yes 00 Special feasibility boring report required. ❑ Yes Detailed contour plot plans required. ❑ Yes❑e .0 Staff Specialist approval required. E] Yes Ll No Lot Infection Date Soils/boring report by / Project # Date Soils Map Page—! Soil Type Approved by - - Datel-fi-/1"0 Type of System:„,,r No. of Bedrooms (1) Septic Tank Soil Rate'Required ❑ Existing M ew 1:1 Additional E) Replacement e 1y, D Gals.«% GOcf (2)%Leach line sq. ft. Sidewall allowance ft. Sq. Ft. Install Line(s)—Ft. Long, Ff. Leach bed Sq. area) rock/ th min. inches Ft. tre per running ft. ©,1 /A rock below drain lines 'OO° ., area Leach lines/bed-special design for slope: Applicable (3) Pit Diameter No. Pits Pit BI Seepage Pit total depth •• ..10,0- N/A '” ' Overburden factor6' /(,t` Max. allowable depth D f0 This application isapr' roved/ e.iedlfor 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. '06) Septic tank and sewer lines must be 50' from any wells r/l o t"Y 6'° < - `°"'_-.1 t (2k Leach lines must be 100' min. from any wells including exp 77 area (3) Seepage pits must be 150,' -min. from any wy lt,'ncding expansion arear-f /(7 ,rlicy, • Signature of Health Official r RECEIPT NO. f Issued by Com` i'/- Date Z/ r District: ❑ Riverside Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe ► ' Distribution: WHITE—Office file YELLOW—Applicant PINK -Bldg. Dept. GOLDENROD—Pending File DOH -SAN -122 (Rev. 4/88) 0( .4 _ OI f ICE OF AGRICULTURAL C0.MMISSIONE R AND WEIGHTS MEASURES 49- 613 Ilwy 86., 8ti to D 12 CoacIIellEa,, CA 92236 619-342-8291 E. LEON SPAUGY COT++S,ilO.'ER LAMES 0 WALLACE ASS+SIANE CTANIISSIUNtR CLEMENT BE`VENISIE SEALER DA'L'E (` C' l ' i - CASE M. LEI" 6 LI" Iy 11 1.4. DEVELOPER'S , NAME t S T R R R 6 ©A-1 s'r lea e r1 sa AJ ADDMSS t PnLm 5PC 1o(J& s 7-2-4 '2, TELEPI ZONE: 32 2" %n 2, d SI/ Dear Developer: 7Ty- 0 3.3:... After reviewing your laiidscapblg plans, all plant material listed is not in violation of quaraEitine laws governbig the Coachella Valley. if substitutions do_ occur end they differ frun. pl'ant .nk3Lerial listed, this office nnust be notified .. immediately. Thank you ,for protectiEig and preserviEig tl-e Coachella Valley's.pest=free enviroment. Ag ulLural Cotitni.ssioner's office cct Indio. and Riverside Office wl