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BLDG (0309-022) + PLBG (09092) + SFD (002520)53660 Avenida Madero 0309-022 09092 002520 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 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: (1) 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 9a% z F Signature of Owner +s;z, ,fy 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,' pro isions/ yy D,afe: " . ' Y' 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 the above-mentioned property for inspectiob purposes. Signature (Owner/Agent)'` *4` N r , / /a e'!!e.- Date PERMIT PERMIT" ,BUILDING DATE +' VALUATION LOTc i°z TRACT JOB SITE APN ADDRESS nv p Atp n 11 nna fi. Y, y JCi.' . y.. • .A.'U`J".l ll A MA`' KWO OWNER CONTRACTOR / DESIGNER / EN (NEER , li 'a '.r l2.' 3 J3T~S '1y 37.., -. Cs `tJh1!?T3 •• 3 ' .:;: ;NJ e USE OF PERMIT k34 t_4W. Y W.,RX,*LfN WAIA, C!t'Y 3TANVA1PD S T71 900, L,YS'e'NY J4T. ' NS1524AIM110 Coat MT 11,'1L39'ir1MMU(:3110Tl:' CONOTR11'i T1.aMFEE ICi1.51CC, gip 0 3, 2003 CITY OF LA QUINTA FINANCE DEPT. ',d. b77G Lc5+Gt1. 6.i.44,, "FOSS 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 OX 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 POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Bond Beam —6 Main Drain Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final Gas Piping Y, PLUMBING APPROVALS Gas Electric Final a/Vaste Lines Heater Final Vater 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 Temp. Use of Power Final Utility Notice (Perm) 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 $200.00 or more for the entire project, and such persons are not licensed .as contractors or sdbcvntractors, then you may be an employer..: j If you are an employer, you must register with the State and Federal Government4s.an employer and you are subject to several obligations including_ State and Federal income tax, withholding, -federal social:security-.taxes,>worker's compensaiion 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;ownets 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 ILA QUINTA DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico La Quinta, CA 92253 (760)777-7012 ' FAX: (760) 777-70 b % OWNER'S SIGNATURE/DATE 534&o av-.e, '7A, PROPERTY ADDRESS X309-oo a PERMIT NUMBER(s) Building Address 53-560 A' Owner u l'jtrGv. • . .. P.O. BOX 1504 NO. ae 78-105 CALLE ESTADO. MADERO LA QUINTA, CALIFORNIA 92253 Address City Zip T Contractor Aaaress P. 0. BOX 1908 City Izip ITel. State Lic. I City & Classif. 25084 Lic. # I94 Arch., Engr., Designer 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 Division 3 of the Business aannd` Profession Code, and my license is in/full force and effect: [ ! a a c!_ l`1 f I ( SIGNATURE J­Vvl.y "„i'' t a —f 1 DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec. 7031.5,Buslness 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 filea 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). ❑ I, as owner of the property, or my employees withwages 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 01 proving that he. did not build or improve for the purpose of sale.) - r . 0, l;'as owner of the property, am exclusively contracting with licensed contractors to con- strucf, the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does hot 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.) O 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 Compensation Insurance, or a certified co thereof. Sec. 3800, Labor Code.) . Porgy' t 'o20351-90 'company STA H Pi>(HH. ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed i1 the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: If, after making this Certificate .of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must' forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the. work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated,•and is subject to . expiration it work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to, enter the above-. mentioned property for inspection purposes. Signature of applicant— Date Mailing Address City, Stale, Zip SEVER BUILDING: TYPE CONST.HOOKUP OCC: GRP." A.P. Number 53-660 AVEMIOA MADERO ' 774-103-006 ,Legal Description Project Description SEVER HOOKUP Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ :Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing A a S.M.I. .. Grading Driveway Enc. Infrastructure ` '+ix r• . t • 1Sa`$ei{2.`.J'.1•U. ' !t•fltl.' : 'TOTAL REMARKS. ZO N E: 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. ® $ 2ND FL. SQ. FT. POR. SO. FT..® GAR. SQ. FT. ® CAR P. SQ. FT. WALL SQ. FT. ® SQ FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES STORAGE TANK WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FOUND. REINF. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED HEATING (FINAL) LAUNDRYTRAY AIR HANDLING UNIT CFM GAS (FINAL) 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. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1114 c SEWAGE DISPOSAL FRAMING SQ.FT.GAR ® 3/ac HOUSE SEWER ROOFING ; 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 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. FRAMING FINAL INSP. ROOFING ; REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL TAtyl cv 44 P.O. BOX 1504 No.. 00252 Building 53~660 da imf LA QUINOTACCALIFORNIA92253 • Address .. .. _ Owner .. . . `Mailing' " BUILDING: TYPE CONST: OCC_ GRP.- Address 9519 T d A.P. Number 7'74--103- 03 City Zip Tel. ' ., Wf1 90210Legal Description Mat 17 Contractor. Project Description szlywrlA fmmly 173-rw Glover owlstnictim Address _ 73-925 sw Ill. &Ate K City Zip TO... .. _.. _ . PAIM 2260 State Lic. City & Classif:. Lic. # j, Sq. Ft.' No. No. Dw. Arch., Engr:, Size Stories 1 Units Designer•New E'f Add' C- tltter.❑:- '•. Repair ❑ Demolition -0 Address Tel. City Zip State 3 s 50 Ian.' ft.. of 32" high Lic. # LICENSED.CONTRACTOR'S DECLARATION retainir n I hereby affirm•lhat I am licensed under 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. X• xt' SIGNATURE L - DATE" ` OWNER•BUILDER DECLARATION Estimated'Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following pptn reason: (Sec., 7031.5,Business and Professions Code: Any •city, or county..which requires a 76,189, 00 permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also ... • - ,t.«. requires the -applicant forsuch permitrto file a signed statement that he is-Jicensed pursuant to. PERMIT - - AMOUNT,. - the provisions of the Contractor's License Law, Chapter 9 (commencingrwith Section. 7000) of - Division 3,of the Business and Professions'Code, or that. he is exempt therefrom,- and the basis, - - f - - for the. alleged exemption. Any violation of Section 7031.5 -by 'any. applicant for a .Permit - Plan7Chk. Dep.. .•250.00' +• subjects the applicant to a -civil penalty of not more than five. hundred dollars (5500): , - - 0 I, as owner of the property, or my employees, with wages as their'sole compensation, will .. Plan C6k..Bal. . 6 '.52 do the work, *and tfie structure is not intended or offered for sale. (Sec: 7044, Bufsness andCDnst."s7-:' _ 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, Mech. , 30.00 or improvement is. sold .within one year of completion,. the owner -builder willhave the burden • Electrical 76-.60 ' of proving thafhe did not build or improve for the purpose of sale.) _ ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 1.07.00 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 improvesthereon, and ,who contracts for S.W.. - - ', `, such projects -with a contractor(s) licensed pursuant to the Contractor's License Law.) - . , . -r❑ Lam_ exempt under Seo.- B. 8 P.C. for this reason Grading 20.00 Driveway Enc. 20.00 . Date owner Infrastructure 1fi131.59 WORKERS' COMPENSATION DECLARATION " f hereby affirm that l'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-Q0py is filed with the city. _ ❑ Certified copy, is hereby furnished. TOTAL 2, 003o0Q 1,833.00 CERTIFICATE OF EXEMPTION FROM -REMARKS - WORKERS'. COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation - or less.) • . . • ... . certify that in the performance of tha work for which this permit is issued, 1 shall not employ any person in any manner so as to become.subject to the'Workers" CompensationLaws of California. 'Date Owner " NOTICE TO APPLICANT: If,, after making this Certificate of Exemption you shouldbecome subject to the 'Workers'- Compensation provisions • df the Labor Code, you must forthwith • comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY , .. ry I, hereby affirm that there is a construction lending agency, for the performance'of the work for which this permit is issued. (Sec. 3097, CiviLQode.) 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 stale dhat.the above information is'correct. .I-agreeto-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 'i,ste AW . r3> Date Mailing Address. Y City, State, Zip = - i HARD COPY 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 6 1 2 0 ' 8- .833CG CK • CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. ® POR. SO. FT. ® GAR. SO, FT. ® CAR P. Q. FT. WALL SO. FT. ® SO. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation SLAB GRADE / ' FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER SEV11fA OR SE IC TTA7A7 GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED DUCT WORK 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 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL BOND BEAM 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 ' OKUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE / ' ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEV11fA OR SE IC TTA7A7 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. $ plUs x$ =$ LUMBER GR. FINAL INSP. FRAMING INSP. sFINAL ROOFING cJ y REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH J SU ATION/SOUND / FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL 4 P.O. BOX 1504 APPLICATION ONLY Building ^ 1 ) 78-105 CALLS Addressssn n (1 p , . LA QUINTA, CALIFORNIAORNIA 92253 Mailing Address C) 53 8 City ( ( n Zip( r` Tel. 1n L tP w wa Y.It Y Y'1 i v ! Contractor I Address `73- 102 5 H(,k')L,t 1 t 1 'City, ZiD 'FT -el... State Lic.I City & Classif. Lic. # Arch., Engr., Designer Address I 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 Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec. 7031.5,Sustness 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). ❑ 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 orImprovement 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.) ❑ 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 Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company ❑ Copy is filed with the city. ❑ 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 parson 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 '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 BUILDING DIVISION BUILDING: TYPE CO/ / N-SSTOCC. GRP. / A.P. Number / /-/() .3 "(0 (OR Legal Description , (-l.+ f Project Description Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ r1 t V Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL ,` r 0 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: A5984 7 17 250.00 R CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ 2ND FL. SQ. FT. ® POR. SO. FT. ® GAR. SQ. FT. ® CAR P. SQ. FT. ® WALL SO. FT. ® SO. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APP./EQUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE 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 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER REMARKS: VENTILATION 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. $ 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. OCG FENCE FINAL Vn J JIIaMNI VMCWINI I IALJ. GARDEN WALL FINAL 4%FIEp 2 O w BERMUDA DUNES r RANCHO MIRAGE INDIAN WELLS 0 PALM DESERT J' LA OUINTA a 010 INDIO y o Desert Sands Unihed School District 82-879 HIGHWAY 111, 0 INDIO, CALIFORNIA 92201-5678 ® (619) 347-8631 July'30,,1986 i City of La Quinta Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 Re: 53-620, 53-640, and 53-660 Avenida Madero, La Quinta Gentlemen; The developer of the above referenced lots has mitigated its Impacts on our overcrbwde.d schools by payment of the amount of $628 per unit to be applied to the' cost of district educational faci-li:ties made necessary by such. new development. Sincerely, . .yl John D. Brooks Assistant Supe.ri.ntende.nt Business Services JDB/crm 2 47 Z O PZ U W U) W Z O U LU U) t CO Y Cr Q 2 W cr X Z O U LU N COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION 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 of0 is required when the application is submitted. Check must be made payable to the County of Riverside. Building Department Application Log # Ne(owlrer, Agent, Contractor, Ettr.) Mailing Address City State Zi Code 1 P 64—Telephone y 1 J b Property Adddrr ess_ C iittyy,brr@o/pn/"WRitity' 'Legaall Descri Lon of Prope tt (Lot. PM, TR) 'Assessor's Parcel No. Water AgencysmWlNell_ 6 I.t.t/7 Lot Size l 11 Use of Permi Planning Case N_ C` X SFD. MH Site Preparation Etc.OO C- 1417 (Signature of Applicant Date 1 'The above information must be verified from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE Initial Date Certification of Existing S.D. System required. ❑ Yes © ', No /r;/V ' -./7- 6 _ WQCB Clearance required. Yes ZMN 0 Soils feasibility report required. ❑Yes No Detailed boring report required. ❑ Yes D Detailed contour plot plans required. ❑ Yes No Staff Specialist approval required. ❑ Yes ❑ No Lot Inspection Date— Soils/boring report by/ I 4t Project # Date Soils Map Page r " F 7 Soil Type by W .t1 R7 _Approved _Dater!7 40 Type of System: - 11 Existing L4hrNew E) Additional El Replacement No. of Bedrooms %` G. • (1) Septic Tank / v vU `Soil Rate Required Gals. (2) Leach line sq. nr.. (Bottomatren tr aces) Sidewall._allowance . ft. roc _"'_' Ft. Install Line(s)_ Ft. Long, Ft. w'id,' Wtth-min___inches Leach bed Sq. Ft of / -Sq. per running ft. ❑ N/A rock below drain lines bo ttom area Leach lines/bed-gpecial design for slope: (3) Pit Diameter No. Pits Pit BI Seepage Pit total depth __/l Applicable N/A__ Overburden factor ' -G •• / Max. allowable depth Q / ' .`• - . ` t c. `''-C.t. -r.. ''r ,,, ""'" t- -mi"""l r -.+!d/I . 'i This application isTappro d'/•e ipd for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements set forth in Section 8 abAove. building permit' is necessary for the installs Ion of the above -designed system. (1 Septic tank and sewer lines must be' 50' from any wells (2 Leach lines must be 100' min. from any wells including expansion area !_ 3) Seepage pits must be 150' min. from any wells including expansion area"'/ /0` r 1; Signature of Health Official r" Date RECEIPT NO. (s Y V Issued by_ 5 Date7"" r / _iU District: ❑ Riverside ® Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File DOH SAN 122 (Rev. 2/86) Pete Billington A Associates, Inc. CLIENT JOB NO. /6BB Civil Engineers & Land S6rveyore LOTS /6 117 "eZO4;e 1-9.3 SHT. pF_ — 1445 No. Sunrise Way 619r=,4573Y Palm Springs, CA 92262 a5XJV7,4CA.CMEL/Tq' 4 r AWIX DATE L . Q!//NTA UN/T iVO. /•9 , 98'9a• son y ; rJ o h - •' app' 0 9 so — -9.7 /00.2 X 0A 5 /d/.0 1 00, 9gti `001 o ,SIF 1000 I F.F. /00;0 3 R 0 99 5 , , AAP .9'9.,!5 ( C 9tvRw 91, :I .4 /`47iV/,0.4 /i1AOE.eO