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PLBG (9511-079) + SFD (001947)54435 Avenida Madero 9511-079 001947 LICENSED CONTRACTOR DECLARATION I hereby affirm 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. 684563 A 2/2 6 License # Lic. Class Exp. Date Date 12, f SignatureofContractor OWNER -BUILDER DECLAR - N I hereby affirm 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). ( ) 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 ,9TATF RJtgr) Policy No. 113r36410 (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 provisionsof Section 3700 a Labor Code, I shall forthwith comply Wi • tho a provisio s Date: I 't ' 4Applicant, Warning: Failure to secure Workers' Com risation 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 application agrees to, & shall, indemnify A' '' & hold harmless the City of nrdiAdWe1[gLr Jsioffcers, 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 lhting to the building construction, and hereby autjwrize represQntat sof this City to enter upon the above-mentioned properor inspectio purposes. Signature (Owner/Agent) / Date ALCM e,x e+ BUIL DING PERMIT PERMIT1.51 1 079e DATE °J "J'"' VALUATION W -P ""] LOT TRACT JOB SITE ADDRESS ;5"35 AVENIDA MADERO APN 774-231-008 OWNER CONTRACTOR DENR06R.1~NGIW,F,litNG, & C'O.NRT. 111,1 Ai1'1..A. & FLOY HAYES 6817511ER A= COURT ani433 A:vENID)A A1iADERO Ci LiEDRAL CITY CA 42234 L,A QTJWrA C.A 922.53 (611)327-2200 CBL# 3577 DESIGNERIENGINEER USE OF PERMI1'LUrVJB1NG -V.WER C O NNE0' FEE DESCRIPTION FEES CONTRACT' M40i7MC 1,895.00 LS ESS i MATED COST OF CONSTRUCTION E'EEtll4E'E'FEC SUMMARY PLUW. NO FLIS -- SEWFR 1014000-419-(1013 3o.0a SUB -TOTAL CONSTRUCTION .ANDTLAN CHECK LESS PILE -PAW FEES $0.00 TOTALL'FLt14ff FE SDUE NOW $30.00 RECEIPT DATE BY DATE FINALED INSPECTOR p 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 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 G 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) 7 HAMMER PUMPING INC. JOB INVOICE P.O. Box 2448 CATHEDRAL CITY, CALIFORNIA 92235-2448 IA101 Z9Zn_7AAQ zw (619) 321-7448 CUSTOMER'S ORDER NO. DATE ORDERED / — ,2.5. 7(o ORDER TAKEN BY DATE PROMISED 0 A.M. El P.M. BILL TO PHONE ADDRESS ME B}IANIC Ill\ Vl. CITY HELPER JOB NAM ND CATION / Q d U Q 0`DAY WORK DESCRIPTION OF WORK IMS e Sr - ❑ CONTRACT 0 EXTRA l9 r Sc_W-Pv—% QUANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT 900. Gallons oQj)rq Pumping Fee per 1000 gal. Dumping Fee per 1000 gal. Out of Area Fee Locating / Opening Fee (per hour) Size System: A SERVICE CHARGE OF $20 WILL BE DUE ON ALL RETURNED CHECKS. A FINANCE CHARGE OF 11/2% PER MONTH, 18% PER YEAR WILL BE CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS. HOURS LABOR AMOUNT TOTAL MATERIALS MECHANICS @ HELPERS @ TOTAL LABOR I hereby acknowle ge the s a r ' completion of the above ri ork: TOTAL LABOR TAX /SIGNATURE DATE COMPLETED rT0TALT3T= 21 NOTICE TO OWNER Under the California Mechanics Lien Law any contractor, subcontractor, laborer, supplier or other person who helps to improve your property, but is not paid for his/her -work or supplies, has a right to enforce a claim against .your property. This means that after a court hearing, your property could be sold by a court officer and the proceeds of the sale used to satisfy the indebtedness. This can happen even if you have paid your contractor in full if the subcontractors, laborers or suppliers remain unpaid. To preserve their right to file a claim or lien against your property, certain claimants such as subcontractors or material suppliers are required to provide you with a document entitled "Preliminary Notice:' Original (or prime) contractors and laborers for wages do not have to provide this notice. A Preliminary Notice is not a lien against your property. Its purpose is to notify you of persons who may have a right to file a lien against your property if they are not paid. Generally, the maximum time allowed for filing a claim or lien against your property is ninety (90) Days after completion of your project. TO INSURE EXTRA PROTECTION FOR YOURSELF AND YOUR PROPERTY, YOU MAY WISH TO TAKE ONE OR MORE OF THE FOLLOWING STEPS: 1) Require that payments be made directly to subcontractors and material suppliers through a joint control. Any joint control agreement should include the addendum approved by the Registrar of Contractors. 2) Issue joint checks for payment, made out to both your contractor and subcontractors or material suppliers involved in the project. This will help to insure that all persons due payment are actually paid. 3) After UPON making payment on any completed phase of the project, and before making any further payments, require your contractor to provide you with unconditional lien releases signed by each material supplier, subcontractor and laborer involved in that portion of the work for which payment was made. On projects involving improvements to a single family residence or a duplex owned by individuals, the persons signing these releases lose the right to file a claim against your property. In other types of construction this protection may still be important, but may not be as complete. TO PROTECT YOURSELF UNDER THIS OPTION YOU MUST BE CERTAIN THAT ALL MATERIAL SUPPLIERS, SUBCONTRACTORS OR LABORERS HAVE SIGNED. TRI -STAR CONSTRUCTION P.O. BOX 542 CATHEDRAL CITY, CA. 92235 ph. ( 61.9) 321-0898 fax. (619) 321-7798 TO; CITY OFLA QUINTARE: oat PER MY AGREEMENT -WITH TRI -STAR CONSTRUCTION I WILL RE -SEED OR OTHERWISE COMPLETE MY YARD AFTER THE INSTALLATION OF THE SEWER. THANK YOU, si atur r please p int. name f 5 . f., Building 54-435 Avenida SIO Address Owner Mailing Address P.O. Arw 2 R City Zip Ztslic3 92202 Contractor Address 4 P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 No. 401947 BUILDING: TYPE CONST. V N OCC. GRP.- i2 3 A.P. Number 774--331--008 Tel. 56492728 Legal Description It 8 Project Description S3Wle f&4JV dWE3W.M seem State Lic. City & Classif. Lic. # Arch., Engr.; Designer Address Tel. w City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I em licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professidns'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,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 permil.to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 0.1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) 0 I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) 0 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 0 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 thg work for which this permit is issued, I shall not employ any person in any mannersoas to become subject to the Workers' Compensation Laws of California. D - Siz LVA40 14 Sq e Ft. GAR 430 Stories. i No. Dw. Units New Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation 81,447.00 BY: PERMIT Fii*,%. ' AMOUNT .Plan Chk. Dep. 318.52 Plan Chk: Bal. Rear Setback from Rear Prop. Line 20.15 Const. 379.00 I hereby affirm that there is a construction lending agency for the performance of the Mech. 31,04 31.00 Electrical 70..1.2 Lender's Name Plumbing Moo Lender's Address S.M.I. 5.71 ,50 Grading Issued by: y Date •ki Permit Driveway Enc. 20.00 Infrastructure 1,2.21.71 TOTAL 2,286.71 51.55 REMARKS ate Owner NOTICE TO APPLICANT: It, after making this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Compensation -provisions of the Laboi Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances: ' 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 Address FINAL DATE INSPECTOR 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. ws I certify that I have read this application and state that the above information is correct. Issued by: y Date •ki Permit I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives sof this city to -enter the above- mentioned property for inspection purposes. f , j' j Validated by: Signature of applicant--— ' A f f 'Y. w Date- fZ - Mailing Address — Validation: City, State, Zip A 3 5 4 5 12 11 5 L 6 5 CK HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. ® POR. SQ. FT. p GAR. SQ, FT, ® CARP. SQ. FT. WALL SO. 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 SLAB GRADE FLOOR DRAIN MECHANICAL FEES BONDING WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER SEWER OR SEPTIC TANK 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. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1 Va c SEWAGE DISPOSAL BOND BEAM SQ.FT.GAR ® 3/ac HOUSE SEWER GRADING cu. yd. $ plus x$ GAS PIPING PERMIT FEE FINAL INSP. r[ ✓ 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 PLUMBINGa IUNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE TdL ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. 2 • GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE i2 S 3 ! ! 7 TiFINAL INSP.If BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ _$ LUMBER GR. FINAL INSP. r[ ✓ iFRAMING 7 (/ INAL INSP.3 ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING TFINAL INSPECTIONS CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL t %FIEp 0 " _ = Desert Sands Unified School District N BERMUDA DUNES r RANCHO MIRAGE _ 82-879 HIGHWAY 111 • INDIO, CALIFORNIA 92201-5678 • (619) 347.8631 INDIAN WELLS ti PALM DESERT -b December 6 1985 J`- LA OUINTA 'gyp INDIO y City of La Quinta Department of Community Development 78-105 Calle Estado La Qui*nta, CA 92253 Re: 54-080 Herrera, 54-060 Herrera., 53-365 Mendoza, 53-615 Mendoza, 53-355 Mendoza 54-435 Madero -- Gentlemen: - The developer of the above referenced -.lots. _ has miti'gated.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 fac Tli.ties made necessary by such new development. Sincerely, John D. Brooks Assistant Superintendent - Business Services JDB/.crm Q Z 0 U W H RIVERSIDE COUNTY 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 e 4& State Zip Code a a d Phone . y. 'Property Address/O7 y a Community 'Legal Description of Property (Lot, Parcel Map, Tract) 'Assessors Parcel No. Water SeKing Property From Lot size • SOS,-R- , ., . G(%a - %Y I . G -,r t G i 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 ❑ No a Soils feasibility report required Yes ❑ 'No a Detailed boring report required' Yes ❑ No a Detailed contour plot required Yes ❑ No (5 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 3 New Addition Replacement 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' ❑ Location of System / - 11 04 Q uJCI' f VIV+ t' '- ►'r►. , Additional Requirements % , . (pp io ex U A e ML1A 'QI / 4 pl l-i•a.. f O` + fT ( )0 , + r w,rii f " - A permit is approved/deco dlorthe 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 ystem. Signature of Health Official Date Receipt No. S 7 3 23 Issued By District: Riverside ❑ Indio 29 Hemet ❑ Date DISTRIBUTION: WHITE - Office File YELLOW - Applicant PINK - Building Dept. GOLDENROD - Pending File DOH SAN 122 (Rev 10/82)