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PLBG (9903-129)53523 Avenida Martinez 9903-129 LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of "1= Chapter 9 (commencing with Section 7000) of Division 3 of the Business and 04 W Professionals Code, and my License is in full force and effect. O ch License # Lic. Class Exp. Date tiLUr- 746159 2129)00 Z ti 1.Date Signature of Contractor• * ! (DO~ J .0 C OWNER -BUILDER DECLARATION HWd I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: Z ( ) 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). C°) () I am exempt under Section , B&P.C. for this reason LO N Date Signature of Owner 0. d z WORKER'S COMPENSATION DECLARATION p 1 hereby affirm under penalty of perjury one of the following declarations: r O () 1 have and will maintain a certificate of consent to self -insure for workers' X W LL compensation, as provided for by Section 3700 of the Labor Code, for the mJ Q performance of the work for which this permit is issued. Q U W 1 have and will maintain workers' compensation insurance, as required by O U section 3700 of the Labor Code, for the performance of the work for which this t1 LO H permit is issued. My workers' compensation insurance carrier & policy no. are: 1* Z Carrier Policy No. a GOLDEN UAGLE INS. NWC5.4S _00 J (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 3 subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall fo, hr C comply with those'provisions. Date: Applicant r -•--^ r Will Warning: Failure to secure Worker ompensation 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 ti 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.iinnnsspiection purposes. Vgnature (Owner/Agent) ' ! -------'' ~ Date BUILDING PERMIT PERMTII 9903-129 DATE VALUATION LOT s • I'3 gg S1430,00 TRACT JOB SITE APN ADDRESS 53,523 AW.NIIU M&WFINE 774-1311,013 OWNER CONTRACTOR / DESIGNER / ENGINEER LA.QUIN'1'A 11.FD8Vr-WP&f MONO Sl'Mr.RSt. )WIC'E 78495 CALLS TAMPICO 84033 CABA7.0 N R11 INDIO, CA 92201 LA {; UINFA CA 92153 PALM DI;SEWr CA 022€1 (760)W,.2709 3 C UN .14: USE OF PERMIT SETRC ikBANDON, .1'XGAT-R C0 NNnCT (L0-NiG0 Ilko ECT iii! -021 MS'TM.U`ITI;11) COST OF CON`1'I'RIJM'TONN 1'EItliUT VVE SllMhiARY KLINIBINO kT-Y. - NHVElt lot-wo-419•oUO S3ct.4.0► SUP -TOTAL CON MLICITON A-011 RAN CI{I rK 'I'(i•I't1.1W I'Ij3011•i• VN•HS flUENOW RE.0 IPy /.q , I DATE - `% BY DATE FINALED INSPECTOR 1,430.0 SM1.011) 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. Compressor Framing 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: aN 4-1549 Final Z 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) ECONO SEWER SERVICES P.O. BOX 192 PALM DESERT, CA 92261 /7LA\ 9AC A7A9 /7CA\ -fAA 77/_'/\ JOB WORK ORDER 092M%- \/VVJ JYV^L/ 7J \I VVJ JL V'/ IOU DATE OF DER FAX (760) 347-4978 - ... CUSTOMER'S ORDER NO. PHONE MECHA HEL ER STARTING DATT BILL TO TOTAL AMOUNT ORDER TAKEN BY / ADDRESS 1 ❑ DAY WORK r !166 ❑ CONTRACT CITY ❑ EXTRA JOB NAME AND LOCATION JOB PHONE DESCRIPTION OF WORK PAYMENT TERMS NET 10 DAYS FROM DATE OF SERVICE 'Va% PER MONTH CHARGE AFTER 30 DAYS U No one home A Total amount due Signature / for above work: or I hereby acknowledge the satisfactory completion of the above described work. LJ Total billing to be mailed after completion of work TOTAL MATERIALS TOTAL LABOR PLEASE PAY FROM THIS INVOICE NO STATEMEN!T A BE MAII En TAX DAT O PLETED WOEoBY TOTAL AMOUNT $ U No one home A Total amount due Signature / for above work: or I hereby acknowledge the satisfactory completion of the above described work. LJ Total billing to be mailed after completion of work 4 P.O. BOX 1504 No. 003400 Building 78-105 CALLE ESTADO Address 53-523 "enida Martinez LA OUINTA, CALIFORNIA 92253 Owner Mailing Address A7 "P._ 'Pi City lZip Contractor Stair Cdbstruction Address 247 E. Tahtmits Fav f2 City lZip ` I Tel. State Lic. I City & Classif. 387934 Lic. # 895 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 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 Contractor's 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 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 thathe. 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 of not more than five hundred dollars ($500). O 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 or proving that he did not build or improve for the purpose of sale.), - ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to corv. strucl 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 O Copy is filed with the city. O 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 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 HARD COPY BUILDING: TYPE CONST. OCC: GRP. A.P. Number 77A-131-01-3 ,Legal Description Project Description PlaU B —'Single ?amity Sq. Ft. 1463 No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ GAS, 475' ence 15 Itimated Valuation PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL AMOUNT 59. A9 361yyt . 00 3314 - iRn d5-07 4q. an S_ 2q 20 -An 20.00 1.113.45 REMARKS W I W L.Hat'f 1 r I ti l zl 1 4 r 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 9/29/8—Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SQ. FT. POR. SQ. FT. ® GAR. SQ. FT. ® CAR P. SQ. FT.®' WALL SQ. FT. @ SQ. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET r YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation ROUGH PLUMB. FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GAS (ROUGH) LAUNDRYTRAY AIR HANDLING UNIT CFM HEATING (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 IBATH TUB BOND BEAM SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL LUMBER GR. SQ.FT.GAR ® 3/ac HOUSE SEWER FRAMING /3 Q/, Vic// FINAL INSP. GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE -[::MECH.FEE I PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR _ C_ e --LS 47 GROUNAW MBING UNDERGROUND A.C. UNIT COLL. AREA 56``SLAB GRADE ? ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS / CU t f SEWER OR SEP IC K ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REINF. STEEL GAS (FINAL) &M P. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ -Plus-X$-=$ LUMBER GR. FINAL INSP. 7i J FRAMING /3 Q/, Vic// FINAL INSP. ROOFING r 4 / REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWIA LL LATHING Y1 MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL Desert Sands Unified School District CERTIFICATION OF PAYMENT OF t(D 1 SCHOOL FACILITY FEES j T0: City of La Quinta DATE: Ib Qom% Department of Community Development La Qui Calle Estado 9225 NOTICE: THIS DOCUMENT CANNOT La Quinta, CA 92253 BE DUPLICATED. This is to certify that developer of 4A-IvtA cei which is located at , within this District, has paid school facility fees imposed pursuant to the authority generated by Government Code Sectiost 530 0 in t e amou t f covering a total of square feet of ( residential or ( ) industrial/commercial development and that building permits for this footage in this development may now be issued by your jurisdiction'. 53 -3 5 f0V DESERT SANDS MIFIED SCHOOL DISTRICT 7L—., : 1) 4 1UL White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer (10)-37 TM Co gs Mints rtl i=tiw; VAIJAW LA30 Co. .;.r.7;7280 DOMI3 DRIVE, suns eiag :-,,CARMEL, CA 93923 .40 111000 *:=am &A Awva a*&OW IN vftM .0187760ja I GRANT DEED rwev V-4 11-- 00 12*1 - 4 1 r 9 TW GRANTOR(S) DECLARE(S) DOCUMENTARY TRANSFER TAX IS S 18.15 343 ownauW an ha v&A of pcWtv coo-aVed. CK 0 cow*uM an fuN Win Im slue of IWO Or 9r4ufflbrWK= "'WhIN 910"Ofs". XG u1i co PR - is a 0 city of AND FOR A VALUABLE r M S DERATXW n p -111100 shiCh is 1011111P 8Ckr4WWepode asjv Lu nam MW CAR= "weiii, mum AND WIPS ANOINT TZNMMB hWeby GRANT(O to CMLL& VALLU LM CWNW, a CALT R N I& LINITM PAKTMEaSEzv the lodowin0 dMCriOtl I no property in the StOf C81110MW p iRIVZStSlDstun= 2 BLOCK 244 Or SAM CMMITA AT VALE LA QUINTA, UNIT 23* MW QED IV " in DOM 20, PA= 25 alp M", 312CRAW (W MMIDE IIW, CALITMIA. putt July 17, 1997 sTxrg or CAL040m" COUNTY OF Riverside ss. Onthe 23rd bolont oft VW underli4pNia 0 NOMY PUt*c in WW 1W 11" SOL personaft %v@mvd ChristoRher Lee FraMns and Carole Frahm . piwoon0y known to me 40F p a to nw on UW bow of 80*fscWy eveftMal to t* 19W poM —3 WhOW n0ft 3 ArS subumbW to "W wim" w4&WnwvL aft sawwwWpd 0 MW "W— he— MOW" OL "00 07n Cil"ISM ►L Z O F" U W U) C0 Z O U W Y fs Q 2 W Cr U Z O H U W C0 ,r*a 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 of,$37 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.) Mailing Address , ' L_EAl v't4/4 •h 2 City P A4 <t 1A.A:5 State Zip Code a G2 Telephone /o ff , Job Property Address AVF i'T A/ / City, or'+Gemmunity, Legal Description of Property. (Lot, PM, TR) -f IAXiv 'Assessor's Parcel No. jW ter A e / 4;? Use of PermJ)(,0"e ")&1V 4' elanning Case # Lot Size 77,11 / —u1 / SFD, MH Site Preparation Etc. -0e/ T , 1 '3 lL'- - s=7Signature of Applicant Date The above information must be verified from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE Initial Date –7 Certification of Existing S.D. System required. ❑ YesN_o°l WQCB Clearance required. ❑ YesOiNo`' , Soils feasibility report required. ❑ Yes J2 Nor Detailed boring report required. El Yes ®-plow Detailed contour plot plans required. ❑ Yes " j' 0 Staff Specialist approval required. E3 Yes NO Lot Inspection Date Soils/boring report by Project # Date Soils Map Page Soil Type Approved by I,'. ? Date . Type of System: V No. of Bedrooms (1) Septic Tank Soil Rate Required ❑ Existing ©„New ❑ Additional ❑ Replacement 3 /g!2?27f Gals. (2) Leach line sq. ft. Sidewall allowance Insial Lines) Ft. Long, .01 Leachebed Sq. (o m trench area) ft. rock/ Sq. Ft. . running ft. ®"`N/A Ft. ide with min. inches below drain Ft. om per rock lines area Leach lines/bed-special design for slope: (3) Pit Diameter No. Pits Pit BI Seepage Pit total depth Applicable= N/A factor.,/ ;Tr' E'er ! (J Max. allowable depth –,Overburden f r' C '” . ' /'1''' --*' ''1 . }.w. -'qui %° ?z–. '" A' ' !/-% • ,f ,..rf vn- 'GO"i . V p This application is'a promo d dbniodlfor the design of a subsurface disposal system as indicated on the acc mpanied plot plan using the requirements set forth in Section B above. A building permitr s necessary for the installation oftthe above -designed sgst 01) be Septic tank and sewer lines must 50' from any wells r ,//4 (2) Leach lines must be 100' min. from any wells including expansion area a ),,Seepage r (3 pits must be 1501 min. from any wells including expansion areay /0 t/Cc ' Signature of Health Official' ' Date RECEIPT NO. • - % /I Issued by - l Date l71[ /J' District: ❑ Riverside Eldhclio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File DOH -SAN -122 (Rev. 6186) t