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PLBG (0210-158) + RR (3202) + BLCK (2968) + SFD (2010)53615 Avenida Martinez 0210-158 003202 002968 002010 LICENSED CONTRACTOR. DECLARATION I hereby affirm under penalty of perjury that I am lic_ersed 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 4? 1 S A b HIc ow ilv Date C/ ' ` 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). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business 4 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 perfor"nce of the work for which this permit is issued. My workers' compensation Insurance carrier & policy no. are: Carrier STATS KIND Policy No`. pq011-02-003"" (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 shal forthwith comply with those,provisions. Date: 40, j`' * Applicant.Noe_ Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety r for a permit subject to the conditions and restrictions set forth on his! application. 1. Each person upon whose,behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit Issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. i Signature (Owner/Agent) ' '7d" „ Date r. h Z PERMIT# `'BUfLDING PERMIT` - .- - - 0210 1'S8 DATE VALUATION+. LOT TRACT J013 SITE ADDRESS r 5"V) AJl VX. A AF4711 - APN 774-131--0113 OWNER CONTRACTOR / DESIGNER / EN (NEER BaL & MRS. i OLM, GARCIA M :1'1'AR CONMUMON 53-615 AVR MAItTW, 34730 DATEPA1.IM DRM LAQUINTA CA. 92253 CA113L1 RAL C'T'Y CA 92235 i (760)371-0898 t'.IIIA 762 USE OF PERMIT - Sir.PTIC ARANWK nWPIf R HOOK-UP (W1 .111U101 PRUJI►CT 200'2.92) VALUATION i ;1^00 LS Mrf►''P$,D C09.1' OF +CONS"MUCl' ON 2,Si)El.tM3 P111jaw ME SULC /ZANY PLUMDINO "Y 101-x-419.000 1*100 9UP-TOTA1. (_-6)iff7R9K7n0H ANI) H -AN C``M(7 $30.00 e L 9 PRE-PAHII , $ O , $0.00 AL PERMff FMDUX i1UR now fs .tttl OCT 2 8 2002 WYOFLAAUINTA ' FINANCEDEPT. e RECEIPT DATEABY DAT FNAL D . INSPECTORl 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 APPROVALS 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 SeNer 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 Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: HAMMER PUMPING INC. JOB INVOICE P.O. Box 2448 CATHEDRAL CITY, CALIFORNIA 92235-2448 17AM RAn. Badu 060i321.7448 CUSTOMER'S ORDER NO. DATE O DERRE O f -3 — ORDER TAKEN BY DATE PROMISED ❑ A.M. Cl P.M. BILL T q—,' ✓1 PHONE ADDRESS MEC NI CITY HELPER JOB D} M AND LOCATION V , W Y WORK DESCRI'PTION OF WOR / LALI , L // ❑CONTRACT ❑ EXTRA QUANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT 60 Gallons - n Pumping Fee per 1000 gal. C t i C Dumping Fee per 1000 gal. av,! v✓ Out of Area Fee Locating / Opening Fee (per hour) Size System: A SERVICE CHARGE OF $20 WILL BE DUE ON ALL RETURNED CHECKS. 18% PER YEAR WILL BE CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS. HOURS LABOR AMOUNT TOTAL MATERIALS MECHANICS @ HELPERS @ TOTAL LABOR I hereby acknowledge the satisfactory TOTAL LABOR completion o the above described work: TAX SIGNATURE ff DATE COMPLETED f 3 d -L _ TOTAL 414 P.O. BOX 1504 No. 003202 Building 78-105 CA LLE ESTADO AddressLA QU I NTA, CALIFORNIA 92253 h Owner _ A "'* y ° "'""""`" ' BUILDING: TYPE CONST. OCC: GRP: Mailing Distances: Address , 2-815 Deer , Gross Drive A.P. Number Rear Setback from Rear Prop. Line City Zip Tel. Side Setback from Property Line FINAL DATE PPalu pert 92260 3,46-55965 Legal Description Contractor Project Description Re—roof' C"_ imerm Address 7A_4;9n T1lvrtrw iiisnnr` - City Zip T .. el." . 1di 9220.1 34.5-3751 State Lic. City & Classif. Lic. # Sq. Ft. No. No. Dw. Size - Stories Units Arch., Engr.; - Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ 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 70pp) of Division 3 of the Business and Professions Code, and my license is in full force and effect. _SIGNATURE .r .,.. _ — ..._ R. DATE .. .. - OWNER -BUILDER DECLARATION Estimated Valuation, I hereby affirm that I am exempt from the Contractor's License Law for the following. 50 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 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 theiefiom, and the basis for the Any Section 7031.5 by 'any for - Plan Chk. Dep. - alleged exemption. violation of applicant a permit- subjects the applicant to a civil penalty of not more than rive hundred dollars ($500). Plan Chk. Bal. ❑ 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 Const." r . Professions Code: The Contractor's_ License Law does not apply loan owner of property who t i'Xd N^ 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 for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden Electrical 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- 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 for S. M. - such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading 0 1 am exempt under Sec. B. & P.C. for this reason Driveway Enc. Date Owner 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.) 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, .l 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 or 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 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 Dale Mailing Address City, State, Zip HARD COPY TOTAL REMARKS h -14N W r"rKT01,11 17 5 Y . Vtl ` ' - ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback,frorri Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: 'Date 6/114187 Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. @ $ 2ND FL. SO. FT. @ POR. SO. FT. @ GAR. SO. FT. @ CAR P. SO. 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 BONDING WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED DUCT WORK LAUNDRYTRAY AIR HANDLING UNIT CFM GAS (ROUGH) 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 WATER HEATER 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 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 ROCKSTORAGE 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 c ;' ._ DEC 1 7 1987 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS. GARDEN WALL FINAL Building Address Owner 44 Ov P.O. BOX 1504 No, 002968 78-105 CALLE ESTADO 5.3415 ftmida Mrdzm LA QUINTA, CALIFORNIA 92253 Malting , Address Smw as abom ' City Lao Zip 7564--0842 92 Contractor or 39C --38Q0 BUILDING: TYPE CONST. OCC: GRP. A.P. Number Legal Description Project Description 142 3.d. lit. ' f.61 BlodC WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a'certificale 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'COMPENSATIONINSURANCE (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, alter 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.) Lenders Name Lenders 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. 1 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 TOTAL 45.00 REMARKS ZONE: BY: Minimum Setback Distances: City Zip Tel.` Rear Setback from Rear Prop. Line State Lic. & Classif. City Lic. # Sq. Ft. Size No. No, Dw. -Stories Units Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City . . Zip State Lic. # 3 5 45.00 it LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 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 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 penally 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 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.) O 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.) O I am.exempt under Sec. B. 8 P.C. for this reason Estimated V31UatlOn9��Ilpf 3 .aEt�I PERMIT - AMOUNT Plan Chk. Dep. • - - ' Plan Chk. Bal. Const. -44.50 Mech. - Electrical - Plumbing S.M.I. Grading Driveway Enc. Date Owner Infrastructure WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a'certificale 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'COMPENSATIONINSURANCE (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, alter 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.) Lenders Name Lenders 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. 1 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 TOTAL 45.00 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 3/2/87 Permit Validated by: Validation: A 7 4 3 5 3 5 45.00 it CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMVG FEES IST FL. SO. FT. ® $ 2ND FL. SO. FT. POR. S0. FT. ® GAR. SO. FT. ® CAR P. SO. 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 FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM HEATING (FINAL) 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 BOND BEAM 3/27 S0. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1+/4 c SEWAGE DISPOSAL LUMBER GR. SO.FT.GAR ® 3/ac HOUSE SEWER FRAMING FINAL INSP. 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 APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM 3/27 7 WATER SYSTEM GRADING cu. yd. $ plus x$ _$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING q (� DEC ' E987 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 :d ■ E"':E E 'C :;„:aCE Ela= E :MEWE . 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' .'�0n:■ ::n° a.a... .■ME■SENE.■.�: :aan■.nES n MEN �■ N■� ■ ■NEM ■■■■ 11111 111111111111011111 ■ ■■■. ■■■ .Ea®■C ..■■no C ' E::■■ : : ::C SEEM 11111111 wE...�■..■......E�. _ ■..■. .5 as .. ..:.:■■n: n . ::. --M-M-E-1-1 ------ UNSEEN ■■-.■■■■-E-N---.-■-O--°-�-0-- .■■-■-■-■-■ EN .- 0 10 1n':'®'a'a° ::::■:a:l:e:aMi momNEWS .n.■. ■i:■ .a .■ .nn momE°■■■.■■ ■IN ■ ■H ■EN:. ■C ".®:Ca :'Ca■EC:CCa■E ■■■MINE OEM ■:■::. ■■E■■.■: - ■ ::aaCC:: SEEMS! ::::::°a:a .:�C..n.....-. �■�...C..■..:�■a■■■ MONSOON ■ EVEN 0 ■■-n■E.■■■i -------51■sMM■C■ P.O. BOX 1504 Building 78-105 CALLE ESTADO Address ' . 53-615 Aveni3a TLfttJX= LA QUINTA, CALIFORNIA 92253 Mailing Address P.O. BMC 5535 CityZip Tel. pla3 tArt=n 92635 1 525-8806 Contractor Address City . ' Zip " Tel. State Lic. I City & Classif.B1 .. 1.35068 Lic. # 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 force4nd effect. r! i t 7 ? v t SIGNATURE ' DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contract6ir's License Law for the following reason: (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, atter, 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 or 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 of Section 7031.5 by 'any applicant for a permit subjects the applicanttoa civil penalty of not more than rive 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 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.) ❑ 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.) O 1 am exempt under Sec. MB. & 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 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. f 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.vthis.cityI to. enter the above- mentioned property for inspection purposes! Signature of applicant ✓ +Date _,2 Y t' Mailing Address - r City, State, Zip ' HARD COPY No. 002010 BUILDING: TYPE CONST. VN OCC: GRP. R' A.P. Number 774-131-01 Legal Description Lot 6 Project Description SL"43iq family &A811 iM 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: A4011 1. 2.8.'. J 68&3G f . Sq. Ft. 1344 Size QM 480 No. Stories • 3. No. Dw. Units 1 New 9 Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $ 70,225.60 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 45.73. Const. 346.00 Mech. 34.00 Electrical' 74.25 Plumbing 89.00 S.M.I. 4.94 Grading 20.00 Driveway Enc. 20.00 Infrastructure .. 4 n yy 1 053.40 TOTAL 1 9-48 323 1 1.688.30 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: A4011 1. 2.8.'. J 68&3G f . CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLt7MQkNG FEE.,.. 1ST FL. SQ. FT. ® $ 2ND FL. SQ. FT. POR. SO. FT. ® GAR. SQ, FT, ® CARP. S0. 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 FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED 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. SO. FT. ® c BATH TUB BOND BEAM SQ. 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 FINAL INSP. 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 T -/AROUND PLUMBING /? UNDERGROUND A.C. UNIT COLL. AREA LAB GRADE Z ��[[ (TROUGH PLUMB. 1 / BONDING HEATING (ROUGH) STORAGE TANK FORMS 11tSEWER OR SEPTI *OUGH WIRING �' DUCT WORK ROCKSTORAGE 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 �d� a REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH 1SULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL TI{ a Ky Iup tL 31 4 • flEp 0 _ = = 0 h BERMUDA DUNES r RANCHO MIRAGE INDIAN WELLS H PALM DESERT a JP LA CIUINTA 100 INDIO 11 Desert Sands Unified School Diftrict 82.879 HIGHWAY 1 1 1 • INDIO. CALIFORNIA 92201-5678 • (619) 347-8631 January 7, 1986 City of La Quinta Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 Re: Lot 6, Blk 244, Unit 23 Gentlemen: The developer of the above referenced lot has mitigated its impacts on our overcrowded 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, John D. Brooks Assistant Superintendent Business Services JOB/crm Q Z O H U W N M Z O H U W (n Receipt No. G District: Riverside ❑ Indio ❑ Hemet ❑ DISTRIBUTION: WHITE - Office File YELLOW - Applicant DOH SAN 122 (Rev 10/84) Issued By Date PINK - Building Dept. GOLDENROD - Pending File COUNTY OF RIVERSIDE, 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 %/// L 6 i/ lG' it `', I JC - C ` G ✓ ✓ , f /o i J /t / ( l G -"c' 6e, City State Zip Code Phone 'Property Address 'City or Community" 'Legal Description of Property (Lot, Parcel Map, Tract) 'Assessors Parcel No. Z Water -Serving Property From Lot size Signature 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 Q Soils feasibility report required Yes ❑ No Q Detailed boring report required Yes ❑ No ❑ J Detailed contour plot required Yes ❑ No El Comments: Soils or boring report by Date Approved by Date Soils Map Page ✓ /% Soil Type / = J Tract File No. °' Other' Number of Bedrooms Septic Tank Size (gallons) Rate Required Type of System 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 Location of System Additional Regpirements,, V(/ A permit is app roved%denied>for 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. Signature of Health official - Date Receipt No. G District: Riverside ❑ Indio ❑ Hemet ❑ DISTRIBUTION: WHITE - Office File YELLOW - Applicant DOH SAN 122 (Rev 10/84) Issued By Date PINK - Building Dept. GOLDENROD - Pending File