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PLBG (9708-099)53925 Avenida Martinez 9708-099 04385 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 KGIh f F: {.' / iii 111111 r 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: ( ) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business & Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ( ) I am exempt under Section , B&P.C. for this reason Date Signature of Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ( ) I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ( ) I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier Policy No. S'{'AEis FUND 1.17121)':-` 4 (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 a workers' compensation provisions/oflSection 3700 of the Labor Code, tlsh I f i comply with those provi"irns.Date: jApplicant r Warnin :Failure to secure Workers' Com ensation 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, indemnEf>/ & hold harmless the City of La Quinta, its officers, agents and employees. G 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,;.epresentatives of this City to enter upon the above-mentioned property fort speetion purposes. s Signature (Owner/Agent)'- 7 f Date BUILDINGPERMIT PERMIT# CONTROL°#, .' :; DATE 1411AW97 VALUATION l: ' sl.eiii LOT TRACT JOB E 5 .3 I f "iN,tSf 1{ 4V1! 1. APN 77.347-021 ADDRESS i OWNER CONTRACTOR / DESIGNER / ENGINEER 1 t A It hr 1, r7 '#1111 xf7'S 11"t ,16:trtl 1 I; h.lf• ' ii., x Q , r 'l hlll Cia lI;t, O: tS f1 t7 f1..r I,.a ,f •St 1% N .rt^•11N+.-.1 •/t .• r.fr .,.ly ?t.7i A(. s, !{S••{'i 1 ti).:1.15 'r illl.'14. 1 1 j1.l.I }S{J<! l'.i? Lpp 01 IINi'A CA 07154 PIN I'M 1.111.1,141 " , CA 14-NNA r tfiQ)'1:ffi•7791 't;t.ft '142 USE OF PERMIT t'f "i.r ti k.4 PERMIf FF>tl.SUMMARY h'1.t Y41131ht3 3•"t 1; — :;IwV✓t iC jl)1 •{1t)t)r 1 cf.{1t)t) S,? j.lflt f. 1 s f1t-T{'i`{ i.t"om 110.IfMONANnT'11,ANCfIrA(`yryK WI'AL I'FRMIT fu.EVS I!I' F NK)'i:V 4 a3 Y"I 1 RECEIPT DATE BY DATE FINALED INSPECTOR Cy 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 Sewer 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: L L. Building Address 53-925 Ha ttinelz Owner Coachella Valley Land P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Mailing Address 247 , Tahquitz Way #2 CityZip Tel. Palm Svriacrs I92262 1 322-1020 City &tate uo Lic. # 89!i& Classif. 3$7934 Designer Address Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section t. 7000) of Division 3 of the Business and Professions Code, and my license is in full /force and effeca .4—*' i! 7 R! : CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SO F1 W S UNITS COLL. AREA YALAB GRADE ' YARD SPKLR SYSTEM 2ND FL SO FT. gr HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR SO Fl a DUCT WORK ROCK STORAGE FOUND. REINF. - POWER OUTLET ROOF DRAINS GAR SO. FT. er HEATING (FINAL) - OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) DRAINAGE PIPING CAR P. SO FT. (U WALL SO. FT. @ WATER HEATER DRINKING FOUNTAIN FINAL INSP. URINAL SO FT (a WATER SYSTEM ESTIMATED CONSTRUCTION VALUATION $ GRADING CU. yd. , —plus—x$ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.0OOL HOOD SIGN WASH ER(AUTONDISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED VENTILATION LAUNDRYTRAY AIR HANDLING UNIT CFM FIRE ZONE ROOFING 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 G LLATHING SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID g 1 I c SEWAGE DISPOSAL SO.FT.GAR (& >r:c 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 8 AIR COND. SOLAR SETBACK 9L�, GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA YALAB GRADE ROUGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. - GAS (ROUGH) METER LOOP HEATING (FINAL) - OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM j GRADING CU. yd. , —plus—x$ =3 LUMBER GR. FINAL INSP. ,_G RAMING /6 _� L/,�0� 6 FINAL INSP. �OOFING 6 v p/ V j o REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL G LLATHING MESH INSULATION/SOUND FINISH GRADING 4FINAL INSPECTION —rZ /d -- CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL 4 P.O. BOX 1504 APPLICATION ONLY Building 78.105 CALLE ESTADO Address s 3 9 .251:�7,4.4e?iti6" Z LA QUINTA,-CALIFORNIA 92253 Mailing ' / Address - A' �HQ� TZ W 4 -y '�"z City Zip Tel. P41/V sF701A)G S IF Z 2 G Z 1 32 Z -/O 2 - Contractor Contractor Address ,C,ity lZip I Tel.. 7-G.Z I 32Z -i State Lic. City & Classif. ��7 y Lic. # 9�" 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) t.of Division 3 of the Business and Professions Code, and my license is in full force and effec-- 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, after, 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 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.) ❑ 1, 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. 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 11 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: it, 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.) 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, State, Zip BUILDING DIVISION Z a BUILDING: TYPE CONST. OCC. GRP. A.P. Number_ 774,1'-171-,2n2_,- 7y—/7/-cnZ/,Legal Description f -/7 / .0 i >' Z 3 ,Legal Project Description Sq. Ft.No. Size /p No. Dw. Stories / Units New,® Add ❑ Alter ❑ Repair ❑ Demolition ❑ L /-7e57 Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. vo Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. - Grading Driveway Enc. Infrastructure /1.GG-Ccs c�U TOTAL REMARKS ..,,1 J.v t..narr 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: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE 2ND FL. SO. FT. BONDING 1 YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P.SO. FT. GAS (ROUGH) DRAINAGE PIPING WALL SO. FT. ®' OTHER APP.IEOUIP. DRINKING FOUNTAIN SO. FT. ® TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. GARBAGE DISPOSAL FURNACE UNIT . WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/. c SEWAGE DISPOSAL GAR. FIREWALL SO.FT.GAR ® 3/ac HOUSE SEWER LATHING , 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.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION rR 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 1-13 COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION P 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 0 is required when the application is submitted. Check must be made payable to the q r ounty of Riverside Pq M 0 H H W m U 0 0 EH U W Building Department Application Log N Name (Owner, Agent, Contractor, Etc.) Mailing Address $T.4,t2,2. •-LV7 t 7,yfiGu,rt V110VO'Z, City State Zip Code Telephone "Job Property Address L/, i , ". btyror-,,Gem r4_&ty *Legal Description of Prpty.,.•(Lot-, PM, TR) *Assessor's Parcel No. er g Use of Permit i:ulPf ,.Ale 42 . Lot Size 7 71/- / 7/ - O 2./ C {c `•� SFD , MH Site Prep Etc.r '• f J Planning Case N Signature of Applicant Date *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 reqd. Yes[ ] No[ %� / �� f r r WQCB Clearance regd. Yes[ ] No [' ] / - Soils feasibility report reqd. Yes[ ] No[/V }i Detailed boring report reqd. Yes[ 7 No 1 /1 1 ! Detailed contour plot plans reqd. Yes[ ] Ido V] - i Staff Specialist approval reqd. I Yes[ ] No[_] Lot Inspection Date Soils/boring report by// Proj. # Date Soils Map Page'/ Soil Soil Type G_( Approved by C Date 1 ra -- Type of System: No. of Bedrooms (1) Septic Tank Soil Rate Required Existing New Addition Replacement //,}/ Gals. (2)'Leach line sq. ft. Sidewall allowance Install Line(s) j Leach/ bed (Bottom trench area) ft. rock/ Sq. Ft. Ft. Lon Ft. wide Sq�"Ft-.,sof per running ft. with Min. "-inches rock bottom N/A [&,]' below drain lines area Leach lines/bed-special design (3) Pit Diameter No. Pit Seepage Pit total depth, -,.i for slope: Applicable .'.'e's[ ] 6' Bim]" Pits BI , N/A (/Overburden factor /Y. Max. allowable depth This application i.s approvedAdeniad for the design of a subsurface disposal s --stem as indicated on the acco�' mpannied plot plan using the requirements set forth in Section B above. A building permit is necessary for the installation of the above -designed system. (1)� Septic tank and sewer lines must be 50' from any wells, �"• ' (') Leach lines must be 100' min. from any wells including expansion area�'�__'��� �) Seepage pits must. be 150' min. from/any wells including expansion area Signature of Health Official Date RECEIPT NO. t. Issued by Date 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) r: r 2aG OFFICE OF AGRICULTURAL CO;NIMISSIONER AND WEIGHTS & MEASURES 49-613 Ilwy 86, Suite B-12 'Coadiella, CA 92236 619-342-8291 E. LEON SPAUGY CO%IMISSIO-,ER JAMES O WALLACE ASSISTA\I COMMISSIONER CLEMENT BENVENISTE SEALER DATE CASE NO. R p 7 r ,jL1, -a7 z`7 -- Co DEVELOPER'S NAME: .5 -1 -ACL CJ SE a CA I ADDRESS: cv Li tz - 1 A4 , u % A - N L TELEPI oNE: ( 6 1 ) 3 �) of - /o Q (-) Dear Developer: After reviewing your landscaping plans, all plant material listed is not in violation of quarantine laws governing the Coachella Valley. If substitutions do occur and they differ frau plant material listed, this office must be notified immediately. Thank you for protecting and preserving the Coachella Valley's pest -free environment. rid' Agricultural nnissioner's office cc: Indio and Riverside Office 7-7 Y -- f ?/ - d 2-1