BLDG (0011-067)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
Tact
Date ti f�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&RC. 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:
Cartier Policy No.
43TAMi�F33
(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 All fofthwith comply with hose provisions
Date:. a' a.r tApplic ntT
Wa ning Failure secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director.of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that'the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
�$ignature (Owner/Agent) ,�'�%`^� %' , `� r' % Datee
BUILDING PERMIT PERMIT #
DATE VALUATION LOT (j'_, TRACT
JOB SITE APN
ADDRESS
^K'�_!a&?61 A�'it4i•fklsl't7�L'�:d'.r� a it, w _r . L.�..' .,.
OWNER
52480 JAVERIDAINJENDOZA
Lh Q;f1A.
USE OF PERMIT
CA 92253 'MIERMAL CA 02254.
11 (7f;6)?76--/663 Blif 281;10
).' ru-P.,400FrIWITH, 25 Y'ZAR. COMP S111W )`Y..1P'S (CLASS h R.W.rQ'O)
REROOF
3�350.001z
P E�.t'F".(1c�'��';E4'.>t.,R 90M: i+ &RY
REROOF SEF? 10), -000M418.000 $10,00
11AT3-£O'k'ALCC)NSTfiT.ie."°.t 011TKM PT Ali-C2WC':f $30.00
LESS PRIE-PAMM-0 $D.00
RECEIPT DATEr 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
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
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)
Building
Address
Owner
P.O. BOX 1504`. N4. 002847
52-88'v A cta 1,ks&= LA QUINTACL CALIFORNIA 92253
Address,
City Zip Tel.
. 922 X54-03
Contractor
Address
$lam
City . - Zip' Tela
st
BUILDING: TYPE CONST: - • OCC: GRP.-
193.
-
A.P. Number
Legal Description-. s
Project Description
State Lic.
City
& Classif..
.Lic. # .
Sq. Ft.
No. No. Dw.
-.
Size .
Stories - ... Units •.
Arch., Engr.,
Designer -
New O • -Add ❑•
Alter O '. Repair ❑ Demolition ❑ • .-
Address
Tel.
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 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,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, Chapter9 (commencing with Section -'7000) of
Division 3 of the Business and Professions Code, or. that. he is- exempt therefrom, and the- oasis. •
. 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 I,1as 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. thatsuch improvements are not intended or offered for sale. If, however, the ,building
Estimated Valuation
ee!!
it I e vxD
-
.. PERMIT
-• - •AMOUNT•' "
•
. ;Plan Chk- Dep:
_ Plari Chk.. Bal.
- -
Const. '
- 2£x.00
McCh.'•
-_
Electrical
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.)'
P-lumbing-
-• 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 .
�. J
S.M.I.-
-
Grading
Driveway Enc.
Date Owner,� !�` * -- ` f'
Infrastructure
WORKERS' COMPENSATION DECLARATION
"
• " " I hereby affirm.'th'at 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..
TOTAL
20..0
'CERTIFICATE OF EXEMPTION FROM
_ WORKERS' COMPENSATION INSURANCE'
REMARKS
•'
-
(This section need, not be completed if the permit is for one hundred'dollars'($100) -valuation.
,..orless.) .. .-. ... - .. ._.
I certify that in the performance of tha 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 shouldbecome
• ,subject' to the Workers' Compensation provisions' of the Labor Code, you must .forthwith
comply with such provisions or this permit shall be deemed revoked.'.
ZONE: BY: '
•-M.inimum Setback Distances: `
Front Setback from Center..Line
Rear Setback from Rear. Prop.. Line
CONSTRUCTION LENDING AGENCY
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.Street Setback from Center -Line '
Side Setback from Property. Liffe
Lender's Name
FINAL DATE
ISSued by:
Validated by:
Validation: -
A7142
' -
INSPECTOR
YDate 1" 27Permit
,
1` Z0': cQ00"' Ck
- .
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.
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. 'f
.'
Signature of applicant {{// , ' ' r Da ; d�,ire
Mailing Address f r
City, State, Zip t.
- HARD COPY.
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. p $
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
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./EOUIP.
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 C
SEWAGE DISPOSAL
0 `�
SO.FT.GAR ® 3/4c
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./EOUIP.
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
0 `�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
UN'S WUNA I UHLWINITIALS
GARDEN WALL FINAL
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APPLICATION FOR TREE PLANTING Job .92,5-29-
I (we), the undersigned, hereby certify and acknowledge that I (we) have read the application and agree that if tiees are required under River-
side County Ordinance No. 457, the applicant agrees to install said trees prior to final inspection. It is understood that no final inspection
will be given until said requirements have been met or exception has been granted by the County. Now, therefore, it is agreed that theprop-
erty owner shall cause the property'lines to be surveyed in the event no survey stakes can be found. Further, it is agreed that the County of
Riverside shall assume no responsibility should trees have to be removed due to lot line errors.
Owners Name W & H BUILDERS. Building Permit No. 3
Mailing Address 12540 Palm, Dr P 0 Box 818 Desert A. Springs state C Zip 92240
Job Address 52880 Avenida Mendoza community La Quinta 4
Legal Description Lot 19 Blk 147 Unit 15 S nta carmelita at Vale
Assessor's Mop, Book &Page J Type Structure Dwelling
Type of Soil' Sand Is water available yeS Road Dept. Plot Plan No.
Type of existing trees in road right—of—way
Trees preferred by applicant (f) Olive (2) Palo Verde 4(3) B zilian Pepper
-
W & BU ILDE
Date 9--EGb . 1979 Owner's Signature
Planning Commission Case No. PERRY C. AOBERTSON
ROAD, DEPARTMENT APPROVAL
Approved species Olea euro aea (Olive) Number of trees 1
Spacing of trees Distance from lot. lines: Front 21 in R Tw Side
Additional requirements Per plot plan on reverse.
r
Date Building and Safety notified 5/79 Signature
REQUEST FOR EXCEPTION
Reason
1 *1,.
Request for hearing: YES F-1tiro
Owner's•Signature —
Planning Dept.
Concur ❑
Date
Road Dept.
(attach additional page if necessary)
(Forward application to Planning Dept. if exception requested)
NO REQUEST FOR HEARING
Non -concur ❑ Explanation
Signature
Concur' ❑ Non -Concur ❑
Date Signature
. _ JYflr
REQUEST FOR HEARING AND COMMITTEEIDECISION
Date hearing established Date hearing notice mailed to owner
Approved ❑ Disapproved ❑ Date Owner notified of decision
Date Building & Safety notified Signature
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NOTICE: THIS IS NOT A BUILDING PERMIT DISTRICT
APPLICATION TO CONSTRUCT Permit No
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE Job 925-nO
IL
i
284 199 9/74 t
CANARY—FILE, PINK—APPLICANT
Owner 4 It BUJUERS Architect H R QHS Contractor 4.0111 Cfid';P
12540 Paint Dr P 0 BOX RIS � 25�4Q I'8ila Dr
Addres 25
d gs A� _
i."ln&_, Ca S'pT $.� Ca
City t iCN t�l� C1tX'kS'£Y" ,�{Ot
Phone Phon Phone
tki NU
cK
W
I (we) the undersigned, hereby certify and acknowledge that I (we) have read the application and agree that if Curb and Gutter, and
Z
Paving, and/or Dedication of right of way is required by the County of Riverside, the Riverside County Department of Building and Safety
3
shall not make a Final Inspection until said requirements have beer' met. 1 am also aware that no work is to be done within the County R/W
O
without an encroachment permit. r / Y
NOW, therefore, it is agreed that I (we) will not occupy said property and will not cause said property to be/ occupied until I w have
complied with all laws of the County of Riverside and the State of California governing said property. if jll_?�,..,,,..s,
DATE 9 Feb 1979 SIGNATURE OF OWNER AND/OR AGENT •://lf l �'�
PF•itKY d%# DBERTSOA
Approval by Signature from the Following Departments Listed Below
Must Be Obtained Prior to the Issuing of a Construction Permit.
( SPACE NO.
`
•
1 USE OF STRUCTURE /
JOB ADDRESS 52880 AVrrilid8 Mendoza I �l
— i SINGLE FAMILY DUPLEX
>'
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LEGAL, DESCRIPTIO OF PROPERTY
;mit 19 14%tUnit APARTMENTS AGRIC..
i\
N H
" COMMERCIAL INDUSTRIAL ❑
La quint$
COMMUNITY
ALTERATIONS
C
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NO. OF SUBMITTED PLANS — _ USE OF PERMIT f ~ LJ .
--
Q
CASE NO.
p Z
NO. OF PARKING SPACES REQUIRED NO. OF BUILDINGS NOW EXISTING —
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ZONE -� SETBACKS: FRONT SIDE ''REAR ' ~
J m
GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE .� r
SETBACK ORDINANCE # __ OF FEET REQUIRED ON STREET
DATE --_ / -jI .SIGNATURE OF LAND USE OFFICIAL
(YES
F,
DEDICATION REQUIRED.: ❑ -NO-C:) NO. OF FEET---
z
CURB AND GUTTER REQUIRED: YES ❑ NO `❑ STREET
W
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
CIMPROVEMENT?
YES m NO C3
2-
°L
DATE �SIGNATURE OF ROAD DEPT. OFFICIAL
a 2 7
QW
SEWAGE DISPOSAL _
_
t
T I47
WATER POLLUTION # REMARKS
�-
FLOOD CONTROL �
CA WAIR POLLUTION
_'i DIV OF HWY ��
o a — s'� YOUR PROPERTY MAY BE -SUBJECT TO
o FLOOD. RIVERSIDE COUNTY ASSUMES
Y.
NO RESPONSIBILITY IN EVENT OF FLOOD.
284 199 9/74 t
CANARY—FILE, PINK—APPLICANT