SFD (9806-108)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
480121 B I C20 C`36 9/30/99
Date ' %� �^ Signature of Contractor ,-�"yam �%
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.
:"i'f A'I 13°JND 1'11,1
(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 shall forthwith comply with those provisions.
,,Date: Applicant
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
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.
'Signature (Owner/Agent) •— - �`�' Date!
BUILDING PERMIT PERMIT# CONTROL#
"�3ilti-1.94
DATE / VALUATION 5224,034.541 LOT 1 TRACT 2769 6
'
JOB Slit
ADDRESS 811"1 M(iUNTMN igENV 1�ANE:
APN 767-480-001
OWNER
CONTRACTOR / DESIGNER / ENGINEER
S,I,OYD & DEBRA A: LESSA:I.D
10141_.)E%rF1.0P1vti#?NT CORP
80101'1:ANGI:ER AV I?
40048 SAGENVOOD 17R
IN.DIO CA 92201
PALMI DESERT C".A. 92261
(760)31-4510 C13L# 1326
F1:%(`rC3a`0 & ASSOC
USE OF PERMIT
SiN _iLE FAMILY DWELLING
741341 VjI LIC, WY 811, 5
Stlu - PMMIT 00Eti NOT 1NCLLWE i3IAXK WALLS OR KA.
�
TRACT CO1`ISMUC ION 3,525.00 SF
PUR(',.E I/FWA•TIO 78.100 W-
GARAL9 , CARPORT 1,114.00 S:t`
EN T1MU' ILD COST OF CONS"x RU 110NN
224,034..50 .
PE.1CtM1jT FEE SUMMARY
r.10NS'1RU(.'TK NFEE 101-I)Of)-418-000 Si,t?7,.ttt3
MAN(Ttf+r*K nI.. 9
rLE DEr0311 101-1100-433-•328 1i2Sa.00
t1113C1L NICAf, FEL 101 -000 -42I -OW li3.i0
ELI RI'CAL FlUt" 101-000-420.000 $245.4A
Iaf,i ImilIN(i. VFT. 101-(til-A194.Ni11 $'71-7 ''5
STitONO NV.iTION 1,11:: :R€;SIT1 101.000-241-000 322.1 110
Q'RAJAN1,; f^6 . 101-0 03-423-000 $20SK)
INI RANTROC" "UR FV1; 225-000-443-342 S4,itp5 ^,6
PRrt(ITSF PIAN 1014)00-441.145
AN TIN 1''tr.BLIC PLACES - Rxal%: 7(t AMX'-255-000 $31(1,)9
SIJB-'1't`)TA(, CONS')'iitr(:'1`I(_)N,ANTT) PLAN (_"F EC"K
S7,712444
LI SS PRE-PAIDFUS
•$250.00
TOTAI, It FiZiViV JT 1!+'1+.KS O1IE NOW
$7,482.94
RECEIPT
DATE
BY/ v `"
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs i
Underground Ducts
Forms & Footings I Qj
Ducts
Slab Grade 1
Return Air
Steel Z
Combustion.Air
Roof Deck {_44-ZZ-20Exhaust
Fans
O.K to Wrap I
F.A.U.
Framing [
Compressor
Insulation 1 - /
Vents
Fireplace P.L. I
Grills
Fireplace T.O. s
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall I
Exterior Lath i S
Drywall - Int. Lath i -
{
i
1
Final
Final i
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs I
Electric Bond
Footings I
Main Drain
Bond Beam I
Approval to Cover
[
Equipment Location
I
Underground Electric
J
Underground Plbg. Test
Final 1
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines t
Heater Final
Water Piping i
Plumbing Final
Plumbing Top Out I
Equipment Enclosure
Shower Pans !
O.K. for Finish Plaster
Sewer Lateral i
Pool Cover
Sewer Connection [
Encapsulation
Gas Piping
Gas Test . 9
Appliances t
rr c-- [ -
Final
` i"
t
Final }
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole [
Underground Conduit
Rough Wiring 1
Low Voltage Wiring I
Fixtures i
Main Service W
Sub Panels I
Exterior Receptacles
G.F.I.
Smoke Detectors [
Temp. Use of Power
L t
r ' [
Final C.
Utility Notice (Perm):
COMMENTS:
V t Ew. LnS . P.O. Bo
Building ,� 71/ /h7 / UINT CALL
Address n LA QUINTA, CALI
Mailing/
Address
City Zip Tel.
Contractor
Address
k,I," IACfc" ;% �'1'�11�.�ISk//—I/S%U
state LIC. t r
& Classif./�U - Lic. q
Arch., Engr.,
Designer i f G U` U �
Address Tel.
i L/- r S`/ `C L / C w,e ✓ Sit S" (9
City / Zipper State
iii: G err � e SFft! 'l .; 4,0Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 commencing with Section
7000) -df Division 3 of e-B�u-s/ipes and Professions ode, and y� i ense is in full force and
effect. � � /� � ���
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8usiness 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).
t-: 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. It, 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.)
I 1 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 contrac(ors) licensed pursuant to the Contractor's License Law.)
f7 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
F1 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 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 pemmif shall be deemed revoked.
54
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit i issued. (Sec. 3097, Civil Code.)
Lender's Name�C1—( �'?
Lender's Address;2 ( f u ri,,l s. g'. n %=. ./ toy.. t �k
This is a building permit when properly filled out, signefJ and validated, and is subject to
expiration if work thereunder is suspended for 180 days. r�
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 purpose /�J//
Signature of applicant /i /' -'�i-0 at0`"e l • �lJ 6'
Mailing Address
City, State, Zip = i_• 1 _
PAI
1504 ETAMPICO /APPLICATION ONLY
FORNIA 92253 /�, J U N 1 U 1998
moi/ i
ILDING: TYPE'CONST.
'. Number 7 4 % o�
� / ✓ oML �.' f 5
)al Description I) T R/ Joe;+ A l q
Project Description
1 C
Sq. Ft. 35-1-5' No. /
Size Stories /
No. Dw.
Units
New'y Add ❑ Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
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:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 9/25/98
No. 17814
Owner NameLloyd & Debra K. Lessard
No. 81-995 Street Mountain View Lane
City La Quinta
Tract # 26769 Lot # 1
Type of Development Single Family Residence
Comments
APN # 767-480-001
Jurisdiction La Quinta
Permit #
Log #
Zip 92253 Study Area
Square Footage 3,525
No. of Units 1
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered
patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes.
It has been determined the above-named owner is exempt from paying school fees at this time due to the following
reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
1.93 X 3,525 or $ 6,803.25 the property listed above and thatbuilding,
permits and/or Certificates of Occupancy for this square footage in this proposed projectamxy now be issued c, ,
' �: m
Fees Paid By CCPD National Bank/DGH Development Corp. 'Jelepho e 347 ;4510
Name on the check f1W 0
By Dr. Doris Wilson "�• �:., ^r��� =
-
Superintendent
xt�
Fee collected /exempted by Juanita Green Payment Received $6,803.25
Check No. 74047
Signature
INOTICE: Pursuant of q embly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run from the dale on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them on the Dislrict('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
Ll
r,
C04NASSESSOR'S PARCEL NUMBERTY OF RIVERSIDE HEALTH SERVICES AGENCY
_ _
DEPAATMENT OF ENVIRONMENTAL HEALTH
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 as indicated on the attached check list.
A non-refundable filing fee is required when the application is submitted. Check must be made payable to the County -of River, ide? App(�yAj, bf this applid"aJ,6
tion shall remain valid for as period not to exceed one year from date of payment. 5135 $214.0
LMS # 017'1dF (A (90,AIM CHK $ 2214 -'(3(
Agent, Contractor, Contact Person
Address City State Zip
Telephone
A%,tC
`/G (.tt/ '"�,4,, r��.-e/ �.1). 1/1 i
'. /•i!jll�
Owner
Address f City . State Zip
Telephoner
Q
/ /
4J 4( L g- sspI� ct
.1--U^/u 4" /e ri 4 `-(P r
I)C'j /41 C
Z
Job Pr erty Address
City
Zip
U
LLI
(0
Lot Size r A en I Use of Permit, P/P, SUP, PUP, etc. Legal Description
/ k'U k t% t t✓ 1� t 11 �✓& A Tl. (d2al E (oT /� %/T A e T o? la 7 0
v
Dwellin MM.Site41,epr+etc. �3y14 q� 4
Signature of App lica t �j/� ♦ Date
�;r� .i�� .-/.rel/ �•YD � !.3
CHECK BOX 1F REQUIRED
`
❑ Holding Tank Agreements Completed
❑ Detailed Contour Plot Plans Required (1 to 5 foot interval)
❑ Certification of Existing S.D. System Required
❑ Grading Handout Provided
m
❑ WQCB Clearance Required
❑ Staff Specialist Lot Inspection Required Thomas Bros. Page
Z
O
(Attach For DOH -SAN -007, Santa Ana Region Only
❑ Lot Inspection Grid
U❑
Soils Percolation Report Required
W
U
❑ Special Feasibility Boring Report Required
❑ Date Lot Inspection Completed: Initials
❑ Rereview Required
Remarks:
❑ Maintenance Booklet Provided
Initials Date
❑ Final Inspection by Department of Environmental Health is required.
OPI!M Soils Percolation Boring Report by BuEN�, ANG/N ��I i Lwe�Project # B'7'r,)� -'4/Date 6 -02 r- ,1
/
Soils Map Page Soil Type Approved By Date
No of Systems
Type of System(s)
❑ yelaing Tank ❑ Replacement
Flew O Addition
No. Dwelling Units /)
Bedrooms, s
1396A., y P. A4414 (M4,
(1) Septic Tank
`
Soil Rate
se/Sand
Greas /Lint Trap
❑ Existing
/e-
S-
7
"44)
al.
dal.
r (
Sq. Ft.
Bottom Area
Total Linear
Ft.
Sidewall Allowance
LLrd(!i f•,IrN �dfk
Se Bed sq. ft. of
go
'
I . rock/ �q. ft. running ft.
Inlet Tested Depth
Lmtall �- Line(s) SQft. long 3 ft. wide with
n.�inches rock belowaJralnlines•or-
Area
/
Proposed Bottom Tested Depth .._lA
A ! 7 A.
A If I (741 L4 Woo,.
Z
Leach lines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below Inlet (BI)
Seepage Pit
Maximum
Other:
O
U
Appficable
-Overburden
Total Depth
Allowable
W
N/A 60" Factor ""'
❑ 5'
TD
Well Review Approved: Date: Well Drilling Permit #
SIGNATURE
Grading Plan Approved: Date:
SIGNATURE
Sewer Verification Approved: Date:
Plan Check Only Approved: Date:
REMARKS: ,r , KY Zt�
c� a -�
N14-
ljis app I lorf I PPR VEDA
above, regarding th disposal
/%� �� pR OFFCESE Ot�I0Y 4 r
�,d•�.•�
a subsurface system as indicated on the
acompanied plot plan, using the requirements set forth in SECTION C above. A build-
Qtrry+�1,�/`
ing permit is necessary for the installation of the above -designed system. No con-
Revenue code O Fee $ ' . d (/
struction is permitted in the required reserved 100% expansion area.
SV
(1) Septic Tank must be Y00 minimum from any wells.
e
M --Check #
0' minimum from any wells, incl Ing expansion_ area.
r) -t— . ! 1'
2) each lines must ?e500"
Gi" OY1- �
Date / r �{J Initial
0
(3 Sewer lines must Inimum from any wells. 0�"
I
� IC •7 . T
Z
�,�.,....." "
O
(4) Seepage pits must be 150' minimum from any wells, including expansion area.
i`
U
W
U)
/r
Signature of Health Official
�1
Date
« % - �,_u, uisuluuuun: vvr i r m—vmce rue; YELLUvv—Applicant; FINK—bldg. Dept.; GOLDENROL—Plans/Records
Dear Builder:
Tiht 4 4 Q"
PUBLIC WORKS CLEARANCE LETTER
FOR
CUSTOM HOME LOTS
Prior to issuance of a building permit, you will be required to obtain clearance from the
Public Works Department for one, or more, of the following:
1. Verification that rough grading is complete, and the pad elevation certifications
prepared by a licensed surveyor, or engineer, are on file in the Public Works
Department.
2. Verification that infrastructure improvements and other required tract improvements
are complete, or sufficiently advanced to warrant building permit issuance.
3. Prepare an engineered grading plan that provides for on -lot storm water retention,
and have it checked and approved by the Public Works Department.
• Tract 26524 (Estancias)
• Tract 26769 (Mountain View Estates)
4. Prepare an engineered grading plan that provides for building pad grading in
accordance with the existing soils report and tract grading plan, and have it
checked and approved by the Public Works Department.
• Tract 28,034 (South Valley Estates)
FOR INTERNAL USE BY PUBLIC WORKS DEPARTMENT
TRACT:
LOT: I
PUBLIC WORKS AUTHORIZATION DATE
$ I --a95 No VWFA-)N U> -w L,,Wg .
F:kPWDEPT\DOCS\FORMS\PW CLEARANCE LETTER.ss
i.,
IJ v f
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification: SFD
Occupancy Group: R3
81-995 MOUNTAIN VIEW LANE
Type of Construction: VN
Owner of Building: LLOYD & DEBRA K LESSARD
=5
=1' Building Offici
Bldg. Permit No:: 9806-108
Land Use Zone: RL
Address:
80101 TANGIER AVE
City:
INDIO CA 92201
By:
KIRK KIRKLAND
Date:
3-30-99
POST IN A CONSPICUOUS PLACE