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0103-236 (BLCK)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 655861 B I-TiC I` 0861 1W 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). ( ) 1, 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: Cartier Policy No. (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 thoZprovisions,,-" 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 inspectionp Signature (Owner/Agent) `//�br .� ^ �r.: � sera• r Date ' A� m v BUILDING PERMIT PERMT# r t DATE VALUATION LOT TRACT t '+ JOB SITE APN ADDRESS a OWNER CONTRACTOR/DESIGNER/EN (NEER � r CITY OF Lam. QUM& TOTAL CO`sdsillWC`noW `78-195 CALLEETAWTICID 723093 COUNTRY MUD DR Vr.E P -4d2 1A,g01W A CA 92233 PALM I7&ca'.'ERT CA 92260 060)360.8453 Ck3VA 4968 ; r: USE OF PERMIT i !t MMMALBY:I DIWO 30 1.X 15'aARD III b's'.RU-CITY ST.AWDARD 3614V 6"W{}i31DEN FENCE 6 PIE. WOOD FENCE Ly •F r, MIMA '13 COWS Off' Cri'ax4 laidG%i()X :�. i FEW -11 F .ir ET€3i� Lt1" 00NETRWTION FEZ 101-000-418-000 • r, t STUB-IAC.}'M, COW. MUCUCK PLA14 (MEM ai15.00 LUSS PR&PAID n0ed $0.00 RECEIPT DATE, BY DATE FINALED INSPECTOR I© I INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE JINSPECTOR 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 j Fireplace T.O. Fans & Controls [ Party Wail Insulation Condensate Lines { Party Wall Firewall a I Exterior Lath { Drywall - int. Lath { { { Final Final BLOCKWALL APPROVALS POOLS - SPAS Steel { Set Backs Electric Bond j Footings Main Drain [ Bond Beam Approval to Cover I Equipment Location { Underground Electric { Underground Pibg. Test ( . Final Gas Piping { PLUMBING APPROVALS Gas Test s 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 j -' 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 E G.F.I. Smoke Detectors I Temp. Use of Power Final Utility Notice (Perm) COMMENTS: CITY'OF LA:OUINTA Specifications .for ihe Rehabilitation ofd625 Avenida Rubio (See attached`drawing. Note: the attached -drawing 's -'only: being provided to give an. example of the 2:5' gardenf wall' and landscaping.) EXTERIOR Landscape: ♦ Cultivate and amend -existing soil to provide, fertility to support new landscaping. ♦ Install new irrigation lines at front, yard -assuring coverage of all plant areas. ♦ Install timefclock`for irrigation lines. ♦ Install new- drought. resistant, durable sod in front yard lawn areas. ♦ Install one mature. 15 -gallon tree in the front -lawn •area. (Seethe attached, Plant Material List) ♦ Remove any oleander bushes in the front yard. ♦ Install new 2.5 ft garden wall at front of,ptoperty across frontage per.attached drawing (wall shoul&stretch from -the southern edge of the property to within 5' from the driveway). Wall -to be stucco over'concrete block, reinforced, if required, to local code. Stucco %color,, to match house stucco. color. = Per City Code, wall needs to.be setback on the'' property line; this is,typically 12' from'the curb. See the attached conceptual drawing drid. visit 54-280 Avenida Madero to see how the desert-scape and garden wall can,be -designed. ♦ In front of the ,garden wall and on the, side of the driveway in the front yard, remove any current -plants and gravel and replace with desert-scape; drought -resistant, durable,'native'vegetation. Fill in withAesert-scape`gravel. The dirt underneath the gravel should 'be excavated 3 to 4 inches below grade and- a plastic screen should be laid down underneath the gravel. ♦ Install 10 shrubs -and plant accents. along the foundation on the south -side of the house in front yard and along new front garden wall. Use low -maintenance; durable, and drought -resistant specie's, -giving preference to native vegetation. (See,the attached Plant Material List) Building Exterior: ♦ Prep, prime and paint all_ exterior trim and stucco surfaces, including tthe four columns for the fence (see below) a' id'the garden wall (see.above). Fill in any significant cracks or voids. on the stucco And 'eaves. Colors to be selected by Agency. 4 Install address letters on the wall facing Avenida Rubio on the southern wall on the side oflhe'ggage door, minimum 4" number height. ♦ Install new eritiy way/exterior lights on both sides of the garage. door (one should illuminate the address letters). Replace,the entrywaylight in the front porch near the front door to match the new exterior `lights installed at the garage door. F:\RSG\LAQUINTA\LQHP\Rehab Program\PropRehab\Group B\52-625RubioSpecs.doc 1/3/01, 1:46 PM ♦ Install exterior wooden fence around'property'to.tonform,to=local code. The fence should -be constructed of 6' vertical, cedar (or.,similar material) slats:,: The existing' posts can be reused if they aresin goo'.'d shape: Install ,one steel frameggate on the north side of the house. The gate shoul'd-be anchore'd.by 2:stucco columns;approximately V x 1'. The fence, should be extended to Within five feet from the..edge of the garage on the north side and Within• five feet of the edge of the house on the south side. Also, install 2 stucco columns'on the fence.on the. south side'of.the property, and create a fence between the columns, ,do not.create a steel frame construction gate.' (Visit 54- 280 Avenida Madero for an example of.the stucco column and steel frame construction for the gate). Hardscape: Steam clean existing driveway and walkways. INTERIOR Heating Ventilating and Air Conditioning System.(HVAQ: ♦ Remove existing HVAC and dispose. Replace HVAC system with a new split system appropriately sized for the house. Contractor to locate compressor af'a location agreed to by Agency. Horizontal fan and coil unit to be located in the backyard, unless otherwise. specified by Agency. Clean air defusers. Miscellaneous: ♦ Visually inspect the unit before submitting bid. Include any and all. repairs, or replacement work not included�above; but,necessary iq bring the unit to current code and as new condition. Detail in bid'as needed, breaking out costs separately. ♦ Before inspecting the unit, contact should'be pniAde.with the occupant at (760) - to .schedule a°time to inspect the property, .especially if access to the backyard of the property, is desired. ♦ Include all costs of inspections, permits* licenses, and testing as needed. ♦ Please.use-the enclosed Bid Form or create a Bid For m<that is similar in form and nature in the appropriate.sections as needed per the. above'specifications. ♦ All contractors to submit contractor license number,'name;°and address of responsible managing employee with bid. ♦ Successful bidder will have five days,from award of bid to.submit insurance certificate including- coverage for.Workman's'Compensation, Builder'•s Risk, and Liability Insurance, with at least $500,000 coverage with ahe Redevelopment Agency of the City of La Quinta, as an additionally insured. Any subcontractors should submit proof of.insurance as -well. • The successful bidder will also have five=days from award of bid to obtain a City Business License. F:\RSG\LAQUINTA\LQHP\Rehab Program\PropRehab\Group 8\52-625RubioSpec.doc ' 2 - _ 1/3/01, 1:46 PM