0011-085 (PLBG)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
/48 I ap
C21 C2 I 1130t2c
t
yDate � 'Signature of Contractor 1/ :`__' �J% i `�,� '—
r .
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 thispermit is issued.
( )il'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. '
STATE FUND i lS3�t33 -Std
(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' compensationprovisions of Section 3700 of the Labor
Code, I shall forthwith comply with those �ovions?
Date: /7//! 2 )Applicant—
Warning:
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 forin 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 aty
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 forinspectionpurposes.
Signature (Owner/Agent)A r; 'l` x . �. Date
BUILDING PERMIT PERMITN
DATE VALUATION LOT 0011-•085 TRACT
JOB SITE
APN
ADDRESS M-15.3 AVEMA IME10
y
OWNER
CONTRACTOR / DESIGNER / ENGINEER
DARRY— i SC'fi W..CL
ALMS UAII)HT; GROUN i C ONS':f.
53-15 3 MwIRMA RU13I0
38703 VISI'ADItiVE
LA QUMTA CA 92253
CATHEDRAT.. (MT CA 92234
.(760)324-1911 CBU� 769
USE OF PERMIT
1a'J 1.JY.b st�A'SCS
SEPTIC `I'ANK AFtANDONMENT - SH':V` ER HOOK-UP
VAi.LlXtION 1� 3.tlfl Ida
ii:rTk tai D C:Ci '�1s (:OI4%�sg 'dIG1"IiJY�
1,04SAX)
'L'•FAWI' MAX H'UMMARY
PLL1MBIANO FEE - SWER 03.000-419.000 S30.tT1}
SUB-` OTAL C!014S iRUC`TlON ,-4ND .T.11A S C" C.IC
$30.00
1.2.40 1 .35^I''AD) MWS
I$0.00
(�
RYEAL F':Ie-' kgf ISS DUF. NOW
NOV 17 2000
AT• Y u r LA QUIVA,
g
RECEIPT
DATE " }
BY,
DATE FINALED
INSPECTOR
tt
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:
77
. .�. ...
COACHELLA VALLEY. WATER DISTRICT
CASH RECEIPT DETAIL'
�.
k' C- pC,�'t' �a', ,�.{,���; ":�.f4f �.fC/.`i{, a�. ,"..•i1��1�'`r�1,�' •!4 ��� �� �,
Received From: '.2' —, -Date: Lf.
(,. .Address: _d . %� c f r• . -
BIL 1/ Y�AccountNo. / 2 LotsTract v �
Service Address ✓ _ l 3""4w. to FS)sf 4 G.A. Code
❑ Meter(s) $
❑ Service(s)
❑ Backflow(s)
❑ House Laterals)
❑ DetectorCheck(s) }
!
❑ Meter Surcharge �. .
:€7 Sanitation Capacity Charge p ��
❑ W.S.B.F.C.
❑ Temporary Construction Meter
I"Y ❑ Turn on Charge
❑ Uncollected Account -Name
❑ Inspection Fee - Tract -
Fee - 1,
❑ Plan Check Fees Water I Sewer - '
Tract -
❑ Bond Payment -•A.D. - Bond
Assmt.
❑ Customer Deposit °
❑ Other r
TOTAL $
I Remarks:
41
�.:.
ECash Water Service
k !,!����i 4 a?te ti'• o i
i. Money Cash! �tr r
Order �'•,� �.; / F CVWD-438 (11189)
ALMS UNDERGROUND CONSTRUCTION
38703 VISTA DRIVE
CATHEDRAL CITY, CA 92234
(760)324-1911; FAX (760)324-9541
CA. LIC. #482180
/vou. 20;31D
N St.
JD/e- ase 11e-elp OK f71 e .
H
i
+;
y
��v>ees-7-45s
%��1��
JV�►,�.r�
Vow
/o r\ -.7-o l'o
jJwj(
�2rvn>�S r -Or
...;
��.�trgroknid
N St.
JD/e- ase 11e-elp OK f71 e .
H
\14ATE
R
srPrSg�y., -ESTABLISHED, IN 1918.A5.A PUBLIC AGENCY
O/STRIC�
COACHELLA VALLEY WATER DISTRICT
POST OFFICE BOX 1058 - COACHELLA, CALIFORNIA 92236 - TELEPHONE (760) 398-2651 - FAX (760) 398-3711
DIRECTORS: OFFICERS:
JOHN W. McFADDEN, PRESIDENT STEVEN B. ROBBINS,
PETER NELSON, VICE PRESIDENT GENERAL MANAGER -CHIEF ENGINEER
TELLIS CODEKAS MARK BEUHLER,
RUSSELL KITAHARA ASST. GENERAL MANAGER
PATRICIA A. LARSON JULIA FERNANDEZ, SECRETARY
DAN PARKS, ASST. TO GENERAL MANAGER
January 26, 2004 REDWINE AND SHERRILL, ATTORNEYS
Charlotte Gabish
File: 1112.
36-101 Bob Hope Drive, Suite F-2
Rancho Mirage, California 92270
Dear Ms. Gabish:
Subject: Account No. 606123,351.0.0
53-153 Avenida Rubio, La Quinta
In response to your inquiry, this district does not have available information regarding the
completion of actual hook, up to our sanitation collection system for the above -referenced
property.
In researching our records, we found that the subject property has met our sewer requirements.
It is the homeowner's responsibility to connect their pipeline to the sewer lateral.
If you have any questions please contact Rosie Anacleto, Customer Service Representative,
extension 2420.
Yours very truly,
Richard Shonerd
Customer Service Supervisor
RIA:ra
bc: City of La Quinta2N/0'I'
Post Office Box 1504
La Quinta; California 92253
TRUE CONSERVATION
USE WATER WISELY