09216 (PAT)P.O. BOX 1504_ N 0 .
Building7&105 CALLE ESTADO f
Addres44-120 Carninq La CfvRtA LA QUINTA, CALIFORNIA 92253 /}
Owner
mailing
Address same
City Zip Tel.
La Quinta 1 92253 1
Contractor
ress
City lZip I Tela
State Lic. City
& Classif. I Lic. #
Arch., Engr.,
Designer
Address Tel.
City ( Zip( State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am 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
I 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, Chapter 9 (commencing with Section 7000) o/
" Division 3 o/ the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation o/ Section 7031.5 by 'any applicant for a permit
suWecis the applicant to a civil penalty o/ not more than five hundred dollars ($500).
j% . �(f,'as owner of the property, or my employees with wages as their sole compensation, will
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 o/ 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 /or the purpose o/ sale.)
❑ 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.)
O 1 am exempt under Sec- B. & P.C. for this reason
;t )
Date r owner
iwpooWORKERS' COMPENSATION DECLARAT OIN"
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
,
rker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
icy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
r.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed i/ 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 �enLawof-DateNOi4C ANL I/ er making "thrs'"Ceitilicate of Exemption you should become
subject to th Workers' mpensation provisions o/ the Labor Cotle, you must forthwith
comply with such provisions or MIs permit shall be deemed revoked.
t
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 if 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
LDING: TYPE CONST. -OCC. -GRP.:
P. Number
al Description
Project Description
09216
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:
Sq. Ft.Ido.
Size ^
Stories
No. Dw.
Units
NewAdd ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
23RA-
40 1
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
imigm
Const.
Mech.
Electrical
Plumbing
S.M.I.
j.];
Grading
Driveway Enc.
Infrastructure
r
TOTAL
REMARKS
Y2-
97
Pr
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
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVG
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SO. FT.
OTHER APP./EOUIP.
DRAINAGE PIPING
WALL SO. FT.
TEMP. POLE
DRINKING -FOUNTAIN.
SO FT ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR . SUSPENDED
LAUNDRYTRAY
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
SPARK ARRESTOR
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
LATHING
SO.FT.GAR ® 3/.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 & 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. l
GAS (ROUGH)
METER LOOP
HEATING (F
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.
F>A1 INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION S'A� L
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
C'7-�-a�
�t4 AT E q ESTABLISHED IN 1918 AS A PUBLIC AGENCY Jq� !
s
O/STRic� j � RECO
COACHELLA VALLEY WATER DIURICT
1,1, W�
POST OFFICE BOX 1058 - COACHELLA, CALIFORNIA 92236 - TELEPHONE (760) 398-2651 - FAX (760) 398-3711
DIRECTORS:
JOHN W. McFADDEN, PRESIDENT
PETER NELSON, VICE PRESIDENT
TELLIS CODEKAS
RUSSELL KITAHARA
PATRICIA A. LARSON
January 14, 2004
Lynelle Hustrulid
American Guardian
27 Orchard, Suite 100
Lake Forest, California 92630
Dear Ms. Hustrulid:
Subject: Account No. 507202,223.0.1
44-120 Camino La Cresta, La Quint
OFFICERS
STEVEN B. ROBBINS,
GENERAL MANAGER -CHIEF ENGINEER
MARK BEUHLER,
ASST GENERAL MANAGER
JULIA FERNANDEZ, SECRETARY
DAN PARKS, ASST. TO GENERAL MANAGER
REDWINE AND SHERRILL, ATTORNEYS
File: 1112.
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..
Ir 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.
RIA:ra
be: City of La Quinta Y . `
Post Office Box 1504
` �'- Quinta, California 92253
Yours very truly,
Richard Shone-rd-
Customer
honerdCustomer Service Supervisor
TRUE CONSERVATION
USE WATER WISELY