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0209-003 (SFD)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 800534 101$ I /7C 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: ( ) 1, 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. 7.044, Business & Professionals Code). ( ),.-1 am exempt under Section B&P.C. for this reason r^ a Date Asp i i aM iw Signature of Owner •. ,_ a f 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 workeis' 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 EXEMPT 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 those provisions. � "I - -I'- / Applicant, + Warning failure to secure Workers' Compensation coverage-iunlawful 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. 9 (Owner/Agent)­ :u',`,w,•;1°.'.. _ /i` Date#-% f a7i /a3. Signature PERMIT # BUILDING PERMIT fiy,�49a��i]� u DATE VALUATION LOT, TRACT JOB SITE/!��B�� y��t� y. y�y���p ADDRESS a�#-a�a3.ii.11.4lV;a•�i. APN OWNER CONTRACTOR / DESIGNER / ENGINEER 54-105 AVS."VELASOCI '52-990 1A QTJWTA. CA rAIM LA QI.Y31+' I As " CA 92253 ` I ('s"�0)��uY...�©fit • �13�f�';i:�2 USE OF PERMIT SPI) .. NKlY, 7,382 31)40LE FAMILAP f WELIJ140 PERMIT I.)Cr`PaS NOT 11401 -MV, f: nh "ARIA, Pool Sipa w, D&&wki Alvftfo t. �1 t�� pp ��yyq �v},�,q��.�9 1 pf �f Aly �7 . .yAF4..4t.4Y+f,.�{ ION :. .I,1$6,pL,S00 Sri {W�lpNeE7/n1�R�l�rrl .150,0.'0 sy TS}/RC�+R."d�/-6�"R/t�¢•ip4�it'� ! ` �d'i,1V£'roi�:LiAnfilS'ld" d 1. '!,030.00 sw M4M1M) CONT OF Y0.K!9 ZV*3?X 2.5,4.V9.2 .. ... P1 AGltRE 9{g0AS"RT CdN87RU'lrTION Fri � 101-000a41.8.Org1 �4i�,Olf PLAN CHEC.F2E 1+J9-0DE1-���>31t3 4fr)9.3lS FEF DB.POSIT 101-000.4:39-318 4150A MECHANICAL TOPE M-00 X71-000 00.00 tLEC"1'IICAILIM, P1.,lJMB11JO N'F.:X 101-000.419-000 $1141,0.4 S`FRC,1k3S3 MOTION FEE RESTD '101*000-,241 -000 VS.0 { I'11SrtF'%;LC,bMlMPACT FEt A4050 t MP ICIRMr, A LAP $4,278.v 1171 S3 P P.9 PAM MM 71 4050-09 LN A Of— C;1 DEPS INA RECEIPT DATE fj � `-BY~ DATE FINALED INSPEC 03 i 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 _ p Exhaust Fans O.K. to Wrap F.A.U. Framing ,p't) _,Z� Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 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 Se.ver Lateral Pool Cover Sewer Connection _ _G _ Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) _� O 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) c 78-495 CALLE TAMPICO LA QUINTA, CA 92253 (760) 777-7075 a: ..APPLICATION �67� - A FLOOD PLAIN DEVELOPMENT PERMIT BUILDING SITE LOCATION r ` s FLOOD ZONE'AO"- DEPTH 1 COMMIUNITY- PANEL NUMBER / S C7 5 { p� –�Y'ic L'� 060709 0005 B ' -'Map Revised: 8/19/1991 APPLICANT INFORMATION SECTION APPLICANT NAME I f A -2-- I APPLICANT. ADDRESS. - �' G �� ' (MAILING ADDRESS, NOT THE BUILDING SITE) DAYTIME TELEPHONE NO. - INSTRUCTIONS 1. A Flood Plain Development Permit is required by,LQMC Section 811.040(A). The Applicant should complete the Applicant Information.portion of this application and submit it to the Engineering Deparment along with the required documentation noted hereon at the'same time the Precise Grading Plan is submitted to the Building and + Safety Department for plan checking. 2. Documentation required for STEP 1 OF 2 APPROVAL prior to receiving clearance. for Building Permit. issuance • Copy of the proposed Precise Grading Plan for review and approval containing all information required by the checklist shown on the back of this application. 3. Documentation required for STEP 2 OF 2 APPROVAL prior to receiving Flood Plain Development Permit approval. Note, this approval occurs after forms for the lowest habitable floor are set and before the Building & Safety' Department authorizes foundation construction. s Submit a completed FEMA ;Elevation Certificate" form to the Engineering Department. • Submit 95% relative density soils compaction certification to the, Engineering Department. STEP 1 OF 2 APPROVAL The Precise Grading Plan submitted for this application has been • STEP 2 OF 2APPROVAL . All requirements have been satisfied. This Flood. Plain reviewed and found to contain all data required to satisfy the Development Permit is approved. requirements of LQMC 8.11 The proposed dwelling is eligible to receive a building permit upon satisfying all other Building & Safety Department requirements. 00 UTHORIZED SIGNATURE DATE La Quinta Engineering Department AUTHORIZED SIGNATURE DATE La Quinta Engineering Dep nt AV &-2Fn � FO90 REV -1 11/99 CHECKLIST FOR PRECISE GRADING PLANS IN "AO" FLOOD ZONE 1. Prepare Precise Grading Plan in accordance with Checklist for Precise Plans and the following additional items. 2. All elevations shall employ the NGVD-29 convention. 3. Show and label elevation of "Highest Adjacent Grade" next to the building footprint. This refers to the highest existing natural grade next to the proposed building prior to constructing the elevated the building pad. 4. Show and..label the "Highest Existing Elevation 'on Lot" 5. Show and label the "Lowest Habitable Finished Floor Elevation". Note, this elevation shall be at least ONE FOOT higher than the "Highest Adjacent Grade" elevation. 6. The following grading note shall appear on the plan: All fill material placed under the structure shall be compacted to ninety-five percent (95%) relative density. M90A 10/99 JAMES O. WALLACE PHONE (909) 955.3000 v A94CLOu901 ConvNssbner FAX (909) 955.3012 U11 for of We(ghts & Meosues DATE CASE NO c �' �_-03 WEIGHTS & MEASURES P.O. BOX 1480 RIVERSIDE. CA 92502.1480 PHONE (909) 9553030 FAX (909) 276.4728 . DEVELOPER'S NAME:'lC ADDRESS: �/�. D, X l S �S QK: cyC� 92253 TELEPHONE:. 760) Dear Developer: i Certain plant materidl noted On ypur landscaping plans are I-1 violation .of quarantines governing the Coachella Valley, Riverside County. Since the noted plant material conceivably carries Insects or' diseases that would devastate the Coachella Valley's citrus, date, grape, vegetable or field crop industry, ,the following plant material IS Diml--D IXI'Iiy / L Comi'non NuDie Genus S Species 2•e ove neo►> ��� ,ol�s cJ:!"� C�Bu,�s�� ��.� /�..,� �.e�o� 3. ° 1 co¢ - INCLUDING ANY APPLIANCE ASSOCINIT-m W1'111 This ABOVE-. ' v c�-1--cuarl—a-1-s ova o fL 1e pro _ c ,Teeve - ;,.a+ o .: „ t „ .. F:.ys E t t a t -e d—art-hoc► r—l-arrd s c a [� 1T1� p�I ars sL1Gn i-ti'a-1­. I t - may. be possible to receive the Agricultural Commissloner's npprovnl on the above, if the plant material is. purchased from an approved nursery that 'meets the quarantine requirements, or purchased from a non-quaranLln!d area. The' Agricultural Commissioner's Office Is willing to'work with you on establishing that app oval. Thank you for your cooperation in protecLing and preserving the Coachella Valley's Pest -free environment. Agricultural Commies -loner's Office Authority cited: Agricultural Codel 6301, 6161, 6462, 6164, 6501-6524. cc: Irid,io & Riverside Office *Coachclla Valley District Office, 8276.75_.Highway 11,1,. Rm.14, Indio, CA 92201 (760)863-8291