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0202-102 (SFD)LICENSED CONTRACTOR DECLARATION 'A 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. I.. -'_ License # Lic. Class Exp. 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 sal (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,exe pt Onder Section B&P:614 () for this reason f Date °j tic: , Signature of Owner r. �,( WORKER'S COMPENSATION -13 L-AR'ATION 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. 57 (This section need not be completed if the permit valuation is for $100.00 or less). )4 1 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'dfSection 3700 of the Labor Code, I shall forthwith comply with those•provisions: Date: (r.iB(,I �?7, Applicant— Warning: pplicant Warning: Failure to secure Workers'.. Compensation coverag i unlawful and shall subject an employer to criminal penalties-an`&601l fines up toto $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: hid application. 0 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 ueon the above-mentioned property foriinspection purposes.; »' Signature (Owner/Agent) f ''' i rF,--P`../ Date PERM'nc BUILDING PERMIT „ YC. DATE �I4 �'... - �7LUATINC 1-011" TRACTJOB SITE ADDRESS 78-00 SAGUiA. O DR. APIN OWNER CONTRACTOR / DESIGNER / EN (NEER LEONARD "M OWE'R BUILDEM 111 0-M.BEA C'.,,tticS.:3:': PALM 1)ESERT CA 92260 CB14f USE OF PERMIT r . F' WA3I•f DOIN 114U ' C. Z Le bLA GX WKLL, FULYL-• O `.lUVJ'w5' _ Y APPROACH, 98 COD& ,. TRACT CONSTRUCTION :Lai too SP sp !�1'�'�'OAA gRyy.C���fi1Ctt(PA/TIO al1�.dFi�p0 GA.L'6.1'e\.tVC ARI`0RT 429.00 eC+>F 4 t ESM, W= Cosr UF CC?MMY7MC"I.ff 107,012.09 i.'FXr MTF if' SUMMARY , , CONSTRUCTIUM 1}n 101-000.418.000 tfi 7,50 PLAN CHECK K PEE 101-000.439-319 $363.20 ME Tai POSIT 101-000-438"M8 42%04 MECHANICAL 101-000.421-000 $68,50 9L..WflUC AL, FJU 101-000-420-000 $129,30 PL U MBINO PSE 101-000.419-000 W2.73 STRONG MOTTON 1010 - RE21D 101-000.241.0001 510.1) GRAD1110 FU, 101-4fl0 X3'43 OULI x.210!.00 DEVELOPER IMPACT FEE 51.007,60 0UM•'PCD' AL CONMR.UCT ON AND PUN* r;T4WK $3,472:15 T.E313 :FEE -PAM 11''.,� 4110,00 UL PL CITY " RECEIPT DATES./.�J t BY �_ DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APP OVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings zo, Ducts Slab Grade Return Air Steel Combustion Air Roof Deck O d L Exhaust Fans O.K. to Wrap _ F.A.U. Framing -'o z/ Compressor Insulation - 3 ©L 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 QTY Plumbing Final Piumbing Top Out Equipment Enclosure Shower Pans _ O.K. for Finish Plaster Sevf�f Lateral _ Pool Cover Sewer Connection Encapsulation Ga¢ Piping Gas Test Appliances Final Anal 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: ABuildin ddress / 9K Mailing ,- Address City/., _ Zip /C or Address f� Y p I Tel. State Lic. City //& Classif. Lic. q I Arch., Engr.; Designer Address Tel. City Zip State Lic. q P.O. BOX 1504 V ` 78-495 CALLE TAMPICO APP IC IOiQI�N�Y LA QUINTA, CALIFORNIA 92253 o38 BUILDING: TYPE'CONST. OCC. GRP. A.P. Number /` 6�4 --� /Z - 0 3 LICENSED LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Divisioh,3of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's 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) of Division 3 of the Business and Professions Code, or thathe 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). I: 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. 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 for the purpose of sale.) I'1 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 doesnot 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.) 17 I 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 n Copy is filed with the city. ❑ 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 ($100) valuation or less.) I certify that in the performance of thg work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. ; Date Owner NOTICE TO APPLICANT: Il, after] making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Ihereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that 1 have read this application and state that the above information is correct. I agree to comply with *all city and county ordinances and state laws relating to building construction, and hereby authorize representatives sof this city to enter the above- mentioned property for inspection purposes. Signature of aDPlicant Date Mailing Address City, State, Zip (Legal Description— Project Description eT/ 11•I L Q (/ I . I Lo`�No. (lrck �ia rA&ME_L!TI4 m r' 1A Sq. Ft. , No. Size t'1 Stories No. Dw. Units New ❑ Adtl ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT 11 AMOUNT Plan Chk. Dep. Plan Chk. Bal. t Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Recording Requested By CHICAGO TITL"E,COMPANY RECORDING REQUESTED BY: CHICAGO TITLE COMPANY- COMPANY 10376KC 207057507 WHEN R$CORDBD MAIL THIS DE -ED -AND, UI&ROS, OTHERWISE SHOWN `BELOW,. ' MAIL TAB-: STATEMENT8 TO: LEONARD LAM 111 CHELSEA CIRCLE PALM DESERT, CA 92260 DOC p., .2001=119296 03%23/2001':08:00A.F*o:32.00 Page 1 of 3 Recorded ln-Offtciai Rteords County'of RCv*rslde Gary L. ,�Orso Aasossor, County, Cl; -4 R•en�aa.. A I-_ R GRAW DEET) SW I WSC L JL COPY LONG REFUND NCHG EXAM Oav- 04CA The undersigned grantor(s) declare(s): o Documentary transfer tax is $,.00 (XXX) Computed on full value of property conveyed, or l ..i CGmp;:tEti GTi foilJ. ,, and -'zicumbranc:s remaining at tir±ma of sale. ( ) Unincorporated area: ( ) City of and DL FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, ROBERT GOLDSTEIN and BARBARA GOLDSTEIN, husband and wife and DANIEL GOLDSTEIN, a single man all as joint tenants hereby GRANT(S) to LEONARD LAM, A SINGLE MAN the real property in the City of La Quinta,. County of Riverside, State of California, described as: Lot 88, Tract Desert Club Manor Tract No. 1, as, per map recorded in Book 22, Pages) 53 inclusive of maps, in the office of the County -,,'Recorder of said County.... THIS GRANT DEED IS BEING RECORDED TO CORRECT%THE.,GRANT.DEED THAT RECORDED NOVE[4BER 22, 2000 Dated November 22, 20.00 AS INSTRIIMENT. N0.2000 -4i67782 S DLD HAVE SHOWN LOT 89 ONL State of California County of Riverside } S.S. ROBERT GOLDSTEIN On Nnvemh r 27; 2000 bef:iT U .tiieeixarhyR- p.p'�—f JA .A%�Ci1.c personally appeared,- B ARA GOLDSTEIN Daniel Goldstein ' personally GOLDSTEIN p y known to me (or proved to me on DANIEL GOLDSTEIN' the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon . behalf of which tlie''person(s) acted, executed the instrument. WITNESS my hand and official seal. Signature -MAIL TAB STATMMA Tot LEONARD LAM KATHY R. PIPER •` =' _ COMM -41258249 m 1A Nota ry;Public.CalifOmia N RIVERSIDE COUNTY -• My Camra. Exp. March 10, 2004 (This .area for official notarial seal) ASSESSOR'S PARCEL NUMBER COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY 12411. —3i'Z — 03`'� DEPARTMENT 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 Riverside. Approval of this applica- tion shall remain valid for a period not to exceed one year from date of payment. LMS # / Age t, Contractor, Contact erson Address City State Zip Telepp^h-onre —1 456 Owner Address City State Zip Telephone Q 7 4030 SAG uN20 OJob Property Address City Zip WLot Size " Water Agency/Well Use of Permit 'P/P, SUP, PUP etc. Legal Description lA to J $ _ Dwelling, MH�Site Prep., etc. Signature of Applicant % Date CHECK,BOX IF REQUIRED If any,,box is checked, this applic!5ionn shall be considered rejected until - ❑ Detailed Contour Plot Plans Required (1 to 5 foot interval) the information is provided an�,the fee paid. Resubmittals later than 90 d ais' atter date noted below may require repayment of fees. ❑ Staff Specialist Lot Inspection Required fn 0 Holding Tank Agreements Completed Thomas Bros. Page Grid z � ❑Certification of Existing S.D. System Required ❑ Date Lot Inspection Completed: Initials U❑ WQCB Clearance Required LU (Attach for DOH -SAN -007, Santa Ana Region Only) Remarks: ❑ Soils Percolation Report Required ❑ Maintenance Booklet Provided ❑ Special Feasibility Boring Report Required ❑ Final Inspection by Department of Environmental Health is required. ❑ Rereview Required Initials Date Please call 24 hours PRIOR to inspection. C/42 / Soils Percolation Boring Report by Uc/Project # Date Soils Map Page Soil Type Approved By Date No of Systems T pe of System(s) No. Dwelling Units (1) Septic Tank Soil Rate Grease/Sand Holding Tank ❑ Replacement New ❑ Addition Bedrooms, Fixture Units Grease Intcp/Lint Trap Existing �Mc e / S Gal. Gal. Sq. Ft. Total Linear Sidewall Allowan a Leach Bed sq. ft. of Bottom Area Ft. Bottom Area ft. roc sq. ft. running ft. Install Line(s) ft. long ft. wide with Inlet Tested Depth❑ NA Proposed Bottom Tested min: • , incrhes rock below drainlines or `. r t U Depth Z Leach lines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Inlet (BI) Seepage Pitf Maximum Other: 0 H Applicable ` Total Depth Allowable Depth , C Plvzo (c a 1 i' W r W N/A Overburden Factor ❑ 5' TD f 0 Well Review Approved: Date: + W II rDrilling Permit # SIGNATURE �'�•r ( GZ (31�4 :141 \ Grading Plan Approved: Date: Io q sl �O ( r r� rlct Sewer Verification Approved: Date: Plan Check Only Approved: Date: REMARKS: X ...r a e-, vfit kpu t rN nAg0kiL b : . �'C. Fi J ig ky n Air ..1 Sea S. �i ��-- S�lh 1 ♦ �O � �(( A,f ��. � �l r� a� r G' n . 2'- t . � � �f fit , �i KSS _ 1�.H ,/-ti,�w� �%�� �l[. A(M R�e l'r..�l�RIA 1. :��� S.i.d•��se itY`�c, C.+\t:t.�A�� ,wn��rr}N �� � C This application i APPROVED/D NIED for the category checked in SECTION B above, regarding fte-desigr�gLa subsurface disposal system as indicated on the r" _ FOR OFFICE USE ONLY t acompanied plot plan, using the requirements set forth in SECTION C above. A build- is for installation sing permit necessary the of the above -designed system. No con- struction Is permitted In the required reserved 100% expansion area. Revenue code Fee $ ' (1) Septic Tank must be 100' minimum from any well§. Check # (2) Leach lines must be 100' minimum from any wells, including expansion area. Date -6-0 Q InitlaI_1 0 Z (3) Sewer lines must be 50' minimum from any wells. tt�d1`1 1 LD (4) Seepage pits must be 150' minimum from any wells, including expansion area. F– U W 1 Signatur6lof Health Official C 0 Date DEH -SAN -122 (Rev 9/98) Dlstribution: WHITE—Otfice File; YELLOW—Applicant; PINK—Bldg. Dept.; GOLDENROL—Plans/Records OWNER/BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as°the builder of the property improvements specified. For your protection you should 'be aware that as "Owner/ Builder" you are the responsible party of record on such a permit.. Building permits are not required to be, signed by;property owners unless they are personally performing their own work. If your work is being performedby.someone,-- ther than yourself, you may protect yourself from possible liability if that person applies -for the proper permit in his other name.' Contractors are required by law to be licensed an&bonded,by the State of California and to have a business license from the City or County. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then' you may be an employer. If you are an employer, you must register with the State and Federal"Government,as an Fmployerand you are subject to several obligations including State and Federal income tax" withholding, federal social security taxes, worker's compensation insurance, disability insurance costs and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. For more specific information about your obligations, under. Federal Law, contact�the Internal Revenue Service (and, if you wish, the U.S. Small Business Adminstration). For'moie'specific• information.about your obligations under Stare Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through: their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is,to secure an "Owner/Builder" building permit, erroneously implying- that"the property owner is providing his or her own laboi.and material personally. Building permits are not required to be, signed .by property owners unless they are performing 'their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N. Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, CITY OF LA QUINTA DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico La Quinta,CA 92253 (760) 777-7012 FAX: (760) 777-7011 OWNE ATURE/DATES — —1` -7 F 41 ('2 PROPERTY ADDRESS PERMIT NUMBER(s) CITY OF LA QUINTA SUB-CONTRAC-I UK us I JOB ADDRESS PERMIT NUMBER OWNER LF_o,vgrt.P (-4/-\ BUILDER This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work on this job. Any changes to this list must be approved by the Building Divisior,prior to commencement 6f work. Failure to comply will result in a stoppage of work and/or the voidance of huildinn nprmit Fnr parh annlirahlp tr�rip .11 ;. `F ....� ;- - - r �_�_.-.'_.._..__ __ - on 0I. WFJLMAU• I UbIJUIRSU. 7tade 1sCl§ssirFgat+on;: Co ua r' z . Q ,- o .r Wor�Cers,Co eiisatFon lnsuran4e .; 4:1 _ l�Fisipgss'iicense Company Name Classification License Number Exp: Date ,.'n,rier Name Policy Number Exp. pate License Number Eitp. Date' le -g. A, 11, C-8) (xXXXxxI (xxixx/xx)' (e.g. State Fund, CalComp) (Format. Varies) Ixxlxxlxx) a (xxxx) (xx/xxJxx) L4 Z� % / GQ�y"�b MING rC 5 /J?i fl / J ' sxrsucT sTFD (c 517 t✓ A%. LA,/c-'%. MQ$ONR1' ��� �� r"l-. C 1p•Z: �ie> �. � T j'fJ .� •' r7 j�,. .�. •r�3 PLtlemlC,`iCsl Sand i er Plumbing'c-36. 75945. 2 M 03 Em' loVee Gr `u16404 2 10/01/02 LASH PLASTER {iC•35), i i B"Cn)7L�`r` .. _ , ��.... 6�/ �- t�P`- -,. �t tiv,at: iC'zoc La Quinta Air=conditioning '- `C20 r 749342 5/31/ 2 Exempt n/a F.n%'a .• 05;951.. EIECTRICAi t 1U1 M — rtooiNc rc�9) ` U Orae a and Son's Roo K in C-3 7628 9.. -31 03 State ' ds 154 264. 4 .1 OZ / SHEEj METAL 1031 Iott(NGtc�15i JIM GIAZINGiC771 Desert Windows Inc. G17 737824 7/31/ 1 State Funds 1396204 6/1/0 3085 12/31/ r INSIl1A710N — 91lIVAGE iiISP 1C�12F :�er - • , r'AtNi'jArG (C.�31 x7,. .., - -• _ r cltvlrr nl.ic 5At o cA131HETSc sr ��- is �s 4 8 7 q4- r�F,d,Gse wKl✓ ®3�I!. f�f�°'%a ®a.>� ' y'�so� FENCING ie 7;3� �.I,�N � t.ANDSCA7'!NG !C 27) z r 94a1'Y�`1/ . 64Z6 y�Y/0 /V% .