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9904-162 (SFD)LICENSED CONTRACTOR DECLARATION I hereb'Y;affirrh under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the -Business and N6fessiionals Code,, and my'License is in full force and effect. License# Lic. Clasi r Exp. Date 30199 Ar U -M Signature of 6ontrac�t_ A_. I I f OWN.ER-BUILDER DEC60ATION I hereby affirm under penalty of perjury -that I am exempt from theContractor',s, License Law for the following reason -..,-ti ­,,i,,as ownerb(t'he property, or rn . y 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 cohtractorsto "Construci I.the project roj1�ect(SecI . .7I 044., Business & Professionals Code). ' I .... .. . ­.- , 1 ( )_ I am exempt under Section —, B&P.C. for this reason Date nSignature of Owner WORKER'S COMPENSATIOWDECLARATION 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. (X) 1. 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 perrhit'is'1ss,ued.*.My workers' compensation insurance carrier & policy no. are: Carrier Policy No. 229-9S VNIT 00 18991 (This section need no i t 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'Sedtion 3700 of the Labor Code, I Shalifforth!with comply with those provisions VDate:. ' _ZJr �, qjApplidzffi Warning: Failure to secure Workeqs' Cbmpfinsation cove - rage is unlawful and Shall subject an employer to criminal penalties and civil fine's up to $100,000, in addition to the cost of com pensati on,, damages as provided for in Section 6706 of the'Labor Code, interest and att6mey'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. 4 Each.p6rson 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 appli6aton,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,l-lha"ve read -thW60pi ication and state that the above information is correct. I agree,,to comply with all City,. and State laws relating to the -building construvion,-and hereby authorize representatives of this City to enter upon the *above-mentioned property-fQr-inso-ection purposes. �/�c'Ig lure (own wArient) BUILDING PERMIT PERMIT #9904-162 DATEDLOT h S366,041 1,19 TRACT 1, 1, yUUE I JOB SITE-' ADDRESS, 49475 AVE NIDA ELL 1N1110 APN 631-34141:11 OWNER, CONTRACTOR DESIGNER ENGINEE I R li ISTM (3 CQN St)LTJ�40 lt�VJCF OiEORCY I A CLARMCINVE EW.1 S LSK M P 0.113OX 19190 5.117.5 CALU QUM ,LA QUINT ex L A Q)LITYM A CA 92253 6(�)77 1 84 C,%Lft 4989 USE OF PERMIT VED _PMUIT DOE 140-f INCILUM, TULOCR WALTI-s' OR POOL V{f­3_1 orvi C01,01-1 UcNiX SF GARA0181CIVRPORT 906.00 sr? 0 PORMPA310 165,00 w-, KSTIMATED COST 0- F CON917RUCTION 366,ift'.1.80 11MMIT VEMSUMMARV .VLAN CHECK VIM `4 CONSTRUMON MM 0; -000-418-1100- $1, 574.01 MIX_ f 11W CAL f TIE 101 -000 -421 -NO S1110.50 U4UMIC --Vr. Ek. 101-000-120-000 $2 rZ. 6 3 PLUM9INGFEC 101-000-41940 STP,agp_ M,0 CJT FSE - RY, e, f1 101-(100-741-000 Q36 3 OR-WEANG FE'P� 101-0004.23-000 $20.00 INFRAITIRLICTUR6 r(TX, .225-000-443-:342 V1,000.00 ART M PUMAC PL -&CM9 RESID 701-000-255-000 $66fUs MM MAN CHEC $10,213,2) LESS RKE-PAID FEES T*0`L%L PEANIff FEMS DUENOW 5,510,11311 RECEIPT DATE ByZ Y DATE FINALED INSPECTOR 21 -v INSPECTION RECORD t 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 t Compressor Insulation O Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Ziff, 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 I ice, Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans OX for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test — pry Appliances Final COMMENTS: Final Utility Notice (Gas) �p't�! C- ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit 8 Rough Wiring Low Voltage Wiring , Fixtures Z Main Service P Sub Panels p Exterior Receptacles G. F.1. Smoke Detectors i;. Temp. Use of Power Final Utility Notice (Perm) • 4 4 " P.O. BOX 1504 APPLICATION ONLY Building 78-495 CALLE TAMPICO Address • �`1 1 (�,J/�1/�A������UINTA, CALIFORNIA 92253 Owner c�'�i� Mailing Address `f"7 ���1 Q Git; /IZiptl?7:2 3 JTel. ,- Contractor l s Address P. 0 ttYL� State Lic. &-GlasS4. Arch., Engr., Designer Address ; 1 J. City I hereby.affirm 9hal'I'am 7000), of Division 3 of th zip Z2 -S-3 =/ Z-()'7 Zip Tel. 76n=I-71- .DING: TYPE -CONST. OCC. GRP. Number • �4:� (, P3i Legal Description roject Description " 5 CD Lic. # a� Sq. Ft. Size New ❑ e Tel. -1-71- 3� Sta,t I Lic..# //L ,- LICENSED ,LICENSED CONTRACTOR'S DECLARATION r ,licensed under provisions of Chapter 9 (comment Business and Professions Code, and my license is OWNER -BUILDER DECLARATION I herebyf frm 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 that -he 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). l: 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- i strucl 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.) 1-1 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION -"'~- 1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, ore certified cop thereof. c. 3800, Ly Code.) Po icy, No. Company'-^��.� 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 lhg 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: If, after making this Certificate of Exemption you should become subjectto 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 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 No. No. Dw. Stories Units Add ❑ Alter ❑ Repair ❑ Demolition ❑ 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 V P N 1 F_ia Estimated Valuation PERMIT AMOUNT 1 Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. 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 Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 - CERTIFICATE OF COMPLIANCE Date 4/5/99 No. 18552 Owner NameBCK Investment Group No. 49-275 Street Avenida El Nido City La Quinta Tract # Lot # Type of Development Single Family Residence Comments APN # 631-341-011 Jurisdiction La Quinta Permit # Log # Zip 92253 Study Area Square Footage 4,443 No. of Units 1 At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It has been determined the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 imthe amount of 1.93 X 4,443 or $ 8,574.99 the property listed above and that.building . r. permits and/or Certificates of Occupancy for this square footage in this proposed project may now be`issued Fees Paid By CC/Bank of America/Georgina Clarke `. NlephonP. , Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Juanita Green Payment Received $8,574.99 - ,t/ Check No. 201594685 Signature NOTICE: Pursuant of Asseely Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from he date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to collect them on the Dislrict('s)(s') behalf, whichever is earlier. Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting La Quinta Golf Estates Community Association P. O. Box 162 La Quinta, Ca 92253 (760)564-2177 FAX (760)564-4882 April 21, 1999 Building Department City of La Quinta P. 0. Box 1504 La Quinta, CA 92253 RE: New Construction Lot #119 (49-,2-6T Avenida El Nido) d 7.5 Gentlemen: The Architectural Committee of La Quinta Golf Estates has reviewed the plans for the construction of a new home at said location. The Committee finds that these plans meet all the criteria setforth in the CC&Rs and have, therefore, approved them as presented. If you have any questions, please contact the office. Yours truly, Tom•:A. Kennedy Co-chairman Architectural Committ e TAK/bk CC: fl ASSESSOR'S PARCELNUMBER NW OF RIVERSIDE HEALTH SERVICES AGENCY 631— 3y/ —0// - DEPARTMENT OF ENVIRONMENTAL HEALTH PERMIT APPLICATION FOR A SUMNIFACE SEWAGE DISPOSAL SYSTEM %PPUCANT. 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. t non-refundable filing fee is required when the application is submitted, Check must be made payable to the Couri4;r'"tib i, sld iA fd�ja�of this applZ "tort shall remain valid for a period not to exceed one year from to f payment r,3.1-15 $214. UW0#0 0, T 0.0 14 QV,;071 CHI% $214. C Well Review Approved: Date: Well Drilling Permit # diONAYURE Grading Plan Approved: Date: si Sewer verification Approved: Date: Plan Check Only Approved: � Y.��J naa a: REMARKS: te d.._ �tIU' P This application ' ED FOR OFFICE USE ONLY a4w4e-regarding _ .a subsurface disposal system as Indicated on the acompanled plot plant, using the requirements set forth in SECTION C above. A build- . -7 ng permit is necessary for the Installation of the above -designed system. lie Revenue code ��3 r �o Fee $ IJClt�4• 0� atruction In rteardftd In the raoulred res— ed 100% s=naon area, (� (1)Septic Tank must bk soler minimum from any wells` / 0 AA,` ' JC^ d A" Cli6ck Ar (2) Leach lines must be 100' minimum from any wells, including expansion area Date /) Initial D3 Sewer lines must be 50' minimum from any wells. fQ• T" 7 (Seepage pits must be 1W minimum from any wells, Including expansion area. q JQ M,,. FAsti TSFJ -J f, A71[..t. 'InA,rr/ Signature of Health Official /a - /- ?if Date DEH -GAN -122 frte„ AgEit Contractor, Contact PersoQJ1 A U V07)��Qet Address City State Zip r o. �. v L C ..2 -26/ Telephone - Owner Address City t State P L cwt - j4j�hons -z a o 2 Job Property Address I Y9- a 7S 4•l r - v, UA Fi /4f/ DO City La 61,01;V -W Zip V 0) Lot Size z x oiler Age L r/t cry se of Permit, PIP, SUP PUP, etc. wEccin4s �+� 6,4ngGF Legal Description Lor !� Qa,�r� Gacf Fr�.fd / /6t Il6 i _- � "//Ae WA7'-rt nit i (/� elan nature of Applican f/� n°/ r L "-'177.,Date CME t EGUI If any is cked, this appll n shall be considered rejected until ❑ Detailed Contour Plot Plans Required (1 to 5 foot Interval) the info Is provided and the fe "d. Resubmittals later than 90 da er date no a repayment of fees. ❑ Staff Specialist Lot Inspection Required m ❑ Holding Tank Agreements Completed Thomas Bros, Page Grid Z ❑ Certification of Existing S.D. System Required ❑ Date Lot Inspection Completed: Initials ❑ WOCB Clearance Required NF (Attach for DOH -SAN -007, Santa Ana Region Only) Remarks: ❑ Soils Percolation Report Required ❑ Maintenance Booklet Provided ❑ Special Feasibility Boring Report Required (] Fina) inspection by Department of Environmental Health is required. ❑ Rereview Required Initials Date Please call 24 hours PRIOR to Inspection. orin C/42 / Sails Percolation BReport by Lic/Project # Date Soils Map Page 11:711 Soil Type Approved By Date No of Systems ap a Vot Systems) ing Tank Replacement Addition No. Dwelling Units 1) Bedrooms, 1y� S X 1.4 %JI ,Gt7W4� (1) Septic Tank SQ%Gal. Sol! Rate se/Sand G ni Trap Existing Sq. Ft. Total Linear Sidewall Allowance Leach Bed sq. ft. of om Area t. ttom Area kl sq. H. running ft ftInsL. long R wide with ,all (s) Inlet Tested Depth ❑ NA min, rock below drainlines or U Proposed Bottom Tested De Z teach lines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Inlet (01) Seepage Pit Maximum Other: p 1 Total Depth Allowable W �� r Depth l NI Overburden Fa r TD~ T.7 �3 Well Review Approved: Date: Well Drilling Permit # diONAYURE Grading Plan Approved: Date: si Sewer verification Approved: Date: Plan Check Only Approved: � Y.��J naa a: REMARKS: te d.._ �tIU' P This application ' ED FOR OFFICE USE ONLY a4w4e-regarding _ .a subsurface disposal system as Indicated on the acompanled plot plant, using the requirements set forth in SECTION C above. A build- . -7 ng permit is necessary for the Installation of the above -designed system. lie Revenue code ��3 r �o Fee $ IJClt�4• 0� atruction In rteardftd In the raoulred res— ed 100% s=naon area, (� (1)Septic Tank must bk soler minimum from any wells` / 0 AA,` ' JC^ d A" Cli6ck Ar (2) Leach lines must be 100' minimum from any wells, including expansion area Date /) Initial D3 Sewer lines must be 50' minimum from any wells. fQ• T" 7 (Seepage pits must be 1W minimum from any wells, Including expansion area. q JQ M,,. FAsti TSFJ -J f, A71[..t. 'InA,rr/ Signature of Health Official /a - /- ?if Date DEH -GAN -122 frte„ LSMG CONSULTING SERVICES GENERAL ENGINEERING CONTRACTORS CA. LICENSE NO. 742117 P.O. BOX 1490, LA QUINTA, CA 92253 (760) 770-8866 V*- 0 641 May 27, 2000 Tom Hartung Director of Building and Safety City of La Quinta P.O. box 1504 La Quinta, CA 92253-1504 RE: Final Inspection Requirement —4927�5$Avenid@W Niiio`N7, LE'aJQuinta-� Dear Mr. Hartung All of the corrections requested by MR. Gary Hartman, Building Inspector, have been completed except for the following minor exceptions: (1) patching in areas where the outlets were embodied in the stucco and in areas where the electrical contractor was looking for outlets and light sensors; and (2) Some minor discoloration and fine hairline cracks. The plastering contractor, B.G. Plastering, has been notified and has agreed to complete all the corrections by June 16, 2000. If for any reason he doesn't complete them, we will do so and charge him for the corrections. Since these are cosmetic changes, minor in nature, the owner, Georgina Clarke has agreed to accept the house "as is" and desires to move in during the week of June 1, 2000. By signing this letter, Ms. Clarke acknowledges her concurrence. Z,%- "O'WLEDGED AND AGREED TO gina Clarke .. _ a' - n ��- r i� 1� ,�,�� \�° � �9 `Y � �, �' ,� �, �� �,� � °� �� .� ��