0309-349 (PLBG)i LICENSED CONTRACTOR DECLARATION
I hereby affirm under pe4alty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and. DATE
o, , fessionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
JOB SITE
ADDRESS
65', 14 C4 s: Me,
,Date `3T 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
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 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:
Cartier Policy No.
01.08 FUND t"9S-203
(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.
Daie: 4 r.. - a_ -.'Applicant
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 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.
,,,Signature (Owner/Agent) w'%r . r!v-J�`" 'a Date Zen'
OWNER
,W 13411 DING PERMIT PERMIT#
VALUATION LOT � J49 TRACT
APN
M55 AVE NMA
CONTRACTOR / DESIGNER / EN (NEER
52.0,5g'yyrr� .VRE iIDA Y�1:�Y q , Cr.�Py}G �t 3fv �yTw! fir.
LI�i ��1.fAL�TTA. Gla 9225 J 1�1'L°n)l' f& � C �.\ i�' wi�Ii'�i 9�9A 'vi : ://..+�'i,4 0
Q017 -
USE OF PERMIT
SEPTIC; AL°A.ND.0?J; SEWER C'OWNAC i
VALUATION 1,5'P,40. LD
EI,Tmb' °;lei cfxrr off' o+'s:.+bai!)�:, Ticnow :1.,wo,'uo
FERNIQIMO SUMMARY
111LUMB11140 FEE IRTKE�R 01 -000-1 0+11 19_00-11�
Srp 3 0 2003
CITY O LB` (aU11dYA
plPldoNCE.DEPT-
.J .
IAMB rRE*42AW.$1ZM-
i°m''Al= i-.PM4r1*1 i�: �'d lits" tmIMM
RECEIPT . DATEBY y DATE F1qALED, INS E TOR
INSPECTION RECORD
3
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 Wali 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 Pibg. 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 'i
Gas Piping
Gas Test
Appliances
G S
Final
Final 3 Da
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:
S %?r�CCL /e�3I3
I
A-1 Cesspool Service, Inc.
P.O. Box 580188, North Palm Springs, CA 92258
`Since 1959'
(760) 329-6875 Fax (760) 251-3405
State Lic.#265214
www.alcesspool.com
JOB
�1INVOICE-
ADDRESS L� r` l' nTEC NICIAN
CITY L A Yv I �-- J j /1 HELPER
JOB ADDRESS
SERVICE -ScPUMP SEPTIC TANK RAS SEPTIC TANK BEEN DUG UP? -0=Yes ❑ No ❑ PMP. ON SITE
REQUESTED &RUMP SEEPAGE PIT AT ITS RISER :❑ OFFICE BILLING
C7EwL-R V00r -\JP
QUANT. DESCRIPTION OF PRICE AMOUNT
i 0Q (3
Pumping Fee per 1000 Gallons (or fraction)
Waste Discharge Fee per 1000 Gallons
Locating and Opening Fee (I hr. Min.)
Out of Area Fee
❑ _ THE LEACHING SYSTEM HAS FAILED.
❑ THERE IS AN OBSTRUCTION "UPSTREAM" OF THE SEPTIC TANK
It will be necessary to contact a line cleaning company.
"
❑ WE RECOMMEND MAINTENANCE PUMPING OF THE SEPTIC TANK EVERY
❑ YEAR ❑ OTHER YEAR ❑ 2-3 YEARS
To remove built up solids. This will increase the life ofyout leaching system.
❑ THIS PUMPING WILL PROVIDE ONLY TEMPORARY RELIEF AND NOT
SOLVE CUSTOMERS SEPTIC PROBLEM BECAUSE OF THE ABOVE.
❑ CUSTOMER HAS BEEN GIVEN AN "EXPLAINATION" PACKET.
A SERVICE CHARGE OF $22 WILL BE DUE
ON ALL RETRUNED CHECKS.
A FINANCE CHARGE OF 11/2 PER MONTH, IS% PER YEAR, WILL BE .
CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS.
IF PAYMENT IS BY CHECK
DRIVERS LIC # STATE
1 hereby acknowledge the satisfactory completion of the above described work:
SIGNATURE ,.'
Total
//�
Due
V
OCT -13-2003 11:13R FROM: 70:97777011
FAX Cover Sheet
Date_10-5 Pages to Foffow
�Ylr
FROM- A-1 Cesspool Service, Inc.
P O. Box 580188
North Palm Springs, CA 92258
(760) 329-6875 Fax (760) 252-3405
=4J 1
1 Aga
Post-itw Fs
TO
Phone #
Fdx A
P: 112
l"
OCT -1:3-2003-11:13A FROM:
� 71a, ew
1
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a
OCT -13-2003 MON 09!-5AM ID:
TO:97777011 P:2/2
PACE :1
O
COACHELLA VALLEY. WATER DISTRICT
CASHIRECEIPT DETAIL
Received From: L�L-17% . of " ' '
areas:
4count No. Lot(s) RILk
Service Address SZ.� Q�.5 A 1/tN � AA R -'C Z
❑ Meter(s)
❑ Service(s)
❑ Backflow(s)
❑ House Lateral(s)'
❑ DetectorCheck(s)
❑ .MeterSurcharge
C�• Ration capacity charged I :� ^ ✓
o WS.B.F.c.
❑ Temporary Construction Meter
O Turn on Charge
O Uncollected Account - Name
i' • • ' ❑ Inspection Fee - Tract -
Fee -
O Plan Check Fees Water / Sewer -
Tract -
'_ ❑ Bond Payment - A.D. - Bond
Asamt
O Customer Deposit
❑ Other
1Gr l/ 6/4 r Gl I
NQ 96204
_^ Tract
TOTAL
S
Remarks: sf h l'c C' LA i w yt m o6mca oz7g6iEa c'c> z �z
Dopy to:
Cash Water service
Check
Money ` Cashier
Order `.�VI ;; U
s+' CVWD-138 (11188)
.;
drawing of record.
These deviations from the drawings of record are beyond the control of
�- CVV1�=.therefore; the district will not be responsible foi any charges`-'- `- -.-� -�
incurred by the homeowner as a result of these inaccuracies.
My 1, 2002
1
53
Planning Commission
City of. La Quinta
Post.Office Box 1504
La Quinta, California 92253
Gentlemen:
R1ECLr1 VLv®
AUG 14 1989
CITY'OF LA QUINTA
May 5, 1988 PLANNING & DEVELOPMENT DEPT.
'
Subject: Flood -Hazard letter for
52055 Avenida Juarez in
to Quinta, California
Weare -requesting a letter from you addressed to -Palm Springs Savings
which states that.the above-mentioned address is now designated,`Zone B on
the Federal Flood Insurance rate maps which are in effect at this time.
•Please mail above requested to Ms. Tony Brown, Palm Springs Savings
located at 275 W..E1 Cielo, Suite .C, Palm Springs, California 92262.
The reason.for this request id to satisfy an escrow requirement.
for Escrow Number 7294 with Spring Mountain Escrow. -
Thank you in advance.
-Ben'. in Esqueda
.
p.s. :for any questions you rr_ght have please -call us--at--(
M ria G. Esqueda
STATE FARM
.yam
5 RITA PESCADOR TERAN
INSURANCEo Auto -Life -Health -Home and Business
40-100 WASHINGTON, SUITE 111 (CORNER OF WASHINGTON & COUNTRY CLUB)
BERMUDA DUNES, CA. 92201 TELEPHONE (619) 345-4068 FAX 345-6597
December, 11., 1990
Attn: Building & Safety Department
City of La Quinta
P. 0. Box 1504
La Quinta, California 92253
{ Re: Flood Zoning- -
Building & Safety:
Kindly forward to us a letter from your office verifying that the following
La Quinta property 'is'located in the "B" flood zone:
Property Owner: Property Location:
Angel. Gabriel Esqueda 52055 Avenida Juarez
Thank you for your assistance.
Sincerely,
Rita Teran, Agent
t
• 4(4j
78-105 CALLE ESTADO - LA QUINTA, CALIFORNIA 92253 - (619) 564-2246
December 13, 1990
To Whom It May Concern:
The structure located at 52-055 Avenida Juarez is located in
a "B" flood zone per the revised F.I.R.M. (panels 060709 005
A and 0010 A) for La Quinta. The property was previously
designated as zone AO (depth two (2) feet).
If you have any questions, feel free to contact me.
Sincerely,
BUILDING AND SAFETY
Tom Hartung
Director of Building and Safety
TH/lc
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253