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0651 (PAT)r PERMIT APPLICATION City of La Ouinta L Department of Building and Safety This permit becomes void if work not commenced within 980 days from date of issuance: OR, if work has been suspended or abandoned for a period of 180 days. . - CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if-. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I: am licensed c nder provisions of Chapter 9 .. ' - the -permit is for one hundred ($100) o, less. I certify that in the performance of the work for which this permit is ` (commencing with Section 7000) of Division 3 of the Business and Profession's Code, and my license is in full force - - issued.'I shall not employ any person in anymannerso asto become.subject tothe Workers'Compensation Laws of and effect. California. License Class. Lic. Number Date Applicant =,Date- '•• r te'•'- Contractor, - NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you: should become subject to the Workers' OWNEfi=BUILDER DECLARATION: I hereby affirm that I am exempt from actor's License Lawlor the Compensation provisions of the Labor Code, you must forthwith comply -with such.provisions or this permit shall . following reason (Sec. 7031.5. Business and Professions Code: Any city or co,lnty which requires a permit to be deemed revoked: construct, alter, improve, demolish, or repair any structure, prior to its issuanc:, also requires the applicant for DIVISION OF, INDUSTRIAL SAFETY PERMIT. CERTIFICATION: .such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law 01 hereby certify - that no excavation five (5) or more fiet in d4pth into which a person is required to descend, will be (Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt . made in connection with work -authorized by this permit, and that no buildingstrOcture, scaffolding, falsework, or` l therefrom and the basis for the alleged exemption. Any violation of Secli'on 7031.5 by any applicant for a permit, demolition or dismantling there it, will be more than thirty-six (36) feet high: ?(Chap 3.2, Grp:2 Art 2, Sec341, TitleB. i,'subjects the applicant to a civil penalty of not more than five hundred dollars :$500.): C.A.C.) ^ ` 01 as owner of the property, or my employees with wages as their sole compe 3sation, will do the work, and the: - - 0'As owner -builder, I will not employ anyone to do work which would require,a permit from the Division'of•.. structure is not intended'or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License - Industrial Safety, as noted above; unless such person has a permit to do such work from that. division. Law does not apply to an owner of property who builds:'or'imbroves thereon, arJ who does such work himself or USE OF PERMIT - - through his own employees, provided that such improvements`,are not -intended ar offered -for sale. If, however, the 0 Division of Industrial Safety Permit No: building or improvemnt is sold within one year of completion. the owner -builder w 11 have the burden of proving that Date Applicant he did not build or improve for -the purpose of sale.). 'CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance 0 I, as owner of the property, am exculsively contracting with licensed .contracors to construct the project (Sec. of the work for which this permit is issued (Sec. 3097, Civ. C.). - 7044, Business and Professions Code: The Contractor's License Law does not a)ply to an owner of property who - Lender's Name builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to,the ZONE ORD V. Contractor's License law.).' Lender's Address c. 0 Vam exempt under Sec. B. & P.C. (Attached Certificate). I certify that I have read this application and state that the above information is correct. I agree to comply with all Date —•� / � Y u Owner: ` city and county ordinances and state laws relating to building construction, and hereby authorize representatives r of this county to enter upomthe above-mentioned property for inspection purposes. WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to.self-insure; or a' . - . certificate of, Workers' Compensation Insurance ,'or a certified copy thereof (sec. 3800. Lab. C.)_ :' r °' Signature6f Applicant or Agent Date Policy No: Company CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that 0 Certified copy is.hereby furnished. the information given is•correct. I agree to comply with all state laws and county ordinances relating'to buidling 0 Certifiedcopy is filed wijh the City Building Inspection Department or.City Department. construction, and authorize a'representative .of the City of La Oujnta Department of Building and Safety to enter ' upon the property for which I have. applied for this permit for the purpose of making inspections. . Date Applicant Signature of Applicant or Agent Date APPLICANT NAME) �1-9 A Ei' ! S 5� COY/CC MMUINITY/STATE/ZIP JOB IT wIRE� PACE CITY/COMMUNITAY//STATE/ZIP BOK . PAG PRC C WIN Xf TNN RNG SE'.. S TRACT - LOT MOD SB TRACT NAME - OWNER NAME (L. F. MI) - CONTRACTOR -FIRM NAME ADDRESS - CITY/COMMUNITY/STATE/ZIP , ARC/ENG FIRM NAME ADDRESS CITY/COMMUNITY/STATE/ZIP - ..• PHONE • LICNC M USE OF PERMIT - - BL ZON FSB SSB SSB :'RSB. •- OFC., ZONE ORD V. • ' LOT SZ. END •' SIDE Print Applicant/Agent Name APPL/PRMT DA WIN Xf TOTAL . FEE • o` VALUATION BLDG. DEPT. Pivyel 0 ell NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back 33 Ventilation System 2 Ftgs & Frms 34 Plenums & Ducts 2A Slab Grade 35 Furnace Compart. 3 Steel 36 Inlets & Outlets 4 Grout Blocks 37 Combustion Air 5 Bond Beams 38 Compressor 6 Roof Deck 39 Appl. Clearance 7 Framing 40 Fire Damper 8 Vents 41 Smoke Detection Device 9 Garage Fire Wall 42 Commercial Hood 10 Fireplace P.L. ❑ 43 Final 10A Fireplace T.O. ❑ NPO'N ADDITIONAL INFORMATION - J y SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Lath 12 Internal Lath 12A Drywall 13 Finish Grade INSULATION Thick R Value 7A Walls (Batts) 12B Ceiling (Batts) 12C Ceiling (Blown) 14 Final PLUMBING APPROVALS 15 Ground Plumb 16 Water Piping 17 Rough Plumb 18 Vents 19 Sewage Disposal 20 Sewer 21 Water Heater 22 Water Softener 23 Water Service 24 Gas Test 25 Final Tank Pit L. Line ELECTRIC APPROVALS REAR OF PROPERTY LINE P/L P/I STREET NAME 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final Ir LU z O 0 IXo Z_ O LL J Q to ad df F.: IL _z W D Z Z � J O IL IZ a Z Z~ z(L Q W J � a• APPLICATION FOR TREE PLANTING Job 926-21 I (we), the undersigned, hereby certify and acknowledge that I (we) hove read the application and agree that if trees are required under River- side County Ordinance No. 457, the applicant agrees to install said trees prior to final inspection. It is understood that no final inspection will be given until said requirements have been met or exception has been granted by the County. Now, therefore, it is agreed that the prop- erty owner shall cause the property lines to be surveyed in the event no survey stakes can be found. Further, it is agreed that the County of Riverside shall assume no responsibility should trees have to be removed due to lot line errors. % Owner's Name -W & H BUILDERS Building Permit No. ( �� Moiling Address 930 Vella Road F,i� m Springs State Cazlp 92262 Job Address 51295 Calle Iloilo ommunity La Quints Legal Description Lot 2 Blk 4 Desert Club Tract Unit $2 Assessor's Map, Book & Page '— o Type Structure ame masonite Type of Soil sand Is water available yes Road Dept. Plot Plan No. Type of existing trees in road right—of—way r` Trees preferred by applicant (1) Olive (2) Palos Verdes (3) Brazillian Pepper M-a.a�l �� � "._ _G A Date 11 - -- Owner's Signature �E] SUN , -Gen. Sup' . Planning Commission Case No. ROAD DEPARTMENT APPROVAL Approved species Olea'europaea (Olive) Number of trees 1 Spacing of trees _ Distance from lot {lines: Front 2' in R/W Side Additional requirements'`iPer plot plan on reverse. No street trees will be planted within�10' of driveways. Date Building and:Safety notified _ =9/79 Signature ' - REQUEST FOR EXCEPTION + Reason fy � ti .) 11 , (attach additional page if necessary) Request for hearing: YES ❑ Owner's Signature,.,) 'I (f=orward application to Planning Dept. if exception requested) NO REQUEST FOR HEARING Planning Dept. Concur M D ate Non -concur M Explanation Signature Road Dept. I Concur ❑ Non -Concur ❑ Date ~� Signature REQUEST FOR HEARING AND COMMITTEE DECISION Date hearing established Approved [:) Disapproved Date Building & Safety notified - n Date hearing notice mailed to owner Date Owner notified of decision Signature 1 � a i MIS e 1 � a i MIS PLOT PLAN 2 LEGAL DESCRIPTION: LOT: I ; TRACT.Desert Club Tract Unit -#2 _-CITY/COUNTY: La Quinta/Riverside Owner Job No. 926-21 BLOCK: 4 51295 Calle Iloilo La Quinta, Ca House Plan 4400 A Pad.Elev.: (and finish grade elev. at house corners) Finish Floor Elev.: —Garage Floor Elev.: Sewage Disposal: Install one 1200 gallon septic tank and: CA) one 6ft. diameter seepage pit feet deep NORTH Scale: 11" = 40' - ( ) lineal ft. of 3 foot wide leach line with 3 feet of rock beneath pipe %8/ Aq. Y) RIVERSIDE CQUINTY H AL'1­1-1 D�.-PARTMENT FOOD ESTABLISHMENT XSEW/.32 D'.SFOSAL TRAILER PARK SEPTIC TANK U.0TE-L, �T_ OF LEACH 7.LINE c X PIT 13,-c TO SEWER ---..—WATER LZPOUT �VVATER LINE LAYOUT. ,"G POOL This is to Certify th;!1t the Riversii2o COL.;!-,ty Health Department Approves for-1-1--p-i-ey Z- Installation the tem(s) Checked Above. /T­6'�'�, e Date 3 -- 79 By,Q,�(UK V,5e"). ,t#F „YCITICE: THIS IS NOT A `BUILDING PERMIT APPLICATION TO CONSTRUCT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF RIVERSIDE DISTRICT-- Permit ISTRICT- Permit No �I 284 199 `9/74" - rY _ - CANARY—FILE,- PINK—APPLIC OwnerArchitect" Contractor �' 0 Addres. ress Addre Citytry Cry_ - Phone h Phone 1 (we) the undersigned• hereby certify and acknowledge that I (we) have read '.thb application and agree that if Curb and Gutter, and Z Paving, and/or Dedication of right of way is required by the County of Riverside, the Riverside County Department of Building and Safety 3 shalknot make a Final Inspection until said requirements have.been met. I am also aware that no work is to be done within the County R/W O withoutean encroachment permit. - • NOW, therefore, it is agreed that I (we) will not occu Y" g py•;aid property and will not :cause said property to be occupied until I (we) have complied with all laws of the County of Riverside and the Stateof California governing said property.. + ' .. r .rte' vww�.�wr,......► DATE SIGNATURE OF OWNER AND/OR AGENT r` • _ -11 3 9,1 C-1 ? Approval by Signature from the Following Departmenh Listed'Beo Must Be Obtained Prior to the Issuing of a Construction Permit. *4ptr. �7 -`. �' + .� 1 SPACE NO. f�y�,�, *� 1 �'"30 t2 USE OF $IRUCTURE — JOB ADDRESS V � — SINGLE FAMILY E] DUPLEX } tEGAL�TIIT_ Z f�: `/l Y r APARTMENTS �] AGRIC. [� , O t. �� �tsr+t�r�� . ;�Ie .� � COMMERCIAL INDUSTRIAL Z COMMUNITY NO. OF SUBMITTED PLANS --! 5 ALTERATIONS CJ , USE OF'PERMIT = ���' . +-!•�>7 f `�`� r-�— ___ N Q EASE NO. -"AD. OF PARKING SPACES REQU'RED' -- '-NO BUILDINIGS'NOWQXISTING -- p _Z Q r yOF ZONE' f SETBACKS: FRONT SIDE f' -'r `REAR J m GRADING PERMIT REQUIRED? ; - YES NO ❑ '� LOT SIZE'' SETBACK, ORDINANCE N OF FEET REQUIRED ON s' ' ' STREET r� DATE __�~' �r SIGNATURE_ OF LAND USE OFFICIAL,— FFICIAL DEDICATION DEDICATION REQUIRED: YES ❑ NO ❑• NO. OF FEET.__ CURB AND GUTTER REQUIRED: YES C3 NO C -)f STREET d CAN. CURB AND GUTTER FEASIBLY BE I TA LED? YES ❑ NO ❑ HAS AN ACCEPTABLE PPLICATION •B ENCROACH •T ERMI R DR SAY D TREET 0 ®DEE.F�O,R IMP Y ❑ �C °L il DATE `-r —_�� SIGNATURE OF ROAD DEPT. OFFICIAL .r Z SR�IOAOETRL f WSEWAGE.DISPOSAL ' _ c { ATER POLLUTION REMARKS �s FLOOD CONTROL Z AIR POLLUTION 1Lf y i = H DIV OF HWY 3 o < _ YOUR PROPERTY MAY BE SUBJECT TO o­oeFLOOD. ,RIVERSIDE COUNTY ASSUMES NO RESPONSIBILITY IN EVENT OF FLOOD �I 284 199 `9/74" - rY _ - CANARY—FILE,- PINK—APPLIC