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0004-171 (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 ate /' 4tr' 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 ford, 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. ( f) �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 �STAn. I.'UND Policy No. 22490.0009671 (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`dgree that if I should become si"ibject to the workers' compensation provisions of'Section 3700 of the Labor ,Code, I sha 1' forth ith comply with those ovlsions� Date: Applicant c.. 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 sentatives of this City to enter upon the above-mentioned property for `rfspection,purposes. Si • nature (Owner/Agent) %' -r Date BUILDING PERMIT PERMIT# (MM -171 DATE VALUATION LOT TRACT JOB SITE APN ADDRESS t^ CAL s O L0 76,9-114-017 OWNER CONTRACTOR / DESIGNER / ENGINEER I.A. QUMTA P AR7WM.ZS VWM P.O. BQX450 '78080 Celle Mtado Ste 204 LA QUDITA CA 92253 LA QST{+, CA 9225' (760)564.1866 ML# 859 USE OF PERMIT 01.,E PAWLY DWMWG SFD-PERMi T DOES NOT INCLUOV,13WC IC WALLS OR POOL. LOT S $i.ClCK 4 OF MERT CILUB TRACT 0. t TRACT CONSTRUCTION 1,4 1.00 SF PORCH/PATIO 33.00 Sip OARA EICARPORT $00.00 8F 3 F11% WOOD FENCE 200.00 I.F t. .�:C"�f`'D COS'T� OF C�3k+7S`[x't.°i►�`a.2:ON 69,12.'"+.�3I3 y� yy /y-yr�t+ y-7���.,f'p �7jP:91'I' £ rX' lG. SYJY it � 9 i�''J1YJ.L'AkS A. �, h CONSTRUCTION FEE 101-000`418-000 $594,:+0 PLAN MIEC K FEE 101-000-439-319 $500.07 MW11HANICAL YF1; 101-000-421`000 $60.00 LLECTRIC,ALFeP 191-000-420-000 $129.24 PLUMY31i3C} PL�E 1X11 -000-k419-000 $110.73 CIPAD.INC1 IRE 101-000-423-000 $20.09 yn I9WELOPERIMPACT FEE "' ffi1,90°Y.UU VE `—r PR CIS& PL,&N 101-000-441,x345 $100.00 A. FEE DEPOSIT1131-t�9t1�1 Sy -a I8 ^®a�0.v0 SUB-I`VdiALCO MWilMON AND d',S:JMN CT WiC.K LIMIS PR s -PAID 2 EFS 4250.00 WWI, FLEW f DUX NOW RECEIPT DATE DATE FINALED INSPECTOR 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 O.K to Wrap �J. (y - om 57 y_ys $> Exhaust Fans F.A.U. Framing Insulation 62;?o( C1,23 . pp S ( Compressor Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath _ L_- 005--r- ;r-Drywall Drywall- Int. Lath- 4 Final BLOCKWALL- PPROVALS Final 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 Water Piping _ b-� �a� Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole �Qjj 5 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: ;.•.yiy,.;,.a•.':y,�yr;•j°'y,41•i'Hv rx.v5 parr-�v—•-ew.�`,�;,�t Wil;^ ::�... A. ,'sn: :-.a�'�a'fA'ew'; :•� ;;f6r. sF.,:?�6s': F T i 'R4 r f r J PAID 13 2000 ci P.O. BOX 1504 APPLICATION ONLY Building A � t `� ��� L �-/�'4,�9`'�CALLE T R PI 9 Addresses%%%���111i-'i r[Vlr'x C.L'�r + CALIFORNIA 92253 � .../ Ownepe 8 e -76 ®- -- u I LJT1�l �tiz-r�z..S Mailing 1 �- t - Address t ). x�%C U e tty_ Zia Tel., , ya 2 S'3 64-• 1�:?6 fd Contractor z Addres State Lic./ � City & Classif. �6a j Lic. # ngr., Addresa TeJ: �6 City. Zip State -70 �9-2 C �' Lic. # LICENSED CONTRACTOR'S DECLARATION ` I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of 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 Contractors 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 thstatement. e 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 7031.51by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). C2 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'I 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 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.) 17 1 am exempt under Sec. B. & P.C. for this reason `Date Owner I . 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 r7 Copy is filed with the city. ❑ Certified copy is hereby furnished. ji 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 % 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: If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the i Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. l . "IV 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 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 a0plicant - Date Mailing Address City, State, Zip WHITE= FINANCE YELLOW //1Y v i NlJ'il/ BUILDING: TYPE'CONNST. OCC. GRP. A.P. Number �%� i. ��4 7 Legal Description Project Description Sq. Ft. IL/ No. o. DW. Size Stories nits New Add ❑ Alter ❑ Repair Demolition ❑ r" w;t✓ Estimated Valuation 0' PERMIT AMOUNT Plan Chk. Dep. R �, Plan Chk. Bal.Ir 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: = APPLICANT PINK = BUILDING DIVISION Al Notice: Document Cannot Be Duplicated Desert Sands Unwed School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE Date - 5/18/00 APN # 769-114-017 No. 20455 Jurisdiction La Quinta Owner NameLa Quinta Partners Permit # No. 51-355 Street Calle Iloilo Log # City La Quinta zip 92253 Study Area Tract # Lot # 5 Square Footage 1421 Type of Development Single Family Residence No. of Units 1 Comments - permit does not include block walls or pool. 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 in the amount of 2.05 X 1,421 or S 2,913.05 the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued Fees Paid By CCNalley Independent Bank - Mike Brauckmann Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Ellen Patino r� Signature W Payment Received -f ' ` Telephone .760-409-5422 $2,9:1T3:05 Check No. 216387 NOTICE: Pursuant of Assembly Bill 9081 (CRAP 549, STATS. 19%) 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 the date an 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 District('s)(s) behalf, whichever is either. 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 FJAvr.12. 20001L 3:28PM3V' POWER BROKERS No 1542 P• I 9771RC RQ7Q136iQ7 l M n+cq mom iPL"%m Tlimm Bu"n P.O. Bmt 134 LA QUMA, CALIPOMM 92983 GRANT Dm ' 1 ono -alb s'he undersigned grantor deolare pl, Dooumeatary trasssfet tgse is $19.76 !DO( Com u -ted on full value of uey coaysyed/ or CCaalm�usted ass fµ11 Val1tQ le B l�egf and enB�brences remaining at time of Qale. Unincorporated areas ! � Ci at ,anew a0& A VADUMI1 CQDAi=2W:(X, receipt at which to hereby eoknowledged, . R ti>3M3m A. STE>DIPP>D61, A 4RA0(P n hereby MOM) to a inLLI M TRMW VQ»'P=# Illi MAP= 10i1>;P v 0 the real property in the City of LA GUZO ►, County at Rivareids, stats at oalifornie. V described ser Lot 5, Block i, Chit a%. 3, TMOt beeert club, as per W recorded in seo)k 90, Pa"(s) d inclusive of maps, in the office'of the County Recorder of said County, Dated Merl) 21, XQDO state an Cdiisornia, County at t.eoL sma\e s ) s.s, G=mm a. aT MIN e ore to, w , , personally appeared P `,� so 29 93 Sims proved to me on the basis of satisoutory evi4eooel to be the psreon(el Whose m me(ml LF/mm tubsor0bed to the within instm meat ar4 sakaouiedged to ma that lie/she/bboy* executed the one in his/her/Oheio authorised ospaoity(ies), and that by hie/herAW" signatures) an the instsvmsnt the person(s), or the entity upon bo"19 of which the person(e) acted, executed the instrument. WLIW id Signet MAIL TAX STATE' PITS MS MR9ARA tiff aR01tJN f (Thio area for official notarial meal) ,,.,, J County of Riverside Health `service A9enn Environmental Health l DATE 0411812000 TUE _ 5135. $214.00 i TOTAL $214.00 CHECK $214.00 Terri M No 00532 TIME 14:10. �V 00 I L0 0-0 r -1a ASSESSOR'S PARCEL NUMBER COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY 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, Conta Person L45r r' . - — / 4) ea City State Zip AddLo,j�,r 4-1; & 9 o­--rn CA . ciz z -:;-3 Telephone 1-;74-/856 Q Owner ,��� �a 01-9 /"lCl��/ ;-• F-�:DIF:4.t `A dr ss City State Zip -7 Telephone � a� ZO Job Property Address �' 3S,e C,4 /L p/ t_ v City A ltr�'d► C� • Zip `72 z S`� � V LU Lot Size r Water Agency/Well Use of Permit, P/P, SUP, PUP etc. Legal.pescription Dwelling, MH Sit Prep., etc. JC`I A 19 1 *E t!L(3��� %Z* -'j- OQ}!%� Signature of Applicant Cr! Date CHECK 16"U IF REQUIRED ���• � C�(i tr � � (26 If any box is checked, this application shall a considered rejected until ❑ Detailed Contour Plot Plans Required (1 to 5 foot interval) the Information is provided and the fee Id. Resubmittals later than 90 days after date noted below may require repayment of fees. ❑ Staff Specialist Lot Inspection Required i ca 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 Cate Please call 24 hours PRIOR to inspection. C/42 / Soils Percolation Boring Report by Lic/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 t S �tL Grease Intcp/Lint Trap Existing F, t{, , ,. �1'VC,� Gal. 100.. 1 Gal. Sq. Ft. Total Linear Sidewall 4llowance Leach Bed sq. ft. of Bottom Area Ft. Bottom Area ft. rock/ sq. ft. running ft. Install Lines) ft. long ft. wide with Inlet Tested Depth ❑ NA min. inches rock below drainlines or U Proposed Bottom Tested Depth Z Leach lines/bed special design for slope: (3) Fit Diameter No. Pits Pit Below Inlet (BI) Seepage Pit Maximum Other: 0 Total Depth Allowable i- Applicable I Depth UJ .N/A Overburden Factor ❑ 5' 5 \ ` L�Q TD `I� y 3 I Well Review Approved: Date: Well Drilling Permit # SIGNATURE Grading Plan Approved: Date: sI Sewer Verification Approved: Date: Plan Check Only Approved: Date: REMARKS: SPw�d,k s.._�e.� �n�� r,,,t 6C L t/ d•( A... �oy..1 4v,l;44rS 1 1 k 1-1.1111 fir_ . n•�F-51e n/ f. ,c. d, -+:.L -e d. •,e- G l • 1 ,,1 (�►n` �[l � �'t7-j-!/PQS (CdOt.� SGr-tTi�- SVS%i„� ! This application is`APPROVED/_DENIED for the category checked in SECTION B FOR OFFICE USE ONLY above, regarding the design of a subsurface disposal system as indicated on the acompanied plot plan, using the requirements set forth in SECTION C above. A build- ,^�11 , V ing permit is necessary for the installation of the above -designed system. No con- struction In permitted In the required reserved 100% expansion area. Revenue code 1 by 5 j Fee $ (1) Septic Tank must be 100' minimum from any wells. 4Check # (2) Leach lines must be 100' minimum from any wells, including expansion area. jj t� f Date L'i ` 1 U ` 00 Initial 0 (3) Sewer lines must be 50' minimum from any wells. o o S 3 Com. Z 0(4) Seepage pits must be 1517 minimum from aiy wells, including expansion area. H �. J U U.1 1-n � \ - Signature of Health Official Date utn-gray-iu tnev groat ulsinouuon: Vn1­111 t—Unice rue; Ttl-ww—Appucant; VINK—tilGg. Uept.; UULDENRUL—Plans/Records to W217 / �Ml 78-495 CALLE TAMPICO LA QUINTA, CA 92253 (760) 777-7075 APPLICATION FLOOD PLAIN DEVELOPMENT PERMIT BUILDING SITE LOCATION .FLOOD ZONE "AO"- DEPTH 1 PC-- T COMMUNITY- PANEL NUMBER 060709 0005 B /V Map Revised: 8/19/1991 APPLICANT INFORMATION SECTION APPLICANT NAME��� ✓� ! �t,�. APPLICANT ADDRESS �{� `z (MAILING ADDRESS, NOT THE BUILDING SITE) (.,QA ts- {T`� -C DAYTIME TELEPHONE N0. INSTRUCTIONS 1. A Flood Plain Development Permit is required by LQMC Section 8.11.040(A). The Applicant should complete the Applicant Information portion of this application and submit it to the Engineering Department 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 y 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. • Submit a completed FEMA "Elevation Certi)rcate" form to the Engineering Department. • Submit 95% relative density soils compaction certification to the Engineering Department. STEP 1 OF 2 APPROVAL STEP 2 OF 2 APPROVAL The Precise Grading Plan submitted for this application has been 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.. A T ORIZED SIGNATURE D TE AUTHORIZED SIGNATURE DATE La Quinta Engineering D rtment La Quinta Engineering Department 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. F080A 10/88 P. O. 'BOX 450 * LA'QUINTA * CALIFORNIA * 922.53-0450 760/564-1866 * FAX -760/564-2627 Certificate of Occupancy City of La Quinta Building and Safety Department This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code, certifying that, at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following.- -BUILDING ollowing.-BUILDING ADDRESS: 51-355 CALLE ILOILO Use Classification: SFD Bldg. Permit No.: 0004-171 Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC Owner of Building: LA QUINTA PARTNERS Address: P.O. BOX 450 City: LA QUINTA, CA 92253 By: STEVE TRAXEL Date: 11-09-00 Building Official POST IN A CONSPICUOUS PLACE