9907-064 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions ofa,
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
731725 I3 owl/20i
Ua/ate /cj"� 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:
( ) * 1, 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.
)� 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
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier TF
UND Policy No.STA
UNI
�1y�
(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 thgse15rovisions.
ate 6'-', Apglicant—"rte:? Zw,'"".'�
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. r
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 e
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 innspection, jArposes.
Signature (Owner/Agent•)✓- Date
PERMIT #
;.6q° BUILDING PERMIT 9907-064
DATE VALUATION SS16.,323.`70 LOT b TRACT T Ts rT I j7
ADDRESS 51-375 C ALF, Ifl�OILO? JOB SITE -
APN . 769-114-0118
OWNER
CONTRACTOR / DESIGNER / ENGINEER
LA CaT; INTA: PARTWMS
1Vr 1Lf.1AM RUS rJ, ,T, ROGO:T2S
M-370 AVENIDA BERMUDAS
56900 JACKSON ST
LAQUIN7A CA 92253
TIMMMAIL CA 92274
(760)399-1200 CEIN 5449
USE OF PERMIT
S1NOI. 1. FAMILY Y iiW,t3i:,.L11` O
SUD ONLY, PbMUT DOES MOT INCLUDE RLOM WALL OR POOL
�
TRA• i CONSTRUCTION L358.00 SF
{3ARAG JCA1tP0RT 480.00 SF
5 M 'WOOD FENCE VO.00 4Y
TIPWEll CONT OF CONS". FLECTION
36,323.70
PENMIT FTU 9QiMMARV
CONSTRUCTION ME 1(TT.-i' l-418-000 �"itti.t30
Pb,AN CH CK FF -H . 101-000439-318
tN. Ct-PNI<:AL IFI 101-000-421-000 SS3. jfl
alC'mICAL F M sla.6.63
I�I;i1�iI3iNLY;I� iS T-{1UU-4Y9-00a 5133.50
S'T'�.�?NC I�1C'3'f'�Ol+?'i!"�Z1(:•)ti�L� Ii9T-f1{1ii-:,�i-iT0I1 3EZ.�3
gRADINO F M, 101 -^OW -42.3-000
INFRASTRUCTURE 22-5-000,443-34-2 $1.870.82
F'RECISE PLAIN � 101-000-�I-30 $25.00
is .i?Jt OSi3 1014=439-318 4250.00
SUB-TOTA-1a CID, N TIRUCIJON JN'D P1,AN C HV,,CK
$it,312M
LESS 1'REPAI.0 F r S
50.00
4250.00
'!oTxl, PER' i1 1: i 1 1�� D1Ih 'N01Y
S , m2so
RE0EIPT .' +
DATE { ...�
BY
DATE FINALED
INSPECTOR
4K
a
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
I
Underground Ducts
Forms & Footings
W 4r
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
- a
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_ p p
Drywall - Int. Lath
6,4'7
Final
Final
POOLS - SPAS
BLOCKWALL
A PROVALS
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
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
2 L v
Appliances
Final
COMMENTS:
Final
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) _�Q
Building'
Addresss"
Owner
Mailing '
Address,__
City Zip
Aaaress
S/ 3 ?B AQ IF it
City lZi
& Classif.
00
Arch., Engr.,
Designer 4
Address
City
vI n�
I _? 2 -
LICENSED
that I am licensed
3 of_the:Business
Zip
' P.O. BOX 1504 APPLICATION ONLY
78-495 CALLE TAMPICO
/jfIo JJ (f LA QUINTA, CALIFORNIA 92253 7, "
ITel.
S641,
i
Tel..
City
Lic. #
ail
j..
Tel,
f State
h Lic. #
i DECLARATION
of Chapter 9 (co
Code, and my lic
Section
uce and
OWNER-13UILDER 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, ChapterJ9 (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).
!; 1, as owner of the property, or my employees with viages.as their sole compensatiori, 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
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.)
0 1 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 it the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thF 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 or ,he Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
BUILDING: TYPE"CONST. !, OCC. GRP.
A.P. Numberr
Lega,l;iDescription .070 4 &"& -d 10CW7* C"LUa
Project Description
1
I
Sia,. Ft.,/ No. No. Dw.
Size /'3 s Zf' . Stories Units
New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Ion
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
R
G
11114
R 9
ZONE: BY:
Minimum Setback Distances;- LA���ci' e
Frofst!Mb ck rom Center Line
t. Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line
Lender's Name
Lender's Address FINAL DATE INSPECTOR
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. Issued by:Date Permit
I agree to comply withall 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. Validated by:
Signature of applicant Date -
Mailing Address Validation:
City, State, Zip
b ! WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
E
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 8/13/99
No. 19176 Jurisdiction La Quinta
Owner NameLa Quinta Partners
No. 51-375 Street Calle Iloilo .
City La Quinta zip 92253
APN # 769-114-018
Permit #9907-064
Log #
Study Area
Tract # BLK4 U2 Lot # 6 Square Footage 1,358
Type of Development
t.
Comments
Single Family Residence
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 _ 'in the'.am6'dnt of
1.93 X 1,358 or $ 2,620.94 the property listed above and;that building %{
permits and/or Certificates of Occupancy for this square footage in this proposed project ffffay now•be issued
Fees Paid By ccNIB/Thomas Buffin
TelepRtane 364-8,470
Name on the check ` , �z;
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Payment Received $2,621.00
Check No. 195301
Signature 6A�i�i��s
INOTICE: Pursuant of Assh(nbly 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 frog( the 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 District('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
i JUN.23.1999 3:57PM (MMMONWEALTH NO.638 P.3i6
J ,
RSC03=0 PJQVXSM 8Yj
CH-TO40 TITLE COMPANY COMPANY
99.8768KC 97.09613.3
M= AECORDBD MAIL TKZS A= AND,
MMISS OTRBmas SHOWN Buaw,
I=L TAX 8TAT00=3 To,
LA QUINTA PARTNERS II
C/0 POWBR BROKERS
LA QUINTA, CA 92263
GRANT DEED APXI 769-i14-012.7
The undersigned gr4ntor(e) declare(e)l
Documentary transfer tags is $13.20
j=j Computed on full value of D arty conveyed or
Ccmputad on lull value lees liens and encuarances remaining at time of sale.
Unincorporated area, t ) City of and
FOR A VALUABLE CONSIDERATION, receipt of which ie hereby acknowledged,
ALICE F, ESQUER, AN M MI4RRIED WOMAN and LUISA ESQUSR, A SINGLE Wam=, MOTHRR A= DArMHTBR
AS JOINT TENANTS
hereby opim (S) to
LA QUINTA PARTNSRS 11
the real property in tho City of LA QCINTA, County of Riverside, state of California,
described as:
LOT 6 OF BLOCK e, 00 $ANTA CUM$LITA AT VALE LA QUINTA, UNIT NO. 2, AS SHOxv
By MAP ON FILE IN BOOK 200 PADS 6 OF -MAPS, RECORDS OF RZVSRSIDE
COUNTY, CALIFORNIA
Dated June 23, 1899
State of California
County of }
On S.S.
before me,
Personally appeared
personally known to me (or proved to the on
the basis of satisfaotory evidence) to be
the person(s) whose names) Ware subscribed
to the within inptxument and acknowledged to
me that he/she/they executed the same in
hie/her/their authorized capacity(ies), and
that by hie/her/their signature(s) on the
instrument the person(s), or the entity upon
behalf of which the persona) acted, executed
the instrument.
WITNESS my hand and official seal.
Signature
DiAIL TAX 9TATMMffT9 To;
£ 'd 60££'ON
ALICE F. ESQUER
LLIISA 81S=
(This area for official notarial seal)
,
I
Sd3N089 d3MOd ffl t:t 6661 'VZ,unp ,
e
COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY ASSESSOR'S PARCEL NUMBER_
9 % / y _U 1 Bl
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. W-2 08 « (►C
$21�'�'�
ww
LMS # CHK ¢$•�'«rr.''1 4 w 0C
Agent, Contractor, Conti&Person t
Address City State Zip
Telephone
/ •
S* v / - jiems - //) v (&)rv�' as . q g
Wj�,7a
Q
Owner
69 Qu iN7/4 RV-DJER`a
Address City State Zip
-5137D �t/f I� ,c�n�u� ' -4q0-(4rrrf1 at. 524!' :
Telephone
0, 8N 7a
Z
°
Job Property Address
City
Zi
0
o1.,4 ,g
U
Lot Size
Water Agency/Well
Use of Permit, P/P, SUP, PUP, etc.
Nrw
Legal DescriptionLLI J�►
�G'a'f f e-� 0f 5!r r!. E,7
AXE
U
tp"
—
Dwellin MH Site Prep., etc.
Signature of 9 ,
-T
Date '
CHECK BOX IF REQUIRED
If any box is checked, this application, shall be considered rejected until
❑ Detailed Contour Plot Plans Required (1 to 5 foot interval)
the information is provided and the fee paid. Resubmittals later than 90
days after date noted below may require repayment of fees.
❑ Staff Specialist Lot Inspection Required
co
❑ Holding Tank Agreements Completed '^�!.
Z
Thomas Bros. Page Grid
°
❑ Certification of Existing S.D. System Required
U
❑ WQCB Clearance Required
❑ Date Lot Inspection. Completed: Initials
LU
(Attach for DOH -SAN -007, Santa Ana Region Only)
Remarks:
L3 soils PercolationReport Required
❑ Maintenance Booklet Provided
❑ Special Feasibility Boring Report Required
❑ Rereview Required Initials Date
❑ Final Inspection by Department of Environmental Health is required.
Please call 24 hours PRIOR to inspection.
C/42 / Soils Percolation Boring Report by r t k Lic/Project # Date
Soils Map Page Soil Type t_1 f, Approved By Date
No of Systems
of System(s)
(ding Tank
No. Dwelling Units
(1) Septic Tank
Soil Rate
Grease/Sand
f.
o• ❑ Replacement
;New ?o Addition
Bedrooms, Fixture Units
ittt
r
i j
/ �
Grease Intcp/Lint Trap
❑Existing
Gal.
i'
Gal.
Sq. Ft.
Bottom Area
Total Linear
Ft.
Sidewall Allowance
Leach Bed sq. ft. of
rock/ sq. ft. running ft.
Install Linnee�(S)-''-M ft. long ft. wide with
Bottom Area
Inlat Tested Depth r? r ❑ NA
min. (inches rack below drainlines or
F
Proposed Bottom Tested Depth
U
Z
Leach lines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below Inlet (BI)
Seepage Pit
Maximum
Other:
°
Applicable
Total Depth
•*',
Allowable
Depth
✓`
U
N/A ,,Overburden Factor
❑ 5' (T6'
�t
TD y3
�/ 7
Cl)
Well Review Approved: / SIGNATUREDate: Well Drilling Permit •#
Grading Plan Approved: Date:
SIUNATURE
Sewer Verification Approved: Date:
Plan Check Only Approved: Date:
REMARKS: %�r IJ htiui : �+ ° % A.1• ✓. raa. S`i�. t.•.� .F �e r� 1
This application is APPS ROVED/ ED NIED 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-
ing permit is necessary for the installation of the above -designed system. No con_
structlon Is permitted In the required reserved 100% expansion area.
Revenue code �.3.7 41.4 .3 A Fee $_ nx[ I �•
'^
(1) Septic Tank must be 100' minimum from any wells.
per. n ^ Q
k
pp
�r Chlec# (9 c-42-11
(2) Leach lines must be 100' minimum from any wells, including expansion area.
Date I ck
~ oZ2- ! l Initial �•
0
(3) Sewer lines must be 50' minimum from any wells.
(�I �.
Z
°
(4) Seepage pits must be 150' minimum from any wells, including expansion area.
U
LU
U
Signature of Health Official
Date
--• • -^^ •-- r •-• --• .• � . � � ,• I.— —1n 0 rnn, I FLwvv—rppncam; rmn—mag. uept.; UULUhNHOL—Plans/Records
Certificate of Occupancy .W 7Ae�c �,
City of La Quinta
Building and Safely 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 ADDRESS:
Use Classification: SFD
Occupancy Group:
51-375 CALLE ILOILO
Bldg. Permit No.: 9907-064
R 3 Type of Construction: VN Land Use Zone: RM
Owner of Building: LA QUINTA PARTNERS
Building Official
Address: 51-370 AVENIDA BERMUDAS
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 03-07-00
POST IN A CONSPICUOUS PLACE