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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 4 (commencing with Section 7000) of Division 3 of thrsaBusiness and
professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
Date 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,477044, Busi en ss & Professionals
Code). t
() I am exempt under Section , B&P.C. for this reason
Date f. "Y' Signature of Owners C-?"_
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:
Carrier Policy No.
(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 wit0hose provisions.
Date: ,� �l 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 propdrty for inspection purposes:'
/Signature (Owner/Agent) _<---Date
BUILDING PERMIT PERMIT#
DATE fY �� VALUATION $3,000.W
LOT TRACT
JOB SITE ADDRESS *77-270 C,A.�W.E ` Tk'C A APN r74-26-&T'is4
OWNER CONTRACTOR/DESIGNER/EN (NEER
PAULDaT I"Y'MS OV413 _R / RT. L1) LM
°77 27 0 CALLS MAXE 7 7-x70 CALLE MATE
LA QUINTA CA 92253 LA taiJWA CA 42253
3 - CUff
USE OF PERMIT
PLUW17:40
VALUATION
X000100 L9
F611MA7,ED COSH OF C';ONM C:'1101 -F 3SM)p"00
PLUPOBINO FIsY .. SEWER 101-000-419-000 $30.00
]IMA'T
7 'iRU'C 7T01,i Ake PI:.PIN C H-PlIrM $30.00
121004 LESS PRE -PAID ;EES $0.00
DITEPOW "00)
CION.-A QIIATA
RECEIPT
DATE �� BY �_ ID/ E / D� G� INSPEC��
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
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 Wall Firewall
Exterior Lath
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
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
Appliances
J—Z ZZ
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COACHELLA VALLEY WATER DISTRICT¢� '
CASH RECEIPT DETAIL TO
10001
CASH
' Received From:+j ` i}«� L� f Date:
t t t S
Address: 1 t) Ys -C,, I f . f ; t'�Je1 ��(• i.. �.t�' '' � : �
Lots
Account No. - f�
Service Address () 1 :-i ��—' �'� L E- G.A. �1
❑ Meter(s) $ 7
j
O Service(s)
❑ Backflow(s)
❑ .House Lateral(s)
❑ DetectorCheck(s)
❑ Meter Surcharge '
a, anitation Capacity Charge
O W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account -Name I
O Inspection Fee - Tract - lli
Fee - t-
❑ Plan Check Fees Water / Sewer -
Tract - .'
❑ Bond Payment - A.D. - Bond
_ J
Assmt.
❑ Customer Deposit
❑ Other i
. t � = t, n - • TOTAL $ -
Remarks:
Ilaclopy to:
Cash / •,i :K:w e;et- Water Service
1 II
Check .. = f
i. Cashier l
Money i
Order CVWD 438(11/89)
drawing of record..
These deviations from the drawings of record are beyond the control of
CVWD; therefore, the district will not -be responsible for any charges
incurred by the homeowner as a result of these inaccuracies.
July 1, 20M
EC -Sewer Service, Inc.
dba ECONO SEWER SERVICE
P.O. Box 581029, North Palm Springs;F k. 92258
(760) 346-2793 (760) 328-770
Fax (760) 251-3405
JOB TICKET
BILL TO PHONE
FUL" "J
ADDRESS/ ^,z%cc4,F -TFC P E
TECHNICIAN
``NI
CITY n QU(�-Tn G 0j–Av6AHELPER
QUANT. DESCRIPTION OF PRICE AMOUNT
P ool< UP
-
Pumping Fee per 1000 Gallons (or fraction)
SERVICE
:0—PUMP SEPTIC TANK HAS SEPTIC TANK BEEN DUG UP9.O-YeS ❑ No
E] PMT. ON SITE
REQUESTED
❑ PUMP SEEPAGE PIT AT ITS RISER
❑ OFFICE BILLING
❑ PUMP GREASE TRAPYellow
Cast.
Locating and Opening Fee (lhr. Min.)
❑ OTHER
8 Yellow Office
QUANT. DESCRIPTION OF PRICE AMOUNT
16CJG
Pumping Fee per 1000 Gallons (or fraction)
co
Waste Discharge Fee per 1000 Gallons
Locating and Opening Fee (lhr. Min.)
Out of Area Fee
Li 5 00 6ha2- 0 i -:� L4006
6 /0 5
GREASETRAPS
RECOMMEND INLETIOUTLETBAFFLE REPAIR.
EXCESSIVE GREASElFOOD/DEBRIS.
EXCESSIVE ODOR.
RECOMMEND MORE FREQUENT PUMPING.
❑ RECOMMEND LINE CLEANING.
SEPTIC SYSTEMS
❑ 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 of your leaching system.
❑ THIS PUMPING WILL PROVIDE ONLY TEMPORARY RELIEF AND NOT
SOLVE CUSTOMERS SEPTIC PROBLEM BECAUSE OF THE ABOVE.
❑ CUSTOMER HAS BEEN GIVEN AN"EXPLAINAT(ON PACKET.
A SERVICE CHARGE OF S22 WELL BE DUE
ON ALL RETRUNED CHECKS.
A FINANCE CHARGE OF 1 1/2% PER MONTH, 18% PER YEAR, WH,L BE
CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS,
IF PAYMENT IS BY CHECK
DRIVERS LIC. 0 n /1 .4 STATE
I
1 hereby acknowledge rhe/1satisfactory co pletlon of e eeddescribeedd work:
SIGNATURE ' %(
� -, /�`-'�/
Due
FLOORPLAN
Borrower: PAULDEN EVANS
Property Address: 77270 Calle Tecate
Citv: LA QUINTA
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State: CA
TbNed bond beam with fountains
Brick
Pool
Brick
Covered Brick
Garage Patio 0 30.0'
16.5'
N
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wfi clilui
Stale g m 3
o 5' edroom C:71
Ivin Room
r' 'm .%Bath g
v l Pavers lKllcher�
�yf Laundry 1 tLr
16.0' o
Covered
Brick Porch
roved b : Date Reso #
❑ tanning Comm SIOn view of mountains
❑ ity Council Motorized qalo
flfTimunity ❑ev. Dept, sketch only. Interiors and other features not nece!
to iatS
Cite No. _
Exhibit
❑ VVfth Conditions
skotdh by Mea IV ^
Comments: C4VOW--o F'"J - N61 Th (46 AW 04COS6C aA-�
File No.: 0408LQCv-Evan1
Case No.:
92253
AREA CALCULATIONS SUMMARY LIVING AREA BREAKDOWN
Code Description Size Net Totals Breakdown Subtotals
GLAl Firet Floor 1286.00 1286.00 Firat Floor
GAR Garage 276.00 276.00 2.0 x 30.0 60.00
20.0 x 60.5 [121 0-0
0
1.0 x 16.0 16.01