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0001-017 (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 B / i�f3l?�i Qate �i-�•r�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: 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 with those provisions.,'-. Vie: 4•-'a,7`�XApplicant 4-J e./���� Warning: Failure to secure Workers' Compensation coverage is unlawfdl 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: 1'S g ature (Owner/Agent) Date�f- PERMIT # BUILDING PERMIT (WI -03 7 DATE VALUATION $"t7.58.911 LOT 20 TRACT MIK4 112 JOB SITE r— --- a •..w ..,r � 1 ADDRESS :�i 9�1�t�. ws.w_+sri tt�13"NAbt4`51. APN Ar. , ! 4-115-004 OWNER CONTRRACTOR/ DESIGNER . II 9 TRU 'BLE' �E•�NGI(NYEE^�RR ��T try1 iRIsFILFUCO3 1C. . 90-033 AVENUE 43 WD10 CA 9:201 (7050)U2 7-9755 CKN 57,91 9 USE OF PERMIT SrK(Xfi1 �lR AIWLY DWELLNICY N E ) 4061 a %rOM NOT NCLUDE BLOCK WALL OR POOL. 7: o PLAN CA -190K HEL1QQ'i'1O1� APPL1E-1) 1 (A MUL'11Y.LF FLAN SUB 11-TA.L. T A, s' CONSTRU ON @,5175.00 .19 PORCHiPAN10 247.0 SP C'rAAA(_1t:'7CAf 3° )XT 472.00 SF, 5 FT. WOOD P1;NCE 201).Oo Lf ' "-+ D t":�,S Or MINS, �s��:1C".�'.t_•OR,' ysr' �p t �. L�7' ir Fff. 01L,POS!11' 401-000-439 3118 Mxti`."1'd!it1^'CT(>l�f t; Ifill, -OM-4.1R-000 ,.`UAf?,9,�1D •an - .ti' f:/'.. 1...R �1,+1.•L?, A�.I.�IS tA1p0 A o 1 4i A..Tl ME ;lits CCAL FEE Itix-uGt-�o2l-e i(3 517 esti ELL- KICAL F• Eh S 1 Zs.v 7 nj��,��! VZAiATNI i .1`14 ! 011-/(�)//(��n- 419-(}l��y/(��i $11a.75 aF. pr^�.��.}�� 3•3�� �� /{-�� 10 /�rr STRONG N10��!'ION fTH ` d�,Li 1D .Ilii -000-2141'-000 $9.91) ORP,01NO Fhb 141 -WO -423-i" aN.60 1. lElii;'SW>P�R "AG t' f'E8 $1.007,00 AFC18E tai .SON 101-000-44-1-3+45 $100IDO ct Tt3-'rO Viz. CO -_,;,,'5r ?:UCMI Off} AND P!.AN C HEC $3,91)4.47 LESS PIR111,I)MO FEES 4111150.001 TOTAL :l'!ti:>I#MIT i! +!✓1:*I,S1 ME NOW S2,34447 RECEIPT DATE BY DATE FINALED INSPECTOR toe J INSPECTION RECORD OPERATION t DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING Set Backs APPROVALS MECHANICAL APPROVALS Underground Ducts Forms & Footings Slab Grade _ Ducts Return Air Steel Combustion Air Roof DeckCa J Exhaust Fans OX to Wrap Framing / c_F.A.U. [ �� d� 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 .S ® S 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 /g p0 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 COMMENTS: y Final c� Utility Notice (Gas) FIT' t 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) - P.O. BOX 1504 APPLICATION ONLY Bu i Id i n/ 78-495 CALLE TAMPICO Address C role Alue h%elv e— LA QUINTA, CALIFORNIA 92253 Owner Address _ City Zip Tel. - Contractor _ '44/,, ( /-) ,i S //t,e /.- Address State Lic. City & Classif. / /- _] D , , -1 1 Lic. # Designers ' Address City IZip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am llcensed under provislons of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Co e, and my license is in full force and effect. / 9' �GNATURE DATE OWNER -BUILDER DECLARATION Ihereby 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 rile a signed statement that he is licensed pursuant to the provisions of the 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 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (E500). l: 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'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.) 1-3 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, ora certified copy thereon). (Sec. 3800, Labor Code.) Policy No.-/ S" b6!,0LCompany STr1 %e f Ls„�d f7 Copy is filed with the city. ❑ Certified copy is hereby furnished. 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 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 Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 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.) 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 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 applicant Date Mailing Address City, State, Zip .DING: TYPE"CONST. S if /2 OCC. GRP. Number 71, _ ~ O o ,I Description /a Project Description Sq. Ft. Size j '-O No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure ' . p• TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line` �(k 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 t Validation: WHITE = FINANCE YELLOW = APPLICANT r PINK = BUILDING DIVISION Notice: Document Cannot Be Duplicated Date 1/24/00 No. 19944 Owner NameWilliam Tribble Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE APN # 774-215-004 Jurisdiction La Ouinta Permit # No. Street SEE BELOW Log # City Indio Zip 92201 Study Area Tract # Lot # Type of Development Single Family Residence Comments 51-300 Avenida Hueneme @ 1,575 sq. ft. 54-062 Avenida Velasco @ 1,575 sq. ft. Square Footage 3150 No. of Units 2 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 1.93 X 3,150 or $ 6,079.50 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_ CC/Prime Bank/William Tribble Telephone 760-347-9755 Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Signature Mary Ann L. Borja Payment Received $6,079.50 Check No. 2196 & 2197 NOTICE: Pursuant of Assembly 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 from 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 ��iw. - f/YT I iVu• �YlM1f■ *tiV • , ( '^r l^Il � r ~ � * -�F'. ', 1�'� t.. f� �u ''•' Nc ASSESSOR'S PARCEL NUMBER .COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY r%� �I4 _ y —del 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 Countyppf Riverside. Approval of this applica- , tion shall remain. valid for a period not to exceed one year from date of payment, �.5 C'/ r U/" 1.4 00' -'VM C K 2 $214.0( LMS # �Ik «^ � :� •�• �. IAC C a` .Agent, Contractor, Contact Person Address City State Zip Telephone f. f ` 7,' // 5�/_ Owner Address City State Zip Telephone Q JI., �..�` ; ,�� i �l..�ra i �' �° X-'7- 5- ZZJob H Property Address / City C r )ll /X -J eo N L° h. /— N 0�.h 7„ Zip WLot 4 Size ! sa. ater Agency It— E1RtHE[i ��L(rv' Use of Permit, P/P, SUP, PUP, etc. 71c+ecilA/4I�lIAZ e4,44 F� Legal Description � G'T,�0 4 C(1(*1v5� prfol7'C;�rlgrACr � jSTIIr('T Dwellin ld+Sit4448p�►etC. �I'[++� Signature of Applic `t I rt -0 LI)/AC (,4pWZ,;,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 m ❑ Holding Tank Agreements Completed Z Thomas Bros. Page Grid � LI Certification of Existing S.D. System Required U(3 WOCB Clearance Required ❑Date Lot Inspection Completed: Initials LU rn (Attach for DOH -SAN -007, Santa Ana Region Only) Remarks: ❑ Soils Percolation Report 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 Uc/Project # Date Soils Map Page 1. Soil Type 6Dh_ j' Approved By Date No of Systems Type of System(s) ❑ dlding Tank ❑ Replacement No. Dwelling Units(/ Bedrooms, •F-ixttareJs_44ts. (1) Septic Tank Soil Rate Gre se/Sand Grease ntcp Lint Trap ❑ Existing Addition C�rJ/fM�"ZA'41•4 �oOGal. �. D 'S —�_ EA Gal. Sq. Ft. Bottom Area Total Linear Ft. Sidewall Allowance .! ock/ sq. ft. running ft. v Install \ 'ne(s) ft. long ft. wide with Leach Bed sq. ft. of Bottom Area Inlet Tested Depth ❑ NA min. inc frock below drainlines or Proposed Bottom Tested Depth �► U Z O Leach lines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Inlet (BI) Seepage Pit Maximum Other: I— Applicable pp '5' l D Total Depth I �� Allowable Depth / LU N/A Overburden a TD Well Review Approved: SIGNATURE Date: Well Drilling Permit # Grading Plan Approved: Date: SIGNATURE Sewer Verification Approved: Date: Plan Check Only. Approved: Date: REMARKS:Z" Y��• G�� .�(y /.fo /!I , i -wu l/e�t�'C.✓rt^Tf-t Q_ This application is APPRO EV D/DENIEDIfor,:the;categoryTchecked in.SECTION; 8_ FOR OFFICE USE ONLY abode; 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 the s �-��( �/ Q� of above -designed system. No con- structlon Is permitted In the required reserved 100% Revenue code > Fee $ ref / expansion area. (1) Septic Tank must be).00' minimum from any wells /O Mrs' �'t'� r,;, r �f a/�t Check # 047 4f Q � (2) Leach lines must be 100' minimum from any wells, including expansion area. , Date / ��!/" 9 ilnitlal 17 (3 Sewer lines must be 50' minimum from any wells.T �. Z. 0(4)eepage pits must be 150' minimum from any wells, including expansion area. UJ Signature of Health Official / .,�., Date �.., .�� Te_.. �,�a, �:_._:�...:__. ,.,, „rte ,...• -., .._.. ,.... —viuw ruo, TCLwrv—MPPucanr, rlrvn—nlag. uept.; IiULULNHUL—Plans/Records ri U%'- TAM lw LAWN ,----••� --- 10 mw. /1.OA%. / LEACH C/i7 �{� ila�e�py • '\T2 ' ' 15 GAL A PR 8 ; e� WN �• �� - r •�'. f- r• , r' .r ;ice ! (IF 16 GAL TFEE LAWN f m LAWN EHE \ 41 HGHW/ALL FCR PFEPME1w I GAS TAW GM AND�E�� 12/29/99 WED 17:53 FAX 909 889 7632 AE�QAOINO p6QU887F.D BY: AND WREN QED, MAIL TO:, William Tribble 80655 Avenue 43 India, CA 92201 CONTRACTORS FINANCIAL 1003 004 THIS BPIM FORFMMMUM UGF Cr6Y ASSESSOA'SP/W�LNO: 769-114-005-5 The undersigned Grantor(s) declare(s) that the DOCUMENT TRANSFER TAX IS: ME ORDER NO.: $ 12.10 County • Ciry XX computed on the fun value of the Interest of property conveyed, or ESCt�w rdO.: 19195-004 _--- computed an the full value less the veins of liens or encumbrances OR using thereon as the roma of sale GRANT DEED ---! OR tronsfw is EXE:f>✓IPT from tax for the following mason:, FOR A VALUABLE CONSIDERATION, recelpt of which Is hereby aokncywledged, Kevin Holladay, ea•urvarried man hereby GRANT(S) to William Tribble, a widower so that real property sMiated in the City of LA Qun"A County of Riverside , State of Calffornla, described as: IAT 20 = BLOCK 4, DESERT CLUB TRACT MUT #a AS PER mAP RECORDED IN BOOR 20, PAGE 6 OF MAps IN TIM OFFICE OF TEE CO WTY MORM OF SAID CO MTY Dstrtd Soptembsr 03, 1999 STATE OF CALIFORNIA, / } Ct3tmN'1Y OF Jg2k etff f as } ss. tom., OR4Ege " � —9°% . before me � t"`eCef Notary public, personally appeal �elllYt H0 1 A 9' personally imown to me (or pi me on the basis of satisfactory evidence) to be 5E(s) whose tees) is/are a bsc to the within 1 nt and a kno AOddged to me that he/they eooecutad the same In s/her elr authorized Iry(les), and that by&/her/thdr sign(9) eh the In nt the pen(a), or a entity upon behalf of which the 2n, ) ac , executed the instrument. WPMES and'olHclal sed. /l Kevin Holladay HAE UZ ON . cow. 012M70 4os „n�uosum a rq oae.a eor� sa. +q tans %Awl�Y1tl �a UfaWGanar „m.,r FMAMAIL T STA F..NTS TO: SAME AS ABM - NAME aooaGss OPrY, sD+TB s JP W Certificate. of Occupancy City of La Quinta Bdi.lding'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: 51-300 CALLE HUENEME Use Classification: SFD Bldg. Permit No.: 0001-017 Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RL Owner of Building: WILLIAM TRIBBLE Building Official Address: 80-655 AVENUE 43 City: INDIO, CA 92201 By: STEVE TRAXEL Date: ' 10-04-00 POST IN A CONSPICUOUS PLACE