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10-0224 (PLBG)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 10-00000224 Property Address: 51431 AVENIDA VILLA APN: 773-102-008-3 -000000- Application description: PLUMBING Property Zoning: COVE RESIDENTIAL Application valuation: 5000 Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT LICENSED CONTRACTOR'S DECLARATION 1 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 Class: License No.: Date: Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any ap ant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ( _ 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 and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the 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 or she did not build or improve for the purpose of sale.). (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. , B.&P.C. for this reasofyt :.Date: / i'/ 10 Owner: CONSTRUCTION LENDING AGENCY ' I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 /DIate : 3/18/10 Owner: f 4 LAWRENCE, TOM & MARY 12826 SHORT AVEfgf S LOS ANGELES, CA 9006.6 J Z y 0 Cl !U a 0646 Contractor: 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 and policy number are: . Carrier - - - - - - - - - - - - - - - - - - - - - - -Policy Number I certify that, in the performance of the work for which this permit is.issued, 1 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 t eporkers' compensation provisions of Section 3700 of the Labor Code,�h II forthwi co y with those provisions. Date03 _E Applicant:T WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE'HUNDRED THOUSAND DOLLARS ($100,0001. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. . APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this 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 application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Ouinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 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 county ordinances and state laws relating to building construction . and hereby authorize representatives ofthis �crounty to enter upon the above-mentioned propertinspectio p' rposes. Da[ex/ff Signature (Applicant or Agent): Application Number . . . . . 10-00000224 Permit . . . PLUMBING SEWER Additional desc . Permit Fee 30.00 Plan Check Fee .00 Issue Date . . . . Valuation 5000 Expiration Date 9/14/10 Qty Unit Charge Per Extension BASE FEE 30.00 ---------------------------------------------------------------------------- Special Notes and Comments SEPTIC ABANDONMNET / SEWER HOOK UP ---------------------------------------------------------------------------- - BLDG STDS ADMIN (SB1473) 1:00 Fee summary Charged Paid -------------------- Credited -------------------- Due ----------------- Permit Fee Total 30.00 .00 .00 30.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 31.00 .00 .00 31.00 LQPERMIT Bin # City of La Quinta Building 8L Safety Division P.O. Box 1504, 78-495 Calle Tampico La Qulnta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # b �-� Project Address:t-m l 4 t/e t V, Owner's Name: 4- 61 LL) tLe A C A. P. Number: Address: a Lc r I A/0- QLegal LegalDescription: City, ST, Zip: Contractor: Telephone: � D �� >�Y.. >;,,;;},• 4:;c•:•,y;{;y;;:::.•.fir.• D / � t•^:.4>�s�'?�:>�'��°�«.�czs?:<�» Address: Project Description: City, ST, Zip: Telephoner01 s,'•o'>>s;'`' >zr< State Lic. # : City Lic. #: ' Arch., Engr., Designer: Address: City., ST, Zip: Telephone: State Lic. <;•> .;M ;.m :: t:r:c:,•; :;.:v ;;:> ;<t s:•. .{w:L{ i:)::j'•`,j•:W i iriv�4.;.�>:'i'}i>1f Construction Type: S �� Occupancy: project type (circle one): New Add'a Alter Repair Demo Name of Contact Person: Sq. Ft.: #Stories: #Units: Telephone # of Contact Person: Estimated Value of Project: G e APPLICANT: DO NOT WRITE BELOW THIS LINE N Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan CheekDeposit Truss Cates. Called Contact Person Plan Check2alance Tide 24 Cates. Plans picked up Constructirn Flood plain plan Plans resubmitted Mechanical Grading plan 2od Review, ready for co rrectioassue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''' Review, ready for corrections/issue Developer =mpact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue Schodl Fees Total Permit Fees wo® i P.O. Box 1504 LA QUINTA; CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits IMMETANT! NOTICE TO F ROPE TY OWNER Dear Property Owner. An. application for a building permit has been submitted in your name listing yourself as. the builder of the .property improvements specified at We are.providing you with an Owner -Builder Acknowledgment and Information Verification Fozm to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you,have read, initialed your understanding of each'provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute. this notice unless you, the property owner, obtain the prior approval of the permitting authority. OVA'S ACKNO—W EIR(AMNT ANDYV'ERMCATIEON OF ROOM T1iON- /Dll2ECU S: Read and initial eachstatement below to signify you understand or verify this i*rmation. �I1. I understand a frequent practice of unlicensed persons is to have the property owLer obtain an "Owner -Builder" ding.permit that erroneously implies that the property owner is providing his or her own labor and mate" personally. 1, as an Owner -Builder, may be held liable and subject to serious. financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance -coverage for injuries to workers on my. property- &2- I understand building permits are not required to -be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. ��3 I understand as an "Owner -Builder" I am the responsible party of record on the permia. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. �4. I understand Contractors are required by law to be licensed and bonded in California aad to list their license numbers on permits and contracts. r' (-5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars' ($500), including labor and materials, I nay be considered an "employer" under state and federal law. �6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance; and' contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. �7. 1 understand under California Contractors' State License Law, an Owner -Builder N%ho builds single-family residential structures cannot .legally build them with the .intent to offer them for sale, unless aly work is performed by licensed subcontractors and the number of structures does -not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal. injuries sustainedby any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. "LL 9. I understand I may obtain more information regarding my obligations as an "employee' from the Internal 11 ekenud Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSCR) at 1- 800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. /tL10. I am aware of and consent to anOwner-Builder building permit applied for in my name, and understand that I am the party legally and financially respopsible . for proposed construction activity at . the following address: Sl 2,11 /-��evr, ��a 1 ff l..l ."..-/ _:" 9 L. v� z �I Ll agree that, as the party legally and financially responsible for this proposed construction activity, .I will abide by all applicable laws and requirements that govern Owner=Builders as well as employer's. l2. I agree to notify the issuer of this. form immediately of any additions; deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license,. the Contractors' State License Board may be unable to assistyou with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be ince ivil court. It is_ also important for you to understand that if ani unlicensed Contractor or employee of that individual or firm is injured while working on your property; you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, You will be responsible for verifying whether or not those Contractors are property licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing, fte..permlt. Nate: A copy of the propertp owner's d-4ver's1icen8e, form noiadcadon� or other verification acceptable to the agency required to beiresented when the permit is issued to verify the property owner's signature. �f Signature of property own(' wn �� � / '" Date: Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as. my agent(s) to apply for, sign, and file the documents necessary to obtain anOwner-Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: SANCO PUMPING SERVICE 2502 Morongo Trail Palm Springs, CA 92264 (760) 327-8859 No. 013063 SOLp/DT�O SHIPPED TO 1k; L.�cwf' ./ 1 .lC1-rP O STREET STREET '�) /- / a) vzA CSTATE ZIP CITY STATE ZIP I� a ' CUSTOMER ORDER SA1LESMAN TERMS F.O.B. Y 16 /3-1!519Z166 DATE 3X2/0 A ,r l` PAYMENT DUE UPON RECEIPT 4 *tA"i COACHELLA VALLEY WATER DISTRICT P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 INVOICE Date: 3/17/2010 SUBJECT: 51431 AVENIDA VILLA, LA QUINTA, ACC NO. 606014,719.0.5 "SEWER FEE ONLY" OASIS ESCROW, INC Project: 10-2217 ESCROW TRUST ACCOUNT Project Date: 3/17/2010 69930 HIGHWAY 111, SUITE 214 Amount Due: $3,995.00 RANCHO MIRAGE, CA 92270 GEO: 06-06-01-4 Planner: SANDRA VILLALOBOS TO INSURE PROPER CREDIT,--..LEASE-RETURN IHI$,P_ORTION WITH REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK 1.00 SCC -COLLECTION $1,658.00 $1,658.00 1.00 SCC -TREATMENT $2,337.00 $2,337.00 $3,995.00 PAID . $��oo✓#k 1 �87� MAR. 17 2010 COACHELLA VALLEY WATER DISTRICT SUBJECT: 51431 AVENIDA VILLA, LA QUINTA, ACC NO. 606014,719.0.5 "SEWER FEE ONLY" COACHELLA VALLEY WATER DISTRICT P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 Page 1 I "-11� 11 WWI f 1731 -A WALTER STREET e VENTURA, CALIFORNIA 93003 PHONE (805) 642-6727 December 27, 1983 Henry Winn P.O. Box 1213 La Quinta, CA 92253 Project: 51-431 Ave. Villa La Quinta, CA Subject: Compaction Report 83-12-235 Job No. B -13980-P1 On December 15 and 19, 1983 a representative of our firm performed density tests on the fill placed in the building area on the above refer- enced project. Tests were performed at random locations fn accordance with ASTM 2922-78 and ASTM 3017-78 Nuclear Density Test Procedure. Tests performed as -per authorization of Henry Winn.. The estimated locations of the tests are presented.cn the attached plan with their results being summarized on the attached test report sheet. A total of three (3) density tests were performed. Test results indicate a -minimum of ninety percent (90%) relative compaction has been obtained within the areas tested. In the areas of low density the soils were reworked and retested. The maximum density -optimum moisture was determined in the laboratory in accordance with ASTM D 1557-.78, Method A. Test results are as follows: Soil Description Maximum Density -Optimum Moisture Dark brown silty fine sand. 113.7 pcf 9.9 THOUSAND OAKS (805) 495-8484 VENTURA (805) 642.6727 BAKERSFIELD (805) 327.5150 SANTA BARBARA (805) 966.9912 LANCASTER (805) 948.7538 PALM SPRINGS (714) 328.9131 SAN LUIS OBISPO (805) 544.6187 ►-7 December 27, 1983 -2- LIMITATIONS: 83-12-235 Job No. B -13980-P1 The compaction operations were completed at the time our personnel were called to the site. The test results summarized in this report present the moisture and density only at the locations and depth tested on the specified date. The summarized field and laborator9 tests were performed in accordance with engineering principles genera=ly accepted at this time and location. No opinion is expressed as to the uniformity of the material, compaction, nor adequacy of the material to perform its intended function. No guarantee or warranty of the contractor's work is made or implied. Respectfully submitted, BUENA ENGINEERS, INC. Norman G. Jackson, Jr.. NGJ/NGH/msm Copies.4 - Henry Winn 2 - City of La Quinta 2 - PS file 1 - Vta file 0 Reviewed and Approved Norman G. Hallir. CE 7370 BUENA ENGINEERS, INC. �y CONTRACTOR: ADDRESS REPORT OF RELATIVE COMPACTIONS Job No: B: 139.80-P1 DATE:Decemaez 2711 1983 Report No. 83-12-235 JOB & LOCATION: 51-431 Ave. Villa TEST NO. DATE DESCRIPTION %MOISTURE DRI DENSITY RELATIVE MAXIMUM TESTED IN PLACE IV PLACE COMPACTION DENSITY 1 12-15-83 Per Plan 0.5 4.0 98.0 86 113.7 2 12-19-83 Retest #1 .0.5 14.4 111.0 98 " 3 F.G. 8.1 110.0 97 " F.G. - Finish Grade WE CERTIFY THAT THESE TESTS WERE PERFORMED IN CONFORMANCE WITH COPIES: BUENA ENGINEERS, INC. 83-12-235 December 2,7., 1983 -2- Job No. B -13980-P1 LIMITATIONS: The compaction operations were completed.at the time our personnel were called to the site. The test results summarized in this report present the moisture and density only at the locations and depth tested on the specified date. The summarized field and lab.oratary tests were performed in .accordance with engineering principles generally accepted at this time and location. No opinion is expressed as to the uniformity of the accepted at this time and location. No opinion is expressed as to the uniformity of the material, compaction, nor adequacy of the material to perform its intended function. No.guarantee or warranty of the contractors work is made or implied. Respectfully submitted, BUENA ENGINEERS, INC. Reviewed and Approved Norman.G. Jackson, Jr. Norman G. Hallin CE 7370 NGJ/NGH/msm. Copies 4. - Harry Winn 2 - City of La Quinta 2 - PS file 1 - Vta file BUENA ENGINEERS, INC. A- t .. IN, �.. /wV� � ��..--�-.. �'� �... ".T-y,.�.���.�..7.,�,. r . �'ti it"`f...�.. ,.�.�,..,..:.� r�iti w•�r.✓�-r+��..v-�. �,.:+...r....-,.�... ...ti,.... �....rl.r ,,.t. �, ... a, Z 0 U W (A U Z O U W 0 s _ Al Receipt No.O'�7Gi - Issued By District: Riverside ❑ Indio ❑� Hemet ❑ Date rLe DISTRIBUTION: WHITE - Office File YELLOW - Applicant PINK - Building Dept. GOLDENROD - Pending File DOH SAN 122 (Rev 10/82) RIVERSIDE COUNTY DEPARTMENT OF HEALTH PERMIT APPLICATION FOR A SUBSURFACE DISPOSAL SYSTEM Applicant: Submit this form with three copies of a scaled plot plan drawn to county specifications required on the attached check list. A non refundable filing fee of $15 is required when the application is submitted. Check must be made payable to County of Riverside. Name / Mailing Address /:�/c'R F ,J /90 /3,;x /o)13 City State (' Zip Code Phone 1 /1 q AJ /4 A f :P P 4- 3 s9 V. / J / i/ *Property Address ' 'Xity�or/Community— 'Legal Description of Property (Lot, Parcel Map, Tract) Cft�£ 1/T/q urt/i rr• v�A /4017 / y /'Ace !Ut f s 22-0?3 'Assessors Parcel No. Water Serving Property From Lot size Aom / I ' a u 7IIF,- AJ i /J / IF . l vi77 .Ie- .3 5 U Signature of Applicant Date 'The above information must be verified from Building Application Staff Use — Do Not Write Below This Line /initial Date WQCB Clearance required Yes ❑ No ❑ N' Soils feasibility report required Yes ❑ No ❑ Detailed boring report required Yes ❑ No ❑ Detailed contour plot required Yes ❑ No 0 C Comments: i Soils or boring report by Date Approved b l'Date lv- Soils Map Page Soil Type Tract File No;77 �,a 0t',14'Other Number of -Bedrooms Septic Tank Size (gallons) Rate Required Type of System f f 4 4fi New Addition Replacement El El Leach line sq. ft. of bottom area trench %/ Leach bed (sq. ft. of bottom area bed) Seepage Pit Diameter Number of Pits. Seep/�a[[ge•Pit Depth B71. t nc Total Depth of Pit 5' ❑ soma- Location of System l Additional Requirements- � `�,i9!<� . t,�.:.� �{r�,..My!.t,..r,.•%S t.. fes' 'l" -s� /�`i '!1Q .�ij� l• v2.{.�, . A permit is approv_eldeniedJor the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements set forth in Section B above. A building permit is necessary for the installation of the above designed system. 17 Signature of Health Official Date _ Al Receipt No.O'�7Gi - Issued By District: Riverside ❑ Indio ❑� Hemet ❑ Date rLe DISTRIBUTION: WHITE - Office File YELLOW - Applicant PINK - Building Dept. GOLDENROD - Pending File DOH SAN 122 (Rev 10/82)