9596 (PLBG)78-195 AACIEFDA &'
Owner
HAROLD LARSEN
Mailing
Address SAME
P.O. BOX 1504
78-105 CALLE ESTADO
LA I;QUINT& CALIFORNIA 92253
City Zip Tel.
LA QUINTAeCA 92253 1 564-6538
Contractor
P 0 BOX 192
Zip
& Classif- 460981 1 Lic .# 342—
Designers
Address
City lZipStateI
Lic. #
LICENSED CONTRACTOR'S DECLARATION'.
I;hereby affirm that I am licensedlunder'proVlslons.of Chapter 9 (commencing with Section .
7000) of.Division 3 of the Business -and,ProfessiObs.-Code. and my license Is In full force and
DATE
OWNEI =BUILDER DECLARATION
I hereby affirm that l am exempt from the Contractors License Law for the following
reason:' (Sec. 7031.6,Buahoss and,ProfesaPons Code: Any city or county which requires a
permit to construct, ager, improve,- deal", or repair any structure, prior to Its Issuance also
requires the applicarrt.for such perm# to We a signed statement, that he is licensed pursuant to
the provisions of the Contractors License Law, Chapter 9 (commencing w#h Section 7000) of
'Division 3 o fheBusiness and Professions Code, or that. he la exempt therefrom, and the basis
for the alleged exemption. Any 'violation of Section 7031.5 by 'any applicant for a permit
suh)ecta the apjgc t,to a: civi-penalty of not more than five hundred dollars ($500).
01, as owner of the property; or my employees•wiWwages eh thelr.sole compensation,_wlll
do the work, andahestructure is not Intended or. offeredJor Sale..(Sec. 7044, Bulsness and
Professions code'• The. Contractors License Law, does not apply :to an owner of property who
builds or pnproves thereon and who does such work himself or through his own wrooyess,
provided that' such trryrrovements are not Intended or, offered for sale. h however, the building
or Improvement Is sold wRAln one year of completion, the owner-bunterwl# have the burden -
of provtnp that he did not build or improve for the purpose of sale.)
❑ 1; as owner of the property, am exclusively contracting with licensed contrectore to ooh►
struct the -project (Sec. 7044, Business and,Profesalons Code: The Contractor's License Law•
does riot apply to an owner of property -who builds or Improves, thereon, and who contracts tor'
such projects with a contractoKs)"licensed -pursuant to the Contractor's License Law.)
0.1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION '
I hereby affirm that 1 have a certificate of consent to self -Insure, or a'ceRificate of.
workersC4sairpinsyrAQomRricertifledcopythereof. [$ AgQp,"'C6adad IN
Policy No �+:f t 1(y 5 r Aft"'C60
0 Copy is filed with the city. 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION'FROM
WORKERS'COMPENSATIONINSURANCE
(TMs secdon need not be completed If the permit Is for one hundred do#ars ($100) vefusuon
or lass.)
certify that In the performance of the work for which this permit is Issued, I shall not
=1Z,Fe In. any manner so°as to become subject to the; Workere''Compensatlon
laws of Callfomla
Date owner'
NOTICE TO APPLICANT: M, alter making this Certificate of Exa*tlon you should became
sidged to the 'workers, Compensatlon provisions of the Labor Code, you must lorfhw#b
comply with,such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY '
Ihereby affirm that there _Is,a construction lending agency for the performanee,of the
work for which this permit is Issued. (Sec. 309 7,, C/d1 Code.)
Lender's Name
Lenders Address
This Is a building permit when properly filled out, signed and validated,.and 1s subject to
expiration If work thereunder lasuspended for 1W days.
1 certify that I have, read this applicatiomand .atate 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 iof this city to enter the above.. _
mentioned property for Inspection purposes.
Slgnature.of,applicani Date -
Mclling Address
City, State, Zip
No. 9596
NG: TYPE CONST. HOOKUP OCC: GRP.
Number
Description
:t Description SEVER HOOKUP
Sq_Ft. No. No. Dw.
Size Stories Units
New ❑ Add _❑ Alter ❑ Repair ❑ -Demolition ❑
Estimated Valuation SEWER HOOKUP
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const: .
Mech.
Electrical
Plumbing •
S.M.I.
Grading
Driveway Enc.
Infrastructure
•
TOTAL •
REMARKS
()tris ""'a
;ii—tiS er'
T{J t. •i.�t. ], I i•.r)L j1. ;i1J s t)
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:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL SQ -FT.®.
YARD SPKLR SYSTEM
_
POR SO FT-®
MOBILEHOMESVC.
BAR SINK
GAR. SO. FT..®
POWER OUTLET
I ROOF DRAINS
CARP SO Fr. ®
DUCTWORK
DRAINAGE PIPING
WALL SO. FT.,@,
DRINKING FOUNTAIN.
SQ FT ®
HEATING.(FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE. Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOj(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL.
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
= plus xi
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP.
KITCHEN SINK
ABSORPTION SYSTEM, B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEWPERM
LAVATORY
HEATING SYSTEM- FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. &T.U.
SO. FT. ® c
BATH TUB
SO. FT. ®c
I WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT.,RESID ® 1 Vic
SEWAGE DISPOSAL
SQ.FT.GAR ® 114c
HOUSE SEWER
GAS'PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCKFEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
UGH WIRING.
DUCTWORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING.(FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
= plus xi
=E
LUMBER GR:
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS
VENTILATION
FIRE ZONE ROOFING =
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION, L
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITUU.S
GARDEN WALL FINAL
ESTABLISHED IN 1918 AS A PUBLIC AGENCY
COACHELLA VALLEY WATER DISTRICT
POST OFFICE BOX1058 • COACHELLA; CALIFORNIA, 82236 • TELEPHONE 161%398;2651
DIRECTORS OFFICERS
RAYMOND R. RUMMONDS; PRESIDENT LOWELL'O.WEEKS. GENERAL MANAGER—CHIEF ENGINEER
TELLISCODEKAs;;VICE PRESIDENT BERNARDINESUTTON.,SECRETARY
JOHN P. POWELL KEITH R AINSWORTH. ASSISTANT GENERAL MANAGERIAUDITOR
PAUL W. NICHOLS REDWINE AND SHERRILL. ATTORNEYS
THEODORE J. FISH January 2.7,, 1986
,Fil:e : 0721..1
i.'NameV
VAddV
VSalV
Subject: Sanitation Service for Avila Drive;, Hacienda
La Quinta:, Guijarr,_o Place, 'La Quinta, California
The tract in which your 'home is located' was constructed with a dry sewer system.
This system.was installed in anticipation of the extension of community trunk
sewers.. In October 1985 connection to the community trunk, sewer was made,
thereby activating the sewer- system within your tract.
The developer of your tract, recognizing that the sewer system was not usable,
installed septic tanks for the purpose of providing wastewater treatment until
the sewer system Could be activated. Now that your sewer. system is in service
you may desire to connect to it.
In order to obtain sewer service to your pr.operty.the following items must be
completed:
L. The, owners of. record of the property must complete. the enclosedapplication
for service Bard and return it to the District in the enclosed envelope.
The physical connection of your home, to the community sewer may be. made by
a plumber or sewer contractor of your cho-ice.. The contractor or plumber must.
secure a. building permit from the City of La Quinta and notify the District
prior to installation of the connecting pipeline.
A monthly sewer charge which is currently $11.00 is collected to pay for
treatment of the wastewater generated from your home..
TRUE CONSERVATION
USEWATER WISELY
t
Y
YNameW -2- January 27, 1986
If you have any questions or require additionalnforma;tio'n., please ea l'1
Jim Zimmerman at (619) 398-2651.
Yours very truly,
Lowell 0. Weeks
General Manager -Chief Engineer
AU:lmf
Enclosures/2/.as