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003848, 0108-002 (SFD)City ' Contractor i P.O. BOX 1504 _,iSenhot7e' UYriVe LA QUINTACCALIFORNIA 92253. 'alter L Die, k- mann No. 003848 ` BUILDING: TYPE CONST. OCC:.GRP.- A.P.Number 631-341-001 Zip Tel. Legal Description Project Description e o - City ` lZip - I Tel.- • • State Lic. 81_Classif.- . Arch.; Engr., Designer Address t'Ity Lic. # Sq. Ft. No. No. Dw. Size 2878 Stories Units Tel. I New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ of 61 City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION 1 hereby.y.affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Divislon:3 of the Business and Professions Code, and my license is in full force and SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby "affirm that I am exempt from the.Contractor's License Law for the following reason: (Sec. 7037.5,Buslness and Profeasions Code: Any, city or county which requires a permit to construct, alter, knprove, •demolish, or repair any structure, prior to its .Issuance also reperliea the app8cantfor such.pemiit.to file a signed statement that he•is licensed pursuant to the provisions of the Contractors 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 lora permit aub/eots the applicant to a cht penafty of not more than live 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 isnot Intended or offered for sale. (Sec. 7044, Buisnesa and Professions Code: The Contractor's License Law does not apply to on. owner of property who- buUds or improves thereon and who does such' work himself or, through his own employees, provkfed Mat -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 orbnprove for the purpose of sale.) - 11 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 bullds or Improves thereon, and who contracts for such pro)ects with -a contraotor(s) licensed pursuant to the Contractor's License Law.) llLam exempt under Sec. 8. 8 P.C. for this reason Estimated Valuation - t $1.33yZg5 PERMIT - - AMOUNT - - Plan Chk. Dep. _ - - Plan. Chk. Bal. _ 9 221.75 u ' Const: 568.00 Mich .. Electrical -t- . r' Plumbing3 S ' S.M.I. - - -- (g' %=�p' f - Grading tl0 ; Driveway Enc. 3e396.71 Date owner. Infrastructure WORKERS' COMPENSATION DECLARATION I hereby affirm Ahat I have a certificate of consent to self -Insure, or a certificate of Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company O.Copy is filed with the city. ❑ Certified copy is hereby fumished. CERTIFICATE OF EXEMPTION FROM . WORKERS' COMPENSATION INSURANCE (This section need,not be completed If the permit Is for one hundred dollars ($100) valuation or less.) .. - I certify that in the performance of the work for which this permit Is Issued, I shall not employ arty person in any manner so as to become subject to the Workers' Compensation Laws of California. Date owner TOTAL S4.74PI.76rs: REMARKS . NOTICE TO APPLICANT, If,' after making 'this Certificate of Exemption you should become sutyect to the Worxers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this Parma shall be deemed revoked. - - - CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance oUthe work for which this permit is issued. (Sec.. 3097, Civil Code:) Lenders Name Lender's Address This, Is a building permit when properly filled out, signed and validated, and is subject to expiration, it, work thereunder is suspended for 180 days. I certify that I have read this application and state that the above Information is correct. I agree to comply'with all city'and.county ordinances•and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above-, mentioned property for inspection purposes. Signature of applicant Date Mailing Address' City, State, Zip HARD COPY ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from. Rear Prop. Line Side Street Setback from Center Line Side Setback from Property.Line FINAL DATE INSPECTOR; Issued by: Date I14!$Rermit Validated by: Validation:_ CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE74( 2ND FL. SO. FT. @ BONDING YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR•SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CARP. SO. FT. ROUGH) DRAINAGE PIPING WALL SQ. FT. OTHER APP.IEOUIP. DRINKING FOUNTAIN SO FT ® TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FRAMING GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM REMARKS: KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® I'A c SEWAGE DISPOSAL SQ.FT.GAR (10 34c HOUSE SEWER MESH GAS PIPING PERMIT FEE PERMIT FEE. PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE LUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK ROU D PLUMBING?) I UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE74( OUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF.7 �y ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ -$ 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 CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS. GARDEN WALL FINAL Bu and Mailing Address -4 4 Qa p�L. P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 APPLICATION ONLY 0-1,1 °" BUILDING: TYPE CONST. / OCC. GRP. JA / tr S0.. A.P. Number 6 3 Tel. r7 jc¢ Q. Legal Description Projec t Description 'ScriL/JL�— /631 R ' vo City Zia 7o Tel.: 9 X006 State LI'c. City �� 8 Ciassif. Lic. # ��, Sq. Ft. No. No. Dw. Arch., Engj„ - Siie Stories Units Designer J ice► i New D Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. / v� / ♦ / /v�� r) v n A nLm fa.r .,02 7- c C9 r City r Zip State Lic. # LICENSED. CONTRACTOR'S DECLARATION I hereby affUri that l am licensed under provisione,of Chapter9 (commencing with Section 7000) oI Divlsion3 of the Business and Professions Code, and my license is In full force and effect. SIGNATURE DATE OWNE&BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec, 7031.5;13uanesa end Profesairjna :Dods; Any csy or county whkh requites. a pelrpN to construct, alter, ',mProve, demolish, or repair any structure, prior to Na. Issuance also requires_ the app/kant for such permit to l6e s alyned statement' that he b Ikenaed pursuant to fits provlsMna o/ the Confrector's Lkenae Law, Chapter B (commenclny with Sectlon 7000) of Qlvislon 3 o/•the f3usfrreas and Proleselons Coda, or that. Ae n exempt therefrom, and the baste for the alleged exemption. My ,vbfedon o/ Section 7031.5 •by 'any epp/Mant for a pemdt, subjects the applicant to,a'civN penally o/not more than 8ve hundred dofkra.(5500). D I, as owner of the: property, ormy employees with wages as their sole compensation, will do the work, and the structure Is not intended.or offered for sale. (Sac. 7044, Bu/sness and Professions Code: The Contractor's License Law does not appy to an owner of property who builds or Improves thereon end who ,doea: such work, himself, arthi'ough his own employee$, provided that such liriprovements aro: not intended or offered for sale. M however, the building. or Improvement Is .sold within one year of completion, the owner4kilder will have the burden of proving that he did not build or Improve for the purpose o/ sale.) D 1, as owner of the property, am exclusively contracting with licensed contractors to con• struct the project. (Sec. 7044; Bueness: and Professions Code: The Confractor's License Law does =ply to an owner of property who builds or Improves thereon; and who contracts for such prb/eeto with a contractors) licensed pursuant to the ContractorsLlcense Lew.) D I am exempt under Sec. a, & P.C. for this reason Date, Owner. WORKERS' COMPENSATION DECLARATION 1 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 • . - D Copy is filed with.the city. D Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Ails section need not be'•comp/eted N the pemrlt is for one hundred dollars ($100) valuation 'or lase.) I certify that In "he performance of thq work -for which this permit is issued, I shall not employ any p.,aerson' in any manner so as to become subject to the Workers' Compensation Laws Of California. Date Owner NOTICE TO. .APPLICANT: N, alter making this Certificate of Exemption you should become subJect to the Utbrkers' Compensation provisions of Me 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. 3087, Civil Code.) Lender's 'Name Lenders Address This Is'abullding permit'when properly filled out, signed,and validated, and Is subject to expiration If work thereunder Iesuspended for 180 days. I certify that t have read this application and state thatthe 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 Malling.Addreaa City, State, Zin BUILDING DIVISION Wmated' Valuatjon-]--------------- 1 J PERMIT AMOUNT Plan Chk. Dep. <-v, o t� Plan Chk. Bal. Ti 7 Const. .v Mach: . pQ Electrical 3 . Plumbing / 3 S.M.I. 1, U. 75 - Grading 2-0-00 Driveway Enc. Z . va Infrastructure. 7 -7 TOTAL p, d CD REMARKS i 1 A i~ 4 Tr+l b; . lar '. _ 315 �_22-U8 x �icr�r , .. .. 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. ® $ I UNITS SLAB GRADE ROUGH PLUMB. BONDING 2ND FL. :SO: FT. STORAGE TANK FORMS YARD SPKLR SYSTEM ROUGH WIRING POR. SO. FT. ® / MOBILEHOMESVC. FOUND. REINF.. - BARSINK METER LOOP GAR. SO: FT. ® D POWER OUTLET REINF. STEEL ROOF DRAINS TEMP. POLE GROUT DRAINAGE PIPING SERVICE CAR P. SO. FT. BOND BEAM . WALL Cf Q SO FT.Z �^ LUMBER GR. DRINKING FOUNTAIN FINAL INSP. SO. FT. a FINAL INSP. f URINAL ESTIMATED CONSTRUCTION VALUATION s 1 2JC,— REMARKS:- EMARKSVENTILATION WATER PIPING VENTILATION NOTE:. Not to be used as property tax valuation FLOOR DRAIN FIRE ZONE ROOFING MECHANICAL FEES FIREPLACE WATER SOFTENER VENT SYSTEM' FAN . EVAP.COOL HOOD SIGN WASHER(AUTONDISH) APPLIANCE DRYER GARBAGE DISPOSAL _( FURNACE UNIT WALL FLOOR SUSPENDED MESH LAUNDRY TRAY AIR HANDLING UNIT CFM INSULATIONISOUND KITCHEN SINK FINISH GRADING ABSORPTION SYSTEM, B.T.U. TEMP USE PERMIT'SVC WATER CLOSET' / Z COMPRESSOR HP POLE, TEMIPERM CERT. OCC. LAVATORY HEATING SYSTEM 'FORCED GRAVITY' AMPERES:SERV ENT (Z SHOWER BOILER B.T.U. SO. FT..® c GARDEN WALL FINAL BATH TUB SO. FT..® c WATER HEATER MAX HEATER OUTPUT, B.T.U. SO. FT. RESID ®.1 Vi c SEWAGE DISPOSAL. SO.FT.GAR ® lAc —( HOUSE SEWER GAS PIPING PERMIT FEE. PERMIT FEE �� PERMIT FEE DBL TOTAL.FEES MICRO.FEE MECH.FEE PL.CK.FEENST. FEE ELECT.,FEE SMI FEE PLUMB. FEE �/7.COi.-r <<3 �" t3 STRUCTURE PLUMBING ELECTRICAL HEATING B.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 ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF.. - GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL). TEMP. POLE GROUT 'WATER HEATER _ SERVICE FINAL INSP. BOND BEAM WATER SYSTEM 11 GRADING ' cu. yd. $ plus xs =5 LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS:- EMARKSVENTILATION VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS: GARDEN WALL FINAL RECORDINe.REOUESTED BY (Do WHEN RECORD[) MAIL THIS DEED AND. UNLESS "PIT SHOWN RLOIN: MAIL TAX STATSMSNTS TO: Walter Dieckmann Aawrns 17631 Ranier Drive enT• Tustin, CA 92705 t<L: Titk.Order No. Escrow No. '8673 J tC � W, r t% 00:1111-4 L CO ' po Va `t oS ' Q t Wg I .- � o m� �„ a Qom. ;SPAC[. ABOV[ THIS LINE I R[Of6RO[R•Bs I -- 3 Corporation Grant Deed 5 -.. The undersigned declares that the .documentary transfer tax b ..... 38. 0 :..::....-.,_:..;.:.:�....:c.:._:;.........._....,..�-_.----..... and is ® computed on the full value of the Interest;or properly conveyed,, or is. EI computed on the iull value las the value of liens,or encumbrances remaining thereon at the time of sale. 'no, land, tenements or realty is located in unincorporated area ®. city o(.........?!k-SL!inta_... ...... .- and FOR A VALUABLE CONSIDERATION, receipt of which L hereby acknowledged, OARVBY DEVELOPMENT, INC. e'corporation organized under thelaws of.the State of California hereby GRANTS) to WALTER DIBCKMAIiN, a single man the following described real property in the City of La Quinta' County at Riverside , state of California: Lot 107, La. Quinta rolf,Bstates, Unit il, as per map:recorded in Book 37, Pages `96-98 of Rape, in the office of the County Reacrder.-of Riverside County.. Dat,t Auauet 30, 1984 STATE OF CALIFORNIA COUNTY OF Riverside SS. .On Oft tha.--30th daya_Antluat is SA before me the undersigned. a Notary Pubk In and for saki Coutyaw Stow personally appeared Susan Smith Loridan Personally known 10 me or proved to ma on die basis Of salblactory evkhonoe to be The PreaiAMu, AM mar � W[I�naDnELlPlattl®atla0fdf�C61�BtQtR llmratso I of the corporation_ that execyled.Ihe within. InsWmerd, par. sonaly known to me or Proved to me on IIM basis of -ftkctwy evidence to be The persons who executed tiro within ketnmenti on behaM of the ebrporalion therein rtaMO. and adegwledged to me that or a NOTARY SEALOR�STAMP Ofplr,lAL SRAL ROBERT A LYf AAN m NOTARY],A RIYERSIDT COUNTY IA amts. afta MR,.19, t%ffi i F ' J tC � W, r t% 00:1111-4 L CO ' po Va `t oS ' Q t Wg I .- � o m� �„ a Qom. ;SPAC[. ABOV[ THIS LINE I R[Of6RO[R•Bs I -- 3 Corporation Grant Deed 5 -.. The undersigned declares that the .documentary transfer tax b ..... 38. 0 :..::....-.,_:..;.:.:�....:c.:._:;.........._....,..�-_.----..... and is ® computed on the full value of the Interest;or properly conveyed,, or is. EI computed on the iull value las the value of liens,or encumbrances remaining thereon at the time of sale. 'no, land, tenements or realty is located in unincorporated area ®. city o(.........?!k-SL!inta_... ...... .- and FOR A VALUABLE CONSIDERATION, receipt of which L hereby acknowledged, OARVBY DEVELOPMENT, INC. e'corporation organized under thelaws of.the State of California hereby GRANTS) to WALTER DIBCKMAIiN, a single man the following described real property in the City of La Quinta' County at Riverside , state of California: Lot 107, La. Quinta rolf,Bstates, Unit il, as per map:recorded in Book 37, Pages `96-98 of Rape, in the office of the County Reacrder.-of Riverside County.. Dat,t Auauet 30, 1984 STATE OF CALIFORNIA COUNTY OF Riverside SS. .On Oft tha.--30th daya_Antluat is SA before me the undersigned. a Notary Pubk In and for saki Coutyaw Stow personally appeared Susan Smith Loridan Personally known 10 me or proved to ma on die basis Of salblactory evkhonoe to be The PreaiAMu, AM mar � W[I�naDnELlPlattl®atla0fdf�C61�BtQtR llmratso I of the corporation_ that execyled.Ihe within. InsWmerd, par. sonaly known to me or Proved to me on IIM basis of -ftkctwy evidence to be The persons who executed tiro within ketnmenti on behaM of the ebrporalion therein rtaMO. and adegwledged to me that or a NOTARY SEALOR�STAMP Ofplr,lAL SRAL ROBERT A LYf AAN m NOTARY],A RIYERSIDT COUNTY IA amts. afta MR,.19, t%ffi EO z O_ I— U W U) m z O P U w Y cc Q U7 CC W z O U W U) COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICESDIVISION 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 required'on the attached checklist. Anon -refundable tiling fee of S40 is required when,the application is submitted. Check must.be made payable, to the County of Riverside. Building Department Application Log p Name (Owner, Agent- Contractor t. E ' Mating ,�— J b Property Address 7 t rty M Co y t I Q ; Lego oescnpt on of Propene. (Lot. P.M. TR), , ' l _p 'kk,re.,t Assessor's Parcel No 'Water Agency or Well Lot sae Use,of Permit Planning Case N SFO. MH Site Preparabon•Etc f T •..s,gr,atore-ol-Apptisa �' - Dat t 'The above information must be verN/ed from Building Application STAFF'USE — DO NOT WRITE BELOW THIS LINE i Initial Date Certification of Existing S.D. System required. ❑ Yes No UL'1, WQCB Clearance required. ❑ Yes © No I I Soils feasibility report required. ❑ Yes L1 No Special feasibility boring report required. ❑ Yes ® No V Detailed contour plot plans required. ❑ Yesd No Staff Specialist approval required: El Yes ❑ No Lot Inspection Date Soils/boring report by Project li Date Soils Map Page Sal Type Approved by Date Type of System: No. of Bedrooms (1) Septic Tank Soil Rate Required ❑ Existing �New 11 Additional ❑ Repacement Z (2) Leach line, sq. ft. (Bottom trench ar Sidewall allowance ft. rockJ Sq. Ft. Install—Line(s) Ft. Long, Ft., wide woh min: inches Leach bed Sq, Ft, of bottom per running ft. ❑ N/A rock below drain lines area Leach lines/bed-special design forl'slope; (3) Pit Diameter No. Pits Pit BI Seepage Pit total depth Applicable � E]5' M6 ` t` , t Max. allowable depth N/A Overburden factor YC'P 1.SIL°1 This application is ap-provedNenied for 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. ((1.)) Septic tank and sewer lines must be 50' from any wells (2) Leach lines must be 100' min. from any wells including expansion area t f 1'1(3� Seepae ipils rstust be_ 15 •min. rom any wells including expansion area . P`' t;.) i Signature of Health Official Date RECEIPT NO. `' Issued by t ` .District: ❑ Riverside : Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. Distribution; WHITE—Office fife YELLOW—Applicant PINK—Bldg: Dept.. DOH SAN 122 (Rev 8187) ❑ Blythe GOLDENROD—Pending File 0 l , I A Desert Sands Unified School District CERTIFICATION OF PAYMENT OF NOTICE: o'CHOOL FACILITY FEES BE DupLCATEA TO: City of La Quinta F ®� DATE : Department of'Community Development 78-105 Calle Estado La Quin a, CA 92253 This i.s t certify that /{C l ` �- developer of MAXP?1� Eli It_P which is located at / , within this District, has paid school facility -fees imposed pursuant to the autbority generat n it. o Secjlgp, 53080 in un, covering a tot,A of squa feet o. residential or ( ) industrial/commercial development tha, bu'l ing permits for this footage in this development ma i y our ju ct' n.. �� 1 o DESER--T S ;UNIFIED SCHOOL DISTRICT �►-I x'1287 Whitt- Building Department • Yellow- Facilities Planning • Pink - Accounting • Gold - Developer (10)-37 CO I- N a) W 04 O d � ti W rZ W 0 Z O� P: CD m ti Wa Cn Z 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# Lie. Class ExprDate�--, 6644fs_`�" cif ar c 'bate' ° ° �'�-�C�ignature 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. 1044, Business & Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed .contractors to construct the project (Seo: 7044, Business & Professionals. Code). / O I am exempt under Section. B&P.C. forthis•„Idason j ' Date )Signature of Owner ' }. ICSy� `tiil:.: •� t ':J ;,: 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: Cartier 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 Se Ion 3700 of the Labor Co pvt j.•shall forthwith c mply with those prsions. ti 3',( 1 te: f • i ! f::rPl plicant SJ. ):. 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 Ouinta, 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 pulses. 4 Signature (Owner/Agent) `� J�•.Jv. Date!' BUILDING PERMIT PERMIT# DATE VALUATION LOT L �+�'d�f}i TRACT VA) y - JOB SITE APN ADDRESS 94)10 7i=�..WHOWE R .)]QIVF 659-2%)_001 OWNER CONTRACTOR / DESIGNER / ENGINEER 4HAY "n I3R f0t(.4NN YMSDI CK1&UW COt`73'T`RUC':°3.101+1 3 575 TANGUMOOD LH 76481 .AVE. 47 ISCt"NDEO 010 92029 MWTOA.D(:iMS Ch 9220 C/60)360-6067 C113I4 4744 USE OF PERMIT SI?ECIAl.. 3UPP+.EMYNTAi. TC) PURMIT;03F,AS TO „x:+. MPLIF.TE PREVIOUSLY MUM AND F.XPIRYD SINGIA? r1AT4i1.f..Y fx�TP.Isi,>ildt?. EYJPi14MIND COST OF COI!T IRTIMON 0100 I"9t'Y'Fn` bl'CIMMAiF Y IRMC]i.Al.,D P17,X'T10I4 3t71-000-423.0100 $lUu,tlfl IMPr--& AUG -3W CITY OF LA OUINTA FINANCE DEPT ,1f:W-'I:t'YM CORK? (IC'IiOIx.t JD PLAW (:.',HWX T"D PRE-P,Afb MS $011 Of) '1 Y]rAl, YMMEA` -FUS VVE NOW $1th 4JO RECEIPT DATE BY INSPECTOR MIR CYTON RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUJLDHG APPROVALS MECHAN�CAL APPROVALS Set Backs Underground Ducts Forms & Footings Z Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. _07 Framing JL Z Compressor Insulation _ Cents Fireplace P.L. ] Grills _ Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final 3 _ Final POOLS o SPAS — — ELOC WALL APPROVALS Steel Set Backs _ Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Anal Gas Piping PLUMSWO 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 Final COMMENTS: Final Uhlrty Notice (Gas) ELECTR=L APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles 0Y K G.F.I. Smoke Detectors Temp. Use of Power i Final Utility Notice (Perm) Walter Dieckmann 1575 Tanglewood Lane IJ237 Escondido, CA 92029 July 17, 2001, Mr. Tom Hartung Director of Building and Safety City of La Quinta 78-495- Calle Taxi pico La Quinta, CA 92253 Re: Permit # 3848/ 49-010 Eisenhow�f Dr. Dear Mr: Hartung, My father and I started building this home together several years ago. Unfortunately, he passed away before we were able_ to finish it. I have had a successful relationship with many builders and ,inspectors here in the Coachella Valley -.for over 20 years as a framing contractor. This is probably the most challenging project 1 have been associated with, because of the time frame involved. With your help I will be able to complete this project and create the home my father and I envisioned so long ago. Thank you very much. Sincerely, Walter Dieckmann