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0358 (SFD)LICENSED CONTRACTORS DECLARAT (commencing with Section 7000),of Di and effect. ,License Class Lic. Number .. • Date Contractor . OW44UILDER DECLARATION: ther eby aiRrm that I am exempffrom.the Contrador's License Law for the following reason. (Sec. 7031.5, Business and Professions Code: Any city or curdy which requires a permit to construct, after. improve. demolish. or repair any . structure, prior to its Issuance, also requires the applicant for such permit to (ilea signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing withsection of Division.3 of the Business and ProfessionsCode) or thathetsexempt ;;,therefrom and tae has! s for the alleged exemption. Any violation of Section 71Xt1.5 by any applicant for a.permit -.,..subjects the applicantao a civil penalty of not more than five hundred dollars.(5500:): ❑ L as owner of me property, or my employees with wages as their sale compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7014. Business and Professions Code: The Contractor's License ' Law does not apply to'an owner of propertywho builds;or improves , thereon, and who does such work himself or, through his own employees„provided that such Improvements are not intendeclor offered for sale: If;however; the building or improvemnt is sold within one year of completion, the owner -builder will have the burden of proving that he did hot build or improve for the purpose of sale.). P I, as owner of the property, am exculsively contracting with'licensed,cpntractors to construct the project (Set - 7044, Business and Professions Code: The Contractor's License Law does not apply town ownerol property who builds or improves, thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the .Contractor's License taw.). O Lam exempt under, Sec. B. 3_P.C. (Attach ed Certificate).'_ i, '4, —, Owner •::.--, "c..�_/' WORKERS! COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure: or a certificate o1' Workers'' Compensation Insurance , or a certified copy thereof (Sec. 38M. -Lab. C.)r - Policy, No. Company ❑ Cartilied,apy`is•hereby.lurnished. . - o' Certified copy is filed whh'the City'Building Inspection Department or City Dais Applicant PERMIT APPLICATION City of La Ouinta Department of Building and.Safety This.permit becomes.void, if work not commenced:within 180.days from date, of•issuance. OR, if work his been suspended or, abandoned for period of 180 days. r. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE^ This section need not be ampleted If ION: I hereby affirm that 1. am licensed. under provisions of Chapter 9 .. the permit is for one bun dred ($1001 oJ.ess.d certify that in the performance of the war k•for-which this permit is vision3of.theBusinessandProfessions Code;andmylicense is'infull force.• issaid, I shall not employ any,person in any manner so as to become subject to the.Workers'Compensation Lawsol, California. Department. - ” RESS . 0. Box 704 cr o a, z1CA 92253 "� �AA� Esr Drive a#1 Z�'A 922.53 . 6/i1{Ea" / /3 giyai� U95 1M7 C - TwN RNO 9E s TRACT LOT 5.85' Plumbing Fee 93450 Pmp= y Developient Fee 450400 NAME TOR �T pC �A �JGII[FVNAME jI�� F, MIM =__ - - CON RACTOWFIIRRM NAME - - ADDRESS CITY/COMMUNITY/STATE/ZIP . "IM -3455 �i$y Of La Quinta LICNC 0 ARC/ENG FIRM NAME - ADDRESS CITY/COMMUNITYISTATEIZIP - PHONE . e' LIClIC e USE'OF RMIT LAiplex St.. ZOk FSB Sao age, - .,Ass OFC . ZONE ORD e - LOT SZ " - - - END -SIDE . Date Applicant NOTICE TO APPLICANT: If. after making this . Certificate of,Exemption, yottshould become subject io the Workers'. Compensation provisions of the Labor.Code, you must forthwith complywith such provisions oc.lhis permit shall be deemed revoked. DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: .- ❑ 1hereby certify thatnoexcavation live (5)ormorefeet indepthintowhich aperson isrequired todescend,will be" made in connection withwork authorized by this permit. and that no building structure. scaffolding. falsework or demolition or dismantling thereof; will be more than thirty-six (35) feet high: (Chap 3.2, Grp 2, An Y, Sec341, Title 8. CAC.) a ❑ As owner -builder; I will not employ anyone to do work which 'would require a permit from the, Division of Industrial ' Safety, as,noted�above, unless such person has a permit todo such work from that division. ❑ Division , of Industrial Safety Permit No. Date - Applicant CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency forthe performance. of the work for which this permit Is, issued (Sec. 3097, Chi. C:p, . Lender's Name Lender's Address 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 thiscountydo enterupon,the-above=mentioned property forinspection purposes; Signature of Applicant or Agent Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY certify I have read this applicatioaand statethat the information given is correct. l' agree to comply with all state laws and aunty ordinances relating to-buidiing construction, and authorize a representative of the City of La Quints Department of Building and Safety to enter upon the property for which ,l.haveapplied for this permit for the purpose of making inspections. - Signature of Applicant or Agent Print.Applicant/Agent Name Date APPL/PRMT 1VT14-83 Wplfm Pemit to =Mt=Ct 1,750 Sq. Ft. of Duplex Mach. Fee $ 36.00 Plan ' C�iods, Fee 250.25 Con t=tion Fee 385400 Electrical Fees-� '34.87 EME Fee 5.85' Plumbing Fee 93450 Pmp= y Developient Fee 450400 R 12 NOV 2 3 1983 �i$y Of La Quinta FSe $1,255.47 VALUATION $83,930.00 ' ,BLDG. DEPT. - ; NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back 33 Ventilation System 2 Ftgs & Frms 34 Plenums & Ducts 2A Siam -Glade j -'L4 TD dSr 35 Furnace Compart. 3 _ Steel 36 Inlets & Outlets 4 Grout Blocks 37 Combustion Air 5 Bond Beams 38 Compressor 6 Roof Deck 39 Appl. Clearance 7 Framing " 40 Fire Damper 8 Vents 41 Smoke: Detection Device 9 Garage Fire Wall 42 Commercial Hood 10 Fireplace P.L. ❑ 43 Ficial 10A Fireplace T.O. ❑ NPON ADDITIONAL INFORMATION c SEWAGE SYSTEM SIZE &LOCATION 11 Lath 12 Internal Lath Inter al 12A Drywall 13 Finish Grade INSULATION Thick Value �La` 7A Wells (Batts) 12B Ceiling (Batts) y �z 12C Ceiling (Blown) 14 Final PLUMBING APPROVALS 15 Ground Plumb 16 Water Piping 17 Rough Plumb 18 Vents 19. Sewage Disposal 20 Sewer 21 Water Heater 22 Water Softener 23 Water Service 24 Gas Test 25 Final Tank Pit L. Line ELECTRIC APPROVALS REAR OF PROPERTY LINE O P lot ��0 P/ (j 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 298 Bonding 30 Fixtures 31 Service 32 Final STREET NAME - RIYERSIDE CQUNTY D&ARTMENT OF �H.EAQM PERMIT FOR;AaS.U:BSURFACE DISPiOSAL,SYSTEM; "APPLICATI;OIV Applicant Su'hfriit thi'sform wuith;three copses of a�scaled''plot plan drawn;totcounty'speclflcafions,regu�red on the attkbbdl'checkylist Anon refundable fiIing,feebfl$1_,5iis�requie' d w,hen;the;app!!ca_ ,ion is subm tted Check,must'be. j rii dd,oayaible to County of',Riverside � n iClty, T. IOfate,• ZIp.Gode - Phone Property Address 'City or,Ccmmtinity 'Legal Desc�iptlon of Property (Lot;'PP; r64A4ap Tract)rt/ AarcNo. Wr gFo r - - LotOessessorsiP , � � Slgnat_`ure olfApplloent •. "'! - '— �T�r / .� - .,, - _ _ The,above information'musf be verified fromiBuildlnq Application i9faff'Uae — Do Not 1Wd BildW.ThlSUIffe_ Initial Date 1NQC6 Clearance reqediuirYes Soilsfeasitiilitylydpdet. ie- red' Yes. El' IN " D;;etai'led'.bori'ngrreport required' Yes etailed contouriplot required. Yes ll, iNo;fl C:omrnents; Soils, orlibo�in,g,repo�tt(ly A'pproiied Soils _Map' Page Soil'; Type ---. Tract'. Number'o Bedrooms,:t - !,Septic Tank Size-(gallonsp I .- , Rate;Required 2 --, Type>of Systern h ,New Ad"clition Replacem"ent, ntic �h'I r r�. _ I yam• ._. r„ ` - l . � 13 _ _ E_ _ 11_ Leach Ilnesq: ft of fn area trench; --- Leach i ed;(sq! ft'of. bottom area be - T, d) ii M Diameter $eeaePr i --- N tuber ofl�ci`s Seepage Pit' Depth B.T. Totirbeiptpiofipit, Od / 51 - 6 p, ILocatlon of System ,Vi=i �1 _ . jZ' . • / �,j l . I 1 ll Additional `Requirements J A;permitis appr, ved%denied�for, the design of asubsurfacedisposal�systemfas indicated on the accompanied�p_I:otiplan using the requirements etforth in;Section B above ;A'build ng perrmJ-;necesracy}forth''e:insta'llat'i`on of'tl e?above , d_ e_signed system ti Slgnaturesof Health Official; Issued By, ��1 ,r-�•--._ O-AA.r:-, 4� Di'strict;- Riverside; E ' Cndio ©-� H-Olp 0 ' IN t. ' -r'= '' DISTRIBUTION WHITE;= OffceAFile; YELL"OW Applican, t ;PINK =;Budding Dept., GOLDENRODI- Pending. File tq - ' - DOM;SAfJ 122'(Rev10%82) ". T - � - • t !,