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9909-194 (PLBG)■� 'LICENSED CONTRACTOR DECLARATION y 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 3%649 C 12 C,34 ^d2 ` 0. 3112(X ,Date ;?0V I 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. (�ql 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.. -e 1-t, �,cLRXIy 0 l (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 pr"ovisio sti. { Date'.' Applicant fF'x•�, r �. �� •. a � .r n 4; \/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 app licaton 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%purpos�es. gnature (Owner/Agent) Date 9- " PERMIT # BUILDING PERMIT "(0.194 DATE VALUATION���{}4j LOT TRACT JOB SITE ADDRESS{-��AiEr�A�t OWNER CONTRACTOR / DESIGNER / ENGINEER •t c.it i uea.i,. �+. ..L..k► a"i.��. i,e,•,a ♦ Li}yv +�!.• at♦ia 530-961. V11,Tt'1i DEL MA,€C 50305 i l?i i l I LA QUoivTA CA 92253 COA.C:4;iYRALA CA, 92236 (7604399-554 (131,'11 al USE OF PERMIT PUN4iNO €tQ- � kCr, a.,9s.As)f1 LJNC AT GUEST. TJOUMi A�hY S•,l LPN I'9 .A'B'..ISM IMIN-A OA.V. lb BI o - frERINUT A'- El". S UMMAR )i 41:E`#C;:.;!;�f.;d•l1:t�f3:��iJ.`.; 1.0.t-(9Jf?••�f13-00s 5i?..� it IRtT�,".��D AI. (7XINC'?`, IK7110N AND PT:,ANCHT,CK � r��Mraap�}St {'FT ES (i�, SEP 2 0'1999 .o,►'1 6 4k91'.!';Isti. 3i) N(.)%V $3 S3 -Ty y fir' L�' RECEIPT DATE BY f DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing 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 Final Final POOLS - SPAS BLOCKWALL APPROVALS steel Set Hacks Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I Gas Piping PLUMBING 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 Utility Notice (Gas) 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) 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 3W.98 •CA2C34C42 05/31/2(11 Date 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. STATE `!r MA) 046425348 (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. Date: Applicant 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 seY 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. BUILDING PERMIT PERMIT# GJ4d; y� DATE VALUATION LOT 99IM1910 TRACT 119/20/199 4►b,2�9f1.CQ1 JOB SITE APN ADDRESS OWNER CONTRACTOR / DESIGNER / ENGINEER USA�! i t� `C. i� : f�.ATE�..�1ND CONSTRUCTION 80-901 VISTA DEL AAA,3t 50305 11fVIY 1.11 LA Q1,014 -TA CA 32253 C4' AC IELLA. CA 92236 (761?)_ 81-5544 CEM 3'! USE OF PERMIT M�LA(M; LEA M LINE, &T OUFST HOUSE VAf:tCI '1ICYN 1,200.00 ,LS 98TIMATED "•)ST sir PERIMIT FEE, SUNVA RY A1S('kI,LAW10US 101• 423.000 PLt3f+3BING FEE -- SEWER 101-0W-41.9-0) OWN SWFMAL CONS"MUCTYO T AND KAN CHECK LESS PRE -PAID FEES T OT At, 11 MiNfIT YEES DIVE NOW RECEIPT I DATE I BY I DATE FINALED' 1,1.00.00 x;37.5() 80.00 37.50 Signature (Owner/Agent) Date I I I I I I J* INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing 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 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 I I Gas Piping PLUMBING 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 Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G. F.1. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) -! i i{ i4 {{! j i; i i!!! {-� ! I �' H I I i i I i j --i. 4 1-i L, ! I i t .{. A COUNTYA, SERVICES AGENCY OF RIVERSID HE 'NT DEPARTMENT OF; ENVII RON ME ALIHEALTH Food X 1 Sew- & Disp6sal �=r- ba, I. Sep 'T k -,qL) [7-1) Trailer Park'. an t H t t", 4e- 1-64" P _LILO; �sq. :t, ol each Line n. '47 -- A74 C 9J_ PikI Via: i : Bi TD M0 Seepage Pit. 'o 2.4 d'4M-A" i .i { I ! I` din Sa,wer �,'5?rm a "Mmining Pca' h��69d in'whe i"Idivid'a-1 sewage disposal di u -2�J40 on-siis rog-snerating watersoftening ce.s! ay be isc a - r 13 system'heren'itin ap-,rovod wiihoui-cle anc; fnim im Q a!i ntrpl'Board: L aniap; Uwe tni—rtspi a Plumbing Code. in must b6 !t6it Ah."s 0 i i.j. SM 1 1 L All sewage Von must c6ink "i --'k -11 conform 4viltli 6�uir6riienn'p! current Uniform -k.!)�ater supply s,�Yvin dispo 41it-ial' r g� di�posal approval. cuttirg, granin- or filling in Axcess a I nulli�'y,sowa �Approval has L --en dbialned from'the Rea4jn Jtbr;QuaI�Y, COntrUl Board. for installation of the sewage ildisRsal'systam. This is to certqy that the Riverside County Environmental Heafth'Serjicbs app; v Sp? iues the subsurface sewage �,/ti�on roves 1 di Sal plot plan to obtain building emit for ihiallid6n:, construction B MAINTAIN 11006 EXPANSIGNAREA-WN. FROM ANY WEU 7v � MIN. 10' FROM ANY t0ME TREE OR WA .TER MAIN ;;& 71a iii 2 /�G�.v�+ Ol, . GL-.'t-��au p�2tiG�1°s�:,2u�� /Ll,�a���:�;�� ate= . W w eZ AaZLoo-e ell. 0! these p181no 7� 95r Or Architect of the r,, 4's, ponsibility FROM DATE OF APPROVAL for the C L y EA di,10-3 not relieve the B,, IS VALiK) R01 liftltb O[Riversil, �49 ar.Architestural desimn - - - - - - - - -- - - -7- --77 t -- -- - I j 7 '+ • -I ` I`�_ '�E :I:'•. -- _I: I.. ! �: �. i ' I ! •I . + I � � ! ( j t t I ' ! { , I �- r I -,- --_ _ ��►`I j_' ��!_ Ll I ' 4F- _�-Y� .i_-=i,_j .!- ! - ;•II{'_-•i.-�'''f��'' '!�'•��l�II'• 'He) I ; _j -j.'.`- ...�I _.r---!-- --! � ( .. ` _ .1_}.' .Lt� _i, _i.�r _I-,--{-I-;-_r I-�; �. � - ' -Yl =e i I { IIk I�{ !I ( (I II !f SQCIv!v�Gi,�. -, r ly i ( P P 'sl 1 L,�'la�><i 4 kri L .1, �-, . j.,_! !� 'i �_:�.�:' _I: � .'� 14 ;.I I-!, ' ! ,' '. ��ti�✓z �'��N.°%��• 70 4- C�oj'. P�j ' UY.-0674 4' •�/ '�'�"' ,�} r+ .s�, c• i f , % ! � i":- 7K -..7 'f `'.`j ,�. -i �, �vti v��n ; :,�„'t .s� �: ° •nr•rr .:�+ v � t t^�:^.-°� hi 'b"tw. �{�i ;. � �.;� rx �.,r-v.,, Tr:e ;.i t �.: } Y y.r �i -7 �. �, d ,:. r' � � 'i 1 •r � 4 ..+,x �+�`; ,.- ASSESSOR'SPARCEL' NUMBER COUNTY OF RIVERSIDE, HEALTH SERVICES AGENCY 7.DEPARTMENT _.330' ' OF ENVIRONMENTAL HEALTH.Gq 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 attached check list. A non-refundable filing fee is required when the application is submitted. Check must be made payable to the, County.of�Rnre fsidey Appre.val of this applicaq� tion shall remain valid for a period not to exceed one year from date of payment. Q4A LMS # K fir"•. Agent;' Contractor, Contact Person ©: ' . � NA Go/!I.57�, co, ir,�; Address City -State Zip. ' S• o• 3 vS fly y : /l l '�®/Jc�/.E'.rtA. �, �a�:� : 'Telephone 2`-0.3.�.5.�'�Y� Owner Address City State Zip. ,•; o- �� �✓, d ` 9- r3 Telephone Q � t � cq . Z Job Property Address TO- '961 Arz ��� City " . `. Zip •. �2� r ,1;�,,�A IU Lot Size IteAgency et. 1 oa ��/Y TiC/M ell�'X� f�/� (, VA�'LEy Use of Permit, P/P, SUP., PUP, etc. REPfs�<<F1�i��✓G G'Acr� t,, ./'vrtGXtA'6 N Legal Description d� lil i' +�.4Irv.. / (m, Pi/ •Dwellin H*site�Prep., eta. ONr .Sig nfat�ure�of•A,pp�licanIql IV Date CHECK BOX IF REQUIRED U If any box is checked, this application shall be considered rejected until ❑ Detailed Contour Plot Plans Required (T 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_ co ❑ Holding Tank Agreements Completed Thomas Bros. Page Grid Z Z 'C] Certification of Existing S.D. System Required ❑ Date Lot Inspection Completed:. Initials U ❑ WQCB Clearance Required LU (Attach for DOH -SAN -007, Santa Ana Region Only) Remarks: ❑ Soils Percolation Report Required ❑ Maintenance Booklet Provided ❑ Special Feasibility Boring Report Required "- ❑ Final Inspection by Department of Environmental. Health is required. ' ❑ Rerev'iew Required Initials Date Please call 24 hours PRIOR to inspection. ,- A C/42-/ Soils Percolation Boring Report by -L-ic/Project # Date / " Soils Map Page Soil Type Approved By • bate No of Systems S m �� e of Systems) % olding Tank s Replacement New ❑ Addition �11 No D Yellir(g,Units(l p�e1� , Bedrooms, Fizturerl) its l�lt��lee-, (1) Septic Tank CX/ *,n/b •' Soil Rate Grease/Sand GreaseIntcp/Lint Trap t)Existing ^ ( �;r(! Gaol CRAI 10,41. Gal. t , T Sq. Ft. Bottom Area Alf" Total Linear Ft. WCC Sidewall Allowance b ` /�%�(^/ Y Leach Bed sq. ft. of Bottom Area / ft. rock/ sq. ft. running ft. Inlet Tested Depth ❑ NA install�L'ine°°(s) n,�:%ft. long ft. wide with min. �inche AYock below drainlines■or. U fJ Proposed Bottom Tested Depth Z 0 Leach lines/bed special design for slope: (3) Pit Diameter No. Pits Pit -Below Inlet (BI) Seepage PR Total Depth Maximum Allowable Other: H WN/A •Applicable ,�' Depth L.Overburden Factor .- ❑ 5' r 5 TD Well Review Approved: Date: Well Drilling Permit #' - SIGNATURE - Grading Plan Approved: Date: Sewer Verification Approved: Date: Plan Check Only fApproved::fS�Date: REMARKS: .)�JR.iCir �/r�/Y�[a M40 4 4A 4,00-11 4-11 ! _ -.. 67 Thissaapplicat o�� PROVED/DENIED."fo t�iercategor� cher' cl-e rSEG�TdONaB •above, regarding the des gni subsurfaca disposal system as indicated on the . �" / �"' FOR O FIC l7S ON Y ' .+f . o :. 7� acompanied plot plan using the requirements set forth in SECTION C above. A build- ing permit is necessary for ,the installation of the above -designed system. No can -he S /�3 c� 1 1•� - Revenue code Fee $ � 7 • �� structlon is permitted -Id renulred reserved 100'Y expansion area. (1) Septic Tank must be;t00' minimum from any wells. Check # • (2 Leach lines �Tust be 100' minimum from any wells, including expansion area. Date Initial - . �� a®M•A. 'r'/iuA L�✓AP7�-x.�,A�',� N%�Mi N. P I10A1 /.7-,�'i: (3 Sewer lines must be 50' minimum from any wells. oil: f C :F• �•� Z .441,wl � (4) Seepage pits must be 150' minimum from any wells, including expansion area. W Signature of Health'Official Date ti utn-5AN-izz Inev aianl - ulsuluuuon: wm I r-vrnce r•ne; TtLww-Nppncanr; rmn-slag. Uept.; UULUtNHUL-mans/Hecoros } {fit} t _ ___ ... -- _- . _ _ _ i� ..,.,,�Y,-� ...,1+V-Y�y..,i,,.., r, 7 .., }. .��f- 1-�.' .- '_+ �_t't .j'-t.-� y . -.a j� i 1.�{-_ j --r-'• a1 }y' a t + j (J� 14J /j~ 77 7 r 7A onNct--j 1,111 s Boom mIM■■■� + J`Tk't-;- ,- ;-fit 77 t # jl ptt + + t. i_ M T^ -C i -� f►� E7�/� i j}{ +_,t �# { f--�- ;..i �—t 97 +— ` - t t }r —4 If t }Tt •-+--+-+- � I I� } �� y t ��.. t 'I i i_T�° i � -Y + � +-a-+-i +�-i---%-=--l-t�+,--i-1--}-L1..;_.i I�'--T-� -y-J��i.-F._•--i�f-�-4� �-' i-1-- - ��-�--{--1.-t-=�1-s�-� -r +-l-s-�-r-t--i--F-. r-•-i-�-}-+-+-`--r-* -Lit.;-i--.-:.-�--+...-'-'-�--v'- -r-,---t-t��-e -�-'�-r-}�-+-i•-+--i--:. �-r -. - !-t T r ! r 1 t r_+ t t �-j t -t i�, i i t_ -+-1 + -i + I 1-i -r + j t t + T -1. 4-4-++-i- t-.J--�.'� -�--� t-�- -F- -+ t--+ �--rL.1-L_ �--1--1-- - 1-} �--5_+ Y.--}-�- f I + •-d--t�--�-s r.�.- r -•--+--r- r -a-• + i-{ t--r-t ± {-t--« i -{ t-}-. -1- 3 --' -r-�- 1 r I I} Y { �- +t + f } + + I_�� .'+-a-�-.--} j Y1.-�' { j 7 -`-. =.;. � ` --f.s-+ a-�.-._ �-T---�--«-i y ._._' Y-�. wo _i'-;- a +----t� {-�-•-..a "t ii .i -r. i y +_ _i Li l+ --r-+ j f! 1 i _ ~ �- 4-T. 1 r t T s i 16 = COUNTY OF RIVERSIDE • Q'EPARTIVIENT OF ENVIRONM NTAL HEAL; H Food A .4wage DWO pt `-Traile{P�[k i ur it' i '7 G <�L} Td �de�•Yw,.i/ / niater .,N ;� 3onn�stcn,bc SO �q..Ft.ach e 7'� 1 /'P E E.r/l.�iA.�G GS4��f LU—to g'I,,6 Ste" int Connection to Sewer1 ,g Poo1T. ' Connect to Exist!rg S.D.S.,2�lo on-sste regenscftening dev!ces may he discharf ed% the iicividu sewage disposal system herlbwith approvso vr'rihout clearance fr am the Wator a,!i��ontroI Board. d Water su I sarvlrc� thisbbinstallatwn must bo from en appro el sdt�ce �,�/�'j t� C _G_All sewagsp0) 'slla Yon must conform'.vith raquiremer.!3 of current Unifarrrr`Plumbing Coda�Any cuttinrading or filling in excess of two(,?_) reel. will nullify sewage dgiosal • ppraval- Approval has been obtained from the Regional Water Quality Control Board for ins:aliation of the sewage disposal system. This Is to car&y that the Riverside County Environmental Health Services approves the sutmbrace se -map - disposal plot plan tq aMin building permit for i aliation, construction BY � t MAINTAIN 10cI% EXPANSION AREA. ?MN. _/&d_'IftM wfu -6 MIN. 10' FROM ANY tMSE TREE OIC WATER Mme. ' S / l/ /l (/�/ K/vF.- j�i%�-(/v [ivy d�� �/ . N !i _ I • Ivo79 , .00 ,/A tt t i � .r �r yVr SiS n �E t it T7 y1'� �f"11�` Y j11A 11 I Che �e �_^L2ifel� �.%e2� Q .O ° tai efCatl y qO-- to1'rp5e%± the J Arc t ct o 1l �Di bar aer3iliraetida"'. • i t r , n