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0107-214 (CONR)LICENSED CONTRACTOR DECLARATION l 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 sr'Date� � Signature of ContractorA "� •�^° 'y . 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). 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. (e) 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 4TAT 9 FUND Policy No. 239-90 0193, x6 (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 Vshould become subject to the workers' compensation provisions pf Section 370,0"of the Labor 06de, I shall forthwith comply with'those • rovisions! % r`` p' / r ijfDate '? �`/� (2/ APPlicar �^� e 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 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 forinspection purposes.X i Signature (Owner/Agent) �r BUILDING PERMIT PERMIT#;�,. DATES f VALUATION LOT' j TRACT J` }!I t bc a1L2 � •i 29894.+2. . o JOB SITE i APN ADDRESS W - M9 WIdAGE C:;'AM P°.T, ACT 777-3(*411, - OWNER CONTRACTOR/DESIGNER/EN (NEER a":r":Ea:4 ldA1�Jf iL+�7 C �7' '>d 1�T a' 'i�i~,LOPMINT 81.1 -100 AVE' $3 MV? CaAWRY Mas DR 4201 LA Q11 7A. CA 92253 ,CA' 92201 USE OF PERMIT e: AT-RAISLK, Fd:yllY3O-ATtC5•t -ONLY PERMIT (CC 0,01 TP., APfA'Si'2ARY C;lAnin 140WORK AUTHORIZED BEYOND POURWO Off GLAD. u L 1 v zy 2001 CITY OF LA QUINTA FINANCE DEPT. bIDW17D CO 'In, OF CONIUMUCTION C01.43T < iXTION IEEE 101.000A.18-©.) ��Ab,ttC SUB->sOTAT CIOM.MUCT(OW AM((PI��LAN rH•VCX tsl�/�f1�1.ral� ppppr.Yy •qq �..11elJal {- 0 f.,I,�AAYJ X�S.'nS.AJ� U/W4lI� MAL DUE NOW Vim= RECEIPT DATE By 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 Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg: Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans OX. 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) y ft94A `TS . t r • o1c)1 (FaugLlqscko ewi.- ) W o! 1 p swCa Clio 11 fi 44 zr' :S ` ..�f r.F,h Na r•Rw P.O. BOX 1504 r APPLICATION ONLY Building( t 7Z 955 CALLE TAMPICO Address (V 1 �.. If'�.CALIFORNIA 92253 ,< Owner ( ` LQ - 1 _*� BUILDING: ' TYPE CONST.OCC. GRP. Mailing Address' ��� I A.P. Numbel\V City egal Descriptioh/ k Y' L ( 2 I �' I Co ct r ,t - Project Description f ' ➢ i ;(, City eL t State Lic. � City 8 Classif. ' 7 Ti Lic. N Sq. Ft. No. No. Dw. Size Stories Units Arch., Engr., � t a .. i Designer �) J(^}` f New, Add ❑ Alter ❑ Repair ❑ Demolition ❑ state Lic. � _ •) LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec. 703 1.5. Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to 'its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's 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 for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ('! I, as oner 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that 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 or improve for the purpose of sale.) I'1 I, as owner of the property, am exclusivelycontracting 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 builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) 17 1 am exempt under Sec. B. 8 P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I 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 n Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed it the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg 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. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) - Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if 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 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: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. j 1 f i Grading Driveway Enc. i j Infrastructure I JUL Z 4 NUI I e� GII I Ur LIA U I TOTAL REMARKS 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: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION ASSESSOR'S PARCEL NUMBER COUNTY OF RIVERSIDE COMMUNITY HEALTH AGENCY- 1719 DEPARTMENT_i DEPARTMENT OF ENVIRONMENTAL HEALTH APPLICATION FOR WASTE"WATER DISPOSAL APPROVAL APPLICANT: Submit this form with four copies of a SCALED plot plan (1"=20' to 1"=40' SCALE) drawn to County specifications as indicated on the attached check list. A non-refundable filing fee is required when the application is submitted. Check must be made payable to the County of Riverside. Approval of this application shall remain valid for a period not to exceed one year from date of payment. LMS # - AgefR�tt, Contractor, Contact Person Address Zip Telephone (CVl7�/1, i��llV7�ii"{ �7. / 2 LCity ! /� JStat�e�,ti�7 A Ioo l� �.? !`�vI r�Ljl�Yfi ( N fG� !/ lGci'%7�j•�r�I Q Owner Address City State Zip C1,7 Telephone 79, OJob Property, - _Address .� City Zip U Lot Size Water Agency/Well Use of Perkt; P/P, SUP, PUP, etc. Legal Description DBA •-. ,y �y ��3.S1 .[^ �• oIJ /y� IIIo r 1, 1.4,✓, ,4,,,, Dwelling, MH Site Prep., etc.` Signature of Applicant. Date / FOR OFFICE USE ONLY CHECK BOX IF. REQUIRED If any box is checked, this application shall be considered rejected until the ❑ Detailed Contour Plot Plans Required (1 to 5 foot interval) information is provided and the fee paid. Resubmittals later than 90 days after date noted below may require repayment of fees. Q' Otherco Staff Specialist Lot Inspection Required Z ❑ Holding Tank Agreements Completed LD ❑ Certification of Existing S.D. System Required Thomas Bros. Page Grid W ❑ WQCB Clearance Required ❑ Date Lot Inspection Completed: Initials (Attach for DOH -SAN -007, Santa Ana Region Only) Remarks: ❑ Soils Percolation Report, Required ❑ Maintenance Booklet Provided `• _ ❑ Special Feasibility Boring Report Required - --- I] Final Inspection by Department of Environmental Health is required. ❑ Rereview Required Initials Date Please call 24 hours PRIOR to inspection. ' - C Pik. Are , : .,E J $,' f 4 ..a s!' /ate e3 1n,I.. ^ e .d :.nn IF C/42 / Soil s,P&colation Boring Report By Lic/Project # Date Soils Map Page z Soil Type Approved By Date No. of Systems Type of System(s) No. Dwelling Units (1) Septic Tank Soil Rate Grease/Sand-- ❑ Holding Tank ❑ Replacement Bedrooms, Fixture UnitsG�e Inpint Trap EJ New ❑ Addition ❑ Existing b Connect to Sewer -2 ;1 r .., k Gal. r'On Gal. Sq. Ft. Total Linear Sidewall Allowance Leach Bed sq. ft. Bottom Area Ft. ft. rock/ sq. ft. running ft. Install Lines) ft. long ft. wide of Bottom Area Inlet Tested Depth ❑ N/A with min. inches rock below drainlines U �r Proposed Bottom Tested Depth or Z 0 Leach lines/bed special design for slope: Applicable/ (3) Pit Diameter' No. Pits Pit Below Inlet (131) Seepage Pit "Total Depth Maximum Allowable Other: / Depth WN/A Overburden Factor ❑ 5,"--'❑ 6' TD 0 Well Review Approved: Date: Well Drilling Permit# - SIGNATURE Grading Plan Approved: Date: SIGNATURE Plan Check Only Approved: (.:.. , Date: , REMARKS: f < r t ... p '"'A / .. / % r '.0 1�, /� �• > 7� . -. r �. v �+'v Cr i This application is APPROVED%DENIED for the category checked in .. v • ;/•� SECTION B above, regarding the design of a disposal system as indicated on the accompanied plot plan, using the requirements set forth in SECTION C A building .is for r '3 3 4 above. permit necessary the installation of the above- Revenue Code Fee $ designed system. No construction is permitted in the required reserved 100% expansion area. K Check # (1) Septic Tank must be 100' minimum from any.wells. . Z (2) Leach lines must be 100' minimum from any wells, including expansion 1+► by Date + Initial area. , ` y� ®C1� 4+" �! 1 O 4eo> $ • H O (3) Sewer lines must be 50' minimum from any wells. LU (4) Seepage pits must be 150' minimum from any wells, including expansion RIVERSIDE: 909-955-8980 area. INDIO: 760-863-7000 Signature SOUTHWEST: 909-600-6180 / Date knu�om) ulsmounon: wnllt—unite rue; YtLLUw—AppllCant; PINK—tfldg. Dept.; GOLDENROD—Plans/Records Coachella Valley Unified SchooYDistrict' T.O. Boz 847, 'Thermal, CA 92274 (760) 398-5909 - Fax (760) 398-1224 ; This Box For District Use Only CERTIFICATE OF COMPLIANCE (California Education Code 17620) Project Name: Country Club oiF The Desert . Owner's.Name: Rancho Capistrano Development Project Address: 80-349 Village Club Pil.dice . Project Description: Sing1e Fami 1y Dwelling/Temporary C1 ub Hou! Date: November 19, 2001 Phone No. 760 398-0699 APN: 772 BOO 011 Tract #: Lot #'s: Type of Development: Residential _% CommercialXXXX Industrial Total, Square Feet of Building Area: 7713 Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement under penalty of perjury and further represents that he/she is authoriz to sign on behalf Athe o er/developer. Dated: /lam /q v/ Signature• SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN ACCORDANCE WITH ONE OF THE"FOLLOWING: (CIRCLE'ONE) Education Code Gov. Code Project Agreement Existing Not Subject to Fee 17620 65995 , Approval Prior, to 1/1/87 Requirement Attention City of La Quinta StaffL Note. Number -of Sq.Ft.. 7713 District to be inftrmed it prod ec Amount perSq.Ft: $ .33 converts from:,corrimercial,Ao residential Amount Collected • $ 2.545.29 Building Permit Application Completed: Yes/No By:, Foch "Tut" Pensis, Assistant Superintendent Administrative Services Administrator in Charge Certificate issued by: Martela Valdez Signature: Facilities C.e< NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES Al rATEMENT OF Fl Section 66020 of the Government Code asserted by Assembly Bill 3081, effective -January 1, 1997, requires that this District provide (1)a written notice to ` the project appellant, at the time of payment of school fees, mitigation payment or other exactions,(" Fees"), of the 90 -day period to protest the imposition of these Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this'Notice shall serve to advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of any other requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as hereinset forth, whether payable at this time or in whole or in part•prior to issuance of a Certificate of Occupancy. As in the latter, the 90, days starts on the date hereof. This Certificate of Compliance is valid for thirty (30) days from.the date of issuance. Extension will be granted only for good cause, as determined by the School District, and up to three (3) such extensions may be granted. At such time as this Certificate exp -fres, if a building permit has not been issued for the project that is the subject of this Certificate, the owner will be reimbursed all fees that were paid to obtain this, Certificate of Compliance. MV:c/mydocs/devfees/certificate of compliance 07/24/01 DEVELOPER FEES PAID AREA: .. .. - AMOUNT: - RCPT #: CK #: CASH: INITIALS: DATE: CERTIFICATE OF COMPLIANCE (California Education Code 17620) Project Name: Country Club oiF The Desert . Owner's.Name: Rancho Capistrano Development Project Address: 80-349 Village Club Pil.dice . Project Description: Sing1e Fami 1y Dwelling/Temporary C1 ub Hou! Date: November 19, 2001 Phone No. 760 398-0699 APN: 772 BOO 011 Tract #: Lot #'s: Type of Development: Residential _% CommercialXXXX Industrial Total, Square Feet of Building Area: 7713 Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement under penalty of perjury and further represents that he/she is authoriz to sign on behalf Athe o er/developer. Dated: /lam /q v/ Signature• SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN ACCORDANCE WITH ONE OF THE"FOLLOWING: (CIRCLE'ONE) Education Code Gov. Code Project Agreement Existing Not Subject to Fee 17620 65995 , Approval Prior, to 1/1/87 Requirement Attention City of La Quinta StaffL Note. Number -of Sq.Ft.. 7713 District to be inftrmed it prod ec Amount perSq.Ft: $ .33 converts from:,corrimercial,Ao residential Amount Collected • $ 2.545.29 Building Permit Application Completed: Yes/No By:, Foch "Tut" Pensis, Assistant Superintendent Administrative Services Administrator in Charge Certificate issued by: Martela Valdez Signature: Facilities C.e< NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES Al rATEMENT OF Fl Section 66020 of the Government Code asserted by Assembly Bill 3081, effective -January 1, 1997, requires that this District provide (1)a written notice to ` the project appellant, at the time of payment of school fees, mitigation payment or other exactions,(" Fees"), of the 90 -day period to protest the imposition of these Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this'Notice shall serve to advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of any other requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as hereinset forth, whether payable at this time or in whole or in part•prior to issuance of a Certificate of Occupancy. As in the latter, the 90, days starts on the date hereof. This Certificate of Compliance is valid for thirty (30) days from.the date of issuance. Extension will be granted only for good cause, as determined by the School District, and up to three (3) such extensions may be granted. At such time as this Certificate exp -fres, if a building permit has not been issued for the project that is the subject of this Certificate, the owner will be reimbursed all fees that were paid to obtain this, Certificate of Compliance. MV:c/mydocs/devfees/certificate of compliance 07/24/01 i Titiv z 014 a" 1� �.. �� P. O : Box 1504 C��of�p 78-495 CALLE TAMPICO (760) 777-7000 LA QUINTA, CALIFORNIA,922,53 FAX (7,60) 777-7101 October. 31, 2001 Mr. Robert Wilkinson Country Club of, the Desert P.O. Box 980 La Quinta, CA 92253 Subject:. 'Minor Use. Permit 2001-316 (TemporaryVillage Clubhouse/custom Home)- Dear Mr. Wilkinson, The Community Development Department has approved your request for a temporary clubhouse in a future custom home at 80-349 Village Club Place, subject to the enclosed ' plan and the following conditions: 1..• Obtain a building permit for the clubhouse structure on Lot 1. 2. No temporary signs are approved unless separately approved. by this Department. 3. Removal of the temporary Village Clubhouse related improvements is required within three months of the initiation of use of the permanent Clubhouse facility for this project. Use of the structure for residential purposes requires Community'.,..* Development Department approval. 4. Landscaping with an. irrigation system shall be provided in conformance with Municipal Code requirements. Landscaping plan shall be approved by the Community Development Department.and Coachella Valley Water District prior to its installation. 5. Parking for the clubhouse shall be in the parking lot on Via Capri adjacent temporary parking lot on Lot 2 --to the west, and available. for use: prior to the clubhouses beginning -of operation, The parking lotto the east may, be installed as a temporary facility with prior approval of the Public Works Department. 6.. Any permits required by the Public Works Department shall be obtained prior to any work' proceeding. p:\stan\Itr app mup 2001-316.wpd t 7. A landscaping plan for the site shall be approved by'the Community Development Department and Coachella Valley Water District prior to beginning of landscaping improvements. 8. Riverside County Health Department approval .shall be. obtained prior to use of "kitchen. 9. The City may elect to add Conditions to this application to mitigate any problems that arise not previously addressed herein. 10. Developer agrees. to indemnify, defend and hold harmless the City of La Quinta.in the event of any legal claim or litigation arisingout of the`City's approval of this project. The City of La Quinta shall have the right to select its defense counsel in 'its sole discretion. This decision may be appealed to the, Planning Commission .provided 'the necessary, paperwork and filing fee of $175.00 are filed with this office within 15 days. If you have any questions, please contact me at 760-777-7064. Very truly, yours, JERRY HERMAN COMMUNITY DEVELOPMENT DIRECTOR STAN B. SAWA Principal Planner Attachment c: Danny Crawford, Building and Safety Department Ad Randall, Building and Safety Department Public Works Department Code Enforcement Department Fire Department 171 P:\STAN\Itr app mup 2001-316. vil clubmpd