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PLBG (13103)P.O. BOX 1504 No. 13103' Building..452-525 Navarro 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner Magd*a1eno. merAles Mailing BUILDING: TYPE CONST. OCC:. GRP.. Address - Zame A.P. Number ityIzip ITel. 'ria QlIinta, CIL 92253 Legal Description Contractoe';'Sdwer Hook-up Project Description,- Hen.&ACA'S'6n Construction,* Address!,. , , re '68-315.:, Rieley Road yty 'Cath€�'dra!'Cipz*p 92234 Tel.: 328-1747 State Lic'­-"-, City Classif.-i,,';25618 4-A, Lic. # 194 ---Arch. Engr. �­T- Desine i. J Address Tel.; City„ State Lic. # LICENSED CONTRACTOR'S DECLARATION I hoerofM affirm that I am' licensed under provisigs of Chapter 9 (commencing with Section r 7 00 siness-lind Prdfes-s-io s'Oode, and my license din fullfforce and ;bn 3 �6fth B b 're SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec.'. 7031.5,Business and Professions Code.' Any city or,county which requires a permit toconstruct, after,. 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). 0 1, 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, 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.) 0', as owner of the property, am exclusively contracting with licensed contractors to con- tr.ct 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 .;7 such projects �with a contractor(s) 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 I have a certificate of consent to self -insure, or a certificate of Worker's Ia certified copy thereof. (Sec. 3800, Labor Code.) sem•Poli Ly. 0. V,-bmpensaI• on Insurance, or 0. Company 0 Copy is filed with the city. 0 Certified copy is hereby furnished. 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.) 11 , . I I , I . I certify that in the performance of thp 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 __��,t -Dwner NOTICE ,TO APPLICANT. If, after making this Certificate of Exemption youshould 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 Ihereby 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 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 Sq. Ft. No. Size Stories No. Dw. Units New El Add 0 - ' - 'Alter 0 Repair 0 4'Demolition-0 ZONE:— BY: Estimated Valuation $4,050.00 ;,k PERMIT AMOUNT -4. Plan Chk. Deo. Plan Chk. Bal.. Const. FINAL DATE Mech. Issued by: Electrical Validated by: Plumbing S.M.I. Validation: Grading -Driveway Enc. Infrastructure IV TOTAL 0•10 REMARKS ZONE:— BY: Minimum Setback Distances: —Front Setback from Center Line y 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. SQ. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) 2ND FL. SQ. FT. FORMS YARD SPKLR SYSTEM POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) OTHER APPJEOUIP. DRAINAGE PIPING CAR P. I SQ. FT. TEMP. POLE WALL SQ. FT. GROUT DRINKING FOUNTAIN SQ. FT. ® FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN ' MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN ' WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM 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 GAR. FIREWALL SQ. FT. ®c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL MESH SQ.FT.GAR ® 3/ac HOUSE SEWER 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 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 9R62PRCY/tRf(7� GH WIRING 1 DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) 04 METER LOOP HEATING (FINAL) OTHER APPJEOUIP. 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 INSULATIONISOUND FINISH GRADING FINAL INSPECTION— NSPECTION CERT. CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL NCTE With proper validation this form constitutes an encroachment permit CITY OF LA QUINTA APPLICATION , FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS T Subdivision Improvement Permit — Class 11 l . DATE: 7-27-93 Minor Improvement Permit Class IV 'LOCATION OF CONSTRUCTION 52-525 Navarro (Street address or Description of Location) PURPOSE OF CONSTRUCTIONpewer connection Sketch (attach construction plans if appropriate) DESCRIPTION OF"CONSTRUCTION - installation of sewer lateral in City Right.-Of—Way See attached Drawing DIMENSION OF INSTALLATION OR REMOVAL 60 L.F. SIZE OF EXCAVATION, IF NEEDED 2' wide 3' deed APPROXIMATE TIME WHEN WORK WILL BEGIN 7-27-93 APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COST $ _ (Including removal of all obstruction, materials, and debris, backtllling, com-• paction and placing permanent resurfacing and/or replacing improvements) In consideration of the granting of*this permit, the applicant hereby agrees to: ti ,eiidemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any ana all ` > penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or proFerty happening or occurring as a proximate result of any work undertaken under the permit granted pursuantito this application. Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when, work will be started. Comply with all applicable City Ordinances, the terms and conditions of the permit and all a6}plicable rules and regulations of the City of. La Quinta and to pay for any additional replacement necessary as the result t is work. .; Signatur cant or / ent Hendrickson Construction 68-365 Kiely Rd. Cath d y, CA 328-1747 Name of Applicant (please print) Business Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. 654167—A 194 Contractor's License No. City Business License No. on file " Applicant's Insurance Company Policy Number .FEES: Subdivision Improvement Permit — Class I II Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Inspection Fee $ '10 Permit Fee Penalty Cash Deposit -Surety Bond if required ' TOTAL: $ 30 4 Receipt No. Received by Date Recorded by PERMIT VALIDATION PERMIT NO. 1818 DATE APPROVED 7-29-93 EXPIRATION DATE • DATE ISSU D' 7-27093 By Admi6istrative Authority TELEPHONE: (619) 564-2246 r (Including removal of all obstruction, materials, and debris, backtllling, com-• paction and placing permanent resurfacing and/or replacing improvements) In consideration of the granting of*this permit, the applicant hereby agrees to: ti ,eiidemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any ana all ` > penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or proFerty happening or occurring as a proximate result of any work undertaken under the permit granted pursuantito this application. Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when, work will be started. Comply with all applicable City Ordinances, the terms and conditions of the permit and all a6}plicable rules and regulations of the City of. La Quinta and to pay for any additional replacement necessary as the result t is work. .; Signatur cant or / ent Hendrickson Construction 68-365 Kiely Rd. Cath d y, CA 328-1747 Name of Applicant (please print) Business Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. 654167—A 194 Contractor's License No. City Business License No. on file " Applicant's Insurance Company Policy Number .FEES: Subdivision Improvement Permit — Class I II Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Inspection Fee $ '10 Permit Fee Penalty Cash Deposit -Surety Bond if required ' TOTAL: $ 30 4 Receipt No. Received by Date Recorded by PERMIT VALIDATION PERMIT NO. 1818 DATE APPROVED 7-29-93 EXPIRATION DATE • DATE ISSU D' 7-27093 By Admi6istrative Authority TELEPHONE: (619) 564-2246