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000969 (RPL)PERMIT APPLICATION City of La Ouinta Department of Building and Safety This permit becomes void if work not commenced within 180 days from dale of issuance, OR, if work has been suspended or abandoned for a period of 180 days. LICENSED CONTRACTORS 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 License Class Lic. Number Date Contractor OWNE"UILDER 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 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) orthat 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 live hundred dollars ($500-): O 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 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 improvemnt 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, as owner of the properly, am exculsively contracting with licensed contractors to construct 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.). ❑ 1 am exempt under Sec. Owner B. d P.C. (Attached Certificate) - �/WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a certilicate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.). Policy No. Company 11 Certified copy is hereby furnished. Certified copy is filed with the City Building Inspection Department or City Department. Date : Z C % f Applicant APPLICANT NAME L. F- MO - r ADDRESS _ CITY/COMMUNITY�//�2STAT ZIP- ,r ,V,/7% 4 Z 2— y�4 JOB SITE AOORESS/SPACE _ CITY/COMMUNITY/STATE/ZIP BOK PAG PRC C TVVN RNG SE S TRACT LOT MOD SB TRACT NAME OWNER NAME IL- F. MI) CONTRACTOIiiFIRM NAME ADDRESS CITY/COMMUNITY/STATE/ZIP —"'-" LICNC N ARC/ENG FIRM NAME ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE N LICNC N USE OF PERMIT BL 1 ZON FSB SSB SSB 11511 OFC ZONE ORD N F I LOT SZ END SIDE CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if the permit is for one hundred ($100) o, less I certify that in the performance of the work for which this permit is issued, I shall not employ any person inany manner so asto become subject to the Workers' Compensation Laws of California. Dale Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subjectto the Workers' Compensation provisions of the Labor Code, you must forthwith comply wilh.such provisions orthis permit shall be deemed revoked. DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: © 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure. staftolding,iaisework.or demolition or dismantling thereol, will be more than Ihirly-six (36) feet high. (Chap 3.2- Grp Z Art 2, Sec341, Title 8, C.A.C. ) n 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 to do such work from that division. ❑ Division of Industrial Safety Permit No- /Date- V Applicant ONSTRUGTIOH 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 3097, Civ. C.). Lender's Name Lender's Addres 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 county to enter upon the above=mentioned property for inspection purposes. Signature of Applicant or Agent Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this applicatidn and state that the information given is correct. I agree to comply with all slate laws and county ordinances relating to buidling construction, and authorize a representative of the City of La Ouinta Department of Building and Safety to enter t , upon,lhe property for which I have applied for this permit for the purpose of making inspeclions- Signalure of Applicant or Agent =Data Print Applicant/Agent Name APPUPRMT r q g DATE J , let TOTAL • FEE • VALUATION PERMIT APPLICATION City of La Ouinta Department of Building and Safety yf,,3 0 This permit becomes void if work not commenced within 180 days from date of issuance, OR, if work has been -suspended or abandoned for a period of 180 days. LICENSED CONTRACTORS 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. n /license Class z% Lic. Number ,+ / Contractor �f/ ^^ ' r 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 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.): t,• 0.1r 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 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. It, however: the bu ilding.or i mprovemnt 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 L.as owner of the property am exculsively contracting with licensed contractors to construct 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.). 0 1 am exempt. under Seca B. 8 P.C. (Attached Certificate). Date Owner WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.). Policy No. Company 0 Certified copy,is hereby furnished. ;07Certified copy is.filedd with the City Building Inspection Department or City /-1- Department. Date /n I A / f /% Applicant APPLICANT NAME (L, F, MI - ADDRESS • . 3 - SSS f/�✓ // clTv/ # v r A�z A4 / C 17 JOB SITE ADDRESS/SPACE ' � 51y- 36,- -3 CITY/COMMUNITY/STATE/ZtP L 14 6) BOK PAG PRC C - TWN PING SE S TRACT LOT MOD SID TRACT NAME ' CONTRACTORRE y Gf+� ADDRESS CITY/COMMUNITY/STATE/ZIP - PHONE#�V --,/,6 LICNC • ;ARC/ENG FIRM NAME ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE • LICNC • USE OF PERMIT BL ZON FSB SSB SSB- RSB OFC' ZONE ORD • •. LOT SZ 'END -' SIDE•. CERTIFICATE OF EXEMPTION FROM WORKERS" COMPENSATION INSURANCE: This section•need not be completed it the permit is for one hundred ($100) o. 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. Date Applicant NOTICE TO APPLICANT: If, after making this Certificateof 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. DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1her ebycertify that noexcavation five (5)ormore feet indepth into which aperson isrequiredtodescend, will be' made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or' .. demolition or dismantling thereof, will be more than thirty-six (36) feet,higK. (Chap 3.2, Grp 2, Art 2, Sec 341', Title 8. C.A.C.) d As owner -builder, I will not employ anyone to do work.which would require a permit from the Division of Industrial Safety, as doted above, unless such person has a permit to do such work from that division. /O Division of Industrial Safety. Permit No. Date/I CfI Applicant rra ..r+ r r •i.n! CONSTRUCTION LEIfDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which.this permit is issued (Sec. 3097, Civ. C:). 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 this county to enter upon the above-mentioned property for inspection purposes. Signature of Applicant or Agent Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this applicatidnand state that . the information given is correct. I agree to comply with all state laws and county ordinances•relating to buidling construction; and authorize a -representative of the City of La ouinta Department of Building and Safety to enter upon the property for which I have applied for this permit for the purpose of making inspections. 1 Signature ofA plicant or Agent r Date r11 rK� T�x� c / rlF l�i� ( Print Applicant/Agent Name APPVPRMT nonq g l 1 /D A� �D/.! I �• E� /11 O ic157,9.c� S©ia 5 •vf 0 ,4?,diAI/ O AC �� iT S6 -So • ' L � %0• o0 AkaI '6%V 6 7, So frJ T TOTAL VALUATION�j�, �o NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS T Set Back 33 Ventilation System 2 Ftgs & Frms 34 Plenums & Ducts 2A Slab Grade 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 Final 10A fireplace T.O. ❑ NO. ADDITIONAL INFORMATION NO. • —71 j 2,-2 1I'RI_' SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Lath 12 Internal Lath 12A Drywall 13 Finish Grade INSULATION Thick Valued 7A Walls (Batts) 12B Ceiling (Batts) 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 p�L PAL STREET NAME 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final DEPARTMENT OF BUILDING & SAFETY COUNTY OF RIVERSIDE CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES I NO. PLUMBING FEES ` 1ST FL. SO. FT. @ ` SO FT. ® 2ND FL I . II POR SO. FT. j GAR. SO. FT. ® CAR P. SO. FT. ® I WALL SO FT ® I SO. FT. ESTIMATED CONSTRUCTION VALUATION $ UNITS oc i�Q�1J �a (�. >{}t(nr S [7Q YARD SPKLR SYSTEM MOBILEHOMESVC. BARSINK POWER OUTLET ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENTSYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGEDISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMITSVC WATER CLOSET (COMPRESSOR HP POLE,TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT ®a BATH TUB SO. FT. ®s WATER HEATER MAX. HEATER OUTPUT, B.T.U. (n o U SO.FT.RESID ®11/40 SEWAGE DISPOSAL SO.FT.GAR ® 3/40 HOUSE SEWER GAS PIPING a [� PERMIT FEE 0 U PERMIT FEE PERMIT FEE Cam• jDBL TOTAL FEES MICRO FEE MECH. FEE 5 oa PL. CK. FEE CONST. FEE ELECT. FEE f coo SMI FEE PLUMB. FEE 7 s18 MICRO FILM FEE f Cop} $ MECH. FEE Dbl $ q PL. CK. FEE $ CONSTRUCTION FEE Dbl $ ELECTRICAL FEE Dbl $ l Io SMI FEE $ s0 PLUMBING FEE Dbl $ TOTALFEES 1$ 0, I 12 M.O. ❑ N.C.❑ CASH ❑ CHECK RECEIVED BY TREES REQUIRED SEWAGE SYSTEM T LL P JOB ADDRESS COMMUNITY OWNER USEOFP�RMIT VALUATION OG F.C.C. GROUP TYPE r— PLAN NO. PLAN CHECKER DATE SUPP. TO PERMIT DATE DATE NOTAPPROVED APPROVED CLEARANCE REO'D PLAN CHECK ❑ GRADING PLUMBING ❑ ROAD DEPT ❑ HEALTH DEPT ELECTRICAL ❑ PLANNING DEPT ❑ LAND USE STRUCTURAL FIRE MARSHAL AUDIT C.R.T. REMARKS: S P� V-14 Nib lz- w G `l' N- C' cod SEWER DISTRICT FORM 284-58 (REV. 8179) VILLA LA QUINTA HOMEOWNERS ASS'N P.O.BOX 15 LA QUINTA,CA 92253 LA QUINTA BUILDING DEPARTMENT REGARDING THE J. HAGESTAD RESIDENCE, PERMISSION IS HEREBY GRANTED TO RELOCATE THE SPA SIX FEET FROM THE PRESENT POSITION INSIDE THEIR INTERIOR PATIO. JOHN SKOBY,BOARD MEMBER (" r . _� �[ .1 i la14 IS -a r I VA4&" -a- 421 '----' ' /y' f ^ A — — — PROPERTY LINE 0 UTILITY POLE J� M CMN BOX --•-- -- UTEITY EASEMENT QE ELEC. PANE BLOWER FENCE(HEGHT,TYPE) © GAS METER (D WATER LEVELER —E—E— UNDERGROUND ELEC. � BENCH MARK � RATE \ALVE l^l —G—G— U DERGF40UND GAS —�� OVERHEAD ELEC. WATER DEPTH GATE VALVE —}— OV€.`2HEAD TELE RAMi --'HITCH ELEC- PEDESTAL ACCESS ECEPTACLE BISHOP GRAPHICSIACCUPRESS O Cl+Of1C0 AIII A•f75M ® HOSE 8113 --- FILL LIPS OF FILTER OH HEATER QD MAIN DRAIN © P TRAP __3 STUB S)t"4 R ac—w DECKO-DRAIN LlG _ T @ AREA DRAIN --� DR RETURN --- PVC DRAM '--� THERAPY GRAB RAILS --� AERATOR UDDER a PUMP GAS GRILL ti CUP AtaMI SEE NOTES ,4 e- asp o scatF =-- V Y I• -IT NOTES: AREA MAP KEY MAP NO NAME ADD"— LOT BLOCK SEC SUBOu i?e n7 r-X& H. TEL.E ,,rra�tt W TELE. SALESMAN 14- Z, 3Yo -y?po) GOLF