001674 (SFD)4
P.O. BOX 1504 No. 001674
Building 78-105 CALLE ESTADO
Address 500 pts LA QUINTA, CALIFORNIA 92253
Owner
Art Ande3"sM BUILDING: TYPE CONST. VN OCC: GRP. R 3
Mailing
Address 45 � ��t �3 I.A.P. Number ia�a-�U5°~Q04
City Zip Tel.
r1 3i xa mwl s �32a€1 340-6935
Legal Description
Contractor Project Description Rilv=3_421 f'.t4a`�$ W t 3l-IL"t
Sam
Address
City Zip Tela
amp-
State Lic. City DIM 1590
& Classif: Lic. # Sq. Ft. No. No. Dw.
MR 430. Stories
'Arch., Engr., Size - � Units �.
Designer New a Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECIMATION
I hereby affirm that I am licensed under provisions of,.Chapter 9 (commencing with Section
7000) of D vision 3 of the Business and Professions�Code, and my license is in full force and
effect.
SIGNATUREf % DATE
OWNER-BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following t+���
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a °hr� ,
perrnit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also '
requires the applicant for such permit to rile a signed statement-that he is licensed pursuant to PERMIT 1 AMOUNT
the provisions of the Contractor's License Law, Chapter. 9 (commencing with Section 7000) of .c•
Divisi6n-3 of the Business and Professions Code, -or the he is exempt therefrom, and the basis ' p��
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit .Plan Chk: Dep. 20.00
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500). . - ..
❑ I, as owner of the properly,.or my. employees with wages as their sole compensation, will Plan Chk. Bal... F0.04
do the -work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and COf1St. (S
Professions Code:. The Contractor's License Law does not apply to an owner of property who 379.0
builds or improves thereon and who does such work himself or through his own employees, Mech. �_�
provided that such improvements are not intended or offered for sale. If, however,
.however, the building i
00
or improvement is sold within one year of completion, the owner-builderwill have the burden Electrical - 80.57
of proving that he did not build or improve for the purpose of sale.) e p
❑ •l, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing . 8540
struct the project.:(Sec. 7044, Business and Professions Coder The Contractor's License Law - _
does not apply to an owner of property who builds or improves thereon; and who contracts for S.M.I. 5.74
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc. 20.00
Date owner Infrastructure 1,221.33
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
O Copy is filed with the city. O Certified copy is hereby-furnished.
TOTAL 7.142 7-8 1. 42.28
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if 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, l 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 ZONE: BY:
subject to the Workers' Compensation *provisions of the 'Labor Code, you must forthwith Minimum Setback Distances:'
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
I hereby affirm that there is a construction lending'agency for the performance of the '
work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
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. Issued by:' 'Date Orr 8 Hermit
I agree to comply with all city and county ordinances'and state'laws relating to building
construction, and hereby authorize representatives ;r�of this" city to enter the above=
mentioned property for inspection purrp,os4sF' —,. ' �Valjd'ated by:
Signature of applicant– = Wit' �'.• �_ Date
Mailing Address �� ✓ ''T _ Validation:
City, State, Zip
A 2 3 1 7 8 15 185228 CK
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®
POR. SQ. FT. ®
GAR. SQ, FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM -
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ®c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
GASPIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBLTOTAL
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
JJ v
SEWER OR SEPTIC `iN' o
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REIN
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
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.
PC (,FRAMING t'i'
FINAL INSP.
/L/
IA ROOFING ZI '/ Q%_
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
11 THING .
MESH
�J,'21NSULATION/SOUND G/
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL.
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL.
,QLK- Y W hi�r��
� � t+GGlt�GtJ
L V P.O. BOX 1504 APPLICATION ONLY
Building ��O c, n � 78-105 CALLS CALIFORNIAESTAD9
Address J ,� o �-,.>•M, LA QUINTA, ORNIA 92253
Owner
Mailing /
Address
r
City Zip Tel.
Contractor
Zip
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under prov,Isions of Chapter 9 (commencing with Section
7000) of Division 3•dN the Business a d Prof 6"sions Code, and my license is in full force and
effectN / /
SIGNATURE / -' DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031;5,13usiness and Professions Code: Any city or county 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 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 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 or 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, as owner of the property, am exclusively contracting 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.)
❑ 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 Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
.O Copy is filed with the city. ❑ 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.)
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
I hereby 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 ins�ection'pur ores. � /fes �
Signature of applicant �i �— Date_x
.Mailing Address
City, State, Zip
BUILDING DIVISION
BUILDING: TYPE CONST. -OCC. GRP.
L�
A.P. Number
Legal Description L- c,4
Project Description
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
stimated Valuation
PERMIT ,l AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
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:_
A2172
8 2 25x00 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. ®
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/e c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/.c
HOUSE SEWER
LATHING
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 OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
E''b s
2� _0
Desert Sands Unified School District
H BERMUDA DUNES r
RANCHO MIRAGE C 82-879' HIGHWAY 11 1 • INDIO..CALIFORNIA 92201-5678 • (619) 347.8631
r INDIAN WELLS H
PALM,DESERT
d` LA OUINTA
INDIO 1�
Aug. 1.,' 1985
City of La.;Quinta
Departmenof.Community Development;-
78-:105 -Cal 11- _ Esta:do
La ..Qui-nta;' -.CA 92253'
Re: La -Quinta..Collve°:.:Lots 3, 4,; 6
Gentlemen:
The developer of 'the above referenced,;. La, Qu i nta Cove Lots
3, 43, " & 6
has mitigated, is impacts on Our-overcr6wded schools by.payment
of the amountlof $628 per unit to. 'be,appli.ed'to the cost of.
district .educational favi-li.tie's -made necessary by such new
development.
Sincerely,
John .:Brooks
Assistant.Superintende.nt
:Business .Serv.ices
.JDB/crm
all
Z
O
11—
U U
W
N
M
Z
O
H
U
W
rn
COUNTY OF RIVERSIDE, DEPARTMENT OF HEALTH
PERMIT APPLICATION FOR A SUBSURFACE DISPOSAL SYSTEM
Applicant: Submit this form with three copies of a scaled plot plan drawn to county specifications required on the
attached check list. A non refundable filing fee of $15 is required when the application is submitted. Check must be
made payable to County of Riverside.
Name
Mailing Address
City ~
State
Zip Code(%
Phone
/ C
'Property Address �'`City�Communitya
'Legal Description of Property (Lot, Parcel Map, Tract)
'Assessors Parcel No. %
Water Serving.Property From
Lot size
Signature of Applicant Date
'The above information must be verified from Building Application
Staff Use — Do Not Write Below This Line
Initial Date ,
WQCB Clearance required Yes ❑ No [I
Soils feasibility report required Yes ❑ No [ f
Detailed boring report required Yes ❑ No ❑
Detailed contour plot required Yes ❑ No ❑
Comments:
Soils or boring report by Date
Approved by -tDate•
i ' U, a G 4Other"`f�
-,
Soils Map Page Soil Type Tract File No.
Number of Bedrooms
Septic Tank Size (gallons)
Rate Required
Type of System
Ne❑wReplacement
Eli
Leach line sq. ft. of bottom area trench ,/
Leach bed (sq. ft. of`bottom area bed)
Seepage Pit Diameter
Number of Pits
Seepage Pit Depth B.I.
Total Depth of Pit
Location of System
" ire+' W
AdditionalG- Requirements
� /> `!tet
k'%C .c•.,Y ,i% �. ,-. s.,._
A permits°approved/den,iedaforthe design of a subsurface disposal system as indicated on the accompanied rplot 'plan�
using the requirements set forth in Section B above. A building permit is necessary for the installation of the above
designed system.
Signature of Health Official Date
Receipt No. �Q �l Issued By 1
District: Riverside ❑ Indio ❑ Hemet ❑ Date j
DISTRIBUTION: WHITE - Office File YELLOW - Applicant PINK - Building Dept. GOLDENROD - Pending File
DOH SAN 122 (Rev 10/84)