05452 (SFD)4
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 54-840 Obregon LA QUINTA, CALIFORNIA 92253
Owner
H. Gordon Brown
Mailing
Address P.O. BOX 59
City Zip Tel.
La Qninta 1 92253 619/566--1486
Gewral Contract
P.G. Box 59
City Zip Tela
La Qafnta 92253 619/564-1486
State Lic. City
& Classif. 524325 Lic. # 1235
Arch., Engr.,
Designer oVaer
Address Tel.
CityI Zip I State I
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.
�GNATURE DATE
OWNER -BUILDER DECLARATION
1 hereby affirin that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Busiress and Professions Code: Any city or county which requires a
permit to construct, after, improve, derna4sh, or repair any structure, prior to its issuance also
requires the applicant for such permit to fie a signed statement that he is licensed pursuant to
the provisions of the Contractors 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. Arty violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civi penally o1 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 Contractors 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 said within one year of completion, the owner -builder will have the burden
of proving that he did not buil 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 buff& or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec_ a, & 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
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be conpAeted If the permit is for one hundred dollars ($100) vatuation
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
Date Owner
NOTICE TO APPLICANT. ff, 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, OW Code.)
Lenders Name
Lenders Address
This is abuilding permit when property tilled out signed and validated, and is subject to
expiration
it
work thereunder is suspended for 180 days.
I certity 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
i
No. 05452
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 774-294--006
Legal Description Lot 6
Project Description Sxn
Sq. Ft. No. No. Dw.
Size 1220 Stories 1 Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$68,210.00
PERMIT
AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal.
I85.�i
Const.
500.W
Mech.
53.50
Electrical
10G.$
Plumbing
157.53
S. M.I.
44.83
Grading
20.00
Driveway Enc.
20.00
Infrastructure
1,496.40
TOTALS
REMARKS I - Ar zI.' . s' ^h- r> x n, nn A,
iAya.'.tfft ?�' ;J Ai_ x . �'.sis.`.)I
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
318/89
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
//99SETBACK
e(G'BL.AB GRADE / � ?-�
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SQ. FT.
STORAGE TANK
FORMS
SEWER OR SEPTI
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
ROCK STORAGE
FOUND. REINF.
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEQUIP.
DRAINAGE PIPING
CARP. SQ. FT.
TEMP. POLE
WALL SQ. FT.
DRINKING FOUNTAIN
SQ FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
-$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOHDISH)
APPLIANCE DRYER
-
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
[
a
p
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMARKS:
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.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 1+/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® V 4c
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
C � 22- -
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
//99SETBACK
e(G'BL.AB GRADE / � ?-�
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTI
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BONDBEAM e-1— -(�
WATER SYSTEM
GRADING
Cu. yd.
$ plus x$
-$
LUMBER GR.
FINAL INSP.
/r
RAMING
VVV
FINAL INSP.
-
ROOFING - / ��
[
a
p
Arl
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWAL 74,
LATHING i
MESH
LLT IOWSOUND
FINISH GRADING
INAL INSPECTION Z-6 -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
'
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
ROTC : THIS DOCSCHOOL FACILITY Es
RIENT CA14NOT �
SE DUPLICATE®
TO: City of La Quinta ` DATE:
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
This is to ertify that U J / ,
developer of , which i
located at , within
this District, has paid school f ci ity fees imposed pursuant to the
autho i y gqne_rat,,eo by /Gvernment C de Sec iott 53080' ' n the amount
covering a total of sq re feet of ( residential or
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
�G
14o 3 4A0Zb,6ql 0--6&,41a -
for DESERT SA DS UNIFIED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • P'ink - Accounting • Gold - Developer
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0007
.. � � . .,�. � rc. 1 er•,.tirP"•R:�"'�7�vr ii�ws r�i ir�;w s � �-.�t� ; � „ � ,. r3,1+1� L a(r'� �C '�'A3 ;Y - 4 :�-�". �u;, r5 ��"'+ -' i •
RECEIPT NO. V� "�""� Issued By f I Date—
DISTRICT:
ate DISTRICT: ❑ Riverside, /Indio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH A°f°'°Or5 Parcel No.
ENVIRONMENTAL HEALTH SERVICES
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 speculations as indicated on the attached check list
A non-refundable filing fee (see below) 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 approval.
Q
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG
Z
0
Agent, Contractor, Contact Person I
--r—�
Phone
�/
Address 8 Phone
% la ��,.•-
/.--
�r�
sit �—�
WOwner
/ /;���
Phone . r
Mailing Address
City Lin • # _
State
ZipJob
Property Address
legal Description Prop. QPM, Treq, Lot)
Lot Size (%
Water Agency/Well
Use of Pirmlt P/P, CU, etc.
Otherew
`
Dwelling, MH Site Prep, etc.
Date
Sig2LtV of Applicant `'` —
CATEGORY: REV CODE FEE
CATEGORY: REV CODE FEE
,M SUBSURFACE DISPOSAL 1238 $45.00
❑ SITE EVALUATION UPON REQUEST 7349 $42.00
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
m
Z
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
p
a. 1 at 4 Parcels (Each) 1238 $45.00
(Lew than 1 year)
U
b. Each Parcel after 4 7344 $16.00,=