BLCK (05340) + SFD (04874)51895 Avenida Madero
05340
04874
T4ht
"
P.O. BOX 1504 No. 05344
Building 78-105 CALLE ESTADO
Address 51-895 memo LA QUINTA, CALIFORNIA 92253
Owner REA.f+ BAM
Mailing
BUILDING: TYPE CONST. OCC: GRP.
Address 1875 BUSINESS CENM AR A.P. Number 773-153-'013
City Zip ITel.
SM BERNAii)Xlsi7 92408 14/884—,7261 Legal Description
Contractor Project Description 145—FlOOT REAMING UALT.
SAME
Address
City Zip Tela
State Lic. City
& Classif. 257254 Lic. # i Sq. Ft. No. No. Dw.
Arch., Engr.,
Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip 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 r ? .
SIGNATURE 4`^h at. , -+" i z 5, DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that 1 am exempt from the Contractor's License Law for the following 2,175
reason- (Sec- 7031.5,13usiress and Professions Code: Any city or county which requires a
Permit to construct. afar, improve, demolish, or repair any structure, prior to its issuance also
requires the appFcant for such permit to rde a signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions of the Contractors License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the BrskIess and Professions Code, or that. he is exempt therefrom, and the basis
for the areged exemption- Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep.
subjects the aPP&ant to a civil penafy of not more than rive hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Brisness and Const. ..
Professions Code: The Contractor's License Law does not apply to an owner of property who
00
builds or rWmves thereon and who does such work himself or through his own employees, Mech.
Provided that such improvements are not intended or offered for sale. ff, however, the building
or kmprovernent is scull wftin one year of completion, the owner -budder wig have the burden Electrical
of provft that he did not buil or improve for the purpose of sale.)
O 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
struct the project (Sec. 7044, Business and Professions Code: The Contractor's license Law
does no apply to an owner of property who builds or improves thereon, and who contracts for S.M,I•
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec_B. 8 P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
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.
• TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars Ef00 valuation
P ( )1 ! t 9 Sft Clt1
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: It, after making this Certificate of Exemption you should become ZONE: BY:
subject to the NAorkers' Compensation provisions of the Labor Code, you must forthwith
onty mpwith such Provisions or this permit shall be deemed revoked. Minimum Setback Distances:
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
Lenders Name
Lenders Address FINAL DATE INSPECTOR
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. 2/8/$9
1 certity that I have read this application and state that the above information is correct. Issued by: Date Permit
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. Validated by:
Signature of applicant Date
Mailing Address Validation:
city, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SQ. FT.
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT.
DRINKING FOUNTAIN.
FT ®
HEATING (FINAL)
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(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
Cu. yd.
$ plus x$
LAUNDRY TRAY
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
VENTILATION
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
FIREPLACE
SQ.FT.GAR ® 3Yac
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 OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
F UND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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.
ar
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
• 4 4 "
P.O. BOX 1504
Building 78-105 C
LA QUINTACAL CALIFORNIA 92253
Address J1"Q}3 F-tx�OrU
Owner
Peal T. £t, ker EntorDri1aA11. xtT[ BUILDING: TYPE CONST. OCC. GRP.
Address 1075 Business Cantor Dr*
City Zip Tel.
Sian Bernardinf t 92408 1714-884-7241
Contractor
Sago
Zip I Tel.
State Lic. 01 5 City
& Classif. u37$rJ+a Lic. #
Arch., Engr.,
Designer
Address
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) t. of Division 3 of the Business and Professions Code, and my license is in full force and
effec
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,Susiness 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 bask
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 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, 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.)
O 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 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: If, alter 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 Inspection purposes. '
Signature of applicant Date
Mailing Address
City, State, Zip
Number 773--153-020
Legal Description
Project Description a • r • n •
t 3 r 1
1
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
Sq. Ft. 1517
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑
Demolition ❑
Estimated Valuation
$84,640
PERMIT
AMOUNT
Plan Chk. Dep.
$250.00
Plan Chk. Bal.
$.
Const.
Mech.
33.00
Electrical
78.61
Plumbing
112.00
S.M.I.
6.92
Grading
20.00_
Driveway Enc.
20.00
Infrastructure
10 066.33
TOTAL
�,�5%.� I• ( /, 1 /
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_INS P�C8T�OR
Issued by: Date Permit
Validated by:
Validation:
1
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT t<r $
UNITS
%LAB GRADE 3- ��-�'7
! J
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. C
FORMS
SEPTIC TAN
POR SO FTa
MOBILEHOME SVC.
BAR SINK
GAR SO. FT. Qc
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APP.IEOUIP.
DRAINAGE PIPING
CAR P. I SO FT. t$
TEMP. POLE
I
WALL SO. FT. (a
GROUT
DRINKING FOUNTAIN
SO. FT. a
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&� t-/
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISHI
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
a
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.
SO. FT. g c
BATH TUB
GAR. FIREWALL
SO. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT. B.T.U.
SO. FT. RESID (ar Iv C
SEWAGE DISPOSAL
SO.FT.GAR gg Vic
HOUSE SEWER
INSULATIONISOUND
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
/LSETBACK —// -
ROUND PLUMBING^
UNDERGROUND
A.C. UNIT
COLL. AREA
%LAB GRADE 3- ��-�'7
! J
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEPTIC TAN
ROUGH WIRING
DUCT WORK
ROCK STORAGE
/ OUND. REINF. l �� �i�
�d `REINF.
GAS (ROUGH) -
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ _plus_x$
_$
LUMBER GR.
FINAL INSP&� t-/
FRAMING
FINAL INSP. �1
1
C ROOFING -` b- vS 1
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR,
GAR. FIREWALL
LATHING �
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
SCHOOL FACILITY FEES Lr1
Cs�al
TO: City of La Quinta DATE:
Department of Community Development 'y
78-105 Calle Estado
La Quinta, CA 92253
This is to certify that J�J�,
developer of e "
located at - 'S - - which is
-1.nwithin
this District, has paid school facility fees `imposed pur ant to the
authority enerated y Government Code S tion 5 0 0 in the a it of
of Q�'�
( cwt. , cti( P " 1 / "-'1
covering a total of uare feet of re idential or
( ) industrial/commercial development and that building permits for
this footage in this development may w be issued by your jurisdiction.
or DESERT SANDS UNI IED SCHOOL DISTRICT
White - 8uildi g Department• ell w - Facilities Plannin • Pink - Accounting • old - Developer
J (10)-37
U111r.E or
A6RICUL I URAL CO,"1MISSIONLIt
AND
WL161 I I'S b. MEASURES
49-613 Ilwy 06, 8111te I1-12
Cuncbelln, CA 92236
619-342-0291
E. LEori SPAt1GY
co•a�n5 �ur..tn
IAMES o WALLACE
�55�Str�► r)ta•ai55iu�l.r.
CUMEvt BENVENS1E
sL.,«n
VNE Iq , 191A_ cnsE lu. Q �� 11 19
UEVEWPER' S WE I N E V I I YJ N ;-- t~ n - c am T tJ C
>\UUItESS 164
ti►c S•i eCn/� r IJ ✓'
'rELL•NIONEt 14) -
5 1 SsQS M A GS---
[dear Developert
After reviewing your landsc7pi.lty plans, nll plant material listed is 11ot 3.11
violation of yuaralltine ljr+gs ticrveininy the Coachella Valley. If substitutions
do occur and they differ [tun plant nviterial listed, tills o[Elce Must be notified)
bu11ediately.
Thauik you Lor ptutectLrg and preserving the Coachella Valley's pest -tree envirum ent.
ngr ural Calm tissioiler, s UL [ice
cct Indio and Riverside U[[ice
f
ft,
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No.
ENVIRONMENTAL HEALTH SERVICES 1-77.3—Ir-3
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 checklist
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 it
Z
Q Agent
t, Cont` or, Con Person Phone ��/ Address & P
p�
TIKj
W Owner Phone Mailing Address
City State _ Zip Job Property Addresp/�/rof Legal Description Prop. (PM, Tract, Lot)
SAl�J ,6ER7VA2r)/Af0 CA' IF 97.0 5) 99� MAorAV LnT Q AI V ?/) NIurT-'y7
Lot Size ter f PermCU, etc. 44 Iwo, -VM Other
e P etc.
nature of Applicant Date
CATEGORY: REV CODE FE_ CATEGORY: REV CODE FEE
SUBSURFACE DISPOSAL 1 $45.00 ❑ SITE EVALUATION UPON REQUEST 7349 $42.00
Ito ❑ MULTIPLE PARCELS WITHIN SAME - (NO PLOT PLAN)
Z LAND DMSION ❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
Q a. 1 at 4 Parcels (Each) 1238 $45.00 (Less than 1 year)
U b. Each Panel after 4 7344 $16.00 ❑ PRELIMINARY ELECTIVE 7352 $45.00
�
13 Rereview (2nd review same parcel) 7344 $16.00 EVALUATION (Attach DOH SAN 53)
❑ Site Evaluation in Conjunction with ❑ HOLDING TANK 7351 $45.00
Critical Area 7346 $66.00 ❑ ALTERNATIVE/EXPERIMENTAL 7345 $13200
❑ Site Evaluation Lot Less than SYSTEM
10,000 Sq. Ft. 7347 $86.00
INITIAL DATE
Holding Tank Agreements Completed 13 Yes ree� V
Certification of Existing S.D. System Required ❑ Yes
WQCB Clearance required. (Attach Form ❑ Yes
DOH SAN 007, Santa Ana Region Only)0. or
Solis Percolation Report Required. ❑ Yes CIO No
Special Feesibllity Boring Report Required. ❑ Yes
Detailed Contour Plot Plans Required (1 to 5 It. interval) ❑ Yes
❑ Yes
staff Specialist Lot Inspection Required ❑ Yes No
Lot Date
Soils boring report by Project ��fk Date
Soils Map Pape Sol Type �d �- Approved by ZiUTA_ Data
- !f -
U No. of Syatsme Typyof Systsm(s) No. Dwelling Units (r) (1) Septic Tank Soil Rail Grease/Send
2 ❑ Holding Tank ❑ Exieft Bedrooms, .r Mlcp
o 7`Fbw ❑ Replacement D Ms• , AALX
U�
� (2) Leach Line Sq. Ft Sidewall elbwance $natal Lines) n�g_,�f�w-ide with sq. nBottom trench area n rock/sq. n min. inches of bottom
per running n „/
Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Seepage Pit T
Applicable Inlet (BI)/ ^'�r�� ,r -
N/A Overburden factor [Y L � (� Max. Allow$le� ppth
No. 2 System *1//+4
REMARKS: -�
This application ' PPROVE Ed1Et3 for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompanne plo plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
Oa —designed system. No construction is permitted in the required reserved 100% expansion area.
Septic tank and sewer lines must be 50' minimum from any wellsN tl
Leach lines must be 100' minimum from any wells, including expansi ar 01 S r
(3) Seepage pits must be 150' minimum froim any wells, including expan n ea
Signature 0 Health Official �[il/: C �T�' R [-n I. - �� �T•d e( r, d a O . ^'�� --
RECEIPT NO._�. 'V33! Issued By Sic
�� Harp I IIgg
,
DISTRICT: ❑ Riverside, 2 -Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records