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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