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SFD (003377)54125 Avenida Madero 003377 v N 4 P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 54-125 Madero LA QUINTA, CALIFORNIA 92253 Owner Address B3-170 Alvarado City Zip Tel. 7bermi. 92274 398-9266 Contractor wrier/Builde City lZip 1. .I Tel. State Lic. City & Classif. Lic. # Arch., Engr., Designer 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. _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,Business 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). . O 1, 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.) ❑ I.am exempt under Sec. B. & P.C. for this reason Date r Owner s - 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 ❑ 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, after making this Certificate of Exemptionyou 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, sighed 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 sof this city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip HARD COPY No. 003377 BUILDING: TYPE CONST. • OCC: GRP. A.P. Number 7774-192-017 Legal Description (Project Description Single Family, ill Ug REMARKS ZONE: BY: Minimum Setback Distances: ' Front Setback from Center Line Sq. Ft. 1270 Size No. Stories No. Dw. / Units New ❑ Add ❑ Alter ❑ Repair ❑ Demoliti9n ❑ FINAL DATE INSPECTOR Issued by:. Date 9/17/87Permit Validated by: Validation: Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. 5 . . Plan Chk. Bal. 49.85 Const. 346.00 Mech. 36, 00 Electrical 70.25 Plumbing 103.00 S.M.I. 4.94 Grading 20.010 Driveway Enc. 20.00 Infrastructure 1.626,50 TOTAL 1 11,926.54 11.676.54 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 9/17/87Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. ' PLUMBING FEES IST FL. SQ. FT. ® $ 2ND FL. SQ. FT. POR. SQ, FT, ® GAR. SQ. FT. ® CAR P. SQ. FT. p 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 WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APP.IEQUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM / P. POLE f� S ✓ 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 FINAL INSP , SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/a c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER VENTILATION GAS PIPING PERMIT FEE FIRE ZONE ROOFING 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 ROUND PLUMBIN UNDERGROUND A.C. UNIT COLL. AREA LAB GRADE ld XC _ ROUGH PLUMB.4-)j BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK /,//ROUGH WIRING/ ;9. DUCT WORK ROCK STORAGE FOUND. Pew. 1 Q61 p. 27 O GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEQUIP. REINF. STEEL GAS (FINAL) / P. POLE f� S ✓ GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ _$ LUMBER GR. FINAL INSP , 44FRAMING _ 7 f . �1 / 1 FINAL INSP. ROOFING l� 2� REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL v LATHING MESH / NSULATION/SOUND ./( FINISH GRADING G INAL INSPECTION)Z �p CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS. GARDEN WALL FINAL Building Address Til_ / 2— P.O. BOX 1504 APPLICATION ONLY 78-105 CALLE ESTADO 4 p /> 17 7 LA QUINTA, CALIFORNIA 92253 Owner GI A L-A,r i v r-eL-tx P, Address e'3 —)-1 O A, L_ 1 / (Z A. C) 0 City tt Zip Tel. Contractor Aaaress c City 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 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. 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,Business and Professions Code: Any city or county which requires a permit to construct, atter, 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 the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 or 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 or completion, the owner -builder will have the burden of proving that he did not build or Improve for the purpose of sale.) O 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 x DateA Anf$47 owner r r WORKERS' COMPENSATION DECLARATION 1 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 ❑ 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 or the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Ihereby 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 aboveinformation 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 BUILDING DIVISION BUILDING: TYPE CONST. OCC. GRP. A.P. Number ?'? `/- l 97 -- ,/ 7 t _ Legal Description Project Description Sq. Ft.I a1 U Size No. No. Dw. Stories Units New L2r Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation .-p s•-6 3 O -a J PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. 3`! . p Mech. 6a Electrical 701 - .Plumbing Plumbing /( 3• S.M.I. of Grading d o d Driveway Enc. / U 'T in /Infrastructure ^ TOTAL —7 A r&, REMARKS Ain n-7 49 rnTvl -275,00 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: CONSTRUCTION ESTIMATE GROUND PLUMBING NO. ELECTRICAL FEES COLL. AREA NO. ' PLUMBING FEES 1ST FL. 1A O SQ. FT. ® L d $ J 6,T 0<'3 HEATING (ROUGH) UNITS FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK 2ND FL. SQ. FT. FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. YARD SPKLR SYSTEM 6 POR. SQ. FT. O %/G CX) MOBILEHOME SVC. WATER HEATER SERVICE BAR SINK GAR. SO. FT. 111/0 CD OCA POWER OUTLET =$ LUMBER GR. ROOF DRAINS FINAL INSP. CAR P. SQ. FT. ® FINAL INSP. ROOFING DRAINAGE PIPING REMARKS: WALL i ✓ SQ. FT. ® S"O -7.2- 03 DRINKING FOUNTAIN SQ. FT. ® FIREPLACE SPARK ARRESTOR URINAL ESTIMATED CONSTRUCTION VALUATION $ GAR. FIREWALL LATHING WATER PIPING MESH NOTE: Not to be used as property tax valuation INSULATION/SOUND FLOOR DRAIN FINISH GRADING MECHANICAL FEES FINAL INSPECTION WATER SOFTENER CERT. OCC. VENT SYSTEM FAN EVAP.COOL HOOD Gr — FENCE FINAL SIGN INSPECTOR'S SIGNATURESIINITIALS WASHER(AUTO)(DISH) APPLIANCE DRYER GARDEN WALL FINAL GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM KITCHEN SINK L� ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP — POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY — AMPERES SERV ENT �� C1 SHOWER L� BOILER B.T.U. SQ. FT. ® c BATH TUB L/ SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. 2 %() SQ. FT. RESID ® 1+/e c / 7$ SEWAGE DISPOSAL �Q gilo SO.FT.GAR ® 3/,c HOUSE SEWER V GAS PIPING PERMIT FEE �0 PERMIT FEE ( V PERMIT FEE v DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE �6OU 70 �j p2a� 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 APP./EQUIP. 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 ON Z O PZ U W CO m Z O H U w 0 Yn Y Q W cr AN Z O F- 0 W COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION 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 specifications required on the attached check list. A non-refundable filing fee of $37 is required when the application is submitted. Check must be made payable to the County of Riverside. (f Building Department Application Log # Name (Owner, Agent, Contractor, Etc.) Mailing Address City RR y State Zip Code Telephone q 'Job Property Address 'City onCommUnity Legal Description of Property. (Lot, PM, TR) ( 'Assessor's Parcel No. (Water Agency,6r ell ' - f t Use of Permit'.) + ^n' Case # Lot Size - SFD, MH Site Preparation Etc s Signature of, Applicant Date 'The above information must be verified from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE Initial Date Certification of Existing S.D. System required. ❑ Yes ❑ No. WQCB Clearance required. ❑ Yes EI'No;-" ,Solis feasibility report required. ❑ Yes O No`, " o- fin,i�`�3 `Detail boring report required. ❑ Yes D<No� Detailed contour plot plans required. ❑ Yes ❑,No Staff Specialist approval required. ❑ Yes C7 No Lot Inspection Date Soils/boring report by Project # Date Soils Map Page%, ^ `' Soil Type - Approved by i d" Datea F , Type of System: No. of Bedrooms (1) Septic Tank Soil Rate Required ❑ Existing D New ❑Additional ❑ Replacement �� �^ ; �� ?Z) Gals. (2)1Leach line sq. ft. Sidewall allowance Install Line(s) Ft. Long, -� � Lekt bed Sq. Bbttom trench area ( ) ft. rock/—Sq. Ft q. Ft."f�iide with min. inches ,._� Ft. of bottopi per running ft. N/A rock below drain lines � _ area a-. Leach lines/bed-special design for slope: (3) Pit Diameter No. Pits Pit BI Seepage Pit total depth 'I� Applicable N/A Overburden factor�6' Max. allowable depth This application:is ap�rove?d;deled for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements set forth in Section B above. A building permitisnecessary for the installation of the above -designed system Septic tank and sewer lines must be -.50 from any wells � (2)\ Leach lines must be 100' min. from any wells including expansion area �3)y Seepage, pits must be 150' min. from any wells including expansion area f Signature of Health Official _ Date RECEIPT NO. District: ❑ Riverside r, Indio Distribution: WHITE—Office file DOH -SAN -122 (Rev. 6/86) Issued by= Date ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File 7 :- NOT _ • Desert Sands Unified School DistrictBE • ���•� ■y:,_ CERTIFICATION OF PAYMENT Nr D1JP�•I�A-rErj SCHOO�riPTLITY FEES TO: City of La Quinta DATE: Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 This is to certify that { L� developer of which is located at -Z !!5- within this District, has paid school facility fees imposed pursuant to the authority generated by overnment Code Sec/ion 3010 14 thamount of co Bring a total of27� squ re feet o�_( ) residential or ( ) industrial/commercial development7nd that building permits for this footage in this development may7 w be ` sued by your jurisdiction. for DESERT SANDS•UNIFIED SCHOOL DISTRICT White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer (10)-37