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RPL (07882) + SFD (05776)53385 Avenida Martinez 07882 05776 P.O. BOX 1504 Building 63-385 j lsy Address °, LA QUINTA, CALIFORNIA 92253 Mailing Address VA PON Rt City JZIp Tel. Address Zip I Tel. State Lic.- City & Classif. I Lic. # Arcn., tngr., Designer 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. 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, 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 or 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 rive 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.) 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) 9censed 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 ❑ 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 it 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 No. 07882 BUILDING: TYPE CONST. OCC: GRP._ A.P. Number UA -091411 Legal Description L ot 7 Project Description pool Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 46,8fj Const. 72,.00 Mech. LO.00 Electrical 27.00 Plumbing 24.00 S.M.I. .35 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: Date6/11/90Permit Validated by: Validation: T CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE 2ND FL. SO. FT. BONDING YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. I SO. FT. GAS (ROUGH) DRAINAGE PIPING WALL SO. FT. OTHER APPJEOUIP. DRINKING FOUNTAIN. SO 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 REMARKS: 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. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER MESH 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 ROCKSTORAGE 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 �O '004,0, '1001240 REMARKS: VENTILATIONFIRE ZONE 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 I. I T4ht 4 4 Q" Building Address 53-385 MARTINEZ P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Mailing Address P.O. RQ$ 1281' City Zip Tel. 1A (= ITA 1 92253 564-w4844 Contractor Address Zip I Tela State Lic. I City & Classif. Lic. # Arch., Engr., Designer Address Tel. City IZip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section =Of Division 3 of the Business and Professions Code, and my license is in full force and SIGNATURE DATE OMINER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for the following reason: (Sec- 7031-5.9rshess and Prolesskons Code: Any city or county which requires a permit to construct ata irprove, demoish, or repair any structure, prior to its issuance also requires the appiconI Jar such pemhit to file a signed statement that he is licensed pursuant to the prorsicns 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 exarpbion- Any violation of Section 7031.5 by any applicant for a permit subjects the 6cant to a cW penally of not more than live hundred dollars (E500). ❑ 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 Cede.- The QxMactorS License Law does not apply to an owner of property who buMfs-or improves Usreah and who does such work himself or through his own employees, provided Ihat such improverners are not intended or offered for sale. If, however, the building or knI raranarrt is sold within one year of completion. the owner -budder will have the burden ofproving trot he dhd not build or irprove for the purpose of sale.) ❑ 1, as owner of the properly, am exclusively contracting with licensed contractors to con- struct the project (Sec 7044, Bhskness and Professions Code: The Contractors License Law does not appy to an owner of property who builds or unproves thereon, and who contracts for such profess wih a conbactur(s) icersed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec B. & P.C. for this reason Date owner J WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 hate' -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 completed ff 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, 1 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 f, after making this Certilkate of Exemption you should become W11090 to the 10116r4ers' compensation provisions of the Labor Code, you must forthwith comply with such prorsiors 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.) Lenders Name Lenders Address This is a building permit when property filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. 1 certify that 1 have need 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 consbuctior, and hereby authorize representatives -of this city to enter the above- mentioned property for inspection purposes. Signature of applirarnt Date Mailing Addn?ss City, State, Zip No. 05776, d; 11LDING: TYPE CONST. OCC: GRP. P. Number 774-091-4319 Legal Description Project Description S.F.D. Sq. Ft. i573 Size No. • Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $87,690. PERMIT AMOUNT Plan Chk. Dep. 250.00 Plan Chk. Bal. 250.77 Const. 585.50 Mech. 66.50 Electrical 113.53 Plumbing 160.50 S.M.I. 13.20 Grading 20.00 Driveway Enc. 20.00 Infrastructure 1,93.4.78 MCISE PLAN 25.00 TOTAL .. 'f t J 7 p f 0 REMARKS I J1444a2 2i'gxetI;jk,.l..rx N•";i,.; iz.. 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 5/1£/89 Issued by: Date Validated by: Validation: Permit r GROUND PLUM BIN� (��f , CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS BONDING * HEATING (ROUGH) YARD SPKLR SYSTEM 2ND FL SQ. FT. tlVER OR SE 1 +06K ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. . SQ. FT. ® GAS (ROUGH) METER LOOP POWER OUTLET ROOF DRAINS GAR. SQ. FT. ® GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SQ. FT. ® WATER HEATER SERVICE FINAL INSP. DRINKING FOUNTAIN, WALL SQ. FT. WATER SYSTEM $ GRADING cu. yd. —Plus—X$—=$ URINAL SO FT ® FINAL INSP. r �� ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation j� fi a ^� ,2 � �'� (Jfl' ID 1 � FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FIRE ZONE ROOFING/— GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIREPLACE LAUNDRYTRAY 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. SO. FT. ® c BATH TUB SO. FT. ®c I WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® VAc HOUSE SEWER FINAL INSPECTION GAS PIPING PERMIT FEE PERMIT FEE MPL.CK.FEE PERMIT FEE DBL TOTAL FEES MICRO FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR ETBACK <6— _ GROUND PLUM BIN� (��f UNDERGROUND A.C. UNIT COLL. AREA ///4� Z/�/CSLAB GRADE � —• .. (�� ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS tlVER OR SE 1 +06K ROUGH WIRING DUCTWORK ROCKSTORAGE FOUND. 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. r �� APR MING .s FINAL INSP. ROOFING 72 j� fi a ^� ,2 � �'� (Jfl' ID 1 � REMARKS: VENTILATION FIRE ZONE ROOFING/— FIREPLACE SPARK ARRESTOR GAR. FIREWALL } ( LATHING``/`/44 MESH INSULATION/SOUN -6 —� Cj FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL T } Desert Sands Unified School District CERTIFICATION OF PAYMENT OF W SCHOOL FACILITY FEES n1l, 436 TO: City � L ,��i+i�t��,+ti �'a1 � t DATE: -� Department of e'42 ippyppe eAA 78-105 Calle Estado La Quinta, CA 92253 This is to certify that n 1 J developer of L , which is located at within this District, has paid school facility ees imposed pursuant to the author't a a d by vernment C d Secti n 530 0 in t o mount of $ _% coveling a•total-of Uquare feet of ( ) Welidential or ( ) industrial/commercial development and that building permits for this footage in this development may now be issued by your jurisdiction. CCK- 10 . for DESERT N S•UNIFIED SCHOOL DISTRICT White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer (10)-37 ��"`�"�=19�YV�`t'�'r�'tit`'`'�`+•�y�'`��*r;>���rr��1-�,�'�.`-��zi�+��§t�"�'�!�' ��`-�'��``'"����`�a�':� RECEIPT NO. "5�0? 0169 DISTRICT: ❑ Riverside, Iff Indio DOH SAN 122 (Rev. 5/88) DISTRIBUTION Issued By+.— Date- 0 ate ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records IA �V_ COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors 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' it �+ Z Q Agent, Contractor, Contact Person Phone Address 8 Phone -� ,. / L- - y is i 9� r LU Ownerr� N ,Pt/ 1 L 7v Phone 95�- 41ff V Mailing Add 'PD City qtate Zip Job Property Addra"24A Legal Description Prop. (PM, Tract, Lot) t)/A/7-A. 9A5�g 3 AM-- _Z / 9 /l Wz6DYX Lot Size star Agency ill Use of Permh P/P, CU, etc.CQ 4 . _ OtherOC j I _�ft CX �vx 1 QO0. V W Dwellyg, H Sit P p, etc. "5' .� -e9 Signature of Applicant Date CATEGORY: r REV CODE FEE CATEGORY: REV CODE FEE O0 SUBSURFACE DISPOSAL 1238 X45.00 ❑ SITE EVALUATION UPON REQUEST 7349 $42.00 ❑ ,MULTIPLE PARCELS WITHIN SAME -- (NO PLOT PLAN) m "LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348 $11.00 Z Q a. 1 st 4 Parcels (Each) 1238 $45.00 (Lose than 1 year) b. Each Parcel after 4 7344 $16.00 ❑ PRELIMINARY ELECTIVE 7352 $45.00 13 U W j ❑ Rereview (2nd review same parcel) 7344 $16.00 EVALUATION (Attach DOH SAN 53) m ❑ Site Evaluation in Conjunction with ❑ HOLDING TANK 7351 $45.00 Crftical Area 7346. `$86.00 ❑ ALTERNATIVEIEXPERIMENTAL 7345 $13200 ❑ Site Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 7347 , $86.00 i �NITIAL� DATE Holding Tank Agreements Completed ❑ Yes Certification of Existing S.D. System Required ❑ Yes � WCICB Clearance required. (Atte&; Form' ' ❑ Yes No DOH SAN 007, Santa An&Region-Only) Soils Percolation Report Required. ❑ Yes Special Feasibility Boring Report Required. ❑ Yes Nk Detailed Contour Plot Plans Required (1 to 5 ft interval) ❑ Yes Other ❑ Yes Staff Specialist Lot Inspection Required ❑ Yes No Lot Inspection Date Soils boring report by Projekt # Data Soils Map Page Son Type u C- Approved by 3 Date U No. of System Type System(.) Na Dwelling Units / (1) Septic Tank Soil Rate Grease/Send Z Q ❑ Holding Tank ❑ Existing 'D'1w ❑ Replaoerner►t Bedrooms,xteLe_ y // Intcp AD/l�yt Gal U - ILI 2) Leach Line Sq. Ft Sidewall allowance Install Lines) R long ft wide with `(:each Bed 94 ft trench area ft rook/ sq. R per running ft / min. inches rock dreinlines or of �a Leachiines/bed special design for slope: (3) Pit Diameter No. Fits Pit Below Seepage Pit Total Other Applicable�/ N/A Overfwrden facto A 5} r O �, Inlet (BI) / Max. Alle,Depih No. 2 System /V/A- REMARKS: &Pou - L� _ O This application i PPROVEENIED-for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated D'plot 0 on the accompanied' plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the above -designed. system. No construction is permitted in the required reserved 100% expansion area. 0 amu ` (1) Septic tank and sewer lines must be 50' minimum from any well/0 l Leach lines must be 100' minimum from any wells, including expansion area Gtr (3) 3eepage pits must minimum from any wells, including expansr/on ar q(/0 ;bel,50' M ,�aSignature of HeaRh Official RECEIPT NO. "5�0? 0169 DISTRICT: ❑ Riverside, Iff Indio DOH SAN 122 (Rev. 5/88) DISTRIBUTION Issued By+.— Date- 0 ate ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records IA �V_ COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL Z� Received FrorM. e Address: A Lot(.) Account No. Service Address 0 Meter(s) 0 Service(s) 0 Backflow(s) 0 House Laterals) • Detector Check(s) • Meter Surcharge N/ Sanitation Capacity Charge 0 W.S.B.F.C. 0 Temporary Construction Meter 0 Turn on Charge 0 Uncollected Account - Name 0 Inspection Fee - Tract - Fee - 0 Plan Check Fees Water I Sewer - Tract - 0 Bond Payment - A.D. --Bond Assmt. 0 Customer Deposit 0 Other 34 r A rinrip < Remarks: e, e 0 COPY to: e. Cash Check A fc Water Service Cashier Money Order CVWD-438 (11/89)