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SFD (04837)53565 Avenida Martinez 04837 "AN ADEQUATELY SIZED DEBRIS CONTAINER 7 P.O. BOX 1504 IS REQUIRED ON THE 10B -SITE DURING Building, 78-105 CALLE ESTADO Address. 53-565 Martinez LA QUINTA, CALIFORNIA 92253ALL PHASES OF CONSTRUCTION nwnpr I - -.. .. ­— I Mailing Address 52x-500 Calhoun Street City Zip Tel. Coachella 1 92235 1 56443 23 Contractor Address City lZip Tel. 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 file a signed statement that he is licensed pursuant to the provisions of the Contractof's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or thathe 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 live hundred dollars ($500). O 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 orimprovement 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) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec.—B. & P.C. for this reason Dale / / ? ° !,i A Owner c.*.. P,,,i`r :'} F: J..-....,1 ,br7 rJ 7r- # .r .fd ,{!`r'Y ,t -^'t.•..,. 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 Of less.) -ti I certify that in the performance of tha 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. .e Date f -r "/-& Owner tdf NOTICE TO APPLICANT., It, 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. BUILDING: TYPE CONST: - OCC. GRP. t .. . A.P. Number. _ 774-131-015 Legal Description Project Description '` • r Side Street Setback from Center Line 1 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.) Sq. Ft. Size No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ FINAL DATE INSPECTOR 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. f N wy 1 1 I certify that I have read this application and state that the above information Is correct. Issued by: Date " ! i i0 Permit I agree to comply with all city and county ordinances and state laws relating to building r Estimated Valuation $71,,907 n mentioned property for inspection purposes. PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal.+ Const. Mech. $$ „ U U Electrical 71«:V.0 Plumbing 105 ou S.M.I. 5,Ux Grading 20 00 Driveway Enc. 20.00 Infrastructure , 319 TOTAL REMARKS * _c Jit: ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 1 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 Lender's Name Lender's, Address FINAL DATE INSPECTOR 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. f N wy 1 1 I certify that I have read this application and state that the above information Is correct. Issued by: Date " ! i i0 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 WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE ` CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES ISI FL SO F1 h $ UNITS SLAB GRADE ROUGH PLUMB BONDING SPKLR SYSTEM 2ND FL SO FT. qtYARD FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR SO FT. Qr GAS (ROUGH) METER LOOP GAR SO. FT. POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POL DRAINAGE PIPING CAR P. SO FT. 0 GROUT WATER HEATER WALL SO FT (d FINAL INSP.�' DRINKING FOUNTAIN BOND BEAM WATER SYSTEM C,giNAL INSP. �' �C., URINAL SO FT a _$ LUMBER GR. ESTIMATED CONSTRUCTION VALUATION $ ROOFING WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTONDISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED 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 WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID 1 V: c SEWAGE DISPOSAL SO.FT.GAR (g 3Vc HOUSE SEWER F AL INSPECTION (/J [ELECT.FEE GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.F:EE CONST. FEE SMI FEE PLUMB FEE STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR M� G S BACK — `3-6F &!�ROUND PLUM BIN _ j 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.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POL GROUT WATER HEATER SERVICE FINAL INSP.�' BOND BEAM WATER SYSTEM C,giNAL INSP. �' �C., //FINAL INSP,74 GRADING CU. yd. $ plus x$ _$ LUMBER GR. FRAMING ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING F AL INSPECTION (/J CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL Desert Sands Unified School District CERTIFICATION OF PAYMENT OF SCHOOL FACILITY FEES NOTICE: THIS DOCUMENT CANNOT W ® � Ct�D TO: City of La��1n-taPLICATED, DATE: / Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 This is to certify tAiat MQ n , developer of I Q I I�� I C nCCe— which is located at — e -Z V- i within this District, has paid school facility fees imposed pursuant to the authority gen rat d by Governme t Code Section 53 80 in the amount f covering a total of JQ0square feet of (x) residential or ( ) industrial/commercial development and that building permits for this footage in this development may now be issued by your jurisdiction. b�X Sd% - fED SERT SA DS • UNIF ED SCHOOL DISTRICT (00� Hab. White - Building Department Yellow - F ci ;ties Planning • Pink - Accounting 0 Gold - Developer (10)-37 v RECEIPT NO. '/5/ 3 Issued By. SIC, Date /- DISTRICT: ❑ Riverside, ❑ Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑. Blythe DOH SAN 122 (Rev: 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records N COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH amore 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 Phone Address & Phone F_ LLIV /Owner f 1.9 iAt7 ✓'i Jrr,J, / i?'. Phone Mailing Address City _ j A State Zip Job Property Addres r , Legal Description Prop. (PM, Tract, Lot) Lot Size .,-.. 4., f " '!. star /Well ! e"- /, t Use of Permit P/P, CU, etc. 4.A W 1 /4/Ms J fti .. d ielli Other geMH 1 jte Prep, etc. t/C.C.L'. ✓ Gt (.i/' , , --fi{[ 4 O Signature of Applicant Date CATEGORY: REV CODE FEE "CATEGORY: REV CODE FEE O" SUBSURFACE DISPOSAL 1238 $45.00 ❑ SITE EVALUATION UPON REQUEST 7349 $42.00 M ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) Z LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348 $11.00 Q a. 1 at 4 Parcels (Each) 1238 $45.00 (Less than 1 year) H, b. Each Parcel after 4 7344 $16.00 ❑ PRELIMINARY ELECTIVE 7352 $45.00 W ❑ Rereview (2nd review same parol) 7344 $16.00 EVALUATION (Attach DOH SAN 53) 0) _ ❑ Site Evaluation in Conjunction with ❑ HOLDING TANK 7351 $45.00 Critical Area 7346 $86.00 ❑ ALTERNATIVE/EXPERIMENTAL 7345 $13200 ❑ Site Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $86.00 'INITIAlL DAT Holding Tank Agreements Completed ❑ Yes 10No / - Certtfication of Existing S.D. System Required ❑ Yes r• ry0 WQCB Clearance required. (Attach Form ❑ Yes 0 `-DOH SAN 007, Santa Ana Region Only) % Soils Percolation Report Required. ❑ Yes No Special Feasibility Boring Report Required. ❑ Yes Q Ne Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes 0 Other ❑ Yes Ca'/Nc Staff Specialist Lot Inspection Required ❑ Yes ,Q No Lot Inspection Date Soils boring report by / `t tJ2-- Soils Map Page / Soil Type G Approved by Date Z -Ogg I U No. of Systema Type W Systems) No. Dwelling Units (/) (1) Septic Tank Soil Rate Grease/Sand Z Q ❑,lblding Tank ❑ Existing J-t ew ❑ Replacement3170 0 ►. Bedrooms, 67xture.Wnits `Grease Intcp Go I W(2) U) Leach Line Sq. Ft. Sidewali allowance Install ._ Une(s) ft long wide with '' - h Bed sq. tL Bottom trench areatt nxk/ sq. ft min. inches dratnfines or of bottom per running ft l3/NA Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Seepage Pit Tots Depth Other. Applicable i BMW 0 7` Inlet (BI) N/A Overburden factor " L- I J4l Max. Allgviablepepth ` Q No. 2 System k/' 4 REMARKS: fj iCiL` i/1^CLri+✓ /LC'"G" r- %17/O- Q- 1L. GL •GL— This application i PPRO / NIEDrfor the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompanie pot plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the Qabove -designed system. No construction is permitted in the required reserved 100% expansion area. Septic tank and sewer lines must be 50' minimum from any wells " &114t Leach lines must be 100' minimum from any wells, including expansiopr ar 3) Seepage pits must be 150' f minimum from a wells, including expansion area c//U 71" A4, D ,um nSi nature of Health Official ff—t_e v RECEIPT NO. '/5/ 3 Issued By. SIC, Date /- DISTRICT: ❑ Riverside, ❑ Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑. Blythe DOH SAN 122 (Rev: 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records N