BLCK (08257) + BLCK (3166) + SFD (3155)53960 Avenida Martinez
08257
3166
3155
Building
Address ss rL
63—%1D *aim
Addr
Owner C '1 Fr ft
Address PO la 1334
City Zip Tel.
Contractor
Address
.4
ty lZip I Tel.
State Lic.I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
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 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).
❑ 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.)
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
Date `'+' owner
a,
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 i1 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 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
No. 08257
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number 774.-172-011.
Legal Description
Project Description 50 Fmcou. S11M Sbwa 81A113und front
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const. HAD
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL 54-71
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 7/16/3 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. I SO. FT.
WALL SO. FT. ®
SO 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
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROUGH WIRING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROCKSTORAGE
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
WATER SYSTEM
SO.FT.GAR ® 3/ac
HOUSE SEWER
GRADING
cu. yd.
$ plus x$
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
�/j /finn //7! /LG
1' a10
*
'e&
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
P.O. BOX 1504 No. .
Building 78-105 CALLE ESTADO
03166
Address 53--960 marauez LA QUINTA, CALIFORNIA 92253
Owner
James Laier Trust BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address uevw- An1l; A.P. Number 77A...177_01 t
City Zip Tel.
Sate Rosa . 95406 707-544-3841 Legal Description
Contractor Project Description :ZQQt of MtAnin$ Vall
Pine Creek Devalcoment
Address
City Zip Tela
State Lic. City
& Classif: Lic. # 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 r
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE _
OWNER -BUILDER DECLARATION Estimated Valuation } n
I hereby affirm that I am exempt from the Contractor's License Caw for the following' pVL
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 PERMIT AMOUNT
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 applicantfor a permit. Plan Chk.. Dep.
subjects the applicant to a"civil penalty of not more than five hundred dollars ($500). Plan Cf1k. BBI - R .2
❑,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 COr1St.
Professions Code: The Contractor's License Law does not apply to an owner of property who 44,50
builds or improves thereon and who does such work himself or through his own employees, _Mach. -
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 Electrical
. 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- Plumbing
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... S.M.I.> -
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
.O 1 am exempt under Sec..B. B. & 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 ,
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. ' ' Company
0 Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL A LA9
CERTIFICATE OF EXEMPTION FROM REMARKS ...r.. •> .•, r e i n i w n n
WORKERS' COMPENSATION INSURANCE `r
_ t Mt t 3 tY
(This section need not be completed if the permit is for one - hundred dollars ($100) valuation +t✓KJ r7 3 , i V 1 At.. i
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 ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code,- you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback trom 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
Lender's Name
Lender's Address 1
This is a building *permit, when properly filled out; signed and validated, and is subject to FINAL DATE INSPECTOR
expiration if work thereunder is suspended for 180 days.
1 certify that I have read this application and state that the above information is correct. .ISSUed by: Date 'i. % f permit -
all agree to comply with** 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
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®
POR. SO. FT. ®
GAR. SQ, FT, ®
CAR P. SQ. FT.
WALL SO. 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
ORMS a
Zigi
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
TEMP. POLE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
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 R AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
ORMS a
Zigi
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
,, ND 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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
11'/JYCV 1 uM"J wumA 1 unrwir 111ALb.
GARDEN WALL FINAL
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Jugs Laier Trust
Mailing I
Address P. 0.. Box 6835
City Zip ITel.
Contractor
_AddressI
53-475 Be==dav
State Lic. City
& Classif. +ii F+GS Lic. #
Arch., Engr.,
Designer
No. 003155
)ILDING: TYPE CONST. OCC: GRP.
P. Number 774--172-011-8
Legal Description
Project Description Trcut 1'14 Tit 'irfnk 7C.A- tan#t• 71
S'Igze t- 1453 No. ories
New CI; Add ❑ Alter ❑
Address Tel.
400' Gar
City Zip State 200' Fanrtn
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 DECLARAT ON
1 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 counlywhich requires.a ,
Estimated Valuation
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
-
PERMIT
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. heisexempt 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 of property who
Plan C.hk. Dep.
Plan Chk.. Bal.
Const.
Mech.
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
Electrical
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.)
Plumbing'
❑ 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
S.M.].
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.)
D I am exempt .under Sec. B. 8 P.C. for this reason
Grading
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
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.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COM P ENSATION 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
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 t -
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
HARD COPY
No. Dw.
Units
Repair ❑ Demolition ❑
AMOUNT
.111 nn
_9; An
1it .t5f1
ln,m
20.00
REMARKS
1.11 CnAi t iiflfit„ i MI -.'JI '2
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 611,0VA-2 Permit
Validated by:
Validati
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SO. 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
ORMS 2 F
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPIEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
P. POLE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
,^ n </ G
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
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
ETBACK 7 —CZ2_ S
GROUND PLUM
UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADE 2.
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
ORMS 2 F
SEWER OR T
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF ,9
22-
GAS (ROUGH)
M R LOOP
HEATING (FINAL)
OTHER APPIEOUIP.
REINF. STEEL
GAS (FINAL)
P. POLE
GROUT
WATER HEATER
SERVICE
SINAL INSP. - !'_(r
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER GR.
NAL INSP. O- Cf.
%RAMING MIZA17IV
INAL INSP.`/ n
ROOFING C _
,^ n </ G
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
ATHING
MESH
SULATIONISOUND 1
INISH GRADING
4(INAL INSPECTION IY -/1? - I
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
SCHOOL FACILITY FEES
TO: City of La Quinta I .DATE:
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
LA
3m,7
This is to certify that s ,
developer of
located at W_
this District, has paid sch of facility fee
authority generat d by Government_ C e Sectio
$ 0 (.94 a tx,nS i
covering a total of square feet of ( ) residential or
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
5 -b` o tu-b► p
53-9toa Mar he -e 7
L,9 -
which is
3 ' t LCt, A , withi4
RA -
imposed pursu nt to the III
1 53,080 in the amount of
r DESERT SANDS UO FIED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
V (10)-37
W
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O
F_
U
W
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U)
Y
Q
W
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W
U)
COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION 77V _/7 0//
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.
Building Department Application Log #
Name (Other, Agent, Contractor, Etc.)Mailing
Address
City
State
CA
Zip Code^ c
G J-
Telephone
�(I C)
"Job Property Address
�j�j
: y .. Gom1710tttly
' Legal Descri tion of Pro
g p (pe y. (Lot, PM, TR) M2ft;;43� �-4
'Assessor's Parcel No. -
Water Agency
CLot
Use of Permit J Planning Case #
Size
c-- � x
8
SFD, MH Site Preparation Etc.
`
��`b
Signature of Applican 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. El Yes S/ Cg
_�
WQCB Clearance required. ❑ Yes
Soils feasibility report required. ❑ Yes
Detailed boring report required. ❑ Yes
Detailed contour plot plans required. ❑ YesXJ o
Staff Specialist approval required. 1:1 Yes SCJ No Lot Inspection Date
Soils/boring report by / /� Project # Date
Soils Map Page Type vApproved
oil by Date
Type of System:
No.of Bedrooms
(1) Septic�Tann�k
Soil Rate equired
;Ne<
❑ Existing ❑ Additional ❑ Replacement
3 K.
/yyy Gals.
,Q
(2),Leach line sq. ft.
Sidewall allowance
Insta Line(s) Ft. Long,
Leach ed Sq.
(eo o tr;ench�area)
ft. rock/ �Sq. Ft.
running ft. Lh`N7A
Ft. wi e h min.—inches
below drain lines
Ft`o§bottom
`_
per
rock \
area
Leach lines/bed-special design for slope:
Applicable
Applicable
(3) Pit Diameter
No. Pits
r)7v.
epage Pit total depth-
epth -
Overburden factor
x. allowable depthN/A
This application s;aPorove ._ rf9'ethfor the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements
do of the ab •,ve :. esigne sy m.
Septic tank and sewer lines must be 50' from any wells o / �f
set fo h in Section B above. A building permNtrI lecessary for the insrs"',
2 Leach lines must be 100' min. from any wells includingex/ _.areaP4I�
Seepage pits must be. 150' min. from any wells 'ncluding expansion are—a/
Signature of Health Official
.RECEIPT NO.�d_, Issued by %'W� Date 5 iC —F 7
Lf
District: ❑ Riverside fridio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File
DOH -SAN -122 (Rev. 6/86)
j
P<gY•9 18 3
urrlcc OF
AGRICULTURAL CO3"111MISSIONER
4080 LIMON STREET, R00'.1 19
RIVERSIDE. CALIFORNIA 92501
(714) 787.2561
46-209 Oasis Street, Room 14
Indio, CA .92201
(619) 342-8291
Dear Developer/Landscaper;
E. LEON SPAUGY
C0MMISS10'IER
JAMBES 0. WALLACE
ASSISTANT COMMISSIONER
Thank you for inquiring with the Agricultural Commissioner's Office regarding
local quarantine laws.
Any diseases or insects associated with the plants/landscaping material presented
on your landscaping plans do not pose a threat to the Coachella Valley Citrus,
Date, Crape, Vegetable, or Field Crop industry. We therefore approve your
landscaping plans.
If however, any substitutions of plants/landscaping materials within your plans
occurs between now and the actual planting date,- you must contact this office
within 48 hours before delivery into the Coachella Valley. Also, the substituted
Plants/landscaping r3at.erial must be held for inspection upon arrival. Any sub-
stituted landscaping material found infected/infested with quarantine pests will
be i;n ediately treated or shipped out of the Coachella Valley at the discretion
of the Agricultural Cc=issioner's Office.
Under penalty of perjury, 1. the undersigned will comply with the above,
Authorized Ager' -t:
Name
Date
Signature
Permit Numbers) n 87 n 5 060 U A- _ S
Dei•eloper .^. _._•.. 'aa 6
Address
AGRICULTURAL CC)'.'`:IS;TC`; ' S APPROVAL
9444Z4 Late 6'- y--
hLtt?Orlt}' cited; Agricultural Code; Sections 6301, 6461, 6462, 6464, 6501, 6521-
6524
cc; 2 Pl n. Cher;, I::dio Orf, cc, fii%erside Office
2 Y O
3 a 7
23 - -U
\.r 9 t
Dear Developerhandscapert
OFFICE OF
GTKULTURAL CO-MM111SSIONE
4080 LEMON STREET, ROG?•1 19 _ co lsslo••cz
RIVERSIDE. CALIFORNIA 92591 0• V.ALLACE
-(714) 787 2561 - ':•:•:S:;STkNT C0.IKIS',10.CP.
Prior to delivery to the Coachella Valley, the following plants /landscaping
❑aterizl should be "free from" the insects/diseases listed. Plants, -landscaping
caterial;.Eppliances, insects and diseases, other than those listed, Ere also
applicable to quarantine lasts and regulations.
Citrus Nursery Stock/Citrus Plants; free from Red, Yellow, and Purple Scale,
Tristeza Cocplex, Woolly knitefly, and Comstock 2'Aalybug.
Euony-us species; free fro❑ Red, Yellow, and Purple scale and Comstock Mealybug•
Crape (Vinifera); insects and diseases.
Olive trees; Olive Lot and Red, Yellew,.end Purple Scale.
Palms trees, genus Phoenix; Prohibited.
Office,
Psidium (Cuav2); Woolly hnitefly._
Please ccntact Agricultural Co=issicner's
Soil, plants and landscaping material with roots ccntaainated with Ozornium Foot
Rot; F.ohibited. Please ccntact Agricultural Co.=issioner's Office,
1:}cri112, viable fors and appliances associated with; Prohibited. Please cc -:tact
r:`ricultural Co—issiener's Office.
Certain plants/landc_caping material from Tulare C,.urty- and portions of Kern
Ccu-ty; Prohibited, Please co -,tact Agricultural Ce.—issioner's Office.
Your ccoperatien is €reatly appreciated, If you have any questions on laws zn-d
rehlctiens gove:- ins.the Cocchella Valley, please do not hesitate to call cur
office.
Si:.c-re!y,
' r_..--:;_ur,.1 C_.._'i •sic1lcr
fits on L1mdsc pjnc Plans; - -
- Sate. lc cation %-tat_cd
c.e1e hon nturl :..e,f eVeloper stal-e]
Statenn_nt 'on landsc o,,». plan(s);
ti'= : Plant materir..l listed a`.=r, -
G-- Trev::'orrt _ of ha'.e teen approved by the A i_cult•jjta't
f' -0z7ic ltu s office. . Lrndsczpe contractor; please contact the developer for status
o_`..F.o iciflturzl Ca r,Lissicner`s aoproval-or denial. ' Piz-'nt t terial_rot conforfung
•.ith cazranL ne 1 :.s ray he destroyed and civil action, tai- -1.
X11 pl t rf>3terial. is subject' to insp ction at the disc tion of Une Acricultural
Ccr r -i ssi_oner's- office. PJ1 plant material dust to free from. FedScale .(Aonidiella
REMARKS:
Signature -