SFD (4832)A
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 51-6-147 Mendoza LA QUINTA, CALIFORNIA 92253
Mailing
Address 79-985 Trinidad
City lZip ITel. I
ntractor
City lZip I Tel.
State Lic. City
& Classif. I Lic. #
Arcn., Lngr.,
Designer
Address FT —el.
City Zip State
I I Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereb0firm that 1, am licensed under Provisions of Chapter 9 (commencing with Section
7000) of ivision 3 of he 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 Contractors 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, of 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).
0 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.)
0 1, 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.)
0 1 am exempt under Sec.—B. & P.C. for this reason
Date —LI _A—kk' Owner **40 pow,
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure or a certificate of
Works r's Compensation Insurance, or a certified copy thereof. (Sec. 3806!Labor Code.)
Policy No. Company
0 Copy Is filed with the city. 0 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 (SIOO) valuation
or less.)
I certify that in the performance of thp 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 Nam
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, Z!
LDING: TYPE CONST.—OCC. GRP.
P. Number 773-142-020
Description
Project Description A - 11P -1).
Sq. Ft. No.
Size 1369 Stories
No. Dw.
New 0 Add 0 _' Alter 0 Repair 0 Demolition 0
Estimated Valuation
$74,1,150
PERMIT
Plan Chk. Dep.
Plan Chk. Bal,
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Eric.
Infrastructure
TOTAL
LIVE
AMOUNT
39.98
3,51.00
36.00
73.03
103.00
5.29
20.00
20.00
REMARKS
vv7iill.., IV I I tot)
I V LfMfi I Itf1f4L %
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
11/16/138
Issued by: Date—Permit
Validated by:
Validation:
- I
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATIL
NO. ELECTRICAL FEES
NO. PLUMBING FEES
ISI FL SO FT 47
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL SO FT. C
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR SO FT. *
DUCT WORK
ROCK STORAGE
GAR SO. FT. 0
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO FT. 6
GAS (FINAL)
WALL SO. FT. a
DRINKING FOUNTAIN
SO. FT. r#
URINAL
ESTIMATED CONSTRUCTION VALUATION
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ -Plus-X$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUT09DIS H I
APPLIANCE. DRYER
FINAL INSP.
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 'A c
SEWAGE DISPOSAL
SO.FT.GAR A4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.;:EE -r�
ELECT.FEE
SMIFEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
�q4q.ROUND
PLUMBI
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEP�"-
ROUGH WIRING
DUCT WORK
ROCK STORAGE
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.
e/k/FRAMING / J6
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR�
GAR. FIREWALL
THING -t
MESH
UINSULATIONISOUND
FINISH GRADING
INAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF t�'J
NOTICE: THIS DOC-190mm'r?�%J ITY N M -M
13E DUPLICAT-E-D,'
Q0
TO: City of La Quinta DATE:
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
This is to certify that
developer of zS�A�V-u 41a,7ril-tj 0,(jej
XC_E_ , which is
located at �5-1 (01 rl AALL LkI bj"& _ /I :�- -) , within
this District, has paid school faciC-Zty fe'es imposed'pursuant to the
au�%r��R, generar�d by Government Code Olt 5 -10 8 0 in the arpount of
A n /D I /\A/V7 'I L�&
$ 11'K 4 " "LA& Iz i.." dw�djd&A-kitp
coveri al of / Dqz�- Rajo, ' square feet 'of (�,,) r�sMential or
( ) industrial/commercial'development and that building permits for
this footage in this development may now be issued by your jurisdiction.
-row Y"�0'0:::: loqs -'�JA I I h """- a QA'
fo-r bk!�'ERT S4DS UNIFIED SCHOOL DISTRICT
White - Building Department 0 Yellow - Facilities Planning 0 Pink - Accounting 0 Gold - Developer
(10)-37
N-,
RECEIPT NO.— 6 Issued By Date
DISTRICT: 0 Riverside, �l �Indio 0 Hemet 0 Perris 0 Rancho Calif. 0 Blythe
DOH SAN 122 (Rev. -5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applican . t PINK -Bldg. Dept G OLDENROD - Pians/Records
sae
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No.
ENVIRONMENTAL HEALTH SERVICES 170 - IV -7, -c�2o
PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM
Applicant: Submit this form with four copies of i scaled plot plan (1 -20 scale) drawn.to County speculations as indicated on the attached check I ist.
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.
<
VERIFY ITEMS IN SEanON A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'*
Z
0
Agent Contractor, Contact Person
Phone
NSz- $(75?/
Address & Phone
W59R-i' -7X/,V/
U.1
C0
Ow
711.157--st 4ez 7-4—IC—
Phone
3Z511�_V7?/
fling Address
X. e -pe -1,11 Ae-eA,0� %L -
city
U /,v
-3
Job Property Address
S-/ -7 10MXPb..�*
Legal Description Prop. (PM, Truct, Lot)
-2.7 0
3 Z
Lot Size
Water Agency/Well
Use of Permit P/P, CU, etc.
Other 3,0"t.,
0/k/0 0
16" D -
9/41
Dwelling, MH Site Prep, etc.
Signature of Ap9kant
Date
CATEGORY: REV CODE FEE
CATEGORY: REV CODE FEE
&-SUBSURFACE DISPOSAL-, 1238 $45.00
o SITE EVALUATION UPON REQUEST 7349, $42.00
CID
• MULTIPLE PARCELS WITHIN SAME
A (NO PLOT PLAN)
Z
LAND DIVISION
�.'1-0 SEWER/SEPTIC VERIFICATION' 7348 $11.00
0
a. 1 at 4 Parcels (Each) 1238 $45.00
(Less than 1 year)
15.
b., Each Parcel after 4 7344 $16.00
0 PRELIMI�MRY ELECTIVE 7352 $45.00
Uj
0 Rer6vlew (2na review same parcel) 7344 $16.00
EVALUATiON (Attach DO H SAN si)
U)
• Site Evaluation In Conjunction with 1%4
10 HOLDING TANK -7351 $45.00
Critl6al Area 7346'*� ft$86.00
0 ALTERNATIVE/EXPERIMENTAL 7345 $132-00
• Site Evsivation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $86.00
6k
L
INP*L DATE
Holding Tank Agreements Completed 0 Yes CYNo
Certification of Existing S.D. System Required 0 Yes 19'No
W0CB Clearance required. (Attach Form 0 Yes EYNo
DOH SAN 007, Santa Ana Region Only)
Solis Percolation Report Required. 0 Yes No
Special Feasibility Boring Report Required. 13 Yes No.10
Detailed Contour Plot Plans Required (1 to 5 It. interval) 0 Yes No
tr,
0 Yes
1 11 No
Staff Specialist Lot Inspection Required 0 Yes 13 No
Lot Inspection Date
Solis boring report by' Project Data
A
Soils Map Page Soil Type Approved by Date
No. of System
Type Of Sys"s)
No.�elllng Units
(1) Septic Tank
Soil Rats
Grease/Sand
Z
0
A.) e-
0 Uolding Tank 0 Existing
3"New 0 Replacement
x`ure Units
IZ2!� �_ -
Grease Intop
--Gal
U.1
(2) Leach Line Sq. Ft
Bottom
Skiewall allowance
ft�rock/, q.fL
�Per
install Ure(s) ft, wide w1th
0
min. inches rock below drainfires or
Leach Bed sq. It.
of b7rn-a'rea
run)*,fq ft...
—
0 NA
e
Leachlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
Seepage Pit Total Depth
Other
Applicable
_�Zzftkctor
Inlet (BI)
Lf 7
N/A — r�den I,
0 5 121-_'6�
bovc
Max. Allowable D1rh
!Z 0
No. 2 System
REMARKS:
r
This application i CAPPROVE /DENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
Z
on the accompani pf plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
0
above --designed system. No construction is permitted in the required reserved 100% expansion area.
<Z�'Septic tank and sewer lines must be 50' minimum from
any wells
Leach lines must be 100' minimum from any wells, including expansion area
U.J
CO
6 Seepage pits must be 150' minimum from any wells, includin�expansion area
Signature of Health Official - Oc-,, Date
RECEIPT NO.— 6 Issued By Date
DISTRICT: 0 Riverside, �l �Indio 0 Hemet 0 Perris 0 Rancho Calif. 0 Blythe
DOH SAN 122 (Rev. -5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applican . t PINK -Bldg. Dept G OLDENROD - Pians/Records
sae
Q1 4P
0
OFFICE OF 1��
AGRICULTURAL CONIMIS51ONLT
AN D
WEIGHTS & MEASURES
49-613 Ilwy 86, Suite B-12
'Coachella, CA 92236
6.1 9-342-8291 -
DATE C,� CASE -NO.
E. LEON SPAUGY
COMMISIIONER
JAMES 0 WALLACE
ASS:S*,A.Nt COMMISSIONER
CLEMENT BENVENISTE
SEALER
DEVELOPER'S NAME: L,_Cf�,6"j
ADDRESS: P.n
_P1a,J0/k6 VIALW\�aRl_z CA '?,-)27b
TELEPHONE: 4
's-( . .�. r7 AL) E- ./Lke:-m862A
Dear Developer:
After reviewing your landscaping plans, all plant imaterial listed is not in
violation of quarantine laws governing the Coachella Valley. If substitutions
do occur and they differ fia, pla_nt imaterial listed, this office must be notified
imnediately.
Thank you for protecting and preserving the Coachella Valley's pest -free environment.
-k , 7a-
grW tural Coinnissioner's Office
cc: Indio and Riverside Office
OG
\���; .y ��� ;�� !►1I��111 ILII! ��
F
PF-
Yj
u l t ofQuinta
I
��
11jutot-U4, anb �$Ufjet� ill ir� ion
This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building!I' I
i; ti 6 Code certifying that at the time of issuance this structure was in compliance with the various
i:ll f!I
ordinances of the City regulating building construction or use. For the following:4.
BUILDING ADDRESS 5I-645 AVFNTnA MFNnn7A
Use Clossificotion S, F n Bldg. Permit No. 493-9
Group RI -3 Type Construction Fre Zone Use Zone SQ j
owner of Building -RUER HARTWIG Address 7g--9$5 TRI ITnAn
. i city $€Rnnl m.,�., n' IISIES BY; HA 6j 'n'
Dote: AI Ir.I ICT 1 S _ 144(1
Building Official -
POST IN A CONSPICUOUS PLACE -_- -