PLBG (001133)PERMIT APPLICATION
?fie City of La Ouinta
Department of Building and Safety
This permit becomes void it work not commenced within 180 days from date of issuance. OR, it work'has been suspended or abandoned for a period of 180 days.
LICENSED CONTRACTORS 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.
License Class I ic. N,4yumber
Date Contractor x t # ti •` ^• r �...
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 section7000) of Division 3of the Businessand Professions Cdde)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 (5500.):
0 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, Business 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 improvemm 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 I, as owner of the property, am exculsively contracting with licensed contractors to construct 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 contractors) licensed pursuant to the
Contractor's License Law.).
0 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).
Policy No. Company,
0 Certified copy is hereby furnished.
O Certified copy is filed with the City Building Inspection Department or City - Department.
Date Applicant
APPLICANT NAME (L. F. MI)
Econo Sewer Const.
ADDRESS 68-415 Perez Road
CITY/COMMUNITY/STATE/ZIP "
Cathedral City, CA92234'
JOB SITE AOORESS/SPACE
51-864 Mendoza
CITY/COMMUNITY/STATE/ZIP / I. '
La Quinta, CA 92253
B'77 3
P,A�G8 2
P5 0 5
C
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TWN
RNG
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TR/ACCT
LOT'
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MOD
so
TRACT NAME '
OWNER NAME (L, FAI) Kersey
CONTRACTOR-FIRM�Applicant NAME l icant
ADDRESS '
Above
CITY/COMMUNITY/STATE/ZIP
Above
PHONE.
328-7760
LICNC II
458232
-
ARC/ENG FIRM NAME -
ADDRESS
CITY/COMMUNITY/STATE/ZIP '
PHONE N
LICNC •
-
USE OF PERMIT Septic system
BL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD .
LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE:- This section need not be completed if
the permit is for one hundred ($100) o• 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 Applicant
NOTICE TO APPLICANT: It, after making this Certificate of Exemption, you should become subject to the -Workers'
Compensation provisions ot•the Labor Code, you must forthwith comply with such provisions or this permit shall)
be deemed revoked. .
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
0 I liereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be
made in'connection With work authorized by this permit, and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, will be more than thirty six (36) feet high. (Chap 3.2. Grp 2, Art 2, Sec341; Title8,
C.A.C.)
0 As' ownerbuilder, t will not'employ anyone to do work which would require a permit from the Division of
Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
_0 Division of Industrial. Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm tliatthere is a construction lending agency for the performance
of the work for which this permit is issued -(Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
I certify that I have read this application and state that the above information is correct.) agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enfer upon the above-mentioned property for inspection purposes.
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: 1 certify I have read this application and state that
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
construction, and authorize a.Yepresentative of the City of La Ouinta Department of Building and Safety to enter
upon the property for which I have applied for this permit for the purpose of making inspections. -
({ Signature of Applicant or.Agent Date
Print Applicant/Agent Name
APPL/PRMT nnl 1'11
12D712/841 S.F. I D
Permit to install
a�Rsx�3�ex
6' x 14' seepage
pit.
Permit Fee
15.00
V
TOTAL
FEE
15100
BLDG. DEPT.
VALUATION 2,000.00
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION I DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Compart.
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
❑
43
Final
10A
fireplace T.O.
❑
NPON ADDITIONAL INFORMATION
�./f!' � /
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath31f
12A ' Drywall
13 Finish Grade
INSULATION Thick R"
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final
I
Tank Pit L. Line
ELECTRIC APPROVALS
I
REAR OF PROPERTY LINE
PSL PyI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
296 Bonding
30 Fixtures
31 Service
32 Final
al
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W
(A
W
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Receipt No. �' 0 1 Issued By
District: Riverside ❑ Indio 0 Hemet ❑ Date
DISTRIBUTION: WHITE - Office File
H SAN 122 (Rev 10/82)
\ 2 !, z ►�'%l
YELLOW - Applicant PINK - Building Dept. GOLDENROD - Pending File
RIVERSIDE COUNTY DEPARTMENT OF HEALTH
PERMIT APPLICATION FOR A SUBSURFACE DISPOSAL SYSTEM
Applicant: Submit this form with three copies of a scaled plot plan drawn to county specifications required on the
attached check list. A non refundable filing fee of $15 is required when the application is submitted. Check must be
made payable to County of Riverside.
Name
Mailing Address
M 1^-k (R c1 CA i z G �' li 1412.5 Z� v
e (D P -)p 1 3 I.) --
ZCity
City
(af-V-a�. (�) Rar-cl
State
co—o—
Zip Code
W : q A
Phone
<�o y
-v
I �; -
'Property Address
'City or Community
'Legal Description of Property (Lot, Parcel Map, Tract)
,a
S 1 g (o `t �1 '� d 0 Z�
Lcl Q u I r\TGt,
'Assessors Parcel No.
Water Serving Property From
Lot size
CNAJ2
Signature of Applicant 'F o Gr -'G --S-z U3 �, f Date
'The above information must be verified from Building Application
Staff Use — Do Not Write Below This Line
Initial Date
L�u� �` �, • r� t , i ' I `l
WQCB Clearance required Yes ❑ No ►❑ ,
Soils feasibility report required Yes ❑ No
Detailed boring report required Yes ❑ No
Detailed contour plot required Yes ❑ No 1
Comments:
Soils or boring report by Date
Approved by Date
Soils Map Page Soil Type Tract File No. Other
Number of Bedrooms
Septic Tank Size (gallons)
Rate Required
Type of System
7er.a
<,,z,�{�, –
New Addition Replacement
0 ❑ ❑
Leach line sq. ft. of bottom area trench
Leach bed (sq. ft. of bottom area bed)
Seepage Pit Diameter
Number of Pits
Seepage.Pit Depth B.I.
Total Depth of Pit
r , X
Location of System
>_i �N r1?�� ,,IF �t,ji-_lt_%v,
Additional Requirements v` ►� �`'`zq\t`sv t'�� �'� '
A permit is approveAenied 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 permit is necessary for the installation of the above
designedsystem. • �.:.
Signature of Health Official Date
Receipt No. �' 0 1 Issued By
District: Riverside ❑ Indio 0 Hemet ❑ Date
DISTRIBUTION: WHITE - Office File
H SAN 122 (Rev 10/82)
\ 2 !, z ►�'%l
YELLOW - Applicant PINK - Building Dept. GOLDENROD - Pending File
0
'rX
Yg/VCvv
N
i®
c'S/ST1r/L 3rauzz6a/A.-
RIVERSIDE COUNTY DEPARTMENT Of eUbLIC Hit AL1 h
DIVISION OF ENVIRONMENTAL HEALTH ` ,
11)
Food Establishment „ F`a: ; _'Sewage Disposal rr
Trailer Park 77- ,_ r:^'=' ...• ��Tinc� "'�`� Gal. Septic Tank
Motel, Apt., Hotel Sq. Ft. of Leach Line
Dwelling x 2O` Seepage Pit(B•-i') — R�PcAeecnel� i
Commercial Building Connection to Sewer .Ti. L4 c, :j
Swimming Pool A Al �S�SL�Imn No on-site regenerating water softening devices may be discharged into the individual sewage �c.s;
system herewith approved without clearance from the Water Quality Control Board.
Water supply serving this installation must be from an approved source.
_ X All sewage disposal installation must conform with requirements of current Uniform Plumbing Code.
Any cutting, grading, or filling in excess of four (4) feet will nullify sewage disposal approval.
Approval has been obtained from the Regional Water Quality Control Board for installation of the sev:
age disposal system. na•%��`� a ��ti- \50C`rour\ a,' W2�\-
This is to certify that the Riverside County Department of Public Health approves for occupancy, construction
or installation the item(s) checked above.
nate_ 12 � �2 I � �••, By �.U. � � .
1 H APPROVAL GRANTED 3Y THE
LTH
DEPARTMENT OF PUBLIC HE LTH
AS VALID FOR ONE ()
FRO;,;I DATE OF APPROVAL.
4tyl 44
Q94&
P.O. BOX 1504
Building S4-864 MENDOZA LA QUINTACALIFORN
DO
Address
CALLE pIA 92253
Address
ROBERT SOC191
Mailing
Address SAME
City Zip Tel.
LA QUINTA 1 92253 664-2825
Contractor
Address
ty jZip I Tela
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I 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, 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).
❑ 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.)
❑ 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
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 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. 12127
11LDING: TYPE CONST. OCC: GRP.
P. Number
Legal Description
Project Description SPECIAL INSPECTION
ON EXISTING ROODS ADDITION
Sq. Ft. 12 X14 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
PEES WAIVED —
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
.S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL U
REMARKS FRES W x ��
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
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SQ. FT.
GAS (FINAL)
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FI SP.
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
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROOFING
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.
SQ. FT. ® c
BATH TUB
SPARK ARRESTOR
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LATHING
SQ.FT.GAR ® 3/ac
HOUSE SEWER
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
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
R /EQUIP.
REINF.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FI SP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION'/004A13
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL