SFD (04486)P.O. BOX 1504
Building—,f 78-105 CALLE ESTADO
��
Address 114a Idoza LA QUINTA, CALIFORNIA 92253
Owner
David mon a
Mailing
Address P„ 0. 4694
City Zip Tel.
Palm Desert 92261 340t1931
Contractor
Address
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, 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 live hundred dollars (5500).
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 or property who
builds or improves thereon and who does such work himself or through his own employees,
provided that suchimprovements 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
or 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 c' — .r►
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. O 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
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number. 774--092-022
Legal Description
Project Description S • F • D,
044 w6
Sq. Ft.1465 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation��
PERMIT
AMOUNT
Plan Chk. Dep.
$450-000
Plan Chk. Bal.
72. 0
Const.
3 115 a DO
Mech.
36
Electrical
b * /xi
Plumbing
S.M.I.
I . b fit
Grading
l; _-t1 ,, VV
Driveway Enc.
4u 11 V0
Infrastructure
7 ♦ / • tig�
Side Setback from Property Line
Lender's Name
Lender's Address
FINAL DATE
INS�rPtECTOR;
TOTAL
4Z .1f
REMARKS
"
I certify that I have read this application and state that the above Information is correct.
ai.:.71 :'1•R.:i� 5�.ft;Y'!..F... "Yany h.l 10
Date Permit
I agree to comply with all city and county ordinances and state laws relating to building
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
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from 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
FINAL DATE
INS�rPtECTOR;
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.
Issued by:
Date 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 ASSESSORS
OFFICE, HARD COPY- FILE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO Fl ip S
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL SO FT. @
HEATING (ROUGH)
MOBILEHOME SVC
BAR SINK
POR SO FT. a
ROUGH WIRING
GAR SO. FT. a
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. SO FT. d?
HEATING (FINAL)
WALL SO. FT. (d
REINF. STEEL
DRINKING FOUNTAIN
TEMP. POLE
URINAL
SO. FT. a
GROUT
ESTIMATED CONSTRUCTION VALUATION $
SERVICE
WATER PIPING
NOTE: Not to be used as property lax valuation
FLOOR DRAIN
' MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTONDISH)
APPLIANCE DRYER
-
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
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
GAR. FIREWALL
SO.FT.GAR (q 3Vc
HOUSE SEWER
2�LATHING,G'�'G -r
GAS PIPING
PERMIT FEE
MESH
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 8 AIR COND. SOLAR
SETBACK
GROUND PLUMBI ,,,_ i2
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. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
—plus—x$
�
-$
LUMBER GR.
-
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING—�7—
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
2�LATHING,G'�'G -r
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
�r p+ OF
� OTICt: THIS DOCU MIM a %0^1101II& .ITY FEES
BE DUPLICATE®.
TO: City of La Quinta DATE:
Department, of Community Development
78-105 Calle Estado
La Quinta, CA 92253
�(al
5L�7
ND
0"4-
Q�
S. v 1cD)
This is to certify that J
developer of which is
located at n- A, j 1 within
this District, has paid school facility fees imposed pursuant to the
authority generat d by 'Gp vernment Code Section 53080 in the amount o
$ � q 1. 45 ( -� 11 160 -
covering a total of 1 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.
tLfor DESERT SANI)S.UNIFIEY SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
0 007
COUNTY OF RIVERSIDE, DEPARTMENT OF HEALTH
ENVIRONMENTAL HEALTH SERVICES DMSION — —
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 of6_$40 is required when the application is submitted. Check must be made payable to the County of Riverside.
Building Department Application Log #
Name (Owner. Agent. Contractor, Etc.)
Mailing Address '
Do 10 Moss
P.o.Foy
City
State
Zip Code
Telephone ,
PI -)LM OcSEn-r
CA•
92Z61
(JIB►) 340-)•931
'Job Properly Address
Gt Gorn>x�it, try
'Legal Description of Property. (Lot. PM. TR)
K-mOAS O A
LA OQI&rIA
Loi m. 2Lk ?.1 -4 <A A ( LIC
'Assessor's Parcel No
'w ater Agency n.WE,+II
r t " - - VAJ$0&,rA
Permit[�ltt �CtYnr:f�ot�
Use of nr1IGL.
_C Planning Case #
i
C.U. W V•
SFO. MH Site Preparation Etc 7
Q
Signature of Applicant - Date
'Tne above information must be verflied from Building Application
STAFF USE — DO NOT WRITE BELOW THIS LINE
InitialDate
Certification of Existing S.D. System required. O Yes �
,�,
WOCB Clearance required. El Yes LJ
Soils feasibility report required. El Yes Z�
Special feasibility boring report required. El Yes � o ,
Detailed contour plot plans required. E] Yes Do
Staff Specialist approval required. ❑ Yes rJ No Lot Inspection Date i
Soils/boring report by� Project # Date
Soils Map Page Soil Type by �4f�f Date
f -.(Approved
Type of System: U
No. of Bedrooms
(1) Septic Tank
Soil Rate Required
El Existing N�few ❑ Additional EJReplacementReplacement
✓!�
Gals.
/ ' c(�l
(2) each line sq. ft.
(B trench area)
Sidewall allowance
ft. rock/ Sq. Ft.
Install Line(s) Ft. Long,
Ft 35i with min. -_Jhes
Leach bed Sq.
ottom
per running ft. ( N/A
rock below drain lines
area
eclat design for slope:
Leach lines/bed-s g p
Applicable
(3) Pit Diameter
No. Pits
Pit BI
f
Seepage Pit total depth 1rvi��p
r r /
Max. allowable depth
N/A burden factor
This application proe •ezriae/.for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements -1
set forth in Section B a ove. A building permit is/ �nnecessary for the installation of the above -designed syste
(1) Septic tank and sewer lines must be 50 any wellsll / D y 4 1 rL
�om
ea`yT �V✓ Y'
(2) Leach lines must be 100' min. from any wells including expffansi�
3) S` page pits must be 150' min. from an wells including exea el f +yw–w
Signatur of Health 01 al r ,,/f� p e
RECEIPT NO.—Issued
/ Issued by • Date
/�
District: ❑ Riverside M-1 dio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe /
Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File
DOH -SAN -122 (Rev. 4/88)
x
q q1
o.F
,�°{•`�� ..�{•f OFFICE OF.
- , s AGRICULTURAL COMMISSIONER
AND
WEIGHTS & MEASURLS
t•""`� 49-613 Hwy 86, Suite B-12
�t,„0,,logo '' 'Coachella, CA 92236
q r v, aQ 619-342-8'291
E. LEON SPAUGY
CO%IHIWONER
JAMES 0. WALLACE
ASSISTANT COMMISSIONER
CLEMENT BENVEINISTE
SEALER
DATEq 19 �� CASE NO. 1-0-C, C� X10 q l5
w k
DEVEMPER' S NAME:
ADDRESS: 72(? 1 If Ke!,j KOScwP�(� �r
TELEPHONE: ((o t(? 9(4o - 3
t 26
Dear Developer:
After reviewing your landscaping plans,. all plant material listed is not in
violation of quarantine laws governing the Coachella Valley. If substitutions
do occur and they differ frun. plant material listed, this office must be notified
inmediately.
Thank you for protecting and preserving the Coachella Valley's.pest-free environment.
As6kcultural Cunnissioner's Office
ccs Indio and Riverside -Office