SFD (07387)T4ht 4 4 Q"
Building 51-616111ava
Address
Mailing
Address 79-66() Bogueron Way
City I Zip JTel.
. . Ber=da
Contractor
Address
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
92201 1 346-4236
State Lic. I City
& Classif. 317390 Lic. #
Arch.; Engr.,
Designer
Address Tel.
City (Zip (State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am,licensed under provisions,of Chapter 9 (commencing with Section
7000) of Division 3 of the Busin�e+ss and Professions,Code, and my license is in full force and
effect. If f•;'.J i,�j ls', ,
r,. 3
SIGNATURE i .'' r e DATE
OWNER -BUILDER DECLARATION
I hereby affirin_•that�I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,6usiness and Professions Code: Any city _ or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
the provisions or 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 penally 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 taw 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 such improvements are not intended or offered for sale. fi, however, the building
or improvement is sold within one year of completion, the owner -builder wig have the burden
of proving that he did not build or improve for the purpose of sale.)
❑ 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.)
❑ 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
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
❑ Copy is filed with the city. ❑ Certified copy is hereby fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the permit is for one hundred dollars ($100) valuation
or less.)
1 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., fi, after makhg this Certificate or 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.)
Lenders Name
Lenders 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.
1 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.
11LDING: TYPE CONST: OCC: GRP.
P. Number 773-144-018
?7387
Description Lot 6
t Description Single Family Dwelling
FINAL DATE INSPECTOR
Issued by: Date 3/21/90 Permit
Validated by:
Validation:
Sq. Ft. 15,50
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$65,360
PERMIT
AMOUNT
Plan Chk. Dep.
250400
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
154.50
S.M.I.
12AU
Grading
20.00
Driveway Enc.
20.00
Infrastructure
,096.30
i
TOTAL.3.3
. Z,3
REMARKS
t40 J r Y i) Sh"Tbf t i. neaa 7_
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 3/21/90 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE 3 �7 !�
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
qR E C ANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)OTHER
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER
WALL SQ. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
SQ FT ®
WATER SYSTEM
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
-$
WATER PIPING
NOTE: Not to be used as property tax valuation
ROOFINGtid
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR GOND. SOLAR
SETBACK 2A O / I -I
GROUND PLUMBING Y27
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 3 �7 !�
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
qR E C ANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.3 �� /0
GAS (ROUGH)OTHER
METER LOOP
HEATING (FINAL)
APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP.
GRADING
cu. yd.
$ plus x$
-$
LUMBER GR.
FRAMING 511O
ROOFINGtid
Ip
0
r
l70
^ �Q
REMARKS.
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING A9&4 9 �D
MESH
INSULATIONISOUND DO
JJJ
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
` e
i P.O. BOX 1504 APPLICATION ONLY
Building1 q _.: 7&105 CALLE ESTADO.. ,
Address . #i 6/"3 �Ivr/�/,JRI /� ,rv� LA QUINTA, CALIFORNIA 92253 f
Owner-
�JEi2/lti Lt Go B
Mailing
Address . i1 G �v a u i,x va von. 7 A.
City lZip ITel.
0
UILDING: TYPE CONST. k OCC. GRP.
P. Number -r%73 /I -/moi- ois�
.gal Description f + li0 /
oject Description Wes
v
Address
City Zip`- Tel..
State Lic. City
& Classif. J Lic. # Sq. Ft. / r No. No. Dw.
Arch., Engr., Size / > S Stories Units /
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop: Line
City
Zip
State
Side Setback from Property Line
FINAL DATE
Lic?,,#
_
' LICENSED CONTRACTOR'S DECLARATION
Validated by:
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Divisio/n 3��of the Business Professions Code,
nd and my license is in full force and
effect / I 3/3 ,PO
r
1
SIGNATURE % / /I DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby aff,m that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Busfness and Professions Code: Any city or county which requires a
permit to construct, after, 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 Sectior`7031t.5'by''any applicant for a permit
Plan Chk. Dep.
subjeUs the applicant to a cNil penalty of not more than frve•hundred dollars ($500).
Plan Chk. Bal.
❑ I, as owner of the property; or -my employees withmages as their.sole-compensation,. will
_
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
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, -_
—Mech --
' provided that such improvements are not intended or offered for sale. O, however, the building
or improvement is said within one year of completion, the owner -budder will have the burden
Electrical
- of proving that he did not -build or improve for the purpose -of sale.)
❑ 1, 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
13I am exempt under Sec B. 8 P.C. for this reason
Driveway Enc.
Date Owner
WORKERS' COMPENSATION DECLARATION',,
I hereby. affirm that .l•have a certificate, of consent: to self-insure,or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. /Seer. 3800, Labor Code.).
Polivar No Company <, " r� > u
Copy is filed with the city: ❑ Certified copy is hereby furnished:
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(Thi section need'not be completed'ff the permit is for one hundred dollars ($100) valuation
or less.) . %
I certify that in the performance of the work for which thi permit is issued, 1 shall not
employ any person in any manner sous to become subject t' the Workers' Compensation
Laws of California.
Date 5 2111 Owner _
NOTICE T APPLICANT: O, after maJong this r if a o1 Exe tion you should become
subject to the Workers' Compensa`8�dnnr provisions of the Labor Code, you must forthwith
compy with such provisions or this permit shall beudeemed revoked.
i t
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
lenders 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, Zip
BUILDING DIVISION
Infrastructure
TOTAL. —Z� _ ci
REMARKS
SUS L qiU ;rtf•rUIS-A 1c A-7
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
s
INSPECTOR
Issued by:
Date Permit
Validated by:
I
Validation: -
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR., SQ. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SQ. FT. ®
FINAL INSP.
WALL- SQ. FT. ®
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
cu. yd.
$ plus x$
=$
URINAL
SQ. FT.
FINAL INSP.
FRAMING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WA SHER(AUTO)(DISH)
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSPECTION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE 7NST.
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)
OTHER APPJEQUIP.
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
SCHOOL FACII,I, ES
TO: Ci o La tubi t l���EID, DATE:
Dg �rementpg! ��r�iufiiiity Development
78-105 Cal% Estado
La Quinta, CA 92253
q.A
Q a1
This is to cIti_fy hat
developer of '^J Ll Q ,0which is I
located at / ,� _ within
this District, has paid school facility fees imposed pursuant to the
a• ha�r�i genera d by G er ment Co e ectiott 53080 • 4eval�nnnrtt of
covering a total of s are feet of (l).resi ntial or /
( ) industrial/commercial development and that buildn permits for
this footage in this development may now be issued by your jurisdiction.
z%
for DESER `§ANM UNIFIED SCHOOL DISTRICT
White -Building Department • Yellow -Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37
COUNTY OF RIVERSIDE ENVIRONMENTAL
HEALTH SERVICES DIVISION y,3( —0/9
PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM,
Applica16 form with four copies of a scaled plot plan (1 -20 scale) drawn to County speculations as Indicated on the attached check IIsL
A non-r9firhdable filing fee (see below) is required when the application is submitted. Check must be made payable to the County of
Cgiftiverside. Approval of this application shall remain valid for a period not to exceed one year from date of approval.
A1
VERIFY ITEMS INSECTI3ON0 A FROM
BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG
Agent Contractor, Contact Person
01
Phone Address & Firm
-2
43042
Owner
Phone. Mailing Address
'City State
Zip
Job Property I Legal Description Prop.
�Addrqss (PM, Tract, Lot) 60 10�115?
&OZ Ig '7�
Lot Size
Water Agen_c_yb.�l
Use ofPermitP/P,CU, etc. -4,0 Other
VSh'.
Dwe:lllin Prep, etc.
Signature of Applicant
Date
CATEGORY: REV CODE ,, -RIF
'< _
FT SUBSURFACE DISPOSAL 1238 ;$ �97. �.00 �OO
CATEGORY: REV CODE FEE
0 SITE EVALUATION UPON REQUEST 7349 $ 43.00
0 MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
LANb DMS46N
0 SEWER/SEPTIC VERIFICATION 7348 $ 17.00
a. 1st 4.Parcels (Each) 1238 $ 57.00
.(Less than 1 year)
b. Ea ch Parcel after 4 7344 $ 24.00
0 PRELIMINARY ELECTIVE 7352 $ 23.00
0. Rereview (2nd review same parcel) 7344 $ 24.00
EVALUATION (Attach DOH SAN 53)
0 Site Evaluation in Conjunction with
0 HOLDING TANK 7351 $ 47.00
Crtticall Area 7346 $111.00
0 ALTERNATIVE/EXPERIMENTAL 7345 $222.00
-0. Site Evalu4on1ot Less than
SYSTEM
i 0,bOD Sq. Ft. 7347 $ 87.00
•
IN7rr DAV—
Holding- Tank Agreements Completed 0 Yes P"No,'
'
Certification of Existing S.D. System Required 0 Yes N
W0CB Clearance required. (Attach Form C] Yes 0
0
DOH SAN 007, Santa Ana Region Only) 00001�'
Soils Percolation Report Required. 0 Yes
Special FeaqIbUtty Boring' Report Required. 0 Yes
Detailed Contour Plot Plans Required (1 to 5 ft. interval) 0 Yes N
Other 0 Yes No
Staff Specialist Lot Inspection Required 0 Yes 03/No
Lot Inspection Date
Soils boring report by 3ct g Date
Soils Map Page - J16 &A Type Approved by Date 3-1�-96
No., of Systems
Typechys'ta_rlle)
No. Dwelling Unita!! /)
(1)Septic Tank
Soff Rate
Grease/Sand
0 HqldIWTsnk 0 Existing
0 Replamnord
Bedrooms. FixturwWritte*
99A,%. ztax
-Gal
MLleach Une Sq. Ft
Sklerwall allowance
I Line(s) fL " _-L-41wide wfth
Leach Bed aq fl.
h area
ft rock/ sq: ft.
per running ft.
min. drainlinse or
to arae
Le6chlines/bed special design for slope:
(3) Ph Diameter
No. Pits
'Ph Below
Seepage PhTOtal Depth
Applic:able,
Lofo�
froe"34
(TD)
Max. Al"Ie Depth
N/A Overburden factor
No. 2 System
REMARKS:W_Z4�
V
This applicat• is APPROVED
10( is �E:D: NIE&4or the category checked in SECTION B abov6*. regarding the design of a subsurface disposal system as indicated
ting
on the acoompin�,Zdpt;. n,
plaa the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
above -designed system. No construction is permitted in the required reserved 100% expansion area.
el)) Septic tank and sewer lines must be 50' minimum from any wells
n
,32,h Leach lines, must be 100' minimum from any wells, including expansion rea
'Seepage pits must be 150' minimum from an wells, including expansi I n ar /0
U3) k- a-4
Signature of Health Official ,A Date 3, 90
RECEIPT NO. 10117 - Issued By_A/ Date 3—
DISTRICT: - 0 Riverside, 9-4 AF 4
rtdie, 0 Hemet ' C7 - Perris 0 Rancho Calif. 0 Blythe
DOH -SAN -122 (Rev. 7/89). DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - PI.4macord.
LW11
Of
OFFICE OF
` AGRICULTURAL COMMISSIONER
AND
WEIGHTS .& MEASURES '
CALVIN C. KAMINSKAS
JAMES O. WALLACE 4080 LEMON STREET, ROOM 19 Assistant Commissloner
Agricultural Commissioner RIVERSIDE, CALIFORNIA 92501 CLEMENT BENVENISTE
Director of Weights d Measures • - Sealer
(714) 787.2561
49613 Highway 86, Suite B12
Coachella, Ca. 92236
(.619)`342-8291
DATE �j S p CASE NO. 2C- S 3 U S �7
DEVELOPER'S NAME: .� 2� Je
ADDRESS: 79 0 0 J ev- o vv
V VA J 3XG
TELEPHONE:
Dear Developer:
After reviewing your landscaping plans, all plant material'listed isnot in
violation of quarantine laws governing the Coachella Valley. If.substitutions
do occur and they differ from plant material listed, this office,must be notified:.
immediately.
Thank you for protecting and preserving the Coachella Valley's pest -free environment.
AL— Z�L,6�
Agr tural Commissioner's Office `
cc: Indio and Riverside Office
i