SFD (04600)1/0"jA
Building
Address 51-965 Nayaxro
Owner
mailing
Address P. Vii. Box 4644
City Zip
Paint Denart 32860
Contractor
fh+iirner1 BUi1.dar
ress
City IZip
State Lic.
& Classif.
Arch., Engr.,
Designer
Address
T4tyl 4 4 Q"
P.O. BOX 1504
78-105 CALLE ESTADO
LA�QUINTA, CALIFORNIA 92253
•_ 1
�R
Tel.
Tel.
City
Lic. #
Tel.
LDING: TYPE CONST
P. Number
` OCC. GRP.,
773-182-021
04 .
Legal Description
Project Description S' F' 1
Sq. Ft. No. No. Dw.
Size 1508 Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
CityZip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000)
effect. of Division 3 of the Business and Professions Code, and my license is in full force and
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 In 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.)
��,yt, 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. 3900, 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 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 Owner
_ `NOTICE TO APPLICANT., g, alter 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
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
sumatea valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
$828205
AMOUNT
8709
:58240", gg�9
36 t 5J "
70.'.5
103.00
20.00
24100
TOTAL`�sa/�.tr
REMARKS
• liT.�../J.L(A'�'Mr � �!`'�.�:i•f�ii.Y •{/lr.T�({.. 11./ ). Sr
ZONE: BY:
Minimufn 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 n
9%2 f /88
Issued by: Date Permit
Validated by:
Validation:
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, 01011,0911111111100 - A55E66OR'S OFFICE, HARD COPY - FILE
I"'- -
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT y $
UNITS
COLL. AREA
LAB GRADE �—
ROUGH PLUMB
YARD SPKLR SYSTEM
2ND FL SO FT. g
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR SO FT. Qt
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
POWER OUTLET
ROOF DRAINS
GAR SO. FT.
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. $O FT. g
GROUT
WATER HEATER
DRINKING FOUNTAIN
WALL SO. FT. (d
BOND BEAM
WATER SYSTEM
URINAL
SO. FT. ra
=$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION S
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
�J���
/ / � / / �/r/ �E _
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTONDISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIREPLACE
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. g c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT. B.T.U.
SO. FT. RESID g t'A c
SEWAGE DISPOSAL
SO.FT,GAR g JV c
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 /'S —�-
GROUND PLUM BIN
��
UNDERGROUND
A.C. UNIT
COLL. AREA
LAB 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.
y Plus xE
=$
LUMBER GR.
FINAL INSP.
RAMING No — y
<�
FINAL INSP.
ROOFING �O- -
� ^/
�J���
/ / � / / �/r/ �E _
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
l/LATHING
MESH
C INSULATION/SOUND
v
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINiTIALS
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
SCHOOL ,F',A ._ 'Y FEES �
"OTICE: THIS DOCUMENT CAN
BE DUPLICATED.QKN
TO: City of La Quinta DATE:
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
This is to ertify t h a�
developer of I—A which is
located at within
this District, has paid school facility fees imposed pursuant to the
authoritV ge rat d by overnment Code Se tion 53080 'n the amount of
$ .I I ( G I q/0
covering a total of
uare feet of a dentital cr
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
1 ta-I •� 11308 X � �/r� = 000
tl�L, P for DESERT SAN S•UNIFIED SCHOOL DISTRICT taw
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37
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In
- .,,,,�. .ry •. ttt •f�iY "7 rN^"�i' �,c �•�+:. .7 t��yi•Y71 �',, i"-.. r-' ��"". ^ .L . �.+, .. _ S 'c.r ... "s
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No.
ENVIRONMENTAL HEALTH SERVICES
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 speculations as indicated on the attached checklist.
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 SECTION A FROM BUILDING 8 SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG #
Agent, Contractor, Contact Person
— V)S MOSS
Phone
2,gb_j931
Address 8 Phone
}?O-Tok (MV aNpn D_-S6lZT CR_
Owner
Phone
Mailing Address
�- ii\ to E
City
State
Zip
Job Property Add ass
Legal Description Prop. (PM, Trract,Lotl ,�3e1 .✓ n� r
In
LA Covin nA
CA
05. lAr&Q0
Lafi (i t9Lw- (Z U I/n,.< [nirrri.,.,
Lot Size
Waw a A y a I'
Use ofP/P, CU, etc
Other �
_50, x !UO i
GVW 9•
.Pperrm'.
�'
Owelling"MH Site Prep, etc.
Signature of Applicant
Date
0,/ CATEGORY: REV CODE ,�F'EE
'
CATEGORY: REV CODE FEE
❑,SUBSURFACE DISPOSAL 1238 Q,p�
❑ SITE EVALUATION UPON REQUEST 7349 $42.00
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
a. 1 st 4 Parcels (Each) 1238 $45.00
(Less than 1 year)
b. Each Parcel after 4 7344 $16.00
❑ PRELIMINARY ELECTIVE 7352 $45.00
❑ Rereview (2nd review same parcel) 7344 $16.00
EVALUATION (Attach DOH SAN 53)
❑ Site Evaluation in Conjunction with
❑ HOLDING TANK 7351 $45.00
Critical Area 7346 $86.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $132.00
❑ Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $86.00
INITIAL C DATE('
Z,9
Holding Tank Agreements Completed ❑ Yes [2,114o , r r}
Certification of Existing S.D. System Required ❑ Yes ❑'�Nrro'/ G
WQCB Clearance required. (Attach Form ❑ Yes la'"No
DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required. ❑ Yes N %
Special Feasibility Boring Report Required. ❑ Yes No f/
Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes h -
Other ❑ Yes Q No
1 �
Staff Specialist Lot Inspection Required ❑ Yes No
Lot Inspection Date
Projecct # Date
Soils boring report by' /J Z—_
��Soils Map Page t Soil Type Approved by ��--._
Date `
No. of Systems
Type of System(s)
No. Dwelling Units
(1) Septic Tank
Soil Rate
Grease/Sand
❑ Folding Tank ❑ Existing
nJ°"New ❑Replacement
Bedrooms, Fixture Units
Q om. •
�d
Grease Intcp
Gal
Gall
($) Leach Line Sq. Ft.
Bottom trenchn
Sidewall allowance
Install Line(s) tL long ft wide with
Leach Bed sq. fL
�w sq. ry•
per running ft
bo" NA
in. inches low drainlines or
of tto. area
!9
Leachlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
Seepage Pit Total Depth
Other.
Applicable
t
Inlet (M
r
N/A � Overburden factor
CS 6
*0
Max. A�ll9wable Depth
4� 0/
No. 2 System
REMARKS: ��%l,,:� p>. e5t_,-�s-
This application is}' PP�ROVEED)PENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompanie p o an, using 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.
[
(1) Septic tank and sewer lines must be 50' minimum from any wells'/(� r
Leach lines must be 100' minimum from any wells, including expansion area el—
(3)Seepage pits must be 150' minimum from any wells, including expansion ara,(�� ��; y4G2
tsj.
Si nature of Health Official Date
RECEIPT NO. /U Issued By S� Data: p 9'
DISTRICT: O Riverside, ❑* Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records
OFFICE OF
AGRICULTURAL COMMISSIONER
AN D
WEIGI-.ITS & MEASURES
49-613 Ilwy 86, Suite 8-12
'Coachella, CA 92236
619-342-8291
E. LEON SPAUGY
CO�T��IS:10`EA
JAMES 0 WALLACE
ASSISTANT fp}I}IISSIU�EP.
CLEMENT BE`VENISTE
SEALER
DATE I CASE ra.
t
DEVELOPER'S NAMEI I (` AJ TS rC YXci S
ADDRESSI
TELI;PI IONEI ( (g l4 ) 9 Li, I c�3
2 1 dao# A
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 nust be notified
imnediately.
Thank you for protecting and preserving the Coachella Valley's pest-f-ree enviroFunent.
j
Agri Lural Caimissioner s OEfice
cc: Indio and Riverside Office
a
I