DEMO (05-3158)Xt
'P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA,' CALIFORNIA 92253
Application Number:
Property Address:
APN:
,. Application description:
Property Zoning:
Application valuation:
Applicant:
/05-00003158
78990 MILES AVE
604-032-022- -00000
DEMO-.COMML/OTHER
LOW DENSITY RESIDENTIA
0
Tuvl44Q" -
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or,
--------------------------------------------------
LICENSED TRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am lic se under pro ' i ns of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Pro es onals Cod , a d my ce se is in full force and effect.
License lass: C21 License o : 0 83
/Date: ontractor:
l'
Ngk-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I Zxempt from the Contractor's Stat 'ce se Law for the
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she 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, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and'who does the work himself or herself through his or her own employees, provided that the
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 or she did not build or
improve for the purpose of sale.).
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractorlsl licensed
pursuant to the Contractors' State License Law.).
(_ 1 1 am exempt under Sec. , B.&P.C. for this reason
Date: .
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there 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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/22/05
Owner:
LA QUINTA REDEVELOPMENT AGENCY
78495 CALLE TAMPICO
LA QUINTA, CA 92253
Contractor:
EMERY LAND CLEARING & GRAD INC
P.O. BOX 1009
THERMAL, CA 92274
(760)391-5840
Lic. No.: 600283
--=--------------------------------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
1� I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier STATE FUND Policy Number 046116532005
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 toye
come subject to the workers' compensation laws of California,
and agree that, if I should bec subject to orkers' compensation provisions of Section/t70 f the Labor Cod ,'I sh orthwt c mpl with those provisions.
ale .1 Q -epplicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERA S UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 15100,0001. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed. under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Ouinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application be as null and void if work is not commenced
within 180 days from date of issuance of such p mi or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the ab e i formation is correct. I agree to comply with all
city and county ordinances and state laws relating to building o truction and hereby authorize representatives
of this c unty to en upon he above-mentioned pro rty f 'spec ' n rpose
Dater nature (Applicant or Agent):. /
i
2
LQPERMIT
Application Number . . . . . 05-00003158
------ Structure Information POOL
Permit DEMO PERMIT
Additional desc .
Permit Fee 45.00
Plan Check
Fee
.00'
Issue Date . . . .
Valuation
. . .
0
Expiration Date 1/18/06
Qty Unit Charge Per
Extension
BASE
FEE
45.00
----------------------------------------------------------------------------
Special Notes and Comments
DEMO OF SWIMMING POOL
Fee summary" Charged
Paid Credited
Due
Permit Fee Total 45.00
.00
.00
.45.00
Plan Check Total .00
.00
.00
.00
Grand Total 45.00
.00
.00
45.00
2
LQPERMIT
Building
Address Vista Dune ,Park
Sheila Weld
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Address
'71431 H. -agar
f'.ity
`Rand Mirage Zip 92270 Tel .63,'9!56$- 625
Contractor
Ra=er Corwtruction
Address
683,65 Perez 8d.
-C'sthedra2. City, "' 92234 '-'019/321,-7448
State Lic. City
& Classif. 410275 Lic. #
Arch., Engr.,
Designer
Address Tel.
City(Zip ( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 affifim that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of t)ivision 3 of t9 Business and Professions Code, and my license is in full force and
effecL
SIGNATURE DATE
OWNER -BUILDER DECLARATION
1 hereby attain that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031-5.Busness and Professions Code: Any city or county which requires a
pend to construct, alfer,hnhprove, demolish, or repair any structure, prior to its issuance also
regnries the applicant Mer such permit to file a signed statement That he is licensed pursuant to
Me provisions of the Contractors 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 bl' 'any appfrrant for a permit
subjects the applicant to a circ 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
Professbm Code_ The Coors License Law does not appy to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that suchrrgrorts are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -budder will have the burden
of provig that he rid not bold or krprove for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to coir
struct the project (Sec- 7044, Business and Professions Code: The Contractor's License Law
does not appy to an owner of properly who builds or improves thereon, and who contracts for
such projects with a cordracter(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
1 hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copyhereof. Sec. 3800Labor Code.)
Policy No Company '�-%.L._.a
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the permit is for one hundred dollars ($100) valuation
or fess.)
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, after makig this Certificate of Exemption you should become
sutjad to the Workers' ConvXwmatron provisions of the Labor Code, you must forthwith
coney wil/h such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 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 abuilding permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 100 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 Addrrss
City, State, Tap
No. 05523
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number Antes Ave.
Legal Descripti
Description Seepage Pit
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
i
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
90.00
Mech.
Electrical
Plumbing
S.M.I.
.49
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances 051 q-) ip ^etc
Fo
ront Setback. from Centeftine4 € .4a #
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
IST FL. SO. FT. ® $
UNITS
`
2ND FL. SQ. FT.
COLL. AREA
YARD SPKLR SYSTEM
ROUGH PLUMB.
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
HEATING (ROUGH)
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
ROUGH WIRING
DRAINAGE PIPING
CAR P. SQ. FT.
DUCT WORK
ROCK STORAGE
WALL SQ. FT.
GAS (ROUGH)
DRINKING FOUNTAIN.
SOFT ®
URINAL k
ESTIMATED CONSTRUCTION VALUATION $
OTHER APPJEQUIP.
WATER PIPING 1
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
SERVICE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
IAUNDRYTRAY
AIR HANDLING UNIT CFM
WATER SYSTEM
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
7� �U 1105—
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
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)
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
7� �U 1105—
\
REMARKS:
VENTILATION
FIRE ZONE ROOFING'
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
)
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93.31 � —
RIVERSIDE COUNTY DEPARMENT OF P3iL'LM I'IEALirM 4
i'`' ! C{J:► OFEt4Vjn MtgM:Lviz.^.LFa
x.r,•il
• U M
FOad FStSb!is,,�rtxnt �• 6 . j �' �'
X iraiiL�r. Park �� :; 5'x::. D s•, al P, s
potel
C. 'ij7 Lim
�' C:;,.......-!:'•, i:;7g 3— ice- x7�`.:r
hin Cr
Syr 1
.WY Wills •
of the
. This ix ...
installa;ian tl.; i _...... % . aonstruct:nn or
Date 3Iw I�39 E; k ,IZt t"S.
tig N#; ANY WUL
A
Z
0
w
C0
Sills boring report by G 1 Project # Date
Sills Map Page Soil Type Approved by Data
No. of Systems Type of System(s) No. Dwelling Unite (1) Septic Tank Soil Rate Grease/Send
0 ming Tank ❑ Existing Bedrooms, Fixture Units l-` . \ /i7 Gmm lr&p
- t$� t1 tt'v•-\C Te s" i?':cte• h'S /"
Gal Gal
(2) Leach Line Sq. Ft Sidewali alkowence� Install Line(s) ft. long ft wide with Leach eed,sq It
Bottom french area fL r� / Sq. R
per running R min. inches rods betordrelnl'mes or, � of bottom area
❑ . NA
L.eachiirMA ed special ign for slope: (3) Pit Diameter
Applicable
N/A Overburden factor ❑ 5 O� 6
:No. -2 --System
REMARKS:
`
'D� tt ry C
No. Pits Pit Below Seepage Pit Total Depth Othar
Inlet (BI) a `%
3 zo, Max. Allowable Depth
This application is APPROVED/DENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
0 on the accompanied plot plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
Oabove -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
U (2) Leach lines must be 100' minimum from any wells, including expansion area �.
Cl) 63)) Seepage pits must be 150' minimum from any wells, including expansion area t U
Signature of Health Official ' � �� — itis -J! `,� l 1`1 Date a t
RECEIPT NO. cl - Issued By i.�``� Date
` DISTRICT: ❑ Riverside, Indio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe
OOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD.- Plans/Records
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Anessors Parcel NO.
ENVIRONMENTAL HEALTH SERVICES
I(,— `
r
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 check list.
A non-refundable filing fee (see below) is required when the application Is submitted. 'Check must be made payable to the County of
j
Riverside. Approval of this application shall remain valid for a period not to exceed one year from date of approval.
Q
VERIFY ITEMS IN SECTION A FROM BUILDING b SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'*
Z
Q
t, Contractor, Contact Person
�C
Phone
�a / -lgs
Address 8 Pion
G� - Q cp
t-1 A 66 N1Sc-
SGS`
W
Owner
P
Maili dress .—
Cl)
S c-4-1. A. 14,-� voxzs
City
State
QAk.,
Zip
Job Property Address
/
Legal Description Prop. (PM, Tract, Lot)
t>0.i
I
i e' 20
f 1 P 5
.Lot Size
I
Water Agency/Well
Use of Permit'P/P, CU, etc.
Other
)tnJ (y%2.(�-
Dwelling, MH Site Prep, etc.
°
Signature of Applicant
Data
CATEGORY: REV CODE FEE
CATEGORY: REV CODE FEE
SUBSURFACE DISPOSAL 1238 f $45.00
❑
SITE EVALUATION UPON REQUEST 7349 $42.00
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
m
Z
LAND DMSION
❑
SEWER/SEPTIC VERIFICATION 7348 $1.1.00
p
a 1 st 4 Parcels (Each) 1238 $45.00
(Less than 1 year)
U
b. Each Parcel after 4 7344 $16.00 \
❑
PRELIMINARY ELECTIVE 7352 $45.00
W
❑ Rereview (2nd review same parcel) .7344 $16.00
\
EVALUATION (Attach DOH SAN 53)
C0
❑ Site Evaluation in Conjunction with
❑
HOLDING TANK 7351 $45.00
CrtticatArea 7346 $66.00
❑
ALTERNATIVE/EXPERIMENTAL 7345 ' `' 1&OD
❑ Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $86.00
NITIAtLt&, � DATE
�' �L 7 7�; ✓S
Holding Tank Agreements Completed ❑ Yes
No t* ��
Certification of Existing S.D. System Required ❑ Yes
C I No t
WOCS Clearance required. (Attach Form ❑ Yes
I I No I
DOH SAN 007, Santa Ana Region Only)
I
Sills Percolation Report Required. ❑ Yes
I I No
Special Feasibility Boring Report Required. ❑ Yes
t
No
Detailed Contour Plot Plans Required (1 to 5 fL interval) ❑ Yes
No
Other ❑ Yes
No
Staff Specialist Lot Inspection Required ❑ Yes
No
Lot Inspection Date
A
Z
0
w
C0
Sills boring report by G 1 Project # Date
Sills Map Page Soil Type Approved by Data
No. of Systems Type of System(s) No. Dwelling Unite (1) Septic Tank Soil Rate Grease/Send
0 ming Tank ❑ Existing Bedrooms, Fixture Units l-` . \ /i7 Gmm lr&p
- t$� t1 tt'v•-\C Te s" i?':cte• h'S /"
Gal Gal
(2) Leach Line Sq. Ft Sidewali alkowence� Install Line(s) ft. long ft wide with Leach eed,sq It
Bottom french area fL r� / Sq. R
per running R min. inches rods betordrelnl'mes or, � of bottom area
❑ . NA
L.eachiirMA ed special ign for slope: (3) Pit Diameter
Applicable
N/A Overburden factor ❑ 5 O� 6
:No. -2 --System
REMARKS:
`
'D� tt ry C
No. Pits Pit Below Seepage Pit Total Depth Othar
Inlet (BI) a `%
3 zo, Max. Allowable Depth
This application is APPROVED/DENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
0 on the accompanied plot plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
Oabove -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
U (2) Leach lines must be 100' minimum from any wells, including expansion area �.
Cl) 63)) Seepage pits must be 150' minimum from any wells, including expansion area t U
Signature of Health Official ' � �� — itis -J! `,� l 1`1 Date a t
RECEIPT NO. cl - Issued By i.�``� Date
` DISTRICT: ❑ Riverside, Indio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe
OOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD.- Plans/Records
4
P.O. BOX 1504
'
Building- 78-105 CALLE ESTADO
Address- 78-"`990 Miles AVOMM:• .. ,LA QUINTA,,CALIFORNIA 92253, � �
,•
Owner. -;:.
4 4
BUILDING:' TYPE CONST. OCC. GRP. ;
-'. Mailing,.� ' ,
Address same
Vista Dunes Mobile Vark
A.P. Number
City~ . - Zip Tel: .
La •"�1L't+.a9 F� 9225 3"
Legal Description
, . • 1
Contractor` ::
owner/Builder
Project Description
Ant heinse
Address •
Cityf ''! Zip Tel.
State Lic..
City
& Classif..
Lic. #
Sq. Ft.
No. No. Dw." ,
Size
Stories Units
Arch., Engr.,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑ ...
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
)t.'of Divisionof the Business and Professions Code, and my license is in full force and
.3
effec
e
_
SIGNATURE - DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
. 1 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, atter, 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
PERMIT
AMOUNT,
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
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
Plan Chk. Dep.
- - -
,r. subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
Plan Chk. Bal.
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
,
Const.
t)v -
9 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
Mech.
- -
• 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
Electrical
'
yor 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 or sale.)
Plumbing
-
'❑ 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
S.M•1•
' t 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.)
Grading
-
❑ I am exempt under Sec. B. & P.C. fornthis reason �
Driveway Enc.
i' l
Date ;rjx owner 2.�"% r"? [ �e-' "ri. _i ��,`�'
Infrastructure
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.
TOTAL
CERTIFICATE OF EXEMPTION FROM
y WORKERS' COMPENSATION INSURANCE
REMARKS
Al
k a he
ji .�"-,>y � 3. •�, .r 3 s.t, �+}�•vv
(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 parson 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 or 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'•
-affirm
Side Street Setback from Center Line
I hereby 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 k Name
Lender's Address ' '•
FINAL DATE
INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
,1�
expiration it work thereunder is suspended for 180 days. -
•
`
- r
. I certify that I have read this application and state that the above Information is correct. =
ISSUed by:
Date i Permit '
1 agree to comply with all city and county ordinances and state laws relating to bullding
construction, and hereby authorize representatives -of this city to enter the 'above-
mentioned property for inspection purposes.
` Validated by: '
Signature of applicant a Data
'
Mailing Address ` j d
Validation: '
GOLDENROD -,'ASSESSOR'S OFFICE, HARD COPY -.FILE r
City, State, -Zip
WHITE FINANCE PINK ` APPLICANT' GREEN BUILDING,
*., .' .. r: wit d' •. •s s`e-u .^=tf.�. r,�5e ,v, r ;,.s �, ' •i r
.. _ ,. .� a .,., a-. �, _ ... _. ,. : . », r.._.....n:F..`S<E..
.,
.... � ,. ..�, r ? -
� _. .#: ,a.-. •r. -.1t.,.. .;,1, aJ .fig � L., -
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
iST FL SO F1 Ip $
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2N0 FL SO FT. a
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FTgr
GAS (ROUGH)
METER LOOP
GAR SO. FT. of
POWER OUTLET
ROOF DRAINS
(FINAL) (� A�)�5
TEMP. POLE
DRAINAGE PIPING
CAR P. SO FT. 0
GROUT
WATER HEATER
WALL SO. FT. @
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
URINAL
SO. FT. ra
=S
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION S
INSP — 0.
WATER PIPING
NOTE: Not to be used as properly tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOKDISH)
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. ® c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ( to c
SEWAGE DISPOSAL
SO.FT.GAR (g 3/4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE I'L.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 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 APP.IEOUIP.
REINF. STEEL
(FINAL) (� A�)�5
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus xE
=S
LUMBER GR.
INSP — 0.
FRAMING
P.( f Q V T
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR'
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
/
FINAL INSPECTION/ / O
111l5
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
ot
P.O. BOX 1504 No, 003881
Building 78.-990 Miles AVenkue LE ESTADO
Address
Owner
la ra Hall
Mailing
Address Same
City lZip IT
Contractor
!� � � i•',M7�,rLTk� 1
Address
Space Center,
.1ding 951
Tela
78 105 CAL
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. 0 4 OCC: GRP. - -
A.P. Number Vista Dunes Islobile Park
Legal Description
Project Description New Cabana
State Ljc.
City
& Classif.
Lic: #
Sq. Ft.
•Size
No. No. Dw.
Stories.. • • " Units
,Arch., Engr ; -
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
~
CityZip
State
- .
Lic. #
_ LICENSED CONTRACTOR'S DECLARATION
-
1 hereby,affirm that I am licensed,undeisprovisions 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..��:i,1
_SIGNATURE " ` - DATE
.: / - .. - OWNER -BUILDER DECLARATION
VIhereby 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
Estimated VBIU2tlOf1
.. ��� .�
!
PERMIT
-
. AMOUNT
-
• permit, to construct, atter, 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 We civil penalty of not more than rive hundred dollars (8500).
❑ 1, asp ner of the property, or my employees with wages as their sole compensation, will
- -
Plan Chk. Dep..•
'.
Plan Chk... Bal.
SO. 42
CO.rI$t.
ry
- J .50 -
do the work, and the structure is not intended or offered for safe. (Sec., 7044, Buisness and
• Professions Code: The Contractor's License Law does not apply to an owner.of property who
Mech.'
- 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. 'lf,- however, the building
Electrical
'
or improvement is sold within one year of completion, the owner -builder will have the burden
• of proving that he did not build or iinprove for the purpose of sale.)
Plumbing '
❑ 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.
S.M.1• -
-
-
Grading
Driveway Enc.
Date owner
Infrastructure
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. .
TOTAL
REMARKS
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
"yL�.:.�... ...
^f:.
(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.
�T ,i I Yy+� "x k-4 C?
Lj '' ;yr�} ;) t L,r a fit. 1' t 23.x%'`7 ;
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.
ZONE: BY: -
Minimum Setback Distances:
Front Setback.from Center Line
Rear Setback from Rear Prop. Line
_ 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.)
Side Street Setback from Center Line
Side Setback from Property Line
Lender's Name
Lender's Address
FINAL. DATE
INSPECTOR
4/21/00
'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.
ISSUed.by: '
Validated by:
Date Permit
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEESNO.
PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT. ®
POR. SO. FT. ®
GAR. SO. FT. (off
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM . FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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)
OTHER APP./EQUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTIONS- —
CERT. OCC.
FENCE FINAL
INbmt; I V K'b biu NA I uKLwINI I IALb.
GARDEN WALL FINAL
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
Indio, CA 92201
v,
CERTIFICATE OF SCHOOL FACILITY FEE WAIVER 1
- j 1..: 3�.5 ,e P.u. t r�� ....J .S .✓...i �.k'.j l_.-sti � ayy'LA t5 +s,0
T0:
DATE :
This is to certify that ' �Yc..2-t. L
developer of hi h is
located at - J Jz e
this school.district, isnot requir d t pay sthool facility.
pursuant to the authority generated by Government"Code Section 53080.'
Building permits for the project indicated above may.now be issued by your,,
jurisdiction•.
for DESERT SANDS UNI IED SCHOOL DISTRICT
White Building Department Ycllow-Facilities Planning ` Pink -Developer. - (10)-38
DATE I. �/zip ' BY.
MOBI LEHOME
140I
Minimum distance from porch
to lot lines shall be 3'-0"
except lot lines bordering
driveways.
HCD 538 (Rev. 10-85)
z;
M
The total occupied area
of a mobilehome lot shall
not exceed 75% of the lot
area.
PLOT PLAN. LOT# Z�
Department of Housing
and Community Development
Division of Codesiand.Standards
Park Name
Address
City zip
Applicant
GI'y-C
Address -2 Q
S� & I Expanding Room Cq.
Mira Loma Space Center
Building 951 1
Mira Loma. California ';0752 7111 -ate -3330
I THE UNDERSIGNED, AS AN AUTHORIZED
REPRESENTATIVE OF THE 0,WNER OF THIS
PARK, HEREBY CERTIFY THIkT ANY AND ALL
LOT LINES AS -SHOWN ON THIS PLOT PLAN
ARE TRUE AND ACCURATE AND ARE CLEARLY }
MARKED ON THE SITE AS REQUIRED BY
CALIFORNIA ADMINISTRATIVE CODE,
TITLE 25, CHAPTER 2, SECTION 1616. ,
rd I
P LOPE TOR DATE
F L.A\ Q�P-,,O� 1MV., TV MAX
Community Dept.
ACCO hU6a; _'c:�a::
e, �3iECT o !rArTALLATk N AS PER R / •
AND ALL APPLICAB
Cr
DATE I. �/zip ' BY.
MOBI LEHOME
140I
Minimum distance from porch
to lot lines shall be 3'-0"
except lot lines bordering
driveways.
HCD 538 (Rev. 10-85)
z;
M
The total occupied area
of a mobilehome lot shall
not exceed 75% of the lot
area.
PLOT PLAN. LOT# Z�
Department of Housing
and Community Development
Division of Codesiand.Standards
Park Name
Address
City zip
Applicant
GI'y-C
Address -2 Q
S� & I Expanding Room Cq.
Mira Loma Space Center
Building 951 1
Mira Loma. California ';0752 7111 -ate -3330
I THE UNDERSIGNED, AS AN AUTHORIZED
REPRESENTATIVE OF THE 0,WNER OF THIS
PARK, HEREBY CERTIFY THIkT ANY AND ALL
LOT LINES AS -SHOWN ON THIS PLOT PLAN
ARE TRUE AND ACCURATE AND ARE CLEARLY }
MARKED ON THE SITE AS REQUIRED BY
CALIFORNIA ADMINISTRATIVE CODE,
TITLE 25, CHAPTER 2, SECTION 1616. ,
rd I
P LOPE TOR DATE
John R. Hawkins
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of.
Banning
Beaumont
Calimesa
Canyon Lake
Coachella
Desert Hot Springs
Indian Wells
Indio
Lake Elsinore
La Quinta
Moreno Valley
Palm Desert
Perris
Rancho Mirage
Rubidoux CSD
San Jacinto
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
Jeff Stone,
District 3 `
Roy Wilson,
District 4
Marion Ashley,
District 5
t
_ V .. '
RIVERSIDE COUNTY .
FIRE DEPARTMENT
In cooperation with the
California Department of Forestry and Fire Protection
210 West San Jacinto Avenue • Perris, California 92570 • '(951) 940-6900 Fax (951) 940-6910
City of La Quinta
Building Department
RE:
W1W_\
CASE #
The Riverside County Fire Departent is ranting (� Fire'ClearancVpr the f Ilov�(�9
Location '19- Qq -0, iU ►" 'M )e l f ry,nA I,. 0o 1 � l "MA n a.
Please call if you should have any que tions 760-863-8886e
��w _
b 1. )
John R. Hawkins
Fire Chief.
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of:
Banning
Beaumont
Calimesa
Canyon Lake
Coachella
Desert Hot Springs
Indian Wells
Indio
Lake Elsinore
La Quinta
4.
Moreno Valley
Palm Desert
4.
Perris
Rancho Mirage
S•
Rubidoux CSD
San Jacinto
Temecula
Board of Supervisors
Bob Buster,
District I
John Tavaglione,
District 2
Jeff Stone,
District 3
Roy Wilson,
District 4
Marion Ashley,
District 5
RIVERSIDE COUNTY
FIRE DEPARTMENT
In cooperation with the
California Department of Forestry and Fire Protection
77-933 Las Montanas Rd. STE 201 Palm Desert, CA 92211-4131 (760) 863-8886 Fax (760) 863-7072
Date
La Quinta .
Building Department
RE UjAr ��►n�s
The Riverside County Fire Department is granting the fire clearance for the following
location
Please call if you should have questions. .760-863-8886. Thank You
I ✓ll If�a% I v�� �f/ Corhmdn (A!
w7I;VYU�
espectfully,
Jas Stubble
Fire Safety Specialist
•