003425 (SFD)fJllu
Building
Address 51-
44
P.O. BOX 1504
78-105 CALLE ESTADO
nee LA QUINTA, CALIFORNIA 92253
Mailing
Address _
City Zip Tel.
Contractor
Address
ty lZip
State Lic.
& Classif.
rvcn., r-nyr.,
Designer
Address
No. 003425
UILDING: TYPE CONST. _ OCC. GRP.
.P. Number 773-081-012-013
egal Description
roject Description Sinale Faril.iy Dwelling
'112 'Infras4t unture Fee Plan'
Lic. # Sq. F
t.
Size
New❑
Tel.
at ,
City JZip State
Lic. # w
LICENSED CONTRACTOR'S DECLADATION
No.
1 Stories
No. DIN.
Units
Add ❑ Alter ❑ • Repair ❑
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
Estimated Valuation
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 applicantfor such permit to file a signed statement that. he is licensed pursuant to
PERMIT
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
'
Plan Chk. Deer
subjects the applicant to a civil penalty or not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk• Bal.
Const.
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
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 sa,'e.) ,
Plumbing
O 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
S.M.I. '
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. B. 8 P.C. for this reason
Grading
Driveway Enc.
Date -Ownerr `I` ��+ �J J
Infrastructure 00dt-,:T
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, ora 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 (5100) 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 Cade.)
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
TOTAL
REMARKS
Demolition ❑
AMOUNT
i
SS
�n
q" -i-4122 54
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: Datet Al gypermit
Validated by: ,rpt
Validation:
HARD COPY
r
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES', -
1ST FL. SO. FT $
UNITS
ROUGH PLUMB.
BONDING HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL. SO. FT.
ROUGH WIRING DUCT WORK
ROCK STORAGE
FOUND. REINF. %�j
v
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
REIN F. STEEL
p
GAS (FINAL) 6 �'�.
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
WATER HEATER
SERVICE FINAL INSP.
DRAINAGE PIPING
CARP. SO. FT.
WATER SYSTEM
FINAL INSP.
GRADING
FINAL INSP. cu. yd.
$ plus x$
WALL SO. FT. @
LUMBER GR.
DRINKING FOUNTAIN
SO. FT. ®
01C (Q (,t//CG9�J
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FIRE ZONE ROOFING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(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, TEM/PERM
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 ® 11/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
FENCE FINAL
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 PLU
UNDERGROUND A.C. UNIT
COLL. AREA
SLAB GRADE / e!5-�-
ROUGH PLUMB.
BONDING HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTI /
ROUGH WIRING DUCT WORK
ROCK STORAGE
FOUND. REINF. %�j
v
OAS (ROUGH)
METER LOOP HEATING (FINAL)
OTHER APPJEOUIP.
REIN F. STEEL
p
GAS (FINAL) 6 �'�.
TEMP. POLE
GROUT
WATER HEATER
SERVICE FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
GRADING
FINAL INSP. cu. yd.
$ plus x$
_$
LUMBER GR.
FRAMING /
ROOFING3
01C (Q (,t//CG9�J
3 _ �
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUNDa7
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF �QA
SCHOOL FACILITY FEES CS.n
TO: City of La Quinta DATE: /�2- L '% --4
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253 m
10E:THIS D®CU NT CANN®
®�
This is to certify that ��Q/ )BMP
���� �•
developer of -.J which is
located at �r/- �� _� n / 3 within
this District, has paid school facility fees imposed pursuant to the
authority generated by Government Code Section 53080 in the.amoun S0
covering a total of Lsquare feet of ( esidential or
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
for DESERT SANDS UNIFIED kHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink -Accounting • Gold - Developer
(
A. / b 3� (10)-37
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OFFICE OF
° •�-'�y-== °,
AGRICULTURAL COMMISSIONER
4080 LEMON STREET, ROOM 19
i-�-
RIVERSIDE. CALIFORNIA 92501
(714) 787.2561
-4),9, lbq
46-209 Oasis Street, Room 14
Indio, CA .92201
(619) 342-8291 '
Dear Developer/Landscaper:
E. LEON SPAUGY'
COMMISSIONER
JAME5 0. WALLACE
ASSISTANT COMMISSIONER
Thank you for inquiring with the Agricultural Commissioner's Office regarding
local quarantine laws.
Any diseases or insects associated with the plants/landscaping material presented
on your landscaping plans do not pose a threat to the Coachella Valley Citrus,
Date, Grape, Vegetable, or Field Crop industry. We therefore approve your
landscaping plans.
If however, any substitutions of plants/landscaping materials within your plans
occurs between now and the actual planting date, you must contact this office
within 48 hours before delivery into the Coachella Valley. Also, the substituted
plants/landscaping material must be held for inspection upon arrival. Any sub-
stituted landscaping material found infected/infested with quarantine pests will
be immediately treated or shipped out of the Coachella Valley at the discretion
of the Agricultural Co=issioner's Office.
Under 'penalty of perjury, I.the undersigned will comply with the above.
Authorized Agent:
Name k S +,3 Date 3/ 3/,�r7
Signature -
Permit Number(s) 7 /e 5 D 3 ZS',4 471-�
Developer (_Q, Address 3 -F - 815 -
AG RIcnTLT,_AL
•S'
AGRICULTLT�AL C0:•^SISSIO`:DR' S APPROVAL
�✓ Date'
Authority cited: Agricultural Code; Sections 6301, 6461, 6462, 6464, 6501) 6521-
6524
cc: 2 Plan Clhecl:, Indio Office, Riverside Office
0
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APPROVED 't
BY:
DATE:
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COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION
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 of $37 is required when the application is submitted. Check must be made payable to the County of Riverside.
S SA- dii Building Department Application Log #
Name (Owner, Agent, Contractor, Etc.)
Mailing Address ,,�
Job Propert Address
'
1LL90CUmmunily Legal Description of Property. (Lot, PM, TR)
.. A Q v t
Af.tE A 66
'Assessor's Parcel No.
WPterAgenc or V II ,L il/l
.�1- _ _/1,7 / ¢�P
Use of Permit�C.tJPX�t"tc/ ��Prann'af`g Case q
Lot Size
��
e-
�
SFD, MH Site Preparation Etc.
D
Signature of Applicant Date
-The above information must be verified from Building Application
STAFF USE — DO NOT WRITE BELOW THIS LINE
Initial �1 Date
ZN01'-_'! p
Certification of Existing S.D. System required. ❑ Yes
WOCB Clearance required. El Yes Ll
Soils feasibility report required. ❑ Yes
///-
,12
_,%��
Detailed boring report required. El Yes L��--
Detailed contour plot plans required. E] Yes V6
Staff Specialist ap1:1proval required. Yes No Lot Inspection Date
Soils/boring report by d224 Ate Project # Date
!, C �p
Soils Map Page Soil Type Approved by i C.._ Date
Type of System:
No. of Bedrooms
(1) Septic Tank
Soil Rate Required
❑ Existing 0911 ew ❑ Additional ❑ Replacement
Gals.
(2) ILRach line sq. ft.,
Sidewall allowance
InstalLine(s) Ft. Long,
Leach bed Sq.
(Bottom t ch area) .
ft. rock/ Sq. Ft.
Ft. wi�e�wt m_in. inches
Ft. of'b'otto
per running ft.
rock below drain lines
area
Leach lines/bed-special design for slope:
(3) Pit Diameter
No. Pits
Pit BI/
Seepage Pit total depth
Applicab�le�
N/A_� ��Overburden factor
[Fjt�
Max. allowable depth T ct0 /
/y
14
G/All,� / 7
This application i "p roved rnedrfcr the design of a subsurface disposal system as indi•ated on the accompanied plot plan using the r rements
setfo in Section B above. A building permit is necessary for the installation o the above -designed system.
1r Septic tank and sewer lines must tie 50' from any wells 0
2 Leach lines must be 100' min. from any wells including expansion tirea t✓ ��`-�i `tea
3 J Seepage pits muse 150' min. from any swells including expansion area. /0
7 elf""iQ��G
!✓ te�oti�'
Signature of Health Official
RECEIPT NO. ��/� Issued by // / Date
District: El� Riverside * Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File
DOH -SAN -122 (Rev. 6/86)
40
01
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