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10258 (SFD)P.O. BOX 1504N o. 10258 Buildins5 x,..565 Ca►ranza 78-105 CALLE ESTADO 0 11. r Address LA QUINTA, CALIFORNIA 92253 /�} �i Owner (ji La Cuinta Partnership Inc. BUILDING: TYPE CONST. Mailing OCC: GRP. Address 5005 Calle Sar_ Raphael #B1 A.P. Number 773-124--016 Y City Zip Tel. Palm Springs 922641 1325-4289 Legal Description Contractor Project Description gPT1 Sane as above Address + . City Zip Tel.: State Lic. City & Classif. 606486 Lic. # 2833 sq. Ft. 1423 No. No. Dw. Arch., Engr., Size Stories Units Designer RDI Architects New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑ Address Tel. 333 .Broadway 1151394-8767 Permit does not include block wall or City Zip •" State pool S.k'. 94133 Lic.# 015789 LICENSED CONTRACTOR'S DECLARATION 1 hereby affir hat I am licensed under provisions of Chapter 9 (commencing with Section ,r-�7000) of Division 3 of the Business and Professions Code, and my license is in full force and effecLµ ' � �..L�-i:• aC�iv i - _SIGNATURE DATE OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractors License Law for the following 82,304.50 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 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) o/' Division' 3 of the Business and Professions' Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation o/ Section 7031.5 by 'any applicant for a permit . Plan Chk: Dep. .2-50.00 subjects the applicant to's civil penalty of not more than five hundred dollars ($500). Plan Chk. BBI. 238.46 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 Const. (} Professions Code: The Contractor's License Law does not apply to an owner o/ property who rj6 .0 _ 0 builds or Improves thereon and who does such work himself or through his own employees, Mech. S5. 50 provided that such Improvements are not intended or offered for sale. If, however, the building r or improvement is sold within one year o/ completion, the owner -builder will have the burden Electrical' 2 V �. of proving that he did not build or Improve for the purpose of sale.) ' O I, as owner of the property, am exclusively contracting with licensed contractors to torr Plumbing 166.50 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. 8.30 such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading 20.00 ❑ I am exempt under Sec. B. & P.C. for this reason Driveway Enc. 20.00 Date owner Infrastructure _ 1813.60 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.) r. Policy No. .Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. • TOTAL 3255.98* 3006.98 CERTIFICATE OF EXEMPTION FROM — REMARKS v WORKERS' COMPENSATION INSURANCE (This section need not be completed If the permit is /or one hundred dollars ($100) valuation or less.) �1 ri " . iq 7 fl �..'�� » .tom.. 110 I certify that in the performance of the work for which this permit is issued, I shall not ���„ � {� ,'T.X„d.. , �. �,�; 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 - ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: i comply with such provisions or this permit shall be deemed revoked. 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 INSPECTOR 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 r 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 CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS A.C. UNIT 2ND FL. SO. FT. SLAB GRADE YARD SPKLR SYSTEM BONDING MOBILEHOME SVC. BAR SINK POR. SO. FT. ® STORAGE TANK FORMS GAR. SO. FT. ® POWER OUTLET ROOF DRAINS DUCT WORK DRAINAGE PIPING CAR P. I SO. FT. GAS (ROUGH) METER LOOP WALL SO. FT. DRINKING FOUNTAIN. SO FT ® REINF. STEEL URINAL ESTIMATED CONSTRUCTION VALUATION $ TEMP. POLEz! WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER HEATER WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER BOND BEAM GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GRADING cu. yd. plus x$ REMARKS: LAUNDRYTRAY AIR HANDLING UNIT CFM FRAMING �lf ROOFING1111 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 ® 1% c SEWAGE DISPOSAL SO.FT.GAR ® 3Vic 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 SEM1I-6R SEPTIC TANK() ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLEz! f 4s� [s GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP. %Z (( FINAL INSP. 40 $ a /2t \ V O GRADING cu. yd. plus x$ REMARKS: _$ LUMBER GR. FRAMING �lf ROOFING1111 VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL THING a7 MESH INSULATIONISOUNDa .�q^ FINISH GRADING Of FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL Building \4 P.O. BOX 1504 APPLICATION ONLY 78-105 CALLE ESTADO G�qR,k^roz yA LA QUINTA, CALIFORNIA 92253 owner Mailing Address---- I City Zip Tel. �', S . 9z�� 3 z - cazs1i Contractor Address Zip JTel.. State Lic./ (City & C(assif. t10C _ <4?6 Lic. # /813—V -Arch., Engr., Designer-egc Address Tel. 33 ;EMc.)ADw.Ay City Zip State S, -F, 9/,ii-3Lic.# LICENSED CONTRACT�.RS DECLARATION I herebyr hat I am lic�sed undf6v��Chapterncing with Section 7000)o a on 3 of the9u"sine d n is n full force and effe . Sf9 ATURE 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 statementthathe 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 Intended or offered for sale. If, however, the building orImprovement 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.) ❑ 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.) O 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. 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 ($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 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 Code.) Lender's Name Lender's 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 JILDING: TYPE CONST. OCC. GRP. I:1.4 - 01(, P..Number -7-7 'It VeArQ% al Description ject Description Sq. Ft. No. No. Dw. Size 3 Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. f. t OF LA OUINTA Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure THANK YOU TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Lin Rear Setback from Rear Prop. Lin 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. SQ. FT. ® $ UNITS SLAB GRADE 2ND FL. SQ. FT. BONDING YARD SPKLR SYSTEM STORAGE TANK MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® DUCT WORK ROCK STORAGE GAR. SQ. FT. @ POWER OUTLET ROOF DRAINS HEATING (FINAL) OTHER APPJEQUIP. DRAINAGE PIPING CAR P. SQ. FT. TEMP. POLE WALL SQ. FT. GROUT DRINKING FOUNTAIN SO. FT. ® FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY 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 GAR. FIREWALL SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL . MESH SQ.FT.GAR ® 3/ac HOUSE SEWER GAS PIPING PERMIT FEEPERMIT 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 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 DESERT SANDS UNIFIED SCHOOL DISTRICT 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be Duplicated (619) 347-8631 Date 1/2/92 1 Type of Permit I La Quinta No. 11082 Permit # Owner Name La Quinta Partnership Inc Log # No. 5005 street Calle San Raphael #B1 City Palm Springs zip 92264 Study Area 213 APN # Tract # Lot # Square Footage 12,846 Type of Development I Single Family Residence No. of units Comments 51-550 Alyaradn, 1423 G_f_; 51-565 Carranza, 1423 G_f_ At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It has been determined the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.58 X ® or $ 4,496.68 have been paid to D.S.0 S.D. for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By L.Q. Partnership Telephone 325.4289 Name on the check By James E. Lively Assistant Superintendent, Business Services Fee collected /exempted by Peggy Reyes r "` Payment Received Signature Chec:k1e.-No. 1017 U 0-1��,� - Collector: Attach a copy of county or city plan check application form to district copy for all waivei-9. - ' Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting 0 Assessors Parcel No. COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH,j7� _ ENVIRONMENTAL 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 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 Riverside. Approval of this application shall remain"valid for a period not to exceed one year from date of approval. LOG # _�A I!g, .* VERIFY ITEMS IN SECTION A FROM A NON -FEE BUILDING & SAFETY (goldenrod) APPLICATION nt, Contr9ctor, Contact Person Phone Address CA LCF City State Zip �v F/Ls ro N J�, Z;�v L �� C. - 3 05-4/211 oa fl sfF L) P 5 rA c; 27e - Owner Phone Address City Stfite Zip Job erty Address City State Zip Legal Description Prop. (PM, Tract, Lot) Lot Size titer Agency-yW Use of Permit P/P, CU, etc. Other G ✓4�MAC 17"A 7- C v�D welling, HSit Prep, etc. d /S'qAJTa V/� [ F u U�/✓Tir] �i✓1T# /) Signature of Applicant Ditef CATEGORY REV CODE FEE CATEGORY REV CODE FEE SUBSURFACE DISPOSAL (per system) 1238 $153.000 SITE EVALUATION UPON REQUEST 7349 $120.00 ❑ MULTIPLE PARCELS WITHIN SAME LAND DIVISION (NO PLOT PLAN) ❑ SEWER/SEPTIC VERIFICATION 7348 $ 58.00 a. 1st 4 Parcels (Each) - 1238 $153.00 ❑ PRELIMINARY ELECTIVE EVALUATION b. Each Parcel after 4 7344 $ 55.00 (Attach DOH -SAN -53) 7352 $ 69.00 ❑ REREVIEW (2nd review same parcel) 7344 $ 55.00 ❑ HOLDING TANK 7351 $119.00 ❑ SITE EVALUATION in Conjuction with Critical Area 7346 $197.00 ❑ ALTERNATIVE EXPERIMENTAL SYSTEM 7345 $656.00 ❑ GRADING PLAN REVIEW DETAILED 1238 $104.00 ❑ SITE EVALUATION Lot Less than 10,000 Sq. Ft. 7347 $172.00 ❑ GRADING PLAN REVIEW CURSORY 1238 $ 55.00 ❑ SECOND FIELD VISIT (SITE EVALUATION) 7346 $ 85.00 ❑ COPIES (LAND USE) 7786-81 $ 50 I ITIAL DATE Holding Tank Agreements Completed ❑ YesNo (/ o Certification of Existing S.D. System Required ❑ Yes �No WOCB Clearance Required ❑ Yes (Attach Form DOH SAN 007, Santa Ana Region Only) Soils Percolation Report Required ❑ Yes IN Special Feasibility Boring Report Required ❑ Yes N Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑Yes No Grading Handout Provided ❑ Yes N Staff Specialist Lot Inspection Required ❑ Yes �No Maintenance Booklet Provided ❑ Yes ,l7 No Lot Inspection Date Initials C/42 / Soils Percolation Boning Report by # Date /Llic/Project Soils Map Page �! r r Soil Type ' Approved By /LC���-- Date No. of Systems Type of System(s) No. Dwelling Units(I (1) Septic Tank Soil Rate Grease/Sand ❑ Holding Tank ❑ Replacement Bedrooms, Fiat itr Greasel�cp/Lint Trap r ❑Addition G] Existing C1 Existing '3 RDA". 4444 f a Gal. 'Z 3 4 Gal. N � Sq. Ft. Bottom Area Total Linear Ft. Sidewall Allowance Install Lin s) ft. long ft. wide with Leach Bed re ft. of Bottom Area \ ft. rohW sq. ft. per running ft. min. me es•rok below drainlines or Inlet Tested Depth m.NAr Proposed Bottom Tested Depth Leachlines/bed special design for slope: g pe: (3) Pit Diameter No. Pits Pit Below Seepage Pit Total Depth I �' � • er: Applicable . � r i Inlet (BI) (TD) pZ Max. Allowable Depth ❑ 5 �6 (� N/A Overburden Factor Well Review Approved: Signature Date Well Drilling Permit # Grading Plan Approved: Signature Date REMARKS: This applic_atio llsrt ROVENiED_for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the aa_om 'aisleft-" r`�1'"'plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the above -designed system. e 1) Septic tank must be 100' minimum from any wells CY /v (21 Leach lines must be 100' minimum from any wells, includj g exp nslon area Seepage pits must be 150' minimum from any wells, including epension ared• Y /Q y� ��� Iv /moi^ �J Signature of Health Official A✓ (/ Date ❑ CASH M CHECK NO. IX3 RECEIPT NO. v D Issued By Q L Date )0/l �/9 Ito I DISTRICT ❑ Riverside C5 Jad cl— ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe DOH-SAN-122(Rev6/91) DISTRIBUTION: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Plans/Records x SCS