002395 (SFD)T 0 4tvl 4 �49MA
u Building 52-775lwm CexZ3"etIl?.3t
`Address
Address
City lZip Tel.
tractor
Address .
77-600 DB3 3
'City -. Zip I Tel.
State Lic. City
& Classif. 4t 'J 7 V Lic. #
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
LICENSED CONTRACTOR'S DECLARATION
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
'yeffect.
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 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 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.)
❑ 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, 1 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: It, 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 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
HARD COPY
LDING: TYPE CONST
P. Number
No. 002395
OCC. GRP.
773-321-001
Legal Description Wt 1
Project Description Iumla fmaux t9pplum
REMARKS
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 6'5-86 Permit
Validated by:
Validation:
1M 1.245
Sq. Ft.��
Size
No.
Stories
No. Dw.
Units
New 0Add ❑P
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$ 64.586.00
PERMIT
AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal.
35.1Z
Const.
331.00
Mech.
30.00
Electrical
6953
Plumbing
173.00
S.M.I.
4.59
Grading
20.00
Driveway Enc.
20.00
Infrastructure
968.79
TOTAL
1.632.19
1,582.19
REMARKS
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 6'5-86 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
A.C. UNIT
2ND FL. SQ. FT. p
SLAB GRADE 2
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
ROUGH WIRING
DRAINAGE PIPING
WALL SQ. FT.
ROCKSTORAGE
DRINKING FOUNTAIN
SQ. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
HEATING (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
GAS (FINAL)
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
BOND BEAM
LAUNDRY TRAY
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 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 Y� 7Z-604"
���6YCCCJJI. D
OUND PLUMBING
j
UNDERGROUND
A.C. UNIT
COLL, AREA
SLAB GRADE 2
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS �2
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
W FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
leEMP.
POLE /-Z
GROUT
WATER HEATER
SERVICE
�#I�NNAL INSP.rQ ?� —O
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
_$
LUMBER GR.FINAL
INSP60=f tg
FRAMING(—(el
e INAL INSP.
ROOFING
u/ (
' I
T
n
L
P
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
ONSULATION/SOUND
FINISH GRADING
1 '
FINAL INSPECTION
w
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS,
GARDEN WALL FINAL
a
COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION 22_ 6
PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM %J ���- �! U
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
30 is required when the application is submitted. Check must be made payable to the
ounty of Riverside
Building Department Application Log N
e (Owner1 Agent,,Contractor,' Etc.).
City
y
! h� �•
*Legal Description of Prpty.(Lot,—PM, TR)
�T � � /�`LK SG, a l a�M� �
*Assessor's Parcel No.
z
Water Agency
C►"L��
Use of Permit J__t_ L0-�-*ifi,xQ ,,N
SFD, MH Site Prep Etc. �F/a
Planning Case H -20 2
Lot Size
•
Type of System:
No. of Bedrooms) (1) Septic Tank
Soil Rate Required
Existing New Addition Replacement3
he
! /?�? 1/ Gals.
Signature of Applicant —
Date
✓�
(2) Leach line sq. ft.
Sidewall allowance
*The above information must be verified
from Building
Application
(Bottom area)
�'ft �yo�ck/ Sq. Ft.
Ft.!>;o`rtg;-.�_�Ft. wide
Sgv�t: of
per running ft.
with Min-. inches rock
bottom
STAFF USE
- DO NOT WRITE
BELOW THIS LINE
area
Initial
Date
Certification of Existing S.D. System
reqd. Yes[
]
No[/]
1 �AII
7 �
WQCB Clearance reqd.
Yes[
]
NoC�I
Soils feasibility report reqd.
Yes[
]
Ido[/]
Detailed boring report reqd.
Yes[
]
No. V3
P1
Detailed contour plot plans reqd.
Yes[
]
Nof�
C
Staff Specialist approval reqd.
Yes[
]
Ido[A Lot
Inspection
Date
W
EQ
Soils/boring reporjt
N
Date
cyby
Soils Map Page lCr1� / Soil Type(AC
Approved by
/Proj.
Date
U
Type of System:
No. of Bedrooms) (1) Septic Tank
Soil Rate Required
Existing New Addition Replacement3
he
! /?�? 1/ Gals.
C] C�]� C]
C]
i
✓�
(2) Leach line sq. ft.
Sidewall allowance
Install Lines)
Leach bed
(Bottom area)
�'ft �yo�ck/ Sq. Ft.
Ft.!>;o`rtg;-.�_�Ft. wide
Sgv�t: of
per running ft.
with Min-. inches rock
bottom
N/A C ]
below drain lines
area
Leach lines/bed-special design (3) Pit Diameter No. nit Seepage Pit total depth—/ X
for slope: Applicable .,J= 6'[�-3! Pits BI
N/A Overburden factor Max. allowable depth 4ni
y%/ ' � � /, .,� /r' � � r :::x /fir. Z.a•-J/!�a�'1.
This application is -approved ieci for the design of a subsurface disposal s: -stem as
indicated on the accompanie plot plan using the requirements set forth in Section B above.
U A building permit is necessary for the installation of the above -/designed system.
Z &&Septic tank and sewer lines must beI50' from any wells c�/ /� /jJ/ �+- %`r
P �(2) Leach lines must be 100' min. from any wells including exp s Yon area l 4
W /(3� Seepage pits must. be 150' min. from any wells including expansion area -//.4
Signature of Health Official Date
RECEIPT NO. ..1 / -1 V .j / 3 Issued by i ./it Date C '? _ tL
District: Riverside [I Indio [w] Hemet [ ] Perris [ ] Rancho Calif. [ ] Blythe[ ]
Distribution: WHITE -Office file YELLOW -Applicant PINK -Bldg. Dept. GOLDENROD -Pending File
DOH SAN 122 (Rev. 2/86)
t��F1E�
=
—0
Desert Sands Unified School District
H BERMUDA DUNES r
RANCHO MIRAGE 82-879 HIGHWAY 111 • INDIO, CALIFORNIA 92201.6678 • 1619) 347.8631
INDIAN WELLS H
,0 PALM DESERT 'v
-P LA OUINTA N
',p INDIO y�
City of La Qui'nta
Department of Community Development
78-105 Calle Estado
La Qui'nta, CA 92253
Re: Lots 1 and 2, Block 156, Santa Carmelita at Vale, La Quinta, Unit 16
Gentlemen:
The developer of the above referenced
has mitigated its impacts on our overcrowded schools by payment
of the amount of $628 per unit to be applied to the cost of
district educational facilities made necessary by such new
development.
Sincerely,
IL j
John D. Brooks
Assistant Superintendent
Business Services
JDB/crm