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04865 (SFD)~ P.O. BOX 1504 Building54-150 C,i�rranza 78-105 CALLE ESTADO AddresLA QUINTA.,CALIFORNIA 92253 Owner VIP -stern American 1,110nat. Mailing ' Address POO. BOX 1379 City Zip Tel. LA Oita nta 1 92253 1 56-4-7411 Gar V Re11ii'1toltiA ress Po 0* Bax 807 F ZIP Tel. 1000 Palms 92276 m 1 346-0408 &'Classjf, 463157 Arch., Engr., Designer Address BUILDING: TYPE CONST. OCC. GRP. A.P. Number '774 -211-•orl7loop Legal Description. - Project Description+ City Lic. # 1114 Sq. Ft.. 172 Size Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that'1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3.6f the Business and Professions Code, and my license is in full force and . effect.•( rr✓ SIGNATURE. I -DATE Ir ( ' l ," OWNER -BUILDER DECLARATION 11 11hereby 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, after, 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 the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or thathe 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 (5500). ❑ 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 thereofr(Sec. 3800, Labor Code.) Policy No. Company 7 . '; ,7- y- Lar - ?O 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., 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 (.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 0486"5 No. No. Dw. Stories - Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $99027 PERMIT AMOUNT Plan Chk. Dep. $254,00 Plan Chk. Bal. 30.50 Const. Mech. Electrical Plumbing S.M.I. .50 Grading Driveway Enc. Infrastructure l t ofn. 21 TOTAL REMARKS 14141rt A fIJltti,. s: sY4i,4:1 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 Permit Validated by: Validation: 1 1 WHITE FINANCE, PINK APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY'- FILE .. r... �. 'a- .!. - .-a ...�.. .•, ,'.'. -•. �.SYr? +' r' ..� d7:'SI v-. �:i. ,,,„• *- _ ti... .. .,.t - ...:)r L.*ri, .. _ ....111 CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIN&FEES - S UNITS 9') 1S7 FL SO FT rp BONDING HEATING (ROUGH) STORAGE TANK FORMS YARD SPKLR SYSTEM 2ND FL SO FT. e DUCT WORK ROCK STORAGE FOUND. REINF. MOBILEHOME SVC. BAR SINK POR SO FTgr - OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) POWER OUTLET ROOF DRAINS GAR SO. FT. 0 GROUT WATER HEATER SERVICE FINAL INSP. DRAINAGE PIPING CAR P. SO FT. ra WATER SYSTEM I GRADING cu. yd. $ plus x$ _$ DRINKING FOUNTAIN WALL SO. FT. td FINAL INSP. FINAL INSP. URINAL SO. FT. (a ESTIMATED CONSTRUCTION VALUATION S WATER PIPING NOTE: Not to be used as property tax valuation VENTILATION FLOOR DRAIN MECHANICAL FEES FIRE ZONE ROOFING WATER SOFTENER VENT SYSTEM FAN EVARCOOL HOOD SIGN WASH ER(AUTONDISH) 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. g c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID 1% c SEWAGE DISPOSAL SO.FT.GAR >r:c HOUSE SEWER FENCE FINAL GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL T07AL 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 PLUMBI 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 GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ _$ LUMBER GR. FINAL INSP. FINAL INSP. ROOFING �/� 5�` REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUNCS 000 FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL P.O. BOX 1504 APPLICATION ONLY Building 78-105 CALLE ESTADO Arirlrass 54-150 Avenida Carranza LA QUINTA, CALIFORNIA 92253 Owner -IESTE11W A1U:R1Cj0J CONS EUCTIOU CO Mailing Address P U r;ox 1379 City + IZip ITO LI225a I A I CI-LIAA-741 1 Contractor (1a r.r L?o�n,nlric . Address 0 :3ox 807 City Zip Tel. Innn TP;%I n7r, - r,IU_ LDING: TYPE CONST. OCC. GRP A.P. Number 774-211-007/008 Legal Description Lola. 17/.18, Blk 285, SCVOLO Unit 26 Project Description S L??Resi rl rand. State Lic. City & Classif. Lic. # Sq. Ft. rS'a_ %E,9J57 11 1A Size Arch., Engr., Designer Ed Diaz New Address Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 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 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 rile 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 or 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.) b 1, asowner 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 0 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 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 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 BUILDING DIVISION No. No. Dw. d72 Stories 1 Units Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation 79,, 0 PERMIT AMOUNT Plan Chk. Dep. ^Z It p, p h Plan Chk. Bal. 5-0 Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure / d 2. 2,1 --i 47 'n 0 r 37 .ai TOTAL —7 -7 17 r7 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 Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS SLAB GRADE 2ND FL. SQ. FT. BONDING YARD SPKLR SYSTEM r POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. SQ. FT. GAS (ROUGH) DRAINAGE PIPING WALL SQ. FT. OTHER APPJEOUIP. DRINKING FOUNTAIN SQ. FT. ® TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. 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, 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. SQ. FT. RESID ® 1 % c SEWAGE DISPOSAL GAR. FIREWALL SQ.FT.GAR ® 3/ac HOUSE SEWER LATHING 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 APPJEOUIP. 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 SIGNATURES11NITIALS GARDEN WALL FINAL :d � .-,_-.» . r .� f+Mr ��:. , _ �r _ "ys;-�' _ 4. _ -J`?_ 1. �h - � M fir.- „�.t:. � � Y +".t -<� '�•.i r ... - .. � ... 4 in A a COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No. ENVIRONMENTAL HEALTH SERVICES _ 77 d H Q©f fie 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 & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'* Agent, Contractor, Contac Person (P Phone S46 Ad ss & Ph a � 5 -7 � . 0. tom.. 13 v , r. Owner IjeS• Phone Mailing Address City StateZip Job Property Address L gal Description Prop. M, Tract. Lot) a8S" _16o Awe ut17���i-of/b Lot Lot Size te enc I+ Use of Parma P/P,,CU, etc. A Qtd n,Vm - Other / A Q q /—q 177 X Dwelling, MH Site Pfep, etc. eSEL- 41075 (3El.Zk) /7 g �C Signature of Applicant Date CATEGORY: REV CODE F E CATEGORY: REV CODE FEE SUBSURFACE DISPOSAL 1238$.45.00— ❑ 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 oe<Holding Tank Agreements Completed /L-`D' �TE_� PML ❑ Yes s N Certification of Existing S.D. System Required ❑ Yes WQCB Clearance required. (Attach Form ❑ YesN❑' o DOH SAN 007, Santa Ana Region Only) Soils Percolation Report Required. ❑ Yes Special Feasibility Boring Report Required. ❑ Yes Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes t1 ' Other ❑ Yes . No Staff Specialist Lot Inspection Required ❑ Yes ❑ No Lot Inspection Date Soils boring report by ProjectDate �# Soils Map Page !' Soil Type Approved by "" " " Date Q D No. of Systems Ty� of System(s) No. Dwelling Units f) (1) Septic Tank Soil Rate Grease/Sand //// molding Tank ❑ Existing New ❑Replacement Bedrooms,-fiixt�are-Units- ,t- /� rease Intcp iaRM Z�A�/ l�Install (JitL `f � -Aft—Gal GW �(2�Leach Line Sq. Ft. Bott Sidewall allowance �Line(s) tong ft wide with each Bed sq. ft. trench area ft rock/sq. tL min. niche doe below drainlines or of tsottorn rea per running ft. Leachlines/bed special design for slope: (3) Pit Diameter/ { No. Pits Pit Below Inlet (BI) Seepage it Tv�t�l Depth /O her. Applicable -1 (� 6 /� / /Z1(yL(J / Max. Allgy aj�l� Depth N/A Overburden factors'' -�^- �r No. 2 SystemN/4- /4-An- .Qr2//Q1 REMARKS: �'%` /ZBz9n-• ��JId �-. 4-W / ' s This application is PROVED E D fort category ch ed in S CTION B above, mgt he design "f a subs rface disposa` I system as indi e on the accompame plot p ari, u ing the requirements set forth in SECTION C above. A building permit is necessary for the installation of above -designed system. No construction is permitted in the required reserved 100% expansion area. rr+� d Septic tank and sewer lines must be 50' minimum from any wells ' f �o SLeach lines must be 100' minimum from any wells, including expansio ar Seepage pits must 1 minimuumfrrom y wells, includinggexpansionn arreef C/138 7�W�..O �l/1i[IrQO i Si nature of Health Offici Dat - RECEIPT NO. 7 a Issued By Date DISTRICT: ❑ 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 .w.... M1 .. _ , .•... r. . ....�n- _.. .. ,. F .. ,1 he r.r.v..r.. .. .. r � .. ... ....w. ... r. -.J ... 1. .� .... ._.. - �.. r e. ... ., x.� �... � .. �. ... .. ....�_ .. . ..J .. .. r xDesert Sands Unified School District �J7 CERTIFICATION OF PAYMENT SCHOOL FACILITY FEES (A TO: City of La Quinta DATE:• Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 This is to certify t P at Com'/'�xi• developer which is located a within t"., Di' t t aai h 'd school facility fees imposed pursuant to the s s ric s p authority generated y Government Code Section 5 080 in the amount of $ ' _ ( covering a total of ' square feet of ( residen't al or ( ) industrial/commercial development and that buil ing permits for this footage in this development may now be issued by your jurisdiction. C'.k 3� a^ L -h-,3 / or ESERT SANDS UNIFIED SCHOOL DISTRICT ?0 White - Building Dep rt t • Yellow \Faacililities Planning Pink - Accounting • Gold - Developer ()I IIr,E OF AGRICUL i URAL COMMISSIONER AND WEIGI I S & MEASURES { 49-613 Hwy 06, Suite 11-12 'Curlchel.ln, CA 92236 619.-342-0291 E. LEON SVAUGY comm inr.O )ARIES O WALLACE A S$IS I A\ 1 1;)'•1'•lltti()\F.P. CLENIENI BUNV NIS1E Sr -AM D1YTE /0 - l� - 88 CASE 10. R fl8 !Z S 14 19 i3 I DEVELOPER'S IW1Et ADDRESS � 1.32 IFELLHIONEt .4L Q � Dear Developer: After reviewiutg your landscaping plans, 111 plant material listed is nor i.11 violation of yuauralltine lacus yoverni.ny elle Coachella Valley. If suUslitutions do occur and they differ [to,, plant material listed, this Office must be notified iim>vdiately. . Thank you Lor proLectiulg and pceservbig the Coachella Valley's pest -free envirornlnnt. 11g 1r cultural Calllu s ner s U[ E ice cct Indio and Riverside UCfice % A ti . r r.