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06722 (SFD)Building Address T 0 0 litif 4 4 a" P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Address P. 0. &,a 772 City Zip Tel. - Contractor Address - La Minta 92253 564-3511 State Lic. City & Classif. 506667 Lic. # 1115 Arch., Engr., Designer Address Tel. City I Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 71XX1) 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 affirdm that I am exempt from the Contractors 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 is issuance also requires the applicant for such permit to Inde a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of EDivfsion 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 chd 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.) ❑ 1, 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 Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company O Copy is filed with the city. p 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: fl, after making this Certificate of Exemption you should become subject to the Nbrkers' 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.) Lenders Name Lenders 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 No. ©6722 1ILDING: TYPE CONST. OCC. GRP.- P.,Number 774-296-015--9 al Description Project Description SSD Sq. Ft. 1534 No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. S Plan Chk. Bal. 335.5 Const. 585.50 Mech. A Electrical 1111 Plumbing 17A. Sn S.M.I. A-14; Grading Driveway Enc. 70.M Infrastructure q1 R TOTAL3.l.RR.G7 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 t217/89 Permit Validated by: Validation: ELECTRICAL FEES NO. PLUMBING FEES fS A.C. UNIT COLL. AREA YARD SPKLR SYSTEM ILEHOME SVC. BAR SINK ER OUTLET ROOF DRAINS FORMS DRAINAGE PIPING ROUGH WIRING DRINKING FOUNTAIN, ROCK STORAGE URINAL GAS (ROUGH) WATER PIPING HEATING (FINAL) FLOOR DRAIN REINF. STEEL WATER SOFTENER TEMP. POLE WASHER(AUTO)(DISH) GARBAGE DISPOSAL WATER HEATER LAUNDRY TRAY FINAL INSP. KITCHEN SINK USE PERMIT SVC WATER CLOSET' A,TEMIPERM LAVATORY ERES SERV ENT SHOWER SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER T. RESID ® 1 Va C SEWAGE DISPOSAL ].FT.GAR ® 3/4c HOUSE SEWER GAS PIPING AIT FEE PERMIT FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE HEATING & AIR COND. SOLAR SETBACK vol GROUND PLUMBING V-1 UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE q/ 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 FINAL INSP. 7�%/7F� GRADING cu. yd. $ -Plus-x$-=$ LUMBER GR. FRAMING •2/ 7/?Q �^; ``� '- w FINAL INSP. ROOFING ��� n/n/41 2 %a y /�O //. ` , / l �/� REMARKS: VENTILATION��/ FIRE ZONE ROOFING: FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING' MESH INSULATION/SOUND 2 l FINISH GRADING 1 FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL ) Building P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Address P. 0. Box 772 City Zip Tel. La uinta 92253 Contractor Address City Zip Tel. La Quinta 92253 564-3511 State Lic. City A Classif. 506667 Lic. # 1115 Arch., Engr., Designer Address CityI Zip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION 1 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. 7031.5,8usiness and Professions Code: Any city or county which requires a permit to construct, after, reprove, damoish, or repair any structure, prior to its issuance also requires the applicant for such permit to W a signed statement that he is licensed pursuant to the provsions or the Contracla's License Law, Chapter 9 (commencing with Section 7000) of Division 3 or the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Arty viofafion of Section 7031.5 by 'any applicant for a permit subjects the applicant to a ctrl penally of not more than rive 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 Contractors License Law does not apply to an owner or property who builds or improves thereon and who does such work himself or through his own employees, provided that such irWovements are not intended or offered for sale. If, however, the building or improvement is said within aha year of completion, the owner -builder will have the burden of proving that he did not build or irpmve for the purpose of sale.) O 1, 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 conlracor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sea 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 Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No Company 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 ff 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 aliforniaDateOwner NOTICE TO APPLICANT: ff, after makig this Certificate of Exemption you should become sutgect to the Workers' Compensation provisions or 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.) Lenders Name Lenders Address This is a building permit when property filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certity 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 Addr�� City, State, Zip FINANCE BUILDING: TYPE CONST No. OCC: GRP.: A.P. Number 774-294-015-9 Legal Description Project Description SFD Sq. Ft. 1530 No. Size Stories 06722 No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ mated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. rn no Electrical Plumbing 17250 S.M.I. 616 Grading Driveway Enc. Infrastructure 1 n1n Lo TOTAL j S3,488. 4; j 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 12/7/89 Permit _ Validated by: Validation: 11 ?i f{ �aLr �7• "Y d ,_•�- ".� - .-s 1 4-'•" ?17 a •fir ,�� `^^-r . 1i*...Yv •,^..L:_G-.r ' i 1 r ♦ �IHi. V,- 0 A Z 0 W W COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH assrasson P°'O'I No. '�� — ENVIRONMENTAL HEALTH SERVICES 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. VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG' fi Agent, Contrwor Contact Pemw ne 'l'53!R Address 8 Phone 1 G 1/i!C Owner r AN o Phone // Mailing Address 0. Sax 77 L �. City OACNf /!/1 State tie Zip �22- fJoob Props Address <! /Q e t/IJld�lt�,A Legal Description Prop. (PM, Tract, Lot) ZO?r ZY Lot Size ter AQencyQMell Use of Permit P/P, CU, etc. G (,(,,tom r Other I! X 4 _/+ Q Q Dwelling, MH Site Prep, etc. S164ture of Applicant Data CATEGORY: REV CODE FEE CATEGORY: REV CODE FEE [].'SUBSURFACE DISPOSAL 1238 e-$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 $13200 ❑ Site Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $86.00 r INITIAL DATE Holding Tank Agreements Completed ❑ Yes Oleo", Certification of Existing S.D. System Required ❑ Yes ❑ No/ i WQCB Clearance required. (Attach Form ❑ Yes ❑,No DOH SAN 007, Santa Ana Region Only) Solis Percolation Report Required. ❑ Yes P'No/ Special Feasibility Boring Report Required. If Yes EI Contour Plot Plans Required (1 to 5 it. interval) ❑ Yes C7/No „Detailed Other ❑ Yes (3 No �No t Staff Specialist Lot Inspection Required .. ;' e ❑ Yes 0 Lot Inspection Date Solis boring report by Project Data Sills Map Page r✓�c7 SOA TWO AMoved by ! cam'// C.— Date No. of Systema Type of System(s) +�� `. No. Dwelling Units (1) Septic Tank Sill Rate �Qroaiie/Sand ❑ Holding Tank ❑ Existing • _ ❑,New ❑ Replaoement -*:fQ , Bedrooms, F �1�n Gr`eene l 2fi��Zt /ry�x �rryr%Gel y���"'i Gd ,,(2) Leach Line Sq. PC. 'Sidewall allowance Ta Install s) R long ft wide with k Leach Bed sq. R 'Bottom trench area !a, R rodV aq. R 4 per running R } " min. nares drainlines or _ ....,,�� of bottom ar9a� 4 O -NA Pip Leachlines design for slope: (3) Pit Diameter No. Pb'- Pit Below' ' Seepage �T�otal Depth O ApplicableInlet N/A ���Overrburden factor 0=5 (t C4"% (BI) ) L[ Max. Allowable Depth / T 70 No. 2 System a -fa 11-fe- 1 1,1161- e3 This application isAPPROVED' EfNIED'for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompanied plot plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the above -designed system. No construction is permitted in the required reserved 100% expansion area. _ 4 (1 Septic tank and sewer lines must be 50"minimum from any wells `+f /V / (2). Leach lines must be 100' minimum from any wells, including expansion area x•-411 (3)) Seepage pits must be 150' minimum from any wells, including expansion area rb 10 /�tr^+ j:- ` Signature of Health Official '✓k �[ / bk-7r *. �%±c�-mac RECEIPT NO. ) Issued By Date DISTRICT: ❑ Riverside, ❑"Indio ❑ Hemet q Perris ❑ Rancho Calif. t ❑ Blythe DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records xi't i' Desert Sands Unified School District CERTIFICATION OF PAYMENT OF ®�+I♦y�• SCHOOL FACILITY FEES TV ts [)OCU CCT cANN® TO: City 8o Lg�UG.4iC®. g Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 DATE: This is to ertify t t developer of which is located at - 0 , within this District, has paid school facility es imposed pursuant to the a tho ' ty g era d by overnme t Co a Sec ios 53080 in the• amount, o� (LL A covering a total of square feet of ( ) residential or. ( ) industrial/commercial development and that building permits for this footage in this development may now be issued by your jurisdiction. 805 Uw • Lu - 11r? 4 CLI fo DESERT NDS UNIFIED1 SCHOOL DISTRICT �p 1530 White - Building Department • Yellow - Facilities Planning • Pink - Accounting! • Gold - Developer (10)-37 01/31/90 16:20 Z 619 724 8639 1st FIDELITY Ate, n �LA TM 'P T IT NL` PR .:Dg . : �� -" Frelm. p.. SIClA P�A VtN Recel"ad I —najo. Address: Lot(s) Tract— G.A. Code' molar(&) . k0l, $ Service(6) ,� 5 0 U. uJ 0 Back(low(G) U House Lateral(e) Ll Doloctor Check(&) U Miller Sumbarge• 61 Sanitatlon Cap so I I y Ohara 0 W.S.B.F.C. 0 Temporary Construotion Motor. U TUMORChafab, 0 Uncollected A000ant - Name 0 inspection Fee - Tract - pat - 0 Plan Chook Fees Water. I Sawor - Tract - 0 Bond Payment - A.D. - ond- A Auml 0 CualomorDep"It U Othar Remarks; OCOPY to: Cash Check r Money Order C�6 TOTAL Water SarYlce CYWD-430 (8104)