06789 (SFD)Building
Address
Mailing
Address
City
4 4 "
P.5CAL0O
X 1504
78-1LE ESTADO
52-19.6; $tuff® LA QUINTA, CALIFORNIA 92253
78401 Highway 211.
Zip
. . La Quints 92233 1 64-2205,,_
Contractor
DGE Construction
Address
• CityZip Tela
Palm Desert 92261 _340--6807
State Lic. City
& Classif. 480121 Lic. #
Arch.; Engr.,
Designer
Address I Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under lirovisions of Chaptey9 (commencing with Section
71100) of Division 3 of the Business and, Professions Code, annd'my license istn full force and
effect. {/ r,! </ 3� %ls', r
_SIGNATURE - i'-' GATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions Gide: 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 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 (E500).
0 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 or property who
builds orvrtproves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. It, 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 coir
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
❑ 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 person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: N, 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.)
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.
BUILDING: TYPE CONST. - OCC: GRP.
A.P.'Number - 773-222--015
Legal Description LO /
Project Description S3
Sq. Ft. 1756 No. No. Dw.
Size - - Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$96.734
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
AMOUNT
i $1
120+76
Plumbing 157+50
S.M.I. 6+79
Grading 20.00
Driveway Enc. 20.00
Infrastructure 2,138.28
TOTAL 1 S3 673.36 �.
REMARKS 4i++i kt 3 c+x=+;±` c 9i t t':t -`?t ? ?.:.i4
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: 1/4/90 Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE 7 AV
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
ROUGH WIRING.
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (ROUGH)
DRAINAGE PIPING
CAR P. I SO. FT. (cp
HEATING (FINAL)
OTHER APPJEOUIP.
WALL SD. FT.
GAS (FINAL)
DRINKING FOUNTAIN.
TEMP. POLE 4!!�IOeA-44
URINAL
FT ®
GROUT
WATER HEATER
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROOFING q3 -fO
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT,, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE IPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACKO
y 0
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 7 AV
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 4!!�IOeA-44
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP. a o"&
$
GRADING
cu. yd.
-Plus-X$-=$
LUMBER GR.
FRAMINGrj �a /
FINAL INSP.
ROOFING q3 -fO
ti/w
/
Avg �' /t
//�
y���/1/_"�/�,( /I�moA•'
/ A
d
• �('y/
4110
REMARKS
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL D QD
LATHING 7
MESH
INSULATIONISOUND --'�
FINISH GRADING
FINAL INSPECTION-
NSPECTION
' 7�
CERT.
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
-
GARDEN WALL FINAL
1
Desert Sands Unified School District
CERTIFICATION QF PAYMENT
Q{A�e �
r-5Cf�OG FACILITY FEES
p-jV.1D.
V'�3I a
DATE: 'tiyo
De arteof Community Development
78-105 Calle Estado
La Quinta, CA 92253
This is to ertify h
developer of whir�j-/
located at / 1eiEi1�
this District, has paid school acility fees imposed pursuant to the
autr�or' t gen r t�db o ernment CodetiSecti St 5308 in t amount ofs 1U SY c �i c ,
covering a total of square feet of ( I/J&141si6ential or
( ) industrial/commercia development and that buil permits for
this footage in this development may now be issued by your jurisdiction.
53- ka-o `U- t oeo
C%�r CRCL f 1 for DESERT SANbS UNIFIED SCHOOL DISTRICT
�G� rr� %l7S�j�
ite it ing Department • Yellow -Facilities Planning •/ Pink - Accoun ing • Gold - Developer
�/� �66 (10)-37
I1
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'�?3v�`it..'.p#;{,,;�;••�`,+�^�y"yi:T7Wl�'ti,�.�y
COUNTY OF RIVERSIDE ENVIRONMENTAL A"msO" Puma! NM
HEALTH SERVICES DIVISION �� - �'Z - APO /5
f` PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM
�7 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 IisL
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.
f,
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG #
t
Agent, Contractor, Contact Person
D.G.H. Const. / David Hm sinkvel.d
Phone
3W-6807
Add ess & Firm
PA Box 29Q32, Palm Dxw t, Ca. 92261
Owner
Ia Qtanta Enterprises / Colataa: Din
Phone
564-M
Mailing Address
78-401 Hwy. 111, Slate G, La (Manta, Ca. 92253
City
State
Zip
Job Property Address
4 4 - St.
alb (P „ T Lot)
r1
la
Ca.
92253
'
Lot Size
Water Agency/Well
Use of Permit P/P, CU, etc.
Other
50M sq. ft.
(7• (J w � 0
Dwelli H Site Prep, etc.
Signature of n
/// ff Date
CATEGORY: REV CODE FEE
CATEGORY: REV CODE FEE
❑ SUBSURFACE DISPOSAL 1238 $ 57.00
O SITE EVALUATION UPON REQUEST 7349 $ 43.00
Qo-46LTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348• $ 17.00
a. 1 st 4 Parcels (Each) 1238 $ 57.00
(Less than 1 year)
b. Each Parcel after 4 7344 $ 24.00
❑ PRELIMINARY ELECTIVE 7352 $ 23.00
❑ Rereview (2nd review same parcel) 7344 $ 24.00
EVALUATION (Attach DOH SAN 53)
❑ Site Evaluation in Conjunction with
❑ HOLDING TANK 7351 $ 47.00
Critical Area 7346 $111.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $222.00
❑ Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $ 87.00
INITIAL DATE
Holding Tank Agreements Completed ❑ Yes CJ No
Certification of Existing S.D. System Required ❑ Yes C( No
WQCB Clearance required. (Attach Form ❑ Yes C No
DOH SAN 007, Santa Ana Region Only)
Sells Percolation Report Required. ❑ Yes C No
Special Feasib8lty Boring Report Required. ❑ Yes C No -�4 * -7-'t L.:?
Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes No
Other ❑ Yes !� No
{
Staff Specialist Lot Inspection Required ❑ Yes p No
Lot Inspection Date
Sella boring report by Proiec Date ^• ''
Soils Map Page Soo Type Approved by �= : pate �1
No. of Systems
Type of Systems)
No- Dwelling Unite
(1) Septic Tank
Soil Rate,
Gresse/Sand
❑ Holding Tank ❑ Existing
roo us Fixture Units
$
Grease Intop
/
9 -New O Replacamm"
Gal
(2) Leech Line Sq. Ft
Sidewall allowance
Install Line(s) ft long ft wide with
Leach Bed sq. ft
Bottom trench area
/
_ ft rock/ sq. R/
per running fL1-1
min. itches rods below dreMlirtee
of Ixeltorrt e►ee
�/
�- ❑ NA
—
Leachlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
Seepage Pit Total Depth
Other:
Applicable %
Inlet (BI)
(TD) - / `7 '
Max. Al�bweble Depth
a
F
N/A Overburden factor
❑ 5
y
No. 2 System
REMARKS:
LOk.r.'t[ Lilvii:. �-/ulrN /M f L,._ �" F n. f�.Lis Is s�/��•/C 7�
This application 1 As PPROVEDIDENIED 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.
(1) Septic tank and sewer lines must be 50' minimum from any wells
(2 Leach lines must be 100' minimum from any wells, including expansion area
C(3) Seepage pits must be 15,0' minimum fromany wields, including expansion area
9"—,
Signature of Health Official ! Gc ' Date -72 - 2 2- " i
RECEIPT NO. P / Z 2 Issued Byy Date 12 ` 2 2 ` -w".9
DISTRICT: ❑ Riverside, 19-Iridio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe
DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE . Office file YELLOW . Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
Of
OFFICE OF
AGRICULTURAL COMMISSIONER
AND
;R ; WEIGHTS & MEASURES N
INSKAS
JAMES O, WALLACE 4080 LEMON STREET, ROOM 49 CALVIN C. KAMilonor
Agricultural Commissioner CLESMENT BENVENISTE
RIVERSIDE, CALIFORNIA 92504 I
Director of Weights d MeasuresSealer
(744) 787-2564
49613 Highway 86, Suite B12
Coachella, Ca. 92236.
DATE I a `-� Q (619) 342 NO. �4 1.2 12 Z
l
DEVELOPER'S NAME:
ADDRESS: - L4 ( C Q7
LA , ,.� �, Cry
TELEPHONE: H) Si9 L{
Dear Developer:
After reviewing your landscaping plans,.'all.plant material listed isnot in
violation of quarantine laws governing the Coachella Valley. If substitutions
do occur and they differ from plant material listed; this office must be notified
immediately.
Thank you for protecting,and preserving the Coachella Valley's pest -free environment.
Agric tural Commissioner's Office
cc: Indio and Riverside Office
Mt
1
D A I LY R E PO RT O l
*GRADING CONTROL
SOIL and TESTING
'K 0
ENGINEERS INC.
JOB LOCATION
CLIENT OR OWNER
REPORT SEQUENCE NO.
GENERAL LOCATION OF FILL
Z-1�5 kle, 1��bic�
PURPOSE OFFILLOR NATURE OF STRUCTURE TO BE SUPPORTED
-E�toU�e Pc,
DATE
3-2310
DAY OF WEEK
� �i.
GENERAL CONTRACTOR
GRADING OR EARTHWORK CONTRACTOR
JOB ENGINEER
HRS.0HARGED0'r"Ai G.ro
CONTRACTOR'S SHIFT
7
CONTRACTOR'S SUPT. OR FORMAN
ASSISTANTS
HRS. CHARGED
SOURCE & DESCRIPTION OF FILL MATERIAL & MAXIMUM DENSITY & M/C
WEATHER
APPROXIMATE YARDAGE
PLACED THIS SHIFT TOTAL TO -DATE
TEST
N0.NSITY
TEST LOCATION
aZ�J /S JC��I D LOTS
ELEVATION
IN
�I FE� .7
COMP.
CURVE
NO.
TEST
MOISTURE
+AOMW%
TEST
DRY
LSE/CU.. FT.
RELATIVE
COMP.
%
RETEST
N0.
NOTES
AUar4l, F� � Seg �iovt
Z
3
133,—
y�r3
Z
eeol cr :�c'c4jo/ t
2
132--7
'So i. i.JPsf .5(!A_
7
Z-
, ¢
1301
97.)
SUPPLEMENTARY REPORT (DESCRIBE EQUIPMENT USED FOR HAULING, SPREADING, WATERING, CONDITIONING & COMPACTING; ALSO REPORTTHICKNESS OF LIFTS, AND
AND NUMBER OF ROLLER TRIPS.)
e r 1,arx ^ l o. I )r 4 rJ 1 61 vl eA
r
r r`hrvA.A (4f r -A
J) or e c c.4 f k I Jn
4.(C���c
• �
wu- 40Atea,-op(e �.�k�e, Cn��[���P�� 'n0
l /4.r 4,11' ick 1 . 1nr^ !C
JOB NO. � COPY SENT TO CLIENT 0 CONTINUED ON NEXT PAGE
PAGE 1 OF ,
105-5/86
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