05731 (SFD)Building 52-510 RUBIO
Building.
Owner
W. R. BAKE.
Mailing
Address 52-448 HAVARRO
City A QUIVTA zip 92253
Contractor
OWNER/BUILDER
City
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer.
Address Tel.
City IZip I State
Lic. #
4
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
LICENSED CONTRACTOR'S DECLARATION
11 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
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.S,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 We a signed statement that he is licensed pursuant to
the provisions• of the Conbactor'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 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, Suisness 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) rrcensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
DateOwner
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 ff the permit is for one hundred dollars ($100) valuation
or less.) "
I certify that in the perfomnancefof 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 f ,
Date Owner
NOTICE TO APPLICANT: ff, 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
1 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 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 Address
City, State, Zip
No.
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 773-283-001
Legal Description
Project Description
05131
Sq. Ft. 1650 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $95,143.00
PERMIT
AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal.
.277.22
Const.
521.50
Mech.53.
W
Electrical
120.41
Plumbing
157.50
S. M.I.
6.72
Grading
20,00
Driveway Enc.
20.00
Infrastructure
2,102.45
M& FICiJ 1 ! r 19,.ta':' S�>;j Lf,16 l''! i
TOTAL
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 5/12/89 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
ROUGH PLUMB.
BONDING
MOBILEHOME SVC.
BAR SINK
POR. SQ. Ff. ®
FORMS
SEPTIC TANK/AL,,
POWER OUTLET
ROOF DRAINS
GAR. SQ. Fr. ®
DUCT WORK
ROCK STORAGE
FOUND. REINF.
DRAINAGE PIPING
CAR P. SO. FT. Q
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
DRINKING FOUNTAIN.
WALL SQ. FT.
GAS (FINAL)
TEMP. POLE
URINAL
SQ. FT. @
GROUT
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEWPERM
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+A c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3Vic
HOUSE SEWER
GAR. FIREWALL
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 PLUMBIN71
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEPTIC TANK/AL,,
ROUGH WIRING,
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) 3 sJ
/
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 //Aw
FINAL INSP. . /y
ROOFING/0 .�(�-
�j
O u
o
b
a
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING fDWN ' 0
MESH
INSULATION/SOUND `ry
s
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
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rt
Fitch Engineers Inc.
January 17, 1990
City of La Quinta
78 105 Calle Estado
La Quinta, Ca. 92253
SUBJECT: 52 510 Avenida Rubio
Gentlemen:
Enclosed please find beam calculations for the above referred to
residence. These calculations show that the 4 X 8 beam used along the front
entry way spanning 13 feet will support the load transmitted to the beam.
Respectfully,
WM. H.
FITCH
R.C.E.
12571
CIVIL ENGINEERING — PLANNING — SURVEYING — DESIGN
P.O. BOX 4551 PALM DESERT, CA 92261
(619) 345-7667
U
K
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH IAssamis Parcel NO'
ENVIRONMENTAL HEALTH SERVICES 1773 -02Lf3 - 04)
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 3 SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'*
Agent. Contractor, Contact Person
^
Phone
Address 8 Phone
-
Mailing Address
L�
-g",
fly
ip
ob Property Address
Legal Description (PM, tact, Lot)
=
7
edwp ✓!t
i. &-12 , %S� G
Lot Size
Water A�gencYi 1; i
Use of Permit P/P, CU, etc.
Other�Q
c�[7
Ilir@, MH Site P , etc.
1 �
Date
Signature of Applicant
CATEGORY: REV CODE FEE
CATEGORY: REV CODE FEE
Oee-SUBSURFACE DISPOSAL 1238
❑ SITE EVALUATION UPON REQUEST 7348 $42.00
❑ MULTIPLE PARCELS.WfTHIN SAME
r
(NO PLOT PLAN)
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
a. 1st 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 -J
❑ 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
IWM��LL� DATE
Holding Tank Agreements Completed ❑Yes No //v/tom ' � 3��
Certification of Existing S.D. System Requited ❑ Yes No
WbCB Clearance required. (Attach Form ❑ Yes No
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 it interval) ❑ Yes
Other ❑ Yes
Staff Specialist Lot Inspection Required- Q Yes No
Lot Inspection Date
Soils boring report by Date
A=��J
Soils Map Page / Sol Type `-'� Approved by Deme 3-23
No. of Systems
Typkjof Syatem(s)
No. Dwelling Units /)
Septic Tank
Soil Rate
Greeae/Send
.
ydding Tank ❑ Existing" .
O Replacement
-`Bed a
_(1)
G'Mase IMap
38D�+ - /IMk
���Gal
f
(2) Leech Line Sq. Ft
area
Sidewall allowance
ft.
Irretall,,,�_ Lme(s) R kxig ft wide with
_
L
Bed sq, ft.trench
sq. L
pft. rookl fl.
NA
min. irxhes"r w� drai A=.or6
of rea
a ���
Leachlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
Seepage Pit Total Depth
.�fK/N/A
Other.
Applicable
/
J
Inlet (Bq
Overburden factor
/ [ / f'
Max. AI 34 � Ie+Depth
No. 2 System 1114-
4-REMARKS:
REMARKS:
This application i PPROVED T E -01 -for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the aaoompan' pot 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 160%,expansion area.
(1) Septic tank and sewer lines must be 50' minimum from any wells
Leach lines must be 100' minimum from any wells, including expansion area' r
G�ry�th
kir(3 Seepage pits must 1550Qm-i�nimuum/from any wells, including expansion ar /� �� .
o r
. 'I'.
' w' /q�
Si nature of Health Official 3' Dat
� f
RECEIPT NO. 5,0 0 9_ Issued By W/1 Date
DISTRICT: ❑ Riverside, L9",/ Indio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe -
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
i
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