06710 (SFD)T4ht 4 4. Q"
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 52-770 Rubes LA.QUINTA, CALIFORNIA 92253
Owner
The Bab= Family Trust
Mailing
Address 42-710 Lim HaU Poad
CityZip Tel.
Bermda Duras 92201 1 .
Contractor
Hitbael Yews
Address
Tela
State Lic. I City
& Classif. 354862 Lic. #
Arch., Engr.,
Designer
Address Tel.
No.
BUILDING: -TYPE -CONST. OCC: GRP.
A.P. Number 773-313--003
Legal Description
Project Description UD
06710
Sq. Ft. 1,642 No. No. Dw.
Size Stories Units
New O Add ❑ Alter ❑ Repair ❑ Demolition ❑
City Zip State
Lic. #
Z 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 1 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
permft to construct, alter, Improve, demolish, or repair any structure, prior to its issuance also
requires the applicard for such permit to file a signed statement that he is licensed pursuant to
the provision,'of the Contractor's License Law, Chapter .9 (commencing with Section 7000) of
Dmsion 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any vk#ation of Section 7031.5 by 'any applicant for a permit
subjects the applicant toe civilpenally of not more than fire hundred dollars (8500).
❑ 1, 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 Contractors 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 Mgt such improvements are not intended or offered for sale. If, however, the building
or Improvement is said wilhrn 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 proiects 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) vatuation
or less.)
1 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 Calnfomia
Date Owner
NOTICE TO APPLICANT: M, after making this Certificate of Exemption you should become
suWect to the Workers' Conpensafron provisions of the Labor Code, you must forthwith
crampy with such pvovisars Or Ibis 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 Nanu
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.
1 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
stimated Valuation
$91.361
Minimum Setback Distances:
PERMIT,
.
AMOUNT
Plan Chk. Dep.
)
6$250.0)
Side Street Setback from Center Line
Plan Chk. Bal. 4ll
Side Setback from Property Line
$ 263.14
Const.
INSPECTOR
603.54
Mech.
Issued by:
53.50
Electrical
115.57
Plumbing
157.50
S.M.I.
6.44
Grading
20- 0a
Driveway Enc.
20.00
Infrastructure
2017.37
TOTAL
$39507.W
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
12/5/89
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
PLUMBING FEES
UNDERGROUND
A.C. UNIT
COLL. AREA
IST FL. ' SO. FT. $
UNITS
r
BONDING
HEATING (ROUGH)
YARD SPKLR SYSTEM �
r
2ND F� SO. FT.
Poe
SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
GAS (FINAL)
TEMP. POLE ''2111ya
DRAINAGE PIPING
CAR P. I SO. FT. ®
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN.
BOND BEAM
WATER SYSTEM
URINAL
FT ®
GRADING
cu. yd.
$ -plus-x$-=$
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
ROOFING /�/fiQ/%
jL
FLOOR DRAIN
MECHANICAL FEES
REMARKS:
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
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, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
MESH
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
FINISH GRADING
SO.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///
ROUND PLUMBING /f�
9
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE/ 11% O
ROUGH PLUMB.
4F
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
Poe
SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE ''2111ya
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP. O
GRADING
cu. yd.
$ -plus-x$-=$
LUMBER GR.
FRAMING i'?} /*A
FINAL INSP.
ROOFING /�/fiQ/%
jL
f� `2 /, �y„ , _
`
Q
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALLVV
LATHING' WI, / Y/16 Pv
MESH
INSULATIOWSOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
,11,...1 j`•^y=-•tet '�,',aG y.3 „ii. :z �y 'Sr.�St �•�•.:. .:N.
�:- fa r yaw7'...+r�'cs.b`F-v;Fy��
RECEIPT NO.
Lf0K7/6 Issued By U I Date
1
DISTRICT: ❑ Riverside, ❑ Indio ❑ Hemet • Q Perris ❑ Rancho Calif. ❑ Blythe
DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records
a/
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COUNTY OF RIVERSIDE ENVIRONMENTAL A""'O1f NIX
HEALTH SERVICES DIVISION
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 IlsL
A non-retundable 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.
Q
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG #
Z
O
Agent or, Contact PeMnhone
int fsO��/
i%i% (/J2-�/D
Ad ress &Firm .^ ��
L i n4�t OWL
�(A
Oww. r'
/L/ 7lQcJ5`Ir�
q? 14,11A #41 �lr �1120�
U)
-7t6 ZADt)'X-5
CityJ _ /_
t
Zip
Job Pr Address
Legal Description Pr (PM, T L�)
Lot Size
Water Agency/Well
Use of Fenn' P/P, CU, etc.
Other
1
0� t V
1�1JDwell
MSite
Pref, etc.c
Signature of Applicant
Date
CATEGORY: REV CODE FEE
CATEGORY: REV CODE FEE
)K SUBSURFACE DISPOSAL 1238 $ 57.00
❑ SITE EVALUATION UPON REQUEST 7349 $ 43.00
CO
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348• $ 17.00
Z
a. 1 st 4 Parcels (Each) 1238 $ 57.00
(Less than 1 year)
b. Each Parcel after 4 7344 $ 24.00
❑ PRELIMINARY ELE(tTIVE 7352 $ 23.00
W
❑ Rereview (2nd review same parcel) 7344 $ 24.00
EVALUATION (Attach DOH SAN 53)
C&
❑ 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 No
Certification of Existing S.D. System Required ❑ Yes No
WOCB Clearance required. (Attach Form ❑ Yes No
DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required. ❑ Yes No
Special Feasibility Boring Report Required. ❑ Yes No
Detailed Contour Plot Plans Required (1 to 5 ft interval) ❑ Yes No
Otlter ❑ Yes No
Y,
Staff Specialist Lot Inspection Required ❑ Yes No
Lot Inspection Date
Solis boring report by Projecd #t Date
Soils Map Page Sort Type Approved by i Date
No. of Syslems
Type of Systems)
No. Dwelling Units
(1) Septic Tank
Soil Rate
Grease
Z
0
❑ Holding Tank ❑ Existing
XNew ❑ Replacenwrd
Bedrooms, Fixture Units
*31y
/%/) o
I
t• c� Z
2 J
G I
rW' of
V v Gal
IUB/ p
Gal
U)
(2) Leach Line Sq. FL
Sidewall allowance
Install Line(s) It. long ft wide with
Leech.Bedraq:
Bottom trench area�,,�+�
'N�nnin�tt sq• ft
min. inches rock below draJnlines.or
of bottom area
perLeachlines/bed
special design for slope:
(3) Pit Diameter
No: Pits
Pit Below
SeepsQ� Pd 9ta1 Depth
ether
Applicable
Inlet (BI)
(TD)
1+y�%�gT
ZQ aMf F le epi
N/A Overburden tecta
T
❑ 5 6���
No. 2 System
REMARKS:
This application i APPROVED/ DENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
/plan,
oCl n the accompan using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
Z
above -designed system. No construction is permitted in the required reserved 100% expansion area.
0(1)
Septic tank and sewer lines must be 50' minimum from any wells
U
Leach lines must be 100' minimum from any wells, including expansion area
Seepage pits must be 150 from any wells, ` cludi� expansion area
U)
r
1 -
Si nature of Health Official Date
RECEIPT NO.
Lf0K7/6 Issued By U I Date
1
DISTRICT: ❑ Riverside, ❑ Indio ❑ Hemet • Q Perris ❑ Rancho Calif. ❑ Blythe
DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records
a/
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7iADURESS
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luear Wveluper1
ftdsctr ilatcl hlotm� ;An
till 1116th tiyterlol lisledsu�sllluttivlts,;:
nEter IcevleW jig your le {.. 1C ...
violntcil oC yua�?tttlnp 1'tl•rs �cweii try llr" ��6lteal� Vulley•; ,
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[t�sn I,lntrt: nalel lul'`llsteil� tills vt`Cice nrvsl tie tiotEiec�
do .occur.. Eutd t , y
servlt llie Cvoc1ie11� Valley'_s. Vest-[]ee envlrolrt�ent.
'111mik you lvr-pculectL y olid l le ,,y
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF L4
SCHOOL FACILITY FEES CA
�lJtl
TO: City of La Quinta DATE: 1,20
49
Department of Community Development
78-105 Calle Estado [p ,^��Yl�o t� t�tS t� s►1
La Quinta, CA 92253 NQTICE: ICE: THi33 DOCC'U�°3 ENT CANNOT
BE DUPLICATED,
This is to certify that GLI�`7
developer of which is
located at within
this District, has paid sch�,,lacility fees impose pursuant to the
authority generated by G�yernmTent Code Section 53080 in the amount of
covering a total of square feet of ( ) r sidential or
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
for DESERT SANDS•UNIFIED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37