04992 (SFD)Building
Address 54-595 Rubio
allev La
Mailing
Address A7 V, o'hfr.tt L4aw 4
City Zip Tel." '
Contractor
P.O. BOX 1504 AN ADEQUATELYNW DEBRIU
78-105 CALLE IS REQUIRED ON THE 10B -SITE DURING
LA QUINTA, CALIFORNIAORNIA 92253 9
-77-1 ALLPHAA- ES OF CONSTRUCTION1
Zip I Tel.'
w.
State Lic. City
& Classif. 387934 Lic. #
Arch., Engr.,
Designer
Address I Tel.
City I Zip I State 1
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I 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. r e
..rC, c�.s.,.�„fix � :! .� �� .” y i' i .rJ �.a•' ter. �.
SIGNATURE - % DATE
OWNER -BUILDER DECLARATION
I hereby affirim that 1 am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Susiness and Professions Code: Any my 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 tide a signed statement that he is licensed pursuant to
the provisions o1 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 bast's
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 dc0ars ($500).
❑ 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, 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. H, however, the building
or improvement is sold within one year of completion, the owner -builder wrL have the burden
of proving that he did not build or unprove for the purpose of sale.) . .
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to com.
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 seleinsure; or a certificate of
Worker's Compensation Insurance, or a certified copy,ffiereof: (Sec .3800, Labor Code.)
Policy No Company �' f J
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(this section need not be completed if the permit is for one hundred dollars (E100) 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: H, 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
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
BUILDING: -TYPE CONST. - OCC: GRP.
A.P. Number 7 4—.) 7 3 —a.. t
Legal Description
Project Description
Sq. Ft. 1409
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
4104 f l,trAaP
17f), 6' ponel
Va,nrA
Estimated Valuation
S76.105
PERMIT
AMOUNT
Plan Chk. Dep.
n
Plan Chk. Bal.
6A AS
Const.
IAA is
Mech.
1 nn
Electrical
24.12
Plumbing
n nn
S.M.I.
44 A
Grading
20.00
Driveway Enc.
[ski 00
Infrastructure
1.679.85
TOTAL -
S2.618.43
__V2, •-. 'r
REMARKS
rte. �. qq ••33
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 1 2 %,1 3 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT.
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
AS (ROUGH)
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
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
�/% /f,
/✓f
�F, OUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
FSETBACK
LAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMSER
OR SE161K
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
AS (ROUGH)
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
FINAL INSP.
ROOFING
/� �( , I `l
/U. �/J'
/ / .��/
REMARKS:
VENTILATIONd—
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
III• . THING -/6-
I1''ESH
INSULATIONISOUND
FINISH GRADING
F NAL INSPECTION
/y
CERT. OCC.
1
ENCE FINAL L (p' 0
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF S:n1
NOTICE. -SCHOOL FACILITY FEES +
9 D®C, ENT ���
gg �o f� a �J
TO: City of La Q rota +�� AT ®� IVQ®TDATE: _/ , c>a
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
This is to certify that
developer of Q, - wh'I`tCtif�✓
located at -
this District, has paid school facility fees imposed pursuant to the
authority generated.by Go ernment Code Section 53.080.4n the amount of
covering a total of square feet of ) residential or
( ) industrial/commercial development and that building permits fcr
this footage in this development may now be issued by your jurisdiction.
*'53-S� (✓ o (oj),R-(c. / //)
/j,Q q 1'2'
— //V7/1ab for DESERT SANDS—UNIFIED SCHOOL DISTRICT
/#4 % = // a8 /kk-b'
///,3)(Meo- Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
C/— /` 39173 (10) 37
.={�,.4a r' .° C'':'a1'o�=7,S��q�•.�2 u, �..,a�'°.`; Yi���'i'��"ra�G �.�.sr�*��r.�t�.. ..;;sx: �;: r�,��..r
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4
COUNTY OF, RIVERSIDE. DEPARTMENT OF HEALTH Assessors Parcel No.
77K—
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 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 iron date of approval.
Q
JVERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATDN LOG'*
Z.
0
Agent, Contractor, Contact Person
Phone
Address & Phone
U
STi4 Q A A..,157 -IL d 0,7,1404)
3 O 22. to
W
Cl)
Owner \
60 9a IE EV L.4 AAD
Phone
Mailing Address `y
a 7 C .4Ho-v/rZ U)AP/ _.ZJ
City
-?;qf
State
Zip
Job Property Address �W/44
Legal Description Prop. (PM, Tract, Lot)
q 5?viA-AG-s
92z4
Ac, 7-S", /3L�C!.z a61Nir.2J
Lot Size10Aj�-e16,-.
Use of Permh P/P, CU, etc. - 4A Our .lm
Other
&Dw�elflng
S
HSrep, etc,17/
Signature of Applicant
Date /
CATEGORY: REV CODE
CATEGORY: REVCODEII FEE
_FEE
SUBSURFACE DISPOSAL 1238 $45.00
❑ SITE EVALUATION UPON REQUEST 7349 .l $42.00
❑ MULTIPLE PARCELS WITHIN SAME ` ' -
(NO PLOT PLAN) ;
Z
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 , $11.00
Q
a. 1 at 4 Parols (Each) 1238 $45.00
(Less than 1 year)
H.
b. Each Parcel after4 7344 $16.00
❑ PRELIMINARY ELECTIVE 7352 $45.00
W
❑ 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/EXPERIMEMTAL 7345 $13200
❑ Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $86.00
INITIAL DATE
Holding Tank Agreements Completed ❑ Yes ❑'No r, Ric f /.;t- %-
Certification of Existing S.D. System Required ❑ Yes N
i
WQCB 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 El 10-0."
Detailed Contour Plot Plans Required (1 to 5 it interval) ❑ Yes ❑
Other ❑ Yes tNB
Staff Specialist Lot Inspection Required
❑ Yes l No
Lot Inspection Date
Solis boring report by i Project # Date
j
Soils Map Page Sod Type APPed Date 1r;? 7 v
U
Z
No. of Systems
/Type of Systems)
V Tank ❑ Existing.
No. Dwelling Units l)
(1) Septi Tank
Soil Rate direase/SwW
-mase
❑ding
Bedmoms,�Fixture�lnttame
%d Intcp
0
b'New ❑ Replacement
3/3,0/744- dwi
�
Leach Line Sq. Ft
Sidewall allowance
Install =tt=, Line(s) R long a wide with
Leach Bed sq. ft
h 8ree
ft rock/ ft
per running ft.
min. Indies dreinlines or
,ofbottom� area
L.eachlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
Seepage Pit Total Depth
`
Other.
.
Applicable
M= C11 6 /
Inlet (BI)
/
Max. Alg�Ole/Depth
N/Ay/Overburden factor
//[
No. 2 System/4
REMARKS:
w
This application i -LP RPRP OVED%D ,Wor the category ked in SECTION B above, regarding the design of a suosurface.disposal system as indicated
,.
. 0
on- the `aocompan using. the requirements, set forth •iri•SECTION C,above A building permit is`necessary. for the installation of'the
Z
above designed system: No construcion is permitted in the required reserved' 100% expansion area = :
Septic tank and sewer' tines must be 50' minimum from any wells (-//(f
i
(2) Leach lines must be 100'• minimum from' any'welis, including expan'sIBM ea ds"
Y31 I Seepage pits must be 150' minimum fromajny wells including ar
expansidn
Si nature' of Heafth Official �i / / iC %„� hz� 7-d /?n I,
RECEIPT NO. ' J T Issued By ��t/� �a� - � r�
T - i y
•DISTRICT:' ❑..:Riverside, D Indio. ❑�4Hemet. ❑ Perris.- 0 'Rancho Calif. ❑. Blythe .
,.�.: .. .
DOH SAN 122 (Rev. -5/88) DISTRIBUTION. _ WHITE Office file YELLOW �Applioiint PINK . Bldg. Dept - GOLDErJROD - Plans/Records
r�
- VM R^� 01 ICE OF E. LEON SPAU6Y .
' s
AGRICULTURAL /��Cr,0�1N115510NCR � VES 0 WALLACE
.�,• j d r;\I V V t ASSIVAN't CI)MNIISSIM-Ut .
v [ ^ �� `" WEIGII]S &'NIEASUIZES CLE�IE`11BEtiVE^.ISTE
1�`) S �flt-- � SEALER
`}.'� 49=613 Ilwy 86, -Suite B-12'
'Coachella, CA 92236
-4r v 6q 619-342-8291
DATE 2 — �8 • CASE NO. DPS /ZS 2 O 4- -e
DEVELOPER'S NAME s /a 2 c (5 4>ST.2 �Jc ri o
ADDRESS s Y7 ' �. T.9 f�Q LL /re-,
t.
TELEPHONE: s c) Z0
Dear.Developer:
After.reviewing your landscaping plans, all plant material listed is not in
violation of quarantine laws governing the Coachella Valley. if substitutions
do occur and they differ frun plant material listed, this office must be notified'
immediately:
Thank you for protecting and. preserving the Coachella Valley's Nest -free environment.`
n .L
Agricultural Can sioner's Office
'ec: lndio`'and Riverside Office
2E ;'S�S9S ,SCC B!d L,a
LoT .•5"' dee 27a Z,�
�' 7 7 yc. 2 o 7 t