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001724 (SFD)i Building Address 5"28 Owner P.O. BOX 1504 78-105 CALLE ESTADO Patio LA QUINTA, CALIFORNIA 92253 mailing dI Address P.O. B= 1420 City lZip ITel. Contractor .Address -- >r City JZip Tela State Lic. City & Classif. Lic. # 216 Arch., Engr., Designer Address Tel. City Zip State .. - Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that.l-am licensed undenprovisions of Chapter 9 (commencing with Section 7000) of DivisiX",-3on=of thee Business and rofessions Code,_and'my license is in full force and effect. !A, � e%...n Ir �� . _SIGNATURE A- I C .I" -y DATE N•- OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason; (Sec. 7031.5,Business and Professions Code: 'Any city or county 'which requires a permit io construct, alter, 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 ($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. 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.) - - ❑ 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 projects with a contractor(s) licensed pursuant to the Contractor's License Law:) 0 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) valuation ."ss.) 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: If, 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. No. 001724 11LDING: TYPE CONST. VN OCC: GRP. M P. Number 774-2n--018 Legal Description lot 6 Project Description SIMIA-5 ftaUy dMIUM i7M 1440 Sq. Ft. No. No. Dw. Size MR 440 Stories I Units i W New ® Add ❑ Alter ❑ Repair ❑ Demolition ❑ 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 Lender's Address This is a building permit.when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. 1 certify that 1 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 represent tiv s of this city to enter the above- mentioned property for inspectiorro,{/turposes. Y Signature of applicant Date Mailing Address o City, State, Zip HARD COPY PCS VIM PM CIF ei= PMUTT. 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 Estimated Valuation $'75o,524.00 INSPECTOR PERMIT Date Permit AMOUNT Plan Chk. Dep. 250.00— 5fl.€ 0' .Plan Validation: PlanChk. Bal. A2b8C. 52.75 Const: _ 361.0 Mech. 28.00 Electrical- ' ' 78.10 Plumbing 81.40 S.M.I. 5.27 Grading 20.00 Driveway Enc. 28.10 Infrastructure 1,132.86 TOTAL. 2 : Ise _ 1,'7 j8. 98 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 Permit Validated by: Validation: A2b8C. S. 2,.4. 177&48 CK CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. @ $ UNITS r 2ND FL. SQ. FT. @ BONDING YARD SPKLR SYSTEM POR. SO. FT. @ MOBILEHOME SVC. BAR SINK GAR. SO. FT. @ POWER OUTLET ROOF DRAINS CAR P. I SO. FT. @ GAS (ROUGH) DRAINAGE PIPING WALL SO. FT. @ OTHER APP.IEOUIP. DRINKING FOUNTAIN SO. FT. @ TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. BOND BEAM WATER SYSTEM 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 DECVr 17 1 LAUNDRY TRAY 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. SQ. FT. @ c BATH TUB SQ. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID @ 11/4 c SEWAGE DISPOSAL LATHING ' a SQ.FT.GAR @ 3/ac HOUSE SEWER SH GAS PIPING PERMIT FEE INSULATIONISOUND 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 PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC / ROUGH WIRING DUCT WORK ROCK STORAGE ' FOUND. REINF. J GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. 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 DECVr 17 1 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING ' a SH INSULATIONISOUND FINISH GRADING INAL INSPECTION CERT. OCC. FENCE FINAL I UN'J 51UNA I UKLWINI I IALS, GARDEN WALL FINAL S o — = ° BERMUDA DUNEDesert Sands Unified School District N S r RANCHO MIRAGE 82-879 HIGHWAY 111 A INDIO, CALIFORNIA 92201-5678 0 (6119) 347-8631 INDIAN WELLS rn PALM DESERT a P LA OUINTA �o INDIO ,' September 24, 1985 City of La Quints Department of Community Development 78-105 Calle Estado La Qui'nta, CA 92253 Re: 54625 Ave. Rubio Gentlemen: The developer of the above referenced lot has mitigated_j'.ts impacts on'our overcrow:de.d schools by payment of the amount of $628 per.unit to be applied to the cost o district educational faci'li.ties,made necessary by such. new development. Sincerely, John D. Brooks Assistant Superintendent Business Services . JDB/crm ro Z 0 U W y C U Z 0 U W 0 f� '� Receipt No. A 4 C t� �� �Z Issued By flQ District: Riverside ❑ Indio ® Hemet ❑ Date 1 (t DISTRIBUTION: WHITE - Office File YELLOW - Applicant PINK - Building Dept. GOLDEN 3OD - Pending File DOH SAN 122 (Rev 10/84) COUNTY OF RIVERSIDE, DEPARTMENT OF HEALTH PERMIT APPLICATION FOR A SUBSURFACE DISPOSAL SYSTEM Applicant: Submit this form with three copies of a scaled plot plan drawn to county specifications required on the attached check list. A non refundable filing fee of $15 is required when the application is submitted. Check must be made payable to County of Riverside. Name Mailing Address o City State Zip Code Ptione 'Property,Address 'City or Community 'Legal Description of Property (Lot, P'crcel Map, Tract) a u:.� �a .c/ a ,G /w 7e ,'Assessors Parcel No. Water Serving Property From Lot size Signature of Applicant / Date 'The above information must be verified from Building Application Staff Use — Do Not Write Below This Line Initial Date WQCB Clearance required Yes ❑ No ❑ A,�y 1, Cit Soils feasibility report required , Yes ❑ No I 1 Detailed boring report required Yes ❑ No o 1 Detailed contour plot required Yes ❑ No ❑ Comments: Soils or boring report by (� w ` ��' Date Approved by Date Z Soils Map Page Soil Type Tract File No. Other Number of Bedrooms Septic Tank Size (gallons) ����, Rate Required I ��� Z Type of System Addition Replacement 0 oo r �� -i s a 1:1N.w ❑ Leach line sq. ft. of bottom area trench Leach bed (sq. ft. of bottom area bed) Seepage Pit Diameter Number of Pits Seepage Pit Depth B.I. To al Depth of Pit 5' ❑ 6'0 Location of System c�10, Z -( A-!�- Additional Requirements G+ �� l �.�1 l.i ll+� t ^�(i � � l f-( u r � v •,,, t��. A permit is=approved denied f o r t h e design of a subsurface disposal system as indicated on tt• a accompanied plot plan using the requirement's set forth in Section B above. A building permit is necessary for the installation of the above designed system. Signature of Health Official Date f� '� Receipt No. A 4 C t� �� �Z Issued By flQ District: Riverside ❑ Indio ® Hemet ❑ Date 1 (t DISTRIBUTION: WHITE - Office File YELLOW - Applicant PINK - Building Dept. GOLDEN 3OD - Pending File DOH SAN 122 (Rev 10/84)