10898 (SFD)rs
Building
A midi.. 51,105 Ramirez
Owner
David Ross Miller
Address P. 0. Box 722
City La Quinta Zip 52253
Contractor
Pacific Trades
Address .
ty
Zip
State Lic.
& Classif. B 425381
Arch., Engr.,
Designer
Address
P.O. BOX 1504 140. 1 O O U V
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 773-061-016
el. 564-5823 Legal Description Lot a Block 173
Project Description S D
,City ;
Lic. # 1955 Sq. Ft. No. No. Dw.
Size • 1257 Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition .0
Tel.
Permit.'does not include block walls or
City
Zip
State
Lic. #
pool
r 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 Cod�,-.and my license is in full force and
effect. \ \�iL.Pw
SIGNATURE 1 f _ , t DATE
E - OWNER -BUILDER DECLARATION
I hereby affirm that, I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to fife -a signed statement. that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with. Section 7000) of
Dfvkion 3 of the Business and Professions Code, or that. he is exempt therefrom, and the bask
for the alleged exemption. Any violation or Section 7031.5 by 'any applicant for a .permft
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
[11, as owner of the propeity,,'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.' g, however, .the building
Estimated Valuation
7219.50
PERMIT
AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal.
9 • n
1
COr1St.
e
.-� 531 • 50
Mech. `
. 50
Electrical -
' '17. 1 n
or improvement is sold within one year of completion, the. owner -builder will have the burden
-of proving that he did not build or irnprove for the purpose of sale.)
Plumbing
147 . 00 '
O 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.)
❑ I am exempt under Sec. B. 8 P.C. for this reason
S•M..l. ..
7 . 60
Grading
20. 40
Driveway Enc.
20.00
Date Owner
Infrastructure
1654. 1 9
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.)
Poligy No. _Com''pany
O Copy is filed with the city. O Certified copy is hereby furnished.
5.4
TOTAL�.�
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE I
REMARKS
(This section need not be completed if the permit is for one -hundred dollars (5100), valuatbon
or less.) - _
1 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 4o 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 'provisfons of the Labor Code, .you must forthwith
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY:
Minimum Setback Distances: -
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING'AGENCY
Side Street Setback from Center Line
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.) .
Side Setback from Property Line
Lender's Name
FINAL DATE_
Issued by:
Validated by:
INSPECTOR
Date Permit
Lender's 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
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
I IPOWEROUTLET
ROOF DRAINS
CAR P. I SO. FT.
GAS (ROUGH)METER
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN.
SO FT ®
TEMP. POLE �� a�
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
FINAL INSP_7.1
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
o
ROOFING /� 0 � L
aaarrr���
GARBAGE DISPOSAL
FURNACE UNIT WALL .FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
VENTILATION
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
SO. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
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 i PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
ti
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEPTIC TANOUGH
WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF. elf
GAS (ROUGH)METER
LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE �� a�
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP_7.1
FINAL P. —2
$
GRADING
cu. yd.
plus x$
_$
LUMBER GR.
FRAMING !/ /Q
V
o
ROOFING /� 0 � L
aaarrr���
PioWvy 6 /11 � L
6
�1�QolU» �,�
✓
(B I
X. 0
11
V
^'
2 l T'�•
�(��%ZL%j f�r`" •�)
`
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING
MESH
INSULATIONISOUND 6 01 (�
FINISH GRADING
FINAL INSPECTION -1
CERT. OCC.
.. FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
DESERT SANDS UNIFIED,SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated (619) 347-8631
Date 5/14/92
No, 111395
Owner Name
Type of Permit
David Ross Miller
No. 51105 street Ramirez
La Quinta
Permit #
Log #
city La Quinta zip 92253 study Area 113
APN # 773-061-016 1 Tract # I Lot # 0 Square Footage 1 1257
Type of Development Single Family Residence No. of units
Comments
At the present time, the Desert Sands Unified School District does not collect fees on
garages/carports, covered patios/walkways, residential additions under 500 square feet,
detached accessory structures or replacement mobilehomes. It has been determined
the above-named owner is exempt from paying school fees at this time due to the
following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 1.58 X 1 57 or $ 1,986.06 have been paid to W&U.SM. for
the property listed above and that building permits and/or Certificates of Occupancy for
this square footage in this proposed project may now be issued.
Fees Paid By. David Miller Telephone 564=
Name on the check
By James E. Lively
Assistant Superintendent, Business Services
Fee collected /exempted by Vickie J. Durrett
17,,-� - a
Signature Cc,tiL l t�
Payment Received
Check No. 2850
Collector. Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
yf,4,�N•�%'4C
' •_,W .,,yea . �� ,t;,. ;r' 1 �y t Y� : r �, u': • n M1 s .:Y12 .1,..
COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY Assessors Parcel No.
%3 V� I O
-- DEPARTMENT OF ENVIRONMENTAL HEALTH
FApp�llcant:
t
ERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM,
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.
�(Ppl;ro oRthis(application shall remain valid for a period not to exceed one year from date of approval.
LOG 4 & SAFETY APPLICATION
# VERIFY ITEMS IN SECTION A FROM A NON -FEE. BUILDING (goldenrod)
ent ContrO'b"r,tbontact Person
Phone
S8,1
Ad ss City State Zip
o . �>< 7 Z -Z < p �. • �, c a 0" X77 2
Owner
Phone
Address City State Zip
JN
Job Property Address Sty
Rpt Ac .,.:
State
CA
Zip
I -z
Legal Description Prop. (PM, Tract, Lot)
LvT
Lot Size
I
Use of Permit P/P CU, etc.
Other h k
a
ell' MH Sit Prep, etc.
X (u
SS Vim\
c/
b C1 -2 .
Signature of Applicant R
Date
CATEGORY REV CODE }FEE
CATEGORY REV CODE FEE
SUBSURFACE DISPOSAL (per system) 1238 $453.00
❑ SITE EVALUATION UPON REQUEST I 7349 $120.00
❑ MULTIPLE PARCELS WITHIN SAME LAND DIVISION j
t
(NO PLOT PLAN)
❑ SEWER/SEPTIC VERIFICATION 7348 $ 58.00
a. 1st 4 Parcels (Each) 1238 5 $153.00
❑ PRELIMINARY ELECTIVE EVALUATION
b. Each Parcel after 4 7344 er $ 55.00
(Attach DOH -SAN -53) 7352 $ 69.00
❑ REREVIEW (2nd review same parcel) 7344` $ 55.00
❑HOLDING TANK 7351 $119.00
❑ SITE EVALUATION in Conjuction with Critical Area 73461- $197.00
❑ALTERNATIVE EXPERIMENTAL SYSTEM 7345 $656.00
r❑
❑ GRADING PLAN REVIEW DETAILED 1238 $104.00
SITE EVALUATION Lot Less than 10,000 Sq. Ft. 7347 $172.00
❑GRADING PLAN REVIEW CURSORY 1238 $ 55.00
❑ SECOND FIELD VISIT (SITE EVALUATION) 7346 $ 85.00
❑ COPIES (LAND USE) 1 7786-81 $ .50
NITI DATE
Holding Tank Agreements Completed ❑ Yes
Certification of Existing S.D. System Required ❑ Yes 7
��N)
WQCB Clearance Required r'" ❑ Yes
(Attach Form DOH SAN 007, Santa Ana Region Only) .
Soils. Percolation Report Required O Yes NN
Special Feasibility Boring Report Required ❑ Yes B' N
Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes
Grading Handout Provided 1) Yes _ +
Staff Specialist Lot Inspection Required -- - O Yes
Zo
Maintenance Booklet Provided ❑ Yes Lot Inspection Date zlnitials
C/42 / Soils Percolation Boring Report by' ! Lic/Project # Date
(�
��A v AdK x
Soils Map Page Soil Type "+� Approved By Date
s
No. of Systems
Type of System(s)
No. Dwelling Units I
(1) Septic Tank
Soil Rate
crease/sand
H g Tank C3 Replacement
Bedrooms, rliis
t /Lint Trap
aew ❑ Addition
:3601t.1— 4
Gal.
, 3 �(
., Gal.
❑ Existing-,;
r
Sti Ft.
Total Linear
Sidewall Allowance
InstallLine(s) n. long n. wide with
Leach'Bed sq. n.
Bohm Area
n. rocki sq. ft. per running n.
Inlet Tested Depth NA
minin k below drainlines• or
pn, ttom Area
Proposed Bottom Tested Depth
Leachlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
Inlet (Bp
Seepage Pit Total Depth
(TD) '�a8
er:
Max. Allowvle Depth
Applicable
�
))
N/A Overburden Factor.
Well Review Approved: Signature Date Well Drilling Permit #
Grading -Plan A proved: Signature D e
REMARKS: 5yi-�
ZI
This application ' APPROVED%= for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the acco ata=ri ' building permit is necessary for the installation of the above -designed
system, pArmofted in the required resented 100% 1
1) Septic tank must be 100' minimum from any wells 9/ /0
Leach lines must be 100' minimum from any wells, inclu ng a nsion area
3 Seepage pits must be 150' inimum from any wells; including xpension area
,`+
rf //D
Signature of Health Official kt'1 Date
f //
RECEIPT NO. ao� 3(�
I
DISTRICT: ❑ Riverside
DOH -SAN -122 (Rev 1/92)
�t
D� ❑ CASH LtfCHECK NO. a
Issued By ` Date-
eAndi6". ❑ Hemet ❑ "Perris ❑ Rancho Calif. ❑ Blythe
DISTRIBUTION: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Plans/Records