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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