08089 (SFD)Building
Address
Owner
Bfi2
Mailing
Address
City
16
E S�
Contractof'
AddreAddre—�1iav:
City
TAtif
44
f�GGfGV .
P.O. BOX 1504 No. 08089
78-105 CALLE ESTADO
��� .� LA QUINTA, CALIFORNIA 92253
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BUILDING:. TYPE CONST. OCC: GRP.
A A.P. Number 773-033-00
Legal Description L.# 9g
Project Description Simla Famllv nmltinn
Zip I Tel.:
State Lic. I City
& Classif. Lic. #
Arch:, Engr.,
'Designer
Address Tel.
City ( Zip ( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70 OO) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE,'.! w 7`'•'- "-'• DATE
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 to 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 (S500).
❑ I, as owner of'the property,tor`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
orimprovement 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.) '
' ❑ ],as ownerof.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 contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exer4t'untler 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
0 Copy is filed with the city. O 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 ($100) valuation
or less.) .
I certify that in the performance of tha 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.
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 f6r'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 sof this city to enter the above-.
mentioned• property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
Sq. Ft. No. No. Dw.
Size . 1466 Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
4A
PERMIT _ AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech. Q
Electrical
Plumbing r�..
S.M.I.
Grading
Driveway Enc. >n
Infrastructure _ *A
TOTAL 204_:"IM—AV—
REMARKS IMAiR
REMARKS
� tJfr;3•.. c lav
is Gt: r. afc:.f5�;
ltr"iIdi+; 'f'91�Y�`
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 DATEINSPECtTOR
Issued by:
Date V11 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
FOR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SO. FT. ®
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEQUIP.
DRINKING FOUNTAIN.
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FRAMING 7 (e ,a?w
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAL
5
G�71 0
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/acHOUSE
SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE4ELECT.FEEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE 1PL.CK.FEE
CONST. FEE '
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR'
SETBACK
GROUND
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
414 SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (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.
NAL INSP S
FRAMING 7 (e ,a?w
FINAL INSP.
ROOFING /1._< A
VENTILATION G
LAL
5
G�71 0
REMARKS:
FIRE ZONE ROOFINGFIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING-� Oww % /J Q
MESH
INSULATION/SOUND 7/3 %
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
r
GARDEN WALL FINAL
TO:64l�
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
SCHOOL FACILITY FEES
DATE:
=C)
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NOTICE: THIS DOCUMENT CANNOT
BE DUPLICATEDt
This is to certify that K
developer of which is
located at , within
this District, has paid school facility fees imposed pursuant to the
authority enerat d by G vernment Code Section 53080 in the am unt of
$ �. ( O -) 96�®O
covering a total of square feet of ( ) sid ntial 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
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to
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Ass"f01P"O'1No'
ENVIRONMENTAL 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 Ilat
A non-refundable filing fee (see below) is required when the application is submitted. Check must be made payable to:,the County,of.•
Riverside. Appy al.of this application shall remain valid for a period not to exceed one year from date of approval.
VERIFY ITEMSCiniSECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG #.'f +
ai4tZintractor, Contadi -°Person
PhoneAddress
& Firm
Owner
Phone
Mailing Address
City �(/'�''
�Aj 9��"
State
Zip
t Job Property Address +
jgjrption Prop. (PM, Trect lot) `
�U rsy.e "t
'
Ij L
9,0
1
L•0 f ilzt Mrrir+f
Lot Size
Water Agency/Well
Use of Kermit P/P, CU, etc. {*% ,•
Ottier
r
•
- , p
Dwelling qi Site Prep, etc.
/
iii auk f z� t .�„ S
t}: dNy���� d
'h.
Signature of Appli r>t * .
Q Datew C
CATEGORY: REV CODE FEE
. —1" +,
CATEGORY: REVZODE;.1
•SUBSURFACE DISPOSAL 1238 R $ 57.00
711!
O SITE EVALUATION UPON REQUEST 7349r `,$'43.00'
MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $ 17'OO;f,
a. 1 at 4 Parcels (Each) 1238 $ 57.00,
(Less than 1 year) y
b. Each Parcel after 4 7344 $ 24.00
O PRELIMINARY ELECTIVE , .'. 7352 $ 23:00
O Rereview (2nd review same parcel) 7344 $ 24:00
) '
EVALUATION (Attach DOH SAN 53 ,4 ;y
❑ Site Evaluation in Conjunction with
❑ HOLDING TANK 7351 ' $ 47.00'
CrtticelAiea'�� 7348 $111.00
O ALTERNATIVE/EXPERIMENTAL 7345. $222.00
❑ Site Evaluation Lot Less than•',
SYSTEM,
10,000 Sq. Ft. • 7347 $ 87.00
v" }
INITIAL' * DATE
`71
Holding Tank Agreements Completed 11 Yes ([r] No $ mow* •�
Certification of Existing S.D. System Required 0 Yes P No
• ,"� +^"
WQCB Clearance required. (Attach Form ❑Yes � No �
DOH SAN 007, Santa Ana Region Only)
SdIs Percolation Report Required. ❑ Yes No
Sp'ecal FeasibilityBoringReport Required. ❑,Yes No •1 #
Detailed Contour Plot Plans Required (1 to 5 ft interval) • ❑ Yes No-
Other • ❑ Yes No
Staff Specialist Lot Inspection Required, „ , _ O Yes No' '•' ,
• �Lol Inspection Date A
.i �(0 fa ` ' a
Sills boring report by Pro)ect Data
Sails Map Page ` °I Sol Type Approved by A;. I d (./ I U Dda e
No. of Systems
Type of Systems) '
No. Dwelling Units
(1) Septic; Tank
Soil Rate
Greese/Send
/
f
❑ Holding Tank ❑ Existing
' New ❑ Replaoemm"
Bedrooms, Fixture Units
( s�t2
Grease Intcp
y 11
b �• 21 beg, '
I♦�
% Vt%Q
I �lU
m
Gal
�
Gy
(2) Leach Line Sq. Ft
Sidewell allowance`, ---
Install Line(s) K long $ wide with
Bar egift « .
Bottom trench anis„.4
�• fL
running fL
min. inches rock below drsinl¢iee•
boltomarea
0 NA
l9echlines/bed special design for slope:
(3) Pit Diameter '
No. Pits
Pk Below
Seepage Ph Total Depth {
i Other:
Applicable
•'
Inlet (BI)
(TD) -1 7'
N/A. Overburden factor
❑ 5 6 \
..
/y !.
Mez: Allowable Depth /
No. 2 System C
-
REMARKS:
+ice
t
6
This application is APPROV4DENIED for the category checked in SECTION Baabove, regarding the design of a subsurface disposal system as indicated
on the accompanied.010tAn, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
above -designed system. No construction is permitted in the required reserved 100% expansion area.
i
Septic tank and sewer lines must be 50' minimum from any wells
(2) Leach lines must be 100' minimum from any wells, including expansion area
'miiniimumm..fr000mmany
wells includin expansion area
(3) Seepage pits must be 150�.IMG
Z;& go
Signature of Health Official . Date
f �17hd
RECEIPT NO.� Issued By I ( fd� Date J y
DISTRICT: ❑ Riverside, ❑ Indio ❑ Hemet O Perris ❑ Ranch • Calif. ❑ Blythe
i •
.. r
DOH -SAN -122 (Rev. 319o) •DISTRIBUTION: WHITE -.Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
OFFICE OFd
AGRICULTURAL COMMISSIQNER.
AND'
WEIG,NTS *,MEASURES,
..,, s.. CALVIN C:•KAMINSKAS.
JAMES O: WALLACE 4080 LEMON STREET ROOM 19 nssistont commtsstoner '
Aprlouthrrdl Commtsstoner RIVERSIDECALIFORNIA+92501 CLEMENt BENVENISTE, .
1 M
dtouct Welphts.easures Sector
ofteE�
� f (714) 78Z-2561.:
49613 Highway -46 , Suite. 812
Goacheha, Ca
`;92236
(619) 342-8291-:
DATE S� n C� 1 ci 0' O CASE NO. 2L_ --s (0 (Pq t�
DEVELOPER'S NAME= � Y'
ADDRESS: --0 12o -G boo's� iCi23U�=✓• �'% �� L. F
i
TELEPHONE:'(���j) S b - 'Y��.Z7
wc-lK '(o (o i
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Dear. Developers L-A QO mT-ALAQZZS3
After reviewing your landscaping plans, all plant material listed is not in
violation of gUarantihe laws governing`,the' -Coachella, Valley. If substitutions
do occur and they differ frcan.plant .material lis ted, .this -off ice•must be notified
immediately. t
Thank you for protecting and preserving the Coachella Valley's pest -free environment..
i
Agricultural Canniss ioneTV's Office 7
cc: Indio and Riverside Office
Lu S' ' WQSV�i ►� r o.
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40 Buena Engineers, Inc.
79-811 B Country Club brive
Bermuda Dunes, CA 92201 • (619) 345 1588
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Client Name `
Client Address
c
Client Phone
DATE
TEST LOCATION
JOB NO.
ELEVATION
FIELD.TESTING
'lpf
PROJECT
4' L
Loi ?v
,���;►a��
LOCATION
L '
a
CONTRACTOR
OWNER .
(10W”) C
cvr
WEATHER
TEMP. o at AM
( /) (
1 J l'L- V�. z
° at PM
PRESENT AT SITE
je j2 1
A -
-TEST
NUMBER
n..F�
TEST LOCATION
LOT'
NO.
ELEVATION
FIELD.TESTING
REFERENCE CURVE
MOISTURE
. CONTENT
%
DRY
DENSITY
lbs./Cu.ft.
MAXIMUM
DRY
DENSITY
%
MAXIMUM
DRY
-DENSITY
lbs./cu. ft..
OPTIMUM
MOISTURE
CONTENT
%
---1 A4
A -
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-
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REMARKS:
f
FIELD REPORT
CLIENT REPRESENTATIVE SIGNATURE TECHNICIANS SIGNATUREK/� t1 Q