001318 (SFD)} PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
r This permit becomes void if work not commenced within 180 days from.date of issu
LICENSED CONTRACTORS 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 Gode: and my license is in.full force
and effect. �__....
License Class Lic. Number
Date Contractor
OWNER -BUILDER DECLARATION: I hereby alfirm'that-1 am exempt from tliq 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 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 oLlhe 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 applicanPfora permit
subjects the applicant to'a civil penalty of not more than five hun I4d1,.dollars ($500.):
0 I, as owner of the properly, 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„Business and Professions Code: The Contractor's License
Law does not apply to an owner of property who builds, or improves thereon, add.who does such,work himself or
through his own employees, provided.that such improvements are not intended or offered for sale. It, however, the
building or.improvemnt 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.).
0 I, as owner of the property, am exculsively contracting with licensed contractors to construct 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 contractorls) licensed pursuant to the
Contractor's License Law.). f
0;1 am exempt under Sec. \ t� B. 8 PaC. (Attached Certificate).
Dale owner - '
WORKERS'.COMPENSATION DECLARATION: 1 hereby affirm that I have•a certificate of consen to self -insure, or a
certificate of Workers' Compensation Insurance , or a certified copy/thereof (Sec. 3800. Ldld'.C.).
Policy No. Company
' 0 Certified copy. is hereby furnished. .
0 Certified copy is filed with the City Building Inspection Department or -City 'Department. .
Date Applicant
APPLICANT NAME (L; F. MI)
ADDRESS '
P.O. Box' 1341
CITY/COMMUNITY/STATE/ZIP
La Qui.nta, CA .92253
JOB SITE ADDRESS/SPACE
514.405 Avenida Ramirez
CITY/COMMUNITY/STATE/ZIP '
La Quintin, CA 92253
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PI.tHt1JLM Fee
TRACT NAME•
OWNER NAME (L, F. MI) AWlicant .
CONTRACTOR -FIRM NAME applicant
ADDRESS a�YG
CITY/COMMUNITY/STATE/ZIP abme
PHONE •
- 50.00 PD. DEPOS17
LICNC./
984.03
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE II
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,
USE OF PERMIT
single fanuly duiellim
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RSB
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LOT SZ
. 'END
SIDE
once, OR, if work has been.suspended or, abandoned for a period of 180'days.
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This -section need not be completed if
the perrnit.is for one hundred ($100) o, less. 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
_Date Applicant
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.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:,
0 I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be
made in connection with work authorized by this.permit'and that no building structure, scaffolding, falsework, or.demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8,
C.A.C.) '
0 As owner -builder, I will not employ anyone to-do *work.which would require a permit from the Division of
Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
0 Division of Industrial Safety Pgrmit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
.o19he work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's'Name
Lender's Address
certify that I have read,this application and state that the above information is correct. l agree to comply with all
city and county ordinances and state laws relating to buildingconstruction, and hereby authorize representatives .
of this county to enter upon the above-mentioned property for inspection purposes. '
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: _I certify I have read this application and statethat
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
construciibn, and authorize`a'aepresentative ogle City of La Ouinta Departmentof Building and Safety to enter
upon the property,for which f,have applied for this permit for the purpose of making inspections.
Signature of/Applicant or Agent / Date
1 _
Print Applicant/Agent•Name
APPL/PRMTn.ni �� 8
P- -85 S.F.D.
Pennit to construct 1205 sq. £t. of
house with 61 sq.
ft. of porch. and
480 sq. ft. of garage as per apprvW
Fiiar�s •
Mech • Fee
28.00
Plan Check Fee
274.81
Const, Flee
325.00
Elect. Fee
70.74
%a Fee
4.48
PI.tHt1JLM Fee
81.00
Prop- Devei. Fes
450.00
1,234.03
- 50.00 PD. DEPOS17
984.03
TOTAL EE
1,'234.02
A 0 6 3 7
BLDG. DEPT.
4. 10
VALUATIONju 63,688.00
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION DATE ` INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
4c,
�� ,
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
ra •x(40 ge— 57Cj
35
Furnace Compart.
3
Steel
Ll— S $
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
ay
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
❑
43
Final 72
10A
fireplace T.O.
❑
NPON
ADDITIONAL INFORMATION
G
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb 4-
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final Y4
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL P/I
STREET NAME
26 Power Pole --o G
27 Conduit
28 'Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Finalcl 5' OT 1Y
GAM
j
I
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
L IA
PC) iia zs
City
State
Zip Code
Phone
. a, (Jildnt a
' -cam; . , I
-,- -0-'2-5.
'Property Address
'City or Community
'Legal Description of Property (Lot, Parcel Map, Tract),
�J—ati V
L,, ��
!vl 2 ?'--�3
Ao,
'Assessors Parcel No.
Water Serving Property From
Lot size
(" �V
S
�T&I',Ili'
__
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
Soils feasibility report required Yes ❑ No
Detailed boring report required Yes ❑ No
Detailed contour plot required Yes ❑ No
Comments-.-
omments:Soils
�' /'r��' ti r "c
Soilsor boring report by �r �� Date
r
Approved by Sal- Date
Soils Map Page Soil Type Tract File No. /Oiher��
Number of Bedrooms
Septic Tank Size (gallons)
Rate Required
Type of System
, �
New Addition Replacement,
[
❑d�
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.
Total Depth of Pit
5' ❑ 6' p'
",v r
Location of System / / J
Additional Requirements
A permit is approved/denied for the design of a subsurface disposal system as indicated on the accompanied plot plan
using the requirements set forth in Section B above. A building permit is necessary for the installation of the above
designed system.
i
r en- '-y2 7
Signature of Health Official Date
Receipt No. (: q� ! c/
District: Riverside ❑
Issued By
Indio 13' Hemet ❑ Date
r7- /o- S'
DISTRIBUTION: WHITE - Office File YELLOW - Applicant PINK - Building Dept. GOLDENROD - Pending File
DOH SAN 122 (Rev 10/84)
r 4.
78-105 CALL`E EST'AD0 LA QUINTA'- CALIFORNIA: -92253 = (619) 564-2246
October 3 1985
RE: Dan and Ann Jerninas'l.newly constructed, home.
51-405 Avenida: Ramirez
The above.mentioned,property is.in what we call a Flood Zone AO.
This means-the.finished,,floor, must, be- 2,'fbet above;the.highest
point of -the crown of tfie'°° street : _' `
x
The property in questioir has been inspected -aiid .was found to be
in accordance withall-building'standa_rds; including_ the height
of their finished floor -pad.; -
If you have any questions, please contact the-undei'signed at
La,Quinta.City Hall.
Sincerely,
00MMUNITY DEVELrOPMENT . DEPARTM=
BUILDING. DIVISION
T(xn :Hartung.
Buildirig�,Inspector
TH/psn