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003589 (SFD)Tdy Gv P.O. BOX 1504, No. 003589'- Building 0358- Building 78-105 CALLE ESTADO Address 52-295 Ramirez LA QUINTA, CALIFORNIA 92253 Owner Terry `tax BUILDING: TYPE CONST. OCC: GRP.- .. Address A.P. Number 7?1.-7".-w*k1.A City Zip Tel. _ ��� i�rttrt Legal Description Contractor Project Description s4nyg re Eft i 1— Address.. .. City_ Zip. .. Tel.' State Lic. City & Classif.. Lic. # Sq. Ft. No. No. Dw. Arch.; Engr., _. Size sssi. Stories - Units Designer New ❑ •• Add ❑ Alter .0 Repair ❑ Demolition p Address Tel. CityZip State Lic. # LICENSED CONTRACTOR'S DECLARATION hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section ' 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE .. .. .. _ . OWNER -BUILDER DECLARATION EStlmateCl, ValuationI hereby affirm that I am exempt from the Contractor's License Law for the following�.I ` reason: (Sec. 7031.5,Business and Professions Code: Any. city or county which requires a 00 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 thal,he is licensed pursuant'to - PERMIT. - AMOUNT 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 • Plan Chk. 'Dep.' C;,(t t' subjects the applicant to a civil penalty of not more than five'hundred dollars ($500).- - q I; as owner of the.property, or my employees with wages as their.sole'compensation, will Plan Chk.,Bal.' w do the work, and the structure is not intended or offered for sale: (Sec. .7044, Buisness and . COr1St. 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, ' Mech. ' .. 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 Electrical - ; 7a.00 of proving that he did not build or improve for the purpose of sale.) _ • 0 1, as owner of the property, am exclusively contracting wilh.licensed contractors to con- Plumbing M 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 S.M.I. - - 5. 78 such projects with a contractors) licensed pursuant to the Contractor's License Law.) ❑ I am exempt under Sec. B. 8 P.C. for this reason - Grading 20.00 Driveway Enc. 20.00 Date' Owner .riInfrastructure 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 isfiled with the city.. ❑.Certified copy is hereby furnished. _ TOTAL $2,798.78 CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (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 thg 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 1 ;r Laws of California. ih, ry ! ti Date .Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemptionshould' become ZONE: - BY: subject' to"the Workers' Compensation provisions of the Labor Code, you'you_ must forthwith .Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. - - - Front Setback from Center Line CONSTRUCTION LENDING AGENCY. Ihereby 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's 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 l 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 ' City, State, Zip HARD COPY i Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR. - NSPECTORIssued Is . suedby: Date 1 /2618Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. ® $ 2ND FL. SO. FT. POR. SO. FT. ® GAR. SO. FT. ® CAR P. SO. FT. WALL SO. FT. ® SO. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation ROUGH PLUM FLOOR DRAIN MECHANICAL FEES HEATING (ROUGI'r( , WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GAS (ROUGH) LAUNDRY TRAY AIR HANDLING UNIT CFM HEATING (FINAL) - 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 BOND BEAM SO. FT. ® c WATER HEATER MAX..HEATER OUTPUT, B.T.U. I SO. FT. RESID ® 1+/a c SEWAGE DISPOSAL LUMBER GR. SO.FT.GAR ® 3/ac HOUSE SEWER �INAL INSP. �_ ��� OOFING GAS PIPING PERMIT FEE, I 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 PLUMBIN NDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUM BONDING HEATING (ROUGI'r( , STORAGE TANK FO M SEW I A ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) - OTHER APP./EOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE 2-110/1 GROUT WATER HEATER SERVICE 00'FINAL INSP. BOND BEAM WATER SYSTEM $ GRADING cu. yd. plus x$ _$ LUMBER GR. FINAL INSP. �pP� FRAMING �INAL INSP. �_ ��� OOFING -T/,V �1 /J i�/ �/_ -G(/��� / o ji \ REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING S/ MESH GkNSULATION/SOUND L FINISH GRADING ,'/ZINAL INSPECTIOl f -S;- a' CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS. GARDEN WALL FINAL Desert Sands Unified School District CERTIFICATION OF PAYMENT OF SCHOOL FACILITY FEES TO: City of La Quinta Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 DATE: Sol Cw%ol as Doc �v • This is to certify that , developer of which is located at i- within this District, has paid school-f46iity fees imposed pursuant tm the authority�enerated by Government od Sectiot 53080 in the amount of covering a total of square feet of (g,,-�res deutial or' ( ) industrial/commerc'ial development and that building permits for this footage in this development may now•be issued by your jurisdiction. for DESERT SANDS UN IED SCHOOL DISTRICT + White - Building Department • Yellow - Facilities Plannin • Pink - Accounting 0 Gold", Developer l� • / (F r (10)-37 Ell co Z O U LU U) Y cr Q LU 101 COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION 773- a6`- OXY` 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 specifications required on the attached check list. A non-refundable filing fee of $40 is required when the application is submitted. Check must be made payable to the County of Riverside. r % b Building Department Application Log # Name (Owner. Agen ontractor. Etc.) Mailing Address City State Zip c9de Telephone -Job Property Address day -c?% C.., '� Legal Description of Property. (Lot. PM. TR) e�?�,��� o{- �-;G./-7 'Assessor's Parcel No 7 73 �/ a i -aier A enc _deft , , a>/ �/ �� !1 _ Use of Permit Pia�Ang Case M SFD. MH Site Preparation Etc. Lot Size / � AQ R $,gnalure Of Appl, nl Date 'The above information must be verified from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE Initial / Date Certification of Existing S.D. System required. ❑ Yes��A� - -� WOCB Clearance required. ❑ Yes o� Soils feasibility report required. ❑ Yes i Special feasibility boring report required. ❑ Yes cs� Detailed contour plot plans required. ❑ Yes 0` N , Staff Specialist approval required. ❑ Yes Lot Inspection Date Soils/boring report by Project # Date// Soils Map Pag4 1, Soil Type Approved by Datef Type of System: 40 ❑ Existing 54 ew ❑ Additional ❑ Replacement No. of Bedrooms .3 h^ 00,?( (1) Septics Tank �uw Gals./� Soil Rate equired G� ( Leach line sq. ft. (68thm trench area) Sidewall allowance ft. rock/ Sq. Ft. per running ft. ©1%A Install Line(s) Ft. Long, Ft. wl twit min. inches rock below drain lines Leach •ed Sq. Ft. ofabo om area Leach lines/bed-special design for slope: Applicable_._ N/A �� Overburden factor (3) Pit DiameterNo. . 6' Pit Pit BI j /�4 Seepage Pit total depth Max. allowable depth SLOE ./ 0 lGl�.rt-Grf -� This application is pproved i'ed<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 permitA necessary for theins Ilati of the above -designed systgm. 1) Septic tank and sewer lines must 4150' from any wells -4/ 1 IGv (2 Leach lines must be 100' min. from any wells including ex •ansi n area C� 3) Seepage pits must be 160' min. from a y ells including expansion area G �0 f-,�A 4�1�/� �►-ac.�-+ � S� Signature of Health Official Z RECEIPT NO._ / Issued by `��& A , Date �-�V�- District: ❑ Riverside -Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe Distribution: WHITE -Office file YELLOW -Applicant PINK -Bldg. Dept. GOLDENROD -Pending File DOH SAN 122 (Rev 8187) /0 J7 16 " ST UCC \ `,S( -1. t)AAN it Sys 7�0� RIGHT S o v T ft � .° SOOT Ir Yr3) r UrYf?) iD -A),v,,,s 7j •r -; t-, r O J 1 pi A `v 5'� . ! ! � � C { _ I V. artt I { 6'0 At DPS, ( <t iJ :n I S P A \, C -T y�? f . \ • l u F_ r, H it { �`)-�' �, 7,_ i1 J_. 5HE ET �D j _ t Fi1w, A G\ Y S % \ u. 30 V 1000 C. UTlL�TY r --- .rY �, T-Jp a3 POLE y -