003736 (SFD)•
gig&
444
P.O. BOX 1504 No. 00736
78-105 CALLE ESTADO
Address 52-825 Ramie. LA.QUINTA, CALIFORNIA 92253
Owner
Joe W. Sterna.-.
BUILDING: -TYPE CONST. OCC: GRP.
Mailing
Address
City Zip
La
. Cain -a 9223
Contractor
Address
A.P,Number. 773-322-017
Tel.
42•-3170 . - Legal,Description
Project Description``
HARD COPY
City -
Zip
Tel.
State Lic.
City
& Classif.
Lic. #
Sq- Ft.No. No. Dw.
1250
Arch., Engr., ..
Size Stories - -Units
Designer
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ -
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
7000) of Division 3 of the Business and Professions Code, and mylicense is in full. force and '
effect. t
_SIGNATURE DATE
' OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law forth; following$66,877
Estimated Valuation
reason: (Sec. 7031.5,Business and Professions Code: Any city or county . which • requires a
•repair
permit to construct, atter, improve, demolish, or any structure, pdor'to its',,issuance also
• requires the applicant for such permit to file a signed statement that 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 Yiofessions Code, or that. he. is exempt therefrom, and the basis
for the alleged exemption. An violation of Section 7031.5 by"any applicant for, a permit
- r
Plan Chk. Dep:.$250.00
'subjects the applicant'to a civil penalty'ofnot more than five hundred dollars.($500). -
..
Plan ChkBBI. c7p s t
❑ I, as owner of the property, 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
Const. 3-31.00
Professions Code: The Contractor's License Law does 'nol'apply to. an owner of .property who.
builds or improves thereon and who does such work himself or through. his own' employees,
Mech. 36-00
provided that such .improvements are, not intended or offered for sale. 1f, however, the building
or improvement is sold within one year of completion, the ownerbuilder will have the burden
of proving that he did not build or improve for the purpose of sale.) -
_• Electrical 69.75
❑ I, as owner of the property,, am exclusively contracting' with licensed contractors to con-
Plumbing ��
struct the project. (Sec. 7044; Business and Professions Code: The Contractor's License Law,
does not to builds improves thereon, for. -
S.M.I. -
apply an, owner of property who or and who contracts
such projects with'a contractor(s) licensed pursuant to -the. Contractor's License Law.) -
""'�
.•
Grading ;
e:
0-
- O I.am.exempt.under Sec. -•- B. & P.C.- for
for this reason,
s
Driveway Enc. 20,. 00
Date -Owner ' `
Infrastructure 1,469.00
WORKERS' COMPENSATION DECLARATION
'I hereby -affirm that 1 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 is, filed with the city.. .❑ Certified copy is.hereby furnished.
TOTAL S2,341.34
CERTIFICATE OF EXEMPTION FROM _
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundredI
'dollars ($100) valuation
; „-,,., .,n„r. .w rF-; ripe-,
or less.) - - -
I certify that in the performance of the work for which this permit is issued, I shall not
,1,,. ,..i,
,
S
iwf1 B r d r-�
J
{( y?rj`�ay t, �ianpi;w ..v nqI 'i y
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 ofExemption. you should become
ZONE: ----
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Line '
hereby affirm that there is a construction lending agency for the performance of'the
.Center
work for which this permit is issued. (Sec. 3097; Civil Code.)
Side Setback from Property Line -
Lender's; Name
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.
FINAL. DATE INSPECTOR '
"� / 8
I certify that I have read this application and state that the above information is'correct.
Issued by: Date Permit
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.
Validated by:
Signature of applicant --Date-
ateMailing
MailingAddress `
Validation:.
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT. ®
WALL SQ. FT. ®
SQ..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
'`5
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER .
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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.
SQ. FT. ® c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/a c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSP.
ROOFING
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 PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK �—
GROUND PLU BING
UNDERGROUND
A.C. UNIT
COLL. AREA
i� SLAB GRADEC/—C
'`5
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR W1
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_ $
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
9�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL t )�y e
lee
LATHING /
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL
"
Desert Sands Unified School District
L CERTIFICATION OF PAYMENT
OF Sr7J
SCHOOL FACILITY FEES f
TO: City of La Quinta DATE:
Department of Community Development
78-105 Calle Estado
La Quinta CA 92253.H
2253 .:tn gt
BE Dpi LI A`ED.
This is to certify that
developer of p which is
located at�- within
this District, has paid school fac i y fees imposed pursuant to the
authority generated by Government ode'Sect•o,t 53080 in the amount ofd
$ /, 8%S xx ( —
covering a total of 5 square feet of (1,-) "residential-or
( ) industrial/commercial development and that building pe_mits 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
y0 --7o3.�&..1 c,o> s7
I
71"
COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION
`3.1- - 0 7
PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM x73
Applicant: Submit this form with four copies of a socale d plot plan (1-20 scale) drawn"to C66nty '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.
Building Department Applicx.ion L60 #
Name (Owner. Agent. Contractor. Etc.)
C; 72E�;2-bl)
Mailing Address
y
State
�I
zip cod
Telephone
j
'Job Property Address
,-City or.�Commuq)ty
M_6w/l 'Al j.
'Legal Description of Piciperly. (Lot. PM. TR)
V'17
'Assessor's Parcel No
-173 3-� 2
(_WatercAgencj'6rwL4j_
Use Of Per�11—NI-tt& Z2^^Plaorning Case #
Lot Size
H Site Preparation Etc.
7
Signature of Applicant✓ Date'
*The above information must be verified from Building Application
STAFF USE- DO NOT WRITE BELOW.THIS LINE
2 Initial Date
Certification of Existing S.D' System required. ❑ Yes 2 No
WQCB Clearance req6ired. Yes No.
Soils feasibility 'report required. El Yes 2 Nox
Special feasibility boring report required. El es 12 No
Detailed contour plot plans iequired. Yes .12 No
Staff Specialist approval required. El Yes ®No Lot Inspection Date
Soils/boring report by 2 Project # Date
- - — -� i _f . 7 -efli
Y
Soils Map Page �/s Soil �Tvy I _6 __•-Approvecl by Date 3•
Type of System: V
No. of Bedrooms
3
(1) Septic Tank
/am
Soil Rate Required
0 Existing QNew Additional ❑Replacement
(2) Leach line sq. ft.
.11
Sidewall allowance
Line(s)—Ft Long,
Leach bed Sq.
(Bottom- trench area) d
ft. rock/Sq., Ft.
ft. 4 N/A
Ft -.wide with min. inches
drain ll�ne
Ft."ofibpttom
per running
rock below
are
Leach'lj�nes/becl-specia/Sesign for slope:
(3) Pit Diameter
No. Pits
Pit BI r
SeepaW Pit total depth
I Applicaple,__-_`*�fi
U ' factor
N/4__�verb' rden
!�---'O
Max. alowable.depth
/�
A
e,
This application-i-s-appr—ovedl�nTedifor the design of a subsurface disposal system as indicated on the accompaiied plot plan using the requirements
set forth in Sec��Dn—B —abdveA 66ildin.g permit is necessary for the installation of,the above -designed system
(1) Septic tank and sewer lines must ee 50' from any wells—Y /a
(2) Leach lines must be 100' min. from any wells including expappon area
7,V
Seepage pits must be'1501 min. from any wells including expansion areq_/
(.4.
Signature of'Heallh Official
RECEIPT NO. 33'J-3 Issued by— Date—
District: ❑ Riverside El Indio El Hemet 0 Perris 0 Rancho Calif. El Blythe
Distribution:. WHITE—Office file YELLOW— Applicant PINK—Bldg. Dept. GOLDENROD— Pendinc File
DOH SAN 122 (Rev 8/87)
P