05531 (SFD)Building
Address
Owner
4
P.O. BOX 1504
52�9�2 �B 78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Stnrose Properties, I=.
Address 72-850 Sosera Rd.
City Zip Tel.
Pelf desert 92260 6
Contractor
sate
.. Address
Tela
State Lic. I City
& Classif. 517085 1 Lic. #
Designer ' Buebmlans Drafting
Address Tel.
619/340-0887
City Zip State
Palm Desert 92260 Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affil that 1 am.ficensed under provisions of Chapter 9 commencing with Section
7000) W Division 3.of'the.Business'and Professions Code,.#gdlicense is in full force and
effect
SIGNATURIEz'DATE
OWNER-I11.11ILDEf1 DECLARATION
1 hereby affmn that I am exempt from the Contractor's License Law for the following
reason: (Sec- 7031-S,Bshess and Protessions 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 fcamt for such perxT to fie a signed statement that he is licensed pursuant to
the provisions of the CmbacAor-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 exenptiom. Any violaffm of Section 7031.5 by 'any applicant for a permit
subjects the appirai to a ciWpenafy of not more Nan five hundred dollars (5500).
❑ 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
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 ammovemens are not intended or offered for sale. If, however, the building
or improvement is sold w&A ane year of completion, the owner -builder will have the burden
of proving that he did not brill or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sec 7044, Business and Professions Code: The Contractors License Law
does not appy to an owner of property who bolds or improves thereon, and who contracts for
such projects with a cord acem(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date Owner
1MORKEFO COMPENSATION DECLARATION
WorkI hereby
Compensation Mat I have a certificate of consent to self -insure, or a certificate of
pensation Insurance, ora certified copy thereof. (Sec. 3800, Labor_Code.J
Policy No Company N" is:'�* ". -
OrCopy is filed with the city- ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(rhis section need not be completed if the Permit is for one hundred.dollars ($100) valuation
or 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 California
Date owner
N077CE 70 APPLICANT-- f, ager nmakfng this Certificate of Exemption you should become
subject to the VAN*am' Conparsafion provisions of the Labor Code, you must forthwith
comply wih such pmrsimms or this pend 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
Lenders Address
This is abuilding permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certity that 1 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. Zm
No. 05531
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 773-32a-011
Legal Description Lot 16
Project Description
Sq. Ft. 1437
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ 'Demolition ❑
Estimated Valuation
$71,11$.OQ
PERMIT.
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
l9 . , 3
Const
Mech.
4'.1311
Electrical
108.88
Plumbing
1641.03
S.M.I.
5.04
Grading
20.00
Driveway Enc.
20.00
Infrastructure
1,564.74
TOTAL
G
REMARKS
.3.�'LFX,•°�'`"�T�ti?rt2 !� Yt"lt°t i] ' '�S:11'i i. � i f �•
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 DATE INSPECTOR
3115/89
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR SQ FT ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEQUIP.
DRINKING FOUNTAIN.
FT ®
TEMP. POLES
✓✓✓
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�
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
1
lT
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
SPARK ARRESTOR
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LATHING �% , /d
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBI
VrttNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
OR SEPT
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLES
✓✓✓
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSPQ
GRADING
cu. yd.
$ plus x$
-$
LUMBER GR.
FRAMING 7�
FINAL INSP.
ROOFING
1
lT
REMARKS
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING �% , /d
MESH
G,6NSU LATIONISOUN D�'�j- Jr '�"7
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
1
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF'.
SCHOOL FACILITY FEES
- NOTICE.- THIS �OC:t6MENT
CAN
�E DUPLN ®T
IC
Tb":'t"y of La':Quinta DATE:—�—%
C,
-Repa'r'tment.of..Community Development
78=105 Calle .Estado
.:.. La :Q,u,inta•,",. CA 92253
rA
th• s is .to certif that
,
dev'e:loper of
which is
loc"aaed 'at ¢ " a —
,-- within
this' D.ist.iica..,-vias paid school facility fees imposed
`purse to the
. uthor'i. gene:r,at d by o ernment C e Sect'ost 5
080 .in the amount of -'�a
'....: co.v.e•ring a "'tot*;wr of ; square feet
of ( -residential o"r
) i*ndus.tria"1./pomme_r.cial.development and that building
permits for
this footage inethks: development may now..be-issued
by _ydur jurisdiction.
:. ( 1461.
" for DESERT S DS
UNIFIEj1_SCHO0L DISTRICT
White "'"Building Department . • Yellow - Facilities Planning "0' Pink -Accounting
• Gold -Developer _
1101-37
In
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No.
177-3-
ENVIRONMENTAL HEALTH SERVICES 7
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 list:
A non-refundable filing fee (see below) is required when the application is submitted. Check must,:)e made payable to the County of
Riverside. Approval of this application shall remain valid for a,period not to exceed one year from date of approval.
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'*
Agent Contractor, Con ct PersonPhone
.9
Address & Phone
ILI 42 = r- - L-:� 102
7-2-
-
Owner
Phone
Mailing Address
C*
,J
State
Zip
2
Job Property Add -19
_2
Legal DescribtiDn Prop. PM, Tract, Lot)
,5;7
Lot Size',
ter Ag6ric-YAwr
Use of Permit P/P, Cu. etc. 4 q LV(W,- AJ
Other
A
Is'
z'A
Date,
Signature Of Ap scant
CATEGORY:. REV CODE EEE____
CATEGORY: REV.CODE FEE.I
SUBSURFACE DISPOSAL 1238
0 SrTE EVALUATION UPON REQUEST 7349 $42.00
0 MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
LAND DIVISION
0 SEWER/SEPTIC VERIFICATION 7348 $11.00
a. 1 st 4 Parcels (Each) ..1238 $45.00
(Less than 1 year)
b. Each Parcel after 4 7344 $16.00
0 PRELIMINARY ELECTIVE 7352 $45.00
• Rereview (2nd review same parcel). 7344 $16.00
EVALUATION (Attach DOH SAN 53)
• Site Evaluation in Conjunction with
13 'HOLDING TANK 7351 .$45.00
Critical Area 7346 $86.00
0 ALTERNATIVIE/EXPERIMEN11 - AL Y :-7345 $132-00,
13 Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $86.00
ANITIA
4� V DATE
Holding Tank Agreements Completed 0 Yes WeNo
Certification of Existing S.D. System Required 0 yes
W0CB Clearance required. (Attach Form 0 Yes No
DOH SAN, 607, Santa Ana Region Only)
Soils Percolation Report Requlred. 0 Yes yon
Special Feasibility 136ring Report Required. 0 Yes
Detailed Contour Plot Plans Required (1 to 5 ft. interval) 0 yes - No
Other 0 Yes
Staff Specialist Lot Inspection Required 0 Yes 0�No
Lot Inspection Date
Soils boring report by Project # Date
Soils Map Page SOV Cd C, Type Awroved by d La— Dale 3-Z
No. of systems
Tyly of Systems)
19 Holding Tank 0 Existing
No. Dwelling Unite (.()
Bedrooms, 154mejUnlis
(1) Septic Tank
Soil Rate
Grease/Send
%,.Grease Intop
0 Replaomnent
GRI
(2) Leach Line Sq. Ft
"iciiom trench am
Sidewall allowance
It. fL
Install Llne(s) It. long wide with
-Leach Bed sq. ft.
rack/_ sq.
per running ft.
min. __14, �rock.!Wlow drainliries or
of b'ottogh
Leachilros/bed special design for slope:
(3) Pit Diameter
No.,Pits
Pit Below
Seepage Pit Ir Depth
Applicable
pp Icable
N/A Oveftr�en factor
6
Inlet (6)
t
r
.
MaiAlowab� Depth
_Leff
440
No. 2 System
REMARKS:C-
This application APPROVED -NIED-for, the category checked in SECTION B above, regarding the design of a s ibsurface disposal
' Z""u uRJ indicated
system as
'requirements
on the accompani&!-M�paus"ing the 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.
1 Septic tank and sewer lines must be 50' minimum from any wells
S-6
&2 Leach -lines must be 100' minimum from any wells, including e n grea
Seepage 150' from
pits must be minimum any wells, including expansioN area
ignature of Health Officia) Date
RECEIPT NO. Issued B
Dat9s
DISTRICT: 0 Riverside, Indio 0 Hemet 17 Perris 0_ Rancho Calif. 0 Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLD =NROD - Plans/Records
Z