002354 (SFD)414 l�GliltrGv
P.O. BOX 1504 No. €002354
Building53._210 ,LZ�sfag.� 78-105 CALLE ESTADO 1'
Address LA QUINTA, CALIFORNIA 92253
Owner
Pink
Mailing
Address 52-625 EiSenhouVi 3XIVra
City Zip Tel.
. La eta . . 32353 1 564-0046
Contractor
:Address . -.
ty lZip
State Lic. I City
& Classif.- 39%91 Lic. # 680
Arch., Engr., -
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR„$ DECLARATION
I herebyaffirmthat 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
OWNEk-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 for 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 or 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 rive hundred dollars ($500). - .
❑ j, 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 improvements are not intended or offered for sale. If, however, the building
or improvement 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.)
O I, as owner of the property, am exclusively contracting with licensed contractors to -con-
struct the proiect.-(Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner or property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
.O 1 am exempt under 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
O Copy is filed with the city. 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is forone 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
Laws of California.
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 774-052-011
Legal Description LOT 14
Project Description _Single'fadly
dweniM
Date Owner
NOTICE -TO APPLICANT., If, after making this Certificate of Exemption you should become
ZONE:
BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Sq. Ft. Q j No.
Size - �;^- Stories
No. Dw.
Units
New E�,f Add ❑ Alter ❑ Repair ❑ Demolition ❑
reidg &1w iwindes 140 lig.
ft. of 3 --foot
hicth 'bLack retainincr mall.
Rear Setback from.Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
Ihereby affirm that there is a construction lending agency for the performance of the
Estimated Valuation
q{� ��+ nr� �4 =+ �j ` /��
. f i�7t r 56...1.00 ��ia a i-� � 21:00.01 )
79.515.00
:PERMIT
AMOUNT
Plan Chk. Dep..
Plan Chk.. Bal.
85#41
Const.
339.50
Mech.
30.00
Electrical
76.08
Plumbing
103.00
S.M.I'.
5.09
Grading
20.00
Driveway Enc.
20.€ 0
Infrastructure
1,146.23
mentioned property for inspection purposes.
Validated by:
Signature of applicant Date
'Mailing Address '
TOTAL 2.135.0-
11885.5r `
.REMARKS
A 5 5 4 6
5 7 1885,31 it
HARD COPYT
Date Owner
NOTICE -TO APPLICANT., If, after making this Certificate of Exemption you should become
ZONE:
BY:
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 Center Line
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.) _
Side Setback from Property Line
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I
5�7�8
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
'Mailing Address '
Validation:
City, State, Zip +
A 5 5 4 6
5 7 1885,31 it
HARD COPYT
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
A.C. UNIT
2ND FL. SO. FT. ®
SLAB GRADE
YARD SPKLR SYSTEM
FOR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ, FT, @
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. ®
SEWER OR SEPTI Aft�PROUGH
DRAINAGE PIPING
WALL SO. FT. ®
DUCT WORK
DRINKING FOUNTAIN
SQ. FT. ®
G
URINAL
ESTIMATED CONSTRUCTION VALUATION $
HEATING (FINAL)
OTHER APPJEQUIP.
I�REINF. STEEL
WATER PIPING
NOTE: Not to be used as property tax valuation
TEMP. POLE L
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
SERVICE
FINAL INSP. 6, t,/ -d
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GRADING
yd.
$ —Plus—X$—=$
LUMBER GR.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
X&RAMING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
ROOFING
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
GAR. FIREWALL
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 PLUMBING ',C
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTI Aft�PROUGH
WIRING
DUCT WORK
ROCK STORAGE
/
10, FOUND. REINF. /
G
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
I�REINF. STEEL
GAS (FINAL)
TEMP. POLE L
GROUT
WATER HEATER
SERVICE
FINAL INSP. 6, t,/ -d
BOND BEAM SWATER
SYSTEM
GRADING
yd.
$ —Plus—X$—=$
LUMBER GR.
(,& FINAL INSP.&) 11Wcu.
X&RAMING
ANAL INSP. lO aL!-� �p
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
-
MESH
pN�S
ST!90 OUND 7%�Gt7
FINISH GRADING
iq&INAL INSPECTION 6-6yj-rf
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
4
d�FI ED
0
0 Desert Sands Unified SchoolDistrict
BERMUDA DUNES
RANCHO MIRAGE 0 82-879 HIGHWAY 111 0 INDIO, CALIFORNIA 92201:-5678 0 1619) 30-8631
INDIAN WELLS ti
PALM DESERT
-b
P LA QUINTA
INDIO
May'6, 1986
City of La Quinta
Department of 'Community Development
78-105.Calle.Es-tado
La Quinta, CA 92253
Re- Plot Plan 86-289
Gentlemen:
The developer of the above referenced lot
has mitigated Tts i'mpact§.on our overcrowded
schools by payment
of the amount of $628 per unit to be applied to the 'cost of.
district educational faci'lfties made necessary by such new
development.
Sincerely,
J-%
John D. Brooks
Assistant Superintendent
Business Services
JDB/crm
COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION7_
PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL, SYSTEM � � � - � �Z Cxjah
pplicant: Submit this form with four copies of a scaled plot plan (1-20 scale) drawn to
ounty specifications required on the attached check list. A non-refundable filing fee of
30 is required when the application is submitted. Check must be made payable to the
ounty of Riverside
Building Department Application Log #
Name (Owner, Agent, Contractor, Etc.)
Mailing Address
0c r\ 7tC��_ ��\Pik Y� .4 �
�
� � �1_� i.\�c.e1\l"-,vJ('4�J
City
State
reqd. Yes [
Zip Code Telephone
7
0
*Job Property. Address.
*City or Community
L,
*Legal Description of Prpty. (Lot, PM, TR)
fir,,,4,e7.
�?�•n\
\.�\ 1r<'t- �-\r Uk+ t- XA
*Assessor's Parcel No.
Flater Agency
Use of Permit
Lot Size
Or e'1
SFD, MH Site Prep Etc.
7 Nof#
]
Planning Case #�
Detailed contour plot plans reqd.
Yes[
7 Nor.
7
r
ure of Applican-_ Date
*The above information must be verified from Building Application
Type of System: No. of Bedrooms (1) Septic Tank Soil Rate Required
Existing New Addition Replacement . i 11-`00 Gals.
[ ] IM [ ] [ ]
(2) Leach line sq. ft. Sidewall allowance Install Line(s) Leach bed
(Bottom trench area) ft.. rock/ Sq. Ft. Ft. Long, Ft. wide Sq. Ft. of
per running ft. with Min. inches rock bottom
N/A [ ] below drain lines area
Leach lines/bed-special design (3) Pit Di eter No. Pit Seepage Pit total depth { '�
for slope: Applicable 5' [ ] ' (Ir Pits BI
N/A Overburden factor ' ! y Max. allowable depth
\., k. (kit, , S i
f C>C� C% M-. X (�Cr L ddr!
V' c t c(k f � l F r c ( � rr t { G
x
This application is approve l/denied for the design of a subsurface disposal s --stem as
indicated on the accompanied plot plan using the requirements set forth in Section B above.
o A building_ permit is necessary for the installation of the above -designed system.
H((;,))Septic tank and sewer lines must be 50' from any wells
P (2�`)Leach lines must be 100' min. from any wells including expansion area
W (,'3P Setlepagepits must be 150' minfrom any wells including expansion area
Signature of Health Official Date
RECEIPT NO. ) Issued by !.. C. Date
District: Riverside [I Indio Hemet [ ] Perris [ ] Rancho Calif. [ ] Blythe[ ]
Distribution: WHITE -Office file YELLOW -Applicant PINK -Bldg. Dept. GOLDENROD -Pending File
DOH SAN 122 (Rev. 2/86)
Initial Date
Certification of Existing S.D. System
reqd. Yes [
] No 11
7
WQCB Clearance reqd. -
Yes[
] No[
]
j
Soils feasibility report reqd.
Yes[
] No
Detailed boring report reqd.
Yes[
7 Nof#
]
z
Detailed contour plot plans reqd.
Yes[
7 Nor.
7
r
0
H
Staff Specialist ipfr`oval reqd.
Yes[
7 No_
7
Lot Inspection.Date
c�
w
co
Soils/boring report by
�7
Proj.
# Date
Soils'Map Page Soil Type
Approved by
Date
Type of System: No. of Bedrooms (1) Septic Tank Soil Rate Required
Existing New Addition Replacement . i 11-`00 Gals.
[ ] IM [ ] [ ]
(2) Leach line sq. ft. Sidewall allowance Install Line(s) Leach bed
(Bottom trench area) ft.. rock/ Sq. Ft. Ft. Long, Ft. wide Sq. Ft. of
per running ft. with Min. inches rock bottom
N/A [ ] below drain lines area
Leach lines/bed-special design (3) Pit Di eter No. Pit Seepage Pit total depth { '�
for slope: Applicable 5' [ ] ' (Ir Pits BI
N/A Overburden factor ' ! y Max. allowable depth
\., k. (kit, , S i
f C>C� C% M-. X (�Cr L ddr!
V' c t c(k f � l F r c ( � rr t { G
x
This application is approve l/denied for the design of a subsurface disposal s --stem as
indicated on the accompanied plot plan using the requirements set forth in Section B above.
o A building_ permit is necessary for the installation of the above -designed system.
H((;,))Septic tank and sewer lines must be 50' from any wells
P (2�`)Leach lines must be 100' min. from any wells including expansion area
W (,'3P Setlepagepits must be 150' minfrom any wells including expansion area
Signature of Health Official Date
RECEIPT NO. ) Issued by !.. C. Date
District: Riverside [I Indio Hemet [ ] Perris [ ] Rancho Calif. [ ] Blythe[ ]
Distribution: WHITE -Office file YELLOW -Applicant PINK -Bldg. Dept. GOLDENROD -Pending File
DOH SAN 122 (Rev. 2/86)
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