001178 (SFD)APPLICANT NAME (L, F. MI) BriJ.�^in PJcran e '
AODREss P.O. BO2c -•1040 '
� PERMIT
APPLICATION •• [!'; � 3 —'o r
City of La Ouinta
<• Department of
Building and Safety!
• This permit becomes void if work not commenced within 180 days from date of issuance. OR, if.work has been suspended or abandoned for a (.eriod of.180 days.-
_ t
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSVION INSURANCE: This.section need not be completed if
LICENSED CONTRACTORS: DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9
the permit is.lor one hundred ($100) 0, less. I certify that L'1 the performance of the work for which this permit is '
(commencing with Section 7000) of. Division 3 of the Business and Professions Cade; and my.license is in full force
issued, I shall -not employ any person inany manner so ast-, become subject tothe Workers'Compensation Laws of '
and effect. - - '
California.
License Class :Lic..Number
Date Applicant
• Date Contractor
NOTICE TO APPLICANT: It, after making this Certificate:ol Exemption; you should become subject to the Workers'
'• OWNER -BUILDER DECLARATION, I hereby that I airi�exempt fro m" the�Coritractor's License Lav for the •
Compensation provisions of, the Labor Code, you must forhwith comply with such provisions or this permit shall
be deemed revoked.
,.following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permil,to ... •
'.
•• construct, alter, improve. demolish, or repair, any structure, prior to its issuance, also requires the applicant for'
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:. - r,
such per miVto file a sig ned statement that he is licensed pursuant to the provisions of the Contractor's License Law
O'l hereby certify that no ex . cavation five (5) or more feet irrdepth in . to which a person is required to . descend, will be
(Chapter 9(commencing with section 7000) of Division 3.o1 the Business and Professions Code)or.that he is exempt
made in 'connection with work authorized by this permit, a td that no building structure. scaffolding. falsework, or .
therefrom and the basis for the alleged exemption: Any violation of Section 7031.5 by any applicant for a�DermiI.
Idemolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2,-Sec341, Title8,
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): •
CAL.)' .
0 I. as owner of the property, or my employees with wages as their sole compensation„will do.the work, and the
p As owner -builder, I will not employ anyone to do coo k which would require a permit from the -Division of
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License .
Industrial Safety; as noted above; unless such person ha: a peimit to do'such work from that division.
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. It, however, the
O Division of Industrial Safety Permit No
building orimprovemntissold within one year ofcompletion, the owner -builder will have the burden of proving that-.
Date - Applicant
he did not build or improve for the purpose of sale,).
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
0 1. as owner ofthe property; am exculsively contracting with licensed contractors to construct the project (Sec:
of the work for which this permit is issued (Sec. 3097, Ci •. C.). .... ;,� ...,�...
7044, Business and Professions Code:•TheContractor's License -Law does not applyto an owner of property who
Lender's Name
' builds or improves thereon, and who contracts for such projects with.a contractor(s) licensed pursuant to the
LOT SZ
,-Contractor's License Law.).
Lender's Address
O I am exempt under Sec. '� B 8 P.C. (Att ched,Certifjcate)
° r `y
� •
I certify.that.l have read this application and state that theabove information is correct. I agree to comply with all
.. .. - - r
Date Owner',
city and county ordinances and state laws relating to building construction, and herebyauthorize representatives
' '-•
of this countyto enter upon the above-mentioned property for inspection purposes. •' -
WORKERS' COMPENSATION DECLARATION:1 hereby affirm that thave a certificate of consent to self -insure, ora
.
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec..3800..Lab. C.).
Signature of Applicant or Agent 5 Date
Policy No. Company 7
'
CERTIFICATE OECOMPLIANCE AND AUTHORIZATION OF ENFRY: I certify I have read this statethat
❑ Certified copy.is hereby.furnished.
the information given is correct. I agree to comply with at state laws and county ordinances relating to buidling `r
' O Certified copy is tiled with the City Buildidq Inspection Department or City Department:
.. , .
constructio . and authorize a'representative,ol the City a La Ouinta Department of Building and Safety to enter
upon the'pioperty for which,) have applied�fo tAis+permirfor the purpose of'making inspections: < •. ,
Date Applicant
/ i. (•
:
`signature iof Applicant o�Agr� Date
/
Print Applicant/Agent Name
APPLICANT NAME (L, F. MI) BriJ.�^in PJcran e '
AODREss P.O. BO2c -•1040 '
CITY/COMMUNITY/STATE/ZIPJa eta',.CA 92253
JOB SITE ADDRESS/SPACE 53-'320 Avenida Ramirez '
CITY/COMMUNITY/STATE/ZIPJ
s
a QWnta, CA 92253
B K74
/
P UG82
PRO04C'
'22.00
CAckk Fee
TWN .
RNG ! •,
SE .
'S
TRACT - -
LOT21
6.65
PUmbi,ng Fee '
MOD
S8
450.00
TRACT NAME
OWNER NAME (L. F, MI)' Awlicant ` '• .
CONTRACTOR -FIRM NAME fli& � JojjnSil: fo f' 0ngC3t
' - V 11t1�11t�y z\.Alltii\.
ADDRESS P.O. Box 2288
CITY/COMMUNITY/STATE/ZIP T,,..7: �i •/�7t 92202
PHONE • 347-7171 ,J1�A�V
L�I•C3C57169
ARC/ENG FIRM NAME ...
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE •
TOTAL
FEE.
LICNC A,
w
USE OF PERMIT s111 JA: CYW6^
BL
ZON
,FSB
SSB
SSB .:RSB
OFC
LONE ORD a
LOT SZ
END :•.
SIDE* -
. APPUPRMT ' S r '/ y
i■■' �TF
35-85 �.P. D• .
Permit to cconstxvct 1592 sq. ft. of S.F.D:;
' 1
91 sq. ft of porch drd 430 sq.ft. of 1
image as per, appy Pis • ; , ..•
Mech• Fee
'22.00
CAckk Fee
• �:'tO poi; 3� ;
�Plan
� ���rp�(T� /'�
Elect. Fee
43.13
SDI Fee
6.65
PUmbi,ng Fee '
50.50
Prop, Devel. Free
450.00
. 250.00) ' PD 12/14 4-;
•
TOTAL
FEE.
1-•3l&:fl5 .
i
»•r
` r VALUATION} j%':
- BLDG. DEPT.. ' ..
NO.
OPERATION DATE INSPECTOR
NO.
OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
rj
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Compart.
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
S7f
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
10A
Fireplace T.O.
❑
NO.
NO.
ADDITIONAL INFORMATION
V
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath`
12A Drywall S
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal S
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL P/1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
` ,%fIEo
o
e/�'
C
Desert -Sands Unified School District
y BERMUDA DUNES r
RANCHO MIRAGE
82-879 HIGHWAY 1'11 O INDIO, CALIFORNIA 92201-5678 • (619) 347-8631
_ INDIAN WELLS y
0 PALM DESERT.a
%P LA OUINTA ��
January 1 %., 1,985
p INDIO 1
City of La Quinta
Department of Community
Development
78-105 Calle Estado
La Qui'nta, CA 92253.
Re: 53-320 Avenida
Ramirez
Gentlemen:
The developer of the
above referenced home
has mitigated its'i'mpacts
on our overcrowded schools by payment
of the amount of $628
per unit to be appli.ed'to the cost of
-district educational'facili:ties
made. necessary by such. new
development.
Sincerely,
John D. Brooks ..
Assistant `-Superintende.nt
Business Services
JDB/crm
r
Z
0
U
W
iN
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O'
F
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RIVERSIDE COUNTY 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
/3 r x
City
State
Zip Code
Phone
'Property Address
'City or Community
'Legal Description of Property (Lot, Parcel Map, Tract)
'Assessors Parcel No.
Water Serving Property From
Lot size
7-X1 A" e-1 e-r�� ���% r
-fir, x
Signature of Applicant Date
'The above information must be verified from Building Application
Staff Use — Do Not Write Below This Line
Initia Date
WQCB Clearance required Yes ❑ No 4
Soils feasibility report required Yes ❑ No
Detailed boring report required Yes ❑ Not
Detailed contour plot required Yes ❑ No [b
Comments: 1
Soils or boring report by r` Lam' Date
Approved by Date
Soils Map Page Soil Type Tract File No. Other
Number of Bedrooms
Septic Tank Size (gallons)
Rate Required
Type of System
New Addition Replacement
El Q
Leach line sq. ft. of bottom area trench
Leach bed (sq. ft. of bottom area bec)
Seepage Pit Diameter
Number of Pits
Seepage.Pit Depth B.I.
Total Depth of Pit
Location of System
74 AV-t�+ �� 'bkO t:Z t. 1(\
Additional Requirements
(L o
A permit is approved/denied for the design of a subsurface disposal system as indicated of the accompanied plot plan
using the requirements set forth in Section B above. A building permit is necessary for -he installation of the above
designedf(s,ystem. .
Signature of Health Official Date f
Receipt No. '��Cl n �� Issued By -K ec
District: Riverside ❑ Indio .0 Hemet ❑ Date _Q��
DISTRIBUTION: WHITE - Office File YELLOW - Applicant PINK-' Building Dept. GOLDENROD - Pending File
DOH SAN 122 (Rev 10/82) '