001177 (SFD)PERMIT APPLICATION
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 period of 180 days.
LICENSED CONTRACTORS 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 my license is in full force
and effect.
License Class Lic. Number _
Date Contractor
OWNER -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 to 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 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 byvany applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
O 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, Business 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 i mprovemnt is sold within one year of completion• the owner -builder will have the burden of proving that
hedid not build or improve for the purpose of sale.).
O 1, as owner of the property, am exculsively contracting with licensed.contractors to construct the project (Sec.
7044. Business and Professions Code: The Contractor's License Law does not apply to an owner o1 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:r•� -' _ 'r`B:Y..C: {�ftacched Certificate)..
Date Owner,s
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, ora
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800: Lab. C.).
Policy No. Company
O Certified copy is hereby furnished.
O Certified copy is filed with the City Building Inspection Department or City
Date Applicant
Department.
APPLICANT NAME (L, F. MI) Brian 11d's xx*
ADDRESS P.O. B= 104U
CITY/COMMUNITY/STATE/ZIP La 7i=ta, CA 9 153
JOB SITE ADDRESS/SPACE *,)J-.J4U Menlda HaMIXeZ'
CITY/COMMUNITY/STATE/ZIP Za QU; n•a, CA 92253
11C�+�
BOK74
PtG'32
PRVG,®GJ
C
TWN
PING
SE
S,
TRACT
LOT 20
MOD
se
TRACT NAME None
OWNER NAME (L. F. Mq Applicant
CONTRACTOR -FIRM NAME PI& Johnson Clonstn=tim.
ADDRESS P.O. ECSC 2288 .
CITY/COMMUNITY/STATE/ZIP JrKl o, C 92202 '
1..1177����ii��JJ
PHONE • 347-7171
1.1.357169
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE •
LICNC •
-
USE OF PERMIT fmn ly dwelling
�AG-.-•..a.Aj+,
rf-SSB
BL
ZON
F39
SSB
RSB
OFC .
ZONE ORD .
I
LOT S2
END 1
SIDE
M1
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPEN£ATION INSURANCE: This section need not be completed it
the permit is for one hundred ($100) o, less. I certify thct in the performance of the work for which this permit is
-issued. I shall not employany person in any manner so a . to become subject to the Workers' Compensation Laws of
California.
Date Applicant
NOTICE TO APPLICANT: If. after making this Certificate :If Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must YJrthwith comply with such provisions or this'permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATON:
O 1 hereby certify that no excavation five (5) or more feetin depth into which a person is required to descend, will be
made in connection with work authorized by this permit and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, will be more than thir-y-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title 8,
C.A.C.)
O As owner -builder, I will not employ anyone to do work which would require a permit from the Division of
Industrial Safety, as noted above, unless such person las a permit to do such work from that division.
O Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that dere is a construction lending agency for the performance
-of the work for which this permit is issued (Sec. 3097, civ. C.). +
Lender's Name
Lender's Address
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state lawsrelatingto bulding construction, and hereby authorize representatives
of this -co uttty to,epter upo`if a- ve"m tpropeLtyQfor inspection purposes.
z Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF :NTRY: I certify I have lead this application and state that
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
construction, and authorize a'representativeof the Cit- of La Ouinta Department of Building and Safety to enter
upon the propedyy jo,:which I,l ��a�lied fo�t6is;perni[ lop the purpose of making inspections.
Si nature of Applicant or Agent% 7 Date
Print Applicant/Agent Name
APPUPRMT nni 1 77 VIS -85 S.F.D.
Permit to construct 1592 sq. ft. of S.F.D.
91 sq: ft. of porch and 430 sq. ft. of
garage as Per approved Plans.
Mech. Fee 22.00
Plan Check Fee 306.33
Const. Fee 388.00
Elect. Fee 43.13
Smi. Fee 6.65
Plimcbing Flee 50.50
Prop. Devel. Fee 450.00
11266.61
\A (250.00) PD. 12/14
�Q. 1r068Y95
1,016,•61
TOTAL
FEEL
•
BLDG. DEPT.
VALUATIONn�QO
v /.
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION I IDATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
�-
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
?
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
ADDITIONAL INFORMATION
' I
/ —t—,14
'fly
�u� y / O � / , 4 .
/ V
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath AL
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C7 Ceiling (Blown)
14 Final
PLUMBING APPRqVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
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
P/L P/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures '
31 Service
32 Final
�\f1Ep
-
. _ = —0
Desert Sands Unihed . School District
y BERMUDA DUNES r
' RANCHO MIRAGE-
82-879 HIGHWAY 111 O INDIO. CALIFORNIA 92201-5678 I6f9) 347-8631
' INDIAN WELLS,, H
o .PALM DESERT
"
f�LA OUINTA 7�a
Jahu.a ry 17, 1 985
V INDIO �.
City of La Qui:n-ta
`Department of Community-
Development
78-105 Cal Te Estado`
La Quanta, CA '922,53 .
.
Re: 53-340 Avenida
Ramirez'
Gentlemen: =
The developer of the
above, referenced. home
has mi ti:gated its impacts on our overcrowded school s by .,pa orient
of the amount of $628
per unit to be applied to the, cost ,of
district educational
facfili:ties'.made necessary by such.. new
development.
Since,rely,'
,John D. Brooks .
Assistant Supe.rntende.nt
Business Services
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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
It I� l'l%<� � .chi c�
/�'� X
City
State
Zip Code
'hone
'Property Address
'City or Community
'Legal Description of Property (Lot, Parcel Map, Trract)
'Assessors Parcel No.
Water Serving Property From
_ot size
�?
Sr' -e-- r;;—A-- c7 e- –Ie-'- ���f � i � A?
Signature of Applicant- Date
'The above information must be verified from Building Application
Staff Use — Do Not Write Below This Line
Initial] Date
WQCB Clearance required Yes ❑ No ❑� �-- (z�ll�`!y
Soils feasibility report required Yes ❑ No -
Detailed boring report required Yes ❑ No
Detailed contour plot required Yes ❑ No 21,
Comments:
Soils or boring report by 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
I'Doo
New Addition Replacement
Leach line sq. ft. of bottom area trench
Leach bed (sq. ft. to bottom area bedl)
Seepage Pit Diameter
Number of PitsSeepage•Pit
Depth B.I.
Total Depth of Pit
51 El 6';&
'
1c
Location of System
Additional Requirements, tt7ro Px �A�Cfs•- air-�.�
fh �
A W..,, . E- i S o ' roes- L -r
A permit is approved/den- ei d -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 permit is necessary for the installation of the above
designed system.
�
Imo, (' 8`•!
Signature of Health Official Date
Receipt No. 4 5 / Issued By '
District: Riverside ❑ Indio W Hemet ❑ Date'"
DISTRIBUTION: WHITE - Office File
DOH SAN 122 (Rev 10/82)
YELLOW - Applicant PINK - Building Dept. GOLDENROD - Pending File
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4 . s _ - Elevation"Certification
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- Re:-
' •;• Rough"Grade Pad
.Lot20,-.Block.82,_Unit,No. 10,
^ -• anti _ ylhL ...-. � t � ' r -.rt
......Santa.-Carmelita At ValeLa Quinta K t�. �, �y� �� ✓r y � . L �'A, r^ -_,
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Recorded in�M.B. 18 Page A70 Riv.f./� S
lr�..tr CI• 41:: iQ 4 . iYwYFi ed 4Y*M✓ iSsr W yr 7°i. Lk rA
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y',5•l yr :.M T. .3Yr, ^Y "'4.1w'.. driJ: Rtw+. �'~ �' t•.T-h•rl' "•r-.` ��..r� .M"n<{.n h'.:r� t,:.. rt+Y s. e+ -..t. . .�yiny�,.,r} :r -'f •1�•1�:llF4�>\L. •.Fi3-v3 . x.7 »'t nt' '/: •e:.
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Rr•wtn TDear,_Sir
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This'~is. to certify that on - July 12, 1985, A-1 Surveying Co. Inc.,
^< `did •perform„a' field -survey -for-elevation on said lot.. J
ir, �,.,-. ��.F �.n .v.w•n `�.. •+w ah..:-.. L ,.i 4 �`¢.i . 4 ., �ti, y r•tiS . Ji � 1 Iwo +..i "�.?w� �ii•!y .� � �n.
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vl iAbr ti. �.7 (++ \ ! - l�{ I ft �I."rfj4{14»
We --'found the elevations of, -the rough grade'; padl'to be ;within i,;,I
! I : < ,..
=planned elevation.1;,This twe#:feel is+ :ia+ !3 ibfsta1nt2�ial 1.; "lla
- .. • - I. .L.�1; i31., t � 2 } IN TIIM Y' .A+f •,(iµ 31 - �i•I M\114 RT l..
u F r.r r
,,,.,conformance-.', of thei approved' 'grading plan } �r� ° y,I �i,1 1�;; :''!:-i''
t ;er t • i"�: • jt F, ttlrn
• .r .-• `� - '�' ♦. tli y r ° •�'i i 1 I .'' t fli. "; 4i �i � �yt i. .< t}+ 1ti
Respectfully sub tted
_.,. .. - . • . �•ai fi"rt•b+'K,.i✓aw 36. � � .�`'.}ira✓�.�i. f« .yw 7
•� � 7 . «. 7 i. 4 S t t of � _ _ _
Jerry Dennington R.C.E. #26943
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