06684 (SFD)4
P.O. BOX 1504 No. 06,684
Building 78-105 CALLE ESTADO
Address 53,435 RAMIX*X LA QUINTA, CALIFORNIA 92253
Owner _
Mailing
David Diller BUILDING: TYPE CONST. OCC: GRP.-
Address 1719 S. Ttelt ijmt St.774-081-MO _
- A.P: Number
City Zip Tel.
Oceawilde 92054 1619-M-7088. Legal Description
Contractor. Project Description rSFD ~
Omer/Builder
Address
City Zip Tela
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Arch., Engr., Size 1620 Stories Units
Designer New ❑ Add.❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 -hereby affirm that I am licensed under Provisions of Chapter 9 (commencing with Section
70001 of Division 3 of the Business and Professions Code, and my license is in full force and
effect... , :}k 1 -
_SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation C �}
I hereby affirm that 1 am exempt from the Contractor$89
Contractor's License Law for the following ,347
.reason: (Sec. 7031.5,Bustness 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 rile 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 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 perms Plan Chk. Dep. $250.00
subjects the applicant to a civil penalty of not more than five hundred dollars (5500)-
0 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 25•6
do the work, and the s1pucture is not intended or offered for sale. (Sec. 7044, Buisness and Const. 594-59
Professions Code: The Contractor's License Law does not apply to an owner of property, who
builds or improves thereon and who does such work himself or through his own employees, Mech. 55.50provided that such improvements are not intended or offered for safe. If, however, the building �y
•
or improvement is sold within one year of completion, the owner -builder wig have the burden Electrical 76 '$
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 1T3. Sei
struct the project. (Sec. 7044, Business and Professions Code: The Contractors License Law 6.30
•
does not apply to an owner of property who builds or bnproves thereon, and who contracts for S.M.I.
such projects with a contractors) licbnsed pursuant to the Contractor's License Law.)
Grading 20.00
❑ I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc. 20.00
Date owner Infrastructure 1,974.9+4
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. .Company + �
O Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL $3,454.2&
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE YY _
(This section need not be completed if the permit is for one hundred dollars ($100) valuationit1 Li -r (45.101- 3 jV.4 e1:'
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
Date owner
NOTICE TO APPLICANT: N, 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 shah be deemed revoked. Minimum Setback Distances:
Front Setback fron Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, CW Code.) Side Setback from; Property Line
Lenders Name
Lenders Address
- This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
expiration it work thereunder is suspended for 180 days. 1:r 22/83
I certify that I have read this application and state that the above information is correct. Issued by: Date Permit
Iagree 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
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. Fr. ® $
2ND FL. SO. FT.
POR. SO, FT. ®
GAR. SO. FT. ®
CAR P. SO. Ff.
WALL SO. Ff.
SO Fr. ®
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
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROCKSTORAGE
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
WATER SYSTEM
SO.FT.GAR ® 34c
HOUSE SEWER
GRADING
cu. yd.
$ plus x$
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 �i�
GROUND PLUMBING 1'
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE `
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
C1'ANK
ROUGH WIRING
DUCTWORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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. 0 / 2
FRAMING 2/ <� /��
FINAL INSP.
ROOFING)&J-, �� n
`!?¢
%a%�
`//f
.D
�jj.�
REMARKS.
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING roly d
MESH
INSULATION/SOUND}'
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF too
SCHOOL FACILITY FEES
T0: City of La�gu ���DATE: 9O
Department of Cftri9}brta ,� �e"�1� meq#
78-105 Calle Estado ®, IV07-
La Quinta, CA 92253
t
This is to e r t i f y that I V: ►--V uv / "lilllitJUL• ,
developer of wh'ch jM�I/�)���
located at y n /
this District, has paid school faoaity fees imposed pursuant to the
au g/r�it ge erat-�dqVorgrnment Cod S ction 3080 in the a W/M of
$ b ( o� �--
covering a total of s r fe of ( ) residential. or
( ).industrial/commercial development and that building permits fon'
this footage in this development may now be issued by your jurisdiction.
a hornQ - I (o20
for DESERT S DS•UNIFIED SCHOOL DISTRICT
White - Building. Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Deve•oper
0 007
'tom- �'`:3r �c� },�_YS,•:y,•�-s�,r, ;s'�'�.vG:si�-�`'�sr"fie-'�"`a"'�•+Ns*•�t�n�i-'Si��i
RECEIPT NO. /Issued By %�/�- Date
DISTRICT: ❑ Riverside, Indio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe
DOH -SAN -122 -(Rev. 7/89) DISTRIBUTION: WHITE,- Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
41
COUNTY OF RIVERSIDE ENVIRONMENTAL 6Ot' No.
7 — —
HEALTH SERVICES DIVISION � C7 z v
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 liaL
i
A non-refundable filing fee (see below) is required when the application is submitted. Check must be 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.
Q
�I
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG
Z
O
Agent, Contractor. Contact Person
V
Phone
ff
Address & Firm
-CQ5
ACJk
L9- i
i 9
U
W
Owner
Phone
Mailing Address
City State
Zip
Job Property Address1 Legal Description Prop. PM, Tract, Lot)
Lot Size �
Water Agency ell
Use of Permit P/P, CU, etc . a Other
W &.100
�
D.,.w,el�g; MH Site Prep, etcL
g' Signature of Applicant
Date
CATEGORY: REV CODE FEE
CATEGORY: REV CODE FEE
II SUBSURFACE DISPOSAL '. 1238 $ 57.0O
❑ SITE EVALUATION UPON REQUEST 7349 $ 43.00
Co
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
LAND DIVISION
❑• SEWER/SEPTIC VERIFICATION 7348 $ 17.00
Z
O
a. 1 at 4 Parcels (Each) 1238 $ 57.00
(Less than 1 year)
b.' Each Parcel after 4 7344 $ 24.00
❑ PRELIMINARY ELECTIVE 7352 $ 23.00
CJ
W
❑ Rereview (2nd review same parcel) 7344 $ 24.00
EVALUATION (Attach DOH SAN 53)
U)'
❑ Site Evaluation in Conjunction with
❑ HOLDING TANK • 7351 $ 47.00
Critical Area 7346 $111.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $222.00
❑ Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $ 87.00
f INITIAL. % DAT/E' t
'Holding Tank Agreements Completed ❑Yes C NUJ �o ma�` J
Certification of Existing S.D. System Required ❑ Yes
pa
WOCB Clearance required. (Attach Form ❑ Yes :�O.
DOH SAN 007, Santa Ana Region Only) l
Soils Percolation Report Required. ❑ Yes
000
Special Feasibility Boring Report Required. ❑ Yes ET No
Detailed Contour Plot Plans Required (1 .to 5 fl. interval) ❑ Yes fa N6 oo
Otheri ❑ Yes_~J2fNe _
i
Staff Specialist Lot Inspection Required ❑ Yes9
Lot Inspectioi Date
Soils boring, report by Proiacl,* Date
/
Soils Map Page / ( Soil Type C Gi, t✓ Approved by �c C.�C/i -�- Dale N41
U
No. of Systema
_Type Systems)
ifig Tank ❑ Existing
Noo, Dwelling Unita
(1) Septic Tank
Soil Rate
Qreaee/Sand
❑ ReplacenwnM
Beddrooma,,F(7RurszUnihi<Gree�BdrttCp
-3 602
'al
Gel
CO
.(kLeaoh Line Sq. FL
Sidewell allowance
Install_ Li* iL long k wide with
Leach gad ea. ry
Bdftotrench area
_ ft rock/ sq. R
®- �rosl�
min. inches c drainl'mes or
of bottom
per running ft
C3^"h1A r
rttelowa
Leachlines/bed special design for slope:
(3) Pit Diameter
No. Pita
PR BelowTD
I
See
( ) pad Total Depth
Otder.
able
App
-
eD ie5" C9' 6 r
nlet
Max. AlDepth
NN/A_ Overburden factor
--�wv��
hNabIr9/
fy
No. 2 System VIA
f
REMARKS: Q ��
/,IA) r
� .i ✓ G Ail , ,�/ _ /X�_
® �
V
0
This application is,A'PPROVE F I FITEEFfor the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompanred� using the requirements set forth in SECTION C above. A building permit is iecessary for the installation of the
Zabove-designed
system.. No construction is permitted in the required reserved 100% expansion area.
0
.10/ 0 "4-•Pim
Septic tank and sewer lines must be 50' minimum from any wells (
V(
W3)
`
Leach lines must be 100' minimum from any wells, including expansio
Seepage pits must be 150') minimum from�an�y wells, including expansio area41' ,
� tiV � ZXPte
(/ /TYSi natureof HeaRh Official ,, � /f% O
RECEIPT NO. /Issued By %�/�- Date
DISTRICT: ❑ Riverside, Indio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe
DOH -SAN -122 -(Rev. 7/89) DISTRIBUTION: WHITE,- Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
41