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07572 (SFD)Building Owner T4-tyl u P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Mailing Address PQ Box 415 City Zip _ Tel. R ncho Mirage 1 32270 Contractor Address Zip State Lic. City & Classif. Lic. # Arch., Engr., Designer Address Tel. City = (Zip (State I Lic. # LICENSED CONTRACTOR'S DECLARATION.,,r� I hereby affirm that I am licensed under provisions of%Chapter 9 (c6mmencing with Section 7000) of Division�3 of the Business and Professions oCode, and,gyyr Icense is in full force and effect. _SIGNATURE✓ - '�— / � LY DATE OWNER -BUILDER DECLARATION. I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Susiness 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 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ 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 improvements are not intended or offered for sale. If, however, the building orimprovement 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.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (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 contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 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 ❑ Copy is filed with the city. O Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one 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. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit 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.) A No. OT5T2 BUILDING: TYPE CONST. OCC. GRP.- A.P. Number 617"381'"05 Legal Description Lot 45 Desert Club Tmct #I Project Description Single FwAly Dwelling 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 Lender's Name Lender's Address FINAL DATE This is a building permit when properly filled out, signed and validated, and is subject to Sq. Ft. 1635 Size No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ 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:_ _ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. § �Q Plan Chk. Bal. 269.09 Const. Mech. Electrical Plumbing S. M.I. Grading 20-01111 Driveway Enc. 20.00 Infrastructure 2,024.45 Waned Tha-d Fr in 79 � 71q TOTAL REMARKS 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 Lender's Name Lender's Address FINAL DATE This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. Issued by:_ 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,— _INSPECTOR 4/19/ Permit CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS SLAB GRADE 7 ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. FORMS SEWER OR SEPTICUN� fd ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) / TEMP. POLE /ka «< DRAINAGE PIPING CAR P. I SQ. FT. GROUT WATER HEATER WALL SO. FT. ® FINAL INSP. DRINKING FOUNTAIN SQ FT ® WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ =$ WATER PIPING NOTE: Not to be used as property tax valuation FRAMING FLOOR DRAIN MECHANICAL FEES O O (0 I b WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ®11/. c SEWAGE DISPOSAL INSULATIONISOUND SO.FT.GAR ® 3/ac HOUSE SEWER FINISH GRADING 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 901WPLUMBINUAW UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE 7 ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTICUN� fd ROUGH WIRING DUCT WORK ROCKSTORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) / TEMP. POLE /ka «< GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP./,� 1 GRADING cu. yd. $ plus x$ =$ LUMBER GR. FRAMING FINAL INSP. ROOFING///,�k j/ ,!0ZQ O O (0 I b (J REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING ��W/✓ �/� �O MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION/2/ Cy v c CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL P] ��— 'r�tECEIPT NO. Issued By Date i 41), DISTRICT: ❑ Riverside, ❑ Hemet Q Perris ❑ Rancho Calif. ❑ Blythe 1 DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHrTE - Office. file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records W/ COUNTY OF RIVERSIDE ENVIRONMENTALAMMMa0n PaMal11ilm 17-3,l — HEALTH SERVICES DIVISION 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 IlaL 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 VERIFY ITEMS IN SECTION A PROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG # a Z Agent T LlD Person fP1F_3//5"' .95 - Z to SI ►!/,&+e �`�2 /11�i0 �',4.9 W Phone Maui Add / 0) Ctty State % D/��cn^p t Prop. (PM. Trnc1 ) yr' / �L. 1 4.5 lot Size Use of Permit P/P, CU, etc. 4 01uefx Other 471yA #/ rILr �D C , Owelli e Prep, etc. Signature of Appl' Date CATEGORY: REV CODE CATEGORY: REV CODE FEE SUBSURFACE DISPOSAL 1238 ❑ SITE EVALUATION UPON REQUEST 7349 $ 43.00 m `$ ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348 $ 17.00 Z 0 a. 1 st 4 Parcels (Each) 1238 $ 57.00 (Less than 1 year) 8 b. Each Parcel after 4 7344 $ 24.00 ❑ PRELIMINARY ELECTIVE 7352 $ 23.00 W ❑ Rereview (2nd review same parcel) 7344 $ 24.00 EVALUATION (Attach DOH SAN 53) UY ❑ Site Evaluation in Conjunction with ❑ HOLDING TANK 7351 $ 47.00 Critical Area 7346 $111.00 O ALTERNATIVE/EXPERIMENTAL 7345 $222.00 ❑ She Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $ 87.00 qq � -d�aL - a Holding Tank Agreements Completed ❑Yes !:N Certification of Existing S.D. System Required ❑ Yes WQCB Clearance required. (Attach Form ❑ Yes o DOH SAN 007, Santa Ana Region Only) Soft Percolation Report Required. ❑ Yes Special Feasibility Boring Report Required. ❑ Yes Detailed Contour Plot Plains Required (1 to 5 fl. interval) ❑ Yes _ Other ❑ Yes Staff Specialist Lot Inspection Required ❑ Yes Lot Inspection Date Soils boring report by Project Date lit 9 Soils Map Page Sod Type Approved by Date fJ No. of Systems Twdof System(.) No. Dwelling Units (r (1) Tank Sol Rate /Send O �Irp Tank ❑ Existing Bedrooms, /� Gel Gel W Leech Line Sq. Ft Sidewall allowance 1 II ft wide with �� l.rne(s) ft � Leach Bed a% tL ht. It. rocW sq. R min. `�' rock below drat clines or arae per running it Lsschlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Seeps Pit Tgt'al Depth Appli�� /r / *mow (TD) Max. Allowable Depth N/A Overburden factor t�6 6 1J (Lw No. 2 System REMARKS: r p for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated This application i �Plan, on the accompaniethe requirements set forth in SECTION C above. A building permit is necessary for the installation of the of signed system. No construction is permitted in the required reserved 100% expansjpn area. 1 Septic tank and sewer lines must be 50' minimum from any wells 91rrea Leach lines must be 100' minimum from any wells, including expansio/O ��^,LJSeepage pits must be 50' minimum from an wells, including pansqK ; .6C;& `% �9 0 tura of Heatth -Official k/"• Date ��— 'r�tECEIPT NO. Issued By Date i 41), DISTRICT: ❑ Riverside, ❑ Hemet Q Perris ❑ Rancho Calif. ❑ Blythe 1 DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHrTE - Office. file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records W/ Desert Sands Unified School District CERTIFICATION OF PAYMENT OF SCHOOL FACILITY FEES TO: City of La Quinta Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 NOTICE: DATE: LA to 4-1 f J&Fhn -THISt)0WU TEfl� C BE I)uPLICA This is to certify that developer of which is located at j' ithin this District, has paid school facility fees imposed pursuant to the authorit Aener{ted by Government od sec ioli 5 080 in the mount ofelm (� covering a total of Q square feet of ( resi ent' 1 or ( ) industrial/commercial development and that buil ing permits for this foots e n this development may now be issued by your jurisdiction. " 1e /LA— S�' L( 9:5 r_4:q . for DESERT SANDS UNIFIED SCHOOL DISTRICT White - Building Department a Yellow - Facilities Planning ■ Pink - Accounting ■ Gold - Developer (1007