06632 (SFD)Building
Address 46-301 Roadrumer
Owner
Mailing
Address 43-365 T"w Ave.
City Zip Tel.
. Palm Desert - 92260 3
Contractor
Address
el.'
State Lic. I City
& Classif. 553471 Lic. #,
Arch., Engr.;
Designer
Address Tel.
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
City(Zip I
State
Lic. If
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of ton 3 of the Business and Professions Code, and my license is in full force and
effect
SIGNATURE DATE
OWNEt-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5.8usiess and Professions Code: Any city or county which requires a
permit to construct, alter, irprove, dernofish, or repair any structure, prior to its issuance also
requires the appicard for such permit to fife a signed statement that he is licensed pursuant to
the provisions of the Cormactors License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business ad Professions Cade, or that. he is exempt therefrom, and the basis
for Ore alleged exenptim- Any violatba of Section 7031.5 DY -any applicant for a permit
subjects the applicant to a ad penally o1 not more than five hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will
do the wodr, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Canbactorls License Law does not apply to an owner of property who
builds of improves therein and who does such work himself or through his own employees,
Provided that such twovannadts are not intended or offered for sale. It, however, the building
or improvement is said wit A one year or completion, the owner -builder will have the burden
of proving that he did not build or inprove for the purpose of sale.)
❑ [,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 appy to an owner of property who builds or inproves thereon, and who contracts for
such projects with a contractorls) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec R, & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION c
Wo*=affirm that I have a certificate of consent to self -insure, or -a certificate of
pensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
❑ 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 it the permit is for one hundred dollars (8100) 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
N077CE TO APPLICANT: f, after mafdg 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 Oris permit shag be deemed revoked.
CONSTRUCTION LENDING AGENCY
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.)
Lenders Name
Lender's Address
This is abuilding permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 100 days.
I certity that 1 have read this application and state that the above information is correct.
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.
Signature of applicant Date'
Mailing Address
City,. State, Zip
No. 06632
TBUILDING: TYPE CONST. OCC: GRP.
-. A.P. Number 617—AG2-010
Legal Description
Project Description SFD
Sq. Ft. 1$4 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $105,658
PERMIT
BY:
AMOUNT
Plan Chk. Dep.
$250.00
Plan Chk. Bal.
305.91
Const.
Side Setback from Property Line
660.50
Mech.
INSPECTOR
53.50
Electrical
Issued by:
123.60
Plumbing
157.50
S.M.I. 1,
7.42
Grading
20.00
Driveway Enc.
20.00
Infrastructure
2,322.33
Fringe—Toed Lizard
120.18
TOTAL
$4,040.91
REMARKS
rr.:,r+;, rig*nyt�.t
ti r.i_rst9 r qIl
s iyil
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
FINAL DATE
INSPECTOR
11(x7%89
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. " PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO_ F7. @
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT.
SOFT ®
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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH) •2
J�
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
I
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.
SO. FT. ® c
BATH TUB
FRAMING 112,1 �O FINAL INSP. Q
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 V4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
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 PLUMBINGELECTRICAL HEATING & AIR COND. SOLAR
O
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
p�
SLAB GRADE �/G 1/�
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) •2
J�
ER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL L/�
GAS (FINAL)
MP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR. FINAL INSP.
FRAMING 112,1 �O FINAL INSP. Q
ROOFING /// 7
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING yl
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
REMARKS:
FINSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
r
A
jilding
idress llfY'
MA- kA J
ailing 4 J ,
idress
P.O. BOX -1504-------- APPLICATION ONLY
12()�}/7 %J4 N/V /� /� 78.105 CALLE ESTADO
LA QUINTA CALIFORNIA 92253
ram
Z"
-ip
)Pity �r_- a F til 9)� Cin JTN� -4 3 r,
Contractor CA 1,
State Lic.'} City
& Classif. -� Lic. #
Arch., Engr., ;
Designer
Address V I / Tel.
City( Zip I
State
Pf Lic. #
LICENSED CONTRACTORS DECLARATION
I herebyy affl t � ehl licensed under provisions of Chapter 9 (commencing with Section
7000) of Divisi f'Itle usiness and Professions Code, and my license is in full force and
I V - OWNER -BUILDER DECLARATION
I hereby a rmm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Susiness and Professions Code: Any city or county which requires a
permit to construct, after,- 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 -a
mr
Business d 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 crvilpenalty o/ not more than me hundred dollars (5500).
❑ 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, Suisness and
Professions Code: The Contractor's license Law does not appy to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,. _..
provided Mat such improvements are not intended or offered for safe. ff. however, the building .
orinprovement Is sold within one year of completion, Me owner-butider wig have the burden
of pro" 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 project (Sec. 7044, Business and Professions Code: The Contractors License law
does not apply to an owner of property who builds or Improves thereon, and who contracts for
such projects with a contractors) gcensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. a_ g P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 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. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed fr Me pemW Is for one hundred dollars ($100) valuation
or less.)
1 eertlfy that In the performance of the 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
I .. of California
Date Owner
NOTICE TO APPLICANT: tl, after making fids Certl7cate of Exemption you should becrome
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this per it 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.)
Lender's Name
Lenders Address
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 certify that I have read this application and state thatthe above Information Is correct.
1 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
Signature of applicant Date
Melling Address
City, State, zip
57-Z q fi
, ZOO At
UILDING: TYPE CONST. OCC. GRP.
j
.P. Number �7 /O O
Description
A Description
Sq. Ft. y No. No. Dw.
Size r/ ! Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑
PERMIT
AMOUNT
Plan Chk. Dep.
y eq
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
)tiG —
TOTAL
O, a
REMARKS
-
0 00
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setbac4 fracri Property Line
FINAL DATE INSPECTOR
Issued by: Date - Permit
Validated by:
Validation:
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF7
SCHOOL FACILITY FEESI
iLI7E1
TO: City of La Quinta DATE:
Department of Community Development
78-105 Calle Estado _
La Quinta, CA 92253 NOTICE: c��p' G �"�� U" -M T CA6 NOT
This is toc rt;fy t at i /LL'
developer of O� GJQ which is
located at -—f 44,- wi=hin
this District, has paid scho facility fees imposed pursuant to the
authority generated by Government Code Section 53080 in the jamount of
covering a total of Q square feet of ( ) res1'deniial or
( ) industrial/commercial development and that building permits far
this footage in this development may now be issued by your jurisdiction.
`1 /*" � for DESERT SANDS UNIFIED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
x(101-37
e
RECEIPT NO. / -- Issued By 'P Date
DISTRICT: - ❑ Riverside; . _ C9--ndio ❑ Hemet C7 Perris ❑ Rancho Calif. ❑ Blythe
DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
COUNTY OF RIVERSIDE ENVIRONMENTAL Ane"Ors Partm NO.
- 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 spec(ilations as indicated on the attached check list
A non-refuridable 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 FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG #
Z
_O
ContPersgn
Costa vV
C
ne ^�
3
Address & Firm
ULU
Owner (�
Phone
Mailing Address
U
v
to
D City ^ ��•- ((^^ //�� ICA
Job Property Address
Descri0ion�P�roop. (P• Tr(�' Lot)
a
1^_JC VC
1�
Rea r /=�.wHt�
..a l Imo. �O
Lot SlzeWater
-Van
Agency/Well
Use of Perm" P/P, CU, etc. CWacG W. ��
Other
� �
l�.. • V V • .
wellin MH Site Prep, etc.
Signature of Applicant
Data
CATEGORY: REV CODE FEE
CATEGORY: REV CODE FEE .
L9� SUBSURFACE DISPOSAL 1238 $ 57.00
❑. SrrE EVALUATION UPON REQUEST 7349 $ 43.00
Co
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348• $ 17.00
Z
a. 1 at 4 Parcels (Each) 1238 $ 57.00
(Less than 1 year)
F, ;;
U❑
b. Each Parcel. after 4 7344 $ 24.00
❑ PRELIMINARY ELECTIVE 7352 $ 23.00
Rereview (2nd review same parcel) 7344 $ 24.00
EVALUATION (Attach DOH SAN 53)
U `
. ❑ Site Evaluation in Conjunction with
❑ HOLDING TANK 7351 $ 47.00
CrfticW Area 7346 $111.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $222.00
❑ • Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $ 87.00
INITIAL DATE
Holding"Tank Agreements Completed - ❑ Yes No
Certification of Existing S.D. System Required . ❑ Yes ❑ No
WC,CB Clearance required.' (Attach Form ❑ Yes ❑ No
DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required. ❑ Yes ❑ No
Special Feasibility Boring Report Required. ❑ Yes No
Detailed Contour Plot Plans Required (1 to 5 ft interval) ' ❑ Yes No
Other ❑ Yes No
Staff Specialist Lot Inspection Required ❑ Yes No
Lot Inspection Date
Soils boring report by Project # Date
Soils Map' Page Sol Type S h Approved by Data
U
No. of Systems
Type of Systems)
_No �r ling Units
(1) Septic Tank
Soil Rate
Grease/Send
Z 0.
❑ H9kiing Tank ❑ Existing
Ba re Units
Gfease Intop
�IQew ❑ Replacenwrd
`
0110
ZQ
Gal
U
�.
(2).Leach Line Sq. FL
Sidewall allowance
Install OMC- Lne(s) '7b n, long 3 � ff wide with
Leach Bed sq. fl.
Bottom trench area
_ h rock/ R
min. / 2 inches rode below dreinlines or
of bottom area
Jb
per running R
r
Leachlines/bed special design for sbpe:
(3) Pit Diameter -
No. Pits
Pit Below
(TD) Seepage Pit Total Depth
Other:
Applicable
Inlet (BI)
Max. Albwable Depth
N/A rden tactor
❑ 5 O 6
No. 2 System
REMARKS:
0
This application is APPROVED/DENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompanied plot plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
Z
above -designed system: No construction is permitted in the required reserved 100% expansion area.
O1
Septic tank and sewer lines must be 50' minimum from any wells
U(2)
Leach lines must be 100' minimum from any wells, including expansion area `
Seepage pits must -be 150' rreiWi�'�9 um from any wells, including exp sion area
on
nature of Health Official '^' Date
RECEIPT NO. / -- Issued By 'P Date
DISTRICT: - ❑ Riverside; . _ C9--ndio ❑ Hemet C7 Perris ❑ Rancho Calif. ❑ Blythe
DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
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