06235 (SFD)Building
Arttlracc 78-625 $agu ir0
Owner
Tamco Di aopamt Inc.
Address P. 0. Box 4694
City Zip
Palm Iie8E)K' '
Contractor
Address
State Lic.
& Classif. 379468
Arch., Engr.,
Designer
City
Zip
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Tel.
Tel:
City
Lic. # 120
Tel.
ZipIState
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
-N%! 7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
_SIGNATURE 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 (5500).
0'1, 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
bullds or= 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 improvement'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.)
❑ 1, 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 contractors) 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.. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
I'this section need not be completed'ff the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of the. work for which this permit is issued, l shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California-
Date---L-Owner
aliforniaDate Owner
NOTICE TO APPLICANT: d, 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.)
Lender's Name
Lender's Address
This is a building permit when property 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.
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 Dale'
Mailing Address
City, State, Zip
BUILDING: TYPE CONST
No. 06235
OCC: GRP.
.P. Number 617-383-012
Legal Description
Project Description
Validation:
Sq. Ft. 1.36$3
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$78,849
PERMIT
AMOUNT
Plan Chk. Dep.
$250.00
Plan Chk. Bal.
221..35
Const.
545.00
Mech.
51.50
Electrical
1}6,70
Plumbing
166.50
S. M.I.
5.53
Grading
20.00
Driveway Enc.
20.00
Infrastructure
1,735.85
rri :e-T®ed Lia rd 68.87
TOTAL
$3,193.30
REMARKS:,I
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 DATEINSPEfCTOR
8/29! a9
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
r
LAB GRADE
ROUGH PLUMB.
BONDING
;ARD SPKLR SYSTEM
2ND FL. SO. FT. 0
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN.
BOND BEAM
WATER SYSTEM
URINAL
SO FT ®
=$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
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 PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK'��
ROUND PLUMBIN /s
UNDERGROUND
A.C. UNIT
COLL. AREA
r
LAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
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.
FRAMING -12-clel
FINAL INSP.
ROOFING _
h-�' j g j I ` J O A,
J
p
6
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
t6THING
MESH
INSULATION/SOUNyl'06;Aj– –OtC�
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
A- i
4p-
P.O. Box 1504 APPLICATION ONLY
Building78-105 CALLE ESTADO
Address 7�f LA QUINTA, CALIFORNIA 92253
-:-/ 4 It. -
722.`1 lye
Contractor.,
f- ":•I X-
City 7 zjo_- Tel-'
City----
& Classif. Lic. #
Arch, EngrJ
Designer
IR 0
Address
City Zip State
LIC. #
UCENISEDCONTRACTOWSDECLARATION;
I hereby affirm that I am licinsed under provislorisj of Chap(commencing with Section
70p0j ofDIvIslorill of tWBustriess arid Professions 4_and my license p Is In full fored and
--OWNEWSUILDER DECLARATION
I hereby that I am exempt from the Contractors Ucense,'Lw for the following
7031 5,13usiness and Professions Code: Any'cily or county ~ requires a
dwwfisftj•or repair -y,6&ucb" _pdor4o,fts issuance also._.
to pie 8_100ned statement that -he is licensed pursuant-to—
the proftions of the Contractoes License Law, Chapter9 w1th Section 7000) 0.
QHslon 3 of ft Business and Professions code, or that. he ft --V, Merefrom. and the basls
alleged ex4WSon.--Ahy vbAklcin -of'Sec7f6i7031.5 -by any -4pilkant'-lbr a -pe-W_
penalty of not more Man rim hundred dollars ($500).
-- 04, asowner-of-the property, or my employees with.vgagesasthelfsofe.compansatioNAvill—
do the work, and the structure Is . not Intended or offered for sale. (See. 7044, Suftness and
Professions License Low does not apply,to an owner of property who
-btillft,or -who -does - such work•hknsaff or -through -his own awpbyeas.—
Intermlad or offered for safe. (/,'however, the building
r"W=T7 of completion, the owner-bulider will have the burdeWEO
—ofpn)v*WUW he did not bid or lip vve-for the popos& ofsalle.1-
r of
_g.,.a9,:mer the property, am exclusively contractln%,W licensed contractors to con,
The Contractors License Law
does not apply to an owner of Property who 6511IT-or 11,60 os tfi6i8&,_ aped 'WO _0onffa&i-AW—
such prqbcts with a contractor(s) licensed pursuard to the Conbactorl; License Law.)
d V@W-exempt —under'S-eic
Data Owner
WORKERS' COMPENSA COMPENSATION DECLARATION
Aeraby=affirm-that. I -have a certificate of,consent to -self -Insure, or a certificate of --
Workers Compensation Insurance, or a certified copy thitweat. (Sec. 3800, Labor Code.)
PoIk;YNQ=======rompany—_--
Q_Copy fa filed with the city- 0 Certified copy Is hereby furnished.
-- CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
or Am-need-Abt-W-ionptefed-If ine'-pm-Triff-ft-for one hundred dollars ($100) vatuation
.) . t
I*CerUty that-In'the-performance of ttV work-for,which, this permit is Issued, I shall not
employ any pBf3O11 in any manner so as to become subject to the Workers' Compensation
Data ,Owner
A0077CE - TO - APMJCANr.- lf,'-after making -this Cardficale-of Exerrpthn you should became
subject to the Workers' Compensation provisions of ft Lebon Code, you must "with
compily with such provisions or this permit shall be deemed revoked
CONSTRUCTION LENDING AGENCY
Ithat them Is a construction lending agency for the performance of the
work for which this permit Is issued. (Sec. 3097, CM Code.)
Lenders
Lenders Address
Tfils Is a building permit When propiprly 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.
I agree to c with
aIth all city and county ordinances ano elate laws relating to building
m
constructi!MAPauthorize representatives of this city to enter the above-
mentioned property for Inspection purposes.
Signature of applicant —Date -
Mailing Add
City, State, Zip
IILDING: TYPE CONST.—OCC. GRP.
P. Number- 4�1 Z_
gal Description 1- J
Diect Description- 5. 15 d.
'Size -
I -L__)
-Stories ---Units
'New O-f--7Add 0---- -''Alter,O--Re'p�.iirr-Ek----D�e�molition-0
ZONE. BY:
Minimum Setback Distances:
Front Setback from Center Lin
Rear Setback from -Rear Prop. Line
Side Street Setback from Center Line
—Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
Estirfiatel:I'Valuatlon
--plan-Chk. Dep.----
D
Chk. Bal.
"Const.
`Electrical
,:J,I?,),uMbing
Driveway Eric.
InfrjjS—trUCtjjie7-'7-_—
TOTAL
O
REMARKS
009182 10 753P
OA -27-:A9
ZONE. BY:
Minimum Setback Distances:
Front Setback from Center Lin
Rear Setback from -Rear Prop. Line
Side Street Setback from Center Line
—Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
n }
<<. Desert Sands Unified School District
ti•S ``,
CERTIFICATION OF PAYMENT a
OF
- SCHOOL FACILITY FEES -
.. ":D
T0: City of La Quinta DATE: g/7/
Department of Community Development= +'"
;
78-105 Calle Estado 't
' La Quna CA 92253 -
} itNOTICE: -HIS �������I�T C�1i�Rl�� . _l
r• • �E V V LICATE®(
v
`._.. This is to certify that
_
'T developer of �( which
'located.
at. — rL�O.L within
j
this District, has paid sch:ol facility fees imposed pursuant to the 'f .'
.'authority generated by G vernment Code Section 53080 in the amount of
covering a total of square feet of (x) r sidential or
r
industrial/commercial development and that'building permits for.
this foJ/oltage in this development may now be issued by your. jurisdict,
for DESERT SANDS UNIFIED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37 .
µ rte.
MST
RECEIPT NOW—' �*Issued By Date ` l
I' DISTRICT:' ❑, Riverside, p<haio . Eft`jHemet 'J7 Perris, ❑ Rancho Calif. ❑Blythe "
"` i i DOH SAN -122 (Revue. 5/88). DISTRIBUTION: WHITE - Office file T YELLOW -Applicant PINK ; Bldg. Dept ~ GOLDENROD - Plans/Records
P.
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH IV `Assessors Parcel No.
ENVIRONMENTAL HEALTH SERVICES ,� a —
'
PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM,-'
.r.•
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 IisL
A non-refundable filing fee (see below) is required when the application is submitted. Check must be made payable to the County of
k •
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 A SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'*
z -
Agen� Contractor, Contact Person
'Phone -'Address
a Phone -,
r-
AVL- G - mbss
LU
Owner
Phone
Mailing Address
City.
State 0
-Zip
Jo pert Address �/%� /
Legal Description Prop. (PM, Tract, Lot)
PAt.m FSE T
CA.--
9276.1.
Lo—r III . 1Dr_VW_T CLUM AlAtJOIL
Lot Size
ter Agent
Use of Permit P/P, Cg atc..-4.1 0 cr�
Other
100/P
ell
eic.
Signature of Applicant
- J Date
CATEGORY:, .- REV CODE FEE -
CATEGORY: REV CODE FEE
SUBSURFACE DISPOSAL 1238$45.00 • s
�0 SITE EVALUATION UPON REQUEST 7349 $42.00
❑ MULTIPLE PARCELS WITHIN SAME -�- *'
(NO PLOT PLAN)
m
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
fp
a . 1 st 4 Parcels (Each) 1238 $45.00
(Less than 1 year)
H
b. Each Parcel after 4 7344 $16.00
❑ PRELIMINARY ELECTIVE 7352 $45.00
W
❑ Rereview (2nd review same parcel) 7344 $16.00
EVALUATION (Attach DOH SAN 53) .
❑ ' Site Evaluation in Conjunction with v - ..
❑ HOLDING TANK 7351 $45.00
Crttk:al Area 7346 'T, $86.00
❑ ALTERNATIVE/EXPERIMENTAL • 7345 5 $13200
❑ Site Evaluation Lot Less than ,
SYSTEM
10,000 Sq. Ft. • 7347 $86.00
INITIAL DATE
Holding Tank Agreements Completed ❑
-YesNo
'
Certification of Existing S.D. System Required - ❑Yes -
WQCB Clearance required. (Attach Form ❑ Yes
DOH SAN 007, Santa'Ana Region Only) '
Solis Percolation Report Required. ❑ Yes
1
---,�_
Special Fe sibility Boring Report Required. , ,4/ , . �J ❑ Yes
r
Ft O
Detailed -Contour Pbt,Plans Required (],to 5 ft; interval), ❑ Yes
O
;Specialist ,Lot
Staff Inspection Required'' ❑ Yes l7 Nof
1
k t, • + ) 1 Lot -Inspection Date
ti.
�
'' Soils boring report by Rroject# Date
Soils Map Page .Soil .Type41 Approved by t' Date 06
w
U
No. of Sysl ins a
" Type (Syatem(s)
Na Dwelling Unita I
(1) Septi Tank
Soil Rate .\
Qrease/Sand
*Z
• Q
/ '
/1
❑ Hglding Tank ❑'F_xiattng .
'New ❑ Replacement '
Bedrooms erdnUa
� �
G'%9ese IntCp
E
,r ,Q.D2m.
D.
WGal
IA --L L�
4 _ I _ al.
r<
W
i
(2�Leach Line Sq. Ft
�: Sidewall allowance
Irk Linea) R long R wide with U
Leach Bed sq. R
i-
trench area
. rock/ ft sq. It
per running
min. �roc�k below drainrnes or
°��of urea
��
Leachlines/bed special design for slope:
Appl'icaMe
(3) Pit Diameter
No. Pits
on Below
dw G(BI)
' 1,
Seepage Pit Tojal Depth
*0
•
//
� Ih '6
/
Max. Allowable/Depth
N/A 'I Overburden factor
-,,N/A
No. 2 System A
REMARKS:."
r. N
This application i APPROVED ,^ IrlIES for the' category checked in SECTION'B above, regarding the design of a subsurface disposal system as indicated
f 0
on •the accompan plo plan, using the requirements set forth, in SECTION C above. A building permit isnecessary for the installation of the
Oabove
-designed system: _INo construction is permitted in the required reserved 100% expansion area.
: U
W
(1 Septile tank and sewer lines must be 50' minimum from any,wells,Off /0
w....
.Leach lines must be 100' minimum from any wells, including expansion rea• /
(3 Seepage pits must be 50' minimum from any wells, including expansionlareaCZi/(2
�0
S-
t� ,
Sr nature of Health Official Date
RECEIPT NOW—' �*Issued By Date ` l
I' DISTRICT:' ❑, Riverside, p<haio . Eft`jHemet 'J7 Perris, ❑ Rancho Calif. ❑Blythe "
"` i i DOH SAN -122 (Revue. 5/88). DISTRIBUTION: WHITE - Office file T YELLOW -Applicant PINK ; Bldg. Dept ~ GOLDENROD - Plans/Records
P.
ME
U lEvr+Sent;ry
co ru. ur. cn
fi array .F �Ih1.I551U1.ILll y
o V,AtLA(. .
07 n6l'11U;L`9TUIll11 LU �n. irs
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' M I.LE IUNI nF.`VEhIS1E
BVI It;l lI5 ti hlLl\SUItLS J~ ,, s��un
v -. _/t� 6`LJ. Ilwy �116� �l1�tEce 11 IP"I
_ ., .. t:�s(a t t � • x/lam 7S 7 � � � ( / f� / �
DUE
DEV
CLA1'Clt'S 11111i�t ~ . CO (--JC-LO.M:.C..
AUUIWS5't O ;Qti t}:EQ 9
,m A scle,r. FCS _ zu
�'rt,t;hltUw�� t bl� l 3�0 � 146
War Wveluperl
Atter revlewlnq.your. lali(15CJI)i;l,l�� 110I1'3� flll I11f11Yt llt3keCi�1 liSlCdsubsMutluns
violf�tivll cif: yuar�i;tinP air.O►s cluveiiiinq ll�e t_vacllell� Velle:y. 1
do occur cud they t11Efie;r [tciii �ilailk n►�lellftl� `11s'leJ,
lllls dCice nlusl tie IlotiFiecl
1 `and it esetvit►y ll►e Cv cltella; Valley's l�eSU. Elee eflvirotn�flt.
'1'llat k you lvr ptvtectL y.
Lo 7 /l2 .pC-SES: cLU6 In.4A/d& .
'1lgrlcuJ.teura3. Gcaiit�ssiwrier s;�V [lce. ,
cc$ Indio, Farad' iaverslde- u[,[ ice
•