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05005 (SFD)Building Address 68-121 Santa Ursula Mailing Address City Bermuda Dunes Contractor Address City P.O. BX 1504 Nuo 7&105 CALOLE ESTADO "AN ADEQUATELY SIZ- DEBRIS _&ff LA QUINTA, CALIFORNIA 92253 IS REQUIRED ON THE JOB -SITE DURING ALL PHASES OF CONSTRUCTION" BUILDING: TYPE CONST. OCC: GRP.- try A.P. Number 5 1 ?-2 vOy_u 13 Tel. - 92201 345-8225 Legal Description Project Description S • • F . D Homes I. State Lic. City & Classif. Lic. # 564 Arch., Engr., Designer Address —FT—el- IState Lic. # �J LICENSED CONTRACTOR'S�ECLARATIONJ hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section Q000)t f Division 3 of the- usiness�and Professions Code, and Incense is in full force and OWNEWBUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec. 7031.5,Busfness and Professions Code: Any city or county which requires a Permit to constnrct, after, irtprove. demolish, or repair any structure, prior to its issuance also requires the applicant for such pemtit to fie 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 permN subjects the applicant to a civilpenalty of riot more than five hundred dollars ($500). ❑ 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 bul. 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. 11, however, the building or improvement is sold within one year of completion, the owner-bu0der will have the burden of proving that he did not build or irprove 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 inproves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. R. & P.C. for this reason Date owner WORKERS' COMPENSAnON`DECLARATION I hereby affirm that I have a certificate of,conient to s f -insure, or a certificate of Workers Compensation Insurance, or a certified copi, th fe`of. (Sec. 3800, Labor Code.) Policy No. Com � ( A ' 1f ❑Copy is filed with the city. ❑ Cerlifi&1copy is hereby furnished. . CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed N the pemrt 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 mabV this Certificate of Exemption you should become subject to the Workers' Compensation provisam; 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, CW Code.) Lenders Name Lenders 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. 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 Sq. Ft -No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ PAA3 And Ti1Dt'.i lint_ 12%el"illed iia thiis perm r Estimated Valuation S 199p 57A PERMIT AMOUNT Plan Chk. Dep. tY Plan Chk. Bal. 4 Const. f;An. 5 Mech. -4 !t--1 Electrical 1111 -62 Plumbing € A S.M.I. 1 QD Grading Driveway Enc. Infrastructure A O TOTAL REMARKS 1 f ty Y.Y'Yb. 1'Y. 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 Issued by: Date 12/19/Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS SLAB DE �ZZ- ' ROU HPL..UUM/M��B. BONDING YARD SPKLR SYSTEM 2ND FL SO. FT. FORMS OR�EPT N � ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SO. Ff. ® GAS (ROUGH) METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. I SO. FT. ® GROUT WATER HEATER WALL SO. FT. ® FINAL INSP. DRINKING FOUNTAIN SO Fr. ® WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. B 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. Ff. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1 Vi c SEWAGE DISPOSAL SO.FT.GAR ® VAc 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 ETBACKY Z —Z GROUND PLUMBINC12--4�1 <k UNDERGROUND A.C. UNIT COLL AREA SLAB DE �ZZ- ' ROU HPL..UUM/M��B. BONDING HEATING (ROUGH) STORAGE TANK FORMS OR�EPT N � 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$—=$ LU BER GR. FINAL INSP. B R MING L L7 FINAL INSP. . R FING ..� �. 6,A ��' REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL HING IV MESH SULATIONISOUND, 7 z / FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL Desert Sands Unified School District �p+r CERTIFICATION OF PAYMENT II H� SCHOOL FACILITY FEES ( ,�' �D 6�'�,°�+iiI���r (tea T0: City of La QuintaAr�� "ANAro DATE:/—Z9— R Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 This is to certify that ' developer of which is located at – a- within this District, has 6aid school facility fees imposed pursuan to the authoritgen rated by Government C de Sec iolt 5 080 in the amount cf t le covering a total of square feet of (,,.) residential or ( ) industrial/commercial development and that building permits for this footage in this development may now be issued by your jurisdiction. -7-a�/ r = 0-770 � Seo =�Aq V White - Building Department • Yellow - Facilities Planning • Pink - Accounting O Gold - Developer (10)-37 tr� � e i- 10 Signature of Health 'Official COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No. QG o0 ENVIRONMENTAL HEALTHT.SERVICES — — w 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 IisL A non-refundable filing fee (see below) is required when the application is submitted. Check must be made payable to the County of • 's �[// RECEIPT NO. T Q 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 0 Agen .:Co or, Contact e rson Phone Address & Phone ❑ Hemet. ❑ Perris Ow O�/s✓t� Phone Mailing Address OH SAN 122 (Rev 5/88) DISTRIBUTION CKY State 9Zip aoaperess(f -%�� Legal Descriptio Prop. (PM, Tract, Lot) 2-.q- Lot Size / Wats S(�L se of Permit P/P, CU, etc. 1,4 UujAlrxi lin - H Si rep, etc. -m27/9Ar Other /r J _ Signatureof Appl' Date CATEGORY:.T' ' '" EV CODE FE S f. i CATEGORY: REV CODE FEE ®UBSURFACE DISPOSAL 1238 < ❑ SITE EVALUATION UPON•REQUEST 7349 $42.00 "- m ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT,. PLAN). Z LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348 $11.00 'l 0 a. 1 st 4 Parcels (Each) 1238 $45.00 (Less thanYea►) U, b. Each Parcel after 4 7344 $16.00 ❑ PRELIMINARY ELECTIVE 7352 " $45.00 "(Attach W ❑ Rerevlew (2nd review same parcel) 7344x$16 t�0 EVALUATION DOH SAN 53) ❑ Site Evaluation in Conjunction with❑, HOLDING TANK - 7351 $45.00 Critical Area 7346 $86.00 ❑ ALTERNATIVE/EXPERIMENTAL 7345 $132.00 ❑ Site Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $86.00 �INI•TI` DATE Holding Tank Agreements Completed ❑ Yes 20d'o ' —ff Certification of Existing S.D. System Required ❑ Yes !Nz L DOH SAN 007, Santa Ana Region Only) WQCB Clearance required. (Attach Form ❑ Yes 13/No,"- Sails Percolation Report Required. ❑ Yes Special Feasibility Boring Report Required. ❑ Yes Detailed Contour Plot Plans Required (1 to 5 iL interval) ❑ Yes Other 13Yes Staff Specialist Lot Inspection Required ❑ Yes No inspection Date Solis boring report by " �# Date Solis Map Page / Soil Type ` Approved by ��C�� `-� Q� �- / � ` 00 Dat e UNo. ZLL of Syms of Syatem(s) ❑,oIdIng Tank ❑ Existing JNe❑Repcet No. Dwelling Units I Bedroom, FlIrtft (1) Septic Tank Soil Rate G aase/Sand "'Case IntcpZ 1A,_ 3JA -Gall/S -"?o Leach Una Sq. Ft i ? om trench area .r { �# Sidewall allowenceil R =W _6 sq. ft. per running ft / ' Install ` Une(s) ft long A wide with min. irrdies�oc� bebw drafnflnes or t Leach Bad sq. ft Of J Leachlines/bed special design for slope: (3) Pit Diameter No. Pita Pit Behar Seepage Pit Total Depth Applicable �_ N/A 'Overburden factor / - Irh(Bth E/a J F Max. All Depth 7U 0"e No. 2 System IV114 l REMARKS:4Yt G� I i .01 This application 1 PP VE D ENED for the category checked in SECTION B above, regarding the design of a subsurface disposal. system as indicated Q ZO on the. accompanied plot" plan; using the requirements set forth in SECTION C above. A building permit is`necessary for the installation of the • - above -designed system. No construction is permitted in the required', reserved 100% expansion area. Septic tank and, sewer lines must be 50' minimum from any wel s S 7-9 (2 Leach lines must -tie 100', minimum any Includingezp`nsio W -from; wells, arm Seepage pits must be.1 , minimum from any wQells, including expansion. area �/p- �I-w �G2dfGtry Cw.QO i- 10 Signature of Health 'Official QG o0 w • Date • 's �[// RECEIPT NO. T Q Issued By �%(/ Date pO - 3 0 -O b. ')ISTRICT: .0 Riverside,-fndio ❑ Hemet. ❑ Perris ❑ Rancho Calif. ,y, ❑. Blythe . ' 47-- - OH SAN 122 (Rev 5/88) DISTRIBUTION WHITE Office file YELLOW Aprplicant' f PINK Bldg Dept GOLDENROD Plans/Records