0401 (COMB)PERMIT APPLICATION . -)
-City of La Quinta I . ..
Department Building Safely
_a4I
CITY/COMMUNITY/STATFJZIP
of and
This permit -becomes void if work not commenced within.180 days -from date of issuance, OR; if work has been -suspended or abandoned for'a period of 180 days.
t:•CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section.re6d not b6co.pleted if -
,'LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am. licensed -under, provisions of'Chapter 9 •
the permit is far one hundred ($100)o, less. I certify that in the performance of the work for which this permit is
(commencing with Section 7000) of Division 3 of the Business.and Professions Code, and my license is in lull force-
issued. I shall not employ any person -in any manner so as to'become subject to the Workers'Compensation Laws of
and effect.
California.
License Class Lic. Number
..Date Applicant,
Date Contractor,,
NOTICE TO APPLICANT:. If,after making this Certificatiof Exemption, you should become subject to the Workers'
`E
OWNER -BUILDER DECLARATION: I hereby affirm1hat"I am exempt.from the Contractor's License Law.for the
Co.mpensation provisions of the Labor Code, you must forthwith comply with. such provisions r this perrit.it shall
0
following reason (Sec. 7031.5.� Business and Professions Code: Any'city.or county which requiresa.permit to
be deemed revoked
construct, ilter, improve' demolish, or, repair,any Structure; prior to its issuance, also requires the applicant.for
DIVISION OF INDUSTRIAL. SAFETY PERMIT CERTIFICATION:
such permit to file asigned statement that heis licensed pursuant to the provisions of the Contractor's License Law
.0 1 hereb . y certif . y . that no excavation five (5) or more feet in dbpth i'nto which a Odrson is required to descend. will be
(Chapter. 4(co-mmencing with section 7000) of Division 3 of Business and Professions Code) or that he is exempt
made.'in connection with work authorized by'this permit, and that no building structure; scaffolding. falsework.lor'
,A violation of Section i031.5 by any applicant for a permit
therefrom and the basis for.the alleged exemption. y.
- ' 9 .
demolition or dismantling thereof.'will be more than fhirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2; Sec341, Title 8,'.
subjects the appli6an't to a civil penalty of not more;than five hundred dollars ($500.):
C.A.C.)
.0 1, as owner.of the.property, or my employees with wages as their sole compensation, will do the work, and the -
ci As owner-build6r, I'will not employ anyone to do work which would require a permit from the Division of*'
structure is not intended. or offered for sale (Sec. 7044. Business and.Professions Code: The Contractor's License
Industrial Safety; as noted Above,.unlesi such person has a permit to do such workArom that'division:
• Law does not apply to an owner of property who builds: or improves thereon, and who does such work himself or
intended for however,
. 1. . . 1. . I , .., I . .. . . . . 1. . I . . I , — ,
ci 0 Division of IndyAtrial, Safety. Permit No.
through his own employees: provided that such improvements are not or offered sale: It, the
PHONE 0
building or i mprovemnt is sold within one year of completion, the owner -builder will have the burden of proving thatI_
Date Applicant,
,.!�e,.dittnot build or improve for the purpose of sale.)..
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a constructionlinding agency for the performanci
0 1, as owner of the property. am exculsively contracting with licensed contractors to construct the project(Sec.
of the Work- for which this permit is issued. (Sec. 3097, Civ.C.).
7044. Business'and Professions Code: The Contractor's License Law does not apply.to an owner of property who
Lender's Name
builds or, improves thereon, and who contracts for such projects.with a contractor(s) licensed pursuant to the
Contractor's License Law.).
B. & P,,C: Certificate).
Lender's Address -
I that,l have.read this application and slatethat the above information is correct. I agree to comply with all
0 lam exe III u If •S (Attached
0�:
certify
city and county ordinances and state laws relating to building.construction, and hereby authorize representatives
Owner
.1
WORK IR S' COMPENSATION DECLARATION: -1 hereby affirm that I have a certificate of consent to sell -insure, ora
of this county to enter upon the above-imentioned property for inspection Ourposes. , ' .- 4 .1
certificate of Workers', Compensation Insurance-, or a certified copy thereof (Sec. 3800. Lab. C:).- -
Signature of Applicant or Agent Date
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and statethat
.0 Certified,copy is hereby furnished.
the information given is correct. I agree -to comply with all state laws and counly,ordinances,relating to buidling
I7 Ceriified 6py is filed with the City Building Inspection Department -or City' Depaitment.
construction, and authorize a' representative of the City of La Quinta Department of Building and Safety to enter
-rIEND
upon the property for which I have applied fdr"this permit for the purpose of making inspections.-- ;j�.
Date Applicant
Signature of Applicant or Agent Date
Print Applicant/Agent Name
fr
IF
APPLICANT NAME (L F. MI)
ADDRESS
47 ro-Ile? A4021
_a4I
CITY/COMMUNITY/STATFJZIP
i6ei SITE ADDRESS/SPACE
CITY/COMMUNITYISTATE/ZIP
SOK
PAG`,'
PRC
C
TWN
FIND
SE
S
TRACT
LOT—
MOD
S8
TRACT NAME
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME
0"&-p
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE a
LICNC 0
'ARC/ENG FIRM NAME
7
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE 0
LICNC 0
USE OF PERMIT
OL
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FSB
SSB ,
'SSB ?
RSB 1.,
OFC-;
FZONE ORD -11I..
-rIEND
SIDE.,
APPUPRMT DATE zwk.
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,,VALL.�ATION'
4q
BLDG! D T.
NO.
OPERATION DATE INSPECTOR
NO. OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33 Ventilation System
2
Ftgs & Frms pbL
34 Plenums & Ducts
2A
Slab Grade
w
35 Furnace Compart.
3
Steel
36 Inlets & Outlets
4
Grout Blocks
37 Combustion Air
5
Bond Beams
38 Compressor
6
Roof Deck
/,2
39 Appl. Clearance
7
Framing
40 Fire Damper
8
Vents ,
41 Smoke Detection Device
9
Garage Fire Wall
42 Commercial Hood
10
Fireplace P. L.
❑
43 Final
10A
Fireplace T.O.
❑
NON ADDITIONAL INFORMATION
JAG
40/0 K
l
�✓//�/ ��
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb T
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer $° SEP
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL PAI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
i
II o--- SPECIFICATIONS
Size _Volume ----- Gallons.
/>. Templateo. —__ -.—Shape
-_-
Surface-_ --Perimeter -�—�- L/F.
EKv ++�'i` y��J ) i •_:.__.--�_._----`--"_�_----""-..`'Y. Depths. M_,,�jr� m .
i : r . F:7,L , �LL J �-----Max mum olurne Steak
Spa Size _ _ -_. _ _._Volume -.-.. gallons,
f r, EXCAVATION
Finish Elevation:
A ��^ G Access �t ft .. - ---Ste Preparation
!`Ct. % -.__ - --, Gradin _:____ -
Dirt Removal!Loads to Dump .A_ j:_ .
\, Dry Well Locathon --_.-
Fence Removed BY _-._ _----_Reolaced BY __ Material
Size of Opening-_u___`_
•� ( i % "`-�vt \ a NOTE: No painting or matching of texture will be done'
?. T PLUMBING
--_ Filter Type Ar ( {.__Size '�---_
c Pump Type __._"5la�ize _hQ -
r-
VJ� ir.- Skimmer T r _ __.._Size �� - --- No.-
i p til �1 yPe �{,
F Heater Type _-LAA &--:L-
Heater Vent By• •-� i-f-lr �`.�-gz__� - --
T� �T
- t Jet Pump Type LY12'� Size
Blower Type __ -- --Size g
Equipment Location . -15 - _ ___ P/C Slab/Pit f
C L1
Plumbing Material-
Suction: Size_ Len th 1,' Ft. Discharge �,-- q Size .Zi._ Lgth.--Feet.
Waste To _,_..._-_._ Size Length --- Feet.
GV f MMI Q. Returns in Pool: Nurgber--- .. --__.:Size z__ Length - Feet.
Return Inlet Type
Fill Line (With No Obstructions)Size__ l-gth. _ -_. Ft..A/S Valve Location.
Gas Line By i�'a . --Size _ _ -.--I.,Length --- _:_ Feet.
�`
Automatic Cleaning ',P j }F !`�.__.0 N_--__ _ ---_T---
T ,
.1� (
SPA INFORMATION
Suction: Size -_ LgM Fa. Dischg.Size SLgth. Feet.
Jet Type___-- Number
b t t),&LL' Jet Air Line Number_ __-Size -`_-_..Length Feet.
Blower Return Size Length Feet.
/� �t^ Selector Valve Type .Number __—Size
tf L-A( { V' ' I LL- Filter Type ^_-_- __----Size
i Pump Type---
__-n SkimmerType--__,_- -- -- Size
J-X.�.� ' `• F- „' f"`-' Heater Type ____._____.._ Size',..
Heater Vent By
Jet Pump Type--.--
Blower Type..----
�.Q} iii•
Egwpment Location �-.-_.--_-_ PIC SlablPit :------_--
Plumbing Material.
Suction: Sizes—_ Length Ft.Discharge Size-- Lgth.—Feet.
I
Waste To
Size ---Length .Fee .�+,
Returns in Pool: Number:__ _. , .-__Size _ _._ _Length Feed.
Return Inlet Type----
Fill Line (With No Obstructions) Size- __Lgth..._ -:: Ft. A/S Valve Lxa!io• .
.+
s Gas line By _-..,--__.Size-_...___-::_:Length---. _: Feet,. `
Automatic Cleaning
-TU 1ZL50 VALVE,
STEEL ---
r _ Standard/Special
' Raised Bond Beam 6 ;__.12'" _:....-18" -Other._.,,_
Po�15L,� SWI a_�� _
SPaDam Wall. '�Aj�a�..,T.�..'t 'Lflei
GUNITE y
Corner Rd n: - - ---_Inle s - e
- t --- J Steps P�P���.___�.�---Fill Line Location
Grab Rail-'_ _..-::Hand Rail- Cup Anchors""
Seat/Bench e_-
Spa Information
TILE AND COPING
Tile _-.Color -
--Coping/Other-Cantilever _.
Trim:------------Numbered Tile -----
/ �p f �+ a �/ Brick_------- ---------_--------------� .
POOLAREA TO B NCL®$ED B 1 Special Detail: See "STEEL,, ..GUNITE"
P _
—
MI%1IMUM 5 FT. H H FE.N�CE.
1C/ S
/ ELECTRICAL
\ ALL GATES TO BE yELF-CLOSING By: NtA. L, ht J� __Cord Length — Feet.
U. •,J.• Box Locationc.� Switch Location_ ND SELF- e '
Filter Run -_.._Ft. Jet Run ____Ft. light Run Feet.
Switch Run .Ft. Panel Change
\ jjr i Spa Switch Location_ -
I t^ Heater Switch Location_
-. - -- ---------
r i�.J���� F90FAOC� f �t DECKING
Finish----Sq, Ft.
!, Color Anchors -
-- --- Risers._- _Ft. Expansion.--
Standards
zpansion:—
Standards Boar&Slide--
Deck
- -- - --- - - -
PLASTER
Lights � _ N me Plates --_L---Recessed Steps
Cup Anchors__- ____Rail Anchors ^__Grills
CITY OF LAQU
! NTA �
ETY DEPARTK4ENT
- - - ---_ -
_ APPROVED: , BUILDING &�;
—CON-DLT
A CUSTOM DESIGN FOR:
ih f --- -- - ---- ----—
N T�iLLATiO�! AS PER I n)�,PAS
SUi3.1E.CT TO I S NAI'
D 3ESS 50`2:45 <AL.L.i✓ F116ILAN(A,
M ' a - >r AND 14LL-APPLICABLE nDES CIT LIA, 62Ui
Designers & Builders for over 35 years
r0. E SCo4-5t?_L7
73-547 Highway 111/Jensen's Shopping Center (7j
Palm Desert, California 92260 DATE r�v.ti
I 619-346-6115
State License # C53-238947 _ _ +�� �_ �.',-
DATE _ • 5,SCALE t OWN. BY nAI LfC..IE.. 1 CNK. BY SHEET j OF
` .BISHOP GRAPHICS/ACCUPRESS
PEORDER NO A-%295
9
to
Z
0
110-
U
LU
U)
Receipt No
Issued By /�� (�(/. /�GZ<y�
District: Riverside EJ Indio—Cf Hemet D - Date
DISTRIBUTION: WHITE - Office File YELLOW - Applicant PINK - Building Dept. GOLDENROD - Pending File
DOH SAN 122 (Rev 10/82)
I
RIVERSIDE COUNTY DEPARTMENT OF HEALTH
PERMIT APPLICATION FOR A SUBSURFACE DISPOSAL SYSTEM
Applicant: Submit this form with three copies of a scaled plot plan drawn to county specifications required -.on the
attached chec k list..A non refundable filing fee of $15 is required when the application is submitted. Check must be
made payable to County of Riverside.
Name
Mailing Address
City
State
Zip Code
04_25-S
Phone
CSZ_
*Property Address <
City r-r—emmutaity—
*Legal Description of Property (Lot, Parcel Map, Tract)
Z'y 66'.
'j y
*Assessors Parcel No..
Water Serving Property From.
Lot size
'&6'nSirGreof_4-Wicant Date
*The above information must be verified from Building Application
Staff Use — Do Not Write Below This Line
Initial Date
2F
WQCB Clearance required Yes ❑ No
Soils feasibility report required Yes. ❑ No
Detailed boring report required Yes El No
Detailed contour plot required Yes El No M.
Comments:
Soils or boring report by Date
Approved by Date
Soils Map Page vSoil Type* Tract File No. 5,�-dz4MwAltr0ther
Number of Bedrooms
1
Septic Tank Size (gallons)
Rate.Required
Type of System
New Addition -Replacement
.
/
El
Leach line sq. ft. of bottom area trench
Leach bed (sq. ft. of bottom area bed)
Seepage Pit Diameter
6
Number of Pits
2
Seepage,Pit Depth B.I..
Total Depth of Pit
52 [B"-,
�O T, D,)
�o
.Location of System
Additional Requirements
J
d pos system as indicated on the a#dffDpr4a-h4jted
A permit ii.mkproved.4 -ey-fied for the design of a subsurface'dis pan
using the requirements set forth in Section B above. A building permit is necessary for the installation. ofeFeabove
desi ed ystem.
_Sig. ature of Health Official Date
Receipt No
Issued By /�� (�(/. /�GZ<y�
District: Riverside EJ Indio—Cf Hemet D - Date
DISTRIBUTION: WHITE - Office File YELLOW - Applicant PINK - Building Dept. GOLDENROD - Pending File
DOH SAN 122 (Rev 10/82)
I