10447 (SFD)Building
Address
Owner
A &
50--915 Paloma
M Builders
Address P. 0. Box 366
City Zip
La Quinta 92253
Contractor
A & P? 3ftuilders
Address
fi F�STte
State Lic.
& Classif. 487534
Arch., Engr.,
Designer
Address
City r
Zip
78-105
P.O.
8 10.O. BOX 1504 LE ESTADO ! -} N O . J.O f4
LA QUINTA, CALIFORNIA 92253 /
BUILDING: TYPE CONST: OCC: GRP.
Tel.
. 564--4832
Lic. #
Tel.
Zip (State
Lic. #
626
I LICENSED COINTRACTOR'S DECLARATION
I hereby affirm that';i( aril licensed under provisions'df Cliapte�{commencing with Section
7000) of Division 3 oilthe Business and,PFofessions Code.and my license is in full force and
effect. f;;ilii k. _.0------
r . OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
.reason: (Sec. 7031.5,Business 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) or
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).
O 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
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.)
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 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 t
a,
WORKERS' COMPEN#SATION DECLARATION
I hereby affirm that I have a certif. a a of consent to se[Liasure,, r a certificate of
Worker's Compensation Insurance, or a certid copy thereof gca2e0M�aboc Code.)
Policy No. Company _
.O,Copy is filed with the city. ❑ 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 the work for which thispermit is issued, I shall not
employ any peon in any manner so as to become subject to the Workers' Compensation
Laws of
Cal ifornirsa.
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 constructionlending 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 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 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 sof this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
A.P. Number 26710 MB 21/61-62 Unit 5
Legal Description Lot 77 S 78 (Portions, of each)
Project Description Sa` D
Sq. Ft. 2104 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Permit does not include block culls
or Pool
3tlmatea valuation
126,929.20
PERMIT
AMOUNT
Plan Chk. Dep.
250.30
Plan Chk. Bal.
374.60
Const.�E3'
j/j•+�tt
Electrical
1 2-: £•6
Plumbingk--z
S.M.I.
12.70
Grading8
eta,
Driveway Enc.
Infrastructure
fy - 197X.-2-7 27_55-7 , 6r
Arts in Publi y
67.32
Ovi
TOTAL
REMARKS
3. V t,tf,51'1 3 ILratgl_. a 1C i17
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 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMPING FEES '
IST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. ®
DUCT WORK
DRAINAGE PIPING
WALL SQ. Ff.
GAS (ROUGH)
DRINKING FOUNTAIN.
SQ FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
-Plus-X$-=$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
r'-° :LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
t SHOWER
BOILER. B.T.U.
SQ. FT. ® c
BATH TUB
FIRE ZONE ROOFING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SPARK ARRESTOR
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 UMBING ELECTRICAL HEATING & AIR COND. SOLAR'
SETBACK
GROUND PLUMBIN l /
NDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEIfwER 9Fi SEPTIC TANKS a
4OUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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 y,2 �a
FINAL INSP.
ROOFING 31( .2/j,
C7 b`/c
V 3
F�
� i W
nn
(0,
8
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 3
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTIONS�G
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
DESERT SANDS UNIFIED, SCHOOL DISTRICT
82=879 Highway 111
NOTICE: Indio. CA 92201
Document Cannot Be Duplicated (619) 347=8631
Date 2/5/92. Type of Permit I La Quinta
No. 11166 Permit #
Log #
Owner Name A & K Builders
No. 50915 Street Paloma .
City. L a - :Quinta Zip 92253. Study Area 0
APN # Tract #' Lot # L _j square Footage . 2104.
Type of Development Single .Family Residence No. of units
Comments
At the present time, the Desert Sands Unified- School District does not collect fees on
garages/carports, covered patios/walkways, residential additions -under 500 square feet,
detached accessory structures or replacement- mobilehomes. It has been determined
the above-named owner is exempt•from paying school fees -'at this time -..due to the
following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facdityfees imposed pursuant to Government Code 53080
in the amount of-
the
f or $;3,324.32 have been aid to D.S.U.S.D. for
0, D P
the listed above and that buil . rmits.and/or,.Certifi_ Certificates of Occupancy for
ProPeY : Pe P9
this square footage iii;this proposed project may now, be Lssued.
Fees Paid By A & M Construction Telephone 564.4M
Name on the check _
By James E. Lively.
Assistant Superintendent,.Business Services
Fee collected /exempted by •Vickie J. Durrett
Payment Received
Signature —EL Check No. 1642
Collector-. Attach a copy of county or city plan checkapplication form to district copy for all waivers.
Embossed Original- BuildingDept /Applicant Copy - Applicant/Receipt Copy - Accounting
F
. vc .. :a, ►R' .: a�:.. yxF,r r� nl�,+'S�.rW+spy'P�,r;�n/F,�'��M'•;fly'�Ylti!'ca�`.��•,�,� :A?K^��.�'�fl�ii '!",',i'.
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH w"oOf P fON MM
ENVIRONMENTAL SERVICES DIVISION 76q
PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM
Applicant: Submit this form with four copies of a scaled plot pian (1-20 scale) drawn to County speculations as indicated on the attached check list
A non-refundable filing fee (see below) is required when the application is submitted. Check must be made payable to the County of
(IRy'ver§ide. App*al;gi this application shall remain valid for a period not to exceed one year from date of approval.
iB$ �r /
VERIFY ITEMS�NjYSECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG #(-�`e
E o QnS n or, Cont&c6%.Peison1
^
Phone
41 V6 -3Z
AddressFirm
J�l
- ,�34 ��c ��
. .3
Owner
Phone
Mailing Address
City
State
Zip
Job Property Address 7 $ S lb
Legal Description Prop. (PM, Tract, Lot) 6
�►
c
22-13
4144-1
Lot Size
Agency/Well
Use of Permit P/P, CU, etc.
Other
9O j
/Water
G
Dwelling MH Site Prep, etc.
Signature of Applicant
Dee
CATEGORY: REV CODE FEE
CATEGORY: REV CODE FEE
SUBSURFACE DISPOSAL 1238
❑ SITE EVALUATION UPON REQUEST 7349 $ 43.00
/ • MULTIPLE PARCELS WITHIN SAME g�
(NO PLOT PLAN) .
LAND DMSION
❑ SEWER/SEPTIC VERIFICATION 7348 $ 17.00.
a. 1 st 4 Parcels (Each) 1238 $ 57.00
(Less than 1 year)
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)
❑ Site Evaluation in Conjunction with
❑ HOLDING TANK 7351. $ 47.00
Critical Area 7348 $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 MA
Certification of Existing S.D. System Required ❑ Yes No
WOCB Clearance required. (Attach Form ❑ Yes No
DOH SAN 007, Santa Ana Region Only)
Solis Percolation Report Required: ❑ Yes No
Special Feasibility Boring Report Required. ❑ Yes No
Detailed Contour Plot Plans Required (1 to 5 R interval) ❑ Yes No
Other ❑ Yes No
Staff Specialist Lot Inspection Required ❑ Yes No
Lot Inspection Date
Sella boring report by �( �� Project if Date
Soils Map Page Soil Type Approved by E�V�� Date'
No. of Systems
Type of Systeme)felting
❑ Folding Tank ❑ Existing
Units (1) Septic Tank
Flxture UnMs
Solt Rate
Greaae
Grease
New ❑ Reptaoertwrrt
(J
�y L�LGal
(2) Leach Line Sq. Ft
Sidewall allowance
Install Une(s) R long it
Leech
BottomR
R rock/ sq.
min. below dreMlines
of arae
per running R
NA
Leachlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
Seepage Pit Total Depth
Other:
Applicable
L
Inlet (BI)
�D) t►A�
Max. Allowable Depth
yy
N/A V/ Overburden facto
6
/
(/O
No. 2 System
REMARKS:
This application s APPROVE ENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompan 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.
(1) Septic tank and sewer lines must be 50' minimum from any wells
2 Leach litres must be 100' minimum from any wells, including expansion area
3) Seepage pits must be 1 ' minimum from any wells, including expansion area
Hr
Signature of Health Official
RECEIPT NO. / Issued By /��/� Date-
DISTRICT:
ate DISTRICT: ❑ Riverside,x radio- ' ❑ .Hemet D Perris ❑ Rancho Calif. ❑ Blythe
I
DOH:SAN-122 (Rev. 3/90) DISTRIBUTION: WHITE; Office file YELLOW - Applicant PINK • Bldg. Dept GOLDENROD - Ptans/Reoords
/Fo,QN/A
7ENT,471lE.oq�P�'ELfJAi�?
BYO.. 2 6
�.,
ATTACHMENT No. 2
. OCT V 1990'.:
w' -'CITY " OF LA QUINTA
W'NING b DkDPMBir DEFT.
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