9466 (SFD)44
P.O. BOX 1504
Building 51-70078-105 CALLE ESTADO
Address Juarez LA QUINTA, CALIFORNIA 92253
rjack Inc.
Mailing
Address P. Q„ Box 59
City Zip Tel.
La Quinta 92253 5648-1486
Contractor
General Contract Management
Address
same
Zip I Tel..
State Lic. City
& Classif. B 54325 Lic. # 3235 '
Arch., Engr.,
Designer
Address Tel.
CityZip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I he eby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7x00) of Division 3 of the Business apd.ft essions_Cod and my license' is in full force and
effbt—
S G ATu E pA7E
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt•from the'Contractot's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
No. 9466
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 773-113-003
Legal Description
Project Description SFD
Sq. Ft. 1483 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Permit does not include block walls or
pool
Estimated Valuation
8'.;578.60
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
PERMIT
AMOUNT
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
Plan Chk: Dep. -
' 25 a. 0 0 '
' subjects the applicant to a civil penalty of not more than five hundred dollars.($500).
Plan Chk. Bal.
230. 3 5
" ❑ 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
Const.
C tt
• 5 V
•builds or Improves thereon and who does such work himself, or through his own employees,
that
Mech.�
513
. provided such improvements are not intended or offered for sale. If, -however, the building.
or Improvement is sold within one year of completion„ the owner-bullder will have the burden
Electrical
•
1�'2 g
of proving that he did not build or improve for the purpose or sale.) ,
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
15 7 5 Lt
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
S.M.I.
5.74
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. B. & P.C. for this reason
Grading
20 � G0
Driveway Enc.
20.00
Date owner
Infrastructure
3.797,27
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
O,Copy Is filed with the city. -❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM '
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed If the permit is for one hundred dollars ($100) valuation
-{ f
- 80RIi J. il( aiYuse I;%�".7, "'�f.'i..,_ 30
or less.)
1 certify that in the performance of thg work for which this'permit is issued, I shall not '
.
x17 it h1SS3 1 11t.?3left,.
_
!i 47 i.%T
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT., It, after making this Certificate of Exemption you, should become.
ZONE:
BY:
. subject'to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. -
Minimum Setback Distances:
Front Setback from Center Line
{
CONSTRUCTION LENDING AGENCY .
Ihereby 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 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 of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
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. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CARP. SQ. FT.
WALL SQ. FT. ®
SQ FT ®
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
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROCK STORAGE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
METER LOOP
LAUNDRY TRAY
AIR HANDLING UNIT CFM
OTHER APPJEOUIP.
IKITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SQ. FT. @ c
BATH TUB
WATER SYSTEM
SO. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
FINAL INSP. /
SO.FT.GAR ® 3/ic
HOUSE SEWER
ROOFING ��<
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECHI FEE PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK_�(�_A.
ROUND PLUMBING
,.7 UNDERGROUND
A.C. UNIT
COLL, AREA
SLAB GRADE . d`
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK2 gylW WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF. _ �%�/�
a,
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
FINAL INSP.
ROOFING ��<
M
{J 6 I
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESRNRIALS
GARDEN WALL FINAL
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated (619) 347-8631
Date 4/17/91
No. 10544
Owner Name
Type of Permit
Charjack Inc.
No. 51700 street Avenida Juarez
city La Quinta zip 92253
La Quinta
Permit #
Log #
Study Area 113
APN # 773-113-003 I Tract # Lot # Square Footage 11483
Type of Development I Single Family Residence No. of units 1�
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 facility fees imposed pursuant to Government Code 53080
in the amount of 11.58 1 X 1483 or $ 2,343.14 have been paid to D.S.0 S.D. for
the property listed above and that building permits and/or Certificates of Occupancy for
this square footage in this proposed project may now be issued
Fees Paid By General Contract Management Telephone 564-1486
Name on the check
By Richard M. Beck
Director, Facilities Planning & Development
Fee collected /exempted by Shelley D. Bennett
Payme& Received
Signature £ . ,�.� .
,.," Check, -lea. 012873
Collector: Attach a copy of county or city plan check application form to district coy for all waivers.
•'V" '
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
-,-,,_.. �e..�.r+wgl,ra^a-, qY'i-+; 14i"yq`Q`j ''��`gy�T'�L__'�.�}3��" ,Y'�''r+f7�' 'a�N� 'I�'���,�,�'" � -�{�. •" ,�',S,
... � '""Y F xTi `1 - 'tit �!�. ilii ""-��.° ��rf`•5�+.
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTHAn"*M ftMW3 fft
ENVIRONMENTAL SERVICES DIVISION / /"3— 00
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 list
A non-refundable filing fee (see below) is required when the application Is submitted. Check must be made payable to the County of
�(]j �yRIV7ftde.@ApQrov�al`lof this application shall remain valid for a period not to exceed one year from date of approval.
VERIFY ITEMS
,,IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG # r;� 14 �!
4jWtJ.
Contractor, Con '' ^Ferro^
2e • VM
Phone
dress &Firm
/ice l
i� GSA
�y
(� �-f•
Owner
Phone
Mailing Address
City
A.
State
Zip
Job Property Address ./
Legal Description Prop. (PM, Tva Lot)
A,
'r i3G- dr z,e/ Jac:
Loi -Size!
er Ar" rx / $II
Use of Perr4 P/P, CU, etc; G �L t .'
Other
H• e et��—
o��.
ren:
Signature of /lppfZdffl _ ..
Date
CATEGORY: REV CODE FEE
CATEGORY: REV CODE FEE
V SUBSURFACE DISPOSAL 1238 5:7,1
SITE EVALUATION UPON REQUEST 7349 43.00
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN) .
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $ 17.00
a. 1 at 4 Parcels (Each) 1238 $ 57.00
(Less than 1 year)
b. Each Parcel after 4 7344 $ 24.00
❑ PRELIMINARY ELECTIVE 7352 $ 23.00
❑ Rere-Aew (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
jINITIAL DATE
Holding Tank Agreements Completed ❑Yes
21N0'�
Certification of Existing S.D. System Required ❑ Yes • N
WQCB Clearance required. (Attach Form ❑Yes m N' o
DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required. ❑ Yes C4' *"
-41
Special Feasibility Boring Report Required. ❑ Yes 00
Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes y Nom
Other ❑ Yes
Staff Specialist Lot Inspection Required ❑ Yes i
Zo
Lot Inspection Date
Shca boring report by Pro K Date
! f �//
Solis Map Page f Soft Type `. CRC .-"' Apprd by �/ C Dame 1`"
No. of Syafems
Type of�S�yafe its)
❑ Ing Tenk ❑ Existing
No. Dwelling Units/)
Bed
(1) Septic Tank
Solt Rate
Graeae/Send
0 1rrEcp
•
�- New O ReptaoertNxrt
�``R`�,'_"'�
� 11
{? / �l
%/fj��
Gel
��•--• � -r /
�
(2 Leach Line Sq. FL
Sidewall allowance
Irtatal ft. long wide with
hLLeach Bed sq. ft.
Bottom trench araeLxre(s)
It. rock/ sq. fL
per Nnrllrlg ft
min. below drelnlines or
of area
ti
Rte:
o,�NA
Leachlines/bed special design for slope:
(3) Pit Diameter r
No. Pita
Pit Below
Seepage Ph Total Depth
"Other.
Applicable
r `,
(
Inlet (BI)
(TD)
Max. Allor Depth
N/AiOverburden factor
❑ 6
L�
No. 2 System /l l n
REMARKS:
42
This application i APPROVED ^ ENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompan us,tkieui a nts set forth in S C OM,.C.�4ave,.QA,.buil. permit is necessary for the installation of the
above -designed system. No oonstructioh"is permitted in the required reserved 100% 1
expansion area.
1�1_) Septic tank and sewer lines must be 50' minimum from any wells ,s•���� .f ,�fa�... ��
Leach lines must be 100' minimum from any wells, including expansionrar�a
3) Seepage pits must be 150' minimum from any wells, including expa sion�areaaf, f%
Signature of Health Official fc_.G�
•�+ �+�'� Date �!
RECEIPT NO. /:;?C;2 /Issued By Date
DISTRICT: ❑ Riverside, dro.4 ❑ Hemet O Perris ❑ Rancho Calif. ❑ Blythe
DOH -SAN -122 (Rev. 3190) DISTRIBUTION: WHITE . Office file YELLOW . Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records