9978 (SFD)4.
Building
Owner
Aaron Hamilton
Mailing
Address P. 0. Box 1771
City Zip
La Quinta [92253
Contractor
X dk Owner/Builder
•414 a
7&105 CALOLE ESTADO X 1504 � � . 997 8.
LA QUINTA, CALIFORNIA 92253
I iR
State Lic.I City
& Classif.. Lic. #
rlrcn., r=nyr., .
Designer
Address Tel.
City Zip State • : '
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE LATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law forthe following
reason: (Sec. 7031.5;Buisiness and Professions Code: Any city or county which requires a
permit to construct, atter, improve, demolish; or repair any structure, prior to its issuance also
requires the applicant for such permit to rile 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 exernpt 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 dogars ($500).
IV I, as owner of the property, or my employees with wages as their sole compensation, will
Ido 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
'stiuilds or improeps thereon and who does -such work himself or through his own -employees,
provided that such improvements are not intended or offered tot safe. If, however, the building
or improvement is sold within one year of completion, the owner udder wrTl have the burden
of proving•that he did not build or improve 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 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/ �/ / ` r Owner /1'X1, 20-17
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
(This section need not be completed it the permit is for one hundred donars ($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 making this CerWkXe 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 which3his 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 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 Date
Mailing Address
City, State, Zip
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 773-244-010-2
Legal Description Lot 1 Block 267 Unit 17
Project Description SFT) .
Sq. Ft.157. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Permit includes wooden fence, permit
Foes not include patio or pool
m
Estimated Valuation q /y 0/�
92.317.0
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
Precise Plan
TOTAL
REMARKS i
m
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:
AMOUNT
.00
27(l[-
X744
55.50
129.06
163.53
9.30
20.00
20.00
2038.88
00
qr-S { Iu F
4".,- 1 _ 3315. 98 c98 -.
.98.
3315.98
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. PLUMBING FEES
1ST FL SQ. FT. ® $
2ND FL SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. 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
HEATING (ROUGH)
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH) METER LOOP
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
REINF. STEEL
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN 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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1Vi c
ISEWAGE DISPOSAL
FIRE ZONE ROOFING:
SQ.FT.GAR ® 3/4c
HOUSE SEWER
SPARK ARRESTOR
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEEPLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK !� /L1 <f/
s
GROUND PLUMBING ��klNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER O%X&P*l0-iAW( ROUGH 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
FINAL INSP.
FINAL INSP.
GRADING
cu. yd.
$ plus x$ =$
LUMBER GR.
FRAMING Z11 1/
ROOFING
VENTILATION
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•
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REMARKS:
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING"fOW4/
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
(11
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
t" Document Cannot Be Duplicated (619) 347-8631
Date 10/9/91 Type of Permit I La Quinta
No. 10919 Permit #
Owner Name Aaron Hamilton Log #
No. 52485 street Ave Juarez
City La Quinta zip 92253 Study Area 112
APN # 773-244010-2 Tract # Lot # 0 Square Footage 11573
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 facility fees imposed pursuant to Government Code 53080
in the amount of 1.58 X 11.573 or $ 2,485.34 have been paid to D.S.U.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 Aaron Hamilton TelephoneV
Name on the check
By James E. Lively
Assistant Superintendent, Business Services
Fee collected /exempted by Vickie J. Durrett
Payment Receive*,,* j `
Signature r��C�211!l�.iJU Check No. 1378
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
i' x
►�i
f
fir
�
Payment Receive*,,* j `
Signature r��C�211!l�.iJU Check No. 1378
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
q.,,,S.„,ti,�.a'�' �,yk�i`'tisM��T'6�,.,,��`�ta'YZ�'-`F..,, �. __-;�....^,r„r,'.."-r.:..T="�7'i'a:'''_'yt-+�'-37"'IJs'Y.`us9s-'�"""Xt"^nr<�^^���,''�: *•-"�-�..w•..r—+nt`r.
RECEIPT NO. ` �3 Issued By Date— !S
DISTRICT: ❑ Riverside,'. ` T] In45-11f ❑ ' Hemet ❑ Perris O Rancho Calif. ❑ Blythe
DOH -SAN -122 (Rev. 3/90) DISTRIBUTION: WHrTE - Office file YELLOW - Applicant PINK - Bldg. Dept— GOLDENROD - Plans/Records
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COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH::,..,•_..,;JA,/s=PaMelN°'
11DENVIRONMENTAL
SERVICES DIVISION �`i `T
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
Oiiverside. Approval of this application shall remain valid for a period not to exceed one year from date of approval.
,p /)
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG #
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°
Agee rector, t 1tact Person
rio 14 r-014:7-00
Phone
Addres .& . ',an .✓
,.�-
W
�Owner
Phone
Malling dress
/?7
m
CityZq
Slate
ip
Job Property Address
Sa-fBSG
Legalript' Prop. (PM, TrecL Lot)
LaT %oa /6SA,✓r4 C,fa
,1�Gtit�13
Lot Size
ter A encr I
Use of Permit P/P, CU, etc —
Other
ailing,
H Site Prep, etc.
Signature of Applicant
Date
CATEGORY: REV CODE FEE
CATEGORY: REV CODE FEESUSURFACE
DISPOSAL 1238 $Z.
SITE EVALUATION UPON REQUEST 7349 $ 43.00
J000
m
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
LAND DMSION
SEWER/SEPTIC VERIFICATION 7348 $ 17.00
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O
a. 1 at 4 Parcels (Each) 1238 $ 57.00
{Lass than 1 year)
b. Each Parcel after 4 7344 $ 24.00.
❑ PRELIMINARY ELECTIVE 7352 $ 23.00
W
❑ Rereview (2nd review same parcel) 7344 $ 24.00
EVALUATION (Attach DOH SAN 53)
U)
❑ Site Evaluation in Conjunction with
❑ HOLDING TANK 7351 $ 47.00
Critical Area 7346 $111.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $222.00
❑ Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $ 87.00
IAV
Holding Tank Agreements Completed ❑ Yes C�� l D
Certification of Existing S.D. System Required ❑ Yes l�No
WOCB Clearance required. (Attach Form ❑ * Yes P` ?O
DOH SAN 007, Santa Ana Region Only)
Solis Percolation Report Required. ❑ Yes
Special Feasibility Boring Report Required. ❑ Yes ■
Detailed Contour Plot Plans Required (1 to 5 ft interval) ❑ Yes �" N/cy
Other ❑ Yes f�d,'/NN,,o,,
Staff -Specialist Lot Inspection Required - ❑ Yes
'" "" Lot Inspection Date
Soils boring report by Project Date
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Soils Map Page t Sol Type Approved by �� Date
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No. of Systems
TyVe of Systems)
Tank ❑ Existing
No. Dwelling Unita
Bedrooms, Fixt wWriits
(1) Septic Tank
Solt Rate 'a,� ,G_rease/Sand
(3Tbaee Intop
_O
/
rO=ing
❑ Replacement
3 // /Li�,,�
/�
Gd
NR). Leach Line Sq. Ft
tnfnch area
Sidewall allowance
�fL sq. ft.
InstaThy L.ine(s) ft long H wide
min. rc below drafnlinea or
pd
leach Bed aq ft
be`
per runni ng
NA
L.eachlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
Seepage Pit�Tc)tal Depth
(TD) ^��O
Applicable
ej �
�/�/
�' 6
Inlet (81)
/
Max. Albwagle Depth
N/A Overburden f actor
Q
No. 2 System IA -
REMARKS: C�:��/�Crtd� � /G��(�
/�/JL4'�Jr•�.
��%
S / /C/Li C�..s{✓^. �io-'e
/Ale
i/ J
This application is PPROVED' ENIED'for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompanied plot �slttg-tAe—ra)remenfs—set„f in SECTION C above. A building permit is necessary for the installation of the
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above -designed system. construction is permitted in the required reserved 1 expansion area
1) Septic tank and sewer lines must be 50' minimum from Q( /
any wells o / t.
Leach
LU I
y�
lines must be 100' minimum from any wells, including expansion area 1
(3). Seepage pits must be 150', minimum from any wells including expansbn areJa� r!0 (��6 /
p
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Signature of HeaRh Official V - l
i— GZ�G Date {
RECEIPT NO. ` �3 Issued By Date— !S
DISTRICT: ❑ Riverside,'. ` T] In45-11f ❑ ' Hemet ❑ Perris O Rancho Calif. ❑ Blythe
DOH -SAN -122 (Rev. 3/90) DISTRIBUTION: WHrTE - Office file YELLOW - Applicant PINK - Bldg. Dept— GOLDENROD - Plans/Records
Ifs
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