05733 (SFD)t�
Building 52-565 JUAM
Address
Mailing
Address BOX 921.
City
RIALTO
Contractor,
' SAB
4
P.O. BOX 1504 No. 05733
,.
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Zip Tel.
92284 1710875-6000
Address
'City I Zip Tela
State Lic. City
& Classif. 361079 Lic. # 1175.
Arch., Engr.,
Designer "
Address Tel.
City I Zip I 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 DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractat's License Law for the following
reason: (Sec. 7031.5,Buskiess and PWIessions Code: Any city or county which requires a
permit to construct, after, improve, demolish 'or repair any structure, prior to its issuance also
requires the applicant for such perm# to Me a signed statement that he is licensed pursuant to
the provisions of the Contractors 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 vidation of Section 7037.5 by 'any applicant for a permit
subjects the applicant to a civ0 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 Contractors License Law does not apply to an owner of property who
builds oranproves thereon and who does such work himself or through his own employees,
'Provided that such improvements are not intended or offered for sale. It, 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 trrprove 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 Owner
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.
.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed N, the permit is for one hundred dollars ($100) valuation
or less.) -
I certify that in the performance of the 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: ft, 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 permft shaf/ 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, 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 100 days.
I certiy 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 773-244-007
Legal Description LOT 6
Project Description $F
9
Sq. Ft. s No.
Size Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
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
Estimated Valuation
$100127.7-00
PERMIT
' - AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal
292.49
Const.
643.00
Mech.
53.50
Electrical
120.40
Plumbing
157,50
S.M.I.
2.37
Grading
M.f 0
Driveway Enc.
_20X0.
Infrastructure
TOTAL
—. 7 A
REMARKS '
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
5/12/£9
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING WS
IST FL. SQ. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
LAB GRADElej ��
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
ROUGH WIRING
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
GAS (ROUGH)
DRAINAGE PIPING
CARP. SQ. FT. ®
HEATING (FINAL)
OTHER APPJEQUIP.
WALL SQ. FT. ®
GAS (FINAL)
DRINKING FOUNTAIN
TEMP. POLE
URINAL
SQ FT ®
GROUT
WATER HEATER
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROOFING �/ a
LAUNDRYTRAY
AIR HANDLING UNIT CFM
�l
1p/SSP11
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
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® Vic
HOUSE SEWER
LATHING t%)WAI i9 D
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
ETBACK��
GROUND PLUMB
G ,
UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADElej ��
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
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. �/ �' s �O
GRADING
cu. yd.
$-p lusxt
=S
LUMBER GR.
FRAMING
FINAL INSP.
ROOFING �/ a
]�
`✓
�l
1p/SSP11
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING t%)WAI i9 D
MESH
INSULATIONISOUND /� 9
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
t
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
NOTICE: THIS WCUMENT ICANNCrV qA
c TFrq, SCHOOL FACILITY FEES
TO: City of La Quinta DATE:
Department of Community Development
78-105 Calle Estado Ido
La Quinta, CA 92253 /011
This is to certify that ULU i -
developer of a , which is
located at + I I 16 YP,71 , within
this District, has paid school facility fees imposed pursuant to the
Suth r,ity enerat d by Go ernment ode Se tiost 30 0 'n the a ung o f
( 1 K e?
covering a total of square feet of ( ) esidential or
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
125131471
for DESERT SANDS UNIFIED 4SeHOOL DIS
Aftq qVS
h //W, ,,hit j' uildiing Department • Yellow - Facilities Planning 0 Pink - Accounting • Gold - Developer
Ie',R L 'c- "`- - (10)-37
RECEIPT NO. �-/ `�
DISTRICT: ❑ Riverside, ❑ Indio
DOH SAN 122 (Rev. 5/88) DISTRIBUTION:
Issued By Date
❑ Hemet 17 Perris ❑ Rancho Calif. ❑ Blythe
WHITE -.Office file • YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
EL711111
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No.
ENVIRONMENTAL HEALTH SERVICES GO
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
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 3 SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG x
Z
O
Agent, Contractor, Contact Person
f,4?r a
Address s Phone
v
ow LA KA4 1E70
7S 6 060
W
A>,4N/
Phone
Mailing dress
cn
SAwn?
V. 0Noi( 12V
ity
State
CAS 11-
Zip
Job Property Address &�q
L07— !a
Legal Description Prop. (PM, Tract, Lot)
L
Z
••e,.e
13LK 16-7 ,o.&,-,,o BAR ra
Lot Size
Water Agency/Well
Use of Permit P/P, CU, etc.
Other (JMJI'T- AJv I?
141 S x
C- . V- W9
Owell n Site Prep, etc.
AprtJ ^ Zy
Q's ► l .r.�.� .Q.
Signature of Applicant I
51 — 7 - k
Data
CATEGORY: REV CODE FEE
CATEGORY: REV CODE FEE
13 SUBSURFACE DISPOSAL 1238 $45.00
❑ SITE EVALUATION UPON REQUEST 7349 $42.00
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
m
Z
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
O
a. 1 at 4 Parcels (Each) 1238 $45.00
(Less than 1 year)
U
b. Each Parcel after 4 7344 $16.00
❑ PRELIMINARY ELECTIVE 7352 $45.00
W
❑ Rereview (2nd review same parcel) 7344 $16.00
EVALUATION (Attach DOH SAN 53)
❑ Site Evaluation in Conjunction with
❑ HOLDING TANK 7351 $45.00
Critical Area 7346 $86.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $13200
❑ Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $86.00
INITIAL DATE
Holding Tank Agreements Completed ❑ Yes No
Certification of Existing S.D. System Required ❑ Yes No
WOCB Clearance required. (Attach Form ❑ Yes No
DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required. ❑ Yes ❑ No
Special Feasibility Boring Report Required. ❑ Yes ❑ No
Detailed Contour Plot Plans Required (1 to 5 ft. interval) ' ❑ Yes ❑ No a
Otter ❑ Yes ❑ No
t
Staff Specialist Lot Inspection Required ❑ Yes No E
Lot Inspection Date
Soils boring report by Project # pate
Soils Map Inge Sold Type Sh ` Approved by J � i" Date
U
No. of Systema
Type of Systems)
No Iing Units
(1) Septic Tank
Soil Rate
Grease/Sand
Z
❑ Holding Tank ❑ Existing
re Units
Grease Intop
O
t) /,
rylJ�ew ❑ Replacemeat
L 6
2
Gel
Gel
UJ
(2) Leach Una Sq. Ft.
Bottom
Sidewall allowance__,
Install Lwre(s) ft. long a wide with
Leach Bed sq. R
trench area
/
R rock/ sq. R
per ru Ing ft
min. Inches rock bekrnr dr�ainylines tSrf�
7
❑ . NA
L.aachlines/bed special design for,slope:
(3) Pit Diameter
No. Pits
Pit Below
Seepage Pit Total Depth
Other
Applicable
115
Inlet (Bl)
lir_ i s '
N/A rden faktor
" 6
0,4j(
y•
Max. Allowable Depth
Zo
No. 2 System
REMARKS:
This application is PPROV /DENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
0
on the accompan' pot plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
Oabove-designed
system. No construction is permitted in tae required reserved 100% expansion area.
(1 Septic tank and sewer lines must be 50' minimum from any wells
U
Leach lines must be 100' minimum from any we/s, including expansion area
IJJ
�(2)
Com' Seepage pits must be 15o' minimum, from any wells, including xpansion area
c�
Signature of Health Official ! pie % �/ 2
RECEIPT NO. �-/ `�
DISTRICT: ❑ Riverside, ❑ Indio
DOH SAN 122 (Rev. 5/88) DISTRIBUTION:
Issued By Date
❑ Hemet 17 Perris ❑ Rancho Calif. ❑ Blythe
WHITE -.Office file • YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
EL711111