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07633 (SFD)1, . f y 4 P.O. BOX 1504 Addrress 53-3r5 AVIMidl >flJa:"8_Z LA QUINTAdi78-105CCALIFORNIA 92253 Owner $ar` y Brant Mailing Address B ox 52 City I Zip ITel. Contractor General Contract ftme wlt Address PO RIX 59 City lZip _ Tela State Lit. City & Classif. ' 52432SJ Lic. # 1235 Arch., Engr.,, f. Designer, Address Tel. CityZip 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 Businessnd Professions Code, and my license is in full force and effect. S G'NATUR DATE OWNER•B-UfC[ EWDECiXRNTION I hereby affirmrrn th exempt from-the•Contractofs 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) 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 subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ 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.) ❑ 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 1 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. No. 07633 BUILDING: TYPE CONST. OCC: GRP. A.P. Number 77.4.-034-017 R .010 Legal Description Laft $ A a Black In Project Description Single family dilltelling � iZ� lkla��s,,,�'► Sq. Ft. 2450 No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ 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 thg work for which this permit is issued, I shall not employ any person in any manner Boas to become subject.to>the Work ss -Compensation Laws of California Owns - Date Owner NOTICE TO APPLICANT. If, after makingthis Certificate of Exemption p you s9t uld become subject to the Workers' Compensation provisions of the Labor Code,, you mu 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 which this permit is issued. (Sec. 3097, CivilCode.) 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 stimated Valuation 129 1005 PERMIT AMOUNT Plan Chk. Dep. isim. an Plan Chk. Bal. na, Const. Mech. Electrical Plumbing S.M.I. 9.03 Grading Driveway Enc. Infrastructure TOTAL s� • s REMARKS C � , E} ,. } '. [ ` 10 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 INSPECTORR Issued by: Date 4/23/n,rmit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES, 1ST FL.. SQ. FT. ® $ UNITS �. 2ND FL. SQ. FT. BONDING YARD SPKLR SYSTEM POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT, ® POWER OUTLET ROOF DRAINS CARR SQ. FT. GAS (ROUGH) Q/? �o V a DRAINAGE PIPING WALL SQ. FT. OTHER APPIEQUIP. DRINKING FOUNTAIN. SO. FT. ® TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FRAMING GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED /I / ® O • 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. SQ. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11% c SEWAGE DISPOSAL SO.FT.GAR ® V4c 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 L STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR - SETBACK Y 57 GO I-AIBI UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE 4 a;1f/Q/10 ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS R 01, SEPTIC TANK ROUGH WIRING, DUCT WORK ROCK STORAGE FOUND. REINF. 6>, GO �I/� GAS (ROUGH) Q/? �o V a METER LOOP HEATING (FINAL) OTHER APPIEQUIP. .REIN F. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP. �P $ GRADING Cu. yd. plus x$ =$ LUMBER GR. FRAMING FINAL INSP. ROOFING /I / ® O • REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND AM FINISH GRADING FINAL INSPECTION, / Gj QAh CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL T4hf 4 4(V Quiftro 78-105 CALLE ESTADO - LA QUINTA, CALIFORNIA 92253 - (619) 564-2246 December 18,' 1990, To Whom It May Concern: The structure located on A.P.N. #'174-034-017 and 774-034-018, lots 5 and 6, in La Quinta is addressed 53-355 Avenida Juarez, La Quinta, CA. Very truly yours, BUILDING AND SAFETY DEPARTMENT Tom Hartung Building and Safety Director Mark Harold Inspector TH:es LTRTH10 MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253 Jr 4 �IGGiiV 4v P.O. BOX 1504 APPLICATION ONLY Building _ _ 78-105 CALLE ESTADO Address _-5 LA QUINTA, CALIFORNIA 92253 Owner 5 BUILDING: TYPE CONST. OCC. GRP. Mailing I 1� t1 Address A.P. Number/ 'i �1 t 1 �l �% 0 I City ]LIP Tel. Legal Description Lo7-S Contractor / Project Description -� Address o o- / N vny C ulm State Lic. e( City Lic. # 8 Classif. S 3-Z s l2� Sq. Ft. No. No. Dw. Size Stories Units Arch., Engr., � - Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section osion• of the Business and Professions Code, and my license is in full force and e7000) SIGNATUREDATE OWNER -BUILDER DECLA TION hereby I for following Estimated Valuation �f I affirm that am exempt from the Contrac is License Law the Code: Any reason: (Sec. 7031.5,Business and Professions city or county which requires a perdf to constrict, after, Improve, demolish, or repair any structure, prior to its issuance also.- _ f requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT AMOUNT the proviskms 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 nor the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep. subjects the appicant to a civil penalty of not more than five hundred dollars ($500). Plan Chk. Bal. p r� ❑ I, as owner of the property, or my employees with wages•as their.sole compensation, will ,_ [ s do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. Code: The Contractor's License Law does not apply to an owner of property who. budds or improves thereon and who does such work himself or through his -own employees.. Mech. provided that such improvements are not intended or offered for safe. ll, however, the building or improvement is sold within one year of completion, the owner -builder wig have the burden Electrical of provimg 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- Plumbing 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. O such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading 11 1 am exempt under Sec B. 8 P.C. for this reason , Driveway Enc. Date owner Infrastructure 15/ —7 WORKERS' COMPENSATION DECLARATION 1 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•herebytumished: - TOTAL CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REMARKS 111� S o� < n 7 h r;q A._. <—/gin r n �_ 2 n (This section need not be completed if the permit is for one hundred dollars (4100) valuation Orton ) V _ w _ - i.© -CASH 1 TOTAL. 1 '� � 275� Q0 1 certify that in the performance of the work for which this permit is issued, I shall not employ any Calir ppeerson in any manner so as to become subject to the Workers' Compensation Laws of a. Date owner NOTICE TO APPLICANT- ff. 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 construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lenders '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 DIVISION 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: x Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL.402 SO. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SO. FT. FORMS SEWER OR SEPTIC TANK POR. SO. FT. ® MOBILEHOME SVC. BAR SI K u L POWER OUTLET ROOF DRAINS ' GAR.'L SO. FT. OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE DRAINAGE PIPING CARP. SO. FT. GROUT WATER HEATER WALL SO. FT. ® FINAL INSP. DRINKING FOUNTAIN SO. FT. ® WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ =$ WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM FIRE ZONE ROOFING KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB LATHING SO. FT. ®c IWATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1+/e c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER FINISH GRADING 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 SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE 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 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 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL Go V Z _O b W (J) M Z O b (JA COUNTY OF RIVERSIDE ENVIRONMENTAL Aftenm P'r°N Nm HEALTH SERVICES DIVISION k7y — 6 3y —� 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 IIsL A non.,efundable filing fee (see below) is required when the application is submitted. Check must be made payable to the County of ,Ftiverside'NApprovai of 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 # '`A9anf. Contractor, Con kf0erson Phone Address & Firm Owner /4 S / Phone / Mailing Address / Cityto Zip Job Property Address .S3.3S s[J/4R�Z Legal Description Prop. (PM, Treat, Lot) BGS/8a Z07 -S s�6 Lot Size Water Agency/Well Use of Permit P/P, CU, etc. Dwelling, M Site Prep, etc. Other � I —3— Z7- / o Signature of Applicant Date CATEGORY: REV CODE FEE CATEGORY: REV CODE FEE SUBSURFACE DISPOSAL 1238 $ 57.00 ❑ 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 ❑ 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 Certification of Existing S.D. System Required ❑ Yes No WOCEI Clearance required. (Attach Form ❑ Yes I I No DOH SAN 007, Santa Ana Region Only) Solis Percolation Report Required. ❑ Yes I I No Special Fwaibpity Boring Report Required. ❑ Yes No Detailed Contour Piot Plans Required (1 to 5 ft. interval) ❑ Yes No Otfter ❑ Yes NO Staff Specialist Lot Inspection Required ❑ Yes No Lot Inspection Date Soils boring report by �/ /c Project Date Soils Map Page Sop Type 144 Approved by pate No. of Systems - / Type of System(s) ❑ Figlding Tank ❑ Existing ®'%w ❑ RepFaoenwr» �� elling Unita �Bedrookfis Fixture Units (1) Septic Tank Soil Rate Greeae/Sand Grease Intcp (2) Leach Line Sq. Ft Bottom trench area Sk wall allowance It. rock/ R per running ft Install Line(s) It. long n wide with min. inches rock below drahrlines or Leach Bed sq. ft of bott!!qeree 0 NA Leachlines/bed special design for slope: ApplicaWe N/A Overburden facts (3) Pit Diameter ❑ 5 No. Pits Pit Below Inlet (BI) /G r Seepage Pit Total Depth (TD) 1.7 - 9 -N/A Other: Max. Allowable Depth z No. 2 System n 1 A vD f< o REMARKS: / /vS MPL ( t.✓o Afi j /.v �• i) I✓Q _ r/ h D/DENIED for the category checked'in SECTION B above, regarding the design of a subsurface disposal system as indicated This application(s �DtVDIan, on the accomp�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. Septic tank and sewer lines must be 50' minimum from any wells 9Leach lines must be 100' minimum from any wells, -including expansion area ) Seepage pits must be 15(( c0' minimum from any welll/s`,includin xpansion area Signature of Health Official 7\/'--, ( Date RECEIPT NO. I« " �,J Issued By V Date _q —�'7' 96 DISTRICT: ❑ Riverside, i�7 ndio ❑ Hemet q Perris ❑ Rancho a if. ❑ Blythe DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE - OlTice file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records t Desert Sands Unified School District CERTIFICATION OF PAYMENT OF SCHOOL • %QVY FEES QAfI TO: City 9 �L' suont"��®� DATE:LW g1 qO f� �� D "�r"Ft en( faOtlulnity Development ® 78-10 aVa11Estado La Quinta, CA 92253 This is to certify Wiat1I`�-- V developer of which is located at , within this Distric , has paid school face ity f e imposed pursuan to the $ut ity gen (t by Gove nment Code e d o 53 80 in the mo nt of D covering a total of square Weet of ( ) residentia r ( ) industrial/commercial development and that buildin permits for 7C this footage in this development may now be issued by your jurisdiction. 60 Cr � / N fo&Q" J), 7(7t. r DESERT SA S•UNIFIED SCHOOL DISTRICT White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer (10)-37