003109 (SFD)T4.hf 4 a 4 � Quiar(A
P.O. BOX.1504 NO- 003109
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 774-071-011
Legal Description
Project Description Sinicile ralltily DYp'.-T l inti
Buildin
Address 53""4�s0 Avenida Juarez
Owner
Rick Johnson Const ructioir
Mailing
Address _ 3i
City Zip Tel. .:
T.= P1sa'i'f1! fi
Contractor
Same
Address
City JZip .. _ Tel....
State Lic.
& Classif:
97169
City
Li#
Sq. Ft.
Size -c.
- 1� o
No.
Stories 'I.. -
No. Dw.
Units 1
Arch., Ehgr.
Designer
New EX Add ❑
Alter ❑, Repair ❑ Demolition ❑
Address
Tel.
v r qrp
F �
FINAL DATE
_ City
Zip
State
Lic. #
Porch
204
V *
WV�sGiCIiZC'
LICENSED. CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70 OO) of Division of the Business a nndd..Professions/C:ode, and my license 'isin fullforceand '
effect.!/d-'�r'►.%''l�
SIGNATUREDATE
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 Coder 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 fhe 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.)
^ -
❑ I am.exempt under Sec. B. t. P.C. for this reason
Estimated Valuation
w� .
PERMIT. .
,.
AMOUNT
•
Plan Chk. Dep.
-
Plari Chk. Bal.
COf1St.
w
Mech.
Electrical)
Plumbing
Iin ^ n()
S.M.I. -
Grading
2111 .1nn
Driveway Enc.
20.013
Date owner
Infrastructure
1324.89
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.. O 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 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
TOTAL 92339..50
P20A9,.84
REMARKS
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 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 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 -
Mai ' ling
ateMailing Address
City, State, Zip
HARD COPY
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-S%1:1./A Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUM W49 FEES 1 r
IST FL. SO. FT. ® $
2ND FL. SO. FT. ®
POR. S0, FT. ®
GAR. SO. FT. ®
CAR P. S0. FT.
WALL 50. FT. ®
SO. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
!GK(IfFORMS —1
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
FINAL INSP.
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® IVa c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION
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
//�n�
i/�
GR UND PLUMBING -"((I/
UNDERGROUND
A.C. UNIT
COLL. AREA
///WETBACK
/,/�etaB GRADE �! a
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
!GK(IfFORMS —1
EWER OR SEPTI F'AIQ��
'' VV
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
%FOUND. REINF. ��
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
&�IEINF. STEEL — `
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ —Plus—X$—=$
LUMBER GR.
FINAL INSP.
V/'�RAMING g— — C
INAL INSP.
ROOFING (
Jy('
/ �'V,
U fi
t7
G S/PT •L
DEC 1 7
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LA ING
MESH
r S TIONISOUND�
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS.
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
SCHOOL FACILITY FEES
TO: City of La Quinta DATE:
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
r
This is to certif that
developer of,v which is I
located at 5 ,3 - within
this District, has paM schoo facility fees imposed pursuant to the
auth ri_ty generated byovernmen �;=ction 53080 in the noun of
$ S,Oa
covering a total of 16 S p square feet of ( r dential or
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
White- Building Department • Yellow
r DESERT S DS NIFIED SCHOOL DISTRICT
Facilities Planning • Pink - Accounting • Gold - Developer
0 007
COUNTY OF RIVERSI IRONMENTAL HEALTH SERVICES DIVISIOI %
PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM?77f-071- Q 1l
Applicant: Submit thisr;form with four'copies of a scaled plot plan (1-20 scale) drawn to
o_unty specifications required on the attached check list. A non-refundable filing fee of
^7 30 is required when the application is submitted. Check must be made payable to the
ounty of Riverside
{ _ Building Department Application Log N
a
Name (Owner, Agent, Contractor, Etc.)
074"
Mailing Address
x0 -
City
//�, A �/%� � �'?�
State,
4"H
Date
Telephone
? z f z _s G�/'- 2. 2- s
*Job Pro Address
or
Yes C
C *C ity,:or4.,Ctimrt}u3 t3c
*Legal Description of Prpty. Lot, PM, TR
*Assessor's Parcel No.
Water Agency
IeTYP
Use of Permit -y—,_010 -1/41H. Avl-fr
Lot Size ,
/
= Ol%
OrLW
/`J
SI�C/ MH Site"Prep Etc. Vw
r'
L ,j,
Planning Case NSC
] No C`]
ignature of Applicant Date
*The above information must be verified from Building Application
STAFF USE - DO NOT WRITE BELOW THIS LINE
�6 Soils/boring report by I r Proj. # Date
Soils Map Page rIV%Soil Type dc' Approved by Date V ) 1
rt '
U
Type of System: No. of Bedrooms) (1) Septic Tank Soil Rate Required�u,
Existing New Addition Replacement i Gals. C,/
[ ] [&dam LIl i 7
(2) Leach line sq. ft. Sidewall allowanceInstall Line(s Leach bed
(Bot.om trench area) ft. rock/ Sq. Ft. Ft. Lon Ft. wide Sq�+F,t. of
per rynriing ft. with Min. '`inc es rock bottom�`1�
N/A ,CV]"� below drain lines area
Leach lines/bed-special design '(3) Pit Diameter" No. Pit Seepage Pit total depth -%.,/.Y
for slope: Applicable =Mi+ 6' EV Pits BI
N/A L�Overburden factor I itL Max. allowable depth Vo
'
0
This application is(P ved dgnled for the design`of a subsurface disposal s --stem as
indicated on the accompani-eT plot plan using the requirements set forth in Section B above.
A building permit is necessary for the installation of -the above -designed system.
(1 Septic tank and sewer "lines must be X50' from any wells -(/014•1in.j'a,
ct . f mf - r = .r 4 (t.��.
(2) Leach lines must be 100 min. from any wells including expansion area
C3,)) Seepage pits must. be 150' mina from any wells including expansion area4/p..�s,,,,
Signature of Health Official Date Ufa
RECEIPT NO. I "1 f1 Lj Issued by Ll Date -/ 7 /t7
District: Riverside C ] Indio [O"Hemet [ ] Perris [ 7 Rancho Calif. [ ] Blythe C3
Distribution: WHITE -Office file YELLOW -Applicant PINK -Bldg. Dept. GOLDENROD -Pending File
7
DOH SAN 122 (Rev. 2/86)
Initial
Date
Certification of Existing S.D. System reqd.
Yes C
] No C/7%,
WQCB Clearance reqd
Yes[ Yes[
] NoC'IJ/
R
Soils feasibility report reqd.
Yes[
] No C`]
] (�
Detailed boring report. reqd.
Yes[
No.
/
Detailed contour plot plans reqd.
Yes[
] Nor/]
Z
0
E'
Staff Specialist approval reqd.
Yes[
] Nor/3Z
Lot Inspection
Date
�6 Soils/boring report by I r Proj. # Date
Soils Map Page rIV%Soil Type dc' Approved by Date V ) 1
rt '
U
Type of System: No. of Bedrooms) (1) Septic Tank Soil Rate Required�u,
Existing New Addition Replacement i Gals. C,/
[ ] [&dam LIl i 7
(2) Leach line sq. ft. Sidewall allowanceInstall Line(s Leach bed
(Bot.om trench area) ft. rock/ Sq. Ft. Ft. Lon Ft. wide Sq�+F,t. of
per rynriing ft. with Min. '`inc es rock bottom�`1�
N/A ,CV]"� below drain lines area
Leach lines/bed-special design '(3) Pit Diameter" No. Pit Seepage Pit total depth -%.,/.Y
for slope: Applicable =Mi+ 6' EV Pits BI
N/A L�Overburden factor I itL Max. allowable depth Vo
'
0
This application is(P ved dgnled for the design`of a subsurface disposal s --stem as
indicated on the accompani-eT plot plan using the requirements set forth in Section B above.
A building permit is necessary for the installation of -the above -designed system.
(1 Septic tank and sewer "lines must be X50' from any wells -(/014•1in.j'a,
ct . f mf - r = .r 4 (t.��.
(2) Leach lines must be 100 min. from any wells including expansion area
C3,)) Seepage pits must. be 150' mina from any wells including expansion area4/p..�s,,,,
Signature of Health Official Date Ufa
RECEIPT NO. I "1 f1 Lj Issued by Ll Date -/ 7 /t7
District: Riverside C ] Indio [O"Hemet [ ] Perris [ 7 Rancho Calif. [ ] Blythe C3
Distribution: WHITE -Office file YELLOW -Applicant PINK -Bldg. Dept. GOLDENROD -Pending File
7
DOH SAN 122 (Rev. 2/86)
Dear Developer/Landscaper:
E. LEON SPAUGY
COM"IISSIO•IER
)AMES 0. WALLACE
ASSISTANT COM.MI5SIO,NER
Thank you for inquiring with the Agricultural Commiss
local quarantine laws. ioner's Office regarding
Any diseases or insects associated with the plants/landscaping material presented
on your landscaping plans do not pose a threat to the Coachella Valley Citrus,
Date, Grape, Vegetable, or Field Crop industry. We therefore approve your
landscaping plans.
If howeve'r, any substitutions of plants/landscaping materials within yourlans
occurs between now and the actual planting datentacp
office
within 48 hours before delivery into the Coachella oValley•coAlsot thethissubstituted
plants/landscaping material must be held for inspection upon arrival. Any sub-
stituted landscaping material found infected/infested with quarantine pests will
be immediately treated or shipped out of the Coachella Valley at the discretion
of the Agricultural Commissioner's Office•
Under penalty of perjury, I.the undersigned will comply with the above.
Authorized Agent:
Nara��%/�S�^-� /2_l/l/f�'� CT. Date_ — -
Signature
Permit Number(s)
dam`
d` g
Developer
Address_ ? 2 -
AGRICULTURAL
AGRICULTURAL C0"`SISSI0?DR'S APPROVAL
Date_5
Authority cited; Agricultural Code; Sections 63.01, 6461, 6462, 6464, 6501, 6521-
6524
cc: 2 Plan Check, Indio Office, Riverside Office
a
? Q
O
�+� 1,1� o
OFFICE OF
m
AGRICULTURAL COMMISSIONER
4080 LEMON STREET. ROOM 19
RIVERSIDE, CALIFORNIA
�-
92501
M •"•IM (1111 G' J
(714) 787.2561
�Y9, 1Bq
46-209 Oasis Street, Room 14
Indio, CA .92201
(619) 342-8291
Dear Developer/Landscaper:
E. LEON SPAUGY
COM"IISSIO•IER
)AMES 0. WALLACE
ASSISTANT COM.MI5SIO,NER
Thank you for inquiring with the Agricultural Commiss
local quarantine laws. ioner's Office regarding
Any diseases or insects associated with the plants/landscaping material presented
on your landscaping plans do not pose a threat to the Coachella Valley Citrus,
Date, Grape, Vegetable, or Field Crop industry. We therefore approve your
landscaping plans.
If howeve'r, any substitutions of plants/landscaping materials within yourlans
occurs between now and the actual planting datentacp
office
within 48 hours before delivery into the Coachella oValley•coAlsot thethissubstituted
plants/landscaping material must be held for inspection upon arrival. Any sub-
stituted landscaping material found infected/infested with quarantine pests will
be immediately treated or shipped out of the Coachella Valley at the discretion
of the Agricultural Commissioner's Office•
Under penalty of perjury, I.the undersigned will comply with the above.
Authorized Agent:
Nara��%/�S�^-� /2_l/l/f�'� CT. Date_ — -
Signature
Permit Number(s)
dam`
d` g
Developer
Address_ ? 2 -
AGRICULTURAL
AGRICULTURAL C0"`SISSI0?DR'S APPROVAL
Date_5
Authority cited; Agricultural Code; Sections 63.01, 6461, 6462, 6464, 6501, 6521-
6524
cc: 2 Plan Check, Indio Office, Riverside Office
a
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