05687 (SFD)Building 53-480 JUAREZ
Address
Owner
SQUIUSY SSTHP33L4N
P.O. BOX 1504
78-105 CALLE ESTADO
LA.QUI�NTA, CALIFORNIA 92253
Mailing
Address BOX 3$6
City Zip Tel.
MICRO W-MG1;+ 92270 1619/327-43,84_
OMMR/BUMD&R. w
Address
City
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
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
700p) t. of Division 3 of the Business and Professions Code, and my license is in full force and
effec,
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions 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 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).
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 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 -budder will have the burden
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, apt 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. '4. �="'S�i �i 4•Y't
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 if 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: 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.)
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.
1 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
No. 05687
11LDING: TYPE CONST. OCC: GRP.
P. Number 774-071-012
Description LOT 13 - BLX 133 18
t Description $FD
�,°�1.y kt�' 1'^�ai�:•f' �.0-'�+�� Ir1R.��'-�Zfli t 1: s �..i 1 is
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 5/1/89 Permit
Validated by:
Validation:
Sq. Ft. 1545
Size �- _:.;
No. 1
Stories'
No. Dw.
Units
New Add ❑
Alter ❑
Repair ❑ Demolition ❑ .
Estimated Valuation
$85,437.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
209.25
Const.
581.0-0
Mech.
49.00
Electrical
107.93
Plumbing
159.50
S.M.I.
5.09
Grading
20.00
Driveway Enc.
20.00
Infrastructure
1,909.46
TOTAL
REMARKS
`
�,°�1.y kt�' 1'^�ai�:•f' �.0-'�+�� Ir1R.��'-�Zfli t 1: s �..i 1 is
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 5/1/89 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
UNITS
Iz"B GRADE Ste•
IND FL SQ. FT.
BONDING
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOMESVC.
BAR SINK
POR SQ FT ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEQUIP.
DRAINAGE PIPING
CAR P. SQ. FT. ®
TEMP. POLE
WALL SQ. FT.
GROUT
DRINKING FOUNTAIN
SQ FT ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP. 90
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTOHDISH)
APPLIANCE DRYER
REMARKS:
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11% c
SEWAGE DISPOSAL
MESH
SQ.FT.GAR ® V4c
HOUSE SEWER
INSULATION/SOUND
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 ��.
ROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
Iz"B GRADE Ste•
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
E OR SEPTI
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REIN F.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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. 90
FRAMING
FINAL INSP.
ROOFING -�� — F71
V 70QlG
l!/
lag
F' C (t Q z
5 '
�
�O
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE(1�
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
1
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
y� p� P� O F
NOTICE: THIS 1)0 SCHOOL
`.sFACILITY FEES �
BE DUPLICATED, N®l DATE:
TO: City of La Quinta
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
This is to certify that l/t ► �����"�
developer of which is
located at within
this District, has paid school facilty fees imposed pursuant to the
a it Herat d by vernme t C d Sectio 5308 Vt�T am un f
$
C
covering a total of L4 S square feet of (X) reside tial or
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
"0' (V"YVA
qq for DESERT SAND UNIFIED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37
\+
�S�l . a.,t�_ .� ..., ..:+�•: -,.i «"� .�� �,. � ' s.�,S �. �`� '.' � .:���N},'�i£� r;;�1q '�" . *�i++ l�acr
Q�W
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Atrseseors Psn:el No.
ENVIRONMENTAL HEALTH SERVICES —
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 Itst
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 & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'*
2
O
Agent, -Contractor, Contact,Person—
� � 1
Phone
t/
` _
& Phone
OS
OS
8
1 t ^r, i n 1•, d—
S d7 %\
\
J L � " (.0 1�
U
Owr>ar"� ''r
Phone
Mailing Address
ity ( ]�,_ftte
Zip
Job �rN Address
Legal Description Prop. (PM, Traci, Lot)
Gn,.�
a civ,..
Lot Size
Water A .nc r
Use of Permit P/P, CU, etc.
Other �+,N
r
c i 1 •..,..,
� ozQ
^ IO
V
Dweliin MH Site Prep, etcW
_ Signature of Applicant
Date '
CATEGORY: REV CODE FEE
CATEGORY: REV CODE FEE
O` SUBSURFACE DISPOSAL 1236 $45.00
❑ SITE EVALUATION UPON REQUEST 7349 $42.00
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
Z
LAND DMSION
❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
p
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)
U)
❑ Site Evaluation in Conjunction with ;t "
❑ 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
4
NITI/A/L DATE
�l
Holding Tank Agreements Completed ❑Yes - ! �-
Certification of Existing S.D. System Required ❑ Yes /
IN
WQCB Clearance required. (Attach Form ❑ Yes 1
DOH SAN 007, Santa Ana Region Only)
Solis Percolation Report Required. ❑ Yes
�N� Special Feasibility Boring Report Required. ❑ Yes
Detailed Contour Plot Plans Required (1 to 5 R interval) ❑ Yes d
OCter ❑ Yes
Staff Specialist Lot Inspection Required ❑ Yes ❑ No r
Lot Inspection Date
Soils boring report by `/ Prow*_ Date
Soils Map Page Sol Type �a Approved by /W� /
Deb
V
No. of Syaterns
Type ° a)
Tank ❑❑
No. Dwelling Unita I
Bedrooms
(1) Septic Tank
Soil Rate
RkGrease/Sand
Gra��� Inicp
Q❑ding
3l�D�M • rt�lax
�
U
�
e(2� Leach Line Sq. Ft
Sidewall allowance
Inshil� _ Line(s) R long f< wide with
a Bed
trench area
ft rock/ sq. ft
min. below, dminrmes or
�R
per running ft
`
Leachlines/bed special design for slope:
(3) Pit Diameter
No..Pita
Pit Below
Seepage Pit Total � 9epth
',
Other:
ApplicableInlet
N/A Overburden factor
am - 6 I
(BI)
/(�/
Z s7
Max. AI �!ajDepth
No. 2 System //4
REMARKS:��
C051 4111
This application s APPROVED €NtEU-for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompan o Ian, 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 the required reserved 100% expansion area.
Septic tank and sewer lines must be 50' minimum from any wells C% / 0 7/'Ax,�
Leach lines must be 100' minimum from any wells, including expansion jar _ s"
(3 Seepage must be from
to
pits J1150' minimum any wells, including expansion area
7 - w
A4IL
lC�t%</. . ,C"�d-19-0
Si nature of Health Official_ Dat _ N�
RECEIPT NO. J f / J Issued By ate
rO
DISTRICT: ❑ Riverside, 0� ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office He YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
GJ
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49—(►l3 Ilwy 116, 9ulte 11-12
Cnr,c1,e11►,/ CA 9ZZ36
619-34Z-0291
IME qllq /_8 �
bEvE;Lorr,It' S
ADDRESS
CASE 11)• 7X 9q Cl�`7
'1'ELL;I'I IUIdC t ( Q) - �-
tk�;
Dear hevelopers
After revlewiny your 181 10SCOI) Ih KI ('11 planet nyterial listed
dsIs itaL titutlivns
viclatiols DE quarantine 104s (luvellibly the l listed,hella Valley.
do occur and they differ [tun 1110th n►-ateri�l listed, thls office must be nvtilied
bmediately.
'11olik you fur prvlectlsly alld pLeservilly the Coachella Valley's pest -free envirolel>ent•
n cultural Caullls vnerI s UL [ Lce
ccs .111di0 Euld Riverside office