05850 (SFD)Building
Address
Owner
Mailing
Address
City
Contractor
Aridresc.:
4
` P.O. BOX 1504
78-105 CALLE ESTADO
53n060 JUARICZ LA QUINTA, CALIFORNIA 92253
ASR & MS DOW''DING
Zip
CAL WEST CONSTRUCTION
n y}y C
75-145 ST. CMUES
PaN D:8 S; VRC 4i'i26f} Tel.
State Lic.
& Classif. ,�3,1 3587.39
Arch., Engr.,
Designer
Address
Lic. #
Tel.
No. 45850
BUILDING: TYPE CONST. OCC: GRP.•
A.P..Number 774-151-032
" Legal Description
Project Description S
?�MCRVTATr PAPLmon MST HE compffim
8864''
r Sq. Ft. 2036 No. No. Dw.
Size Stories Units
t a _ New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
City ZipI State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
71100) 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 Contractors License Law for the following
reason: (Sec. 7031.5.absess and Professions Code: Any city or county which requires a
permit to construct, after, eve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such pend to Me a signed statement that he is licensed pursuant to
the proovstons of the C n1ractors License taw, Chapter 9 (commencing with Section 7000) of
Dhisi n 3 of the Business and P►Wess ons Code, or that. he is exempt therefrom, and the basis
for the alleged exenpfimn- Any violation of section 7031.5 by 'any applicant for a permit
subjects the apprcard to a cidpenafty of rat 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 Contractors License Law does not apply to an owner of property who
builds or improves duereen and who does such work himself or through his own employees,
provided tial such nprovernesds are not intended or offered for sale. If, however, the building
or Improvement is sold witto one year of completion. the owner builder will have the burden
of proving that he did not build dimprove for the purpose of sate.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sec 7044,' Busbess and Professions Code: The Contractors License Law
does not apply to an owner of properly, who odds or Improves thereon, and who contracts for
such projects wih a contractor(s) licensed pursuant to the Contractor's License taw.)
❑ 1 am exempt under Sec a- & 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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This sedon need not be completed d the permit is for one hundred dollars (E 100), valuation
or less.)
1 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 APPLK.ANT: I• after mnabrg Ilds Certificate or Exemption you should become
subject to the Wbrkers' Conponsatim provisions of the labor Code, you must forthwith
comply with such PfDvh os or Itis peed shag 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
Lenders Address
This is abuilding permit when property 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 appticant Date
Mailing Address
City, State, Zip
ZONE:
BY:
Minimum Setback Distances:
NO PPL
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
Estimated Valuation
$107,604.00 t+i•00
Issued by:
PERMIT
Validated by:
AMOUNT
Plan Chk. Dep.
750-00
Plan Chk. Bal.
Const.
bl.UU
Mech.
Electrical
Plumbing
S.M.I.
4L
Grading
Driveway Enc.
Infrastructure
it, •�
TOTAL
273.0v
1,2 t.9u
REMARKS{l`}3:;-G°
��t.Et''2
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
INcTTOR
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
,9I�LAB GRADE
YARD SPKLR SYSTEM
2ND FL SQ. FT.
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
ROUGH WIRING
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. SQ. FT.
HEATING (FINAL)
WALL SQ. FT.
REINF. STEEL
DRINKING FOUNTAIN.
SQ FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTOHDISH)
APPLIANCE DRYER
$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LUMBER GR.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
AMING -
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
FIRE ZONE ROOFING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.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
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK -. G) -
6IIGROUND PLUM
UNDERGROUND
A.C. UNIT
COLL. AREA
,9I�LAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
S WER OR SEPTI
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
$
GRADING
cu. yd.
-Plus-x$-=$
LUMBER GR.
FINAL INSP.
AMING -
FINAL INSP.
ROOFING0//��
I
l
'
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
l�LATHING
MESH
/� I
INSULATIONISOUN s / "6q
1 111
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF �
IV®*rice. MIS SCHOOL FACILITY FEES �
Q DOCU c
TO: City of La u �U•PLIC� E�� C,4N, f ,: (�
Department of Community Deve %ment
78-105 Calle Estado
La Quinta, CA 92253
This is to certify that 11' A ZALCA;n
developer of +�, which is
located at , within
this District, has paid sc of facil' y ees imposed pur uant to the
au o�'t�gee (tech b Gov r ment Code ection 3080 i the/amou
covefring a total of _ square feet of ( ) residential o1c
( ) industrial/commercial development and that building permits for i
this footage in this development may now be issued by your jurisdiction.
G �l'7 3ZALdej�-7� (3�AXPA4,t J
(.p I- (tJA for DESERT SA S NIFIED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
0 007
� � l i j• ( {13':.L' .. }ia ^t'`3, r�:3. i r �. .3. � ;:, �iT` T.'.� � -r-�,I •ll '. _� r Q - .. � /,� h; � Y'r ,�tj.�, �1
' 1
q
1 �X�n:
i •i j� t�t,.sit i r If' 4'' LP' �..;s..v
of
I
ULeach
Assessors Parcel No.
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH
�/
ENVIRONMENTAL HEALTH SERVICES 171716-
�
PERMIT
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 Ilst.
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 8 SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'*
Z
0
r.11=ct n '
Phone
Address 8 PhoneT�
A
IT
W
Owner
Phone .
Mailing Address
j`C—�ity
State
Zip
Jsoob' Property Addres
-;Legal Description Prop. (PM, Tracy, trot) f
�i'
/ / l / iib sa W�
Lot Size I /
�+ ter Agerk�WelI
Use of Permit P/P, CU, etc.
f I
Other 0 /Y � I
is x qac
4 Ur.�,�
.�
� .� •
—Dwelling MH Sit�rep, etc.
Lr'
signature of Applicant
Date
CATEGORY:" REV CODE FEE
CATEGORY: REV CODE FEE
®!' SUBSURFACE DISPOSAL 1238 $45.00
❑ SITE EVALUATION UPON REQUEST 7349 $42.00
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
ZLAND
DMSION
❑ SEWER/SEPTIC VERIFICATION 7348 I $11.00
O
a. 1 st 4 Parcels (Each) 1238 $45.00
(� than 1 yW - f
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
O ` . 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
INIT `DATE GQ
Holding Tank Agreements Completed ❑ Yes
i
Certification of Existing S.D. System Required ❑ Yes o�
WQCB Clearance required. (Attach Form ❑ Yes O�N0
DOH SAN 007, Santa Ana Region Only)
Solis Percolation Report Required. ❑ Yes
Special Feasibility Boring Report Required. ❑ Yes C3'
Detailed Contour Plot Plans Required (1 to 5 R interval) ❑ Yes
OC1er ❑ Yes
F"No
Staff Specialist L.ot Inspection Required ❑ Yes
Lot Inspection Date
Sills boring report by Project Date
//d/1 ��
Sills Map Page Son Type Approved by Da 3 --eff
U
No. of Systeme
Ty of Systeme)
No. Dwelling Unita /
(1) Septic Tank
Soo Rate i
-, iresse/Send
Z
0
Holding Tank ❑ Existing
I r9�New O Replacement
Bedrooms, Fixtur"alts
3 �Q/1" 1/ L%2 �g/N /174X
k,
G e�ae 1
I
—Gal
'(2) Leach Line Sq. Ft
�Sidewall allowance
Install � Llne(s) R long R wide with
Leach Bad a% IL
It. rrun eq• ft
per running ft dAC�A -
min. 4>cf> to belgw drain -
area
Leachlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
Inlet (BI
Seepage P Total Depth
Appllcabl
N/A �r� Overburden factor
Max. Allowable Depth
No. 2 System /lcir..
REMARKS:
This application i ,AP ROVED , t.Al1ED for the category checked in SECTION B above regarding the design of a subsurface disposal system as indicated
0 .
on. the accompanied p dt� pan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
--Z
' „<0
' above -designed system. No construction is permitted in the required reserved 100% expansion area.
S O Septic tank and sewer lines must be 50' minimum from any wells D//O
lines must be 100' minimum from any wells, including expansion Area
Seepage pits must be 150' minimum , m any wells, including expansion area /0 �
+
�LeJ��P.ri GU.� �f S=a13-cQ�/ �� Qer�,
Signature of Health Official Date
EN
i
1 RECEIPT NO. Sia Issued Bygt&�cS� - Date
i
i DISTRICT: ❑ Riverside, ndio ❑ Hemet Q Perris ❑ Rancho Calif. ❑ Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
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