06115 (SFD)Building
Address 53-571 HavatTo
T4ht44,4"
- *
P.O. BOX 1504 N O .
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing I
Address
City Zip Tel.
. Zndio 92201 341-0331
Contractor I
Owner/Builder
Address
State Lic.I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City IZip I State I
Lic. #
LICENSED CONTRACTOWS 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
OWNERMILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,8usihess and Professions Code: Any city or county which requires a
permit to constrict, after, improve. demoBh. or repair any structure, prior to its issuance also
requires the applicant for such pemd to lie a signed statement that he is licensed pursuant to
the provisions of the Conbactar's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the 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 rive 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 thereon and who does such work hirseff or through his own employees,
provided Nat such 'improvements are not idended or offered for safe. If, however, the building
or improvement is sok/ 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 safe.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sec. 7044, Bushess and Prolessions Code: The Co ctor's License Law
does not apply to an owner o1 property who builds or ' roves thereon, d who contracts for
such projects with a contractor(s) licensed pursuant to the ¢o tractor'skicen a Law.)
O 1 am exempt under Sec a_ &:P:C, f, r this on
Date ,Ay owner . y
t
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
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed it the perm? is one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thp`mparfi for ich this permit is issued, I shall not .
employ any person in any manner so as to b6time ubjecGto the Workers' Compensation
Laws of Cal ifomia. t
Date Owner 4*
NOTICE TO APPLICANT: ff, after mating this Certificate` of Exemption you should become
subject to the Workers' Conperrsalion p .1 ..ons of the Labor Code, you must torthwith
comply with such provisions or On pemrt 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. (Sea 3097, CiviCode.)
Lender's Name-
Lender's
ame
Lender's Address
This is a building permit when property filled out, signed and validated, and is subject to .
expiration if work thereunder is suspended for 1110 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
06115
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 4.A_ _ 77li..-J1A_f1?Q---------f
Legal Description
Project Description
Minimum Setback Distances: m
Front Setback from.Center Line
Sq. Ft. =
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Side Setback frons Property Line
Estimated Valuation
$76:.278
PERMIT
AMOUNT
Plan Chk. Dep.
_tet
Plan Chk. Bal.
S 2 ..69
Const.���
Mech.
53,511
Electrical
90.78
Plumbing
157.50
S.M.1.
5.39
Grading
213.011)
Driveway Enc.
20.00
Infrastructure
1s 78.02
TOTAL
sf3 .y F�9 JT /&Z
REMARKS
, `'"//
�+ I I'
ZONE: BY:
Minimum Setback Distances: m
Front Setback from.Center Line
Rear Setback fron Rear Prop. Line
Side Street Setback from Center Line
Side Setback frons Property Line
FINAL DATE INSPECTOR
Issued by: Date! /26189 Permit
Validated
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
/
CAR P. y SO. FT.
WALL SO. 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
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
r•
SO.FT.GAR ®3/ic
HOUSE SEWER
//
RAMING �`
FINAL INSP.
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
BACK — /V -
ROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE /
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS (,
q4SEWEROR SE _l;)G�
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
I, cu. yd.
$ plus x$ =$
LUMBER GR.
r•
FINAL INSP.
/
//
RAMING �`
FINAL INSP.
ROOFING '
/D� �C �% —-
Cl i
r
�}tJ1�
A�
/vVi�
/
�N �G
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR.
GAR. FIREWALL
LATHING _ —
MESH
INSULATION/SOUND
CJ
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Desert Sands Unified School, District
CERTIFICATION OF PAYMENT
OF Lt1Al
-NOTICE: THIS DOCs"" FACILITY FEESMENT CANNOT
cca�
BE DUPLICATE® 9�9�u
TO: City of La Quinta DATE:
Department of Community Development
78-105-Calle Estado
La Quinta, CA' 92253
This is to certify that. CUXZLLI�
,
developer of/ti'( , , which is
located at - within
this District, has paid school facility fees imposed pursuant to the
a thority gen rat d by overnmen Code Seet'olt 53080 in the a ount of
sI 1 b (, (Q0� 0� �d 64, ' 4 )
cov ring a total of` square feet of ( residential or
( ) industrial/commercial development and that.building permits for.—
this-footage
or. -
this -footage in'this development may now be issued by your jurisdiction.
��-- �q-q,7
for DESERT NDS UNIFIED SCHOOL DISTRICT.
p
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
+ (10)-37 ,
PIN
69..
RECEIPT NO.Issued By
Date -7
DISTRICT: , 0 Riverside, M� Indio 0 Hemet 17 Perris ❑ Rancho Calif. 0 Blythe
DOH SAN 122 (Rev. 5/88). DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel 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 asiridicated on the attached check IIsL
A non-refundable filing fee (see below) is required when the application Is submitted. Check must be made payable to the County of
Riverside. A shali remain valid
Approval of this application 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'.*
Z
0
Contact P41son, Agent ��or,
Phone
AddIess & Phone
112018_45)(
cal&
pil-bo-tsr
rM
Owner I_.,—
P
Mailing Address
CO
77-2-ACIC
cityZip
S
Job Property Add rIess
LrW DM-lp�on Prop. (PM, Tract )
f)
m
, Mfg— 241 ALM I I iT
Lot Size
ter AgepawUse
of Permit P/P, CUetc.�
Oth&
Dwells keh.
g, Prezetc.
91
Y
Signature Of $6plicant
Date
4F
CATEGORY: REV CODE FEE
CATEGORY: REV FEE
111001SUBSURFACE DISPOSAL 12318 swsizo
o SITE EVALUATION UPON REQUEST .7349 $42.00
0 MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
Z
LAND DIVISION
0 SEWER/SEPTIC VERIFICATIPN 7348 $1.1.00
0
a. I at 4 Parcels (Each) 1238 $45.00
(Loss than I year).
b. Each Parbel after 4 7344 $16.00
0 PRELIMINARY ELECTIVE 7352 $45.00
Uj
0 Rereview (2nd review same parcel) 7344 $16.00
EVALUATION (Attach DOH SAN 53)
13 SiteEvaluationin Conjunction with
13 HOLDING TANK 7351 .$45.00
Critical Area 7346 $86.00
0 ALTERNATIVE/EXPERIMENTAL 7345 $132.00
❑ Site Evaluation Lot Less than
SYSTEM,
10,000 Sq. Ft. 7347 $86.00
JINfTIAI, DATE
Holding Tank Agreements Completed 13 Yes C3040
Certification of Existing S.D. System Required 0 Y, C�N5
WQCB Clearance required. (Attach Form 11 Yes ; Zo
DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required., 0 yes
Special Feasibility Boring Report Required. 0 Yes
Detailed Contour Plot Plans Required (1 to 5 It. interval) 0 Yes0
13
Other yes
F�NNO
Staff Specialist Lot Inspection Required 13 Yes
Lot Inspectloot Date
Solis boring report by Date
DPW
Sills Map. Page Type Approi by A
fed Date
A
No. of System
TVpctS) TK9)
Na Dwelling Units
(1) Septic Tank
Soil Rate
Grease/Sand
Z
0
A, I
0 Tank 00 Existing
0
Replacement
Bedrooms&�_ a
I
",*UG Intop
'so"
3.6440;vt &
<�/ A
.
Gal
w
C0
J2 Leach Line Sq. Ft
Ritomtiprich
Sidewall allowance
Install, Lk*s) ft. long _& WWAli�
Leach Bed sq. It.
area
It. rock/— sq. It.
per running' ft.
min. rusk, drainfines or
Leachlines/bed special design for slope:
(3) Pit Diamete I r
No. Pits
Pit Below
Seepage Ph Total Depth
7
Other.
Applicable
Inlet (81)
tad
Max. Allap
owle Depth
N/A Overburden factor
No. 2 System
REMARKS:
This application t.,;-IXAFPTPZR�O.VE:D>.Eg--b-NIEE) for' the category checked in SECTION B above: regarding the design of a subsurface disposal system as indicated
0
on the accompan!6d-plot' plan, 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.
10 Septic tank and sewer lines must be 50': minimum from any wells
Leach lines must be 100' minimum from including
ing 4 �i ra
LLI
W
an wells, expansi rec
y
Seepage ' including I,J.e,
must be 150, from
pits minimum any wells, g'ex'pansion reaY/01144-
"cA Z��
Signature of Health .
Official .. Date 7 gq�
RECEIPT NO.Issued By
Date -7
DISTRICT: , 0 Riverside, M� Indio 0 Hemet 17 Perris ❑ Rancho Calif. 0 Blythe
DOH SAN 122 (Rev. 5/88). DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records
' BVI
E, LE014 5'nI�GY
UI IIU Ur coaAn, ur.•tn
� ��-1.. s nGIIIC:U>rl MAI.(:U�1hIiS51UI�ILII Inacs v v�nLIncs: '
CIEMENI tSf WEMSIE'
. M WI:ICil I 1 b. HEASUBES scAun
l :.�t -VI�. 49-611 Ilay IIG Ilul to 11-'I2
= lrr
C11 9ZZJ6
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��^ry �1'6q� G19-3��Z-0'l91
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CASE
VEVELAE'Elt'5.1•IN'll;t�
nu�l�ss . Q 7 (4 3
L9s'�
iulac
tb4311, yl s�-� �''�`�►�`'�
Lear neve lope r r
AEter 1
eviewi119 your l�Ildsctll)i.Llcl Illuns, rtll Illultt nyterl�l listeds�sli.l-ut'iolls
V1010tioii UE yuarallth►e l�)+�s c�uvelltinylelcl l listed, tills eoE[ice, must be notified
do occur E,IId they diE[er [tttn I la
ium>ediately: '
.
I end Iteservilly the Coachella Valley's -1'esk-[>ree envirvl>tl�ent.
Thank you kor ptutectll y
nyr di -mal Catlltlssloller s V L [ice
cc$ 111di0 Gild IZivetside U[[ice
- a
OWNER/BUILDER INFORMATION.
Dear Property Owner:
An application for building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/ Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless'they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her, name.
Contractors are required by law to be licensed and bonded by the State of California and tc have a business license
from the City or County. They are also required by law to put their license number on all permits for which they
..apply.
If you plan to do your own work; -with the exception of various trades that you plan to sub•_ontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other, costs) is $200.00 or more for the entire project, and such persons are not litinsed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an employer -and you are subject
to several obligations including State and Federal income tax withholding, federal social security taxes, worker's
compensation, insurance, disability insurance costs and unemployment compensation contribt:tions.
There may be financial risks for you if you do not carry out these obligations, and these risks ate especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal 3evenue Service (and, if
you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.,
If the structure is intended for sale, property owners who are not licensed contractors are avowed to perform their
work personally orthrough their own employees; without a licensed contractor or'subcontraotor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building
permit, erroneously implying that the property owner is providing his or her own labor aid material personally.
Building permits are not required to be signed by property owners unless they are performing 'their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' Stagy License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very,truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253..
(760)777-70,12'
• FAX: (760 777-7011 •
OWNER'S SIGNATURE/DATE
411110 V41.14114V
PROPERTY ADDRESS
PERMIT NUMBER(s)
e