05052 (SFD)Address 53-745 Cortex
Owner
Mailing
Address
City
Setae
State Uc. I City
A Classif. t , a ., r Ljc. #
Arch., Engr.,
Designer
Address
City IZip I State
Lic. #
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm flat 1 an licensed under provisions of Chapter 9 (commencinmlth Section
Dhftlon 3 of the Business and Professions Code, and my license is Inll force and
r
SIGNATURE .. _- -- _ ^�-.._ DATE
OwNEABULLDER DECLARATION
1 hereby atria. that I am exempt from the Contractor's License Law for the following
reason: (See. 7031.5.8uslium and P►o/esefons Code: Any coy or county rhlrh requires a
pemdt to conchae; agw, bre. derno65h, or repair any shuchae. prior to Ae Issuance afsd
requires the app0 1 for arch perml< to tie a. signed statement that he, Is Bcerrsed pursuant to
the provisions of the Oorma birV License few, . or thChapter9 (commenchig with Section 7000) of
Ohdsion, 3 d Me Business and Pradessfons Cadeat. he Is exempt therefrom, and Me basis
for the albged ruer>ptlos., Any vial3don of. Sectio, 7031.5 by any applicant for a pemdt
aMjeets theto a chdpatedy of not more then Ow hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages as their solwcompensation, will
do the work. and the structure Is not intended or offered for sale. (Sec. 7044, Buteness and
Fhofessbrs Cade. The Qortracto's License Law does not apply to an owner of property who
bukb or+tVroves therein and who does such work htrnseff or through his own eurployees,
provided that error ir�rovwaevds are not intended or offered for sale. fl„ however, the bulkftrrp
or 111provemeal is sold o9hir one year of corpledm, the owner4xdder wig have Me burden
of Proving 09 he and not build or irpmve for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contractingmith licensed contractors to eon•
slruct the project (Sec 7044. Busbrian and Professions Code: The ConbactaA License Law
does rat appy "to an -owner of popedy intro builds or bproves thereon, and who contracts for
such projects weh a%=) liceesed pramrant to the Contractor's License Law.)
❑ 1 am exempt undo Sac tT, & P.C. for this reason
Date Owner
WORKERIF COMPENSATION DECLARATION
I hereby affirm that 1 have a certificate of consent to self -insure`, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
policy No- Company
❑ Copy Is filed wM the city. ❑ Certified copy. Is hereby fumished.
CERTIFICATE OF EIIEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(/Ms Section Tread not be conpbfed If the pems7 is for one hundred dollars (i100) veioation
crime.)
1 certify that in the performance of thy work for which this permit,is issued, I shall not
sW person in any manner so as to become subject to the Workers, Compensatlon
Data ifa� Owner
NOTICE TO APPLICW . Q silo making this Certilkate of Exempdon you should become
subjeG m the I fobms' Conper,satbn provisions of Me Labor Code, you must fcdhwdh
campy wdh such, r 11 1 w Mrs pea dt sW be.deerned revoked -
CONSTRUCTION LENDING AGENCY
1 hereby affirm flat that is a construction lending agency for the pedornsnee of the
work far which Urs permit is issued. (See. 3097. OW Code.)
Larder's Name
Lenders Addres.a
This Is a building perml when property filled out, signed and validated, and Is subject to
expiration it work thereunder is suspended for 180 days.
1 ewtiy flat 1 lace read this application and state that the above Information is correct.
I all— 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 applirrut tate
Mailing Addras.a
city, State, an
AN AD
IS REQUi QED UIN THE JOB -SITE DURING
PHASES OF CONSTRUCTi�7Nf1
LDING: TYPE C ST. OCC: QRP.-
P. Number 7 7A _ 1 D 1 _Q 1 7
Description
Description S T? s.13
Sq. Ft -No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
L
PERMIT
AMOUNT
Plan Chk. Dep.
$9 tin
Plan Chk. Bal.
$ 90 12
Const.
397.00
Mech.
39.00
Electrical
79.09
Plumbing
j 0O
S.M.I.
6.13
Grading
20.00
Driveway Enc.
20.00
Infrastructure
TOTAL
:92«949875
REMARKS
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
12/27/88
Issued by: Date Permit
Validated buy:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
PLUMBING FEES
1ST FL. SO. FT. a $
UNITS
B'GRADE �i
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
r
2ND FL. SQ. FT.
FORMS
-EWER OR SE �
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO, FT. a
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE .
DRAINAGE. PIPING
CARP, SO. FT. a
GROUT
WATER HEATER
WALL SQ. FT. ®
FINAL INSP.
DRINKING FOUNTAIN. '
BOND BEAM
WATER SYSTEM
URINAL
SO FT a
=$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING:
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIREPLACE
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. a c
BATHTUB
SO. FT. a c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID a 116 c
SEWAGE. DISPOSAL
SQ.FT.GAR a 34c
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
I ETBACK . / O _
G OUND PLUM E0
UNDERGROUND
A.C. UNIT
LOLL. AREA
B'GRADE �i
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
-EWER OR SE �
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REIN F. STEEL
GAS (FINAL)
TEMP. POLE .
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
t plus xS
=$
LUMBER GR.
FINAL INSP.
fl FRAMING' Q
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
ILINSULATIONISOUN DD
FINISH GRADING
FINAL .INSPECTION
CERT. OCC,
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
GARDEN WALL FINAL
,
r
Q
Z
5
t10
Z
O
G
Z
W
Co.
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH
RECEIPT 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'Countyspecuiations as indicated on'the..attached check list:
A non-refundable filing fee (see below) is required when the application is submitted. Check must be. made payable,to ;1ha ,County of
Riverside. Approval' of this application shall Tema n.velid for a period not to�exceed one year from date of approdal. -
VERIFY ITEMS IN SECTION A FROM BUILDING 8 SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'S
Agent, Contractor
!�//!
d Phone l/I✓ C 4i �9 c��S�
PhoneMailing
��
Address /
�22�
G—
Clly
Zip
Job Property Address
p/�i�-r�c
(PKLot)
Cost
� �FC" 7 ��
Lot Size
Water AgencjNN(ell
Use of'P�emrit P/P, CU, etc
Other
'10y �J� f
,$4_0
Dwelling; MH Ske.Prep,.etc.
An
St nature of rrt ica
_ Date
CATEGOR: REV CODE FEE '
CATEGORY- REV CODE FEE
;Ih. SUBSURFACE DISPOSAL 1238 5.00
q SITE EVALUATION UPON REQUEST 7349 $42.00
b MULTIPLE PARCELS WITHIN SAME L—��
(NO PLOT PLAN)
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
a. 1 at 4 Parcels (Each) 1238 $45.00
(Less than 1 YW
b. Each Parcel after 4 7344 $16.00
❑ PRELIMINARY ELECTIVE 7352 $45.00
❑ Rereview (2nd review same parcel) 7344 $16.00
EVALUATION (Attach DOH SAN 53)
❑ Site Evaluation in Conjunction with
❑ HOLDING TANK 7351 $45.00-! .
Critical Area 7346 $86.00
❑ ALTERNATNE/EXPERIMENTAL 7345 $13200
❑ Site Evaluation Lot Leas than
SYSTEM
1 %000 Sq. Ft 7347 $68AO
filA I L I S
'❑
Holding Tank Agreements Completed Yes No
Certification of Exietlng SD. System Required ❑ Yes No
WQCB' Clearmroe required. (Attach. Form ❑ Yes No
DOH SAN 007, Santa -Ana Region Only)
Sella Percolation Report Required. ❑ Yes No
Special Feasibility Boring Report Requked. ❑ Yes No
Detailed Contour Plot Plans Required (1 to 5 fL Irderval) ❑ Yes No
Otlter ❑ Yes No
Staff Specialist Lot Inspection Required ❑ Yes No
Lot Inspection bate
Soiis,boring report by. �� Project* Date
Soils Map Pegs Sol Type Approved by Dale
No. of systema
type of SysterrKell
No. Dwelling Units
(1) Septic Tank
Sod Nate
GMSMIZBW
Holding Tank 13 Existing
O
Bedrooms, Fixture Unite
/ 2
3 gr, VL;Y.
(2)l Line SW Ft
Bottom trarrdr
Sidewall allowartge
1t rock/ /� aq R
Install LineW long r► wide with
inches dralnl6res
Leach Bed tI
d area
perrunning
min rode or
O NA
LeachllnesAwd special design slope:
(3) Pit DiemeW
No: Pits
PR.Bebw
Seepage Tgtal Depth
Other
Applicable
❑ 5 ,�/
6
1;t,
Inlet (BI)
I
I
Max. Allowable Depth
WA Overburden tactor
J
y
No. 2 System
REMARKS: IN A Q t 1AA G 61 1 D U/
This application is PPRO ENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as Indicated
on'the acco .pan pot plan, using the requirements set forth in SECTION C above. A building permit Is necessary for the installation of the
above -designed system. No construction to permitted In the required reserved 100% expansion area.
Septic tank and sewer lines must be 50' minimum from any wells
123 Leach lines must be 100' minimum from any wells, in
including expansion area ✓
.Seepage pits m be 50' flllfiirn m from y`wells , i luding expansion area IM rO �.�a
�
Si nature of Health Office p
_tg ? Issued By yv..�g Date (� A s/es
DISTRICT: ❑ Riverside, 1� Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
DOH SAN 122 (RewS/88) DISTRIBUTION: WHITE - Office file YELLOW,-' Applicant PINK - Bldg. DepL GOLDENROD - Plans/Records
0 R
1A V. a 1 �OF f lf_E OF E. LEON SPAUGY
Q COMMIS:10NER
AGRICULTURAL UOtit(`11SSIONER JAMES o WALLACE
ASSISiA%t COMMISSIONER
V .� I'�)
WEIGHTS &MEASURESCLEMENT BE`VEINISTE
SEALER
49-613 Ilwy 86, Suite 8-12
��'Coachella, CA 92236
Mq
?.9, q� 619-342-8291
DATE / 2 - / `% - ,� 8' CASE No. of 8 R 5 12 / YA
DEVELOPER'S NAME: ��� Ce�.�/I,e.o7 I�� �0
ADDRESS: r 3 —
22x3
TELEPHONE: A
Dear Developer.:
After reviewing your landscaping plans, all plant material listed is not in
violation of quarantine laws governing the Coachella Valley. If substitutions
do occur and they differ from plant material listed., this office must be notified
immediately. "
Thank you for protecting and preserving the Coachella. Valley's pest -free environment.
Agricultural Ccauds ner's Office
ec: Indio and Riverside Office
Desert Sands Unified School District
L��C'C$RT$CA1fiOF`F PAYMENTiy .:cam.
Lu `SCHOOL FACILITY FEES
TO: City of La Quinta DATE:
Department of Community Development
78-105 Calle. Estado
La Quinta, CA 92253
This is to certify that L
developer of
located at
this District, has paid school ci.lity fees
authority gen ra a by Popprnment Cod S cti
co ering a total of ,quaee/
( ) industrial/comme.c.ial development and �
this foothis development mnow e
la footage may
P40
White - Building Dent • Yellow -Facilities P
/Ou
tx.7
tt.�31
1-2 2 9 4 �++
Iicn
ed pursuant t.o the
80 in thelamount of
�
o , 6,
0
(feet of ()C1 iesidential or
hat buil ing permits for
issued by your jurisdiction.
I
SANDS UNIFIED SCHOOL DISTRICT
• Pink - Accounting O Gold - Developer