87-0220 (SFD)Building ! G
Address.
Owner
Mailing
Address
Legal Description G O / Z�
w�4�/bLl 1t���� Project Description
Lic. #
Tel.
City( Zip I
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
-
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70 OO) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
S GNATII DATE
y OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Buslness and Professions Code: 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 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, Bussness 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.)
❑ 1 am exempt under Sec. B. & 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 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: If, alter 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.
Icertify 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
t - BUILDING DIVISION
Sq. Ft.N"o.� No. Dw.
Size '%' Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑
Demolition ❑
D/LGIP
W a 0 l i F�ibG l 7i /
w
Estimated Valuation
PERMIT
AMOUNT -
Plan Chk. Dep.
Z SrU, O -0
Plan Chk. Bal.
`/'. Ly
Const.
`
Mech.
-3 ,ce
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
l
Alc I;LAIV 5, 0 6
9� 8 Y
TOTAL
7
REMARKS
011r�4 R'1 4A 70PO 1)i—n,—QR 4 h
10 CASH i TWAL 1
2 0 Q1)
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 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
GROUND PLUMBING
NO. ELECTRICAL FEES
NO. PLUMBING FEES
y
r
$77 !/ 0
UNITS
BONDING
HEATING (ROUGH)
STORAGE TANK
IST FL. SQ. FT. ® s `
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
YARD SPKLR SYSTEM
c
2ND FL. SQ. FT.
GROUT
WATER HEATER
SERVICE
Z r
�' `l
MOBILEHOME SVC.
WATER SYSTEM
BAR SINK
GRADING
cu. yd.
$ Plus—x$—=$
POR.
/ SQ. FT. ®
r!
7 q
POWER OUTLET
FINAL INSP.
ROOF DRAINS
FINAL INSP.
GAR. v SQ. FT. ®
ROOFING
REMARKS:
VENTILATION
DRAINAGE PIPING
CAR P. I SQ. FT. ®
FIREPLACE
2 d
I ace Z O
FOUNTAIN
GAR. FIREWALL
WALLDRINKING
SQ. FT.®
LATHING
MESH
SQ. FT.
URINAL
ESTIMATED CONSTRUCTION VALUATION
$
WATER PIPING
NOTE: Not to be used as property tax valuation
CERT. OCC.
FLOOR DRAIN
MECHANICAL FEES
INSPECTOR'S SIGNATURESIINITIALS,
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
GARDEN WALL FINAL
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
-
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
O
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
—
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. 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
C7
/A*
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR GOND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
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.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL
r Q
z
O
H
U
W
We
z
O
H
U
W
U)
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CC
Q
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CC
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h,•f7.�rJ'�.L.'i•�,Jr�"F'tY�+"S:'�,firs;+`ri�"��,yrl�'�'prr➢r�"�`'"
COUNTY OF RIVERSIDE, DEPARTMENT OF HEALTH
r%
ENVIRONMENTAL HEALTH SERVICES DMSION 73 — 3 — 00.)L—
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 specifications required on the attached check list.
A non-refundable filing fee ofIX&is,required when the application is submitted. Check must be made payable to the County of Riverside.
—�. Building Department Application Log p
Name wne Agent. C nuactor. S.)
Mailing Add7dress,
District: ❑ Riverside
40�",kll,2V6
City
slate
Zip Code
Telep one
YELLOW—Applicant PINK—Bldg. Dept.
GOLDENROD—Pending File
DOH -SAN -122 (Rev. 4/88)
'Job Property Address
1
Legal Description of Property (Lot.PM. R.
4rv16 .F:GI
K�—
- r o Gv
'Assessor's Parcel No
ewater Agency I
Use of Permit r r 0-410;Planning Case tr
Lot Size
772 -1.f-3 - 00
�
fi'�
SFO. MH Site Preparation Etc
Stnature of Applicant Date
'The above information must be verified from Building Application
STAFF USE — DO NOT WRITE BELOW THIS LINE
— Initial Date
,
Certification of Existing S.D. System required. ❑ Yes u No, l, 7-/S--9
WQCB Clearance required. ❑ Yes CN )
Soils feasibility report required. ❑ Yeses
Special feasibility boring report required. ❑ Yes Ltd
Detailed contour plot plans required. E) Yes LTJ No
Staff Specialist approval required. ❑ Yes FIINo Lot Inspection Date
Soils/boring report by Project p Date
Soils Map Page Soil Type e Approved byDate���
.
Type of System:
No. of Bedrooms
(1) Septic Tank
Soil Rate Required
❑ Existing ew ❑ Additional ❑ Replacement
�'�"
Gals.
(2) 6,ach line sq.`ft.
Sidewall allowance
Install Line(s)—Ft. Long,each
OF
bed Sq.
(Botto ench area)
ft. rock/ Sq. Ft.
Ft. wl t
,��h min. inches
FFOtto
per running ft. [ill
rock below drain lines
area
Leach lines/bed-special design for slope:
Applicable r�
(3) Pit Diameter
/6'
No. Pits
Pit BI
Seepage Pit total depth —.2
N/A_ � Overburden factor
096 M
"XL
r
Max. allowable depth / d
This application is rove /�emiedfor the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements
set forth in Section B a ove: A building permit is necessary for the installation of the above designed s ste. .
(1) Septic tank and sewer lines must be 50�/om any wells'/ /U ��P,o�. S i S
(2 Leach lines must be 100' min. from any wells including expa sion rear`
11�+' Seepage pits must be 150' min. from any:wells including expansion areac/m
Signature of Health ONicial Da'e
RECEIPT NO.
3&2 cP,
Issued by EAL
Date1ZI r —13' i
District: ❑ Riverside
®ndio
❑ Hemet ❑ Perris ❑ Rancho Calif.
❑ Blythe
Distribution: WHITE—Office
file
YELLOW—Applicant PINK—Bldg. Dept.
GOLDENROD—Pending File
DOH -SAN -122 (Rev. 4/88)
M
COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION - ' '•� I "�
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 specifications required on the attached check list.
filing fee is is Check Coun'ty�f Riverside.
A non-refundable of $40 required when the application submitted. must be made payable to the
a
Building Department Application Log #
Name (Owner. Agent. Contractor. Etc) I
Mailing Address
Giy" J�
Slate
Zip Code
Teiepihorie
L�% /% ^•�
'Job Progeny Address
'CIX Community � Le I Description of Property-
ri G'u
'Assessors Parcel No (
-Water Agency or, Well
' ",,
"71 Lot Size
Use of Permit 1 .rAdYA�planning Case M
G
I
SFD. MH Site Preparation
Etc
Signature of Applicant f �' Date
V '7ne above information must be verified from Building Application
STAFF USE — DO NOT WRITE BELOW THIS LINE
Initial Date
Certification of Existing S.D. System required. ❑ Yes ONo� 1
WOCB Clearance required. ❑ Yes O No r
Soils feasibility report required. ❑ Yes ❑"Noz
/ r
Special feasibility boring report required. ❑ Yes ❑" Nom•
Detailed contour plot plans required. ❑ Yes C -)Nb
Staff Specialist approval required. ❑ Yes El No Lot Inspection Date
Soils/boring report by` - - Project # Date
Soils Map Page �� Soil Type '11414 Approved by-�.��� Date
Type of System: vNo.
of Bedrooms
(1) Septic Tank
Soil Rate Required
❑ Existing ❑'New ❑ Additional ❑ Replacement
Gals.
�3 �• Da�f��/!
(2) Leach line sq. ft.
trech area)
Sidewall allowance
ft. Sq. Ft.
Install Line(s)—Ft. Long,
Ftde,with inches
Leach bed Sq.
Ft. botto`
(Bottom
rock/
ft. D -N/A
. I min.
below drain lines
ofof
per running
rock
area
Leach lines/bed-special design for slope:
Applicable
(3) Pit Diameter
No. Pits
Pit<BI
Seepage Pit total depth �d
r
N/A_s,�Overburden factor
�r5' (E 6'
I
I v
Max. allowable depth �d
f
���1� dMira.r"JC:% , ., �I..c.,.•-�►+,f�.-� I/1'� U .�,t'.Q-Irt+/,�r�-'.
f
This application is approvedIdemed for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements
for
set forth in Section B A building permit is necessary the installation of the above -designed system.
(1) Septic tank and sewer lines must be b0' from any wells} yl�-
(2) Leach lines must be 100' min. from any wells including expansion area
�,+
((3))•Seeepagepits must b�ee,150' min. from any wells including expansion area'
(:'
�.-•�.�P�lr � r` ��-,,. - .0 iJ• �—.�- t��P Gr LtI`a�.;�G, ..�7-..•3 ' � xs� l`'L'y- t
Signature of Heanb OHaal � - - /�,,��,�Oate t � �• �
RECEIPT NO.—Issued by Date
- District: ❑ Riverside ❑ Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File
DOH SAN 122 (Rev 8187)
r.UX
OR
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
SLA
tL;(
�"'.f rte? SCHOOL FACILITY FEEScANNor
r
eqny a,wj
"t
TO: City of La Quinta ( WY•
DATE: 10 �/—Qpqp
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
This is to certify that
developer of
which is
located at
Q i within
this District, has paid school fa 'lity fees
imposed pursuant to the
authorit rygrat d bG e me t C I a pctiott
5.3-R80 in h mount of
covering a total of square
feet of (,K) reslidential or
( ) industrial/commercial development and
that.building permits for
this footage in this development may now be
issued by your jurisdiction.
131 CO o DESERT
SA DS UNIFIED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
0 007
OF R�
a s
O
M
A ti, •'
qry }s9
DATE % i "; I k P,
DEVELOPER'S NAPE:
OFFICE OF E. LEON SPAUGY
AGRICULTURAL CO;NIMISSIONER COMMISSIONER
ANDJAMES 0 WALLACE
ASSW.A`.t C19.14M15510\ER
WEIGHTS & MEASURES CLEMENT BE\VENISTE
SEALER
49-613 ►iwy 86, Suite B-12
'Coachella, CA 92236
619-342-8291
CASE NO.`��� 1
7- k C_i S t JS :. Z AJ '.
ADDRESS: ` �
TELEPHONE:
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
iumediately.
Thank you for protecting and preserving the Coachella Valley's pest -free environment.
Agricultural Ccumissioner's Office
cc: Indio and Riverside Office
�C'707c> (f -0P_- ,Ez L_ A
I
�T 23