002352 (SFD)44
P.O. BOX 1504 N o .
Building 78-105 CALLE ESTADO
Address 53-080 $mnift V41m i LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address 52-625 12aWJV4eX Drive
City Zip Tel.
L3 c�wixta 92253 564-01046
Contractor
Address . I
Zip Tel.
State Lic. I City
& Classif: 39%91 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
7000) 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 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business 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) or
Division 3 of the Business and Professions Code, or that. he is exempt therefrorim,' 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).
❑ 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 -builder will have the burden
or proving that he did not build or Improve for the purpose of sale.) -
0 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 or property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
O 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
O 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, 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.
0312352
BUILDING: TYPE CONST. OCC: GRP.-
A.P. Number 774-0,55-003
Legal Description lot 3
Project Description SilL bi ly .4344ErUlm
Sq. Ft.
Size
New OX AnLwAdV?
No.
Stories
No. Dw.
Units
Alter ❑. Repair ❑ Demolition ❑
Pemit also includes 140 lin. ft. of
Estimated Valuation
1 70,515.00 Wirclud 2100.00) .
PERMIT
AMOUNT
Plan Ctik. Dep...
250..0#
Plan Chk. Bal.fr•41
Const.
Mech.
3*.00
Electrical
WAR
Plumbing
103.00
S.M.I.
5.0
Grading
.20-00
Driveway Enc.
20.00
Infrastructure
1,146.23
Issued by:
Date Permit
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-
TOTALw
Validated by:
REMARKS f
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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.)
Side Setback from.Property Line
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR
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.
5-7-86
I certify that I have read this application and state that the above information is correct.
Issued by:
Date Permit
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.
Validated by:
Signature of applicantDate
Mailing Address
Validation:
City, State, Zip
A5547
5 7 188531 CR
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
FOR. SQ. FT. ®
GAR. SQ. FT. @
CAR P. SO. FT.
WALL SQ. 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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
J0 BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING ,
(J� / ✓FINAL INSP. /b / _ D
GAS PIPING
PERMIT FEE
A C. /Ol-
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
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
,-I�OUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
C EWER OR SEPTIC f�
OUGH WIRING 2
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
%iiEINF. STEEL
3
GAS (FINAL)
EMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
J0 BOND BEAM
U
WATER SYSTEM
GRADING
Cu. yd.
$ plus -.X$-=$
LUMBER GR.
(FINAL INSP/0-a L/ .��
FRAMING ,
(J� / ✓FINAL INSP. /b / _ D
ROOFING
A C. /Ol-
L/
�m
REMARKS:
VENTILATION
FIRE ZONE' ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
e14INSULATION/SOUND' �) �
✓—
FINISH GRADING
q(,&INAL INSPECTION
CERT. OCC.
FENCE -FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL
_ o �\W
_ j.0
y BERMUDA DUNES r
RANCHO MIRAGE
INDIAN WELLS ti
PALM DESERT
4 LA OUINTA
"'1p INDIO y�
Desert Sands Unified School District
82-879 HIGHWAY 111 • INDIO.,CALIFORNIA 92201-5678 • (619) 347-8631
May 6, 1986
City of La Quinta
Department of Community Development
78-105 Calle Estado
La Qui'nta, CA 92253
Re: Plot Plan 86-288
Gentlemen:
The developer of the above referenced lot
has mitigated i:ts impacts on our overcrowded schools by payment
of the amount of $628 per unit to be applied to the cost of
district educational facilities made necessary by such. new
development.
Sincerely,
John D. Brooks
Assistant Supe.ri.ntende.nt
Business Services
JDB/crm
COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION .�.�u - C) -
PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM 1
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 of
30 is required when the application is submitted. Check must be made payable to the
County of Riverside'
Building Department Application Log $
Name (Owner, Agent, Contractor, Etc.)
(J
C Mailing Address
,
City
8 giiature of Applicant:"
State
Zip Code
Telephone
*The above information must be verified
from
01 1 =
+
`Job Property Address
*City or .Community
*Legal Description of Prpty..*(Lot, PM, TR)
*Assessor's Parcel No.
YJater A enc
Use of Permit
Lot Size
BELOW THIS LINE
Or Well
SFD, MH Site Prep Etc.
Planning Case #
Initial Date
',
(J
,
8 giiature 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
reqd. Yes C
7
No C
WQCB Clearance reqd.
Yes[
7
No
7
Soils feasibility report reqd.
Yes[
J
No[
Detailed boring report reqd.
Yes[
J
Ido(
7
PQ
Detailed contour plot plans reqd.
Yes[
J
No F.
o
H
Staff Specialist approval reqd.
Yes[
7
No[
7 Lot Inspection Date
U
W
Soils/boring report by t,,��
Proj. N
_
Date
Soils Map Page Soil Type
Approved by
Date
Type of System: No. of Bedrooms) (1) Septic Tank Soil Rate Required
Existing N w Addition Replacement i I Vc:� Gals.
� P l �� nl /��
(2) Leach line sq. ft. Sidewall allowance Install Line(s) Leach bed
(Bottom trench area) ft. rock/ Sq. Ft. Ft. Long, Ft. wide Sq. Ft. of,
per running ft. with Min. inches.rock bottom
N/A C J below drain lines area
Leach lines/bed-special design (3) Pit Dia,, tter No. Pit Seepage it total depth te'�
for slope: Applicable 5' C 7 6' E; Pits BII
N/A Overburden factor ' 1%4 Max. allowable depth
(4 (A -t 1Uta j �y(�u� ^,•�., �t.(< � l -t � ���' T. �� � C L,.rc..\1
GJ,;LU f C\.kl J v� G` , c,v 0 (U �v l f C. , 1 i'(' ( t
x
W ---i
rz -
This application i� approve. /denied for the design of a subsurface disposal s --stem as
indicated on the accompanied plot plan using the requirements set forth in Section B above.
o A building permit is necessary for the installation of the above -designed system.
H( W eptic tank and sewer lines must be 50' from any wells
[� �'(�2) Leach lines must be 100' min. from any wells including expansion area
w((-3> Seepage `pits must be 150' mina. from any wells including expansion area
Signature of Health Official Date
RECEIPT NO. Issued by % Date i f 2 It
District: Riverside [I Indio C, Hemet [ J Perris C J Rancho Calif. C J BlytheC J
Distribution: WHITE -Office filet YELLOW -Applicant PINK -Bldg. Dept. GOLDENROD -Pending File
DOH SAN 122 (Rev. 2/86)