002402 (SFD)44
QUO&
r P.O. BOX 1504 N o...
B%ilding 106 3i& VeLaSI :3 78 105 CALLE ORNIAESTAD9..002402
Address LA QUINTA, CALIFORNIA 92253
Owner
3s
` BUILDING: TYPE CONST. OCC,. GRP.
Mailing
Address 5 --625 Hi.Selatia 'D•� A.P. Number
City Zip Tel. -
�. � 92253. 5?8-' Uz ' . - Legal Description lot 4
ContractorProject Description mle family > l�.
1
..Address ...
City. ""_ _ Zip ' Tel..
State Lic. ...City g 1452
& Classif. Lic. # Sq.- Ft. im, 422 No. No. Dw.
-Arch., Engr:, Size Stories Units
- - --
Designer._ New ❑X""Add 6" Alter ❑- -.Repair ❑, .. Demolition ❑•
Address Tel.
CityZip 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
Estimated Valuation
1 hereby affirm that I am exempt from the Contractor's License Law for the following ISA75'000
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 rile a signed statement that he is licensed pursuant to PERMIT AMOUNT
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' Plan Chk..Dep... °'Ir �-Il*f
-subjects the applicant to a civil penalty of not more tharrfive hundred dollars ,($500). - - -
Bal.
Chk. a.
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan
do the work, and the structure is not intended or offered for sale. (Sec.' 7044, Buisness and Cionst. '
Professions Code:The Contractor's License Law doesnot apply to an owner of property •who
builds or improves thereon and who does such work himself or through his own employees, - ' Mech. V) f
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 Electrical
of proving that he did not build or improve for the.purpose or sale.) _ _�-- . .
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing^
struct the project. (Seca 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 S.M.1.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - - -
Grading
" ❑Iain exempt under Seca. B. t. P.C.- for -this reason '
Driveway Enc. 20.00
Date owner Infrastructure.��'
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. �7
TOTAL ,RUiE
CERTIFICATE OF EXEMPTION FROM REMARKS_� _�%�
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 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.
rvvn — A—LI ANI: If, aner maxing rms uenmcate or exemption you should become
subject to the Workers' Compensation provisions oV the 'Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby 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. -
I certify that I have read this application and state that the above information is correct.
I agree to comply with'all•cit 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
HARD COP
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
'Permit
Issued b
Date
Validated by:
Validation:
A5]45
6 10 181,"4,76 U
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
2ND FL. SO. FT.
HEATING (ROUGH)
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
HEATING (FINAL)
DRINKING FOUNTAIN
SO. FT. ®
GAS (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER HEATER
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GRADING
cu. yd.
$ plus x$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP.
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. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAR. FIREWALL
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
NECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING r✓�
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
SEWE OF R ANj%�
ROUGH WIRING
DUCTWORK
ROCKSTORAGE
````--FORMS
' OUND. REINF. /y
O�
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
DEC•
4 N`
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING�--
MESH
INSULATIONISOUND
r
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
'06�f1E0
= = Desert Sands Unified School District
w BERMUDA DUNES r
RANCHO MIRAGE 82.879 HIGHWAY 111 • INDIO, CALIFORNIA 92201-5878 • (819) 347-8831
INDIAN WELLS
PALM DESERT
DESERT a
%P'LA QUINTA
"O INDIO
June 4, 1986
City of La Quinta
Department of Community Development
78-105 Calle Estado
La Qui'nta, CA 92253
Re: Parcel # 7740550040, Lot 4 Block 216, Unit 21
Gentlemen:
The developer of the above referencedlot
has mi.ti'gated i:ts impacts on our overcrow:de.d schools by payment
of the amount of $628 per unit to be applied to th.e'cost of
district educational faci'li.ties made necessary by such new
development.
Sincerely,
J,
�.
John D. Brooks
Assistant Superintendent
Business Services
JDB/crm
COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION _
PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM "- (QW4
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
ounty of Riverside
rts Building Department Application Log b
a
0
0
H
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ame (Owner, Agent, Contractor, Etc.)
STAFF USE - DO NOT WHITE
Mailing,Address
=k t n n
kl� V
C \ter -A . P(i
City
State
Zip Code
Telephone
*Sob -Property Addres's
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*City or Community *hegnh Descriptioi, of{P'rpty.—(Lot, PM, TR)
\ ,�• �» "7 �� r r.
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*Assessor's Parcel No.jWater
Agency
("Or-Wel3
Use of Permit •+ �,
° Lot Size
Yes
J Ido[ I
SFD, MH Site Prep' Etc.
,
Detailed boring report. reqd.
Yes C
Planning Case N r w %"
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zDetailed
contour plot plans reqd.
Yes[
I
J Nof. J
P,
Date I
*The above information must be verified from Building Application
Fn Soils/boring report by r) n � ,�0 Proj. k Date
Soils Map Page Soil Type Approved by Date
U
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0
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U
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Type of System: No. of Bedrooms) (1) Septic Tank Soil Rate Reauired
Existing New Addition Replacement Gals. '
(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' Diameter No. Pit Seepage Pit total depth
for slope: Applicable C J 6'[)(J Pits BI
N/A Overburden factor! I Max. allowable depth
I�
KACkh An k.X 100 %;—,,PA%.A it. n -°,Pf I Ct)' N .w+ fk .< c.0 P`
t
This application is approv'e`d%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.
A building permit is necessary for the installation of the above -designed system.
((l D Septic tank and sewer lines must be 50' from any wells
(2) Leach lines must be 100' min. from any wells including expansion area
(39) Seepage pits must. be 150' min. from any wells including expansion area
Signature of Health Official Date. '
RECEIPT NO. Issued by l /*, Date i 1� •, 1s /
District: Riverside [I Indio C,] Hemet [ J Perris [ J Rancho Calif. C J Blythe[ J K
Distribution: WHITE -Office file YELLOW -Applicant PINK -Bldg. Dept. GOLDENROD -Pending File
DOH SAN 122 (Rev. 2/86)
STAFF USE - DO NOT WHITE
BELOW THIS LINE
Initial Date
Certification of Existing S.D. System reqd.
Yes[
J No C kJ
}}
WQCB Clearance reqd.
Yes[
J No[
Soils feasibility report reqd.
Yes
J Ido[ I
Detailed boring report. reqd.
Yes C
J No.1
zDetailed
contour plot plans reqd.
Yes[
I
J Nof. J
o
\
P
Staff Specialist approval reqd.
Yes[
J IIo[ J Lot
Inspection Date
Fn Soils/boring report by r) n � ,�0 Proj. k Date
Soils Map Page Soil Type Approved by Date
U
z
0
H
coH
U
w
Type of System: No. of Bedrooms) (1) Septic Tank Soil Rate Reauired
Existing New Addition Replacement Gals. '
(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' Diameter No. Pit Seepage Pit total depth
for slope: Applicable C J 6'[)(J Pits BI
N/A Overburden factor! I Max. allowable depth
I�
KACkh An k.X 100 %;—,,PA%.A it. n -°,Pf I Ct)' N .w+ fk .< c.0 P`
t
This application is approv'e`d%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.
A building permit is necessary for the installation of the above -designed system.
((l D Septic tank and sewer lines must be 50' from any wells
(2) Leach lines must be 100' min. from any wells including expansion area
(39) Seepage pits must. be 150' min. from any wells including expansion area
Signature of Health Official Date. '
RECEIPT NO. Issued by l /*, Date i 1� •, 1s /
District: Riverside [I Indio C,] Hemet [ J Perris [ J Rancho Calif. C J Blythe[ J K
Distribution: WHITE -Office file YELLOW -Applicant PINK -Bldg. Dept. GOLDENROD -Pending File
DOH SAN 122 (Rev. 2/86)