07862 (SFD)No. 0,7862.
P.O. BOX 1504
Building 78-105 CALLE ESTADO,-
Address�. AVe• LA QUINT�A;,:CALIFORNIA 92253 "
Owner ,
haduk, Inc. BUILDING: TYPE -CONST. , OCC: GRP.
' Mailing ... �•
Address ROX 59A.P. Number 774-0555-011 \
CityZip Tel.
�3 X64 4M Legal Description
ContractorProject Description SinalL Family Zli�
It4.rlrt.xitr. .
Address.• "
City ! Zip Tel.:
,State Lic. City
& Classif. 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 an rofessions Code, and my license is in full force and
effect.
SIGNATURE "- DATE
OWNER -BUILDER DECLARATION
I heieby affirm that I am exempt from the,Conlractor'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) 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, 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
of proving that he did not build or improve for the purpose of sale.)
O 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.)
❑ I am exempt under Sec. B. & P.C. for this reason
Date Owner
rWORKERS' 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' COM PENSATION•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.
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.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency forthe 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 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
Sq. Ft. �69 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ t ,'Demolition ❑
REMARKSis a+KdS2'? 4t� :sls "A'_ 1 qty
{o ' l at a''i<. �:. .� ,��i-n ah6
ZONE:
BY:
Minimum Setback
Distances:
Front Setback from.Center Line
Rear Setback from Rear Prop. Line '
Side Street Setback from Center Line
Estimated Valuation
Side Setback from Property Line
s
PERMIT
AMOUNT
i
Plan Chk. Dep.
INSPECTOR
Plan Chk. Bal.
3
Const.
Dater
Mech.iiti
Electrical
-
Plumbing
S.M.I.
6 29
Grading
20-00
Driveway Enc.
Infrastructure
TOTAL
R; _ i71 _w; A _ 401 _ RI
REMARKSis a+KdS2'? 4t� :sls "A'_ 1 qty
{o ' l at a''i<. �:. .� ,��i-n ah6
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
7l90 Permit
Issued by:
Dater
Validated by:
Validation:
ro-7�~.`t 4�. ,et I�, � �f: � �`�"� ,_ .L`:.� _ �. � rt1'� .. '�� � S.. �.r' •':s
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
I
2ND FL. S0. FT.
SLAB GRADE
YARD SPKLR SYSTEM
POR. SQ. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. ®
DRAINAGE PIPING
WALL SQ. FT.
DUCT WORK
DRINKING FOUNTAIN.
SQ FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
METER LOOP
WATER PIPING
NOTE: Not to be used as property tax valuation
REINF. STEEL
FLOOR DRAIN
MECHANICAL FEES
GAS (FINAL)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® I'A c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ec
HOUSE SEWER
FIRE ZONE ROOFING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
TiWCRO FEE
M=CH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
3
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBI o
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SE TA I
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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. 3 7
FRAMING 4
O
FINAL INSP.
ROOFING
//��
A*,
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
QQ
LATHING WN �� JO
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESINITIALS
GARDEN WALL FINAL
P.O. BOX 1504 APPLICATION ONLY
; ding 78-105 CALLE ESTADO
Address 2. O 4 1 #3UINTA, CALIFORNIA 92253 �-
Owner
BUILDING: TYPE CONST. OCC. GRP.
Addllress }�
_ A.P. Number
r
State Lic_ City
A Classif. 7 �� —3 'z Lic. q /21
Arch., Engr.,
Designer
Address I Tel.
City IZip State
LICENSED CONTRACTOR`S DECLARATION
1 hereby affirm that I am licensed under Drovisions of Chapter 9 (commencing with Section
�of Division 3 of the Business and Professions Code, and my license is in full force and
SIGNATURE DATE
OWNEWBUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractors License Law for the following
reasort (sec_ 7031.5,11usbess and Professions Cade: Any city or county which requires a
psrml to construct, afIm
ar, prove, demolish. or repair any structure, prior to its issuance .also
requires e atN I for such permit to No 'a s0med statement that, he -19 licensed -pursuant -to ..--
the provisions, of " Contractor's Lkense Low, Chapter 9 (com merklp with section 7000) of
ClWon 3 of the lirsaress ane P olasslans Code, or that. he Is exempt therefrom. and the oasis
for Me * a9eped e:errptlon. Arry vbfationof section 7031:5 -by -any applcanf-'for .a pemdt
strgecte Me d m a tlr/porreRy o/not more Man five hundred do9ars (f500)-
0 1, as ownei of the property, o my employees with wages as their sole compensation, will
do the wodi, and the structure Is not intended or offered for sale. (Sec. 7044, &Awess and
Professions Coda: The Contractors Uoense Law does not appy to an owner of property who
do - ==ft- vat.+: E_'r;.^Y or Mraaph his o= onipbbyeea,.
ryovided Mal such irproroments are not intended or offered for safe. If, however, Me bfdlp
or �prwernerd Is= wfhl one year of completion, Me owner-0uider wf Aare Me burden
of provig Mat he ad not build or hprore for the purpose of sale-) - - - • - - --
❑ I, as owner of the property, am exclusively contracting with licensed contractors to coi►
stnrct the project (Sec. 7041, Business and Professions Code: The Contractor's License Law
does not appy to an owner of property who bulbs or Ipoves thereon, and who contracts for
such pvgjects with a contractor(s) Or sed pursuant to the Contractor's Ucense Law.)
❑ 1 am exempt under Sec B. a P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby -affirm that 1 have a certificate of consent to sell -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Pollcy No Company
❑ Coq Is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(runs section need not be coo, ad I Me permit Is for one hundred dofans ($100) vatuat/on
or issa-)
I certify that in the performance of the work for which this peril is Issued, 1 shall not
armqof person in any manner so as to become subject to the Workers' Compensation
Data --Owner
NOTICE TO APPLICANT: If after mabV MIs Certificate of Exemption you should become
abject to Me Kbkers' Compensation provisions of the Labor Code. you must forthwith
coney with arch rywhim- or Mit permit shad' be deemed revoked.
CONSTRUCTIONLENDING AGENCY
cork for which
�aifirm that there is a construction lending agency for the performance of the
permit is issued. (Sec. 3097, Chi Code.)
Lenders 'Nama
Lenders Address
This is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days -
1 certify that 1 have read this application and state that the above information is correct.
1 agree to comply with all city and county ordinances and state laws relating to building
oonsbuctioti and hereby authorize representatives of this city to enter the above-
meritioned property for inspection purposes
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING DIVISION
Description
1 Description S,
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
Issued by: Date Permit
Validated by:
Validation:
Sq. Ft.
Size
No.
Stories
No. Dw.
Units /
New ❑ Add 0
Alter ❑
Repair 0 Demolition ❑
Estimated Valuation
- -- - PERMIT --
•- ...
-- - AMOUNT
- Plan Chk. -Dep.- -__ ._
.. —2-
Plan Chk. Bal.
:Const.
Mech.
Electrical
Plumbing
—
-
S. M.I.
Grading
Driveway Enc.
Infrastructure
`-
TOTAL
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
Issued by: Date Permit
Validated by:
Validation:
Desert Sands Unified School District
pp��
CERTIFICATION OF PAYMENT
OF
Alorice SCHOOL FACILITY FEES )
BS I)Otl p�
T0: City of L in' " 'le��" DATE: 14/go t
Department of Commu ityyUvelop nt�07`
78-105 Calle Estado
La Quinta, CA 12253
( 4�r� I I g)
This is t ce�r ify th t 6 lav """ W�
developer'( �I (,l�tJ w is .ice
located at - - th n
this District, has paid school facili fees imposed pursuant to the �JJ�
$uth jrit�r generatI Eby , ern t C de Sec iost 5 080 '�Jnheamount( �y��v7
covering a total of square feet of ( residential o
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
ao L yj- for DESERT SA DSNIFIED SCHOO DISTRICT
01-14�,D44-v "-6
White - Building Department • Yellow - Facilities Planning • Pink ,A�c1co�un/ttiing�. • Go) - Developer
f�� (10)-37
�l
COUNTY'OF RIVERSIDE ENVIRONMENTAL Attt�.stan P"°'I Na
HEALTH SERVICES DIVISION
RECEIPT NO. 3 •'` d Issued By Date —a
DISTRICT:- ❑ Riverside, 61"Ae ❑ Hemet Q Perris ❑ Rancho Calif. ❑ Blythe
DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records
COUNTY'OF RIVERSIDE ENVIRONMENTAL Attt�.stan P"°'I Na
HEALTH SERVICES DIVISION
ZE
PigWRIAFiPUCATj10N FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM
Applicant: Submit-this�orm with four copies of a scaled plot plan (1-20 scale) drawn to County speculations as indicated on the attached check Ilst.
A non efuridable filing fee (see below) is required when the application is submitted. Check must be made payable to the County of
O,Riverside.
Approval of this application shall remain valid for a period not to exceed one year from date of approval.
NO3K /71
1
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'# i1(
v
Z
QAgent
C�ornttreartctor, CPerson
61
Phone Address &Firm
re/1r_T
_
W
U)
.hi9t r> f-1 �
Phone Mailigg Address
r4 y/-�1 l e ISG . r7' S-7ZA ,-,/-
City/
$tate
Zip
Job Property AddressLegal
Description Prop. (PM, Tract,,Lot)
�¢_,AiC(/��hSro
LoT ►'z 1s C 2/u.,
Lot Size
<fftir AgenoyiyVetl
wr+
Use of F%rmit P/P,-CU, etc.
4�;r
Other � 7�m a
Prep etc.
"Signatur plicant
Date
CATEGORY: REV CODE
CATEGORY: REV CODE FEE
SUBSURFACE DISPOSAL 12 57.00
38`''� $���
❑ SITE EVALUATION UPON REQUEST 7349 $ 43.00
CD
❑ MULTIPLE PARCELS WITHIN SAME _
(NO PLOT PLAN)
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $ 17.00
Z
O
a 1 at 4 Parcels (Each) 1238 $ 57.00
(Less than 1 year) "
b., Each Parcel after 4 7344 $ 24.00
❑ PRELIMINARY ELECTIVE 7352 $ 23.00
U
❑' Rereview (2nd review same parcel) 7344 $ 24.00
EVALUATION (Attach DOH SAN 53)
fn
O Site Evaluation in Conjunction with
❑ HOLDING TANK 7351 $ 47.00
Critical Area 7346 $111.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $222.00
❑ She Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $ 87.00
INITIAL/ DATE
Holding Tank Agreements Completed ❑ Yes I�'N /L- 'rJ
'Certs ication of Existing S.D. System Required ❑ Yes��Noo
WOCB Clearance required. (Attach Form ❑ Yes
DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required. ❑ Yes
Special Feasibility Boring Report Required. ❑ Yes No
Plot Detailed Contour Plans Required (1 to 5 ft interval) ❑ Yes
Other ❑ Yes 1-'
Staff Specialist Lot Inspection Required ❑ Yes No
Lot Inspection Date
Soils boring report by Date
D
Soils Map Page W Type 04( Approved by Date
tJ
Z
O
No. of System
Type Systems)
❑ F�olding Tank O Existing
No. Dwelling Unita j
Wriftsw
(1) Septi; Tank
Soil Rate
Grease
kireeeeIntop
�jfCGal
_3Q 0Bedroorns,�X
r!�'/ �
r i' "'-L=/ ti
�
Gel
W
U)
(2) Leach Line Sq. FL
trench area
Sidewall allowance
nx k/ ft.
I I 6
Line(s) ft. long fr wide with
-Leach
Leach Bed s4 R
per running K
D
min. rook below drakrlines or
-
Leachfines/bed special design for slope:
Applicable i
(3) Pit Diameter
i
No. Pits
Pit Below
Inlet (BI)
Seepage Pit Total Depth
(TD)..
�Qttrer
1 �Max.
N/A iLrr" Overburden factor
I
` !
Allowable Depth
('4a
No. 2 System
REMARKS:"_ A" ' lad. _ _ AJy
d � �
This application i PPROVED . • IED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompanied t p n, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
Z
above -designed system. No construction is permitted in the required reserved 100% expansion area.
O
Septic tank and sewer lines must be 50' minimum from any wellsq /o ✓u•.
tI
Leach lines must be 100' minimum from any wells, including expansion res?e
�
tW
( Seepage pits must be 150' minimum from any wells, including expansion area Q//o 11AeX1 Y
Signature of Health Official d Date � 3 - 7
�`�✓�' �v GAJ/ / d
RECEIPT NO. 3 •'` d Issued By Date —a
DISTRICT:- ❑ Riverside, 61"Ae ❑ Hemet Q Perris ❑ Rancho Calif. ❑ Blythe
DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records
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 iTu
st be notified.:
immediately.
Thank you for protecting and preserving the Coachella Valley's pest-fiee environment.
Agricultural Coinnissjofier's Office
cct Indio and Riverside Office
OFFICE OF
AGRICULTURAL COMMISSIONER
AND
WEIGHTS MEASURES CALVIN C. KAMINSKAS
JAMES O. WALLACE
AmIstanI Commisslonef
.4080 LEMON SI ' REEI. ROOM `19 CLEMENT BENVENISIE*.
Agilculltral Commlsilonnt
RIVERSIDE, CALIFORNIA 925011.
Sealer
0119clor 01 welghlo & Measures
(7114) 767.2561
49613 Highway 86, Suite B12
Coachella, Ca. 92236
(619) 342-8291
CASE W
DATE
DEVEWPER, S NAME:
j < q -e
ADDRESS:
/7-
TELEPHONEt
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 iTu
st be notified.:
immediately.
Thank you for protecting and preserving the Coachella Valley's pest-fiee environment.
Agricultural Coinnissjofier's Office
cct Indio and Riverside Office
- - 4 - - 'A .
M
AV
TI(- Ila a U*Uta
N,
t Building;
Uniform
requirements of,.Pection 306 of the
ht to the reqU with the'varibus
;This - Certificate issued'pursu-0 . n compliance
issuance this strucionure, was'.
gthat at the time Of de. c6rtifyinth6 following!Co ructor,use.--kFqr
f the City regulating Ouilding.,qonst
Oiponce, - s 0
53-246 Velasco
-.4"OUILDING,. ADDRESS 7 07862
Bldg ' N
Permit 0
SFD
U zone _:S R
T� useClassification
• 'VNFire Zone'
77.
R3 Ty pp• Construction Lz;.. .
Group - . ` -i - - !I
Box 9
a cl.
:.Owner of,Building
. . . ..... .....
........ BY'
City T. a—D I
P march 7, 1991
Date;
Building Offic101 POST IN A --avospianut PLACE;
y