05540 (SFD)��.
T 4ht 4
P.O. BOX 1504 No. 0-554
BuildingV�, X25 �� ® 7&105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Al vigil. Co.
BUILDING: -TYPE CONST. OCC: GRP.
Mailing
Address 73-567 Fred 'Waring
773-264--020
A.P. Number
Legal Description
Project Description
Lot 9
Sgb
Citypitl:tn ' '
�+, Bart
Zip
S226t3
Tel. _
619/568-€2225
Contractor
Al vigil CO.
Address
72-880 Pred 'Warms
City
Zip
Tel.'
besert
92250
511/558-0225
State Lic-
City
& Classif. 356058 ., E1
Lic. #
/,
Sq. Ft. 2274
Size
No. No. Dw.
Stories Units
Arch., Engr-, -
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Designer Bob 'Harmn Assoc.
Address
Tel.
6.19/323--5704
City
Zip
State
-palm Spring$
Lic. If
LICENSED CONTRACTORS DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
71100) of Division 3 of the Business and Professions Code, and my license is in full force and
,
SIGNATURE "DATE
OWNItWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
A
$.69!966.73 0
reason: (Sec. 7031.5,Buskrress and Prolessions Code: Any city or county which requires a
permit to construct, after, improve, demoish, 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
PERMIT
AMOUNT
the provisions of the Contractors License Law, Chapter 9 (commencing with Section 7000) of
?
Division 3 of the Business and Professions Cade, 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:" , • -�
��
subjects the applicant to a cin? penally of not more than five hundred dollars ($500).
Plan Chk. Bal"."
190.95
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
Const.r
0 • 50
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractors License Law does not apply to an owner of property who
Mech. .r
:3.50
builds or bnproves thereon and who does such work himself or through his own employees,
provided that such urrprovements are not intended or offered for sale. If, however, the building
Electrical
9.9
or improvement is said within one year of conptetion, the owner -builder will have the burden
of proving that he did not build or kgxove for'lhe purpose of sale.)
Plumbing
57.50
❑ 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 to builds improves thereon,
4.90
apply an owner of property who or and who contracts for
such projects with a contractors) licensed pursuard to the Contractor's License Law.)
S.M.I.
Grading
20.0
❑ 1 am exempt under Sec— -----___R & 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 cert�ed.copy-thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby fumished..
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
t D7i� v�}s"Z .ilii rE..k*rG ria»[i?`2.'il:r.n a �~At8
(This section need not be completed it the pomnll 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 anyperson in any manner so as to become subject to the Workers" Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: ff, after nkdav this Certificate of Exemption you should become
ZONE:
BY:
subject to the Workers' Compensation Provisions of the Labor Code, you must forthwith
comply with such provisions or this penny shall be deemed revoked.
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
FINAL DATE
INSPECTOR
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.
3/21189
1 certity 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 applicant Date
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
[1ST SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM e
2ND FL SO. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOB]LEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
FOUND. REINF.
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
HEATING (FINAL)
OTHER APPJEOUIP.
REIN F. STEEL
DRAINAGE PIPING
CARP. SD. FT. ®
GROUT
DRINKING FOUNTAIN.
WALL SO. FT.
FINAL INSP.
BOND BEAM
URINAL
SO. FT. @
GRADING
cu. yd.
$ plus x$
=$
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE Not to be used as property tax valuation
ROOFING
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, TEM/PERM
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 ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
M'=CH.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
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
(
SEWER OR SEPTIC/
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REIN F. 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 6 —/
((
FINAL INSP.
ROOFING
j1
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
MESH
/
G INSULATIONISOUND/
CCC
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
NOTICE: THIS .,CCe � CHOOL FACILITY FEES W
�r . MEET CAMNOT
BE DUPLICATED
TO: City of La Quinta c DATE: o (i8t1
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
This is to certif t at C� ,
developer of(� which is
located at34
— 5 within
this District, has paid school facility fees imposed pursuant to the
au y raked b pqvernment de Se tion 308 the amount f r((
co ring a total of quare feet of ) res'den i 1 or
( ) industrial/commercial development and that buil in
g permits or
this footage in' this development may now be issued by your jurisdiction.
1 �14 1� J a -
r)G�
White - Building Department • Yellow
0,
for DESERT S NDS UNIFIED SCHOOL DISTRICT
Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37
i
RECEIPT NO. ` Issued By lC C\ Date
t DISTRICT: ❑ Riverside, / Indio ❑ Hemet
Q Perris ❑ Rancho Calif. ❑ Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE -Office file YELLOW -Applicant . PINK - Bldg. Dept GOLDENROD - Plans/Records
17'A
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No.
ENVIRONMENTAL HEALTH SERVICES
PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM
Applicant: Submit this form with four copies of a scaledplot plan (1-20 scale) drawn to County speculations 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 the County of
Riverside. Approval of this application shall remain valid for a period not to exceed one year from date of approval.
Q
VERIFY rTEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG' #
Z
O
Al Contractor, Contact Person
Phone
Address & Phone
v
L Ilr`
0.)4
tJJ
Owner _
Phone .
Mailing Address
it' "Al 7--e- -C P A i le S
S A,*r e -
City
State
Zip
Job Property Address
Legal Description Prop. (PM, Tract, Lot)
T�
Cp
q•2z 5 3
fiN/* �Co� e y— C07' 0 S/aai6 2.n
Lot Size "i
Water Agency/Well
Use of Permit P/P; CU, etc. ..
Other
f
Dwelling, MH Site Prep, etc.
'"
Signature of Applicant .
4:
'Date ('• " ` ``- ; a'
CATEGORY: REV CODE ..FEE,''
CATEGORY: REV CODE FEE
P\SUBSURFACE DISPOSAL,},, 1238 500
❑ SITE EVALUATION UPON REQUEST 7349 $42.00
❑ MULTIPLE PARCELS WITHIN'SAME
(NO PLOT PLAN)
LAND DIVISIONh ;
E3SEWER/SEPTIC VERIFICATION 7348 $11.00
Z
0
f..,. 1'b „
a 1 st 4 Parcels (Each) :11238 $45.00
(Less than 1 year)' '
U
b. Each Parcel after 4 7344 $16.00
❑ PRELIMINARY ELECTIVE 7352 $45.00
W
❑ Rereview (2nd review same parcel). 7344 $16.00
EVALUATION (Attach DOH SAN 53)
co
❑ Site Evaluation in Conjunction with
❑ HOLDING TANK 7351 $45.00
Critical Area Y� 7346 $86.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $13200
❑ Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $86.00
`.
INITIAL DTE
Holding Tank"Agreement's Completed ❑Yes 11 No
Certification of Existing S.D. System Required ❑ Yes No
WOCB Clearance required. (Attach Form ❑ Yes I I No
DOH SAN 007, Santa Ana Region Only)
Sills Percolation Report Required. ❑ Yes I I No
Special FeasibNity Boring Report Required. ❑ Yes No
Detailed Contour Plot Plans Required, (1 to 5 ft interval) ❑ Yes No
Other ❑ Yes No
• r
Staff Specialist Lot Inspection Required ❑ Yes ❑ No
Lot Inspection Date
V )A 4
Sills boring report by Project Dste
Soils Map Page Soil Type Approved by Dame
U
No. of Systems
Type of Systems) „ r '
No. Dwelling Unita
(1) Septic Tank
Soil Rate
Grease/.�
O
❑ Holding Tank ❑KEicisting
'11 New ❑ Replacemerrt
Bedrooms, Fixture Units
+
Greats Intcp
l�
U
(2) Mach Line Sq. Ft
Bottom trench area
Sidewall allowance
/
(t r ook/ sq. R
install Urlee(s) ft bng R wide with
min. rock below drainl'a mes
Leach Bed sq. tt %
of bottom'area
prunning n
/
i
❑ :NA
forpe:
Leachlines/bed special desig:07r
(3) Pit Diameter
No. Pits
Pit Below
Seepage Pit Total Depth
Other.
Applicable
N/A Overburden fact
5 >,6)`'_Max.
Inlet (BI)❑
Allowable Depth
T
No. 2 System
REMARKS: \ G� Gtr
\\-a t V\ Cl t �•t (O C
This application i PPROVE /DENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
0
on the accompan14d 0161 pal n, usingthe 'requirements set forth. in SECTION C above. A building re q g permit is necessary for they installation of the
Oabove
-designed system. No construction is permitted in the required reserved' 100% expansion area.
H
C) Septic tank and sewer lines must be 50' minimum from any wells
U
(2) Leach lines must be 100' minimum from any wells, including expansion area
OW
�> Seepage pits must be 150' MIn mum frorb any wells, incl ding expansion area � 14 (U
Signature of. Health Officials
i
RECEIPT NO. ` Issued By lC C\ Date
t DISTRICT: ❑ Riverside, / Indio ❑ Hemet
Q Perris ❑ Rancho Calif. ❑ Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE -Office file YELLOW -Applicant . PINK - Bldg. Dept GOLDENROD - Plans/Records
17'A