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002021 (SFD)Building Address , � V,�, Owner PWA L ieb Mailing Address 145 a3..A., Wdti= City lZip Tel. Contractor T3ai� n -m Address . IOU P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 No- 002021 BUILDING: TYPECONST. V OCC: GRP. R"1 A.P. Number 774.425-003_ Legal Description 3..,.� Project, Description Sle Emily ftallkg 145 BX. BY: Minimum Setback Distances: City A3130_r'k_ X, Zip 1 Tela Sts—%tam; Side Street Setback from Center Line State Lic. & Classif.B —1 1181440 City Lic. # 13" Sq. Ft. Size R 4$0 No. Stories 1 No. Dw. � Units Arch., Engr., ~' - - Designer New ,9 Add ❑ Alter ❑ . Repair ❑ Demolition ❑ Address Tel. 04010 1 28 168&36 U City _ Zip State Lica# f _ ~ t LICENSED CONTRACTOR'S DECLARATION I hereby affirm that -I am licensed under provislons,of Chapter 9 (commencing withfSection� 7000) of Division 3 of the Business and=Rrofessfons Code' and my license is in -full force and effect.' ' �.'�7�+"!� _ DATE OWNER -BUILDER DECLARATION fI hereby affirm that] am exempt from .the Contractors License Law for the following reason: (Sec. 7031.5,Business and Professions Code:`Any city or county which requires 'a permit to construct, atter, 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 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 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 Contractors 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. 8 P.C. for this reason Estimated VdlUatlOn fi p S8 • `q 01226*60 -.' PERMIT - AMOUNT , Plan Chk. Dep. - Plan Chk. Bal. - 46.0 COf1St. �c 346.00 Mech: Electrical' - 'J `�>j Plumbing -�� S.M.I.w,� Grading 20.00 Driveway Enc. 2040 Date owner Infrastructure 1,053.40 WORKERS' COMPENSATION DECLARATION I hereby affirm that Ihave 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 0 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 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 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 city and county ordinances and state laws relating to building construction, and hereby, authorize representatives sof this city to, enter the above- mentioned property for inspection purposely. J /,Cy y J/ r _ 4 s Signature of applicant �. �, J - % r: tD v 4 -- Mailing Mailing Address City, State, Zip HARD COPY TOTAL 1.938.30 1 1.6N.30 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: 04010 1 28 168&36 U CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ 2ND FL. SQ. FT. p POR. SO. FT. ® GAR. SO. FT. ® CARP. SQ. FT. @ WALL SO. FT. ® SQ 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 ROUGH PLUMB. FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GAS (ROUGH) LAUNDRY TRAY AIR HANDLING UNIT CFM HEATING (FINAL) KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HF POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ® c BATH TUB BOND BEAM SQ. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1+/a c SEWAGE DISPOSAL LUMBER GR. SQ.FT.GAR ® 3/ac HOUSE SEWER FINAL INSP. ROOFING GAS PIPING PERMIT FEE REMARKS: 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 ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS �SEWER OR SEPSIC AN GG Itf ROUGH WIRING DUCT WORK ROCKSTORAGE FOUND. REINF. GAS (ROUGH) LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) LLMETER 'OTEMP. 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 17 it REMARKS: VENTILATION FIRE ZONE ROOFING ' FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND S G n FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS. GARDEN WALL FINAL tttt ��flEp o �o r 0 Desert Sanas Unified SchoI District N BERMUDA DUNES r RANCHO MIRAGE _� 82.879 HIGHWAY 11 1 6" INDIO_. CALIFORNIA 92201-5676 0 (6191 347-8631 INDIAN WELLS H PALM DESERT a f LA OUINTA 'Jp INDIO ti • January 7, 1986 City of La Quinta Department of Community Development 78-105 Calle Estado La Qui'nta, CA 92253 Re: Lot 1, Blk 228 Unit 22 Gentlemen: The developer of the above referenced lot has mitigated its 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 Superintendent Business Services JDB/crm Building �� • �� Iv Address Owner T4bt " P.O. BOX 1504 APPLICATION ONLY 78-105 CALLE ESTADO uQ,[-AD LA QUINTA, CALIFORNIA 92253 Address / s A, fit/, 'T/,W City Zip Tel. /-�icl��iUTr ct2�G.�2 Contractor BUILDING: TYPE CONST.y OCC. GRP. A.P. Number -7-�7c/- / LiS vol- Z Legal Description y Zf Project Description —' r Address / Zi S— A - lL / i,(///!r//.� t! City Ga � r(/_L &A -V1/ Zip -1 11- Tel.. State Lic. & Classif.��� ,d,4 �JZ�L�1/0 City Lic. # Sq. Ft. Size % No. No. Dw. / Stories 1 Units Arch., Engr., Designer New p`� Add ❑ Alter ❑ Repair ❑ Demolition ❑ 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. „✓>s//�,// i^'v�– /— �� G'�I ~/-•vim X� .. J - SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I 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 Estimated Valuation PERMIT AMOUNT r 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 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 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 Code: The Contractor's License Law does not apply to an owner of property who Plan Chk. Dep. Plan Chk. Bal. Const. Mech. builds or Improves thereon and who does such work himself or through his ownemployees, 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.) Electrical Plumbing ❑ 1, 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 S.M.I. . Grading Driveway Enc. 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 ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REMARKS (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 Exemptionyou 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. ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line 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.) Side Street Setback from Center Line Side Setback from Property Line Lender's 'Name FINAL DATE INSPECTOR Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. 1 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. Issued by:' Validated by: Date Permit Signature of applicant Date .Mailing Address Validation: A 3 7 6 6 1 9 25Q00 CK City, State, Zip BUILDING DIVISION CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. � FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SO. FT. ® GAS (ROUGH) METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SQ. FT. ® GROUT WATER HEATER WALL SQ. FT. FINAL INSP. DRINKING FOUNTAIN SQ. FT. ® WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM I 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 LATHING SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1+/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER FINISH GRADING 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 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 TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. 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 INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL �i'•M;i �,1:�-•':;::.:.•:"'-i.../''-""yr,,,,yrN-•--ti,..-s`+-....eti-r.'""^��,---•-"•s.._y.::• �••�•�.;.,;-.-..��..Y...�Y-�.,.,''y-�x1-.i':^"yr.M••,'+`f1•t`.r"'"^",�.�•;,e...,,.y,•„a,..._..�y..rti.--�.--,t..".•w-.rr Z,0 Q Z O H U W M Z O H U W ca U Z O P U W COUNTY OFRIVERSIDE, DEPARTMENT OF HEALTH PERMIT APPLICATION FOR A SUBSURFACE DISPOSAL SYSTEM Applicant: Submit this form with three copies of a scaled plot plan drawn to county specifications required on the attached check list. A non refundable filing fee of $15 is required when the application is submitted. Check must be made payable to County of Riverside. - Name Mailing Address ►�-� 5. mAKINQ YAF"T Cove Pfr. C'Qx 54 35 City State 7Zip Code Phone (ley fdt% L7 (4 -7/ C) 'Property Address '`City or Community, 'Legal Description of Property (Lot, Parcel Map, Tract) 'Assessors Parcel No.Water 77Y - 12 .l ~ vO I ^ Z� Serving Property From / 6-o f � (/ 6-o Lot size J U y I a Q C/ ./. •S /_1 /� . Signature of Applicant Date - *The above information must be verified from Building Application Staff Use — Do Not Write Below This Line Initial, Date WQCB Clearance required Yes ❑ NoED � Soils feasibility report required Yes ❑ No 0 ❑ Detailed boring report required Yes No O Detailed contour plot required Yes ❑ No 01 Comments: Soils or -boring report by Date Approved by % r Q�C.. f�-�'` `� Date� j q (- t // / 1 s Soils Map Page Soil Type Tract File No. 151 Other Number of Bedrooms Septic Tank Size (gallons) — � �� / /� (J (f U� Rate Required ��C a _ Type of System N4--' Addition Replacement � Leach line sq. ft. of bottom area trench ^ Leach bed ((sq. ft ofbottomarea bed) Seepage Pit Diameter 5p' 61 Number of Pits Seepaaggee Pitt Depth B. 1. /7 Total Depth if Pit Location of System Add itiona0equirements .�,&,e X44 )4 A permit is apppr ed/denied for the design of a subsurface disposal system as indicated on the accompanied plot plan usingJheequip re ents set forth in Section B above. A buildi4 permit is necessary for the installation of the des/ignedrsystem. Signature of Health Official`- .0 - Date Receipt No District: Riverside ❑ 1466 7 Z 7 ?• Indio El Hemet 11 Issued By Date .3o DISTRIBUTION: WHITE- Office File , YELLOW- Applicant -PINK- Building Dept. GOLDENROD- Pending File DOH SAN 122 (Rev 10/84) BAN v NGl)%,ZFT:s, lw.e. • 17?l -A WaKc!-Streel VENTURA.. C!VJIFORN11A 93003 (8-05) 042-6727 . . THE FOLLOWING WAS NOTED: N COPIES TO RH&COX IUA SIGNED 0 PrIl Ir U; LC;(: -1 IV': CONl RACTO OWNER WEATHER a -S L/ TEMP. 0at AM . at PM PRE,-,E,NT AT S -Tr it COPIES TO RH&COX IUA SIGNED