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001721 (SFD)P.O. BOX 1504 No.. 0017 21 Building 78-105 CALLE ESTADO Address 53-521 AMA& VelW= LA QUINTA, CALIFORNIA 92253 Owner Jkffmv Larsim BUILDING: TYPE CONST.- OCC: GRP. - Mailing' Address 551-620 ;��� OZe A.P. Number 974.124-013/14 . City Zip Tel. L92253 564-3123 Legal Description TAft 1 . 2 . lot L"AwceY 1n Promss . Contractor. Project Description R> le X19 &A411im ...Address ._ abM- _. City. ..... _ Zip.. Tel... State Lic. City Mn2044 & Classif. Lic. # Sq. Ft. No. No. Dw. Size 6� Stories .,. Units .. .Arch., Engr.,.... ... - - - . - .. Designer New pAdd ❑ • Alter ❑. Repair ❑ Demolition ❑ Address Tel. 77 City Zip State _ . Lic. # LICENSED CONTRACTOR'S DECLARATION ^ I hereby affirm that I am licensed under provisions of Chapter'g (commencing with Section %^+ 7000) of Division 3 of the Business andProfessions Code; and my license is,in full force and effect. . SIGNATURE DATE OWNER -BUILDER DECLARATION Estimated Valuation 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 b' - permit to construct, alter, improve, demolish, or repair any'structure, prior to its issuance also AMOUNT requires the applicant for. such permit to file a signed statement that -he is:licensed pursuant to - PERMIT - ' the provisions o/:the Contractor's License Law, Chapter 9. (commencing with Section 7000) of - Division 3 -of the'Busines's andProfessionsCode, or that. he is exempt therefrom, and life basis- - for the .alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan•Chk: Dep.I[)� subjects the applicant to -a civil penalty o/ not more than five hundred'dollars ($500). " -Plan Chk. Bal. ❑ I, as owner of the property, or my employees with wages.as their sole compensation, will 1-40-19 do the work, and the structure is not intended or offered for -sale. (Sec. 7044, Buisness and� Q Const. Professions Code; The Contractor's License Law -does not apply to an, owner o/ property who - w builds -or improves thereon and who does such work,himself or through. his own employees, Mech:. '' �� provided that; such improvements are not intended or offered for sale. I/, however, the, building 00 or improvement is sold within -one year of completion, the owner -builder will have the burden Electrical J�.. o/ proving that he did not build or improve for the purpose o/ sale:) - -. - . .. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 843.00 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 . S.M.I.' .. 12_91 such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - - - ❑ 1 am exempt under Sec. - B. & P.C. for this reason Grading MAIM . Driveway Enc. 20.00 Date ` 'r ;r-=� Owner t 411f Infrastructure 1.675.14 WORKERS' COMPENSATION DECLARATION hereby affirm that 1' 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. 0. Certified copy is hereby furnished. TOTAL _£ 1 2,562.69 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.).. . _ certify that in the performance of the work for which this permit is issued, I shall n-ot 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 o/ Exemption you should become ZONE: BY:, subject 'to the Workers' Compensation provisions' of the Labor Code, you must .forthwith comply Distances: - comply with such provisions or this permit shall be deemed revoked. ' Front. Setback from Center Line Rear Setback from Rear. Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from i.enter.,Llne 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•Llne 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. I certify that I have read this application -and state that the above information is correct. ISSUed b Date Permit . t' I agree to comply -with all city and county ordinances and state laws relating to'buildirig y construction, and hereby authorize representatives -of this city to enter the above-. M. entioned property for inspection purposes. Ir Validated by: Signature of applicant � -t- • f7'- . Date Mailing Address(" r Validation: City, State, Zip A2638 9 19 256269 ft 1 HARD COPY CONSTRUCTION ESTIMATE ._ NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS SLAB GRADE 2ND FL. SQ. FT. BONDING YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS CAR P. I SQ. FT. GAS (ROUGH) DRAINAGE PIPING WALL SQ. FT. OTHER APP./EQUIP. DRINKING FOUNTAIN SQ FT ® TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. / �p GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM 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. SQ. FT. ® c BATH TUB SQ. FT. ®c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL GAR. FIREWALL SQ.FT.GAR ® 3/ac HOUSE SEWER LATHING 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 lx AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS Elf SEWER OR SEPTIC ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. 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. / �p FRAMING FINAL INSP.j hQ ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION/ CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS, GARDEN WALL FINAL �1f1Ep - • \\\\ I I C ' Desert Sands Unified School District H BERMUDA DUNES RANCHO MIRAGE 82.879 HIGHWAY 111 9 INDIO, CALIFORNIA 92201-5678 ! 1619) 347-8631 INDIAN WELLS H PALM DESERT a %P LAOUINTA INDIO September 19, 1985 O ti • ' City of La Quinta s Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 Re: 53521 Avenida Velasco, La Quinta 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 faci"li.ties made necessary by such. new development. Sincerely, John D. Brooks Assistant Supe.rintende.nt Business Services JDB/crm M a Z 0 U W m Z O H U W U) COUNTY OF RIVERSIDE, 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/1) / Mailing Address 5/C 2v C�f�'ri��Gvw City State Zip Code Phone 'Property Address C 'City or Community 'Legal Description of Property (Lot, Parcel Map, Tract) Ou _17A 'r' 'Assessors Parcel No. Water Serving Property From ` Lot size .T �t. MS.v "t �+1 i G ��i„/ fg'i7�`n.,�Clc- "tit. K.t.ae. L�{�"" l..•e/ U _ C... �gnatV�Applidant Date 'The above information must be verified from Building Application Staff Use — Do Not Write Below This Line InitialDate WQCB Clearance required Yes ❑ No ©`f Soils feasibility report required Yes ❑ No 3 Detailed boring report required Yes ❑ No Detailed contour plot required Yes ❑ No ® ! Comments: - , Soils or boring report by Date Approved by r) �- �/' �Date "L je '' Soils Map Page Soil Type Tract File No,!5;/ Number of Bedrooms 3 /7 C.7Lf AL /New Septic Tank Size (gallons) Rate Required,,, Type of System Addition Replacement Leach line sq. ft. of botfom area trench Leach bed (sq. ft. of bottom area bed) c Seepage Pit Diameter ,e5 61 Number of Pits Seepage Pit Depth B.I. Total Depth of Pit Location of System Additional Requirements A" A permit 'lis- pp ovedkd�epiiead,for the design of a subsurface disposal system as indicated on the accompanied plot plan using the•regtafre—ments set forth in Section B above. A building permit is necessary for the installation of the above designed system. ` (� fi T Xjam f" r !r / /f1.'i'� i%(.%., U Signature of Health Official ' ,.. Date Receipt No. r y District: Riverside ❑ Indio ❑� Hemet ❑ DISTRIB TION: WHITE - Office File YELLOW - Applicant DOH SAN 122 (Rev 10/84) Issued By �!-f✓�"r Dates PINK - Building Dept. GOLDENROD - Pending File 'f'7iJ