05793 (SFD)1
P.O. BOX 1504 NO. 05793
Building 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
DAVE
Mailing BUILDING: TYPE CONST. OCC: GRP. .J
, " .�
Address 43-67.5s CA.MIEL CIRCi. � A.P. Number ?7A_1?S_A(K
City p Tel. -_ •` - Li!' 6�
Cit Zi ,
Pi ��%tT 926ti 345-63w Legal Description
Contractor a Project Description
S.F.D. • `
D.G. CONSTRUMON
Address
SAM
City Zip Tela
State Lic.
& Classif.
Lic. #
Sq. Ft. No.
��%i
Size _ • Stories
No. Dw.
Units
Arch., Engr.,
Designer
New ❑ Add O
Alter ❑ Repair ❑ ; ' 'Demolition ❑
Address
Tel.
;
CityState
Zip
,A
Lic. #
LICENSED CONTRACTORS DECLARATION
I hereby that Pram licensed
affirm 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. �:; r C� ,dam J f
SIGNATURE DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractors License Law for the followingt�3i�jT.(}
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 forsuch permit to Me a signed statement that he is licensed pursuant to
PERMIT
AMOUNT - w• � j
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 or Section 7031.5 by 'any applicant for a permit
• Plan Chk. Dep.
250.00,,
' subjects'the applicant to a civil penalty of not more than Iv , hundred dollars ($500).
Plan Chk. Bal.
242.24
O I, as owner of the property, or my employees with wages is their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Suisness and
Const.
r.
Professions Code: •The Contractor's License Law does not a" to an owner of property who
- ?1�,.�si •
. builds or improves thereon and who does such work himself or through his own employees,
Mech.
'•
- 66.5(
provided that' such improvements are not intended or offered for sale. If, however, the building
•r
'
or improvement is sold within one year of completion, the'owner-budder will have the burden
Electrical
1)[2405;-.. '
• 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 I
50 -
154; 50
struct the project: (Sec. 7044, Business and Professioas 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.
•+sC
I2. 75 '
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec -• B. & P.C. for this reason
t'` �✓--
Driveway Enc.
'20.00,- ,
Date Owner
Infrastructure
PRECISE PLAN--_-
._ • 25.,OO
WORKERS' COMPENSATION DECLARATION
I' hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers 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:
TOTAL
,
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS}(tt'}
(This section need not,be completed if the permit is for one hundred dollars (8100) valuation
z• .s rT ; ry x :y.• w r . < r
' or less.) ,.
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any personnia in any manner so as to become subject to the Workers' Compensation
Laws of Califor
Date_' Owner
' NOTICE TO APPLICANT: If, after making 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 permit shall be deemed revoked. S
,
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
Ihereby affirm that there is a construction lending agency for the performance of the
•Side
work for which this permit is issued. (Sec. 3097, CivitCode.) ..
Setback from Property Line
Lenders Name
Lenders Address
FINAL DATE
° `
INSPECTOR
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.
h
sl��89
I certify 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
r�
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
RAD ,
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
DRAINS
GAR. SO. FT. ®
TEMP. POLE
IROOF
DRAINAGE PIPING
CAR P. SO. FT. ®
FINAL INSP.
,/GROUT
'C'( BOND BEAMWATER
SYSTEM
DRINKING FOUNTAIN.
WALL Sp. FT.
=$
LUMBER GR.
FINAL INSP.
URINAL
SO FT ®
/ ROOFING
(�
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
FIREPLACE
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, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
Sp. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
CERT. OCC.
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 PAM id" ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
aw GRO D PL gpp
UNDERGROUND
A.C. UNIT
COLL AREA
RAD ,
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPIEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
WATER HEATER
SERVICE
FINAL INSP.
,/GROUT
'C'( BOND BEAMWATER
SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
RAMING - S - g
FINAL INSP.
/ ROOFING
(�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND ti
FINISH GRADING
AL INSPECTIO ^ 7
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
t
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
NOTICE: SCHOOL FACILITY FEES
'fir `Br�r .00UM NT 10ANN
or
TO: City o f E a" QPin-JDATEDs DATE:
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
QA
This is to certif t
developer of (J ,. which is
located at — within
this District, has paid school facility fees imposed pursuant to the
au thoxUi ivrated by Qqvernment C e Se iolt 53080 in the a oun of?
covering a total of quare feet of ( ) re ide tial or
( ) industrial/commercial development and that buildi g permits for
this footage in this development may now be issued by your jurisdiction.
1-1570L for KESERT SANDS UNIFIED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37
.�;��• �''"° "`-�.'T7'`+,1's'�':''�"'?�,�"�u �,,:,, �� �o`.� .�Y- ��r�,• "�;7fi:;; A'F'';�.s',."`Fz,l=,`;���{�
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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 scaled plot 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. '
r .
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPUCA71ON BUILDING DEPARTMENT APPLICATION LOG'
Agent, Contractorr�Contact�Person d.
Phone
Address & Phone1
Ga . {�1RP°
/� 5
J
pivner�� - +f
Phone
Mailing Address
City
State
Zip
Jo Property Address
legal Description Prop.(PM, Tract, Lot)
Lot Size
'P'a er Age I
Use of Parmh P/P, CU, etc. a a<<�
Other /
104
"�
Dwelling, 'SRe P
M etc.
Signature of Applicant
/ Date
CATEGORY:r ! REV CODE FEE_
CATEGORY: REV CODE FEE
ol
111- SUBSURFACE DISPOSAL '� 1236 FQ $45.00
• ❑ SITE EVALUATION UPON REQUEST 7349 $42.00
❑ MULTIPLE PARCELS WITHIN SAME -
(NO PLOT PLAN)
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
a. 1 at 4 Parcels (Each) 1238 $45.00
(Less than 1 year)
b. Each Parcel after 4 7344 $16.00
❑ PRELIMINARY ELECTIVE 7352 $45.00
❑ Rereview (2nd review same parcel) 7344 $16.00
EVALUATION (Attach DOH SAN 53)
❑ Site Evaluation in Conjunction with
❑ HOLDING TANK 7351 $45.00
Critical Area {; 7346 $86.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $13200
❑ Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $86.00
IN IAL DATE
Holding Tank Agreements Completed 13 Yes
Certification of Existing S.D. System Required .❑ Yes 121 No
WQCB Clearance required. (Attach Form ❑ Yes Ilio
DOH SAN 007, Santa Ana Region Only)
Sills Percolation Report Required. ❑ Yes ET NO'.
Special Feasibility Boring Report Required.❑Yes d
Detailed Contour Plot Plans Required' (1 to 5 fL interval) ❑ Yes
Other ❑ Yes
��N
Staff Specialist Lot Inspection Required, " ❑ Yes No
Lot Inspection Date
Sills boring report by 4ti�. #=' Date
Map Page SON Type Approved, by Deft o'
Soils --
No. of Systema
Tyfq of Systems)
No. Dwelling Un I
(1) Septic Tank
Soil Rate
'rease/Sand
EY Ing Tank O Existing
Bedrooms, FIxti9
CireaseJ
❑ Replacement
3 Mn
1Grd
/ /
Q�j
. �titax
/
Gal
(2�LeaCh Line Sq. Ft
ry3e'-
j Sideviali allowance
Install Uns(s) ft long H wide with
Leach Bed Sq. ft.
gp area
ft rock/ sq• R
min. inches drahilines or
--area
_
per running ft
Leachiines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
Seepage Pit T IDeP1h
Other.
Applicable t
-5"
'
Inlet (BI)
Inlet
v/ Overbu
N/A rden factor ,
{� 1111-6/1
Max. AI 4tQIe,Depth
No. 2 System
REMARKS:
1�This application 's*AJ PP OVED ENtED for the category checked in SECTION B above, regarding the+design of a •subsurface disposal system as indicated "
on the aabmp`an_ed�p o"t' plan, using 'the requirements set forth in SECTION • C above. , A+i building permit is necessary for the installation 60the
above -designed system. No construction is permitted in the requirek( reserved 100% expansion area.
01
Septic tank and sewer lines must be 50' -minimum from any wellsp�
(2J, Leach lines must be 00' minimum from any wells, includingex�ansio er
3 Seepage pits must be X50' minimum from any wells,aincluding expan nra, AWL
Si nature of Heaffh Official
RECEIPT NO. Date�0—
1n r DISTRICT: ❑ Riverside, 12 Indio ❑ Heme q Perris ❑ Rancho Calif. ❑ Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW Applicant . PINK - Bldg. Dept GOLDENROD - Plans/Records
i