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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=,`;���{� 2 0 W 0) U Z C W 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