05697 (SFD)Building 53-770 VE%ASCO
Owner
Mailing
Address 53-195 AVE RAIM
city LA QUIRTA Zip 322531
SM
Address
State Lic. B"X 2205
� Classif.
Arch., Engr.,
Designer
• Address
4
P.O. BOX 1504 No. 0569.*
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 774--165-002
Tel„
t9,/554-3 t 15
Lic. #
Tel.
City I
Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby.affirm that I am licensed under Provisions of Chapter 9 (commencing with Section
7000) of Division�ril
3�,opf�.th4e Business and Professions Code, and my license is in full force and
effect .o�ft7i.f +11 t -'lf A f p-� c- f' �..¢ /
SIGNATURE A. r DATE
I" OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,13usness and Professions Code: Any city or county which requires a
permit to construct, atter, krprove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such pemd to /de a signed statement that he is licensed pursuant to
the provisions of the Contactors License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the eusness 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 civilpenaty of not more than five hundred dollars ($500).
❑ 1, 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 Cordractors License taw does not apply to an owner of property who
builds or impmves 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 orrrprove for the purpose of sale.)
❑ 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) icensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. fi P.C. for this reason
Date Owner
WORKERS COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy`theregf.!(Sec. 3800, Labor Code.)
Policy No Company Y,--, tri y �k, -• '
❑ Copy is filed with the city. ❑ Certified copj 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: It, after m0ft 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.)
Lenders Name
Lender's Address
This is a building permit when property filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certity that 1 have read this application and state that the above information is correct.
1 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.
Signature of applicant Date
Mailing Address
City, State, zip
Description
t Description SFD
Sq. Ft. 1458
Sizel'-
- No. No. Dw.
Stories Units
New Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal.
229.16
Const.
558.50
Mech.
"53.50
Electrical
108,35
Plumbing
, 7.5U
S.M.I.
5-74
Grading
Z0.00
Driveway Enc.
20A 3
Infrastructure
TOTAL
REMARKS
.�:�c-�. eF•'k ..: ds r! ,2,^>s�- Mk C dtl f'.� itti?x .�'X rix t � �
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 5/2/89
Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE �L3—
YARD SPKLR SYSTEM
2ND FL SQ. FT. @
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
ROUGH WIRING
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
!!
GAS (ROUGH)
DRAINAGE PIPING
CAR P. SQ. FT. ®
HEATING (FINAL)
WALL SQ. FT.
REINF. STEEL
DRINKING FOUNTAIN.
leEMP. POLE
URINAL
SQ FT ®
GROUT
ESTIMATED CONSTRUCTION VALUATION $
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.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
LUMBER GR.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FRAMING / 2,171, e >9
LAUNDRYTRAY
AIR HANDLING UNIT CFM
ROOFING4�,,6 11 ff`�
•
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
FIREPLACE
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3V4c
HOUSE SEWER
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 R AIR COND. SOLAR
/,�ETBACK — -
GROUND PLUMBI
/�-
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE �L3—
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
E
ROUGH WIRING
DUCTWORK
ROCKSTORAGE
FOUND. REINF.
!!
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
leEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM tV
WATER SYSTEM
GRADING
CU. yd.
plus x$
=$
LUMBER GR.
FINAL INSP. . %
FRAMING / 2,171, e >9
FINAL INSP. of$
ROOFING4�,,6 11 ff`�
•
/�r� /J�!�
/`
/_� _ �i/w
/J /�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 4,PW V J �
MESH
INSULATION/SOUND /� Q
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
NOTICE: TIS L." SCHOOL FACILITY FEES
CUMENT CANNO
BE DU LIC' ATE i,
TO: City of La Quints DATE: T
Department of Community Development
78-105 Calle,% "do
La Quinta, CA 92253
This is to certify that
developer of,4L/-k1 which is
located at — '% v within
this District, has paid school facility fees imposed pursuant to the
authority g,X01al
at d by overnment Coo ecti 1t 5, 0 O,in the amount of
$ O Ol `!
covering a of square feet of (x residential or
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
C� X40 1 i �,, 0 -
c
for DESERT SAN S UNIFIED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37
A
..l.t"+.t•:- .�.7�IJ: i'_yi� }.. _Yj..lH` %._ w. -.�.ti 'J?'•'• hA�.hl!Y!�iLi.` "'l !Zi`--�1r�7�,�l.,r�
Vit, a RECEIPT NO.Q Issued By Date
DISTRICT: `, ❑ Riverside, 20"ndio ❑ Hemet q Perris ❑ Rancho Calif. ❑ . Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW: Applicant' PINK - Bldg. Dept GOLDENROD - Plans/Records
- 7 -
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COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Asi°'°Or° Pa1°°I NO'
ENVIRONMENTAL HEALTH SERVICES
r
PERMIT. APPLICATION FORA 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. ,
Q
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOI
Z
Apt, Contractor, Contact Person
' S tI'�A
Phone
S 31 lS
Address 8 Phone
53� Iq5 RAM 12EZ
Owner a
Phone .
Mailing Address
cWn
S� rn E'
SNAA t
5 R rn C
City
State
Zip
Job Properly AddrestZ 4444
Legal Description Prop. (PM, Tract, Lot)
LA 1 ''A
Cls
-L:L&
53=1 0 112 c o
DoT -Lb Ly_-L3cj, 0NIT Z21,
Lot Size
gater Agency 1,
Use of Permit P/P, CU, etc.
Other
.
Sb •� O C7
C V w Qi
INA9'1-�f .� I ra C—
Dwel MH She Prep, etc.
a.�.."
Signature of Applicant
Date
CATEGORY: REV CODE FEE
�
CATEGORY: REV CODE FEE
01',S�USSURFACE DISPOSAL I 1238 $45.00
❑ SITE EVALUATION UPON REQUEST 7349 $42.00
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN) r
m
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 ; $11.00
0
a. 1st 4 Parcels (Each) 1238 $45.00
(Less than 1 year) r "'
U
b. Each Parcel after 4 7344 $16.00.
❑ PRELIMINARY ELECTIVE' 7352 $45.00
uj
❑ . 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, i $86.00
❑ ALTERNATIVE/EXPERIMENTAC 7345 $13200
❑ Site Evaluation Lot Less than t
SYSTEM
V 1'01000 Sq. Ft. 7347 $86.00,
ArrIAL DATE
Holding Tank�Agreements Completed ❑ Yes PaPlo �-
f
Certification of Existing S.D. System,Required ��r� ❑ Yes No ,
WOCB Clearance required. (Attach Form ❑ Yes 0/
DOH SAN 007, Santa Ana Region Only) .. f
Sills Percolation Report Required. ❑ Yes O'F
Feas(bil[ty Repoit•Required '� �r�17" Yes y
Spedal Bafng z ;
Detailed Contour Plot Plans Required (1 to 5 It. interval) ❑ Yes .
Other ❑ Yes )a X10 - "
Staff Specialist Lot Inspection Required ❑ Yes - t0 No
Lot Inspection Date
Soils boring report by Project # Date
Q
Soils Map Page / Sol Type Approved by �iW�— Date
i
U
Z
No. of System
Tyw of Syatem(a)
Lp)�OdIng Tank ❑ ExMng
No, Dwelling Units /�
Bedrooms,
(1) Septic Tank
Sol[ Rate
Gresse/Send
Gresse'Intcp
'J' New O Replacement
B. DelGal'l
Al
_0
Gal
U
(2) Leech Line Sq. Ft'
..
Sidewall allowance
InstW Une(s) ft long R widemith
Leach Bad sq
Bottom trench area.�.
n ^mow s4 R
per running It.
min: below drafnlines or
oFbc4torn area
NA
Leachlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Ph Below
Seepage Pit 7bjql,Depth
^�
Other.
Applicabler` � k.�;1
Inlet`(BI)f
N/A. , L' Overburden factor
®
I cF
Max. Allowable Depth
Vo
No. 2 System
REMARKS:
idl
This application 'st - PPROVED IED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
0
on the accompanreTpp oY a ,' using the requirements set forth in SECTION C abo4 A building' permit is necessary for the installation of the
Z
above -designed system. No construction is permitted in the required reserved 100% expansion area.
F
,W
Septic tank and sewer lines must be 50' minimum from any wells c! (.p L„�„�
'Leach• lines- must be 100' minimum from including
/
any wells, expansion ar✓ia-9/ ��o �d��"�
3) Seepage pits must be 150' minimum from any wells, including expansion area
�� W ���
R
Signature of Heafth Official he Q' Date U
Vit, a RECEIPT NO.Q Issued By Date
DISTRICT: `, ❑ Riverside, 20"ndio ❑ Hemet q Perris ❑ Rancho Calif. ❑ . Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW: Applicant' PINK - Bldg. Dept GOLDENROD - Plans/Records
- 7 -
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�; .. _- �. - - - �—.._-_ .. •--•-.••.wr:h .. �,..•.-".1•. ., t-c.'r-.�..t:. "f . , y: =- -..h., ...:. -' ,�'�aa. ,-as
.`• COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAILW _ 2' ? 2I
•t; t ki• �,!'/ `/ �V f`�s
Received From: i ! Date'
Address: <i0
Account No.
t Service Address G.A. Code L
1 fwht J �. may, ;�.+µ`>'tir+
- ❑ Meter(s) S , t : M � res:
O Servlce(s) r,
�.�Ems: x, v
"u
A ` � . 1,. . i Fk � t�sR,+R .tn,T''M.`�4�'r',fy1
y,' O Backflow(8) ih v�"x'",p}
f . ❑ House Lateral(s) Y '"
! his 4• .moi y,
�`b a} t' °`w' ,K 4 �'o vY'• �y�A.� {���i'�:>
J,.'O' DetectorCheck(s) 5Z
`r ❑ Meter Surcharge ' ✓ '` — ) •*rt r �r� =� a,j�te •�r3. `
}s - - - .. s6 - - - - (_�. a £.,' . t y wy, ys. �' •'-t f'- `tf it ;`• ' �
:Sanitation Capacity Charge
1 S K ❑ W.S.B.F.0:P
{c N: ❑ Temporary Construction Meter -t r .. if�i�'�A's �'� ,�}�s�.?,,✓';'x ¢'�,
-'�u:55
�;y�.?
7 s : ❑ Tum on Charge - - - .rf
ElUncollected Account - Name
-' ..i - r1 • r_. •• - ' ' '�v.•..,N,t S yT-a, �z •�,ni �' t. 1' 1 `,i• 3
' ❑ Inspection Fee -Tract - c is 1k� ,�1Kn, g�
Fee- `91�,rr -!F •�''�,-
w , sv-
O Plan `Check Fees Water /Sewer - f. tr �" '°+>a sv " • AN
ti+�
' •- ' Tract - L '�
❑ Bond Payment - A,D. - Bond
W�►4
Assmt i f ` ,\..: 7{ r •x s. "fir y.:l�yi� 'e 7r ,. �1'E > 4t i ,
y i ❑ Customer Deposit
,
' `.❑ Otherti
+ i .. �� ` "� •IT.�`t i6.atra:isx '�:. s .tr Y,� .Y�3fi;. s
TOTAL S etr a�-.Mfi `y'�*'tti V41,1
yA .,.�{• -}� ' �1. • - _ - .itl� •L,.,+y ���, j'Z R :j>f' S�jl+L �� �ZS
Remarks;;
' OCopy to: �y.^ 1. i x.sr'ti`'£`"�' •K�1'<!.
` ,. �' Water Service YyI,X ', «�'v�;
Check 1' i f .` .r .?'s..
- r' wi Y,w -✓ £ _4t
' Money ; '-'t mI•` Cashler V/
' f Order ;� f` } t CMD -43801/89)
7 J ? rl C 1s • 1„ `
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- 4
'Buena Engineers, Inc.
W� 79-811 Country Club Drive, Suite 4
Bermuda Dunes, CA 92201 • (619) 345-1588 / 328-9131
Client Name
Client Addre
Client Phone
DATE
gds-�S
JOB NO.
/37/ 90-�
-PROJECT
(li=L19SG'61
.53720
"LOCATION
CONTRACTOR
OWNER
WEATHER
TEMP.
o at AM
at PM
PRESENT AT SITE
OPTIMUM
MOISTURE
CONTENT
%
TEST
NUMBER
TEST LOCATION
LOT .
NO.
ELEVATION
FIELD TESTING
REFERENCE CURVE
MOISTURE
CONTENT
%
DRY
DENSITY
lbs./Cu. ft.
MAXIMUM
DRY
DENSITY
%
'MAXIMUM
DRY
DENSITY .
IbsJcu.ft.
OPTIMUM
MOISTURE
CONTENT
%
J
s
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u
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REMARKS: ST
If - D i �`-i v C
T i41Z/ SS!//�-i x,
/ - d
6881 CLIENT REPRESENTATIVE SIGNATURE
FIELD REPORT
TECHNICIANS SIGNATURE
M