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002341 (SFD)P.O. BOX 1504 Building 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner mailing - Address P.O. B= U76 City Zip TA 1 a - 9=3 Contractor Jim rte 6t. Address . .. - . . . s� .._ - 1. . .. . . . BUILDING: TYPE CONST. - -1 OCC: GRP.• A.P. Number 774""244"'021 •: 564-3594 ; Y Legal Description lot Project Description City Zip Tel. 4ple valillal 32307 _ State Lic. City MG 1412 & Classif. 3892835 Lic. # Sq. Ft. ' 440 No. No. Dw. - Size ` -Stories - Units Arch.. Engr.; Designer New QX, Add ❑ Alter ❑ Repair ❑ -Demolition ❑ . Address Tel. (This section need not be completed if the permit is for one hundred dollars ($100) valuation City Zip State I certify that in the performance of tha work for which this permit is issued, I shall not s -employ any person in any manner so as to become subject to the Workers' Compensation .Lic. # __ 4 ' LICENSED CONTRACTOR'S DECLARATION. hereby affirm that,I am licensed under provisions, of Chapter 9 (commencing with Section 7000) of Division 3 of. the Business•and Professions Code, and my license is in full force and effect. -71 �• - - - - SIGNATURE' X 0 56_ DATE ZONE: ' BY: J. % OWNER•BUILDER DECLARATION— - I hereby affirm that I arrexempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and. Professions Code: Any city or county which, requires :a ': peimii to'construct, alter, improve, demolish, or repair any structure, prior to its,:issuance also requires the applicant, for such permit to file a signed statement that .he is licensed -pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with .Section 7000) of _- Estimated Valuation !� ( D s$ ' PERMIT'• - - 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 or not more than five hundred dollars ($500)." - 01 , 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 -Plan Chk.. Dep. 2W.00 Plan Chk. Bal. COr1St. Mech. - . 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.) Electrical Plumbing ' -O I, 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 . S. Ma ' • 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 . Grading Driveway Enc. Date Owner Infrastructure WORKERS' COMPENSATION DECLARATION A hereby'affirm that I have a certificate of'consent to'self-insure; or's*certificate of Worker's 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 AMOUNT 358.00- 5.25 58s0R/5.25 20.00 1,U6,U 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 tha work for which this permit is issued, I shall not s -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 ZONE: ' BY: subject to the Workers' Compensation provisions of'the Laboi Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances: - Front Setback.fro.m.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 . work for _which this permit is issued. (Sec. 3097, Civil Code.) • Side -Setback from Property Line 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 by:_.:_,Date Permit - 1 agree to comply witti all city and county ordinances and state laws relating to building construction, and hereby authorize representatives softhis city to enter the - above-. mentioned property for inspection purposes,t.. Validated by: rte ' Signature.of applicant Date Mailing Address % ' " Validation: City, State, Zip ✓ A5597 5 13 1.734,21 CK HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ 2ND FL. SQ. FT. POR. SO. FT. ® GAR. SQ, FT. ® CAR P. 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 BONDING FLOOR DRAIN MECHANICAL FEES '' V(r4FORMS s I • WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER METER LOOP GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED REINF. STEEL LAUNDRYTRAY 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 ROOFING/V�� 6 �� SQ. FT. p c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL VENTILATION SO.FT.GAR ® 3/ac HOUSE SEWER FIRE ZONE ROOFING GAS PIPING PERMIT FEE FIREPLACE 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 OUGH PLUMB. �j BONDING HEATING (ROUGH) STORAGE TANK '' V(r4FORMS s I • ER OR SEPTIC A / RO H WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP. FINAL INSP. GRADING cu. yd. $ plus x$ =$ LUMBER GR. F AMING ®� ROOFING/V�� 6 �� (f Omf /) /ur CA// fie lie �� �y REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING 7 MESH I ISULATION/SOUNDL42 FINISH GRADING /1L L INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL 0 4 P.O. BOX 1504 APPLICATION ONLY Building /n� ( % 1 78-105 CALLE CALIFORNIA9 Address 7 {/A �,1,/��Q LA QUINTA, ORNIA 92253 Owner r - Mailing 1 Address City I Zip ITel. Address State Lic.I City & Classif. Lic. # Arch., Engr., Designer 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. 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 permit to construct, alter, 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 rive hundred dollars ($500). O 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, asowner 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.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Owner 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 - O 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 -of this city to enter the above-. mentioned property for Inspection purposes. Signature of applicant Date .Mailing Address City, State, Zip BUILDING DIVISION BUILDING: TYPE CONST. OCC. GRP. P. Number Legal Description / r7"l. -a�.�y - o a I Project Description s i Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ PERMIT AMOUNT Plan Chk. Dep.. 0 Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL ,9 ,SQ 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 U//-��/� Permit Validated by: Validation: r CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. 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. SQ. FT. GAS (ROUGH) METER LOOP GAR. SO. FT. @ POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SO. FT. @ GROUT WATER HEATER WALL SQ. FT. 10 FINAL INSP. DRINKING FOUNTAIN BOND BEAM WATER SYSTEM URINAL SQ. FT. @ _$ LUMBER GR. ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIRE ZONE ROOFING LAUNDRY TRAY AIR HANDLING UNIT CFM FIREPLACE 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 MESH SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac 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 & 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 APP.IEOUIP. 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 SIGNATUREa/INITIALS GARDEN WALL FINAL ��f1Ep o : .0 wBERMUDA BERMUDA DUNES r RANCHO MIRAGE INDIAN WELLS �► PALM DESERT %P LA OUINTA 'Jp IN DIO y� Desert Sands Unified School District 82-879 HIGHWAY 111.0 INDIO, CALIFORNIA 92201-5678 0 (619) 347.8631 May 13, 1986 City of La Quinta Department of Community Development 78-105 Calle Estado La Qui'nta, CA 92253 Re: 54- 195 Velasco Gentlemen: The developer of the above referenced unit has mitigated its impacts on our overcrowded schools by payment of the amount of $628 per unit to be,appli.ed to the cost of district educational facilities made necessary by such new development. Sincerely, I. vi, J, John D. Brooks Assistant Supe.ri.ntende.nt Business Services JDB/crm m Z O P U W (1) U Z O P U W U) COUNTY OF RIVERSIDE, DEPARTMENT OF HEALTH PERMIT APPLICATION FOR A SUBSURFACE DISPOSAL SYSTEM pplicant: Submit this form with three copies of a scaled plot plan drawn to county specifications required on the ttached 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 LA(ZR-<Roc-;C)ZS Mailing Address P.F-,). 3a>c - //7& City State Zip Code Phone LA Ur PT A rA c_I22 53 -6 q 3 59 'Property Address A v� l`t 'City or Community `Legal Description of Property (Lot, Parcel Map, Tract) _ . � Valksco LA QUik;TA LOT 9 3JocK -282- C) P 17 2( p 'Assessors Parcel No. Water Serving Property From Lot size 2/,'i 0z1 (a COC H LL v U -e W' a C - b 'l' S0 X I o 12-7 /N' Signature of Applican ' Date r 'The above information must be verified from Building Application Staff Use — Do Not Write Below This Line Initial Date WQCB Clearance required Yes ❑ No 0 Soils feasibility report required Yes ❑ No Detailed boring report required Yes ❑ No 0 Not Detailed contour plot required Yes ElNo 0 Comments: Soils or boring report by Date Approved by Date Soils Map Page Soil Typeg'° Tract File No. Other Number of Bedrooms Septic Tank Size (gallons) Rate Required Type of System New Addition Replacement ff- El Leach line sq. ft. of bottom area trench Leach bed (sq. ft. of bottom area bed) Seepage Pit Diameter Number of Pits Seepage Pit Depth B.I. Total Depth of Pit 51 El 61 ❑ ,. Location of System Additional Requirements A permit is approved_/..denied for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements set forth in Section B above. A building permit is necessary for the installation of the above designed system. Signature of Health Official Dale Receipt No. District: Riverside ❑ Indio 0`" Hemet ❑ DISTRIBUTION: WHITE - Office File YELLOW - Applicant DOH SAN 122 (Rev 10/84) Issued By Date ~ "' PINK - Building Dept. GOLDENROD - Pending File