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12769 (RC)Building Address Owner I 4 P.O. BOX 1504 78-IE30 Calle 'i's3Yta)iC(3 LA QUINTA, CALIFORNIA 92253 AUquatin Martinez Address 78-535 Via Sonata City Zip Tel. La 0iiinta, CA 92253 564--7439 Contractor Edward J. Straelczyk Address 82-231 Last Heli© Ct. TAdio, CA Zip 92203 Tel. 347-0399 State Lic. City & Classif. B 439904 Lic. # �? 3:3 Arch., Engr., Designer Address I Tel. CityI Zip I State Lic. If LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am��icrsnsed under, pro`visioris of'Cha ter 9 (commencing with Section 7000) of Division 3 of thcfBusiness an ofessiohs Code `nd mylicense is in full t�ce nd SIGNATURE "' ATE 'OWNER -BUILDER DECLARATION I hereby affirm tha!,Pam 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 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 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, 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) 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.—O"' Company &Copy is filed with the city. O 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 the 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 No. 12769 VN B2 BUILDING: TYPE CONST. OCC: GRP. A.P. Number 769-030--412 Legal Description Project Description Remodel existing pharmacy, add 930 s. £. far new meat market Sq. Ft. 930 No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition C Estimated Valuation $74,503.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 436.24 Const. 527.00 Mech. 62.00 Electrical 100.70 Plumbing 75.00 .S.M.I. 7.45 Grading .00 Driveway Enc. 00 Infrastructure.00 TOTAL REMARKS II ZONE: BY: J U'��� 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 Issued by: Validated by: Validation: INSPECTOR Permit CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. ® $ UNITS SLAB GRADE 1 � BONDING YARD SPKLR SYSTEM 2ND FL. SO. FT. FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SD. FT. ® GAS (ROUGH) METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR. SO. FT. ® TEMP. POLE GROUT DRAINAGE PIPING CAR P. SO. FT. ® FINAL INSP. WALL SO. FT. WATER SYSTEM DRINKING FOUNTAIN. GRADING cu. yd. $ plus x$ =$ URINAL SO. FT. ® FINAL INSP. FRAMING ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FIRE ZONE ROOFING __ GARBAGEDISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIREPLACE LAUNDRYTRAY 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 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER FINAL INSPECTION 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 ROUND PLUMBIN UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCKSTORAGE r FOUND. REINF. C v GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. 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 SIGNATURESIINITIALS GARDEN WALL FINAL DESERT SANDS UNIFIED SCHOOL DISTRICT ; - 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be`Duplicated 61'9=775-3500 ' Date 2/28/94 Type of Permit LaQuinta No. 12688 Permit # Log Owner Name . Martinez, Augustin No. 78-100 Street Calle Tampico City La Quinta Zip, 92253 Study Area 118 T AP1v # Tract # Lot'# 0 Square Footage 930 Type of: Development Commercial No. of units 0 Comments At the -present time, the Desert Sands Unified School District does not collect fees on " garages /carports,, covered patios/walkways,-residential additions under 500 square feet, detached accessory structures or replacement. mobilehomes. It has been determined the above-named owner, is exempt,from paying school fees at this time due` to the following reason: l EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of .27 x 930 or $ 251:10 have been paid to-D.S.U.S.D. for the property listed above,:and that building permits 'and/or Certificates ofbccupancy for. this square footage in this proposed project may now be issued. Fees Paid By 'CASH Telephone 564-7439 Name on the check By Dolores A. Ballesteros Superintendent Fee collected /exempted by `Peggy Reyes. Payment Received Signature� Check No. n/a UV I Collector: Attach a copy of county or city plan check application form to district copy for all waivers, Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting .kv:t�ti �.lf T«f�i�,!+'"4' ��.�j�,A�'�`_K''Cr",�,��'�"Y'7�'%'�►%r 'lf� �h1:i -� �'tiw'r�'Mv�t'X'k�rl'V}l�► 'Y' ♦'n'�y f "'7,' �. ASSESES_ ASSESSOR'S PARCEL NUMBER COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY 761 0-M _ QO DEPARTMENT OF ENVIRONMENTAL HEALTH 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 specifications as indicated on the attached check list. A non-refundable filing fee is required when the application is submitted. Check must be madepayable to the County of Riverside. Approval of this applica- tion shall remain valid for a period not to exceed one year from date of Payment. f LOG # 66 OF LA 011444 Agent, Contractor, Contact Person MA Address City State Zip lT,elephone tL OwnerAddress .x heugr,'d IVA2ro* E,- City State Zip Telephone Q Z Job Property Address City Zip r- 797100 C4kk ' I MP1C0 A 0111 Tij' (14. _ U Lot Size &ater Agen WeIP Use of Permit, PIP, SUP, PIP, etc. Legal Description W to pp' 00 ►1 ��0 accq I�ALI.'y ` COACN('648C.) It vi �DB GSTgaC,.s/lartFl gf� d&V. 'F( 6 &. 6� �� - PU*Stt Wjw.S �A +1m I(W�f"f2 0151/rrr ! r.4 1iif-<I.- 4444 2r5T " SIfrj�a@re of Oplicant ,Date CHECK BOX REQUIRED ❑ Holding Tank Agreements Completed ❑ Detailed ContourPlot Plans Required (1 to 5 foot interval) ertifieation-of-Existng,fr� &ystertrRequired�- ' ❑ Grading Handout Provided m ❑ WOCB Clearance Required ❑ Staff Specialist Lot Inspection Required Z), (Attach For DOH -SAN -007, Santa Ana Region Only s ❑ Lot Inspection ' U❑ Soils Percolation Report Required W ❑ Date Lot Inspection Completed: Initials toia�l Feasibility Boring Report Required �F'easpibilty ""'�'�"' Lif Remarks: ❑ Maintenance Booklet Provided Initials ��✓�" Date - a a " / Final Inspection by Department of Environmental Health is required. C/42 / Soils Percolation Boring Report by Lig(Project # Date " Soils Map Page Soil Type Approved By Date of Systems Ty Syste(s) O Holding k ❑Replacement O No�BwelNrtg�rtite' 4Bedr$izalS ixtar"ni 1) Septic Tank ate area�/Sand- Grease IntcpMntaFrep /lEGkr, Afi) Q T 7M'f rj New ❑Addition E A T Alb , /(%+✓� /{/p, JF Z I� 4010,4 M Ae GrJ. 13 Existing Gal. Sq. Ft. ttom Area Total Linear t Sidewall Allowance '—ft. rock/ - sq. k. running ft. Install a s) ft. long tt. wide with Leach Bed sq. ft. of Bottom Area r Inlet Tested Depth �R'IJA min. inches c below drainlines or U Proposed Bottom Tested Depth Z Leach lines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Inlet (BI) Seepage Pit Maximum Other: O F- U W Applicable / WA ✓Overburden Factor ' �. ❑ 5' Total Depth � TD Allowable Depth to Well Review Approved: A Date: Well Drilling Permit # SIGNATURE Grading Pian Approved: Date: SIGNATURE % f� / Sewer Verification Approved- AGS (�7/ �J ;.. C�/C /dt�. Date: REMARKS: !�G(/i9� D / i (,fin 4. 4 'VIII. 'Aa 04�('!/WGD..'R -d 3- 9V This application i APPROVED ENIE� for the category checked In SECTION B FOR OFFICE USE ONLY above, regarding t e es gn of a sub�ur ageKdisposal system as Indicated on the aoompanted plot plan, using the requirements set forth In SECTION C above. A build- ' 73 �8 Q- 00 Ing permit Is necessary for the installation of the above -designed system. No construc- Revenue code Fees -2 tion Is permitted in the requited reserved 100% expansion area. /1 (1) Septic Tank must be 100' minimum from any wells. ❑ Check # C A S f4 (2) Leach lines must be 100' minimum from any wells, including expansion area. Date ?, i C Cf -1 Initial 0 3® Sewer lines must be 50' minimum from any wells. Z O_ i (4) Seepage pits must be 150' minimum from any wells, Including expansion area. F- U W W // p Signature of Health Official t Date 4 DOH -SAN 122 (Rev 9/93) L Utstribullon: WHI I L --unite t-Ile;'T LLUW—Appncam; MINA Uep1.; UL)LUtrvMUL—manSfrtecores CITY OF LA QUINTA Developers Project Approvals Form Prior to the issuance of the Building Permit for LA- Qc)lg-TA MSI kA-ff 14� at -- 47C� CAU- :LA-/Ab'Cc, the following Departmental clearances must be obtained. r Engineering Dept. Name Title bate Planning Dept. Name Title 'Date Building Dept. Name Title Date - -z;6 ��� �4 /Q