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05712 (SFD)r'r 1 Building Address Owner 4 P.O. BOX 1504 'No. 78-525 ULTDO 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 GEORGE DEMUM 19201 ,- AWOINEMST Zip YORBA L� 92686 Contractor - Address City I lZip I Tel: State Lic.I City & Classif. Lic. # 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 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, atter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to rite 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 y for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a cM1 penalty of not more than rive hundred dollars ($500). — 11 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 Contractors License Law does not apply to an owner of property who &A# 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 -budder 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 Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed N 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: lf, 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.) Lenders Name Lenders 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. 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 a. 05712 BUILDING: TYPE CONST. OCC: GRP. A.P. Number 789-061-003 Legal Description SFD Proiect"Description I r I Sq. Ft. 1699 Size No. No. Dw. Stories Units . New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $98,72$.00 PERMIT AMOUNT Plan Chk. Dep. 250.00 Plan Chk. Bal. ;' :;A35- Const. 64-51 Mech. I -R-53 Electrical 198050 Plumbing 6.93 S. M.I. 200'00 Grading 20.00 Driveway Enc. 2.221A0 Infrastructure TOTAL 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 5/8/89 Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINeftES• i f IST FL. SQ. FT. ® $ UNITS UNDERGROUND A.C. UNIT COLL. AREA YARD SPKLR SYSTEM 2ND FL. SQ. FT. BONDING HEATING (ROUGH) MOBILEHOME SVC. BAR SINK POR. SQ. FT. ROUGH WIRING DUCT WORK ROCK STORAGE POWER OUTLET ROOF DRAINS GAR. SQ. FT. ® METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL DRAINAGE PIPING CAR P. SQ. FT. ® TEMP. POLE GROUT DRINKING FOUNTAIN. WALL SQ. FT. SERVICE FINAL INSP. BOND BEAM URINAL SQ FT ® GRADING cu. yd. $ olus x$ ESTIMATED CONSTRUCTION VALUATION $ LUMBER GR. WATER PIPING NOTE: Not to be used as property tax valuation FINAL I`N�SP FLOOR DRAIN MECHANICAL FEES �v0^ (�_CG O WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER VENTILATION 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 I 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. SQ. FT. RESID ® 1 Vi c SEWAGE DISPOSAL SQ.FT.GAR ® 3Yac 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 PLUMB12 4 ELECTRICAL HEATING & AIR GOND. SOLAR ter. �vyi SETBACK GROUND PZMBING,,05> UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE %.V.PQI 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 APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ olus x$ $ LUMBER GR. FINAL INSP. MING FINAL I`N�SP OOFING tIDDD�/ `ff� ldG Q 0 �v0^ (�_CG O REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR FIREWALL //rrGAR. PYATHING / MESH ,4INSULATIONISOUND�l��-�v/ FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS , GARDEN WALL FINAL Desert Sands Unified School District CERTIFICATION OF PAYMENT OF NOTICE.* THIS DOCUMESCHOOL FACILITY FEES FE DUPLICATED, CANN®9' -� TO: City of La Quinta DATE: �D-30 —D-7 ((A Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 This is to certify thatn /'U , developer of which is located at a within this District, has paid school facility fees imposed pursuant to the au horlty gwf at; d by overnment Code S tion j53080 i t e amou v/0/,,, covering a total of square feet of (LX 4esIdential or ( ) industrial/commercial development and that building permits for this footage in this development may now be issued by your jurisdiction. tlk-t 1 e for DESERT SA DS UNIF�SCHOOL ISTRICT White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer (10)-37 �'.� A',(r � +, i F ..{"� ' C•r ..t' � '�� J � (j } � .,�.� y�.•i Y>�-tet ^ xy. �� �� �•• YV _� . wit '�i' f,�,xi�' ��.,..:r^^nl'K�*l4 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 , Riverside. Approval of this application shall remain valid for a period not to exceed one year from date of approval. Q I Z UP I RECEIPT NO. i .; Issued By . l/ •. D e -T�g DISTRICT: ❑ Riverside, 0 ---Indio -❑ ,Hemet q Perris ' ❑ Rancho Calif. ❑ Blythe DOH SAN 122 (Rev. 5/88) 'DISTRIBUTION: WHITE -Office file. YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assomm Parcel No. ENVIRONMENTAL HEALTH SERVICES 76 — Q�l 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. Q VERIFY ITEMS IN SECTION A FROM BUILDING 8 SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'* Z O Ager Contractor, Perso y` �1c21 ' Address 8 silt JA ��� ?� t?bnti3� Owner e 'fie ✓ evt� a �� P �y �-vin Mailing Add I CFZ.-•e �- W 5- o2 i 4 2 n hoc c S pity J State Zip . 0— J rty j Legal Description. Prop. (PM, Tract, Lot) tri /( !-iaS1-" C4 -i sc-+-W# Lot Size �jo ter A nc Use of Permit P/P, CU, etc L! Other Sr i 3a , c�� H Sit . Prep, etc Signature of Applicant ' Date CATEGORY: REV CODE '' CATEGORY: REV CODE FEE ° ©SUBSURFACE DISPOSAL 1238 ❑ SITE EVALUATION UPON REQUEST r 7349 $42.00 ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) m Z LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION' , . 7348 $11 AO p a. 1 at 4 Parcels (Each) 1238 $45.004 (Less than 1 year) U b. Each Parcel after 41 „ 7344 $16.00 ❑ : PRELIMINARY ELECTIVE 7352 $45.00 LU ❑ Rereview (2nd review same parcel) -7344 ., $16.00 EVALUATION (Attach DOH SAN 53) fn ❑ Ske Evaluation in Conjunction with' ❑ HOLDING TANK, 7351 $45.00 Critical Area 7346 $86.00 • ❑ ALTERNATIVE/EXPERIMENTAL 7345 $13200 ❑ Site Evaluation Lot Leas than * SYSTEM 10,000 Sq. Ft. 7347 $86.00 INITIAL' - DATE Q •f Holding Tank Agreements Completed ❑ Yes t3FNo / Certification of Existing S.D. System Required ❑ Yes ! WQCB Clearance required. (Attach Form ❑ Yes _ r DOH SAN 007, Santa Ana Region Only) Solis Percolation Report Required. ❑ Yes - 000N Special Feasibility Boring Report Requked. ❑ Yes /// Detailed Contour Plot Plans Required (1 to 5 R interval) ; ❑ Yes Other ❑.Yes Staff Specialist Lot Inspection Required ❑ Yes A No ' .. Lot Ir. 3pectim Date Solis boring report by Project Date 6W Solis Map Page & Sol TypeOZIA Approved by Date r U Z No. of Systema / UTYpe of Systems) ❑Holding Tank ❑ Existing No. Dwelling Unita l� Bedrooms, WrAs (1) Septic Tank Soil Rate Gram/Sand Q 9°rNew r ❑ Replacement � ,� 3 1J� AfMq 0 4. k �t Gel U Leach Line Sq. Ft Sidewwl aik„wance Inatella�-y Li_re(s) R long B wide wAh Leach Bed sq. It trench area ft rock/ sq. R min. inch�9"Ipel dreinlines or OFbolbpm area per running ft Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit•Babw Seepage Pit Total Depth lii0 Other. Applicable -'/ N/A Overburden factor • 6 t h,let^feq (�� Max. Allovvabl�Depth U No. 2 System - • _� ..._ . J •, �.._.. _.[_ , ' �.._.- .�. _ . _ w * . _ . ._ . REMARKSi� ti d This applicaCiora,i PROVEt�EINEB for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated 0 rr on the. accom'p'a'n"�Mr"pporplan, using the requirements. set forth in SECTION C above. -A building" permit. is necessary for the installation of the Oabove•designed system. No construction is permitted in the required reserved 100% expansion area. 4 — 0 , Septic tank�anc sewer lines must be 50' minimum from any well LL U) Leach lines must be 100' minimum from any wells, including expansio real �• �r Seepage pits must 150' minimum, from any. wells, including, expans War D Q.s-a+.� yAic";!" nature 7'Ipate A,� Si of Health Otficia a .7 7ZI RECEIPT NO. i .; Issued By . l/ •. D e -T�g DISTRICT: ❑ Riverside, 0 ---Indio -❑ ,Hemet q Perris ' ❑ Rancho Calif. ❑ Blythe DOH SAN 122 (Rev. 5/88) 'DISTRIBUTION: WHITE -Office file. YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records ul 1 u,E U► E. LEW Sl'nt;r,Y co•.r���;�u�.cn AGRICUL I URAL (,UMMISSIUML• Il JAMES o WALLACE AND A1,5151AM CIEMEy1 DF.NVEMS1E WI:IC;1 I I S 1'/. WASURUS SLAW 49 -fou Ilwy 116, Iliilte 11-12 -Cuilchello, CA 9ZZ36 �t'r 9� •1.6q� 61Y -14Z-0291 CASE I IU. UEvE;wv It' 5 14lV•fE t v ` c2 i �� • • r� C� nl)u1t�SS .4 e, CA vi 11 4l,` A.- . �1•ELL•'1'11UwE� � 6 f� 1 S (� �{ ifl 2 1-0 ? G0. QLA- 1t T0. r 1 Lear Ueveluperl 11Eter reviewing your landscill)i.ncl I11011s, aiLi 111011tlle lis fdsuhslitutllons violation of yuatantine 11)ws govemilig the Cvacliella Vall y do occur tend they dl[[er ILL"'plant imAerlal listed, this o[Elce Illust he notlEled llnll�dlately. '1'hmik you Lor prulectilly and Illesetv1119 the Coachella Valley's hest-[ree enviroln�ent. 1►g>cultutal Cai ss�oner s UL [ ice ccs ludlo wide Itivetside U111ce