04556 (SFD)LA .
-Building-
- Adriracca. 110""1111;
Owner .
_' -B,6rbara Jewell Fiat.
Mailing
Address
City Zip
Contractor Mason
Address
BOX 1499
City Zip
?A3:m Springs 1 92263
State Lic.
& Classif. 49821.0
... _..., ......I
Designer 0
Address
�wQ�«rw
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
" BUILDING:- TYPE CONST. OCC. GRP.
A.P. Number 769 -062-005 -
Tel.
Legal Description
Project Description . S F.D.
Tel.
340-9584'
Cit
Lic.# 932 Sq.,Ft. 25.10 • No.
` Size Stories
Tel.
City( 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 3 of the Business and Professions Code ,"and my license is in full:force and,,
OWN ER -BU ILDER: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
04556
No. Dw.
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
_s
-stimated Valuation
PERMIT AMOUNT
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
Plan Chk. Dep.
- V . -
a f:
subjects the applicant to a civil penalty of not more than five hundred dollars (E500).
Plan Chk. Bal.
M
.0 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
Const.+
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.
Mech..
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
Electrical
104 04b
'Of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of'ttie property, am exclusively contracting with licensed contractors to con-
Plumbing+
•
struct the project.' (Sec. 7044, Business and Professions Code: The Contractor's License Law
K '
does not apply to an owner of property who builds.or improves thereon, and who contracts for
S.M.1.
.� • •�•
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
Grading
aCtJ 0 . u
❑A am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure
z'i W11 • tjV
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,(Se_ c. 3800, Labor Code.)
Policy No. Company t �•'--
❑ Copy is filed with the city. '❑ Certified copy is hereby furnished.
4
TOTAL
��i, ,'l�#•��
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
rexv.» r;•c a, n n . Ali.3 _ C +.. e�{1
-(This section need not be completed if the permit is for one hundred dollars ($100) valuation
gilt } �rA
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, alter 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.
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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.)
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
y/ 08
expiration if work thereunder is suspended for 180 days.
1 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
+. WHITE - FINANCE, PINK - APPLICANT, GREEN -- BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILES
__-n.Yyv.✓•!:,:,. � ....._ _:.�...,d _a_ ... _. .+rx ,,. .. A ,. ._ �_.. .. � ..
_ ..-��-( .t:_�Y" __..- � ...
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s- .- .. ,_.A.:•. -.:\-•s. _ ..�. .L �' - -.�. __. _•- .. ..ter _T-
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT y S.
UNITS
9�-61-AB GRADE _ 2
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. (d
FORMS/,'
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT a
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. Cl
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO FT. is
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT. (d
= $
LUMBER GR.
FINAL INSP.
URINAL
SO. FT. r&
ROOFING 1-21001(-Y
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(AUTONDISH)
APPLIANCE DRYER
FIREPLACE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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 1'A c
SEWAGE DISPOSAL
SO.FT.GAR rg 3/.c
HOUSE SEWER
CERT. OCC.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE bL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR
ETI3ACK —�
GROUND PLUMBIN ?,Qr
UNDERGROUND
A.C. UNIT
COLL. AREA
9�-61-AB GRADE _ 2
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS/,'
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF ?-2
CC L l
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 1-21001(-Y
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR'
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURFSlINITIALS ,
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
NOTICE THIS DOCUMFC cE ,Ak'?(fj�MY-FEES_
CSE DUPLICATED,
TO: City of La Quinta DATE:
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
:Carl
s -Ki
fmD
UM
9-1
This is to certify that �n
developer of which is
located at — within
this District, has paid school facility fees imposed pursuant to the
auth r' enerat by Government Code Se d o 5308 in the amount ofd
$ � ( woe1 )
covering a total of )*Ld,&sqtWre feet of (p residen ial or '
( ) industrial/commercial' development and that building permits for
this footage in this development may now be issued by your jurisdiction.
C ---It: Id4
7"ofd,A -= ;�S 10 )(75 % _ N -29 -
White - Building Department • Yellow
1 41
for DESERT SA DS•UNIFIED SCHOOL DISTRICT
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Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37
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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 IkA.
A non-refundable filing fee (see below) is required when the application is submitted. Check must be made payable to the Coup; y of
Riverside. Approval of this application shall remain valid for a period not to exceed one year from date of approval.
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG' #
Agent, Contractor, Contact Person Phone Address & Phone
tv) A -,M. All -'� 0 A)
; Y2, I . C ? _14
Owner/�% j//�jj�
P7+hogne (9 r
Mailing ;Address
C/{
city /� _ �' y� �s�
A A
State
�/j.
a6Zip
Job Property Address Lj
7/Y
Legal Description Prop. (P' +Tract, Lot) s
Y (-4 l , °'��'
.•`"
F
t�k
Lot Size U
Water Agency/Well
Use of Permit P/P, CU, etc.
Other
4
�11��
Dwelling, MH Site Prep, etc.
Signature of Applicant
Ar Date
CATEGORY: REV CODE FEE
e
CATEGORY: REV CODE FEE
B--S-UBSURFACE DISPOSAL. 1238 $`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 st 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 $132.00
❑ Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $86.00
INITIAL- i DATE
Holding Tank Agreements Completed ❑ Yes a No
Certification of Existing S.D. System Required ❑ Yes I No t
I
WQCB Clearance required. (Attach Form ❑ Yes No
DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required. ❑ Yes C No
Special Feasibility Boring Report Required. ❑ Yes I No
Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes No
Other ❑ Yes No
Staff Specialist Lot Inspection Required ❑ Yes No
Lot Inspection Date
Soils boring report by' `� ' Project* Date
Soils Map Page Soil Type Approved by Date
No. of Systems
Type of System(s)
No. Dwelling Units
(1) Septic Tank
Soil Rate
Grease/Sand
❑ Holding Tank ❑ Existing
Bedrooms, Fixture Units
Grease Intcp
❑New ❑Replacement
fJ
/ «i.
Gal
Gal
(2) Leach Line Sq. Ft.
Sidewall allowance
Install Line(s) It. long ft wide with
Leach Bed sq., ft.
Bottom trench area
It. rock ' sq. tL`
min. inches rock below drainlines or
of bottom area
per running ft.
❑ NA
Leachlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
Seepage Pit Total Depth
Other: f
Applicable
61)
� ( L;'
N/A Overburden factor
❑ 5 IY 6
Lj CJ
Max. Allowable Depth
No. 2 System
.r
REMARKS: �.1�t5�`,<<, tQu / C �1 CI NJ (,1
This application is APPROVED/DENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompanied"plot plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
above -designed system. No construction is permitted in the required reserved 100% expansion area.
(•(V Septic tank and sewer lines must be 50' minimum from any wells
(2) Leach lines must be 100' minimum from any wells, including expansion area
'
{(3)) Seepage pits must be 150' minimum from any wells, including expansion areae ` v (' - `-A `'' Lr 7
Signature of Health Official Date
RECEIPT NO.
DISTRICT: ❑ Riverside, 1;1 Indio
DOH SAN 122 (Rev. 5/88) DISTRIBUTION:
C.
Issued By i ,r Date
❑ Hemet ❑ Perris ❑ 'Rancho Calif. ❑ Blythe"
WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records:
i R / V OMCE OF
AGRICULTURAL COMMISSIONER
AND
WEIGHTS & MEnsultEs
4080 LEMON SIREET, ROOM 19
RIVERSIDE. CALIFORNIA 92501
�+.• 1714) 787.2561
utile. 18q
pear Developer/Landscaper:
E. LEON SPAUGY
COMMISSIONER
JAMES O. WALLACE
ASSKTAHt COMMISSIONER
CLEMENF gr-NVENISIE
SEALER
Prior to delivery to the Coachella Valley, the following plants/landscaping material
should be "free frau" the insects/diseases listed. Plants, landscaping material,
appliances, insects and diseases, other than those listed, are also applicable to quar-
antine laws and regulations. .
Citrus Nursery Stock/Citrus Plants; free frau Iced, Yellow, .and Purple Scale, Tristeza
Complex, Woolly Whitefly , and Caustock Mealybug.
Euonymus species; free fran Red, Yellow, and Purple Scale and Comstock Mealybug.
Grape (Vinifera); insects and diseases.
Olive trees; Olive knot and Red, Yellow, an.d Purple Scale.
Palm trees, genus Phoenix; Prohibited. Please contact Agricultural Commissioner's Office.
Psidium (Guava); Woolly W11itefly.
Soil, plants and landscaping material with roots contaminated with Ozoniuin Root Rot;
Prohibited. Please contact Agricultural Ca11ILissiolner's Office.
Hydrilla, viable for11s and appliances associated with; Prohibited. Please contact
Agricultural Col:nissioner's Office.
Certain plants/landscapilig material Fran Tulare County and portions of Kern County; Pro-
hibited. Please contact Agricultural coil lLissloiter's Office.
and
Your cooperation is greatly appreciated. �vtyou
llesitateato callny tourson officeWs I91e telephoneregulations
governing the Coachella Valley, pleasev
number for our district office in the Coachella Valley is (619) 342-8291.
Yours truly,
E n Spaugy
Agricultural Cannissioner
b
ELS/jh
7/15/87