04492 (SFD)r JIII �j/�
P.O BOX 1504STADO
78-105 CALLE Ei
ct it -� • ,.:>
,Address, !'"'�.�� _ LA QUINTA, CALIFORNIA 92253
Owner
`Lawioyl, Schroeder BUILDING: -TYPE CONST. OCC. GRP.'
r, Mailing'
Address 237 N. Port Aitenuen A.P. Number 713— r72' 0 ,"* "„
City - • Zip Tel. " " r
LO
;.4 9003 213—,�3 ,. Legal Description
Contractor - Project Description S F.!).
-Cal West Construction
' Arldress,
.90 Vol
City , •::,,'_ Zip
,M,•.��'-fit"�4���• �7���f3
Arch.;.Engr., ,
Designer
Address;
e,
City 7.� Zip
1 u't —
Tel
City 926
Lic. # 7lnrctr++E9:.tar� .
Tel.
State
Lic. #
f LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under pro`vislbns 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-tne 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
h
Sq. Ft. �� . No. .
Size ' ` Stories .. .
New ❑ Add ❑ Alter ❑
No. Dw.=1:
Units -
Repair ❑ Demolition ❑
L .1
PERMIT.
yd'O9 s 522 W.
AMOUNT,
Dwrsion .3-. of the Business and Profession Code, or t at. he Is exempt there—, and the basis
for the alleged exemption. Any violation o/ Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than rive hundred dollars (E500). f .
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Dep.
• re c'..k
`y�250 w 0G
Plan Chk. Bal.
Const.
- fro. �.,_ d8,.�f1.1f{a�
'fi7� .Of) ? s
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, •
providedthat such improvements are not intended or offered, for sale. If, however, the building1i:1
or improvement is sold within one year o/ completion, the owner -builder will have the burden
o/ proving. that he did not build or improve /or the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Mech.
Electrical
-
- ' !" s + •- r- f I,
Plumbing
_
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.)
❑ I am e xempt under Sec. B. 8 P.C. for this reason
S.M.I.
_
r 640!
Grading
,.
n'�i (�Q
Driveway Enc.
20*00
Date = owner
Infrastructure.a.�
,WORKERS' COMPENSATION DECLARATION
t
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.)
• Policy No. Company � -f /.
"...' -
�. ♦ ❑ Copy is filed with the city. „ ❑ Certified copy is hereby furnished.
1` '1 t
f
TOTAL
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QtdG i7 � � � � 4i '•�-
REMARKS
�C r .� -CERTIFICATE OF EXEMPTION FR OM
WORKERS' COMPENSATION INSURANCE
This, sectfori:nea not. completed if the
( p permit 1s for one hundred dollars ($100) valuation
-.
r1 Y ,
> �"' " "' X".' .i�14 �!u". `� 3U., ..I tb.
r,
orless.);--, ..-. . ••
I certify that in the performance of the work for which this permit is issued, I shall not
.- •_' ,x,>1 E.;,41' '�Y�4i"tL._:t ,: „#; l;t'::.?X.-.
1
.
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
• O
-NOTICE TO'APPLIC.•rANTIt, after making this Certificate or 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
nmum ea
Distances: - .
., , �f
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
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.
FINAL DATE
Issued by:
Validated by:
INSPECTOR
INSPE
j SP CTO ,
Date Permit
- - - -
Signature of applicant Date
Mailing Address
Validation:
i
1 City, Slate- Zip
1 . y
GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE .,yl i
:a,f..,,vii: .l�,.. _ ':ra:,.T•t..4 iF s....--. �'. s:='..+.,..•':.: -. •.i.s '..n,w��.,�r..., ..c- .., i1; f,.�•..>a'?-a-s.
6 d1 ' WHITE- FINANCE, PINK APPLICANT GREEN ,BUILDING,
�!_: ...t :'�+..,.-.�'.vti-..6•u 'Y '.a t•.: t.�'Yr_�..c . ..e. •... .. �:.v� .... r."... ,-...-e.:�t e-.."••�.:�e i.'-. :f
4'
CONSTRUCTION ESTIMaiENO. ELECTRICAL FEES NO. PLUMBING FEES
ISI FL SO Fl rp S
UNITS
GROUND PLUM Bt
UNDERGROUND
A.C. UNIT
YARD SPKLR SYSTEM
2ND FL SO FT. 4t
ROUGH PLUMB
BONDING
MOBILEHOME SVC.
BAR SINK
POR SO FT. a
S ER OR SEPTI
ROUGH WIRING
POWER OUTLET
ROOF DRAINS
GAR SO. FT.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO FT. (g
GAS (FINAL)
P. POLE L
DRINKING FOUNTAIN
WALL SO. FT. 0
WATER WATER HEATER
SERVICE
FINAL INSP.
URINAL
SO. FT. (a
WATER SYSTEM
ESTIMATED CONSTRUCTION VALUATION $
GRADING
cu. yd.
$ plus x$
WATER PIPING
NOTE: Not to De used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
ROOFING
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTORDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LJL-ATHING y`
SO. FT. g, c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @' VA c
SEWAGE DISPOSAL
SO.FT.GAR re 3/4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE hL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUM Bt
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
S ER OR SEPTI
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
- OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
P. POLE L
GROUT
WATER WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
�• ' /
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(s/� —
Ali
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LJL-ATHING y`
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION/6
'
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
:d
y^F DesertF.Sands U_Rif ieii;$ch7oolDistrict
l.i Y E _ arc j-CERTI.F:ICATI.ON_ OF-MAYM N vil� LLON
OF
SCHOOL FACILITY FEES
TO: City of La Quinta DATE:
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
This is to certify that (._AL Win4--r- �
developer of which is
located at �V,,o ) f 1 IJAQ Ls07=M within
this District, has paid school facility fees imposed pursuant to the
authority generated by Gov rnment Cod2iS ctiolt 5 080 in, the am unt of
covering a total of square eet o CX) reside 1aV or
( ) industrial/commercial development an that buil ing permits for
A
fo•tage in this development may no b ued by yo r jurisdiction.
r -DESERT BANDS UNIFIED -SCHOOL DISTRICT
White -Building Department • Yellow -Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37
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COUNTY OF RIVERSIDE, DEPARTMENT OF HEALTH
ENVIRONMENTAL HEALTH SERVICES DIVISION — —
PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM
Applicant: Submit this form with four copies of at scaled plot plan (1-20 scale) drawn to County specifications required on the attached check list.
A non-refundable filing fee oquired when the application is submitted. Check must be made payable to the County of Riverside.
Al Ire,
Building Department Application Log #
Name (Owner. AgentEtc})
Mailing Address
�Contractor.
Kny ,,,I f�
State 1
Zip Codea d
Telephone �FZ i
L
'Job Propeny,Address ,
4
. Cly o Con';Mu[uty
'Legal Description of Property (Lot. PM. TR) i.V/Pr
:�
7
�� rid
'Assessor's Parcel No
ir1N3ter Agenc
r, vJ l ,f w
Use of Per i }(lanning Case #
Lot Size
c -n
SFO. MH Site Preparation tc !YrJ
Ag,a,Vr'/b�,b'f'AWPficSni
!/ Date
'The above information must be verified from Building Application •
STAFF USE — DO NOT WRITE BELOW THIS LINE
Initial Date
S.D. System ❑ Yes 40,,-' / U' /-
Certification of Existing required.
WOCB Clearance required. El Yes IEJ" r
Soils feasibility report required. ❑ Yes
Special feasibility boring report required. ❑ Yes
Detailed contour plot plans required. ❑ Yes I_I N� f
T
Staff Specialist approval required. ❑ Yes No Lot Inspection Date
Soils/boring repo%rt by Project # Date
o
Soils Map Page r I Soil Type C Approved by ;�•N�' Date
10_
Type of System: V
No. of Bedrooms
(1) Septic Tank
Soil Rate Required
❑ Existing Lh"New ❑ Additional ❑ Replacement
Gals.
• 3 49
(2) each line sq. ft.
Sidewall allowance
Install Line(s) Ft. Long,
(ach bed Sq.
(B trench area)
ft. rock/ ,,.- Sq. Ft.
2
Ft. wi a in. inches
lines
Ft. of om
per running ft. /A
rock below drain
area
Leach lines/bed-special design for slope:
Applicable_ '
(3) Pit Diameter
No. Pits
Pit BI
r
Seepage Pit total depth
factor
9*' L�r 6'
1 �
[L
Max. allowable depth_
N/A'vOverburden
This application i �d� p oved/ ied.for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements
set forth in Section abo e. A building permit isnecessaryfor the install tion of, the above -designed s stem.1
1) Septic tank and sewer lines must be 50'�rom any wells
-D�
Leach lines must be 100' min. from any wells including expa sion/ rea `
(3 pits mustbe� 150' min. from wells in I din�gjex a
%_epa�e eany
�n,,ssiiid/�Karea
--7?7W%z'
Signature of Health Onpal iV 611Z
RECEIPT NO. Issued by �i � 7/ Dae T' -& -
District: ❑ Riverside In'�dio ❑Hemet ❑Perris El Rancho Calif. ❑Blythe
Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File
DOH -SAN -122 (Rev. 4/88)