04725 (SFD)-4
ell —„
' . ,
P.O. Box 1504
Building52` 225 Vallelo
Q LA QUINOTA CALIFORNIA92253
•
Address � -'
Owner a
Coachella Valley "Gamd,,
MailingBUILDINTYPE CONST. OCC. GRP.
L G: .
Address . 247'E.' rt'a TQuits VIAI ' #2 A.P. Number 773-222-022
'11C ty Zip Tell '
"' Alm springs 92262' 3;RtIQ2Q Legal Description _ - •-
Contractor°gyp 1"
Marx Construction Project Description
Address
City Zip Tel.
State Lic. City
& Classif. 3579*44 Lic. # Sq. Ft. , s 1463 , No. No. Dw. 5.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel. 47$1 Gsti°age ,
City Zip State 170 64 wood fence.
Lic. #
LICENSED CONTRACTOR'S DECLARATION
• I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of DivviJision'3 of the ,Btus�iness, avndP�rrofessions Code, andmylicense its in full force and, ,
effect. �iC'•'•C-C9..-•O::/ �'`rC:cw'�uw^•Y.,..,..ar •P 1(•',•6w� - _ - ,
SIGNATURE v DATE i ' ti} �• '
OWNER -BUILDER DECLARATION Estimated Valuation @¢ g d 9
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
PERMIT
AMOUNT-,
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
Section 7031.5 fora
Plan Chk: Dep.2�.�
for the alleged exemption. Any violation of by any applicant permit
subjects the applicant to a civil penalty of not more than five hundred dollars (8500).
Plan Chk. Bal.
v 7C1►iii
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
Const.
373 3 ° 00
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improvesthereon and who does such work himself or through his own employees,
Mech.
' . w�i
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
760119
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-
Plumbing
�qy� yq
105 u 00 '
.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.M.I.
-9 .57 .
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
_
0
2000
❑ 1 am exempt under Sec: B. 8 P.C. for this reason
Driveway Enc.
20.00.
Infrastructure
r 755.14 -'
Date Owner
.
WORKERS' COMPENSATION DECLARATION •
I hereby affirm that I have a certificate of consent to seVAnsure or a certificate of .
Worker's Compensation Insurance, or a certified'cop rfhereoh-(Secf386'0, Labor Code.)
Policy No. Company { 'S""'�`�'
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL!
2,v4oTW-
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
�:°`¢"�'�'•?'" 3: C't.1 .I d9'! ..:"�Jcs !; ".+
This section need not be completed if the
( p perm!( is for one hundred dollars (8100) valuation�.-
r
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
a �,• 41'431-1 A I to i VV_ 41 6,'-1 Gs Y . cx✓
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. _
I
.
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 Labor Code, you must forthwith
•• Minimum Setback
Distances:
comply with such provisions or this permit shall be deemed revoked.
- -
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
i
t
work for which this permit is issued. (Sec. 3097, Civil Code.) •;
Side Setback from Property Line
' Lender's Name
Lender's Address
FINAL DATE
S
CTut,
Iqry
This is a building permit when properly filled osigned and validated, and is subject to
-INSPECTOR
t CT /
expiration it work thereunder is suspended for 180 days.
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I 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-
bovementioned
mentionedproperty for inspection purposes. ,
Validated by:
Signature of applicant Date
;
Mailing Address
Validation:
'
City, State,. Zip t )
4,..rWHITE .FINANCE, PINK APPLICANT, GREEN -;BUILDING, GOLDENROD.- ASSESSOR'S OFFICE, HARD COPY - FILE ,
CONSTRUCTION ESTIMATL
NO. ELECTRICAL FEES
NO. PLUMBING FEES
ISI FL SO Fl W S
UNITS
"LAB GRADE /2_ � - <F
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. R
FORMS
SEWER OR SEPTIC
ROUGH WIRING
MOBILEHOME SVC.
r• BAR SINK
POR SO FT &
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. C1
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO FT. 0
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT. 0
= E
LUMBER GR.
FINAL INSP.
FRAMING
URINAL
SO. FT. rd
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ESTIMATED CONSTRUCTION VALUATION S
WATER PIPING
NOTE: Not to be used as property tax valuation
VENTILATION
FLOOR DRAIN
MECHANICAL FEES
FIRE ZONE ROOFING
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTONDISH)
APPLIANCE DRYER
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 14. c
SEWAGE DISPOSAL
'
SO.FT.GAR 3/.c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
M_CH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR
64SETBACK -
--LAB
ROUND PLUMBIN Z�
UNDERGROUND
A.C. UNIT
COLL. AREA
"LAB GRADE /2_ � - <F
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC
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 xS
= E
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
/
ROOFING /2_21q- (�
/ I
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
I NSULATIONISOUN D
FINISH GRADING
FINAL INSPECTION
'
CERT. OCC.
' ENCE FINAL /
INSPECTOR'S SIGNATURESI NITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
p�
CERTIFICATION OF PAYMENT
NOTICE Tr• OF
®O
e � cufiftFSCROOL MC ITY FEES
t:-1 PLICATEDft
TO: City of La Quinta DATE: /0
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
This is to ertify at ,
/ QCJ/j/
/0.1rL1 ,
developer of
which is
located at —
within
this District, has pa d school facility tees
imposed pursuant
to the
au r ' t g r ( by Gov rnme t d Sec
io5t 5,30 in the
amount q J�
.
covering a total of square
feet of (
r sidentiarrl or
( ) industrial/commer ial development and
that building
permits for
this footage in this development may now be
issued by your
jurisdiction.
-� a7tfa M, I o for ES RT
UNIFIED
SCHOOL DISTRICT
,:.�LrZ
TS
-�I�g Department • Yellow - Facilities Planning • Pink - Accounting
• Gold - Developer
�W�e
3
(10)-37
f
sin
COU,,NTY•O* RIVERSIDE DEPARTMENT OF HEALTH '., Assessors Paroel 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 IisL
��
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 & SAFETY APPLICATION BUILDING DEPARTMENT, APPLICATION LOG'#
Z'
O
Agent, Contractor, Contact Person
Phone
Address & Phone
DISTRICT:. ❑ RiversideO • tlndio -• ❑ Hemet ❑, Perris
❑` Rancho Calif. ❑ , Blythe
LU
Owner i
Phone Mailing Address
`
-City. State JZip
Job Property Address ,l/� Legal Description Prop. (PM, Tract, Lot)
/ � P1Pl� C''� i!'Z zb
•3"3 was .v.4 d�1 Le ,ev � - -
Lot Size
.te .. n/c�y I•
Use o/f`PPe(r^/mh P/P,, C}U,, etc.
Other L
^
ening H S' Prep,
.._�.
a etc.
r"
__'1 ._• �i'�-1'.:..
/en. At Af
Signature of Applicant
Date
r
CATEGORY:_..,, REV CODE ; �- _ _
:CATEGORY: REV CODE FEE .
',❑
101l SUBSURFACE DISPOSAL'- �Y 1238
SITE EVALUATION UPON REQUEST 7349 $42.00
'[3MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
C0
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•'
LAND DIVISION
❑ . SEWER/SEPTIC VERIFICATION 7348 $11.00
0
a. 1 at 4 Parcels (Each) 1238 $45.00
(Less than 1.year),,,_
U
b. Each Parcel after 4 7344 $16.00 x
❑ ° PRELIMINARY ELECTIVE 7352 $45.00
lL
❑ Rereview, (2nd review same parcel) 7344 $16.00 1
EVALUATION (Attach DOH SAN 53)
'
❑ Site Evaluation in Conjunction with ( ;; j
❑ HOLDING TANK 7351 $45.1
Critical Area .%, . - ? 7346-. $86.00
❑ . ALTERNATIVE/EXPERIMENTAL 7345 $13200 `.
❑ Site Evaluabdh-Lot Less than ;
SYSTEM s
10,000 Sq. Ft. E 7347, $86.00
INITI DATE
'00'
Holding Tank Agreements Completed O Yes Q
Certification of Existing S.D. System�Required _ ❑Yes
WQCB Clearance required. (Attach Form °� O Yes IN o �=
DOH SAN 007; Santa Ana Region Only) - /'
Sona Percolatforl Report Required. '� ❑ Yes �
Special Feasibility, Boring Report Required. ' ? ❑Yes f ; .
Detailed Contour Plot Plans Required (1 to 5 ft. interval) , ❑ YesFNo
I
Other ❑ Yes - 1
s
Staff Specialist Lot Inspection Required ' ❑ Yes '`
"� Lot Inspection Date
Soils boring report by p�rge'a/#
/
Soils Map Page 1 / [ Soil Type Approved by / Date
0
Z
No. of Systems
TyA of Systems)
❑Holding Tenk ' ❑ Existing
No. Dwelling Units I
Bedroom�
(1) Septic Tank
Rate
�Grease/Send
Gnsawe Intrp
Q
,flew
❑ Replacement
;SoII
Gal
W
(2) Leach Line Sq. Ft
Sidewall allowance . f
Install s1 ft. long k wide with
Leach Bed sQ ft
Bottom trench area
fL rock/ sq. fL
min. inches 'di8inl' or
;
or bottaer► area 4
q'�
per running R
SNA
i
L.eachlines/bed special design for slope:
Applicable
(3) Pit Diameter
No:Pita
Pit Below
Inlet (BI)
Seepage Pit T.ffit Depth
-'rf
r
i
via/
Max. All ble Depth
tee,
.. v
N/A Overburden factor
No. 2 System 14-
..REMARKS: jil-, /Ld-d7�•� ' � O ; _ Gt..._Q„� : .
41
This application ' AP RP OVED -ENIEQ for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
C1
on the accomparlifia p7oT plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of_thel
Oabove
-designed system. No construction is permitted in the required reserved 100% expansion area. ' > w'~ '
Septic tank and sewer, lines must be 50` minimum from any wells 7�^'d .S'00 .
g;;
Leach lines must be 100' minimum.from any wells, including'expansion ar10
,1
(33 Seepage pits must t50' minimum from`any wells, incl ding expansion •area.,
_
Signature of HeaRh=Official '�4f-
sin
'
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��
RECEIPT NO Issued By.
"" 'Date•
DISTRICT:. ❑ RiversideO • tlndio -• ❑ Hemet ❑, Perris
❑` Rancho Calif. ❑ , Blythe
`
DOH SAN 122 (Rev: 5/88) DISTRIBUTION � WHITE c Office file YELLOW - Applicant PINK- Bldg. Dept ----:GOLDENROD - Plans/Records
.._�.
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