002378 (SFD)P.O. BOX 1504 No. a03�
Building �ti M $ 78 105 CALLE
Address � LA QUINTA, CALIFORNIAORNIA 9 92253
Owner
Pdck Joh%,,'tsM CbM*..
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address P.O. 2288 A.P. Number ?73•-263--W8
City Zip Tel.
92-02 564-2228 Legal Description Ljot 15
Contractor. Project Description Simle fmdly U
gt�ttea
Address .
saw
City ... Zip Tel... .. _
Sam
State Lic. City 1592
& Classif. 397169 Lic. # 202 Sq. Ft. No. No. Dw.
Size "� Stories ' Units -
Arch., Engr.,•
Designer New EIX Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #.
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under orovisions-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. aa':..M+/t jti.,E /.r so f ' f" ' "
_SIGNATURE c yDATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following �t
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a ,4Aq• sc0
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 -
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk..Dep.
•subjects the applicant to a civil penalty of not'more than five hundred dollars ($500). Plan Chk. Bal.
❑ 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.s�su6r
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, +
-YP
provided that such improvements are not intended or offered for sale. If, however, the. building •Mech. 0
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical
��
of proving that he did not build or Improve for the purpose of sale.) -
12
.O I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 89.00
slruct the project. (Sec. 7044, Business and Professions Code: The Gontractor's License Law.
does not apply to an owner of property who .builds or improves thereon, and who contracts for S.M•1. -
• such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Q 1 am exempt under Sec. B: & P.C. for this reason Grading
Driveway Enc.
Date owner Infrastructure
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.
TOTALrI.0
CERTIFICATE OF EXEMPTION FROM REMARKS
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 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, 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
Ihereby 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 FINAL, DATE INSPECTOR
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that theabove 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 cityito enter the above-
mentioned property for inspection pturposes. V1r; i Validated by:
Signature of applicant 'r % f�F Date
Mailing Address Validation:
City, State, Zip
A 5 8 0 1 6 13 2 566 CK
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL.SO. FT. ®
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. SO. FT.
WALL SO. FT. ®
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSP.
ROOFING
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
e—SETBACK
UND PLUMBING X11 -Al
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
�ICFORMS
SEWE S K
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
E POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ —Plus—X$—=$
LUMBER GR.
FINAL INSP.
MING
FINAL INSP.
ROOFING
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DEC ) 7 jA
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
t��INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
&C-0 aq w Acc, {
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O
_ = = O
N BERMUDA DUNES r
RANCHO MIRAGE
INDIAN WELLS ti
PALM DESERT a
J' LA OUINTA
`110 INDIO 1'3
Desert Sands Uni&ed School District
82-879 HIGHWAY 111 O INDIO, CALIFORNIA 92201-5878 O (619) 347-8631.
.lune 13, 1986
City of La Quinta
Department of Community Development
78-105 Calle Estado
La Qui*nta, CA 92253
Re: Lot 15, BTk 83, La Quinta
Gentlemen:
The developer of the above referenced tot
has mitigated i:ts impacts on our overcrowded schools by payment
of the amount of $628 per unit to be applied to the cost of
district educational faci'li.ties made necessary by such new
development.
JDB/crm
I
Sincerely,
►d
John D. Brooks
Assistant Supe.ri.ntende.nt
Business Services
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COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION --,?-
`J-PERMIT
PERMITAPPLICATION 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 required on the attached check list. A non-refundable filing fee of
$30 is required when the application is submitted. Check must be made payable to the
County of Riverside
Building Department Application Log N
Name (Owner, Agent, Contractor, Etc.)
Mailing Address
City �`
State
Zip Code
Telephone
*Job Property Address ' " '°*City,ormgemmunity,
*Legal Description of Prpty. (Lot, PM, TR)
I
Le .7- 1�l-e < f � �, )4417o=�
*Assessor's Parcel No.
Water Agency
Use of Permit / %
Lot Size
%% 3 -2, ^ -
i0ro1►1
+
SFD, MH Site Prpe Etc. —;/"i,
Planning Case if
�''� ,
f .�
4 is ! �� ' / 2-
Signature of Applicant Date
*The above information must be verified from Building Application
STAFF USE - DO NOT WRITE BELOW THIS LINE
Initial Date
Certification of Existing S.D. System reqd. Yes[ ] No P"I :-
WQCB Clearance reqd. Yes[ ] No[,'! _
Soils feasibility report reqd. Yes[ ] No 4
Detailed boring report reqd. Yes[ ] No (-"] �
Detailed contour plot plans reqd. Yes[ ] Nor-],
Staff Specialist approval reqd. YesC ] No[ ] Lot Inspection Date
7
Soils/boring report by Proj. # Date
r% 1JA
Soils Map Page' " X Soil Type(„�7 Approved by w Date
Type of System:
No. of Bedrooms (1) Septic Tank
Soil Rate Required
Existing New Addition Replacement
�`� n. Gals.
[ ] [ ]
�`-;` •
Fri ��`/�'�1
(2) Leach line sq. ft.
Sidewall allowanceInstall
Line(s)
Leach bed
(Bottom,_trench area)
ft. rock/ Sq. Ft.
Ft. Long, --_ ..°Ft. wide
Sq-,Ft. of
per running ft.
with Min. inches rock
bottom ,
N/A .0 ]
below drain lines
area
Leach lines/bed-special design
(3) Pit Diameter;-
No.
Pit
Seepage Pit total depth-
epthfor
forslope: Applicable5"7
6' [klf
Pits
..BI
N/A Overburden factor
Max. allowabl.depthC
i
j
This application is,-approved/•aen�re'd for the design of a subsurface disposal s,-stem as
indicated on the accompanied plot plan using the.-requirements set forth in Section B above.
A building permit is necessary for the installation�of the above-designed system.
l)'�Septic tank and sewer lines must be 50' from any wells '�9
(2) each lines must be 100' min. from any wells including expansion_area
Seepage pits must. be -150'.- min---from - any-wells— including expansion area
�
v
Si aIu of He%t�(/•f i ci�1 Date
� r� d (�
RECEIPT N0. k. F' „ d Issued by Date
District: Riverside[ ] Indio [A' Hemet [ ] Perris [ ] Rancho Calif. C ] Blythe [ ]
Distribution: WHITE -Office file YELLOW -Applicant PINK -Bldg. Dept. GOLDENROD -Pending File
DOH SAN 122 (Rev. 2/86)
3 - a
REMARKS: '
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Signature