002339 (SFD)4
P.O. BOX 1504 NO. 002339
Building 53-W0 ��3 IeJO LA QUINO
Address TA CALIFORNIA 92253
Owner
City Zip State
Lic: #
LICENSED CONTRACTOR'S DECLARATION.
I hereby affirm thaQ am licensed under provisions of Chapter 9 (commencing with Section -
7000) of Division 3 ofit'yi..�.�r` hpee Business and Professions Code?'and m licensee .s in full force and
effect. . .IA..i I-_� O;
SIGNATURE Fy" ,f i DATE
-OWNER*
BUILDER DECLARATION y
I hereby affirm that I am exempt from the Contractor's License La for the following
reason:. (Sec.. 703.1.5, Business and Professions Code: Any city or -county . which requires . a
' permit to construct, alter, Improve, demolish, or repair any structure,4prfoi. to its Issuance also
requires the applicant for such permit to file a signed statement that he.is-licensed pursuant to
the provisions oP 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
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
O [,.as owner of the property, or my employees with wages as their sole compensation, -ill
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,
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-
of
urden-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.) .
O 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 CompensationInsurance, 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 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
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.)
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 allicity and county ordinances and state laws relating to building
construction, and hereby authorize representatives' -of this city to enter the above-
mentioned property for inspec""tion purposes.
y s
Signature of applicant t� >�� �.,. ,�' a t V � Date
Mailing Address
City, State, Zip r I
HARD COPY
UILDING: TYPE CONST. OCC. GRP.
.P. Number 774-1605
egal Description T1* 2
roject Description ftmyle far# ly 1inq
BY:
Mailing
Sq. Ft. Y 1424 GM ��� No. No. Dw. "
Size. Stories . . Units
Address
I `:rtcr��
- -
City
Zip
Tel.
1.7 C;,,.'
;:.i1 -
Date` Permit
92284
365--8109
Contractor
Sam
AMOUNT
Address ..
8.3
Plan Chk. Bal..
' City
ConSt.
Zip
Mech.
Tel..
State Lic.
795 AA
Plumbing
City
& Classif.
371587
Grading
Lic. #
Arch., Engr.;
2i Af)
Infrastructure
Designer
Address
Tel.
City Zip State
Lic: #
LICENSED CONTRACTOR'S DECLARATION.
I hereby affirm thaQ am licensed under provisions of Chapter 9 (commencing with Section -
7000) of Division 3 ofit'yi..�.�r` hpee Business and Professions Code?'and m licensee .s in full force and
effect. . .IA..i I-_� O;
SIGNATURE Fy" ,f i DATE
-OWNER*
BUILDER DECLARATION y
I hereby affirm that I am exempt from the Contractor's License La for the following
reason:. (Sec.. 703.1.5, Business and Professions Code: Any city or -county . which requires . a
' permit to construct, alter, Improve, demolish, or repair any structure,4prfoi. to its Issuance also
requires the applicant for such permit to file a signed statement that he.is-licensed pursuant to
the provisions oP 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
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
O [,.as owner of the property, or my employees with wages as their sole compensation, -ill
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,
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-
of
urden-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.) .
O 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 CompensationInsurance, 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 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
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.)
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 allicity and county ordinances and state laws relating to building
construction, and hereby authorize representatives' -of this city to enter the above-
mentioned property for inspec""tion purposes.
y s
Signature of applicant t� >�� �.,. ,�' a t V � Date
Mailing Address
City, State, Zip r I
HARD COPY
UILDING: TYPE CONST. OCC. GRP.
.P. Number 774-1605
egal Description T1* 2
roject Description ftmyle far# ly 1inq
ZONE:
BY:
Minimum Setback Distances:
Sq. Ft. Y 1424 GM ��� No. No. Dw. "
Size. Stories . . Units
New C1. Add ❑ Alter ❑ Repair ❑
Demolition ❑
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by: _
Date` Permit
Validated by:
Estimated Valuation 7111,224e00
PERMIT
AMOUNT
Plan Chk. Dep..
A 5 4 5 9
Plan Chk. Bal..
91.20
ConSt.
364.00
Mech.
16.00
Electrical -
795 AA
Plumbing
g7.1130
S.M.I.
%-15
Grading
7n -m
Driveway Enc.
2i Af)
Infrastructure
7-143.36
TOTAL�€.Ci
�.SU
.REMARKS
FWM. CIOMM SPA AM NN VW
W TRIS t--'ry"�`�.4..i.
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Pro.p..Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by: _
Date` Permit
Validated by:
Validation:
A 5 4 5 9
4 29 184230 S1
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ, FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT._®
DUCT WORK
DRAINAGE PIPING
WALL SQ: FT.
GAS (ROUGH)
DRINKING FOUNTAIN
SQ FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ -Plus-X$-=$
LAUNDRY TRAY
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 ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
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 PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACKIZGROUND
PLUMBINGle (7!K-
UNDERGROUND
A.C. UNIT
COLL. AREA
MSLAB GRADE 5 /a Y
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC N44,_
o
ROUGH WIRING
DUCT WORK
ROCK STORAGE
PL�FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
lam'
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.�7
ROOFING �"� � /1 C �
t
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
d%f1ED
C' o
° Desert Sands Un&d School District
H BERMUDA DUNES r -
RANCHO MIRAGE 82.879 HIGHWAY 111 • INDIO. CALIFORNIA 92201-5678 • (619) 347.8631
INDIAN WELLS H
PALM DESERT a
%P LA OUINTA
p INDIO
City of La. Quinta
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
Re: 53-380 Vallejo, La Quinta, CA
Gentlemen:
The developer of the above referenced lot
has mitigated its impacts on our overcrowded schools by payment
of the amount of $628 per unit to be applied to the cost of
district educational facilities made necessary, by such new
development.
Sincerely,
�. ,/1
,John D. Brooks
Assi.stant Superintendent
Busine.Ts Services:. _
JDB/crm
y
oa
s
COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION
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 specifications required on the attached check list. A non-refundable filing fee of
$30 is required when the application is submitted. Check must be made payable to the
County of Riverside
Building Department Application Log #
Name (Owner, Agent, Contractor, Etc.)
Mailing Address
rl
City I j ` %
Stat1e
y� Zip Code.
Telehjone
*Job Property Addressf
(,*City or-Gomun--ty
*Legal Descript'on of Pr y. (Lot, PM, TR.)
l /Y ///I f t F70
A a i t r,.1 1 -A
t t ( ox-. - --,a,-1 may'
*Assessor's Parcel No.
Water Agency
Use'of Permit
Lot Size
''] t! !
7 !' f �o oo&
Aaac[$e3,B
/ j� i /D
SFD, MH Site Prep Etc. S F
Planning Case #
_
Signature of Applicant Date \ t
1. *The above information st be verified from Building Application
1 \
1 STAFF USE - DO NOT WRITE BELOW THIS LINE
Initial Date
'Certification of Existing S.D. System regd. Yes C ] No C`] 4. ,4,0
;WQCB Clearance reqd. Yes[ ] No G-]
ifeasibility
oils feasibility report reqd. Yes[ ] No C/']/ f
tailed boring report regd. YesC ] Nof.�J �-
Db,
,.ailed� contour plot plans reqd. Yes C ] No C/] _
De'
`.'f Specialist approval reqd. Yes[ ] NoC`jl� Lot Inspection Date
Stagy -
--*S/boring report by Proj. # Date
_
Soil;, Map Page //r/ Soil Type Approved by/l %%% Date ! `
Soils
I`y, v
of System:
No. of Bedrooms (1) Septic Tank
Soil Rate Required
Type , t in New Addition Replacement
i �U�'(% Gals.
Exis
tC. sch line�sq. ft.
Sidewall allowance
Install Line(s)
Leach bed
(2)kLeai trench area)
-ft.rock/- Sq. Ft.
Ft. Long;�^''Ft. wide
Sq. Ft f
(Bott ;a �1
per running_ft.
with Min. inches rock
bottm
o
N/A C ]
below drain lines
area
amines/bed-special design (3) Pit Diameter No. Pit Seepage Pit total depth
Leacht l)e: Applicable ,1M111-6' C Id Pits BI
�1
for sloXjverburden factor /(� Max. allowable depth T10
N/A
r
__ Toved/denled.for the design of a subsurface disposal s --stem as
This appl'ication'is app: Hied plot plan using the requirements set forth in Section B above.
the accompa, a
indicate0on
i. ssary for„the installation of the above -designed systep.
> A building permit is neer ,r
lines must be 50' from any wells y /4 ( � y
�
_(1),Septic-tank-ands ewer , min. from any wells including expansion,/,area 1 .4 /
(2) Leach lines must b' =115 min. from any wells.including expansion area/ 40 . 74 b• y
�3 )�.S- eepage ,pits must tie 15�
Date
R;una.ture of Health Official
RECEIPT NO. ..r -f 7(J . Issueahy, Date <{ f -
” Rancho Calif. C ] Blythe District: Riverside E I Indio C_] Hemet ] Perris yt C ]
Distribution: WHITE -Office file YELLOW=Applicant PINK-Blldd Dept. GOLDENROD -Pending File
DOH SAN 122 (Rev. 2/86) .\
r
i
1
G