05380 (SFD)I � T4ht 4 4 Q"
Building 54-145
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA; CALIFORNIA 92253
F
NW CEMMON BUMMISS INC" -
Mailing
Address P.O. BOX 2401
City Zip Tel.
Phi RESER 92260 346-'4614.
Contractor
Address,
City Zip Tela
State Lic. City
& Classif. 352211 1 Lic. # 130
Designer
Address Tel.
CityI 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
SIGNATURE 'DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,6usoness and Professions Code: Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to We a signed statement that he is licensed pursuant to
the provisions of the Contractor's License taw, Chapter 9 (commencing with Section 7000) of
Division 3 of the Bus -mess and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any viola8on of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than rive hundred dollars (E500).
❑ 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
Professions Code: The Contractor's License Law does not appy to an owner of property who
builds or kmproves thereon and who does such work himself or through his ownemployees,
provided that such improvements are not intended or offered for sale. ff, however, the building
or improvement is sold within one year of completion, the owner-bur7der will have the burden
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 contracton(s) licensed pursuant to the Contractor's License Law.)
❑ 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 Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company �..•�' * a ..
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
f,
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (5100) valuation
orless.)
I certify that in the performance of the 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: 8, alter 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, Cin? Code.)
Lender's Name
Lender's Address
This is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certity 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.
Signature of applicant Date
Mailing Address
City, State, Zip
No. 05380
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 77A-712—nlA
Legal Description
Project Description Cf.'I9m
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date2/22/89 Permit
Validated by:
Validation:
Sq. Ft.
Size 1€00
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
89,902
PERMIT
AMOUNT
Plan Chk. Dep.
250.00 `
Plan Chk. Bal.
260A,81
Const.
594.50
Mech.
Electrical
13I.R8
Plumbing
1S .Sf
S.M.I.
6.30
Grading
2o. -no G
Driveway Enc.
2000 7
Infrastructure
�. 1,984.54
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date2/22/89 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
SEWER OR SE
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SQ. FT. ®
LUMBER GR.
FINAL INSP. r/ 1
/
WRAMING
URINAL
SD. FT. @
91// Y 3 �� / �[
`` (///� O I f���
�.� J �r,PA�•
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
VENTILATION///J�
FLOOR DRAIN
MECHANICAL FEES
FIRE ZONE ROOFING
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/ic
HOUSE SEWER
FENCE FINAL
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE 7ONST.
FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
&S TBACK
CGROUND PLUMBIN ��
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SE
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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. r/ 1
/
WRAMING
FINAL INSP.
�OOFING j 13—
91// Y 3 �� / �[
`` (///� O I f���
�.� J �r,PA�•
REMARKS:
VENTILATION///J�
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING —
MESH
— INSULATION/SOUND —
t
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
SCHOOL FACILITY FEES
1140TICE: THIS DOCUMENT
TO: City o;`LaQUnta °f E� CANNOT' DATE:
Department of Community b'evelopment
78-105 Calle Estado
La Quinta, CA 92253
This is to e r t i f y t h t C�.� CZ�U�✓� '
developer of which is
located at within
this District, has p id school facility fees Ymposed pursuant to the
d4UY
enerat d by Government C de Sectio 53080 in he amount of
66 covering a total of square feet of ( ly) residents 1 or
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
9 1(000 th a._IA11 0 - aaA ot,
�-Ft-- —v)to O for DESERT NDS•UNIFIED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
0 007
�i�,�yR 1' ^W ��P. P,�r�'p.!r3.TA'�- - -. 'i ,r !. ,..N.p. I' �;-. "I r�'.TMi `I ,' �"'�M�p�'•R l'_ s
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH ' Aseeemm Parcel PIo.
177Y�
-" ENVIRONMENTAL HEALTH SERVICES = a1Q
-PERMIT APPLICATION FORA 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 list
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.
VERIFY ITEMS IN SECTION A FROM BUILDING 8/SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'$ s
n t rector, Contact PersonP ne��I
OVAa 1101- -S
17V�
Adddress8 Phone
� mpjAY
✓I
0�Y11Li15
Jt/ 78
�Add6X
`
`(�� s, g- to :
a
i Job Property Address
A lO
Legal Desc pt lon P_ro_p_./�PM Tract Lot) s
�4A =.
Tu IL vYl e 5 e t'i"
Cv -I YY vF
r Ani L LU'�i f
Lot Size. ._ . f_
-Water Agenc eli —
- Use.ot Permit P/P,-CU, etc:-Othery
7 r
/
/
/ s
a,l
wegi�g,.MH Site Prep, etc.
R
of Applicant
Date
CATEG &Y I REV CODE FEE
CATEGORY: REV CODE FEE
❑2t16SURFACE DISPOSAL 1238 $45.00
❑ SITE EVALUATION UPON REQUEST 7349 $42.00
.G. MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
_., a. 1 st 4 Parcels (Each) j 1238 $45.00
(Less than 1 yew
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 0 $86.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $13200
❑ Site Evaluation Lot Less than
SYSTEM t
10,000 Sq. Ft. 7347 $86.00
INITIAL DATE
Holding Tank Agreements Completed ❑ Yes C No
Certification of Existing S.D. System Required ❑ Yes I No . '
WOCB Clearance required. (Attach Form ❑ Yes No
DOH SAN 007, Santa Ana Region Only) '.
Soils Percolation Report Required. ❑ Yes I No r
Special Feasibility Boring Report Required. ❑ Yes No .
Detailed Contour Plot Plans Required (1 to 5 R interval) ❑ Yes No
Oder—/ ❑ Yes NO
Staff Specialist Lot Inspection Required ❑ Yes No t
«Lot Inspection Date
t—
Soils boring report by I-- ► Project Date'
•�-
SGt h
Soils Map • Page Soil Type Approved by Data L
No. of System
Type of Systems)
Ing Tank ❑ ng
No. Dwelling Unita
Bedrooms
(1) Septic Tank
Rate
=
GGreaase1d1
%O
, ❑ Repteet
,Soil
-2S F Z/1000
raoyu I
Ga
,-/ Gel
(2) leech Line Sq. Ft
Bottom trench
Sidewali allowance
R R
Install Lines) R long wide with
Leach Bed sq. K
rods/ sq.
per running ft.
min. Inches rocklines or
of bottom.ar"'
Leachtines/bed
special design for pe"
Applicable
(3) Pit Diameter
No. Pits
Pit Below
Inlet (BI)
Seepage Pit Totalpepth
17 '
Other:
Max. Ailowablepepth,
N/A Overburden factor
O 5 6
l -
1 Lt
No. 2 System
REMARKS:` 7
IVA, n t
E'
This application iAPPROVED ENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the .accompand �p pan, using the requirements set forth in SECTION :C above.4 A building permit ' is necessary for the installation_ of the
sabove-designed system. No construction is permitted in the required�ireserved 10096 expansion area.
1) 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 ;
rs :� . 3) Seepage pits must be 15100''' minimum from any wells including expansion area `
��//Z����/ o
Signature of Health Official ' ` Date
'RECEIPT NO. �U 1( Issued By ( Dater
DISTRICT ❑ Riverside, 2)�ndio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe'
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
A
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SLAM
DEVE:WPER' S I•W1Et e
ADDRESS
�1ELL• !'I IUWE t t � � q 1 3 4 � — � io l .
Dear Wveloperl
Mier teviewinq your I.mOsCUP1.11q Itlalls� fill Irlant nyter}al liif sted -I'
violation of: yvaucalltine lfl�►s e�uveillllly On 0,1010110 Valley.
do occur t�l�d they cllE[er [tun I►lallt n►�alerlal listed, tills oltice nn)st be 11vtiEied
bulp-dlately .
111a11kY ou Lor ptvtectLly alld Ilieservlrny tile Coachella Valley's pest -[tee ewitullieut•
11grcul tutal Cam s over s ul [ ice
cct 111d10 Enid Itivetside U[ [ 1ce
4
JOHN H. HACKER & ASSOCIATES CLIENT JOB NO.
CIVIL ENGINEERS j
4501 E. Sunny Dunes Rood LEGAL SHT. �_ OF
Suite C
Palm Springs, CA 92264 DATE
(619) 327-4565
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