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05381 (SFD)4 P.O. BOX 1504 No. 05381 Building 78-105 CALLE ESTADO Address 54-•175 VALLEJO LA QUINTA, CALIFORNIA 92253 Owner Mailing NW (MER"10K SUMM ILIO BUILDING: TYPE CONST. OCC: GRP.- Address P.O. BMI 2401 A.P. Number 774-211-4119 City Zip Tel. PALL DESEW 92260 346-4614 Legal Description Contractor _ Project Description Cwt Address City Zip Tela State Lic. City & Classif. 352211 Lic- # 12 0 Sq. Ft -No. No. Dw. Arch., Engr-, Size' • 1600 Stories Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip 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 effect - SIGNATURE A r - -. '•DATE OWNEWBUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from .the Contractor's License Law for the following tp�q n r�A reason: (Sec. 7,031.5,Business and Professions Code: Any city or county which requires, a 89 902 permit to construct, after, 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 Ne provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) o1 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. 21i= subjects the applicant to a civil penalty of not more than five hundred dollars ($500). Bal. Chk, d. ❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan 260.81 do the work, and the structure is not intended or offered for sale- (Sec- 7044, Buisness and (`,Or1St. of n _ Professions Code: The Contractor's License Law does not apply to an owner of property who 594.50 builds or improves thereon and who does such work himself or through his own employees, Mech. t 1t provided that such improvements are not intended or offered for sale. If, however, the building 53.50 or improvement is sold within one year of completion, the owner -budder will have the burden of proving that he did not build or improve for the purpose of sate.) Electrical 131.18 ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing ' 157.50. 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-1-`. such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) 30 Grading 20.00❑ 1 am exempt under Sec- B. & P.C. for this reason Driveway Enc. 20.00 Date Owner Infrastructure 1,984.54 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 cerlified,copy thereof. (Sec- 3800, Labor Code.) Policy No. company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. . TOTAL , CERTIFICATE OF�EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (This section need not be completed If the permit is for one hundred dollars (E100) 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 n, after making this Certificate of 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 shad be deemed revoked- Minimum Setback Distances: 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;, .`_ „�w?fir Q' work for which this permit is issued. (Sec. 3097, Civil code.) Side Setback fromiRroperty4Line - 3 Lenders Name v tiiti:�1 t�/i/t{ % J4aa J Lender's Address FINAL DATE INSPECTOR 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 certify that I have read this application and state, that the above information is correct- Issued by: Date 22(89 Permit 1 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. Validated by: Signature of applicant Date Mailing, Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. ® $ UNITS COLL. AREA LAB GRADE ROUGH PLUMB. YARD SPKLR SYSTEM 2ND FL. SO. FT. HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR. SO. FT. ® DUCT WORK ROCK STORAGE FOUND. REINF. POWER OUTLET ROOF DRAINS GAR. SO. FT. ® HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) DRAINAGE PIPING CAR P. SO. FT. ® GROUT WATER HEATER DRINKING FOUNTAIN WALL SO. FT. FINAL INSP. BOND BEAM WATER SYSTEM URINAL SO FT ® GRADING cu. yd. plus x$ =$ ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES OK TT, O --r4,REMARKS: �/ I✓ , d �r a /�"I� WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER VENTILATION GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIRE ZONE ROOFING LAUNDRY TRAY AIR HANDLING UNIT CFM FIREPLACE 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/. c SEWAGE DISPOSAL SO.FT.GAR ® 3/.c 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 SETBACK C 6 LROUND PLUMBINGf f UNDERGROUND A.C. UNIT COLL. AREA LAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. 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. 3> © L(, CFRAMING/�- 7� �T FINAL INSP. 60OFING 7 —ei OK TT, O --r4,REMARKS: �/ I✓ , d �r a /�"I� VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL r THING e.2 da - MESH 1 INSULATIONISOUND, / „C FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESlINITIALS GARDEN WALL FINAL Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quints, CA 92253 Document Cannot Be Duplicated 760-771-8515 Date 1/7/00 No. 19889 Owner NameCarrie Jessie Macy CERTIFICATE OF COMPLIANCE APN # 774-212-019 Jurisdiction. La Quinta No 54 175:: Street Aven' a_Vallejo City La Quinta zip 92253 Permit # Log # Study Area Tract # Lot # Square Footage 265 Type of Development Residential Addition No. of Units 1 Comments !65 sq. ft. patio enclosure to convert to family room At the present time, . the Desert Sands Unified School District does not collect fees on. garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It has been determined the above-named owner is exempt from paying school fees at this time due to the following reason: Residential Addition 500 Sq Feet or Less EXEMPT This certifies that school facility fees imposed pursuant to Government Code 53080,— in the amount of 0.00 X 265 or $ 0.00 the property. listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now lie issued Fees Paid By N/A -Came Jessie Macy Tele-4827-4827pone97 eF Name on the check r r By Dr. Doris Wilson r Superintendent Fee collected /exempted by Ellen Patino Exempt $0.00 Signature�uwli Check No. N/A JOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the go -day approval period in which you may protest the fees or other payment idenlifig;' above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to :ollect them on the District('s)(s') behalf, whichever is earlier. Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting ��«��f�%"�iV"'�+s'"�"''°�r. ��f'rr''I�'�`�""�`�'rY�'''�i���=�` ��F*�{.*ty�•,�,:t"�"��'�'v'r � � 4 COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH a> sors Pa'eIpNo. 77y — ENVIRONMENTAL HEALTH SERVICES PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM Applicant: Submit this form with four copies of a scaled piot,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 shalt:remain valid for a period not'to exceed one year from date of approval. V RIFY• ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG' # t factor, Contact rson P ne •' Z- Address & P <07V"_ e ova S �l 3-1.37 A a Ouvner^ XJ *t rp Jo Property A dress Ls/gel'Descrri�ip��tion m e (o 1 %3 !i n L-it�2/rlQ U � r Lilt Size WaterAga /YVeir — - Use of Permit P/P CU, etc. (A•lvri-tV LJ ' ' Other wellin H Site P rep, tc. � _C/ —07 Data Applicant CATEGORY: REV CODE FEE CATEGORY: REV CODE FEE ❑�' DISPOSAL .1238 $45.00 ❑ SITE EVALUATION UPON REQUEST 7349 $42.00 �SSUBSURFACE IY MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) LAND DIVISION r ❑ SEWER/SEPTIC VERIFICATION 7348 $11.00 ' a..• 1 st 4 Parcels (Each) 1238 $45.00 (Less than 1 year) t = b. Each Parcel after 4 7344 $16.00 ❑ PRELIMINARY ELECTIVE 7352 $45.00 d 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 $86.00 ❑ ALTERNATIVE/EXPERIMENTAL 7345 $13200 ❑ Site' Evaluation Lot Less than SYSTEM /-'197347 $86.00 10,000 Sq. Ft. INITIAL DATE Holding Tank Agreements Completed F 13 Yes No I I Cart III cation of Existing S.D. System Required ❑ Yes C No WOCB Clearance required. (Attach, Form ❑ Yes I No /��r; DOH SAN 007, Santa Ana Region Only) T Solis Percolation Report Required. ❑ Yes, I No Special Feasibility Boring Report Required. ❑ Yes I No 'Detailed Contour Pk)t Plans Required (1 to 5 ft. interval) ❑ Yes I No Otter ❑ Yes C No " Staff Special.ist Lot Inspection Required ❑ Yes I No z Lot Inspector Date 'report i le Solls boringby r Project # Date —T— Solis Map Page Son Type S� Approved by I • 7 Date. No. of Systems Type of Systems) No. Dwelling Units (1) Septic Tank Soil Rate Grease/Sand ❑ Holding Tank ❑ Existing OrNew ❑ Replacement Bedrooms, Fixture Units ° a5� �2 ,f Grease I ;' ALA 3 b,/*-. �x (/ Ud p xGW _ (2) Leach Line Sy Ft,;,' ti ,Bottom Sidewall albwance Install Une(s) - fL longwide with Leach Bed sq. ft. R rock/ sq- R nning It. min. inches ru ,c.beb WV@ lines or of bc4tom a / Leachlines/bed epactal design for01 slo . (3) Pit Diameter No. Pita Pit Below Seepage Pit Total Depth , ': Other: s Applicable _ ❑ 5 6 Inlet (BI) / 1 % Max. Allot Depth N/A Overburden factor a No. 2 System . REMARKS:.t t This -application isPPROV ENIED for the category checked in SECTION B above, regarding the design of a subsurface disposalsystemas indicated on the accompan' plot pian, using the requirements set forth in SECTION C above. A building permit is necessary. for the installation of the above -designed system. No construction is permitted in the required reserved 100% expansion area. 0 Septic tank and sewer lines must be 50' minimum from any wells *( Leach lines must be 100' .minimum from any wells, including expansion area (3) Seepage pits must be 150' minimum from any wells, including expansion area Signature of Health Official / ./"G�/JW Date Q RECEIPT NO. Issued By Date DISTRICT: ❑ Riverside, O Indio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe y DOH SAN 122 (Rev. 5/88) DISTRIBUTION: - WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records CASE; IIU. SNE DEVELOPER'S !11111!; a vJ ADDRESS �L E�clil IolaE t! q 1 3 4— f l Dear Ueveloperl 11[ter reviewillq your lalMtlscOlMl.ntl IIIaIMs, till 111011! nyterlal listed isslitutiolls violatioll v[ quarallt111e ltl•+1s tjov t.1111i lelrial listed, tills ev[[ice y. nrusl. be Irvti[ied do occur F1IMd, they dlE[er [tun 1 1 iunlMediately . tvtectLMy and I�iesetvllMy tIMe.Cvachella Valley's 1-esr-[Lee e11VIM111>ent. '1'11MIk you 1yr p nyr�cu] tutal Caul s viler s Ul [ ice Ccl 111di0 tuld Itivetside Mice I C i E. 1E011 SI'M;t,Y )M ( 1U,E U1 �p•.�in�;ut.tn ;luc:uL i ultnl. ui1hI�55�tJhll:�l nc CO )MMES U V;Al.tA(:r ni AwSIANI r,��•.rn�4n��l.rt ClE?IEN 1 13t.NVE14I51 E WI:IC;I I I S L'. hl(:�\SUIl1:5 s�uin "' 49-GlJ IINy oG, Ilulce a-Iz Concliell�� CA 92ZJG 6IY-J42-0'lYl CASE; IIU. SNE DEVELOPER'S !11111!; a vJ ADDRESS �L E�clil IolaE t! q 1 3 4— f l Dear Ueveloperl 11[ter reviewillq your lalMtlscOlMl.ntl IIIaIMs, till 111011! nyterlal listed isslitutiolls violatioll v[ quarallt111e ltl•+1s tjov t.1111i lelrial listed, tills ev[[ice y. nrusl. be Irvti[ied do occur F1IMd, they dlE[er [tun 1 1 iunlMediately . tvtectLMy and I�iesetvllMy tIMe.Cvachella Valley's 1-esr-[Lee e11VIM111>ent. '1'11MIk you 1yr p nyr�cu] tutal Caul s viler s Ul [ ice Ccl 111di0 tuld Itivetside Mice I C i