05173 (SFD)P.O. BOX 1504
Building 78-105 CALLE ESTADO ED DEB#,
Address 54-945 Vellejo LA QUINTA, CALIFORNIA 92253 "AN ADEQU jOB_sITE DURING
Owner RMIRED ON THE
Coachella Valley Land BUILDING: -TYPE COA I � OF CON'STRUIC-1 1.0m
ST
_OCG, GRP. -
Mailing
Address 7A7 117_ T"UM014II-S, tin," A9 A.P. Number 77A_An1_niA
City zip' 'ITel. Legal . D . escription
Contractor
Project Description
Address
city Zip Tel:
State Lic. City�
& Classif. 387934 Lic. # 89� Sq. Ft. 1410 No. No. Dw.
Arch., Engr., — Size Stories Units *
Designer New 0 Add 0 Alter 0 Repair 0 -Demolition 0
Address Tel. Garaue 4251
City Zip State
I I 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 OATE
OWNER -BUILDER DECLARATION
I hereby affiryn that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Busfness and Professions Code: Any city or county which requires a
Permit to Construct, after, inwrove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Sectiow 7000) of
Divistan 3 of the Business and Professions Code, or. that. he is exempt therefrom, and the basis
for the alleged exerriiiia". Any violation of Section 7031.5 by any applicant for a permit
sWects the appkant to a chdpenatly ofnof more than five hundred dollars (S500).
0 1, 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, Suisness and
Professions Code: 7he Contractor's License Law does not apply to an owner of property who
builds or improves thereon mid who does such work himself or through his own employees,
provided that such kriprovements; are not intended or offered for safe. If, however, the building
or improvement is sold withfin one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
0 1, 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 contractorfs) licensed pursuant to the Contractor's License Law.)
0 1 am exempt under Sec -B. & P.C. for this reason
Date -Owner
WORKERS' COMPENSATION DECLARATION
Worklehereby affirm that I have a certificate of consent to self -insure, or a certificate of
r's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy NO�Company
0 Copy is filed with the city. 11 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATION INSURANCE
(This section need not be completed ff the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thp work for which this permit is issued, I shall not
employ any =n in any manner so as to become subject to the Workers' Compensation
Laws of Cali
Date -owner
NOTICE TO APPLICANT. If. after making this Certificate of Exemption you should become
subject to the ftrkers' 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 Nam
Lenders Address
This is a buildin permit when properly filled out signed and validated, and is subject to
if
expiration work I ereunder is suspended for 180 d�ys.
I cer lify that I have readthis 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 Add
city, State, Zi
Iwo'od fenc . e 6' X 170'
Estimatea valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
I AMOUNT
12-14
to CASH I IMAL. I _y J-66 . S -2
ZONE:—BY:
Minimum Setback Distances:
—Feont
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:
12/29/88
—Date—Permit
Validated by:
Validatiorr--
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. @ $
UNITS
YARD SPKLR SYSTEM
2ND FL. FT. @
SETBACK
&GROUND PLUMBING UNDERGROUND
-SO.
MOBILEHOME SVC.
BAR SINK
POR. SO. Fr. @
BONDING
HEATING (ROUGH)
STORAGETANK
POWER OUTLET
ROOF DRAINS
GAR. SO. Fr. @
ROCK STORAGE
FOUND. REINF.
GAS(ROUGH)
METER LOOP
DRAINAGE PIPING
CAR P. SO. FT. @
REINF. STEEL
GAS (FINAL)
TEMP. POLE
DRINKING FOUNTAIN.
WALL SQ. FT. @
WATER HEATER
SERVICE
FINAL INSP.
URINAL
SO. Fr. @
GRADING
cu. yd.
$ -Plus-X$
ESTIMATED CONSTRUCTION VALUATION $
LUMBER GR.
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIREPLACE
IKITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATERCLOSET�
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT.FEE
SMIFEE PLUMB.FEE
STRUCTURE
PLUMBING
ELECTRICAL
HEATING & AIR COND.
SOLAR
SETBACK
&GROUND PLUMBING UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGETANK
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.
FRAMING
FINAL INSP.
ROOFING
REMARKS: -
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
611THING
MESH
FINISH GRADING
'dlN�L INSPECTION
CERT. OCC.
FENCE FINAL
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
SCHOOL FACILITY FEES
TO: City of La Qu�iinta
Department of CommuAity beve,l;opment
& rt " . 0 .- 1
78-105 Calle Esta 0 -
La Quinta, CA 92253
DATE:
S -1-A ;a)t'
This is to certify that S;Ti -:7�4)
developeF'of which is
located at within
this District, has paid school facility fees imposed pursuant to the
authority generat ly G
�er/n 5 8 0--iAl t
.4"ent ocle Section 30 he amount of
$
L f
covering a total of s uar fee o residential or
( ) industrial/commercial development that building permits for
this foot in this development may ow
,Age ed by your juris iction.
f
fffrYiSO� SRDS-UNIFIED SCHOOL DISTRICT
White - Building Department 0 Yellow - Facilities Planning 0 Pink - Accounting 0 Gold - Developer
(10)-37
-V� -VK� -5, 4%;
RECEIPT NO. - "A Y\A _2_
Issued _B)(. D�te
DISTRICT: 0 Riversift. Indio 0 Hemet 0 Perris 0 -Rancho-Calif. 0 Bly . I h e
DOH SAN 122 (Rev.'5/88) DISTRIBUT16N: WHITE - Office file YELLOW - Applicant PINK� Bldg. Dept� GOLDENROD - Plans/Records
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel 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 checklist
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 FROMAUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'*
z
0
Agent Contractor, Contact Person
r"C) d
Phone Address & Phone
sz-a -40*4)
U.1
V)
Owner
Phone Mailing Address
, --I'V7' e
city
P.44oi(,
State
Zip
Job Property Add -
X4
U�ription Prop._(PM7TiWI:bt)----
=71
5pet
0-4-
rz z/..*z,,
SV fV so LOT 0
/90 440e 3//
Lot Size
Water Agency/Well
Use of Permh P/P, CU, etc.
,a 0 4PJ .4 r 49 4,-,
471.5,v-,4, x q_ -p 7-�-
Dwelling, MH Site Prep, etc.
'�L Signature of Applicant
CATE - GORY\ REVCODE E,
CATEGORY: REV CODE' FEE
,O-ISUBSURFACE DISPOSAL 123W8 .00
0 SITE EVALUATION UPON REQUEST 7�49 $42.00
11 MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
z
LAND DIVISION
0 SEWER/SEPTIC VERIFICATION 7348 $11.00
0
a. .1 at 4 Parcels (Each) 1238 $45.00
(Less than 1 year)
b. Each Parcel after 4 7344 $16.00
0 PRELIMINARY ELECTIVE 7352 $45.00
LU
0 Rereview (2nd review same parcel) 7344 $16.00
EVALUATION (Attach DOH SAN 53)
(0-
0 Site Evaluation In Conjunction with
0 HOLDING TANK 7351 $45.00
Critical Area 7346 $86.00
ALTERNATIVEJEXPERIMENTAL 7345 $13ZOO
0 Site Evaluation Lot Less than \
SYSTEM
10,000 Sq. Ft. 7347 $86.00
N
DATEi
_� t ,
Holding Tank Agreements Completed 0 Yes No
Certification of Existing S.D. System Required 0 Yes No Jr
WQCB Clearance required. (Attach Form 0 Yes No
-
DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required. 0 Yds No
Special Fwslbillty Boring Report Required. 0 Yes No
Detailed Contour Plot Plans Required (1 to 5 fl. interval) 0 Yes No
Other 13 Yes No
Staff Specialist Lot Inspection Requifed 0 Yes No
Lot Inspection Date
Soils boring report by' Project Date
Soils Map Page Soil Type Approved by Date
0
No. of Systems
Type of System(s)
No. Dwelling Units
(1) Septic Tank
Soil Rats
"a
Grease nd
z
0
0 Holding Tank 0 Existing
1P Now 0 Replacement
Bedrooms, Fixture Units
L
_)Gal
LA I /4t
r
Gre= Int P
t
\A rQQ-- MON(
ko C)L
-,%a
t
-Gal
U.1
(2) Leach Line Sq. Ft
Bottom trer/,c area
Sidewavailowance
ft. r6ck/ - Sq. It.
running ft.
Install — Une(s) It. long wide with
min. — iriches rock Wj�dralnlines or
Leach Bed tL
Of
0 NA
Leachlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
Sepiafp�itifbtal Depth
Other.
Applicable
0
Inlet (131)
N/A — Overburden t,�
5 EX6
t
Max. Allowable Depth
No. 2 System
_Ck
REMARKS: r_� I "_7 Ck 1 -1 kc, -1
This application is rAEP_��/DENIED for the category checked in SECTION B above, regarding the design
of a subsurface disposal system as indicated
on the accompanied plot plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
z
0
arwdesigned system. No construction is permitted in the required reserved 100% expansion area
.. :; —
(1�, Septic tank and sewer lines must be 50' minimum from any wells
0
Leach lines must be 100' minimum from any" wells, inclIng expansion area
Seepage Pits must I?e 50' minimu d-hy wells, including expansion ai�ea 0
L.)CN
Signature of Heaft CU�-
h Official te
RECEIPT NO. - "A Y\A _2_
Issued _B)(. D�te
DISTRICT: 0 Riversift. Indio 0 Hemet 0 Perris 0 -Rancho-Calif. 0 Bly . I h e
DOH SAN 122 (Rev.'5/88) DISTRIBUT16N: WHITE - Office file YELLOW - Applicant PINK� Bldg. Dept� GOLDENROD - Plans/Records
Of
Of FICE OF E. -LEON SPAUGY
AGRICULTURAL CONIMISSIONER
JAMES 0 WACLACE'
-b ANLY 'A5VStA.N1'r')MM1SSjt)%tR .
0 NT BEN
V CLEM.E. 'VENISIE'
WEIGI-ITS & MEASURES
4 -613. Hwy 86, Suite B-42.
9
Toachella, CA 92236
619-342-8291
DATE CASE.M.. 1 2
VCZ r,-,
DEVELOPER'S NAMEr.
ADDRESSt �Q cx t. T, 7-
Y(Z
P -44M C. 9z,
TELEPIMS 440
War Developert.
After reviewing y9ur1andscaping. plans,, all plant mterial listed is not in
violation:of quarantine laws' govern ifig , ti te. Coache lla. Valley. if substitutions
do occur and they differ frun plant material listed. this office toust be. notified
imm-diately.
Thank you for pr . otecting, and.preservi-fig the Coachella Val-ley's pest -free envirormpen t
Agricultural Cotnaissi ier's office
cci Indio and Riverside office
4
J!"P. A C
3,0/_
6) Z_ al
4
.3 Pl