04868 (SFD)11
Building i'46-335 Jeffers;
Address
Owner ,Mr. Mrs. Morris
Mailing
Address Same a
City Zip Tel.
La Quinta 922x3 1_
Contractor
Wright Development Ina. _
Address -
34-400 ;Gate Pain St., ¢ Sui4n .11 _
City Zip Tel.
Cathedral Citi 92234 '� 328-_80.9.-�'
ate Lic. City
&tCla sif. , $00176 Lic. # 1264
•4 4 "
2
P.O. BOX 1504
�� a 78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253.
Designer f
Address
City I Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that�ltam 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. r.✓ /fi{ia, C ..{� J 1 �rr +i;
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,Business 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 file a signed statement that he is licensed pursuant to
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
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
O 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 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 -budder 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 contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
s
WORKERS' COMPENSATION DECLARATION !`r
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
j Worker's Compensation Insurance, or a certified copy.thereof.:(Sec.`3fi00, labor Code. r
Policy No. - I.Company,
01 Copy is filed with the city. 0 Certified copy is hereby furnished.t, Y `
t rW - i
r 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, 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, Civil Code.)
Lender's Name-
Lender's
ame
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 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
11LDING: TYPE CONST. OCC. GRP.
P. Number 617-121-017
gal Description
oject Description •
04868
GV r4 C. DT:_
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Sq. Ft. 135
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Issued by:
Date Permit
Validated by:
Validation:
Estimated Valuation
$102,629,
PERMIT
y1
AMOUNT
Plan Chk. Dep.2t2
•�
Plan Chk. Bal.
Const.
O •5t,f
Mech.
46 , U
Electrical
U I .9Y3
Plumbing
IU3.00
S.M.I.
7. id
Grading
2U.00
Driveway Enc.
20.UU
Infrastructure
2 2 %9 .2!i
Irxxnge-°xoecx
Lzard Yee
x ul.10
4b6 .19
TOTAL
.w zg,,%?3K
GV r4 C. DT:_
Minimum Setback Distances:
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
NSPECT R,
��t%
Issued by:
Date Permit
Validated by:
Validation:
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT ip S
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE
Y
SPKLR SYSTEM
2ND FL SO FT. aARD
BONDING
HEATING (ROUGH)
MOBILEHOME SVC
BAR SINK'
POR SO FT. at
SEWER OR SEPTIC TANK
ROUGH WIRING
GAR SO. FT. Qr
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
DRAINAGE PIPING
CAR P. SO FT. Cr
HEATING (FINAL)
WALL SO FT. @
REINF. STEEL
DRINKING FOUNTAIN
SO. FT. a
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION S
WATER PIPING
NOTE, Not to be used as property tax valuation
WATER HEATER
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTONDISH)
APPLIANCE DRYER
IGARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LUMBER GR.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FRAMING
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT. B.T.U.
SO. FT. RESID g I Y. c
SEWAGE DISPOSAL
SO.FT.GAR rg >r.c
HOUSE SEWER
SPARK ARRESTOR
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE IPL.CK.PEE
CONST FEE !ELECT.FEE
SMI FEE 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)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
$ plus x$
=S
LUMBER GR.
FINAL INSP
FRAMING
FINAL INSPG L.�
/T/ f
ROOFING
� �
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 1 r1 2�
MESH
INSULATION/SOUND 3 PI
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
7d
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
SCHOOL FACILITY FEES
NOTICE: THIS DOCUMENT CANNOT
T0: LC�ty '2'SgCvftnt D, DATE:
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
( li
Lrl
402
g
This is to Fert.ify that / '1`' . ,
developer of which is
located at - within
this District, has paid cho facility fees imposed pursuant o the
authority generated by G v nment Code 9ntion 5 80 in t am n of � e,
co ering a total of square feet of a n t i a 1 or
( ) industrial/comm rcial development and that building permits for
this footage in this development may now issued by your jurisdiction.
DE RT SANDS.UNIFIED SCHOOL DISTRICT
White - Building eparttment • Yellow - Facilities Planning • Pink - Accounting • old - Developer
�/��- (10)-37
_ .'e^r: '/g-r.5�'-sss''e' _ETM.�-:i�`�'SR"Y'a1y'i�,�cc�"�'.�.7*.ei�r�..�+:s �iT'`•wr':'�!�."�.-�g-.''�'w.1'�.k_'.yi�.'�"�.`r:3'7uy�7a..1�'r.""�+ S'�7+Y"•`^�iy 3�'-$F,:B�it' '�1�,""s....`.i.`�•�.:
t
`
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 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.
Q
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'*
Z
Q
A
t Contractor, Contact Person
G-oA
Phone
Address & Phone
v
I too C.
w
Owner
Phone
Mailing Address
M f.i, norizi S
f
City
to
Zip
J b Props Address Legal Description Prop. (PM, Tract )
LJ
_&4A1 reQCT
Lot Size
a
Af
Use of Permit P/P, CU, etc. - uI Other 10,
�%021,b
�teJr ,nc
/Q
19.welling,
a&LL
W w
t i•Y . W
H Site Prep, etc.
•
O
lo 4 71 z
Signature of AppliceAt
CATEGORY: ,.. - REV CODE FEE
CATEGORY: REV CODE -'-'-.'FEE
o.
SUBSURFACE DISPOSAL 1238 $�45
❑ SITE EVALUATION UPON REQUEST 7349 $42.00
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
Z
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
p
a. 1 at 4 Parcels (Each) 1238 $45.00
(Less than 1 year)
H.
b. Each Parcel after 4 7344 $16.00
❑ PRELIMINARY ELECTIVE 7352 $45.00
W
❑ 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
10,000 Sq. Ft. 7347 $86.00
�,► NfTI DATE
Holding Tank Agreements Completed ❑ Yes No 10-31M
0'
_
Certification of Existing S.D. System Required ❑ Yes �;Nol
WOCB Clearance required. (Attach Form ❑ Yes
IDOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required. ❑ Yes
Special Feasibility Boring Report Required. ❑ Yes
Detailed Contour Plot Plans Required (1 to 5 R interval) ❑ YesNo
Other ' _ ❑ Yes
Staff Specialist Lot Inspection Required ❑ Yes No
Lot Inspection Date
Soils boring report by' Date
�%Prroject'#
Solis Map Page Soil TypeC rl_ Q V Approved by �!�t//�-_ Date
0
No. of Systems
of Systems)
No. Dwelling Units
(1) Septic Tank
Soil Rate
ee
e/Sand
GreasIntop
❑ :Zing Tank ❑Existing
❑ Replacement
Bedrooms Fb¢neMnits
U
36,6 ,1c /ki4ftGal
�
-2
COUne
Sq. Ft
(2) Leat trench area
ttom
Sidewail allowance
Lire it." -=Z--ft wide with
Install //
Lea�Bedsq.fft
R rock/ sq. R
3/
min. � inches rock below drainlines-or
p�
per running it 19/NA
'
L eachlines/bed special design for slope:
(3) Pit DiameterNo.
Pita
Pit Below
See page PR Total Depth
Other.
Applicable
I let (BI)
N/AOverburden factor
❑ 5 @-_,6\
Max. Allo Ie.Depth
No. 2 System
QN/
REMARKS %Y If
�- _ i��! HO�.� C%Or,< • fig a.t/�Gl
0
TAris application i PROVE 6r the category c k d in ECTION above, regardin the de ' n f subsurface disposal system as indicated
on the accompan, plot plan, using the requirements t forth in SECTION C above. A building permit is necessary for the installation of the
-designed
' 0
above system. No construction is permitted in the required reserved 1 expansion area.
`1,,, Septic tank and sewer lines must be 50' minimum from any wells / f
LLI
2 Leach lines must be 100' minimum from any wells, Including expansio rea'
_ ..
(3) Seepage pits must be 1500'' jminimum �fronl)an�y wells, includina.expans n.
/
r
p�
Signature of Health Official � J t W..C�G✓yv"c+� �j � �0Date
RECEIPT NO. Issued By�f c l 2: Date !
DISTRICT:: O Riverside; Rf Indio ❑ Hemet ❑ Perris ❑ . Rancho Calif. ❑. Blythe
�•'`'' DOH SAN 122.(ReV: 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant' PINK - Bldg. Dept GOLDENROD - Plans/Records
,. ,. _:: x�_-.'4. �,,.'�.,r: "'< �, fi_L4-�+�:' .ic.c:`...3. _. _':.-, r_e -",:, ��, .,..._. _...";' ,a 1 :... .., __ ..<_� ._. � .. � .. ,. n. ... .✓ _a:^>.i-. _ ... .... .. ... .. _...
/90
L
RM
Building
Address y
Owner
M �.
Mailing
Address
City,
*ht T 4
{APPLICATION ONLY
!. P.O. BOX 1504 '
7&105 CALLE ESTADO
2S0 A,, LA QUINTA,'CALIFORNIA 92253
BUILDING: TYPE CONST. OCC. GRP.
t 1 /
A.P. Number 0/7
r� Zip ` ` Tel.
Legal Description
I Ile Al . �l Project Description / !�
City Zip f VTeC97.3State Lic. & Classif. /�
Arch., Engr.,
Designer
Address Tel.
City IZip _ IState I
Lic. # '
1 hereby affirm that I amflicensed7under provisions of Chapter 9 (g6'mmencing with Section
7000) of Division 3/of theBu sine$a and Professions G�odeyand.my'license is in full force and
effect. i / l Y) � • % /; _ //� 1P_ 9- 2 f.
VAIN •�VILV Cr1-V CVLMRNIIVn�
I hereby affirm that I arrexempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business 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 81e a signed. statement that he is licensed pursuant to
the provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the of,
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).
❑ 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 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 proving that he did not build or improve for the purpose of sale.)
O 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.)
❑ I 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
❑ 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 the work for which this permit is issued, I shall not
employ anyperson 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
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.)
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 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
BUILDING DIVISION
Sq. Ft.
Size
New ❑
imated Valu
No.
Stories
No. Dw.
Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
- PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
005182 10 2?63 a -v
JO t FI` Il i I U I HL 1i�L . Vv
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:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
GROUND PLUMBING
NO.
ELECTRICAL FEES
COLL. AREA
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
co
HEATING (ROUGH)
UNITS
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
2ND FL. SQ. FT.
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
YARD SPKLR SYSTEM
POR. SQ. FT. ®
GAS (FINAL)
TEMP. POLE
MOBILEHOME SVC.
GROUT
BAR SINK
GAR. L SQ. FT. ®
f— U
POWER OUTLET
WATER SYSTEM
ROOF DRAINS
CAR P. SQ. FT. ®
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
DRAINAGE PIPING
n� b
n '�11
REMARKS:
DRINKING
WALL SQ. FT.®
/V V
FIRE ZONE ROOFING
FOUNTAIN
SO. FT. @
SPARK ARRESTOR
URINAL
ESTIMATED CONSTRUCTION VALUATION $10,2
GAR. FIREWALL
LATHING
WATER PIPING
NOTE: Not to be used as property tax valuation
INSULATION/SOUND
FLOOR DRAIN
MECHANICAL FEES
FINISH GRADING
WATER SOFTENER
VENT SYSTEM FAN EVAP.00OL HOOD
CERT. OCC.
SIGN
FENCE FINAL
WASHER(AUTO)(DISH)
APPLIANCE DRYER
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
IKITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
Q
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.�GJ
SQ. FT. RESID ® 11A c
Ilk
�7j
SEWAGE DISPOSAL
L L
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
/0
�-
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE
PL.CK.FEE
CONST. FEE
ELECT. FEE
SMI FEE PLUMB. FEE
/03
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB 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 APP.IEQUIP.
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
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL