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08873 (SFD)ARROW PRINTING. INDIO. CA. 2900 3/90 277081 -CI T4t!t 4 P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 51-400 Diaz LA QUINTA, CALIFORNIA 92253 Owner Mailing Address P.O. Box 366 City Zip Tel. La Quinta 1 92253 1 564-4832 Contractor Address Tel. State Lic. City 8. Classif. 487584 B1 Lic. # 626 Arch., Engr., Designer Address Tel. City I 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 effect. 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, alter, improve, 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 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). ❑ 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, 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.) ❑ 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.) 0 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION Ihereby 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 any person in any manner so as to become subject to the Workers' Compensation Laws of California. I 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 i expiration if work thereunder is suspended for 180 days. I 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. i Signature of applicant Date Mailing Address City, State, Zip I 39Z,;� ee, No. 08873 BUILDING: TYPE CONST. OCC. GRP. A.P. Number 773-044-012 & 013 Legal Description Project Description Parcel Merger Sq. Ft. 2486 Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation 140 606.80 PERMIT AMOUNT Plan Chk. Dep. 250.00 Infrastructure Del Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure 1509.62 - 509.62- Arts in Public 1 1 1. TOTAL 1509.62 1259.62 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 \ffine FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: 4 4 QN&Z P.O. BOX 1504 APPLICATION ONLY Building%—�/_ /�7t 78-105 CALLE ESTADO Address ✓ (/(/ LA QUINTA, CALIFORNIA 92253 Owner I S/s/cdr Address /_/6 /&/ rX s4r-) City Zip Tel. Address Zip State Lic. � City & Classif` � / �% Lic. # a Arch., Engr., Designer Address Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under rm��provisions of Chapter 9 (commencing wiyr Sectio e110D) of ivisi n of the Business and < hs Code, my license i f If force d /c-cL�. SIGNATUREA E OWNEWBUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason_ (Sec. 7031.5,8usirass 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 rile 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 cha7 penally of not more than rive hundred dollars ($500). ❑ 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, Bulsness 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 orimprovement is said 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.) ❑ 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 contraclor(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 1 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 N the permit is for one hundred dollars ($100) valuation or less.) I certify tha in the performance of thg work for which this permit is issued, I shall not employ anyn in any manner so as to become subject to the Workers' Compensation Laws of Cali a � ,1_ Date Owner , N077C - TO APPLICANT: B, alter making this Certificate of Exemption you should become suthjet 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 1 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 11LDING: TYPE CONST. 00C. GRP./ P. Number Description t Description Sq. Ft. il,[��%� No. No. Dw. Size o� /—Q Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ ` V ' 3timated Valuation/O `Y ((J (p _ VO PERMIT AMOUNT Plan Chk. Dep. r - Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. ipftfistructure 9-6 2_ Sr /-)nr Po c L 0/1 hie TOTAL REMARKS f A N � f1T t _ — V��s nniv 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 NO. PLUMBING FEES IST FL. SQ. FT. ® $ 8O UNITS BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK YARD SPKLR SYSTEM FOUND. REINF. 2ND FL. SQ. FT. ® METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE pLL Sp O MOBILEHOME SVC. GROUT BAR SINK SERVICE FOR. SQ. FT. ® BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ GAR. SQ. FT. ® LUMBER GR. POWER OUTLET FINAL INSP. ROOF DRAINS FINAL INSP. ROOFING DRAINAGE PIPING REMARKS: CARP. SQ. FT. VENTILATION WALL SQ. FT. ® ' FIREPLACE DRINKING FOUNTAIN SPARK ARRESTOR URINAL GAR. FIREWALL SQ. FT. ® LATHING ESTIMATED CONSTRUCTION VALUATION $ MESH WATER PIPING NOTE: Not to be used as property tax valuation FINISH GRADING FLOOR DRAIN MECHANICAL FEES CERT. OCC. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN INSPECTOR'S SIGNATURES/INITIALS WASHER(AUTO)(DISH) 2 �� APPLIANCE DRYER GARDEN WALL FINAL GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED /' LAUNDRY TRAY AIR HANDLING UNIT CFM KITCHEN SINK 2 �' 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 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1+/. c 9701SEWAGE DISPOSAL SQ.FT.GAR ® 3/.c 8 HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE / DBL TOTAL FEES MICRO FEE ECCHHH.FE�E/f� PI„GJ( EE CONST. FEE ELECT. FEE SMI FEE 1!5 /PLUMB. /FFEEEE 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./EQUIP. 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 SIGNATURES/INITIALS GARDEN WALL FINAL pppp�OUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Ass"tmftraMNM l ENVIRONMENTAL SERVICES DIVISION 773 _©-elv -0-'-- X13 PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM Applicant: Submit tttis form with four copies of a sceled plot pian (1-20 scale) drawn to County speculations as indicated on the attached check list E00J39A non-re%r h6re%ing fee (see below) is required when the application is submitted. Check must be made payable to the County of .' tverside�,Approval o t is appUcatKxrl shall remain valid for a penod not to exceed one year from date of approval. Q R�{I caq oiCO �Cetrv� �� ERIF�Y ITEMS IN SEC•�T�IOryi A FROM BUILDING &SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG # � H /�A1ggent, Contractor, Contact Person Phone Address & Firm 0. .Y �f' `.I VzAloli z 76re?'> l!4 //te Owner Phone }Mailing Anddress UJ (n do st r Ar x 5 E j& I he / /(T� de'. /' ` S ^� I P • U'' J �� City State Zip Job Property Address �t� /i Ov 4e`9W °" (PM, y L )401r. 3 �• ,0S� • C. moi.//h•y�: . 00111- Lot r,>Lot Size ,,, tomer Agenc r- Use of Permit P/P, CU, etc—;A-4 Other 73/ V /(}O �� pwelling,,M Site Prep, c. Holding Tank Agreements Completed Certification of Existing S.D. System Required WOCB Clearance required. (Attach Form DOH SAN 007, Sella Ana Region Only) Solis Percolation Report Required. Special Feasibility Boring Report Required. Detailed Contour Plot Plans Required (1 to 5 R interval) nlMr Staff Specialist Lot Inspection Required ❑ Yes ❑ Yes ❑ Yes ❑ Yes ❑ Yes ❑ Yes ❑ Yes ❑ Yes jINITIAL �r� N/ �' ryo -- N�c)5 �Nq� IYfJO I Lot Inspection Date _ DATE I U Signature of Applicant Project Daps Soil Type Apprimed by /`"" `` Data Date No. of Systems TA CATEGORY: REV CODE FECf Soil Rate %Q -"Me CATEGORY: REV CODE FEE Holding Tank ❑ Existing New ❑ Replacement p�SUB$URFACE DISPOSAL 1238 Greaeeintcp d SITE EVALUATION UPON REOUEST 7349 $ 43.00 rD ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) Gil! LAND DMSION W 12�Leach L lrie Sq. Ft ❑ SEWER/SEPTIC VERIFICATION 7348 $ 17.00 Z 0 a. 1 at 4 Parcels (Each) 1238 $ 57.00 (Less than 1 year) per running R ❑� b. Each Parcel after 4 7344 $ 24.00 ❑ PRELIMINARY ELECTIVE 7352 $ 23.00 W ❑ Rereview (2nd review same parcel) 7344 $ 24.00 EVALUATION (Attach DOH SAN 53) 0) ❑ Site Evaluation in Conjunction with ❑ HOLDING TANK 7351 $ 47.00 Critical Area 7348 $111.00 ❑ ALTERNATIVE/EXPERIMENTAL 7345 $222.00 ❑ She Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $ 87.00 Holding Tank Agreements Completed Certification of Existing S.D. System Required WOCB Clearance required. (Attach Form DOH SAN 007, Sella Ana Region Only) Solis Percolation Report Required. Special Feasibility Boring Report Required. Detailed Contour Plot Plans Required (1 to 5 R interval) nlMr Staff Specialist Lot Inspection Required ❑ Yes ❑ Yes ❑ Yes ❑ Yes ❑ Yes ❑ Yes ❑ Yes ❑ Yes jINITIAL �r� N/ �' ryo -- N�c)5 �Nq� IYfJO I Lot Inspection Date _ DATE I U Solis boring report by Soils Map Page �' Project Daps Soil Type Apprimed by /`"" `` Data No. of Systems TA of Syatem(s) No. Dwelling Unite l rf (1) Septi: Tank Soil Rate %Q -"Me ZO ❑- Holding Tank ❑ Existing New ❑ Replacement Bedrooms, FixturwUnite-- J jJ1 �� Greaeeintcp 4/71441, ' Gil! W 12�Leach L lrie Sq. Ft Sidewell allowance Install—_— Line(s) ft long M wide with leach Bed aq. tt trench area R rock/ sq. R min. it rock below�or per running R ❑� L.eachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below (TD) Seepage Pit Tgtal�Dgpth AppliCabl6 Inlet (&) �,/ Max. Mlowabl Depth N/A Overburden factor OS u No. 2 System REMARKS: / r'(/! U T�i�application is PRO Efl/�ENI D' for the category chen SECTION B above, re aldi gLthe design of a subsurface disposal system as indicated on the accompanied pbfplan usi �e„retwremegts„set fodb.ira SEUQkL C..at a uildi 9,.�rmit is necessary' for the installation of the Z above designed system. No construction is permitted in the required reserved 100% expansion are .a1 (1) Septic tank and sewer lines must be 50' minimum from any wells t) L�% t.►- 4.��y 2j. Leach lines must be 100' minimum from any wells, including expansion rea W); (3) Seepage pits must be 150' minimum from any wells, including expans n area�10 ��`?✓ Cit!-. 15A Signature of Health Official RECEIPT.NO.. Issued By � Date DISTRICT: , ❑ Riverside, ❑Vindi`4 ❑ Hemet O Perris ❑ Rancho Calif. ❑ Blythe DOH -SAN -122 (Rev. 3/90) DISTRIBUTION:' WHITE - ORloe file YELLOW - Applicant PINK . Bldg. Dept GOLDENROD - Plans/Records 'le DESERT SANDS UNIFIED SCHOOL DISTRICT 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be Duplicated (619) 347-8631 Date 11/29/90 1 Type of Permit I La Quinta No. 110293 Permit # Log # Owner Name A & M Construction No. 51400 street Diaz City La Quinta zip 92253 Study Area 114 APN # 1773-044-012/011 Tract # I ILot # Square Footage 12486 Type of Development Single Family Residence No. of units 0 Comments 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: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.58 X ® or $ 3,927.88 have been paid to D.S.0 S.D. for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By A & M Construction Telephone Name on the check By Richard M. Beck Director, Facilities Planning & Development Fee collected /exempted by Shelley D. Bennett Signature //AAD AeA A Paymex"it Recseitvedx`. bc.v...o. Collector: Attach a copy of County or City plan check application form to Distinct cooFy- Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting X:'t C. , C-11% , t, lossid.—Ii:- V� ®rk"W" NIAll 141 Id A. Nflnt film" - or N. MAI 44"m-1 so P0 lw 1WHO �' � • �'�• •� a _ °r"„' "r” 1 t �t tits I jmsstijv�, silm"I IN/ i*'foeo • off 1*.*4 ml Is It Ira: MAIL1AX 6AA11MINP. lit cat" Pow—"Oft 04 4� TOM# fm 14004l, NOW! 0" !low's emm" &@a"# qat vwu-"oo t "rem MljA* VAL UAIII I C1IM.111i 40, -.00moi to WjRsy.:40 I T I HIS is$ Itiol I val P.61 fllo(qlpi ji laosiolij GIIAN I P4 too ,'•o' NIM hovol ow Coly off Io kill i Illo 0e) %I'llp oil fwa.lolml ft With '13-41"ll 14 400 111411.14 to, lit. -01 oil 111"ok Ill;*- ofP 1014,111 Ill is veto f6l11e j.!4111111 Kq 1fa•ti7 I 9e•'ti9;.�r.�.''rl;• l,.,t, _', f,,,,'•. 'i1. 64 3 a .hill."ION,'F;k1llloplF;; A Cal I I 4`41 1100'0,000 14 it.,' $TAIL OWN" at .4, set 'bfto ism, ft troltrOverod a 41.144 Ivpdt ql drift leiMn}" so 1,,o smijoinift,# ono, om low tomisis too — evmoft!!. 141 top 04p 14t"jW%1 M 4W4,1 I. �,0, IoM 4 vAhmov qnqt!o~ fi: Ai , Will Y o'. OFFICE OF ` V AGRICULTURAL COMMISSIONER O AND pit it• WEIGHTS & MEASURES `_'' CALVIN C. KAMINSKAS JAMES O. WALLACE 4080 LEMON STREET, ROOM 19 Asslslant Commisslonor Agricultural Commtssloner RIVERSIDE, CALIFORNIA 92501 CLEMENT BENVENISTE Dlrectm of Welghts & Measures Sealer (714) 787-2561 49613 Highway 86, Suite B12 Coachella, Ca. 92236 (619) 342-8291 DATE // /S — CASE NO. FSG K Slll 5 q 4 DEVEWPER' S NAME: co"-- S ADDRESS: TELEPHONE: �-� L/dam �v�.�, ,•�-s .O�'�� � Q Dear Developer: After reviewing your landscaping plans, all plant material listed is not in violation of quarantine laws governing the Coachella Valley. If substitutions do occur and they differ from plant material listed, this office must be notified immediately. Thank you for protecting and preserving the Coachella Valley's pest -free environment. Agricultural Carmissio er's Office cc: Indio and Riverside Office tce_�_Sj v��