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05738 (SFD)P.O. BOX 1504 Building 51_860 A'VMDA DIAZ78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Mailing Address P.O. BOX 59 City LA QUINTA 21992253 Contractor GENETAL CONMCT HANAGM I Address I State Lic. City & Classif. 524325 Lic. # 2235 Arch., Engr., Designer Address Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 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 tie 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 or Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penally or not more than fore hundred dollars (S500). ❑ 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 !milds 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. ff, however, the building or improvement is said within one year or completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose or 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 or property who builds or improves thereon, and who contracts for such projects with a contractor(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 ❑ Copy is filed with the city. O Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed it 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 N017CE TO APPLICANT: ff, 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, Ciel 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 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 No. BUILDING: TYPE CONST. OCC. GRP. A:P. Number 773'-I61-006 Legal Description Project Description SM 05738 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 I� $rEy� rQq Issued by: —Date—Permit f Permit Validated by: Validation: Sq. Ft. 1387 Size No. Stories No. Dw. Units New X Add ❑ Alter ❑ Repair ❑ Demolition ❑ GARAGE 430 SQUMI ii FELT no POOL Estimated Valuation $78.756.00 PERMIT AMOUNT Plan Chk. Dep. 250.00 Plan Chk. Bal. •'� Const. 547 • Mech. 3.4 •'IV Electrical k a • 2 Plumbing •3 S. M.I. • 53 Grading 20M Driveway Enc. zoluo Infrastructure 3. 7 TOTAL REMARKS srid• 4 tiii ilii x t YC>+1 tet« 1t►. ts;t r . , �� 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 I� $rEy� rQq Issued by: —Date—Permit f Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS COLL. AREA LAB GRADE — YARD SPKLR SYSTEM 2ND FL. SQ. FT. @ HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR. SO. FT. ® DUCT WORK ROCK STORAGE FOUND. REINF. POWER OUTLET ROOF DRAINS GAR. SQ. FT. ® HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL DRAINAGE PIPING CAR P. I SQ. FT. ® WALL SQ. FT. ® DRINKING FOUNTAIN. SERVICE FINAL INSP. URINAL SQ FT ® WATER SYSTEM ESTIMATED CONSTRUCTION VALUATION $ GRADING cu. yd. $ plus x$ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER REMARKS: 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. SO. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1% c SEWAGE DISPOSAL MESH SQ.FT.GAR ® V4c HOUSE SEWER /� INSULATION/SOUND i" 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 O �FTBACK GROUND PLUM UNDERGROUND A.C. UNIT COLL. AREA LAB GRADE — ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS R 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. FRAMING FINAL INSP. r OOFING72 —a57f / / Q� 111999 D ' REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH /� INSULATION/SOUND i" FINISH GRADING FINAL INSPECTION -,�/.J"\ CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL P.O. BOX 1504 APPLICATION ONLY Building/. w 7&105 CALLE ESTADO Address S1- � � hCA.r JA hI-' LA QUINTA, CALIFORNIA 92253 &1411 BUILDING: TYPE CONST. OCC. GRP. Mailing Address �� A.P. Number Legal Description Project Description City CA Pye.f�.T� Zip 9 �a Tel. ��, � Contractor orlrr4 r� -7- Address Address Cir L Zip 11911?2 Tel. � S�SY/ State Lic. City & Classif. S"Z�i 3Z S Lic. # /23 5 Sq. Ft. Size `5 a r7 No. No. Dw. Stories Units Arch., Engr., Designer New P,` Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City " Zip State Lic. # 40 Q,,7d LICENSED CONTRACTOR'S DECLARATION hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of tension 3 of the Business and Professions Code, and my license is in full force and effect - 6MAUHW N DATE OWNEWBU LDER D CLARATION 1 hereby affiryn that 1 am exempt from the Contractors License Law for the following reasorr (Sec. 7031.5.81 siness and Professions Code: Any city or county which requires a pear* 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 vwawn of Section 7031.5 by 'any applicant for a permit sects the applicant to a cnvt penally 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 drat such inprovoments aro not intended or offered for sale. ff. however, the building orimprovement is sold wild one year of completion, the owner -builder wig have the burden Of proving that he did not hind or improve for the purpose of safe.) ❑ 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 bnproves thereon, and who contracts for such projects with a contactor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec B. & P.C. for this reason Estimated Valuation 78i, 7 `J PERMIT AMOUNT Plan Chk. Dep. "' D Plan Chk. Bal. Z 4 Z� Const. 'Mech. - Q Electrical /07, 2. Plumbing , Qj S.M.I. S , s Grading Z.D ov Driveway Enc.. � DD Date owner Infrastructure > a ID1,411 -2- WORKERS' COMPENSATION DECLARATION hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of Workers Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.) Policy No Company O Copy is filed with the city. ❑ ,Certified copy is hereby furnished. TOTAL -Z_ 7 — 0 o REMARKS nn 7 _ < YY A-) hh 1 t,A 'TOT i 275.00 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (rids section need not be completed ff 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 anyp{�eers Calrf �rnion in arty manner so as to become subject to the Workers' Compensation Laws of a Date Owner N017CE TO APPLICANT: g, after making this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith conpry orate such provisions or this permit shall 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 1 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.) Side Setback from Property Line Lenders Name FINAL DATE Issued by: Validated by: INSPECTOR Date Permit Lenders Address This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. 1 certify that I have ream this application and state that the above information is correct. 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. Signature of applicant— Date Mailing Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. ® $416 UNITS SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK Y ARD SPKLR XSTEM 2ND FL.. SO. FT. ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. - Zd MOBILEHOME SVC. METER LOOP BAR SINK POR. SO. FT. ® REINF. STEEL GAS (FINAL) TEMP. POLE t4 POWER OUTLET GROUT ROOF DRAINS GAR. SO. FT. ® FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ DRAINAGE PIPING CAR P. SO. FT. FINAL INSP. FRAMING WALL SO. FT. r ROOFING DRINKING FOUNTAIN REMARKS: URINAL SO. FT. ® ESTIMATED CONSTRUCTION VALUATION $ FIRE ZONE ROOFING WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES SPARK ARRESTOR WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM FINISH GRADING KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE,TEMIPERM CERT. OCC. LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB GARDEN WALL FINAL SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c L! 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 to ?. t 04 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./EOUIP. 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 INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL Desert Sands Unified School District CERTIFICATION OF PAYMENT OF �'�'���: THIS �+,®�� rR.� - ,O 'L tF�C LITY FEES BE DUPLICATED, TO: City of La Quinta DATE; Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 This is to ertif that YV1J��V developer of-ftVWUJ1L1 A-2 located at — this District, has paid school facility fee au�hority enera d by overnmen C de Sect s covering a total of square ( ) industrial/commercial development and this footage in this development may now be (4104 RA 4jam G— 10— q 4b. ( MOQtJ l -lwi[0a*AAA, whike'h is within imposed pursuant to the oil3080 i7M/ n he amount pf , feet of ( ) residential or that building permits for issued by your jurisdiction. /A 0 phm 0 - ekgmt it for DESERT SANDS UNIFIED SCHOOL DISTRICT White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer (10)-37 t, Z4 A l:'-;;'ia. l;�$'R,t;•jf '�..'''4#�,=��;:;,(_...:-�(`f�$.,rr`;yh„-',"i�y1},'.,r'`.�j'�,=cw;:: :'; COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Asses'°'' 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. VERIFY ITEMS IN SECTION A FROM BUILDING 6 SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG' �Pent, Contractor, Contact Person Address 8 Phone rr-I rPhone �1 - Owner Phone Mailing Address .o •aPdS �i1-Ci'4vir7A cit �y State Zip Job Property Address Description Prop. (PM, Tract, Lot) //JJ r N e� ;�_ 7 al©ck 33 a,✓rA ( 1A14[ Lot Size ter Agenc Use of Plermh P/P, CU; etc. Other F• `�� Dwelling, MH Site Prep, etc. Q / ui#rJ�- l`n A -U �. Date Signature of nt -------------- CATEGORY: REV CODE .FEE- - CATEGORY: REV CODE FEE SUBSURFACE DISPOSAL 1238 ° $45.00 ❑ SITE EVALUATION UPON REQUEST 7349 $42.00 ❑ MULTIPLE PARCELS WITHIN SAME C S (NO PLOT PLAN) , LAND DMSION ❑ SEWER/SEPTIC VERIFICATION 7348 $11.00 a. 1 at 4 Parcels (Each) 1238 $45.00 (Less than 1 year) 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) ❑ She 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 INIT/� D�1 Holding Tank Agreements Completed ❑Yes Certification of Existing S.D. System Required ❑ Yes WQCB Clearance required. (Attach Form ❑ Yes No DOH SAN 007, Santa Ana Region Only) / Sella Percolation Report Required. ❑ Yes Special Feasibility Boring Report Required. ❑ Yes Detailed Contour Pk1t Plans Required (1 to 5 R interval) ❑ Yes Outer ❑ Yes I Staff Specialist Lot Inspection Required ❑ Yes " No Lot Inspection Date Soils boring report by Date Soils Map Page SOA Type ` dc�" Approved by `�'Date -- . IO No. of Systems T of Systeme) No. Dwelling Unita f (1) Septic Tank Soil Rate Grease/Sand Holding Tank ❑ Existing J'Nevv ❑ Replacement Bedrooms, Wb"�_ a Q J 'Grease Intcp -1, G� O Gf �(2 Leach Line Sq. Ft Sidewall allowance Install Une(s) R long ft0 r 4,2k / Bed sq. n trench areaft. rock/ sq. ft. s min. irrcF�es foe( below drainlines or per runningft Leachlines/bed special design for slope: (3) Pit Diameter No. Pita Pit Below Seepage Pit T (r Depth Other, Applicable A - l ( &f Inlet (BI,) / 1" \ N/A teas" Overburden factors 6 j o Max. Alio IerDepth No. 2 System fI A REMARKS : , lee) ,..tet. P770 This application i APPR06VED NIEfl for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompanre plot plan, 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. � y i© Septic tank and sewer lines must be 5o' minimum from any well Zk7 (2 Leach lines must be 100' minimum from any wells, including expansion rea Seepage pits must 150' minimumtr m any wells, including expansion arear//O W P u Signature of Health Official J/ Date ( v4C_ p"Fr^ r-r� is u f 119 Y RECEIPT NO. ` / 9 Yee// / Issued By— Date DISTRICT: ❑ Riverside, lD lndi0 ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe DOH SAN 122 (Rev. 5/88), DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records .01 0 77V U1 nu or A0111CUL I URAL CUNIMISSI011M AN L) 1VIAGI I IS 1ALASUIIES 49-613 Ilwy 116,` Ilulte 11-12 'Cvnche l lll, CA 9223G . 61 Y-342-0191 j)vF'wl'1At15IW'1E1 ►�l/t ,ct A,JQ r"+E'�' NJURESS 1 ' ,m%L1111014Ct � ! F8� ��t N :�� � � AZ h.�. Com..-�-.�•/�,� Dear Developed E. EE014 SPAUGY )AMES U WALVACE A%5151^1 1'N%111110-411 CLEME;II ef.WENISIE sc�un After reviewing your lamiscftllbiq 111611s, fill 111fUit InAerial listed is clot 1.11 violatlull or- yuara11t111e lows tluvet1li11g the tutichella Valley. if substRutlms do occur alld they differ [tu11 111011t aVIterial .listed, this office must be Notified iuuledlately. Thmik you for pltotectilly and 1►ieserviny the Coachella Valley's test -free emituivient. n Agr ce cc# audio Fuld Riverside Ottice 7