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04555 (SFD)R � 4.4 " 04555 P.O. BOX 1504 Building"�� 78-105CALLEESTADO Address 54-080 'DiAz LA QUINTA, CALIFORNIA 92253 Owner Western ;Amorican Construction BUILDING: TYPE CONST. OCC. GRP. Mailin Address P. 0. Box x,379 r" 774-201-005 - - � A.P. Number ` City Zip Tel. S4 Quinta 92253 _ .564-7411: Legal Description ContractorG t ds /R s Project Description Address P. Q. Box 807 City Zip Tel. 1000 Palms 9335 -.043-2671 State Lic. City & Classif. 469157 Lic. # 1114 Sq. Ft. XS3 2 No. No. Dw. Arch., Engr., Size- Stories Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State �4 LIC. # Y, LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed undef 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 GNAT /" ,N DATE OWNER•BUILDER DECLARATION / + I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation 98 reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a 7 ii permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also AMOUNT requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT 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 Plan Chk. Dep. 1►"� 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 Plan Chk. Bal. do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 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, Mech. 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 Electrical 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- Plumbing 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.I. such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. e. & P.C. for this reason Grading Driveway Enc. Date Owner Infrastructure 4;T ♦U46b •ub 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. TOTAL if7 tf4S %. �'!r/ t J. ' CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE 6��33a.i.♦c ek�i ,stp�w y n°� (This section need not be completed if the permit is for one hundred dollars ($100) valuation {liF•fi4Aiff�i�`f it 0,}14,f-'}ti2"tif[1�D.Vti �'� 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, after making this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. 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 work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line - Lender's Name Lender's ;Address FINAL DATE INSPECTOR This is a building permit when properly filled out, signed and validated, and is subject to �' R expiration if work thereunder is suspended for 180 days. 1 certify that I have read this application and state that the above information Is correct. Issued by: Date Permit 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. Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip WHITE - FINANCE, PINK - APPLICANT, GREEN BUILDING; GOLDENiiOD - ASSESSOR'S OFFICE, HARD COPY - FILE CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINS FEES, IST FL SO FT y S UNITS SLAB GRADE 3 GH PLUMB/D �6 � BONDING SPKLR SYSTEM 2ND FL SO FT. aYARD FORMS SEWER OR SEPTIC TANK VIROUGH WIRING/,g ��-� MOBILEHOME SVC. BAR SINK POR SO FT. a a (ROUGH) -/GAS METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR SO. FT. a TEMP. POLE GROUT DRAINAGE PIPING CAR P. I SO FT. 6 FINAL INSP. WALL SO. FT. @ WATER SYSTEM DRINKING FOUNTAIN GRADING cu. yd. $ —Plus—X$—=$ URINAL SO. FT. fa FINAL INSP, r/ � j— ✓ o ESTIMATED CONSTRUCTION VALUATION S WATER PIPING NOTE: Not to be used as property tax valuation �FRAMING / �� �jtrj�� FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WAS HER(AUTONDISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM 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 C 1%/4 c SEWAGE DISPOSAL SO.FT.GAR @ 3i c HOUSE SEWER lcINAL INSPECTION v- . 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 8 AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE 3 GH PLUMB/D �6 � BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK VIROUGH WIRING/,g ��-� DUCT WORK ROCK STORAGE FOUND, REINF, q /e0� / L Y a (ROUGH) -/GAS METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ —Plus—X$—=$ LUMBER GR. FINAL INSP, r/ � j— ✓ o FINA/LL INSP. ROOFING�-`� � VENTILATION v ����%% 0 L1/I �� v 1� �FRAMING / �� �jtrj�� REMARKS: FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR' FIREWALL //GAR. CI4ATHING , to ` Y MESH �C INSULATION/SOUND / L/"6 FINISH GRADING lcINAL INSPECTION v- . CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL t - f. P.O. BOX 1504 APPLICATION ONLY Building 54-080 Avenida Diaz La uinta &105 CALLS CALIFORNIAESTAD9 Address r Q LA QUINTA, ORNIA 92253 Owner WESTERN AMERICAN CONSTRUCTION Mailing Address P 0 Box 1379 City Zip Tel. La Quinta 92253 619-564-7411 Contractor G REYNOLDS CONSTRUCTION Address City P 0 Box 807 La Ouinta 1 92253 1 619-543— State Lic. City & Classif. B1 469157 Lic. # 1114 Designer Address Tel. City 1. Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm thatil am licensed under provisions of Chapter 9 (commencing with Section 7000) of Divlsion'� of Ilia Businessand Professions Code, and my license isn_f/U/1Iforcull e and effect. g,/ ,-,� '� A j. SIGNATUREd"" +'-W ,r "' .o d" DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License taw for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which the, a permit to construct, alter, 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 epplicant for a permit subjects the applicant to a civil penalty of not more than Ove hundred dollars.(8500). : ❑ 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.) _ ❑ 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 doesnot apply o an owner of property who builds or Improves thereon, and who contracts for such projects th a contractor(a) licensed pursuant to the Contractor's License Law.) ❑ I am r empt 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 (S100) valuation or less.) I certify that in the performance of th@ 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: O, alter making this CertlOcate 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 expiration it 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 BUILDING: TYPE CONST. OCC. GRP. A.P. Number 774-201-005 Legal Description Lot 20 N11 Lot 19, Blk 255, SCV@LO U 24 Project Description Single Family Dwelling Sq. Ft. 1, 832 No. No. Dw. Size Stories Units New Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation 'PERMIT AMOUNT Plan Chk..Dep. / U Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. , Infrastructure L` ` ' Ut Gcr r ,AW TOTAL Ce) REMARKS •f I IIIY IIYII 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 NO. ELECTRICAL FEES NO. PLUMBINGC_ FEES A.C. UNIT COLL. AREA SLAB GRADE IST FL. SO. FT. ® UNITS HEATING (ROUGH) STORAGE TANK FORMS YARD SPKLR SYSTEM 2ND FL. SQ. FT. DUCT WORK ROCKSTORAGE FOUND. REINF. MOBILEHOME SVC. BAR SINK POR. SO. FT. ® OTHER APP.IEQUIP. REINF. STEEL GAR. SO. FT. ® POWER OUTLET ROOF DRAINS 'g"1Zf'3F G D DRAINAGE PIPING CAR P. SQ. FT. ® e FINAL INSP. WALL -ZD SO. FT. ®Z `00 Z DRINKING FOUNTAIN GRADING cu. yd. $ plus x$ _$ URINAL SQ. FT. ® FINAL INSP. FRAMING ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FIRE ZONE ROOFING GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIREPLACE LAUNDRY TRAY AIR HANDLING UNIT CFM 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. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/4c HOUSE SEWER FINAL INSPECTION 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 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 ROCKSTORAGE 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 INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL 2 Z 0 U w rA M Z O U W X Z O F- 0 w C0 0 Z O F- U W U) I COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No. t ENVIRONMENTAL HEALTH SERVICES 17711 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 FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'* Agent, Contractor, Contact Person Phone Address & Phone Owner GiJ -�e�n/ A r►'1 e/L! �i�..i G� ,.. T Phoneiling i, - ti' 1 dress Fd �ox 7 `7 C•�y 7, State <::�A Zip CIZZ53 Job Property Address St4-O Legal Description Prop. (PM, Tract, Lot) "W, f uI%., 1 RO Lot Size Water Agency/Well Use of Permit P/P, CU, etc. Other wellin , MH Site Prep, etc. Signature of Applicant Date / CATEGORY: REV CODE FEE CATEGORY: REV CODE FEE q / SUBSURFACE DISPOSAL 1238 $45.00 ❑ SITE EVALUATION UPON REQUEST 7349 $42.00 ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348 $11.00 a. 1 st 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) ❑ Site Evaluation in Conjunction with ❑ HOLDING TANK 7351 $45.00 Critical Area 7346 $86.00 ❑ ALTERNATIVE/EXPERIMENTAL 7345 $132.00 ❑ Site Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $86.00 INITIAL DATE y f Holding Tank Agreements Completed ❑ Yes I I No Certification of Existing S.D. System Required ❑ Yes No WQCB Clearance required. (Attach Form ❑ Yes I I No DOH SAN 007, Santa Ana Region Only) Soils Percolation Report Required. ❑ Yes No Special Feasibility Boring Report Required. ❑ Yes No Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes No Other ❑ Yes No Staff Specialist Lot Inspection Required ❑ Yes No Lot Inspection Date Soils boring report by Project # Date Soils Map Page Soil Type T Approved by ��' Date No. of Systems Type of System(s) Noll3 elling Units (1) Septic Tank Soil Rate Grease/Sand ❑ Iding Tank ❑ Existing Bedroo ixture Units Grease Intcp N 4w ❑ Replacement 3 M aX / D" Gal Gal (2) Leach Line Sq Ft. Bottom trengharea Sidewall allowance Install Line(s) ft long ft wide with Leach Bed sq. It. ft. rock/s1• f� per runnjng ft. � ❑ NA min. inches rock be 1pw drain) n_es or / of bottom Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Seepage Pit Total Depth Other - Applicable / Inlet (BI) / � i . N/A Overburden factor ❑ 5 U 6 oNC /.y Max. Allowable Depth 20� No. 2 System REMARKS: S This application �s AP RO,VE� ENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompa_1r ied p of t 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. s Septic tank and sewer lines must be 50' minimum from any wells (2) Leach lines must be 100' minimum from any wells, including expansion area 0? Seepage pits must be 150' m71mum from any wells, includingnexpansio a' /—�r,c-S `"-"` -� Z Signature of Health Official Date RECEIPT NO. Issued By S/� Date $ 2 J g DISTRICT: ❑ Riverside, 8 Indio ❑ "Hemet ❑, Perris ❑ Rancho Calif. ❑ Blythe DOH SAN 122 (Rev. 5/88) DISTRIBUTION: '" WHITE - Office file YELLOW -Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records Desert Sands Unified School District CERTIFICATION OF PAYMENT NOTICE: THIS DCCUME s"&(GAKMSW.TY FEES BE DUPUCA 1 Bpi. Ire T0: City of La Quinta DATE: --� Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 This is to certify that JI cY�vo[J developer of which is located at Q 4' '70 &- ,&,'erthin �"6. )Jb) this District, has paid school facility fees imposed pursuant to the autho ity enerated by GovernmentCode Sectiol► 53080 in the amount o covering a total of quare feek of ( K_) residential or ( ) industrial/commercial development and that building permits for this footage in this development may now be issued by your jurisdiction. A L— Cy 1�-�pJC !� for DESERT SANDS UNIFIED SCHOOL DISTRICT White - Building Department • Yellow - Facilities Planning 0 Pink - Accounting • Gold - Developer (10)-37