04944 (SFD)4
P.O. BOX 1504 No. 44944
Building 78105 CALLE ESTADO
Address 54-760 Diaz LA QUINTA, CALIFORNIA 92253
Owner
Mailing
GD Di velfJvL• ent BUILDING: -TYPE CONST. OCC: GRP.
Address t Xiie. w y A.P. Number 77A=941—nal
City Zip Tel.
Indio 342--6168 Legal Description
i
Contractor Project Description •
Tela
State Lic.rCity
& Classif. 2 t7 Z 6 d_ I Lic. #
Designer
Address Tel.
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
=of Division 3 of the Business and Professions Code, and my license is in full force and
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,8usiness and Professions Code: Any rxiy Or County which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires
rovisionsf
pot t for such Contracto's License Law, Chapter 9 (coco awrai hg with Section 7000) of
Drvfsion 3 of the Business and Professions Code, of 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 aopicant to a civil penalty of not more than five hundred dollars ($500).
O 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 Contractors License Law does not apply to an owner of property who
Lxilds 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. H 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 conlr2ct0r(s) licensed pursuant to the Conbactor's License Law.)
❑ 1 am exempt under Sec. B. S 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
Workers Compensation Insurance, or a certified copy thereof- (Sec. 3800, Labor Code.)
Policy No Company
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed it the permit is for one hundred dollars (5100) 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.
Date Owner
NOTICE TO APPLICANT: K, after making this Certificate of Exertption you should become
sWect 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 Coda.)
Lenders Name
Lenders 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.
1 certify that I have read this application and state that the above information is correct.
1 agree to comply with all city and county ordinances and state taws 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
Sq. Ft. No. No. Dw.
Size I S O Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
IEstimated Valuation $84,534
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
1
AMOUNT
IRA
_no
111
_ fin
7A_AS
t1A_On
..
4 7
2f)
00
I,RAI
77
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
1216088
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
YARD SPKLR SYSTEM
2ND FL. SO. FT. 0
%
SETBACK -
ROUND PLUMBI Q
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
COLL. AREA
%
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
BONDING
HEATING (ROUGH)
DRAINAGE PIPING
CAR P. I SQ. FT.
FORMS
7 S WER OR
WALL SQ. FT.
ROUGH WIRING
DRINKING FOUNTAIN
ROCK STORAGE
URINAL
—d SO. FT 0
METER LOOP
ESTIMATED CONSTRUCTION VALUATION $
OTHER APP.IEQUIP.
WATER PIPING
NOTE: Not to be used as property tax valuation
GAS (FINAL)
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
SERVICE
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, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ®c
IBATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
GARDEN WALL FINAL
SQ.FT.GAR ® 3Ac
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
STRUCTURE
PLUMBING
ELECTRICAL HEATING & AIR COND.
SOLAR
%
SETBACK -
ROUND PLUMBI Q
UNDERGROUND
A.C. UNIT
COLL. AREA
%
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
7 S WER OR
NK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEJ2
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
ND BEAM' / J
000"`---
WATER SYSTEM
GRADING
FINAL INSP. cu. yd.
FINAL INSP. $/ —Plus—X$—=$
��G Gam, I�`�� /C/_ � �i ��jfC/ REMARKS:
/J/U /L �r4 W ' 1 y COlZIVOI—Ll
I (
r
_ _
cd Ov7 /A.- P240T
LUMBER GR.
19 1
RAMING G -
OFING t / -Y (
1
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
IN ULATIONISOUND
FINISH GRADING
1 I/FINAL INSPECTION moo[ -(
/
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
,ecto-d�yt •E'. � // - �Z % �YCr(�EC C�4/o,J
) �
7 `
RECEIPT NO. Issued By / M ��a4e 1 t 2 2
DISTRICT: ❑ Riverside, �i Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
e
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Asaesaora Parcel No.
ENVIRONMENTAL HEALTH SERVICES
PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM
Applicant: Submit this form with four copies of a scaled plot pian (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 REMS IN SECTION A FROM BUILDING b SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'
Z
0'
Com Contact Pe n Phone
E. re�`e
Address & Phone
LU
Owner Phone
Mailing Address
ro
Lt, v / 0
%/�'c
City -i jt/�p�-
_
?Q ob P rty Address�L6�2 p. { M, Trect
77,
Lot Sizer'
Water Agencya&Use
of PeOther
✓ (db
(�wellin
, MH Site Prep, etc.
Signature of Applicant
Date
CATEGORY: REV CODE FEE
CATEGORY: REV CODE FEE
SUBSURFACE DISPOSAL 1238 5.00
❑ SITE EVALUATION UPON REQUEST 7349 $42.00
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
m
Z
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
0
a 1 at 4 Parcels (Each) 1238 $45.00
(Less than 1 year)
J -.
Each Parcel after 4 77344 $16.00
❑ PRELIMINARY ELECT)VE 7352 $45.00
W
Mr Rereview (2nd review same parcel jet, 344
EVALUATION (Attach DOH SAN 53)
N
[3 Site Evaluation in Conjunction with��tr�/
/~
❑ HOLDING TANK 7351 $45.00
Critical Area 7348 $86.00
❑ ALTERNATIVEIEXPERIMENTAL 7345 $13200
❑ Site Evaluation Lot less than
SYSTEM
10,000 Sq. Ft 7347 $86.00
INITIAA DATX
Holding Tank Agreements Completed ❑ Yes No
Certification of Existing S.D. System Required ❑ Yes No
WQCB Clearance requited (Attach Form ❑ Yes No
DOH SAN 007, Santa Ana Region Only)
Salla Peroolsdion Report Requited. ❑ Yes No
Special Feasibllty Boring Report Required ❑ Yes No
Detailed Contour Plot Plans Required (1 to 5 ft interval) ❑Yes No
Outer ❑ Yes No
Staff Specialist Lot Inspection Required ❑ Yea No
Lot Inspection Date
Soils boring report by' O f) Project Date
Sella Map Page Soil Type Approved by Date
U
No. of Systema
Type of Systems) .
No. Dwelling Units(t)
(1) Septic Tank
Soil Rate
Grease/Sand
Z
O
1
❑ Holding Tank ❑ Existing
ANew ❑ Replacement
Bedrooms,1%dure•Units-
VL Q%(
O�
\
Grease Ir�Cp
F
Gat
om
U
(2) teach Lute Sq. FL
Bottom "
Skfewall eI
R roGc/ aq. `
Install LIne(s) R lcxg fl wide with
min Irnhes dralnlines or
Leach sq. IL
_ettom area
Pal runni tL
❑ NA
Leachlinewbed special des n for s)ope:
(3) Pit Diameter
No. Pits
Pit BelowSeepage
R'Total Depth
Other. _�_
Applicable
O 5 8
`
Inlet (eq
.� t
?((
Max Allowable Depth
N/A�factor
No. 2 System
1
GlkaGtlh (Dc� / c��PauS\�`1 O`V-eG ,
REMARKS:
' c 7
This application s APPRO /B�9 for the category checked in SECTION B above, regarding the design of a subsurface disposal system as Indicated
on the atx ompan plot plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
0
abovg-designed system. No construction Is permitted in the required reserved 100% expansion area.
tank and sewer lines must be 50' minimum from any wellsc(/C Tom' �•Qd� �'`et� `�' S
eWSeepage
UrSeptic
32Leach lines must be 100' minimum from any wells, Including expansi 1
u" ��-�-- w i TSS S
pits must be 1,50' rrarilmum from any wei , IncluNng expansion area
Signature of Health Official Date
,ecto-d�yt •E'. � // - �Z % �YCr(�EC C�4/o,J
) �
7 `
RECEIPT NO. Issued By / M ��a4e 1 t 2 2
DISTRICT: ❑ Riverside, �i Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
e
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
�� l!��{ OF (CA
NOTICE: THIS D®CV�Ew.�S�Qo�IKW4�_ITY FEES
L>,,
BE DUPLICATED, 9 UM
TO: City of La Quinta DATE:
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
This is to certify that
developer of which is
located at i� s = �� within
this District, has paid school facility fees impose4 pursuant to the
authority generate by Goverment CoSectio 53080 in the amount
covering a total of 3, , 3 2- square feet of ( residential or
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
-76
7J'a
for DESERT SANDS•UNIFI SCH00 IST ICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37