05693 (SFD)Building 79-863 tMMARD AO
Address
Owner
RUGME -T. FUCK
Mailing
Address 46-175 JEFFEMOI3
City LAQUMA
Contractor
"Tw
city
I
P.O. BOX 1504 N Q .
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 617-111-008 -
r f,
619/34`,.-1* 891
State Lic.I City
8r Classif. Lic. #
Designer
Address Tel.
City (Zip ( 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
OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec..7031.5,0rsibess and Protessions Code: Any city or county which requires a
Permit to construct, after, improve, demolish, of repair any structure, prior to its issuance also
requires the applicant for such permit to lite a signed statement that he is licensed pursuant to
the provisions of the Contractors license Law, Chapter 9 (commencing with Section 7000) of
Diviston 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the a8eged exemption- Any vkdatbn of Section 7031.5 by 'any applicant for a permit
subjects the appfccant to a civilpenalty of rat more than five hundred dollars (5500).
❑ 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 reproves thereon and who does such work himself or through his own employees,
Provided that such irprovanrsLs 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 &wave for the purpose of sale.)
O 1, 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 contraclorfs) licensed pursuant to the Contractor's -License Law.)
❑ 1 am exempt under Sec. a- & P.C. for•this reason
Date ' , Owner
WORKERS' COMPENSATION DECLARATION
Ihereby affirm that 1 have a certificate of consent to self -insure, or as certificate of
Workers 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 rnanner so as to become -subject to the Workers' Compensation
Laws of California.- _
Date Owner
NOTICE TO APPLICANT: f, after making this Certificafe of Exemption you should become
subject to the Workers' Corrpensation provisions of the Labor Code, you must forthwith
comply with such provisions or the permit shag 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 property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I cerlity 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
Legal Description
N
05693
Project Description
SIM
Minimum Setback
Distances:
Front -Setback from Center Line
Rear Setback from Rear Prop. Line
Sq. Ft. 1n.56g
Size
No.
Stories
No. Dw.
Units
New,, ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
INSPECTOR
5/2/892%Sg
Issued by:
Date Permit
Validated by:
Estimated Valuation.2y%�3.�
>4
PERMIT
_
AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal.
T 700.4.1
Const.
rc' 563.00
Mech.,
55.50
Electrical
-112.32.
Plumbing
169.50
S.M.I.
5.7
Grading
20e
Driveway Enc.
20.,£1.
Infrastructure
1sFkC�.'
FR-1—MB-TOED LII RD
IIG. 16
TOTAL
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 Line
e
FINAL DATE
INSPECTOR
5/2/892%Sg
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
r
'
2ND FL. SO. FT.
HEATING (ROUGH)
YARD SPKLR SYSTEM
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO, FT. ®
ROCKSTORAGE
FOUND. REINF.
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
OTHER APPJEOUIP.
REINF. STEEL
DRAINAGE PIPING
CAR P. SO. FT. ®
WALL SO. FT. ®
WATER HEATER
DRINKING FOUNTAIN
SO FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
LUMBER GR.
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
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, 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 ® 1 Vi c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
HOUSE SEWER
FINISH GRADING
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
f 74-7—
SETBACK
4-7s
SETBACK
GROUND A MBI G UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE Z
OUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SE
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)METER
LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
�r — 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
VENTILATION
d W P_ •ply
?JL/V�
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING i7 k/ -7111
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
I
Desert Sands Unified School District
CERTIFICATION OF PAYMENT, '
OF _
M SCHOOL FACILITY FEESI
NOTICE: THIS DOCUMENT CANNOT -rte
BE DUPLICATE®,
TO: City of La Quinta DATE: `1 /
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
This is t o. c e r -t i f y that
C�� N"'� �t 1✓ L \J'V �1i� ,
developer ofwhich is
located at f,h-��/ Y, within
this Dist'Yict, has paid school facility fees imposed pursuant to the
authorit r ZTa4td by vertiment o Sect'on '530 0 i the am unt o•f$ (A )
covering a total of / square feet of( ) reside tial or
(' ) industrial/commercial development and that builXi g permits for'
this footage in this development may now be issued by -your jurisdiction. -
for DESERT SAN S•UNIFIED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37
r
iJ�•
RECEIPT NO. � / 4) Issued By A Dais
DISTRICT: . ❑ Riverside, 0-'rdio ❑ Hemet Q Perris ❑ Rancho Calif. ❑ Blythe
DOH'SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE. Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD Plans/Records
Em
"COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH AsSeamm 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 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.
Q
VERIFY ITEMS IN SECTION A FROM .BUILDING 8 SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'*
Z
0
Agent, Contractor, Contact Person
Phone
Address & Phone
U
W
Owner GENE �1c
P I� 9/
M _
b lI%7 S'` 42soed
City .
®ui,u 4
State
CA,Z2s3
Zip -
Job Property AddMW
kk
Lega) Description Prop• (PM, Tract, Lot)
1.ot 8 -T � /go
,Z4
9-565 b 146
ao ,2
Lot Size
Water Agenc ell
Use of Permit P/P, CU, etc.
Other
8QX- t n- 1 0#
C Y w oDvyeftg,
MH Site Prep, etc. W Gni`•
Signature of Applicant
Data
CATEGORY:. REV CODE FEE
CATEGORY: REV CODE FEE
/
6 --SUBSURFACE DISPOSAL 1238 5.00
❑ SITE EVALUATION UPON REQUEST 7349 $42.00
m
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT- PLAN)
Z
LAND DIVISION
❑ SEWER/SEPTIC VERIFICAIRON 7348 $11.00
0
a. 1 st 4 Parcels (Each) 1238 $45.00-
(Less than 1 year)
F-
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)
U)
❑ 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
INITIAL DATE
Holding Tank Agreements Completed ❑ Yes k8
;5eZNNoV.
Certification of Existing-S.D. System Required ❑ Yes
WOCB Clearance required.. (Attach Form ❑ Yes
DOH SAN 007, Santa Ana Region Only) /
Solis Percolation Report Required. ❑ Yes 'NO
Special Feasibility Boring Report Required. ❑ Yes
Deteile_d Contour_ Plot Plans Required (1. to 5 R interval) _ ._ ❑ Yes
�.
Other ❑ Yes
Staff Specialist Lot Inspection Required O Yes ❑ No
Lot Inspection Date
Soils boring report by' Project # . Date
G�
Soils Map Page ` SOA Type Approved by Date
U
Z
No. of System.
of System(a)
❑�I Ing.Tank ❑ Existing
No. Dwelling Units //
ms,
Bedroofbdure,Unifa
(1) Septic Tank
Soil Rate
Grease/Sand
resae,
0
B^New ❑ Replacement.
D
�
"3 gaitsl•1;,�yjQ�
A-011
Gal
Gel
U
,
W
r
(2) Leach Line Sq. Ft.
Bottom trench area
Sidewall allowance
it rock/ sq. R
InatelF Lines) R long it wide with
-
irxmes draln� Imes
Leach Bed sq. n
"
per running R
min. or
Leachlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
Seepage Pit Total Depth
Applicable
�,
Inlet (BI).
—/0-"
N/A Overburden factor
(�
Max. Mlowable Depth
No. 2 System / �1
REMARKS:
This application' APPROVE EW -9 for the category checked in SECTION B above, regarding'•the design of a:subsurface disposal system as indicated
0
on the accompanied plot plan, using the requirements set forth iri SECTION C above. A building permit is necessary for the installation of the
Oabove
-designed system. No construction is permitted in the required reserved 100% expansion area.
Septic tank and sewer lines must be 50' minimum from any wellse//0 S-.
JbIJ(1
Leach lines must be 100' minimum from any wells, including expansion r S
IV
3 Seepage pits must be 150' minimum fr m any wells., Rclluding expansion area //0
Cx
� 4
C . ✓!''
T
Sf nature of Health'Official ,iL. 7'Yf e
RECEIPT NO. � / 4) Issued By A Dais
DISTRICT: . ❑ Riverside, 0-'rdio ❑ Hemet Q Perris ❑ Rancho Calif. ❑ Blythe
DOH'SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE. Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD Plans/Records
Em