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05691 (SFD)4 • - - P.O. BOX 1504 No. 05591 Building 53-340 VIUA 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner TI DUPFY Address City Zip Tel. LA QUIM 92253 Contractor Address City State Lic. I City & Classif. Lic. # Arch., Engr., Designer Address Tel. City(Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7001n 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 Contractors License Law for the following reason: (Sec. 7031.5,8usiness and Professions Code: Any city or county which requires a permit to constrict, after, urprove, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to Me a signed statement that he s licensed pursuant to the provisions of the Contractor's License taw, 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 civilpenalty of not more than live 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 Contractor's License Law does not apply to an owner of property who"" buiIds or inproves 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 said with one year of completion, the owner -budder win 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.) ❑ 1 am exempt under Sec. R_ & P.C. for this reason Date - f owner t �" .•�.* WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 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 ff 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 arty manner so as to become subject to the Workers' Compensation Laws of Califomia Date Owner NOTICE TO APPLICANT: d, after making this Certificate of Exemption you should become subject to the Workers' Compeensation provisions of the Labor Code, you must forthwith comply with such provisions or this pertmit 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 abuilding permit when properly 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 BUILDING: TYPE CONST: - OCC: GRP.- A.P. Number �74�-094-005 Legal Description LOT -20 3M 214 Project Description $FD ZONE: BY: Minimum Setback Distances: Font Setback from Center.Line Sq. Ft. 146-6 Size No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ FINAL DATE INSPECTOR 5/1/89 Issued by: Date Permit Validated by: Validation: Estimated Valuation ��� •y .7:�� aCR\i PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal: Const. .76 Mech. ' , 63. 00 Electrical 51.50. Plumbing W9.89 S. M. 1. 15T..50 Grading, 55.81 Driveway Enc. 20,9;90 Infrastructure 20,0 1*814.92 TOTAL REMARKS RPM ]L}t},, '4.w ZONE: BY: Minimum Setback Distances: Font Setback from Center.Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback trom Property Line FINAL DATE INSPECTOR 5/1/89 Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS COLL. AREA 2ND FL SO. FT. ' ROUGH PLUM YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET I ROOF DRAINS CAR P. SO. FT. DUCTWORK DRAINAGE PIPING WALL SO. FT. GAS (ROUGH) DRINKING FOUNTAIN SO FT ® HEATING (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION $ GAS (FINAL) WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER HEATER WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTOXDISH) APPLIANCE DRYER WATER SYSTEM GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GRADING cu. yd. $ plus x$ 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 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/. c SEWAGE DISPOSAL SO.FT.GAR ® 3/ic HOUSE SEWER GAR. FIREWALL 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 PLUMBIN f UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ' ROUGH PLUM BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWGH I MIA WIRIN ` .7' DUCTWORK ROCKSTORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. 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 Z& FINAL INSP. ROOFING -7— 13r IOQ/L` r6 'A � �J 1',n✓v— (/1' REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL THING MESH INSULATIONISOUND - FINISH GRADING FINAL INSPECTION ell S- � CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL t `4 C �r'"ti r '`�3+'„`� n � t •�t ri t%rs ,,+ +,+, � s..� z � -c; �,K ;� �" �.c s r � Y' �.,;: ." f.i � �a ,� � : �', �P"�"��-'s t i y -'���1 +`�''�'3�''Y�T�iI�"���3 ��p�`�N^ '�� "• '�-•>K,�,���p7 •' ���i � �+ r ���i'.�.�?+P# RECEIPT NO. i t-L%i Issued. By �-....� Date DISTRICT: ❑ Riverside, 6 radio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe t DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Asseswrs Parcel No. ENVIRONMENTAL HEALTH SERVICES PERMIT APPLICATION FORA SUBSURFACE SEWAGE DISPOSAL SYSTEM 11 i 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 filingfee see below is required when the application is submitted. Check rust be made ( ) to the County of d payable ,. 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 S SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG' Z O Agent ,, reactor, ContactPerson SlJi�c-�CdS Phone 3Zx-32or Address 8 Phone ?27-32 44 'lYifit-. U 3o X7 3 -44. _,�o UJ to . Owner ��� F Phone . Mailing Address City^ L,� yJd n/T,q State Zip Job Property Address'%'ov,A� "I, Legal Description Prop. (PM; Tract, Lot) L ,147.4 - aK a f if u ki. T zo Lot Size" er Agent I ' Use of Permit P/P, CU, etc. �/U Other f �� `- 3o IK V, w; r D Uf//� f line M sft I/ Dwel ' g� H e Prep, etc. Signature of Applicant Date _ CATEGORY:''` REV CODE FEE''^"'� SUBSURFACE DISPOSAL 1238 J CATEGORY: REV CODE • FEE ❑ SITE EVALUATION UPON 7349 $4200 .00 :3EOUEST ❑ MULTIPLE PARCELS WITHIN SAME - (NO, PLOT PLAN)' m Z LAND DIVISION 0 SEWER/SEPTIC VERIFI ,ATION, 7348 $11.00 O a: 1 st 4 Parcels (Each) 1238 $45.00 (Less than' 1 year) U b Each Parcel after 4 �,j 7344 • $16.00 ❑ PRELIMINARY ELECTriE 7352 $45.00 W 0 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- 0 She Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $86.00 ,: iNdTIAL DATE p %� � 'L) Holding Tank Agreements Completed ❑ Yes LV16o '�• - `Certification of Existing S.D. System Required ❑ Yes Q No E WWB Clearance required. (Attach Form ❑ Yes ❑sN0 DOH SAN 007, Santa Ana Region Only) Solis Percolation Report Required. ❑ Yes G No r i ;Zpedel FeasI0110 Boring Report Required. ❑ Yes .O" No- 11 Detailed Contour Plot Plans Required (1 to 5 It. interval) ❑ Yes IG 1 { Other : ❑ Yes R'No Staff Spectt)ist Lot Inspection Required ❑ Yes E3 No Lot Inspection Date Soils boring report by' Project # Data Soils Map Page �! Sonn Type L_ � Approved by _ _._, Date d a: 3Gi. k q U No. of Systems fyr a of Systems) No. Dwelling Units fir} (1) Septic Tana Soil Rate Greisera" Z' 0 .. ❑ Holdiiig Tank ❑ Existing ❑ rNew ❑Replacement Bedrooms, Fixture•Units Grease Inbcp - Gal.. Gal, UJ "(2) Leach Line Sq. Ft Sidewall allowance tt Ir ll `a.. _ Lirre(s) ft king N wide with Leach Bed sq. tL , �ft7hrea ? rock/ �•'R per running ft ©0KN"A min. inches'r"oack, drainlines or . areaOf Leachlines/bed special design for slope: • (3) Pit Diameter No. Pita Pit Below Inlet Seepage Pit Total Depth i r tither. Applicable N/AOverburden facto 5 17' 6 (BI) %%(/j /' Mai:. Nbwab Depth -r -A—�a>t `A No. 2 System tl ' No. .Av ti REMARKS: 1' 6 ✓'- C.2.r•C-v�C`r,;•/ •rte .r��l�/'An�_ '�: f:' .. - �j! ,�,� */•.-,. - /.//1f Q� J A This application is,APPROVED/D : m for the -category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompan pot pan, using the requirements set forth in SECTION C above: A building perms .is necessary for. the installation of the Oabove L U -designed system. No construction is permitted in the required reserved 100% expansion area. (1 Septic tank and sewer lines must be 50' minimum from any wells n' (2) Leach lines must be 100' minimum from any wells, including expansion area % -U3 Seepage pits must be 150' minimum from any wells, including expans. n area r f , /fit n.�^ 4�..•-18.�,.w Si nature of HeaRh Official W. >�-'• Gan:�i ti f�. G NDat RECEIPT NO. i t-L%i Issued. By �-....� Date DISTRICT: ❑ Riverside, 6 radio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe t DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records I 0I 1Ir.E orAV 16141J., E.. lErnr Slnt;r,Y: s ni�lc:uLl UItnI. GU�thllSstt)t�tElt ,r,�Its o t►:n1lAt:F. p ( •t .�GAND U:MEv1 C,F.NVENISIE m:ICiI.I 15 b WINSUBES sLuin r „, .�Y 1�`! 119=613 llwy 116, 11ul�te 1► -12 - A;011010 111,UA 2236 Arq P v i�ea� 619 -JAZ -0291 CASE IU.ONCE G�� J3aq imCL umvs 1wIE1 (,a Cil` lW -1\UUIES5 P o (�A IJ vLc r t 4 2 GHQ {�tL jc l%5 l ln►' �' 11 Dear IJevelopert After teviewl"q your Lundsce►1rl.iiy 1iluir,, tall 1rlartt n►�terial 1i`�EdsuUslitutiot's violEativn of yuaralltine Ltr�►s c�cwealriny llre Cuucltella Valley. do occur t�Irc� they dlEEer {torr 1110nt n4�leriFal listed, Mals ULE_ce must be IlvtiEiec� illnrediateTy, '1hmik you Lor prvtectbly ulld pto-Setvi.lry the Cvaclielle Valley' 3 ��est E� ee envirvinnlat. ngi ltutal color ss oiierl uL [ Ice cel '11010 talyd Riverside U[ [ice - - • DAILY WORK SHEET y , JOB NAME , JOB NO. DATE TECH. LOCATION CLIENT HOURS WEATHER� -EQUIPMENT r As NO. TEST LOCATION ELEVATION OR DEPTH DRY ' DENSITY PERCENT MOISTURE MAXIMUM DENSITY RELATIVE COMFACTION i i _H r COMMENTS , 3' SOIL TESTING, INC. Phon3 (619) 340-9492 Desert Sands Unified School District CERTIFICATION OF PAYMENT OF ELI SCHOOL FACILITY FEES NOTICE: THIS DOCUMENT CANNOT TO: Ci tyKE 'EMPU A 1 EY® DATE: Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 This is t certify 'chat t)(Jm developerwh'ch located ate J)�ithin this District, has paid school faci y fees imposed �p rsuant to the au.h try enera b vern ent de Senion 5300 in the a ount�o /�� $ ( 1�i/ covering a total of square feet of ( ) re i ntial or ( ) industrial/commercf-al'a-e441opment and that building permits for this footage in this development may now be issued by your jurisdiction. I Ob 1� 4� d&4 0 - 6bMS±t for ESERT SA DS UNIFIED SCHOOL DISTRICT U2 - White - BuildingDepartment • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer P 9 9 P (10)-37