05325 (SFD)F: ti TA-tyl
P.O. BOX 1504 No. 05325'
Building 78-105 CALLE ESTADO
Address 53-$oo v,iTaLA LA QUINTA, CALIFORNIA 92253
Owner tit CHFJ.A 9ALLU LM
Mailing'
BUILDING: TYPE CONST. - OCC: GRP.
Address 247 'E. TAHQUITx #2 A. A.P.-Number 774-1384-003
CityTel• Zip r LOT. 20 BVK 241 M4 23 r
PAL_K SPRIN S 92262 _327.-142t� Legal Description TT
Contractor P DSid?
STAR 01MRS RUCTION
SAMS
State Lic. City
& Classif. 387934 Lic. # 895
Arch:, Engr.,
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) .v
of Division 3 of the Business and Professions Code, and my license is in full force and
effect. - :�.i.^.,s.•w,; i«.� I.4.-� =. t.c.-d...-e •,,,.t: :�•�'{�:�rr`
SIGNATURE r DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to Me 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 applicant for a permit
subjects the applicant to a crud penally of not more Man 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 Contractors 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 ormnprove for the purpose of sale.)
❑ 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 contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. R_ & 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 thei e2f-(Sed. 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 (8100) valuation
or less.) m
1 certify that in the perfotance 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: H. after making this Certificate of Exemption you should become
subject to the Workers' Cornpensatimn provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shaft be deemed revoked.
CONSTRUCTION LENDING AGENCY
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.)
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 certity 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 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
roject escrlptlon
Sq. Ft.17;1
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑.
r
Estimated Valuation
75?0
PERMIT
AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal.
2t1.5
Const.
Mech.
53.50
Electrical
106.41
Plumbing
157.50
S.M.I.
5.39
Grading
20.00
Driveway Enc.
20.00
Infrastructure
1,679.85
TOTAL,
REMARKS
ZONE:—_ . --BY:
Minimum Setk 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 2/7/89 • Permit
Validated by:
Validation:_
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEF,,S 7
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. Q
POWER OUTLET
ROOF DRAINS
DUCT WORK
DRAINAGE PIPING
CAR P. SO. FT. ®
GAS (ROUGH)
METER LOOP
WALL SQ. FT.
HEATING (FINAL)
DRINKING FOUNTAIN.
SQ FT ®
GAS (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER HEATER
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOHDISH)
APPLIANCE DRYER
GRADING
cu. yd.
plus x$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP.
IKITCHEN 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.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SPARK ARRESTOR
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAR. FIREWALLdq
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
ETBACK C/ ,��
��ROUND PLUM BINt /
UNDERGROUND
A.C. UNIT
COLL. AREA
vLAB 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 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
FINAL INSP.
ROOFING — ��
T O // _ ,/��
�' N
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALLdq
f��J
LATHING
MESH
j
INSULATION/SOUND % l�
FINISH GRADING
FINAL INSPECTION
v
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
1
GARDEN WALL FINAL
M
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
NOTICE THIS ® ®CSCHOOL FACILITY FEES
p� UMENT CANNOT
T0: City oBE DUPLICATED DATE:
Department of Community Development
78-105'Calle Estado
La Quinta, CA 92253
• This is to certify that
developer of ' which
located at. �O (9 - Rr'- tR NQ
this District, has paid school facility fees, -imposed pursuant.to the
autho ity generate, by Government o ,; Sec ion 53080 'n the amount,.10
Y -d
OO
covering a total of quare feet of (. ) residlen ill _'Wor
( )
industr.ial/commerc'la'f development and that building permits for
this footage in this development may now be issued by your jurisdiction.
54 -2 o U:eIMC o A -r e -a i 10
'''YI v for DESERT SANDS • NIFIED SCHOOL DISTRICT
t, 40q
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • GoIJ - Developer
eg-it
(10)-37
4.1
T,
f(jJ
Assesrs rcel No.
COUNTY OF<RIVERSIQE DEPARTMENT OF HEALTH I
774soPa
f— /39
ENVIRONMENTAL HEALTH SERVICES
PERMIT APPLICATION F6R:ASUB'SURFACE 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 & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'*
Z
0
F_
Agent Contractor, Contact Person
7,4,;0,a Go 0 S ra ii 42 "r/ -0 A,)
Phone
37-2-/-O20
Address & Phone
U.1
C0
Owner
Phone
Mailing Address
Z 4-17 IF 7WX c/, rz. AJ.Q Z. -
��nyy
State
Zi
I Z e- !J
Job Property NOR, ,dll
S3 4,o o V r 4 1- .4.-X
Legal Description Prop. (PM, Tract, Lot)
4 0 r2 -0 ,CZA! A 1,440 r 2 3
Lot Size
Agency ell
CU, etc
Use of Parmh P/P, -
Other k?4
GJOILPp�
#1ter �ge7
00-
---- 14;q.
,) wev 6V
QZw:eI L—ingMH Site Prep, etc.
6!,!c
Aignature of Applicant
"Date
CATEGORY: REV CODE
ISUBSURFACE
CATEGORY: REV CODE FEE
DISPOSAL v.,t 1238 .,,$_45;0
02
0 SITE EVALUATION UPON REQUEST 7349 $42.00
co
0 MULTIPLE PARCELS WITHIN SAME ';t
(NO PLOT PLAN)
Z
LAND D , 110SION
0 SEWER/SEPTIC VERIFICATION 7348 $11.00
0
a. 1 st 4 Parcels (Each) 1238 $45.00
(Less than 1 year)
b. Each Parcel after 4 7344 *_$16.00
0 PRELIMINARY ELECTIVE' 7352 $45.00
Uj
0 Rereview (2nd review same parcel) 7344 $16.00
EVALUATION (Attach DOH SAN 53)
U)
0 Site Evaluation in Conjunction with
-13 'HOLDING TANK' 7351 $45.00
Critical Area, 7346 $86.00
0. ALTERNATIVE/EXPERIMENTAL - 7345 $ 13ZOO
0 Site Eisiluation Lot Less than
10,000 Sq. Ft. 7347 r. $86.00
SYSTEM
NrMiAl_ DATE 197
11
Holding Tink Agreements Completed 0 Yes 0 No
Certification of Existing S.D.'System Required 0 Yes 0 0
WQCB Clearance required. (Attach Form 0 Yes No.
DOH SAN 007, Santa Ana Region Only)
Sails Percolation Report Required. 0 Yes 0
SpeciaJ.Feas1blI!ty Boring Report Required. P 13 Yes O'No
Detailed Contour, Plot Plans Required (1 to S,ft. interval) 13 Yes ['3 0
Other 0 Yes 0 0
Staff Specialist Lot Inspection Required 13 Yes 13 No
Lot hspectlon Date
Solls.boring.re0ort by HPMW* Date
al 6t
Soils Map Page Soll Type Approved by Date
Z'
0
No. of Systems
Type
0 Existing
0 Replacement
No. Dwelling Un,
Bedrooms,-FixtureVnft
T3 io,04^ /My
(i) Septic -rank
/0?:,
S&I Rate
Grease/Sand
� Int
G -p
—Gal
U.1
(2),Leach Una Sq. Ft
Sidewall allowance
Install Uns(s) It. lom ft wide
Leach Bed sq. ft.
Botri h area
— It rock/_ sq. It.
min. be low drainih
of area
per running It.
Leachlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
Seepage Pit Total Depth
Othe .
Applicable
Inlet (BI),
N/A !�t�_Overbur Overburden factor
Max. Allowable Depth
No. 2 System.
REMARKS:
0'
This application is &PR VEDIEGftr the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
Z
on Ahe accompanied pl6t plan, using the requirements set forth in SECTION 'C above. A building pe -mit is necessary for the installation of the
.
0
H.
above -designed system. No construction- is permitted in the required reserved 100% expansion area
——
(IV Septic tank and, sewer lines must be So' minimum from any wells-/ .4,Lge.0 5
(2 Leach lines must be 100', minimum fromany wells, including
LU
expa6-Mon--area
Seepage, pits must be 1 50'- minimum from any wells, including
. ex pension area
J.
Si of Health Official��_ek&W hwat"e
RECEIPT NO.
Issued By ;Date
DISTRICT-.. 0 Riverside, 0radio 0- Hemet 0 Perris- 0 Rancho Calif.-' 0. Blythe
DOH SAN 122.(F3e'v._5/88) DISTRIBUTION; WHITE - Office file YELLOW Applicant_ OINK - b
Bldg. *
Dept GOLDENROD - Plans/Records
V111
.,,Buena
Errgineers, Inc.
JOB NO.
FIELD TESTING
79-811 Country Club Drive, Suite 4
Bermuda Dunes, CA 92201 (619) 345=1588 328-91
tf -
DRY
MAXIMUM
-MAXIMUM4,
OPTIMU4
TEST
TEST LOCATION -
LOT
006nt Ntime
7,
NO.
•
CONTENT
iDEITY
DENSITY
i wlCllent Address
LOCATION
iMOISTURE
v;p
Y
l r
CONTENT
OWNER
,DATE
JOB NO.
FIELD TESTING
:REFERENCE CURVE
MOISTURE
DRY
MAXIMUM
-MAXIMUM4,
OPTIMU4
TEST
TEST LOCATION -
LOT
PROJECT
NO.
L
CONTENT
iDEITY
DENSITY
DRY
LOCATION
iMOISTURE
I ic .
ba UA.
DENSITY
DENSITY
CONTENT
OWNER
-CONTRACTOR
lbs.16y, ft.
%
WEATHER
TEMP. oat
AM
PM.
-,PRESENT AT SITE
Y
CLIENT REFFIESENTATIVE SIGNATURE
% I :
TECHNICIANS SIGNATURE,'. -
E
FIELD TESTING
:REFERENCE CURVE
MOISTURE
DRY
MAXIMUM
-MAXIMUM4,
OPTIMU4
TEST
TEST LOCATION -
LOT
UMBER
NO.
ELEVATION
CONTENT
iDEITY
DENSITY
DRY
DRY,y
iMOISTURE
I ic .
ba UA.
DENSITY
DENSITY
CONTENT
%
lbs.16y, ft.
%
Y
b' S%7
Ay,
Zo%:y
-,7
J
1
REMARK " 4jr
e_
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J
r A/4;47 "Y "".k, z- _w-./
V.
CLIENT REFFIESENTATIVE SIGNATURE
% I :
TECHNICIANS SIGNATURE,'. -
E