001175 (SFD)I
t r 'PERMITAPPLICATION �3 % �V,0" ' -
- City of
La Ouinta' "
- _ Department oh Building
and Safety • , , ,� ;
• This permit becomes void if work not commenced within 180 days from date.of'issuance,
OR. if work has been suspended or abandoned for a'period of. 180 days. -
c. • _ „
CERTIFICATE OF EXEMPTION FROM WORKERSCOMPENSATION INSURANCE: This section' need not be completed it
LICENSED CONTRACTORS. DECLARATION:. I hereby affirm that 1 am licensed 'under provisions of Chapter 9
the permit is for one hundred ($100) o, less. I certify that in the performance of the work for which this permit is
.(commencing with Section 7000) of Division 3of the Business and Professions Code, and my license is in full force ' •
, : issued, I shall not employ any person in any mannenso as to become subject to the Workers' Compensation Laws of -
and effect.
California. ^,.. y r . . I
License Class' j Lic.'Number.
: Date ° ' ` Applicant
" Date' r Contractor;'
NOTICE TO APPLICANT::If, after making this Certificate of Exemption, you should become subject to the Workers_,i,,, r
k ' '
OWNER -BUILDER DECLARATION: •I hereby affirm that I`am exempt from the Contractor's License Law for the-
. • Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall'
be deemed revokeA.,
following reason (Sec. 7031.5. Business and Professions Code: Any city'or. county which requires a.permit to' ...
-
construct, alter,•improve, demolish, or repair any structure, prior to its issuance, also requires the.applicant for
: 'cDIVISION.OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:. ,
-';such permit to file a silfriedstatement that he is licensed pursuant to the provisions of the Contractor's License La%('.
''•Olherebycertifythat n6e_x6vationfive (5)ormoreteetindepthintowhich apeisonisrequired todescend,will be-''
• (Chapter 9 (commencing with section 7000) 91,Division'3 of the Business and Professions Code) orthat he is exempt _;'. •
'made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or - '
therefrom. and the basis dor the alleged exemption. Any violation of Section. 701.5 by any] pplicant for a permit-, - -'
° •. -demolition or dismantling thereof, will be more than thirty-six.(36)ke1 high. (Chap 3.2, Grp 2. Art 2. Sec 341, Title 8i ..
'subjects the applicant to a civiLpenalty of not more than five hundred dollars ($500.):•
C:A:C.)
13 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
❑ As owner -builder, I will not employ anyone to do work which would requirea permit from the Division of ; a
• structure isnot intended or.offered for sale (Sec: 7044, Business and Professions Cade: The'Contractor's License :. s
, • •. Industrial Safety, as noted above,' unless such•person. hasa permit to do such work from that division.
•> 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 .
Division of Industrial Safety Permit No.
y
building or improverrmt issold.within one year of completion. the owner-builder.will have the burden of proving that ;-
Date Applicant
he did not build or improve for the purpose of sale.)
CONSTRUCTION LENDING AGENCY: I hereby affirm that there fs�a construction lending agency for the performance
O I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec:
of the work for which this permit is issued (Sec. 3097, Civ. C.).-
.).7044:
7044;Business and Professions Code:'The Contractor's License -Law does not apply to an owner of property who ' •. "'
Lender's Name
• builds or improves thereon, and who contracts for such'projects With a contractor(s) licensed pursuant to the--:•'--
- ••
' Contractor's License Law.). ..
�' C
_ Lender's Address
' O 1 am'exempt under Sec, - • �' �� . BB,P`'CI'tAttached rd'ficate)'
I certify that'I have read this application and state that the above information.is correct. I agree to comply with all
Date Owner'
,"city and county ordinances and'state laws relating to building construction, and hereby authorize representatives •
of this county to enter upon the above-mentioned properly for inspection purposes.
- 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. Lab; C.). "•,
`
Signature e of Applicant or Agent Date
Policy No.—Company r r _
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
p Certified copy is hereby furnished:
the information given,is correct: I agree to comply with.all state laws and county ordinances relating to buidling
' ❑ Certified copy is filed with the City Building Inspecfioli Department or City ' Department.
construction,,anddauthorize a'representative,oYthe City of La Ouinta Department of Building and Safety to enter
_
upon the.properfy for which•I 1pave applied�fo4this permit)q`�he purpose of making inspections.
r
Date Applicant
d/ r.
F % Signature of Ap.PlicantoiA9e�ct7i7� Date
• - -
Print Applicant/Agent Name
APPLICANT NAME (L. F. Mq B r i 1 6.R..,w.me '. ..
ADDRESS P.O. Bl;x"1040 .._ • .
CITY/COMMUNITY/STATE/ZIP•PA
pAL,r,J7l�.a�,,,�_�p,,� Villa JOB SITE ADDRESS/SPACE '53-915 Avenida Villa `• .
CITYy/CCOMMUNI)TY/STATE/ZIP T „� - QU „ta, . C 92253
SE" +• \L, .7RNG
OK
PAG PAG13
PRCZ'
1LOT9
CC
TWN7 'L
SE,
S.
TRACT
SMI Flee 6.65.
MOD
SB
-
TRACT NAME Nom-
OWNER NAME (L, F. Ml) y i Cant
CONTRACTOR -FIRM NAME Rick' ..JoL...wn yWiL7t. • • .. •.
/�.,�.
ADDRESS P.O. Box 2288 ... -
CITY/COMMUNITY/STATE/ZIP lt&o ^T C3 ria®•, ,
.•�LL11 LtUU�d.' ILIlJa7�'I1669 1
PHONE 347-71:71
- '
ARC/ENG FIRM NAME '
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE I
J
-
T.
LICNC
-
USE OF PERMIT: y
S Za r+ .T� f • 1' : .'• .
• L.'...�.•.
BL -.
ZON
FSB
SSB
r1
• SSB
RSB
OFC .•
ZONE ORD .
„ ['•
LOT SZ -
1 END '
- SIDE:.
•APPL/PRMT FAt7 '•JL""DIE••H5
SFn ,.
Peanit to construct 1592 sq.' ft.: of S.F.D.
-91 sq. ft. --of porch and 4,30 sq. it.ot
garage as,per approved n1ans.'
Mech.- Fee 22.00
Plan.Chwk Fee
4 �
Elect. Fee. 43.1.3
SMI Flee 6.65.
Plurnb3ng.Fee f 50.50
Prap.'Devel..Fee 450.00
(250.00)
-
Pd. 12/14
� . - ..1,0//6 5•://8'S// .
A166 /-a/
#trr ♦fir "' _
.. , BLDG. DEPT. - a
• � TOTAL'
FEE
'.. ,.. - •[
• +" - .�. '�� '.
.s
ION-
'. VALUAT_�j�
�..
NO.
OPERATION DATE INSPECTOR
NO. OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33 Ventilation System
2
Ftgs & Frms
34 Plenums & Ducts
2A
Slab Grade
35 Furnace Compart.
3
Steel
36 Inlets & Outlets
4
Grout Blocks
37 Combustion Air
5
Bond Beams
38 Compressor
6
Roof Deck
S
39 Appl. Clearance
7
Framing
40 Fire Damper
8
Vents
41 Smoke Detection Device
9
Garage Fire Wall
42 Commercial Hood
10
Fireplace P.L.
❑
43 Final
10A
fireplace T.O. ❑
NO. . N ADDITIONAL INFORMATION
NO.
Fs
� A -s-
i
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall 2 & 2
13 Finish Grade
INSULATION Thick R •
Value
7A Walls (Batts)
128 Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal. 42�$
20 Sewer
21 Water Heater
22 Water Softener
23 -Water Service
24 Gas Test
25 Final
Tank Pit - L. Line
'ELECTRIC APPROVALS
-REAR OF PROPERTY LINE
PSL P/I
r
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 " Final
JJ%\f1EO.s.
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o , \w l//
oo
I)eeert .Sands
.` Un �ied.. School District
y 9ERMUD4'DUNES.r
RANCHO MIRAGE
82.879, HIGHWAY 111 O INDIO, CALIFORNIA 92201.5678 0 (619) 347-8631
r' INDIAN WELLS" <n
►-PALM DESERT a
J' -LA QUINTA
�p
January .l ] 1985.
IND 1.0 ' y�
City of La; Quinta :.
Department of Community
Development
78-105 Calle 'Estado
La Qui'nta, CA 92253
Re • 53-911,,5: Avenida Vi
1 l.a
'Gentlemen-:
The devel.oper of the
above, referenced - home
has mit 'gated. fts`i'mpacts,orr-our overcrowded schools by payment
of the amount-of $628
per-unit to be applied to the cost. of
district. educational
facJ'li`ties� made necessary.,by such. new
development.. .
Sincerely;
John `D. Brooks . -
Assi Stant: Super-intende.nt
Business•Servi;ces.:
JDB/crm
04
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RIVERSIDE COUNTY DEPARTMENT OF HEALTH
PERMIT APPLICATION'FOR A SUBSURFACE DISPOSAL SYSTEM
Applicant: Submit this form with three copies of a scaled plot plan drawn to county specifications required on the
attached check list. A non refundable filing fee of/$15 is required when the application is submitted. Check must be
made payable to County of Riverside:
Name
Mailing Address
City
State
Zip Code
Phone
'Property Address
'City or Community
'Legal Description of Property (Lot, Parcel Map, Tract) IT—
el
'Assessors Parcel No.
Property From .
Lot size
=Walerserving
1-7
0
Signature of Applicant Date
'The above information must be verified from Building Application
Staff Use — Do Not Write Below This Line
Initial Date
WQCB Clearance required Yes ❑ No O/ ��- 12,
Soils feasibility report required Yes ❑ No ®r
Detailed boring report required Yes ❑ No
Detailed contour plot required Yes ❑ No D"'
Comments:
Soils or boring report by ` `�-- Date ! I t
Approved by Date
Soils Map Page Soil Type Tract File No. Other
Number of Bedrooms
Septic Tank Size (gallons)
Rate Required
Type of System
'3
I GLIA
(�
�+ ��.. �
New Addition Replacement
O- 1:1 El
Leach line sq. ft. of bottom area trench
Leach bed sq. ff. df bottom area bed)
Seepage Pit Diameter
Number of Pits
Seepage.Pit Depth B.I.
Total Depth of Pit
5' ❑ 6" O=
f
`�
Location of System
Lt n
rtNCI
Additional Requirements Icp,�o fie.._
A permit is approved/depna:ed for the design of a subsurface disposal system as indicated on the accompanied plot plan
using the requirements set forth in Section B above. A building; permit is necessary for the installation of the.above
designed system. )
&� /
Signature of Health Official ( Date
Receipt No. Issued By
District: Riverside ❑ Indio 'Rl Hemet ❑ Date �•� ' �� ` Q 1`
DISTRIBUTION: WHITE - Office File YELLOW - Applicant PINK - Building Dept. GOLDENROD - Pending File
DOH SAN 122 (Rev 10/82)