04872 (SFD)_ Qum&
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 52-080 Villa LA QUINTA, CALIFORNIA 92253
Owner - I
John Vale* * fir.
Mailing
Address 53-701 Velaaco
City Zip Tel:
Lu'. %inta 92.253 5'6.475.394
Contractor
4' er/lBuild r
Address
City lZip I Tel.
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer
Address—T—Tel.
CityI Zip I State I
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
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, atter, Improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file 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 civil penalty of not more than five hundred dollars (E500).
O 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 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 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. B. & P.C. for this reason
Date ��•{ 'T Owner' r • f
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I 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 if the permit is for one hundred dollars (E100) valuation
or less.)
I certify that in the performance of thg 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., If, after making this Certificate of Exemption you should become
subject 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 Code.)
Lender's Name
Lender's Address
This is a building 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 sof this city to enter the above-
mentioned property for inspection purposes.
Signatu4of applicant Date
Mailing Address
City, State, Zip
ILDING: TYPE CONST. OCC. GRP.
I. Number 773-234-005
Legal Description
Project Description•*�
Sq. Ft.
Size
New ❑
No.
Stories
6„4872
No. Dw.
Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
stimated Valuation
$76070
PERMIT
Plan Chk. Dep.
$250.0
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
AMOUNT
REMARKS
t
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback frors Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date 12/1`88 Permit
Validated by:
Validation:
WHITE FINANCE PINK APPLICANT; GREEN BUILDING, GOLDENROD - ASSESSORS OFFICE HARD COPY - FILE'
_�. Z'::,r r. ..,....�.+ :_, as... .... ..•+:,-...._c� ..••, .kw,r .. r.x�•: r.S].+e.l..ra .<•�x t':�• r1•=r 't_d!`.o.... h.:i,iS,. .. k.'..>.y, i�.+7.9it:. ..+..f:_a:'Y...r �..t5`. .,th.::.:c �.�§ _ __ _ _ T-
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT rp S
UNITS
`
ROUGH PLUMB
YARD SPKLR SYSTEM
2ND FL SO FT. a
HEATING (ROUGH)
STORAGE TANK
,SEWER OR SEPTI N
MOBILEHOME SVC.
BAR SINK
POR SO FT a
DUCT WORK
ROCK STORAGE
GAR SO. FT. Qx
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO FT. 0
TEMP. POLE
WALL SO. FT. (d
DRINKING FOUNTAIN
SO. FT. 0
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE, Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
plus xS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
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, 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 a IIA c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/:c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE YL.CK.FEE
CONST FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR
SETBACK
SLAB GRADE /2 - )—j -
FORMS
FOUND. REINF.
REINF. STEEL
GROUT
BOND BEAM
LUMBER GR.
FRAMING X10'
ROOFING
--1 I/6 —
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING .2—` 6
MESH
lbl,& ATIONISOUN!, � ,C JJ
FINISH GRADING l
FINAL INSPECTION
CERT. OCC. JJJ d
FENCE FINAL
GARDEN WALL FINAL
GROUND PLUMBING /�
UNDERGROUND
A.C. UNIT
COLL. AREA
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
,SEWER OR SEPTI N
ROUGH WIRING
DUCT WORK
ROCK STORAGE
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
GAS (FINAL)
TEMP. POLE
WATER HEATER
SERVICE
FINAL INSP.
WATER SYSTEM
S
GRADING
cu. yd.
plus xS
= E
(SLv�
INAL INSP. �
FJNAL INSP.— § _
V
REMARKS:
�» 1
J ( IC
I —
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
SCHOOL FACILITY FEES �Grl
NOVICE: THIS 1)CCURRET CA
N O/� c�
Q
TO: City of REQ 1n6 .�C���� �4�T DATE:
Department of Community Development. ,
78-105 ('?lle E31 -ado
La Quinta, CA 92253
This is to certify that
developer of. which is
located at'
within
this District, has.paid school facility fees imposed pursuant to the
authority g Hera d by Government Code S c��n 308Q 'n the amou t Of
%
s o (
covering a total of square feet o_f ) residential or
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
�o� cel 1P 1 3)l x O'p % _ 109 7l6b.?
--#,- 13*� for ESERT 'SANDS UNIFIED SCHOOL DISTRICT
White - Building Department • Yellow Facilities Planning • Pink - Accounting 0 Gold - Developer
(10)-37
COUNTY OF RIVERSIDE DEPARTMENT OF•HEALTH Assessors 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 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-irrm'IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'*
Z
' 0 Agent, Contractor, Contact Person Phone Address & Phone
wOwner, Phone Mailing Address
abdt-LVE.Ln 3p- _51A
city State Zip Job Property Adder, Legal Description Prop. (PM, Tract, Lot)
�tLl C �� Tiles C-W OFdlA� (//tc,4 LOT I0..:tN V!�tt�Q�- Cr s►aP lq
Lot Size "ter Agenc Use of Permit P/P, CU etc.. U/ Other,f
G��Fa$M p-Li
welli g, H Sit Prep, etc.
Signature of Applicant
Date
CATEGORY: _� r =REV CODE CATEGORY: REV CODE FEE
C?�SUBSURFACE DISPOSAL` 1238 $45.00 ❑ SITE EVALUATION UPON REQUEST 7349 $42.00
❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN)
Z LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
F 0 a 1 at 4 Parcels (Each) 1238 $45.00 (Less than 1 year)
U. b. Each Parcel after4 7344 $16.00 ❑ PRELIMINARY ELECTIVE 7352 $45.00
lL ❑ Rereview (2nd review same parcel) 7344 $16.00.' EVALUATION (Attach DOH SAN 53)
❑ Site Evaluation in Conjunction with ❑ HOLDING TANK 7351 $45.00
t, Critical Area 7346 $86.00 ❑ ALTERNATIVE/EXPERIMENITAL 7345' $13200
❑ Site Evaluation Lot Less than SYSTEM
10,000 Sq. Ft. 7347 $86.00
r..
' I ITIF.L DATE
Holding ov
Tank Agreements Completed O Yes C��No� •(may t--
Certification of Existing S.D. System Required ❑ Yes E-10No
1
WOCB Clearance required. (Attach Form ❑ Yes '0
DOH SAN 007, Santa Ana Region Only)
Soils Percolation; Report Required. ❑Yes
z �Special,Feaslbilify Boring Report Required. ❑ Yes ❑`No tt
' `Detailed Contour Plot Plans-Required (1 to 5 fl. ' interval) ❑ Yes - i
x Other ,
❑ Yes N
Specialist Lot.Inspection Required ❑Yes �No
s" Lot Inspection Date
s: S011s boring report by" ( #
ate
.,; Soils 'Map Page n{ son Tvi L Approved by D Date
. +E 1
f U f .: No of Sjisbma : Type of Syatem(s) No. Dwelling Units 1 (1) Septic Tank Soll Rate reeae /Sand
a , s Z tag z sY« ❑ulding Tank. ❑Existing Bedrooms, Flxfire hlntta _ 'Giease Intrp
K £ : New ❑Replacement 76104 N'l i9ib4 r ' A
Gel
' fes t Urie Segr�Ft Sidewall albwance Install Une(s)Unti(s) � ry Tong a wide with Leach Bed sq. ft. '
.. ft rocW R min. Inches rock'below drainlines or hof Hatt area
per runningft
�P
bra ` Leachl r s/bed special design foisbpe �(3)IF it Diameter � No: Pits ~Pit Bebw � Seepage Pit Oar,
*?� j 3 l , " Inlet (BI ' �l aKS�a�
a zN/A "Overburden factor y Y a jE(� Max Allowable Depth
,. { i
�.NO a 2 System a� -. .tA ` ..c x ry-w a ;: u•T ,'� ,� ..- � � .. ,
1 rt �,�.- . j s rA r i 1 5" 4 a�.�4 ttij !.f ay * � § �. �•:.ai" ' i � A k� '. � i y - +Y !_ c, r s - Y� -
4 ,4 'f � 'Y �j{�4gl.• .'�R f . " ,} rT•+ N �� � L� J � � T 'W. T i_ 4,�.
'+. �Y Y, 9. -;wf T !N: ."i } i i3 '.,_L. ,fyr F•` ti ' t a R 'Y>'
f �
y
f t! �; This application'is�PP.ROVED� EM171ED fonthe category checked m SECTION B above, regarding the design of a sut_surface disposal system as indicated
0 w.pn' he-accompanied�plot plan using thegrequirements* set-forth in SECTION:. C above. Abu lding `permit is necessary for me_installa4ion of the.
0 atxwe desigrred system. "No construction,is permketl m the regwred re-seryed,10096 expansion area. '
-. ...
tank and sewer Imes must_ be 50 mirnmum trom any ,wellst—
��✓j ,� �. U �� Leachtilines must`be 100' mirnmum from any wells �;includ�ng, expansio ar /�
3 See e its must 150 mirnmum from an wells_; mcludmg expansion areal v
; s�;E '� .'i. 's+-..;� �, ,y ��ryb.a� r��� ,2 _� f 1!-; -,. ,.p. --'�.P.ls a/ -..2a-r•tiJ S ��-
x 't �" " Si nature of Health Official' : ' •� ��1 �4 Date KJ L'. �"'Qe/. a/� tci it
t �• y
s s a: Sr
l�r3 s//17
F r 6 Issueif,BY
y
Riverside,•ICS radio ❑ Hemet ❑� Perris: ❑ "Ran Calif. ❑ Blythe Y
5/88) DISTRIBUTION: WHITE - Offiicefile YELLOW Applicant PINK`- Bldg. Dept GOLDENROD - Plans/Records
i NR-s..-..�,,,�!'"�+�,k'k;�%1"��yCv.. f'1��x'�iy,k�'���+Ft`tAz`*�`.#"�iil'�� r� �* ��yvl.7d+i'_vw2T;'y+�•�rw•,�ed.v++Y+•N.;.y+•" r:ynry:>a,�,
A v v
i '-A
Buena Engineers, Inc.
9 ,
79-811 Country, Club. Drive, Suite 4
Bermuda Dunes, CA 92201 • (619) 345-1588 / 328-9131
Client
Client Address
Client Phone
DATE QQ, ..
/ 18
JOB NO.
3 7'- /o 5-?) -�
PROJECT
z -000��
ELEVATION
LOCATION
G �•
REFERENCE CURVE
CONTRACTOR
�A j7-
OWNER
WEA HER TEMP.
U at AM
° at PM
PRESENT AT SITE
°
TEST
NUMBER
TEST LOCATION
LOT
NO.
ELEVATION
FIELD TESTING
REFERENCE CURVE
MOISTURE
CONTENT
%
DRY
DENSITY
IbsJCu. ft.-
MAXIMUM
DRY
DENSITY
%
MAXIMUM
DRY
DENSITY
IbsJcu. ft.
OPTIMUM
MOISTURE
CONTENT
%
°
z
e
.:=•b'R',x..'',a.C,'41
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REMARKS: 46 w, 2, rt 7.5 Q,
Zpci cY 41 c" -(ar M r,( dahS
S v//P t c
iJ
,n 2=8� Mart r �� t3 fel' o/'` -r were! -9*W'—�
( N- I d Ah LAJ b" 00d
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,% CLIENT REPRESENTATIVE SIGNATURE
.J ! 1
FIELD REPORTa
TECHNICIAN -3 SIGNATURE.. w �'