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002012 (SFD)Building Address 9;7•.740i Axprtfr3m aiJ Owner F3 S�1 0 Mailing Address .P.o. a= 5635 City Zip ?ai.1l xt m 92635 Contractor Aaaress .... . P.O. 5635 City .. Zip Ptallt�cbl� State Lic. & Classif.B1 .. 13SfllSIR -Arch., Engr., Designer Address City Zip I • • L I hereby affirm that I am 7000)of Division 3 of the effect. - 1, : e& 32635 CONTRACTOR'S under provisions' and Profess.ion_'S t P.O. BOX 1504 No. UU;!UJZ 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 BUILDING: TYPE CONST. V OCC: GRP. PI -1 A.P. Number 773-274-003 525-8385 Legal Description 20 Project Description Side fmaly dimilim, an'd WR 111,. 525-8806 I Lic. # Tel. State Lic. # 9 (cbmrtiehcinq with I . • UWNhK-UUILUtKA tOL'ARA1ION j • :I heregy`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 MG 1344 Siz Sq. eFt. 480 No. Stories No. Dw. Units New .® Add ❑ Alter ❑., Repair ❑ Demolition ❑ Estimated Valuation permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also requires the applicant /or. such permit to file a signed statement that he is. licensed pursuant to PERMIT AY AMOUNT- the 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 - Plan Chk. Dep. •• A 250.00 . 'subjects the applicant toa civil penalty o/ not more than five hundred dollars {$500). I, as Plan Chk. Bal. ' 51.00 ❑ 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 r sale. (Sec. 7044, Buisness and Professions Const. 00 Code: The Contractor's License Law does not apply to an owner o/ property who builds or improves thereon and who does such work himself or through his own employees, Mech. . yr•� provided that' such improvements are not intended or,offeretl for sale. If, however, the bultding' or improvement is sold within one year o/ completion, the owner -builder will have. the burden Electrical AA of proving that he did not build or improve for the purpose o/ sale.) O I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing �(. 00 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 S.M.I: - :�� 09 such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ' Grading❑ I.am exempt under Sec. B. &P.C. for this reason 20.00 Driveway Enc. 20.00 Date owner Infrastructure 1+.089.1 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 0 Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL. CERTIFICATE OF EXEMPTION FROM REMARKS 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 manner so as to become -subject to the Workers'Compensation Laws of California. Dale Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should became "of ZONE: BY: subject 'to the Workers' Compensation provisions the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances: " Front Setback from. Center Line Rear Setback from Rear Prop, Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 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.) Side Setback from Property Line Lender's Name Lender's Address 'This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR expiration if work thereunder is suspended for 180 days. I cartify.that.l have read this application and state that the'above information is correct. Issued by: Date Permit 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: /J ; j Signature ofapplicant^��'- it"1^ / ?fF+'D�' /Validated by: Mailing Address,�y' % Validation: City, state, 'Zip y �� A4003 1 28 1734,46 CK HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. ® POR. SQ. FT. ® GAR. SQ. FT. ® CAR P. S0. FT. ® WALL Q. FT. ® SQ. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation SLAB GRADE FLOOR DRAIN MECHANICAL FEES BBONDING WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER SEWER OR SEQC GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM FOUND. REINF. 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 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER BOND BEAM WATER SYSTEM 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 PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE R1OUGH PLUMB. —,12,1 BBONDING HEATING (ROUGH) STORAGE TANK /,FORMS � Z 7 SEWER OR SEQC K r v / �/ //HOUGH WIRING Z/Z, DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) -)"&&P. POLE -2-1 Z06 GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM $ GRADING cu. yd. pI us x$ =$ LUMBER GR. FINAL INSP. FRAMING 'z Z / 6 FINAL INSP. ROOFING — DEC 17 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INbFLUI UH"5 WUNA1 UM blINII IALS. GARDEN WALL FINAL Tr+04t� P 37 io ka Building Address Owner i Mailing Address T• A. P.O. BOX 1504 APPLICATION ONLY 5a'a ' 78-105 CALLE ESTADO V10s LA QUINTACALIFORNIA 92253 If , L-4 - ino-- U/A/ I ( Contractor ( 0 Address/ City, . LLL�2 1-0/J State Lic. & Class i f�O-S/ - 'Arch., Engr, ', Designer Address Lic. # -BUILDING: TYPE CONST OCC. GRP. A.P. Number -7-73- Z 77 Legal Description'/"o ;16 r, Project Description Sq. Ft No. No: Dw. Size 12 ..Stories Units` New Add 0 Alter 0 Repair 0 -Demolitio6 0 'City -7-7zip State Lic. # LICENSED�_CQNTRACTOR'S DECLARATION I herebyaffirm/that I am licensed under provisions -of cepter 6 (COMM, encingwith Section 4v�'Sion 7 3 of the Business a d f6ssIons­C6dF,— 8 -my licen4G 000' of _4r -Urin full force and - 7 affect. SIGNATURE' DATE - OWNER -BUILDER ECLARATION I hereby affirm -that I am exempt C ntractors License Law for the following Estimated' Valuation reason: (Sec. 7031.5,Business and -Professions Code: An 'requires a y,01 or county which vrepair permit to construct, alter, improve, demolish, or -any structure, prior to Its Issuance, also requires the applicant for such permit, to file a signed. statement. that -he. is licensed pursuant to -PERMIT oO'- AMOUNT 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 Any Section 7031.5 by 'any fora Dep. alleged exemption. violation of applicant permitPlan-Chk. subjects the applicant to's civil penalty of not more than five hundred doflars,($500). - . .0 I Plan Chk.` Bal. 1, as owner of the property, or my. employees with wages as their solb compensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and C6nst. 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, Mech. 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 L Electrical of provingthat he did not build or Improve for the purpose of sale.) O 1, as"owher of the property, am exclusively contracting with licensed contractors to con- Plumbing 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' S. M. 1. such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading 0 1 am exempt under Sec. B. & P.C. for this reason Driveway Enc: Date Owner Infrastructure WORKERS' COMPENSATION DECLARATION LZ —,- I hereby affifrn that I havd'a certificate of consent to'self-insure, or a certificate of Worker's Compensation lnsurance; or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. company - 0 Copy is filed with the city. 0 Certified copy is hereby furnished. TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS 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 thp 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. .- — _e Date_L_�_O wner NOTICE TO APPLICANT.Jf, after making this Certificate of Exemption you should become ZONE: BY: subject tothe Workers' Compensation provisions of the -Labor Code, you must forthwith comply with such pro visions or this permit shall be deemed revoked. Minimum Setback Distances: —Front Setback from.Center Line —Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY —Side Street Setback from Center Line I hereby affirm that there is a construction lending agency for the performance of the work ch this permit is issued. (Sec. 3097, Civil Code.) Side Setback frcm.Prooerty Line ,Lender's 'Name Lender's Address FINAL DATE INSPECTOR CITOR - This is a building permit when properly filled out, signed and validated; and is subject to expiration it work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. Issued by: Date Permit 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. Validated by: Signature of applicant Date: .Mailing Address Validation: 'City, State, Zip A 3 7 1 1 1 91 2 5 0. 0 0 CK BUILDING DIVISION CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINCo FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE 2ND FL. SQ. FT. BONDING YARD SPKLR SYSTEM POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS CAR P. SQ. FT. GAS (ROUGH) DRAINAGE PIPING WALL SQ. FT. ® OTHER APPJEQUIP. DRINKING FOUNTAIN SQ. FT. ® TEMP. POLE URINAL .ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. 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. SQ. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL GAR. FIREWALL SQ.FT.GAR ® 3/ac HOUSE SEWER LATHING 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 PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB 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 APPJEQUIP. 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 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH I NSU LATIONISO U N D FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL 4tO F D i o r Desert Sands [Jni:�-ied S.- o0 'District =' y BERMUDA DUNES , RANCHO MIRAGE 82.879 HIGHWAY 1.11 0 INDIO. CALIFORNIA 92201-5878 0 )s19) 347.8631 ,INDIAN WELLS a , PALM DESERT J` LA OUINTA d �o a INDIo January. 7, 1986'. City of 1a .Qui nta , Department,of,Community Deve.l'opment 787105 Calle Estado.. , La Qui'nta, CA .92253 i Re:':'Lot 20, Blk 102; Unit 11 ; Gentlemen: { The developer of the above referenced. lot ' has mitigated its impacts-on our.overcrowded schools by.payment of the .amount of -$628 per un�i t to be applii,ed .to the, cost of district educational.Ifaci'li,ties-made'necessary:by such new deve 1 opmen.t. Sincerely, - John:-.D..Brooks Assis.tant'Superi.ntendent Business;Servires ; „•. JDB/crm - ---- - Q Z O H U W to to Z O I1 -- U U w N U Z 0 H U W Cn COUNTY OF RIVERSIDE, 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. NameMailing 1Z IV 7_ Address City State Zip Code Phone 101 'Property Address %, /• City_or. Community 'Legal Description of Property (Lot, Parcel Map, Tract) KL),g i /�" ,L D 7 ,� /D �. 61 Al /7` 'Assessors Parcel No. -- 0 3 - Water Serving Property From Lot size 6� %F,�.JQ. ✓t.�J..,Pl, fs, .Fi�'-.GPS.. .i'i ��A O.J�/ � Gi R/ .. Signature of Applicant Date 'The above information must be verified from Building Application Staff Use — Do Not Write Below This Line /"Initial Date 74 WQCB Clearance required Yes El No Soils feasibility report required Yes Cl No ® H Detailed boring report required Yes ❑ No ❑ Detailed contour plot•required Yes ❑ No ❑ Comments: Soils or -boring report by Date Approved by tin �„ , Date Soils Map Page Soil Type Tract File Number of Bedrooms`peptic Tank Size (gallons) Rate Required Type of System New Addition Replacement Leach line sq. ft. of bottom area trench Leach bed (sq. ft. of b"ottom area bed) Seepage Pit Diameter Number of Pits Seepage Pit Depth B.I. Total Depth of Pit AF Location of System Additional�+Requirements (/�-� �/7�I 'r7 (Y • // e%" ��✓' ( ..% ,/f� vC--�k�,f�� s' A permit isfap-proved/den:ied 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 bove designed system. _ Signature of Health Official Date Receipt No. � �� � �% Issued By District: Riverside ❑ Indio © Hemet ❑ Date DISTRIBUTION: WHITE - Office File YELLOW - Applicant PINK - Building Dept. GOLDENROD - Pending File DOH SAN 122 (Rev 10/84) I