001329 (SFD)APPLICANT NAME (L: F. MI)••wi,•j "Cern jte� .. i
ADDRESS 50-223 may 86! `•Y#29
= PERMIT APPLICATION-
• - City
of La Ouinta
+ °. ! Department
of 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.
^
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: Thissection need not be completed if' `
• ,LICENSED CONTRACTORS DECLARATION:1 hereby affirm that I am licensed under provisions of Chapter 9
..the permit isfor'one hundred.($100) o, less: I:certif; that. in the performance of the work for which this permit.is • "
' (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
issued; I shall not employ any person in any manner :o as to become subject to the Workers' Compensation Laws of
and effect. ,'
California., ,
License Class Lic. Number
Date Applicant—
pplicant
Date - • "-' Contractor •
Date
NOTICE TO APPLICANT.: If, after making this Certifipteoffxemplion-you should.become'subject to the Workers' '
'OWNER -BUILDER DECLARATION: 1 hereby affirm that I am exempt Irom the Contractor's License Law tor.the
` . Compensation provisions of the Labor Code, you must forthwith comply withsuch provisions or this permitshall .r>
- following reason (Sec. 7031.5. Business and Professions- Code: Any city or county.which requires a permit.to
+ fie deemed revoked:;, .
cconstruct. alter: improve. demolish. or repair any structure; prior to its issuance: also requires the applicant for :'
�' .. .DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:'
such permit to file a signed statement that he is1icensed pursuant to the provisions of the Contractor:s License Law. •
':01hereby certify that 66excavationfive(5)ormore feetindepth into which"a person is required to descend,willbe
•,.. (Chapter 9(commencing with section 7000) of Division 3 of the Business and Professions Code) or that heis exempt.
made in connection with work authorized by this permit; and that no building structure, scaffolding; falsewoik, or
'therefrom and the basis for the alleged, exemption..Any violation of Section:7031.5 by any:applicantfor a permit
-`demolition or dismantling thereof, will be more thanthirty-six (36) feefhigli`(Chap 3.2, Grp 2, Arf 2, Sec 341, Title B:
subjects the applicant to a civil penalty of not more than five hundred dollars (S500.): -
C.A.C.) "v. ,
:1 0 I, as owner of the property: or my employees with wages as their sole compensation, will do the work, and the
b As owner•buildei, I will not employ anyone to -Jo work which would require a permit from the Division. of
structure is not -intended or offered for sale (Sec.,7044, Business and Professions Cdde: The Contractor's License,
Industrial Safely, as noted above: unless such per son has a permitlo 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: II; however, the "
' - 0 Division of Industrial Safety Permit No. '
.building or improverrint is sold within one year of completion. tlte.owner-builder will have the burden of proving that
Date --,Applicant'
Oe did not build o; improve torthe purpose of sale.),
-CONSTRUCTION LENDING AGENCY: I hereby affirm 'hat there is a construction lending agency for the.p'erfoimance
•❑ I; as owner of the property, am exculsively'contracting with licensed contractors to construct the project (Sec.`.
of the work for Which.this permif is issued (Sec. 3097, Civ. C.).••
• 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 tot such projects with a contractor(s) licensed pursuant to'the
Contractor's License Law.). _
Lender's Address
' 0 I am exempt under Sec: " B. 8 P.C. (Attached Certificate).— •%A certify that I.have read this application and slate.hat the above information is correct. I agree to comply with all
Date ` ` /�' 'S Owner jt ' %A� (? �Z2 '/ y' ^' .city and county ordinances and state laws relating -o building construction, and hereby authorize representatives' :
of this county to enter upon the above=mentioned property for inspection purposes. ;
i WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure; ora
,certificate of Workers' Compensation Insurance • or a certified copy thereof (Sec.'3800. Lab. C.)..
Signature of App'Iacant 6rAgent Date
Policy'No Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATIO11 OF ENTRY: I certify I have read this application and state that
' 'O Certified copy Is hereby furnished. ..
the information given is correct. I agree to comply with all state laws and county ordinances relating to•buidling ;
*
O Certified copy is.filed with the City Guiding Inspection' Departmentor City - ^Department..
:.construction, and authorize a'representative of the City of La Ouinta Department of Building and Safely to enter
upon thhee property for which I have applied focthi; permit forthe purpose of making inspections.."
• Date Applicant
O fit. • '.C. ff'j�l: c �d i C! .4.i L.�i `✓ - '% rte- .CP S".
n., ...!
�, . r- • ,-
Signature of Applicant or Agent Date
—
Print Applicant/Agent Name -
APPLICANT NAME (L: F. MI)••wi,•j "Cern jte� .. i
ADDRESS 50-223 may 86! `•Y#29
CITY/COMMUNITY/STATE/ZIP -
•.0 wchella, CA .92236.
JOB SITE ADDRESS/SPACE- ` -
• . 52-410 Avenida Villa
CITY/COMMUNITY/STATE/ZIP ' •' - r .
la Qui nta; CA 92253
BOK -
773
PAG %
274
PRC
008`
C
TWN -
-
RNG
SE
S
TRACT
LOT
yy�
Electrical Fee
MOD -:
'SB
TRACT NAME '
OWNER'NAME (L, F. MI(• + -.
Applicant
CONTRACTOR•FIRM NAME •' '
Apiicant y'
ADDRESS •. -
abave. .
CITY/COMMUNITY/STATE/ZIP'•
above -
PHONE .
250.00`-1PD. DEPOSIT
LICNC II
1,055.17'
+ARC/ENG FIRM NAME - - - -
ADDRESS -
CITY/COMMUNITY/STATE/ZIP
PHONE M '
_ . •
tY
LICNC .
1'; 305:17
USE OF PERMIT Single
y Mgl e. .C..,...i l y .1-�..'� 1 in
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SL ,
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FSB
, SSB
SSB •` -
.RSB " `
.OFC
':20NE ORD'.-,,,.
, •LOT SZ•'
.: END
SIDE,} ,
APPUPRMT•'{'�j �(''} (•{J `
' -fi�l A� 7t4Iw
' DAATE
4�17-85 •S.F.�• fr a,
+_ pewlit to =mtruct
1320 sq. ft. of
muse plus 560 sq.
ft. of 'parch and'
. 440 sq. ft.'of.garage as per approved
plans•
.
Mach. Fee
44.00
Plan Check' Fee _
300.96'- • -
: Const. Fee.
352.00 -
Electrical Fee
62.10 •
" Fee'
Plumbing Ftee.•
'91.00 -
Prop. bevel. Fee
450 0 00 - •
250.00`-1PD. DEPOSIT
•
1,055.17'
_ . •
tY
TO
IFlee
1'; 305:17
n A07.38� 4. .18
1. BLDG. DEPT..
VALUATION 72,668.00
T_
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION I DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
�p
35
Furnace Compart.
3
Steel
G
36 .
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
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.
❑
OP'N
NO.
ADDITIONAL INFORMATION
DEC 7
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall 717
13 Finish Grade
INSULATION Thick R"
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb a1�
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final `
Tank Pit L. Line
ELECTRIC APPROVAL
REAR OF PROPERTY LINE
P/L P/L
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
%k%FIEp
i %o Desert
Sands Unified School District.
a BERMUDA DUNES r
'92201-5678
RANCHO MIRAGE _� 82.879 HIGHWAY 11 1 ® INDIO, CALIFORNIA ® (619) 347-8631
INDIAN WELLS H
10 .PALM DESERT -b
February 20., 1985
IP LA OUINTA
40 INDIO
City.of Palm Desert
73-510 Fred Waring
Palm Desert, CA 92260
Re: Parcel 102, Lot 15 (David
'Cervantes)
Gentlemen:
The developer of the above referenced
lot
has mitigated its impacts on
our overcrowded schools by
payment of the amount of $628
per unit to be applied .to the.
cost of district educational
facilities made necessary,by
such new development.
Sincerely,
r., -7K
John D. Brooks
Assistant Superintendent
Business Services
JDB/crm
COUNTY OF RIVERSIDE, DEPARTMENT OF HEALTH
PERMIT APPLICATION FOR A SUBSURFACE DISPOSAL SYSTEM
Applicant.ySubmit 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 $15s required when the application is submitted. Check must be
made payable to County of Riverside.
Name
Mailing Address
/
fio, , l 'L? � 0 A
-5 -U n -0 3 A/
City
State
Zip Code
Phone
Cn,4(-,� e/1
C
f_ -)D �sG
3 7Z - 7 7/%
'Property Address
f y or Community
'Legal Descrlptio�nt�of Property (Lot, ��cel Map.
�' f 4'bC.�+✓iliF G�G1+.4f *�`
N/ 0 e-
OC.4-'
'Assessors Parcel No.
Water Sdrving/Pr�operty From 1
Lot size
Signature of Applicant Date
"The above information must be verified from Building Application
Staff Use — Do Not Write Below This Line
Initia. Date
WQCB Clearance required Yes ❑ No ED ��� t 0'
Soils feasibility report required Yes ❑ Not
Detailed boring report required Yes ❑ No El
Detailed contour plot required Yes ❑ No [�
,Comments:
Soils or -boring report by '? Date
Approved by ? a �I Date
r � C�v�G
Noel
Soils Map Page Soil Type Tract File e70 O r
Number of Bedrooms
3
Septic Tank Size (gallons)
Rate Required
Type of System
New Addition Replacement
A-�-
,�� ����'��'
oma°'"o ❑
Leach line sq. ft. of bottom area trench
Leach bed (sq. ft. of bottom area bec)
Seepage Pit Diameter
Number of Pits
Seepage Pit Depth B.I. Total Depth of Pit
Locationof System
Additional Requirements / J
/ Vii! �if. 1. �w� , flJ` �s C.L�
/ !r
�f'�ri(,i.f11�f
/�✓....c-r.
�,f
c.x..//.� ,/��,�' /l-�i'{� %"�'Y.;�,d...f..�;Gc.�,..y� �) �I7✓�iU-��S,i'1 oYis--s�-T•-
A permit is appro ed• de.n:ied for the design of a subsurface disposal,"Wstem as indicated o -i the accompanied plot plan
using the requirements set forth in Section Babove. A building permit is necessary for ":he installation of the above
designed system.
Signature of Health Official j Date
Receipt No.
,4G/3/z-4-
District: Riverside ❑
DISTRIBUTION: WHITE - Office File
DOH SAN 122 (Rev 10/84)
Indio 0---, Hemet ❑
YELLOW - Applicant
Issued By
Date
PINK - Building Dept. GOLDENROD - Pending File
r/