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04126 (SFD)1 Building, Address 33-881 villa Owner Mailing Address 34-341' Denise City Fle p Ranio�ho Kira Contractor Address• 4- 341 Demise Way City Zip State Lic. & Classif. 295295 Arch., Engr., Designer Address - Y -44 P.O. BOX 1504, 78-105 CALLE ESTADO ) ` LA QUINTA, CALIFORNIA 92253 BUILDING:•TYPE CONST. OCC. GRP. A.P. Number.. •77+'"'17:"'019 Tel ' 328"'0.75 Legal Description Project Description • �' Tel. City ,.. Lic. #.. Sq. Ft....1522 , No. ' No. Dw. ; Size Stories Units New O ....Add O-° AlterE] Repair O Demolition O 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) 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 Mfirm 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, after, improve,, demolish, or repair any structure, prior to its issuance also requires the applicant• for such permif to file a signed statement that he is licensed pursuant to the provisions of flie'Contractor's License Law, Chapter -9 (commencing with Section 7000) of Division 3 of, the Business and Professions Code, or thathe is exempt therefrom, and the basis for theialleged 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 (8500). 0 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: TheContractor'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 orimprovement 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.) 0 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.) - 0 1 am exempt under Sec. B. 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 Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. 6 `.Company 0 Copy is filed with the city. 0 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 ($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. Date subject, caner,5 NOTICE, TO APPLICANT: If; after making this Certificate of. -Exemption you should become .. ZONE: BY: Subject to the Workers' Compensation provisions of the Labor Code; you must-forthwim r Minimum Setback Distances: . comply with such provisions or this permit shall be deemed revoked. ' "* _ - Front Setback from Center Line Rear. Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY A+, 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.) ; , r - -` Side Setback from Property Line Lender's. Name •v - = Lender's Address _ This is a building permit when properly filled out signed and validated and is subject to FINAL•�DATE INSPECT/OR + 0.' 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' 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: tot enter the _ above r wt + mentioned property for inspectionpurposes:' ; ' ,•5 f Validated by t r.�Signatureofapplicant H Date Mailing Address ,•Validation. +' ' t City, State,' Zip t j��� WHITE FINANCE T PINK APPLICANT,' GREEN r BUILDING GOLDENROD ASSESSOR'S OFFICE HARD COPY - FILE T t i • wN 4 K:r rri . .. .. I-._ r..1 .. r ,..... ^.4_+ti•?.... - ..ir. .Y _.'. .... r...!\.,..rL 11Y.. _ '.., •��t, X;. ..'. K>-: �:.Si'.:a...,-. n..... Wr: 4. 4+•.J.•:'. -. f'. -+..�4 �.., ... %pent f Estimated Valuation, pyhJ 992 .020 PERMIT AMOUNT Plan Chk. Dep.,-'- • 250.00 Plan Chk. Bal. p is Const..382 00 Mech. 33.00 Electrical .7 8.27 Plumbing S.M.I. i .70 Grading 20.0.0 Driveway Enc..Q .ari ' Infrastructure . _ w tt S TOTAL SL775.44 4 REMARKS. caner,5 NOTICE, TO APPLICANT: If; after making this Certificate of. -Exemption you should become .. ZONE: BY: Subject to the Workers' Compensation provisions of the Labor Code; you must-forthwim r Minimum Setback Distances: . comply with such provisions or this permit shall be deemed revoked. ' "* _ - Front Setback from Center Line Rear. Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY A+, 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.) ; , r - -` Side Setback from Property Line Lender's. Name •v - = Lender's Address _ This is a building permit when properly filled out signed and validated and is subject to FINAL•�DATE INSPECT/OR + 0.' 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' 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: tot enter the _ above r wt + mentioned property for inspectionpurposes:' ; ' ,•5 f Validated by t r.�Signatureofapplicant H Date Mailing Address ,•Validation. +' ' t City, State,' Zip t j��� WHITE FINANCE T PINK APPLICANT,' GREEN r BUILDING GOLDENROD ASSESSOR'S OFFICE HARD COPY - FILE T t i • wN 4 K:r rri . .. .. I-._ r..1 .. r ,..... ^.4_+ti•?.... - ..ir. .Y _.'. .... r...!\.,..rL 11Y.. _ '.., •��t, X;. ..'. K>-: �:.Si'.:a...,-. n..... Wr: 4. 4+•.J.•:'. -. f'. -+..�4 �.., ... CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL, SO FT rp S UNITS= A.C. UNIT COLL. AREA SLAB GRADE z YARD SPKLR SYSTEM 2ND FL SO FT. a ' BONDING HEATING (ROUGH) MbBILEHOME SVC. BAR SINK POR SO FTat SEWER OR SE ROUGH WIRING GAR SO. FT. to POWER OUTLET ROOF DRAINS FOUND. REINF. DRAINAGE PIPING CAR P. SO FT. gr HEATING (FINAL) WALL SO FT. C - DRINKING FOUNTAIN SO FT. fa EMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION S 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(AUTOXDISHI APPLIANCE DRYER . y GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LUMBER GR. LAUNDRYTRAY AIR HANDLING UNIT CFM. FINAL INSP. 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 (a1'A c SEWAGE DISPOSAL SO.FT.GAR rsg ;4c HOUSE SEWER GAR. FIREWALL 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 8 AIR COND. SOLAR SETBACK i r.,gAOUND PLUMBING % UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE z ROUGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SE ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) EMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM . y GRADING cu. yd. —plus—x$ = $ LUMBER GR. FINAL INSP. FRAMING 7127 !/ FINAL INSP. ROOFING %� REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH ^ F(41NSULATIONISOUND FINISH GRADING FINAL INSPECTION — �Y 0 CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL Desert Sands Unified School District CERTIFICATION OF PAYMENT r OF n��$GHOO�rpfVLITY FEES mo����. T��� �OCI AME'miBE QU Li �rs� TO: City of La Quinta DATE: Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 LQ LAI This is to C SX tify that - developer.of - , which is located at ��3- / // within this District, has paid school facility -fees imposed pursuant to the authority generate y Gov nment C de Section 53080 in the amou t of ' covering a total of square feet of •( re dential or ( ) industrial/commercial development'and that b.uilding permits for this footage in this development may now be issued by your jurisdiction. for DESERT SANDS•UNIF D SCHOOt DISTRICT White Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer i (10)-37 a Y '� T -,....-...; �� .. . ,. -v - •--may.- ,.r. -.,y .,..� .�.�.�i's,-,w:�i;� J.q ��,:w — 4:" S.Ei,s.:,+�, . j 1 � KQ Z O F— C) W U) ca Z ,O U Lu U) vf+� U) Y lr LLI cr LN Z O P-- C) =U W U) COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION 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 specifications required on the attached check list. A non-refundable filing fee of $40 is required when the application is submitted. Check must be made payable to the County of Riverside. Building Department Application Log # Name (Owner. Agent. Contractor. Etc.) Mailing Address "C V&ZA L l o hl � % 0 E5'11� City II J Slate C Zip Code `! VU7 0 Telephone 1 3Z�- Q `Job Property Address 'Cdy or. Community 'Legal Description of Property. (Lot. PM. TR) S3 Y 04 e- L 4 Qk CDT -1 13Cowe 7 - 'Assessor's Parcel No 'Assessor's Water Agency or Well Lot Size use of Permit Planning Case a _ A SFD. MH Sne Preparation Etc.114 Q %% Sign Lure of Applicant Date The above information must be venlied from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE Initial }Date r �,u ✓ ` t s '•' Certification of Existing S.D. System required. ❑Yes D No .. T I ^- WOCB Clearance required. ❑ Yes © No Soils feasibility report required. ❑ Yes Ei No i{ Special feasibility boring report required. ❑ Yes ❑ No t t Detailed contour plot plans required. ❑ Yes ❑l No t Staff Specialist approval required. ❑ Yes ❑ No Lot Inspection Date Soils/boring report by _'� ` r'"� Project # Date Soils Map Page Soil Type Approved by Date Type of System: No. of Bedrooms (1) Septic Tank Soil Rate Requiredr w 1 / "t_1 ❑ Existing [2�New El Additional ❑ Replacement -•�'N t �= %Gals. C,3a (2) Leach line sq. ft. Sidewall allowance Install Line(s)—Ft. Long, Leach bed Sq. (Bottom trench area) ft. rock/ Sq. Ft. Ft. wide with min. inches Ft. of bottom per running ft. ❑ N/A rock below drain lines area r Leach lines/bed-special design for slope: (3) Pit Diameter No. Pits Pit BI Seepage Pit total depth I Applicablet El 5'6' ( y Max. allowable depth NIA Overburden factor 1A IN r This application is(approved/denied for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements set'fbrth in Section B above. A building permit is necessary for the installation of the above -designed system. k --(l,) Septic tank and sewer lines must be 50' from any wells (2) Leach lines must be 100' min. from any wells including expansion area - J v ),V L< (3),>Seepage,pits.must be;150' rein. from any wells including expansion area y A,\r i- W, ­,r --s Signature of Health Official '"^'" Date RECEIPT NO. �U / District: ❑ Riverside XIndio Distribution: WHITE—Office file DOH SAN 122 (Rev 8187) Issued by 1%_,�G `y Date t ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File u y,S..( Buena Engineers, Inc. NUCLEAR GAGE RELATIVE COMPACTION FIELD DATA SHEET PROJECT: LOCATION: OWNER OR DEVELOPER: GRADING CONTRACTOR: a E C' 1-6 U 0 0 U)Z —i z LOCATION: A(. REMARKS: jz.�� I 79-811 Country Club Drive, Suite #4 Bermuda Dunes, California 92201 JOB NO.: SAMPLED BY:Al-I .01 1' 0112 -2t 2- ..'ti ... ,. _ .... ......... ....... 1... f CzCL (1) 0 0 CC (-) >1 2F- ., re- g(A- or 03033 V. t4o VvLkA.(21L-� W 539 1 g pi fn IF, ]I D TA 0112 -2t 2- -0 E CzCL (1) 0 0 CC (-) >1 2F- 0112 -2t 2- Vtk \rcv-p 2469 Signature LA'a D .BTU -0 16, JL -VV re- g(A- or 03033 V. t4o VvLkA.(21L-� W 539 1 Vtk \rcv-p 2469 Signature LA'a D .BTU