003359 (SFD)r
I CAV
P.O. BOX 1504 No. .003359
Building 78-105 CALLE ESTADO
Address 53-901 villa LA QUINTA, CALIFORNIA 92253
Owner
Jesse Jimenez BUILDING:' TYPE CONST. OCC: GRP..'
Mailing
Address r,r. rnrrgnn Blvd. A.P. Number 774-173-020
City Zip Tel.
India 92201 342479 Legal Description
Contractor. Project Description S'�3 qle FaMTy 6 el I ing
Fmniria Coinstrut ficin
Address
84-336 Margarita St.
City Zlp . Tel...
COACA;; 92236 398-2153
State Lic. City
& Classif. Lic. # Z15 Sq. Ft:No. No. Dw.
Arch., Engr., T _, Size •3? Stories Units
Designer New D Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
#30+ Porch
City Zip State 498! Germ
Lic. #
LICENSED CONTRACTOR'S DECLARATION 2120; Fenee ~
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. .
4�'SIGNATURE `, " DATE _
. LJ j OWNER -BUILDER DECLARATION Estimated .Valuation t
.F
I hereby affirm that I am exempt from the Contractor's -License Law for the following lv7ry�
reason: (Sec. 7031.5,Business and Professions Code: 1t Any .city or county which. requires a ff .1 • ,.
permit to construct, alter, 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 PERMIT • AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of - - �e�
Division 3of the Business and Professions Code, or thah 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.2�• '
• subjects the applicant to a civil penalty'of not more than'five hundred dollars ($500). ,•�
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal:42.10
• 10
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and�t n
Professions Code: The Contractorapply do an owner' property who �J
's License Law does not Const' ��� • 0
:
builds or improves thereon and who does such work'himself or through his own employees, .Meeh. ` 3
,provided that•such improvements are not intended or offered for sale. ff, however, the.budding •
00
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical • - -''
of proving that he did not build or improve for the purpose of sale.) -
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 105.0
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: r
such projects with a contractor(s) licensed pursuant to the Contractor's License Law:) • • - 3
Grading 201
%•4
0- I am exempt under Sec. B. 8 P.C.- for -this reason ��•��
Driveway Enc.
Date owner Infrastructure 1.132.44
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. .
TOTAL S2. (h.-:. 29 1.801.19
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 fr w{5y j v it
Laws of California.{i *}t f {r y;( j , •)
Date Owner "
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 forthwith 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 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 SetbackfromProperty 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 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: DatePermit
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 properly for inspection purposes. Validated by:
Signature of applicant Date .
Mailing Address Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SQ. FT. ®
POR. SQ. FT. ®
GAR. SO. FT. ®
CARP. SQ. FT.
WALL SO. FT. ®
SO. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
tiG FORMS lV —
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
` EMP. POLE 16-9—
6— —GROUT
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
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 ® 11/4 c
SEWAGE DISPOSAL
REMARKS:
SO.FT.GAR ® 3/ac
HOUSE SEWER
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 tJ —
GROUND PLUMBIN96-!>-�
UNDERGROUND
A.C. UNIT
COLL. AREA
24KSLAB GRADE
ROUGH
BONDING
HEATING (ROUGH)
STORAGE TANK
tiG FORMS lV —
1PLLU'MB.
SEWER d W K
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
` EMP. POLE 16-9—
6— —GROUT
GROUT
WATER HEATER
SERVICE
INOk INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP. f+
GRADING
cu. yd.
$ plus x$
,
=$
LUMBER GR.
FRAMING /
FINAL INSP.
ROOFING
'
REMARKS:
VENTILATION
FIRE ZONE ROOFING—�
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING % Z.
MESH
LI�INSULATIONISOUND/`Jf�
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
A • , Desert Sands Unified School District •
I
5
CERTIFICATION OF PAYMENT ~v ,
' e
OF '
SCHOOL FACILITY.rFEES
CD
TO: City of La' Quinta
DATE: V p
_ Department of Community
Development. .
78-105 Celle Estado
La Qui nta, CA 92253OTICU.;,
THIS DOCUMENT CANNOT
BE UPLICATE®.
This is to -certify
that
developer,of -
which is
located at
within
„ this District, has paid
school,,facility fees imposed•pursuant to the `
authogity genera ped by
overn"ment •Cod•i"Sectiol► 53080. i -n the a 'aunt o6,
$
' covering a total ofc3�j['� square feet of (X)' residential or
industrial/commercial development,and that building permits for
this•footage in this development may, now be issued by your jurisdiction.
DESERT SAN6,S IFIED SCHOOL" DISTRICT.
.
White - Building Department •
Yellow - Facilities Planning • ,Pink - Accounting • Gold - Developer
(10)-37
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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 $37 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
E zliMEME2
I 'a2 --q/0 Be -VO.
city
rPD10
State
0A.
Zip Code
9a2-0/
Telephone
1 31.a -/Ws
Job Property AddressCity
of Community'
Legal Description of Property. (Lot, PM, TR) p Y y
-29
Assessor's Parcel No. tWater
Agenc'�° rnw1ellg�I
/�
, Lot Size
Use of Permit f� ►int 1e dC .Y PI'anoing-Case q
Ys
D X
SFD, MH Site Preparation Etc. ��•�
Signature of Appt. ices( t [7, Date
tU V 'The information
above must be verified from Building Application
STAFF USE — DO NOT WRITE BELOW THIS LINE
f/. Initial Date
Certification Existing S.D. System ❑
of required. Yes
WQCB Clearance required. ❑ Yes �ZNo, ( ,
Soils feasibility report required. ❑ Yes
Detailed
boring report required. ❑ Yes E®!eNo
Detailed contour plot plans required. ❑ Yes No
Staff Specialist approval required. ❑ Yes •CI No Lot Inspection Date
r
Soils/boring report by_ Project # Date
Soils Map PageSoil Type •rC., Approved by��✓Date E f
Type of System: v
No. of Bedrooms
(1) Septic Tank
Soil Rate Required
❑ Existing Q,New ❑ Additional ❑ Replacement
::K
Gals.
(2)'Le�achh line sq. ft.
Sidewall allowance
Install '�'Line(s)Ft. Long,
Leach bed(Sq.
(Bottomtrees_ nch area)
ft. rock/ Sq. Ft.
Ft. wide wi humin,., inches
Ft.f''bottom11____
—
per running ft. [95'N/A
rock below drain lines
area
Leach lines/bed-special design for slope:
(3) Pit Diameter %�
No. Pits
Pit BI
Seepage Pit total depth
Applicable
N/A Overburden factor
®g
/ (� i
f r
Max. allowable depth Q
w
1
This application isapr'rovedT enied4or the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements
set forth in Section Vabove. A building permit is necessary for the installation of the above -designed system.
(1) Septic tank and sewer lines must be�50' from any wells 9'''� ', k A9- cl,74161 44,,ea�Y.fJ y 1,6
(2)
Leach lines must be 100' min. from any wells including expansion area '61
(3 Seepage pits must be 150' min. from any wells including expansion area4y. 16,
Signature of Health Official - L�/>s"t✓�� ,Dates -,•
RECEIPT NO. /'-f r/1 Y Issued by �5 4 -- Date X ✓3!
District: El Riverside 2 Indio El Hemet El Perris ❑ Rancho Calif. El Blythe
'
Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File
DOH -SAN -122 (Rev. 6/86)
fir