06744 (SFD)�f.f►t
P.O. BOX 1504 No, 06744
Building 53--450 Villa LA
CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner - .
Harion L. White
- BUILDING "TYPE CONST. OCC: GRP
Mailing.
Address 310 S. t inev St. A.P. Number 774-174-006
City Zip Tel.
Escondido 92025 745-8881 Legal Description
Contractor
Project Description $FD
Address .
City Zip Tel.:
.State Lic. City
& Classif. Lic. # _ Sq. Ft. 1480 No. No. Dw.
Arch., Engr.,
Size Stories Units
Designer 1xvin Deaign Assoc. New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
555 Cajon Suite D _
City Zip State
'Redlands Lic. #
LICENSED CONTRACTOR'S DECLARATION
I herebyy affirm that-Iam.licensed under provisions of Chapter 9 (commencing with Section
7000) of,Divirs n 3 of the Business and Professions Coded my license is in full force and
effecth , - 'Q
SIGNATURE DATE
✓` OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following $8�,9Vn
reason: (Sect. 7031.5,BLsimess and Professions Code: Any city or county which regimes a
Permit to construct, a8er, Improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to lie a signed statement that he s -tkensed pursuant to PERMIT AMOUNT
the provstons 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 ti �� y • •. ,
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep. $25040
subjects the applicant to a rid penalty of not more than rive hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. T J ' $ . 252.47
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Busness and tt� repA
Professions Code: The ContractorCOnSt. -77
Contractors License Law does not apply to an owner of property who 0.00
builds or improves thereon and who does such work himself or through his own employees, Mech. t�
provided that such Improvements are not intended or offered for sale. If, however, the building .7 +JEJ
or Improvements sold within one year of completion, the owner -builder will have the burden Electrical 4 \ '� \ \\' �''y' 9�
of proving that he did not brill or improve for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 157.50
struct the projecL (Sec. 7044, Business and Professions Code: The Contractors License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. 6.23
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) �^
{ 217 •0
❑ I am exempt under Sec B. & P.C. for this reason Grading
Driveway Enc. 20.00
Date owner Infrastructure 1.,875.25
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
❑ Copy is tiled with the city. ❑ Certified copy is hereby furnished. .
TOTAL $3,334.45 1 14, 4/ ;
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE -
(This section need not be completed if the permit is for one hundred dollars (E100)- valuation - tiA4i{S2'J $2`11 17 c� ;?.,.f};'^- ti AA
or less.)
1 certify that in the performance of thg work for which this permit is issued, I shall not : —(;AI;f'f 1 f U I AL Y —4vii 4
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. \ v r
Date Owner h.
N017CE TO APPLICANT: d, after making this Certificate of Exemption you should become ZONE: BY: 1' a r J
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith -
Comply with such provsiorsorthis Permit! shall bedeemed remked. Minimum Setback Distances:
Front Setback from Center. Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
Ihereby 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
Lenders Name
Lenders Address FINAL DATE INSPECTOR
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. 12/12/89
1 certity that I have read this application and state that the above information is correct Issued by- Date Permit
1 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
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
PLUMBING FEES
IST FL SQ. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADEwmQO
YARD SPKLR SYSTEM
E
2ND FL SQ. FT.
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
/
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF. /
GAS (ROUGH)
DRAINAGE PIPING
CAR P. I SQ. FT.
METER LOOP
HEATING (FINAL)
WALL Sp. FT.
REINF. STEEL
DRINKING FOUNTAIN.
SQ FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN x
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
-
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FRAMING 512,41P lg-W
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
FIRE ZONE ROOFING:
SQ. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4C
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 GOND. SOLAR
SETBACK 11OUND
PLUMBIN
/
%
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADEwmQO
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SE '4
/
ROUGH WIRING.
DUCTWORK
ROCK STORAGE
FOUND. REINF. /
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE 3
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP. T?. ��
FRAMING 512,41P lg-W
FINAL INSP.
D
ROOFING ,G �/Q�
a o O py��
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
,,/
LATHING. 0VA 3
MESH
INSULATIONISOUND 6 O�
FINISH GRADING s
FINAL INSPECTION
CERT. OCC_
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL
Building
Address
Owner
AAA210"C L, W t kIT F
Mailing -
Address 31C) G. ST.
City ZipU Tel
1E;SC0NlD1p0 Q
Contractor.
Address
s4 - Y C� ►g-
P.O. BOX 1504 APPLICATION ONLY
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING:. TYPE CONST. OCC. GRP.
A.P. Number 7 14OO(c� l
I
Legal. Description
Project -Description
5
W
/City ]ZII
,cN
Tel:.
16Z
' State Lic_— —
& Classif.
Lic. #
Sq. Ft.
No. No. Dw.
Size
Stories Units
Arch., Engr., _
Designer =IZ� N j�N ��OL
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
.55F;
City.
Zip
State
�V'I�I l0 S
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-
ffectSIGNATURE
'
SIGNATUREDATE
-• OWNER -BUILDER -DECLARATION -'• - '-
I hereby affirm that 1 am exempt from the Contractors License Law for the following
reason: fSec. 7031.5,Bustness and Professions Code: Any city or..county which requires a
EStlmated'ValuatlOh
-
--.— - - PERMIT--
--- - - - - - - -. - AMOUNT .. _
pemttt to construct, after, improve, demolish, or repair any. -structure, prior to its issuance also
requires the'applicant for such'permf to file •a'signed statement'utat-he is-Ocensed 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 rive hundred dollars ($500).
❑ 1, 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
—Plan Chk.•...Dep.,- -
- -
Plan Chk. Bal.
e
Const.
Mech.-
- - -- - -
- Dmfs or snpmves thereon and who does such work himself or through his own employees, _
provided that such improvements are not intended or offered for safe. Il, however, the building_.,
or improvement Is sold within one year of completion, the owner -builder will have the burden
of that __._�_ ._ -_ ._ _
�vkrg improve for the purpose of
Electrical
.
Plumbing
�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 prope who builds or improves thereon, and who'contiacts for
such projects with a contractor(s) licen pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec' ' � - B P.C. for this reason
.,
_ Grading.
Driveway Enc.
Date Ow _
Infrastructure
WORKERS' COMPENSATION DECLARATION
-I-hereby•affirn•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
d
REMARKS
9192 t o n7�� 1 7_/14 _Lill 4 r'1
��'Svi�Cv.�
_
WORKERSCC MP NATE OF NSATION INSURAEMPTION NCE
(This section • `ieed' not be corriplated if "the permit is for one hundred dollars ($100) valuation
or less.)
' A certify that in the performance of the work for which this permit is issued, I shall not
employ any pperson in any manner so as to become subject to the Workers' Compensation
laws of California: - -
VA
4 (i CASH i TOTAL i 275.00
- Owner
N077CE TO APPLICANT:h, after making this Cerifficate of Exemption you should become
subject to the Workers" Compensation provisions of the Labor Code, you must forthwith
• comply with such provisions or this pemrftshaft bedeemed revoked. -
ZONE: BY: ._..
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
Thereby 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 `
Lenders Address
FINAL DATE
Issued by:
Validated by:
INSPECTOR
Date Permit
'
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.K
I certity 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 -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address -
Validation:
'
City, State, Zip
-
BUILDING DIVISION
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES. ,,
` NO.- PLUMBING FEES.
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOFQDRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER
WALL - - SQ. FT, ®
- .
DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
URINAL
SQ. FT. ®
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIREPLACE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.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
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 APP./EQUIP.
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
SCHOOL FACILITY FEES
CANNOT
THIS DOC
�iC?� bQ'ieb tf La�Q,u� n t�° ��Ea�a FED, DATE:
Department o ommunity Development
78-105 Calle Estado
La Quinta, CA .92253
.This is to'certify that C-0;
developer of 0 1 }� which is
located at within
-this District, has paid school facility fees imposed pursuant to the
authori't a er(t d by G vernment Cod Secti n 530 0 in thea ou t of ,� w
$ 44 JQ6 �OZ7
coveting a total of square feet of (residential or
( )"industrial/commercial development and that build in
) permits for
this footage in this development may now be issued by your jurisdiction.
for DESERT SAND UNIFIED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37
V
(�y)Q9
Ile -7
RECEIPT NO. ! V Off/ Issued By A�ejtl�__ Date /A2
�Indi
DISTRICT: ❑ Riverside, Eo 0 Hemet q Perris ❑ Rancho Calif. ❑ Blythe
DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
COUNTY OF RIVERSIDE ENVIRONMENTAL -1Assessm14— --cc(.
HEALTH SERVICES DIVISION
PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM
Appllcante 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
A
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG # --V7W
Z
Z
PhINN one
Agent Contractor, Contact Person 24�9
Address & Firm
C— ftl
^\C—
U
Owner Phone
L• If
Mailing Add
3t0 � UioVCsT-.
City L
f po
State
04-
Zip J0 Property Address
MAY
Legal D ription Prop. (PM, Tract, Lot,%cZwp
1,9 �.
�:
- ,
Lot Size 1
titer A e �yhlNelI
Use of Permit P/P, CU, etc A _ V-,*
Other cs l)
KA
(,LTir
/
Dwellin a Prep, etc.
F
Signature of Applicant-
Date
CATEGORY:. REV CODE FE
CATEGORY: REV CODE FEE
C�] SUBSURFACE DISPOSAL 1238 a!7 _
❑ .SITE EVALUATION UPON REQUEST 7349 $ 43.00
m
❑ MULTIPLE PARCELS WITHIN SAME '
(NO PLOT PLAN)
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348• $ 17.00
Z
a. 1 st 4 Parcels (Each) 1238 $ 57.00 i,
(Less than 1 year)
b. Each Parcel after 4 7344 $ 24.00
❑ PRELIMINARY ELECTIVE 7352 $ 23.00
W
❑ Rereview (2nd review same parcel) 7344 $ 24.00
EVALUATION (Attach DOH SAN 53)
Ing
❑ Site Evaluation in Conjunction with "_� .
Critical Area.
❑ HOLDING TANK 7351 $ 47.00
7346 $111.00`N'a
❑ ALTERNATIVE/EXPERIMENTAL 7345 $222.00
A.
❑ Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $ 87.00
NITIALL� / DATE
Holding Tank Agreements Completed ❑ Yes fL. f J y"�
VNO'�
Certification of,Existing S.D. System Required ❑ Yes of
Clearance required. (Attach Form ❑ Yes�NoWQCB
DOH SAN 007, Santa Ana Region Only)
Soils PercoUdion Report Required. ❑ Yes
Special Feasibility Boring Report Required. ❑ Yes d]
Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ `Yes
ZN�Other ❑ Yes
yNo
Staff Specialist Lot Inspection Required- ❑ Yes
Lot Inspection Date
Soils boring report by ProjectDate
/
r.'Soils Map Page Scr Type . G(G Approved by Date
U
Z
No. of Systema
T of System(s)
��
No. Dwelling Unhs i
(1) Septic Tank
Soil Rate
Greaser,"
!!
Ing Tank ❑ Existing
Bed
V
f
ff
197"New ❑ Replaoenwe,t
A��1
�4�`tt 444-,2
Gel
a G/
�!
UJ
In
2) Leach Line Sq. FL
Sidewall allowance
Irv" s) K long ff wide with
Leach Bed sq. tL
trench area
_ ft aq. fl
per running ft.
min. rode below draMlinea or
`sof bolt -aree
(®SNA
Leachlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
Seepage Pit Total Depth
CKtter:
/
Applicable /I
•
Inlet (BI)
(TD)
W.
W
_
N/A t� Overburden factor
`"
�([ /
Max. All cable Depth
¢ /i�Ar��
No. 2 System
REMARKS:
74
d
i
This application is+t{kFPROVED EKf1ED for the category checked in -SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompa .— o Ian, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
Z
above -designed system. No construction is permitted in the required reserved 100% expansion real
0
(1 Septic tank and sewer lines must be 50' minimum from any wellsIto r
()
Leach lines must be 100' minimum"from any wells, including expansion area
W
(3 Seepage pits musZbe 50' minimum from any wells, including expansion area /�U)%pSi
nature of Health Offic:al!`f��t pate / �J �d / - -
(�y)Q9
Ile -7
RECEIPT NO. ! V Off/ Issued By A�ejtl�__ Date /A2
�Indi
DISTRICT: ❑ Riverside, Eo 0 Hemet q Perris ❑ Rancho Calif. ❑ Blythe
DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records