001176 (SFD)APPLICANT NAME (L. F, MI) Brlan.Morane
ADDRESS P.O. Bmc 1040
PERMIT APPLICATION
City
of La Ouinta
Department of Building and Safety
•This permit becomes void it work not commenced.within 180 days from date
of issuance, OR, if work has been suspended or abandoned for'a period of 180 days. JI
c
CERTIFICATE OF EXEMPTION FROM WORKERS' OMPENSATION INSURANCE: This section.need not be completed if
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under 'provisions of ChapIer,9
the permit is for one hundred ($100) o, less. I certify 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 mannerso asto become subject to the Workers'Compensation Laws of
and effect.
California.— — I I . I . 1
License Class Lic. Number
Date --.Applicant
Date" -1 Contractor
NOTICE.TO APPLICANT: It. after making this Certificate of Exemption, you should become subject to the Workers'
'OWNER -BUILDER DECLARATION::' I hereby affirm that- I am*exempt from ihe-Co*n'tractor's'License,[aw'for the
•Compensation provisions of the Labor.Code, you must forthwith comply with such provisions or this permit shall
following reason (Sec. 7031.5. Business and Professions Code: Any city or.county which requires'a permit to
be deemed revoked'.
construct, alter, improve: demolish, or repair any structure, prior.to its issuance' also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT. CERTIFICATION:
ssuch permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
~=t0 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to dncend:w ill be
(Chapter 9 (commencing with.section 7000),of Division 3 of the.Business and Professions Code) or that he is exempt =
and the basis for the alleged exemption. Any violation of Section 7031.5 by.anyiapplicant for a permit
'made in 66nnection with Wor)Cauthoiizbd by this permit, add that no 6uilding structure, scaffolding. falsework, or
'demolition -(Chap 4,
,,therefrom
subjects ihe'applicint to a'civil penally ot'not more than.five . hundred dollars (5500).'...
or dismantlirig thereof. will be more than thirty-six (36) feet high; 3.2, Grp Z Art 2, Sec 341. Title 8,, -
C.A.C.).1
Q-1. as owner of the prppeqy..pr my employees with wages as their sole compensation, will do the work, and the
Cl As owner -builder; I will not employ anyone to do work, which -Would require:4 permit from the Division of
structure is not intended or offered for sale (Sec. 7044; Business and Professions Code: The Contractor's License
Industrial Safety, as noted above, unless such person has a.jiermit to do such work fromthat division.
Law does not apply to in owner of property who builds, or improves thereon, and who does such work himself or
1: . * . - '* - .. . . . - I I " • .. N!
through his own employees, provided that suctf.improvements are not intended or offered for sale. If, however. the
.0 Division of Industrial Safety Permit No.
building or improvemnt issold.wi(h)n one year of co mpletion, th ' e ' owner -builder will have the burden of proving that
Date 'Applicant
hedid.not build or improve folirM.,purpose of sale.)... '. - . .. ...:.
"CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the perforniadde
0 1, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec:.'
of the work for which this permit is issued. (Sec.•3097, Civ. C.).
7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of propery.who
Lender's Name
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed. pursuant to the
ZONE ORD 0
Contractor's License Law.). r__
Lender's Address
0 Gam exempt under'Sec P'Y,.R:C (Attachid Certificate).,
I certif ' y that I have read this application and state that the above information is correct. I agree to comply with all
I
- ! .
'Pate 'L�,
cit y and county ordinances and state laws relating to building construction, and hereby. authorize representatives
—,6w.ner*^<
of this county -to enter upon the above4entioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby,affirm that I have a certificate of consent to selfinsure, ora
certificate of Workers' Compensation Insurance .
I , or.a certified copy'thereof (Sec. 3800. Lab. C.).
.
Signature of Applicant or Agent iDate
Policy No. Company
I I
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:,jl certify I have read this application and state that
•.0 Certified copy is hereby furnished., 7
the information given is correct. lagree to comply with all state laws,and county ordinances relating lobuidling
0 Certified copy is filed with the City Building lnspeclion Department or City.
construction, and authorize a representative of the City of La'Ouinla Department o1. Building and Safety to enter
upon th rvqvy)r.which I by za of making inspections.
e pplieVovt�is.peimtt�
Date Applicant
,%theCpurpdso
p Date. 4
plj6#t�YAy�ntjo,11'�
Print Applicant/Agent Name
APPLICANT NAME (L. F, MI) Brlan.Morane
ADDRESS P.O. Bmc 1040
CITY/COMMUNITY/STATE/ZIP La Quinta, CA .92253
JOB SITE ADDRESS/SPACE 53-935 -Avenida Villa
CITY/COMMUNITY/STATE/ZIP Ja Q�ta, CA .92253
BOK 4
-P- 3
M2
c
SMI Fee 6.65%-_
TWN
PING
SE
S
TRACT
LOT 10
TOTAL
MOD
S13
TRACT NAME'
OWNER NAME (L� F. MI) PMUCant
CONTRACTOR -FIRM NAME .Mck johnson -.0onst
ADDRESS
P.O. B= 2288
CITY/COMMUNITY/STATE/ZIP Tjxljo,,- CA -92202 -
PHONE a 347-7171'
1.1"N597169
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE •
LICNC
USE OF PERMIT single family &elling
BL
ZONFSB
SSB
RSO
OFC
ZONE ORD 0
LOT SZ
END
SI DE
APPL/PRMT It _1 -8!i S.F*D.
Pemit to'bonstruct 1592-iff. ft. - of
S.F.D. & 91 sq. ft. of porch"and 430
sq. ft. of garage as per app roVed,plans,
mech. MecFee 22.00 -,
k
Plan Mahak Fee
Const. Fee ,-448v,00-
Elect. Fee -43.33
SMI Fee 6.65%-_
:.Plumbinq Fee 50.50-�
Prop. Deml-I., Fee 450.00
(250.00) Pd. 12/14
TOTAL
'41
KbG.DEPT..
4
VALUATION
I
NO.
OPERATION DATE INSPECTOR
NO.
OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Compart.
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air .
5
Bond Beams
38
Compressor
6
Roof Deck
12 ';,JW
39
Appl. Clearance
7
Framing
3
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.
❑
NPON
ADDITIONA I77:ATION
� ^ �12
-
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath , i
Internal Lathp[
12A Drywall
13 Finish Grade
INSULATION Thick
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb S
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 APPROVALS
REAR OF PROPERTY LINE
PSL P)
STREET NAME
26 Power Pole / 3'
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
Deeert Sands LTni ied School 'District "
ip H�BERMUDA DUNES r
!,RANCHO MIRAGE '.
82-879 HIGHWAY 111 O INDIO, CALIFORNIA'92201.5678 • (619) 347-8631
0": -INDIAN WELLS
. PALM DESERT. '
J0:' LAQUINTA +,.,
Januar l%;�- 1985
)
- ; City of- Lai Quinta
3e '
IDepartment of Community:
Development,
78-105,"Calle Estado
La QuTnta, CA 92253-:
E Re : 53"93.5 Aven i`da� V i>l l a
i
Gentlemen•
. +The:devel.oper.of the'-
above, referenced home
`has' .miti:gated its -impacts on our 'overc,rowded'sch.00ls'by payment v
of the amount of '$628
per unit -to be applied to the cost of
di stri ct .educati o,nal .
faci l iti es made necessary by such. new
I development:..
Sincerely,
John<D. Brooks
Assistant Superintendent
Business Services '
JDB/crm
e
i
;7—
RIVERSIDE COUNTY DEPARTMENT OF HEALTH
PERMIT APPLICATION FOR A SUBSURFACE DISPOSAL SYSTEM
Applicant: Submit this form with three copies of a scaled plot plan
Ian 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.
Name.
Mailing Address
Z
x
City
State.
Zip Code
Phone
e""
*Property Address
*City or Community r
*Legal Description of Property (Lot, Parcel Map, Tract)
el 11,1,e
2
7
*Assessors Parcel, No.
Water Serving Property From
Lot size
J A� >
Signature of Applicant Date
'The -above information must be verified,from Building Application.
Staff Use — Do'NotWrite Below This Line
Initial Date
WQCB.Clear,ance required Yes El No ED-
Glf,!Soils feasibility report required Yes El No 0
', y l
;��%tailed boring report required es. No.lh
s'��.&dtailed contour plot required Yes C1 il No.CD. V'
Comments: mments;
17 10
Soils or boring report by OvIF\ L Date
Approved by, Date
Soils Map Page, Soil Type *,'Tract'File No. Other
Number of Bedrooms
Septi . c Tank Size (gallons)
Rate Required
Type of System
New Addition Replacement
El 1:1
Leach line sq. ft. of bottom area trench
Leach bed (sq. t. of bottom area bed)
Seepage Pit DiameterNumber
of Pits
Seepage.Pit Depth B.I.
Total Depth of Pit
5'El 6 (3.Gwt
e`
T- co
Location of System
Additional Requirements
V\A, At,,7 Ca0 0
Ape permit is approve&denied for the design of a subsurface disposal . system as indicated on -the accompanied plot planequire
using the req set forth in Section' B abo . ver A building permit is necessary for the installation of the above
designed system.
Signature of Hearth Official Date
Receipt No. •-Issued By
District: Riverside Q Indio Hem'6t El Date
DISTRIBUTION: WHITE - Office File YELLOW - Applicant PINK - Buildi ng Dept. GOLDENROD - Pending File
DOH SAN 122 (Rev 10/82)'