04641 (SFD)& Classif. ..•
Arch., Engr.;' •,
Designer
LIc. # r Sq. Ft. ,No. No. Dw. ,
Size
J1.533 - Stories Units "
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address t
Tel.
All
�3 i•, '
City
Zip
_+
Lic. #
'. 6,
'
s i
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Divisionof the Business and Professions Code, and my license is in full force and '
Building'^
.3
effect. ,
t K -
P.O. BOX 1504 ..s -
78-105CALLE ESTADO
• • -
Address
Estimated Valuation yq� h
$8 d.230
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
LA QUINTA, CALIFORNIA 92253
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
Owner_
the provisions of the 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
f
a
;;•
subjects the applicant to a civil penalty of not more than five hundred dollars (8500).
-owner
,
Plan Chk. Bal.: - y 84 ;. 34,.
BUILDING: TYPE CONST. OCC, GRP.
Mailing
Address.
, 52-42.5
Villa .
; -
173"213-01C
Mech. • ` -16.00_
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
� • w w y
A.P. •Number- •
Cit Y '"
Plumbing ' ' 10.5 ..'00
•f,,,,,..
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
' does not to owner of who builds or improves thereon, and who contracts for
Zip •'
apply an property
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Tel.
,
to
: nta
Driveway Enc. .0.00.
- " '92253
Infrastructure
���"-2714
�k
Legal Description
_ _
�,. _
Y:•••
WORKERS' COMPENSATION DECLARATION,
Contractor ,.
1{Ji�.�tlt
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
1
Project Description
.
Address
Policy No. Company
" t
- -
TOTAL 02#90,33 E r rd.a,
- •City-
REMARKS
WORKERS' COMPENSATION INSURANCE .
Tel.
(This section need not be completed if the.permit is for one hundred dollars ($100; valuation
G,
•'� or less.)
.
Zip.
t
State Lica
- Laws of California.
+
Date- Owner '
' NOTICE,TO APPLICANT: If, aftermaking this "Certificate of Exemption you should become
ZONE:` BY: -
• subject to the Workers' Compensation provisions of the Labor Code, you must• forthwith
' comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances `a ��. ?-a �._ • .
x ys 1tt zieti ,?j.pt
City
& Classif. ..•
Arch., Engr.;' •,
Designer
LIc. # r Sq. Ft. ,No. No. Dw. ,
Size
J1.533 - Stories Units "
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address t
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 Divisionof the Business and Professions Code, and my license is in full force and '
.3
effect. ,
( SIGNATURE - - DATE-
• • -
;•
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation yq� h
$8 d.230
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
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
- - -
Division 3 of the Business and Professions Code, or thathe is exempt therefrom, and the basis
'Dep.
- ' for,the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
Plan Chk: - G: J• V
subjects the applicant to a civil penalty of not more than five hundred dollars (8500).
-owner
,
Plan Chk. Bal.: - y 84 ;. 34,.
❑ I, as 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
Const. •391 00'.
Professions Code: The Contractor'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,
Mech. • ` -16.00_
provided that such improvements are not intended or offered for sale. If, however, the building
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.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing ' ' 10.5 ..'00
•f,,,,,..
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
' does not to owner of who builds or improves thereon, and who contracts for
_ - - -
S.M.L.
apply an property
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
.5...99'
Grading 2.0.00
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc. .0.00.
Date k7.I.^Alrf owner rI""
Infrastructure
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
" t
❑ Copy is filed with the city.. O Certified copy is hereby furnished.
TOTAL 02#90,33 E r rd.a,
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 thg work for which this permit is issued, I shall not
t
employ any person in any manner so as to become subject to the Workers' Compensation
- Laws of California.
+
Date- Owner '
' NOTICE,TO APPLICANT: If, aftermaking this "Certificate of Exemption you should become
ZONE:` BY: -
• subject to the Workers' Compensation provisions of the Labor Code, you must• forthwith
' comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances `a ��. ?-a �._ • .
x ys 1tt zieti ,?j.pt
Front Setback from Center LI_ntd '
Rea�,Si4tback;from Rear Prop Line
I• CONSTRUCTION LEN DING AGENCY`. i r
4reby'affirm
Side Street Setback from Center Line
that there is a'construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code) - +
x - • . •
-"Side SetbaCk from Property Line '
7
Lender's Name s'
, • i rt ^ , fi : "
Lender's Address
FINAL DATE INSPECTOR
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., ' '
"I
y
„r, t t• + j. di ,
• : certify that 1. 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 jaws relating to building
•'construction, and hereby authorize representatives of Ahis city to enter the above-
mentioned property.for inspection purposes.f rt' , *
Validated by:
Signature of applicant z~' t Date M t t•
t 5 ' ^ ;
,Mailing Addres
_
alidation:
Validation:-
City,
City, State,.Dp
i' s y
WHITE FINANCE PINK APPLICANT GREEN BUILDING,
GOLDENROD - ASSESSORS OFFICE HARD COPY FILE - i
� �. i. ,d.,• ae.t
-.. a s..:1=••rt J,. ,..�...... _3�4. `r`iJ-�i. ,.. >..t, .+a..l't.r .:�.:._. u.'z-.. .'�s. 'F`
••,. "3� .f.o-_..W..., •.ti',i.: 5+: s:.S+_,.,, ':.h`n . -'!. _ al .�tl�<. iY.. i b„Y � ..
'ry. -
CONSTRUCTION ESTIMATL
NO. ELECTRICAL FEES
NO. PLUMBING FEES s
IS7 FL SO FT W $
UNITS
P/IVSLAB GRADED% y —
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. a
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SQ FT, at
GAS (ROUGH)
METER LOOP
GARSO. FT.
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SO FT. i
Desert Sands Unified School District
NOTICE:
p CERTIFICATION OF.PAYMENT
OF
NOTICE: THIS�6d����S4�i00�F�CFi�. t�rtY�FEES i(ll.I
R,
BE DUPLICATED.
TO: City of La Quinta DATE:.
Department of Community Development
78-105 Calle Estado
La Quinta,.CA 92253
This is tonnc,��e,Ar�_,tif tha
(Y' C �
developer of '� Vvc which is
located at _— GLL % within
this. District, has paid school facility fees imposed pu suant to the
autho enerat d by Government ode S ction 53080 in the amoun of _1
covering a total of are feet of( ) residen •al or
( ) industrial/commercial development and that buil ing permits for
this footage in this development may now be issued by your jurisdiction.
`Lb! for DESERT SANDS • D , &lh'iq 0
UNIFIED SCHOOL, DISTRICT
C Wh) Ouilding
ite Department • Yellow -Facilities Planning • Pink - Accounting • Gold - Developer
0 007
t +41 t �i"r t; �:'?`•r�'!. +,...,yA;, f t '� 4iy�Y5.r'SFai .'J.. s ^F f �i1�
5 5
5
. i
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No. .
ENVIRONMENTAL HEALTH.SERVICES :
-PERMIT APPLICATION FOR A SUBSURFACE,SEWAC E DISPOSAL SYSTEM s "
Applicant: 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 mt.st be made payable to the County of
Riverside. Approval of this application shall remain valid for a period not to exceed one year fron date of approval.
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATi.ON LOG' #
: ` t.Agent Contractor, ntact Person
Phone
Address & Phone
Owner'" _• .
. ,, ,
Phone
6 y 27/,
Mailing Add ss �.
a - `l/a-, av-11, -
City
State
Zip'Job
Property Address
`
Legal Description Prop. (PM T ct t� ( IT'
u; . .
c(�- U!/I
Aur
Lot. Size'
afar Agenc /lhW
Use of",,r�mR P/P, CU, etc. 4.� 6) V/ ✓T9
Othe
w
Dwelli H Sit( a Prep, etc.
Signature of Applicant
Date
'CATEGORY: REV CODE FEE
CATEGORY: REV CODE FEE .
SUBSURFACE DISPOSAL 1238 5.OQ . 11
❑ SITE EVALUATION UPON REQUEST 7349 $42.00
❑ `. MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
a.'' 1st.4 Parcels (Each) 1238 $45.00
(Less than 1 year)
b. Each Parcel after 4 7344 $16.00
❑ PRELIMINARY ELECTIVE 7352 $45.00
:.0 Rereview (2nd review same parcel) 7344 $16.00
EVALUATION (Attach DOH SAN 53)
❑ Site Evaluation in Conjunction with
❑ HOLDING TANK 7351 $45.00
Critical Area 7346 $86.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $132.00
❑ Site Evaluation Lot Less than
SYSTEM
10;000 Sq. Ft. 7347 $86.00
r
NO l��� — (DATE
L
Holding Tank Agreements Completed ❑ Yes 0-
Certification of Existing S.D. System Required ❑ Yes ' 0;'No
WQCB Clearance required. (Attach Form ❑ Yes Q" No
DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required. ❑ Yes ®No'
Special Feasibility Boring Report Required. ❑ Yes
Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes P../
VN'
)
Other- ❑ Yes
Staff Specialist Lot Inspection Required ❑ Yes m No
Lot Inspeti�tion Date
Soils boring report by' # Date
/)Project
Soils, Page Soil Type ` �"�"� n p�
.Map Approved by Date
No: of Systems
ype of System(s)
No. Dwelling Units (1)
(1) Septic Tank Soil Rate
Grease/Sand
❑6lding Tank ❑ Existing
Bedrooms, Fixture Units
Grease Intcp
New ❑Replacement
3
//,,Q�,,,�� T ��
+�
Gal
Gal
(2) Leach Line Sq. Ft
Sidewall allowance
Install s Line(s) ft long ft wide with
Leach Bed sq. ft
BoIbmarench area
i
ft rock/ sq. fL
min. inches beb� rainlines a
ofibotto area
per running ft
®I -NA
�1
Leachlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
Seepage Pit otal Depth
Other.
Applicable
fops, 7
Inlet (BI)
./
} .
N/A Overburden factor
6
J Ll
Max. All gvyabig Depth'
;
No. 2 System/A
n=
.,REMARKS: 4"
This application iso PPROVED.DENIED•for the category checked in SECTION.B above, regarding the design of a:subsurface disposal system as indicated
.on the . accompanie pot plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
, above -designed system. No construction is permitted in the required reserved 100% expansion area.
'¢
i) Septic tank and sewer lines must be 50' minimum from any wellscy /0 c
Leach lines must be 100' minimum from any wells, including expansio ar a �+
3) Seepage pits must be150' minimum from aqy wells, including expansion re
nature of Health Official
.RECEIPT NO. 7 �SO Issued By>� Data
DISTRICT: ❑ Riverside, P Indio ❑ ! Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
JF
DOH. SAN,122 (Rev. 5/88) DISTRIBUTION: WHITE Office file YELLOW -Applicant • PINK Bldg. Dept.GOLDENROD Plans/Records