9802-117 (SFD)U)
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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
Zate
74- '7 B `� Signature of Contractorf
✓��
OWNER-BUILDERID LARATION
I hereby affirm under penalty of perjury at I am exempt from the Contractor's
License Law for the following reason,
( ) 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, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section , B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
Se( ) I have and will maintain workers' compensation insurance, as required by
ction 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
(This section need not be completed if the permit valuation is for $100.00 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, and agree that if,F-should become
subject to the workers' compensation �{sions of Section 370 ��o t'he Labor
Code, I sha I fortwith comply with rov siont�� J
(Date: ? ?_ 2Applicant j
Warning: Failu a to secure it ers' Compensation cod�erage is unlawful and
shall subject an employer t6 criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interegt and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to. comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of„ th' City to enter upon
the above-mentioned property for inspection purp S. r r
,'Signature (Owner/Agent) Dated i—.l��ra
BUILDINGPERMIT PERMIT#
CONTROL#
DATE VALUATION LOT 9802-117 . TRACT
8 O 8
$2,608.70 LaT s
�,t�� .r V
JOB SITE (
APN
ADDRESS
51-325 CALI. F GUATEMALA
769-111.-005
OWNER
CONTRACTOR / DESIGNER / ENGINEER
1
WORLD DEVELOPMENT INC
WORLD DEVELOPMENT fNC
'PO BOX 13287
PO BOX 13287
PALM .DE.SEAT CA. 32.255
PALM DESERT
CA 92255
CBL# 5028
USE OF PERMIT
SFD - PMMIT DOES NOT INOLLY ►E BLOCK WALLS OR�CI6L. 75% PLAN
CHECK REUTJCI'TON APPLWI D T=OR MI UnPLE 511BNfI JTA]LMA
�� A
t
In
TRACT CONSTRUCTION 1,300.00 Sr- MAR
1998
PC3t- C""ATIO 95.00 SF
GARAGE/CARPORT 462.00 SF
6 FT, WOOD rrNCE 200.'10 I- 011
yy pp�� p �
LA QU.I1 VTA
t
ESTIMATED COST OF CONS" 1KUC1171ON
82,60S. -i"
PERMIT FEE SiJMMA RY
`
CONST RUC117TAN FEE 101.-000-41$-000 $563.00
PLAN Cf-,ffiL3;.FEE 101-000-439-318 $4177.48
itil-'HANICAL FEE 101-000-131-000 360.00
E"LECrRICAL .FEE 101-000-420-000 $118.24
PLUMBING FEE, 101-000-419-000 $11,21.51)
STRONG MOTION FEE - RESW 101-000-241-000 $8.76
GRAD LNG r, M 101-000-423-000 $20.00
"fN1 ASTROC URE1<EE 225-000-443.342 $1,792.02
PRECISE, "PLAN l Ol -000-4141-3-'45 525.00
PLAN C IECK FEE, 101-000-439-318 4250.00
PLAN (3VECK FEE 101-000-13.9-318 4388.11
SUB -TOTAL CO NS RUC ION AND .PLAN CHECK
53,185.50
LESS Plt&PA1U 1'EES
TOTAL PERMIT FEES DETE NOW
52,577.39
RECEIPT
DATE
BY F
DATE FINALED
INSPECTOR
r:�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS ---,--,.MECHANICAL
APPROVALS
Set Backs I
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
_
Roof Deck
O.K. to Wrap
Exhaust Fans
F.A.U.
Framing
Compressor
Insulation A¢jcs o 9d//Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final 4
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines �
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out 7
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test 9
Appliances
fA_
Final
-
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
c
c
Final
Utility Notice (Perm)
COMMENTS:
�l/y
/
"
�(- 3 29- CA"5 6u hTz k t A LA P.O. BOX 1504
Building /
78-495 CALLE TAMPICO APPLICATION ONLY
Address LA QUINTA, CALIFORNIA 92253
�v t < // /r �� /
< ` ` !!
'
BUILDING: TYPE•CONST.
OCC. GRP.
Mailing
Address .a f 71 j 7
A.P. Number
Legal Description
Project Description
76
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City
1, t !
Zip
Tel.
Contractor
Address
City
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Zip -/y
!y4'✓
Tel.
77Z
_'
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_Tt? �L
AAAI •�+� N--NAVAC410
State Lic.
City
H
8 Classif. /y -?4 6 -7
Lic. #
Sq. It.
Size
No. No. / No. Dw.
Stories / Units
Arch., Engr.,
r
Designer �7�� i�� 7,�1t 4Y J
Newer -O'er_ Add -_5^ --=--Alter ❑ Repair ❑ Demolition ❑
Address )
�7 ,t`� ,,�''�,�,� c/)�
/
Tel
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A Li
City
:,7.✓�trr? ry
Zip1
I71'�i
State
Lic.#
—
LIC NV,ED,.COMTRR+A Ops" �C.LARATION
I hereby affirm haattj afii licens8d un r p si. - h ter 9 (commencing with Section
•o
7000) of Dio theeBusi sPsfio s Cod nd my license is in full farce and
effect.
GNAT M d,Or DATE
'ECL.ARATION
OWNER•BUI ER
I hereb aft• m that I am exempt from a Contractor's License Law for the following
Estimated Valuation
reason:`(Sec. J031.5,Business and Professions Code: Any city or county which requires a
f
+:^
PERMIT
AMOUNT
permit to construct, alter, improve, demolish, or repair any structure, prior to'its issuance also
requir4 the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisio'hg of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Mvision"`!'of the Business and Professions Code, or that.he is exempt therefrom, and the basis
Plar Chk. Dep.
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 live hundred dollars ($500).
Plan Chk. Bal.
•y
1-: I, as owner of the property, or my employees with wages as their sole compensation, will
Const.
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
Mech.
-_
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
Electrical
C;) Qp
or improvement 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.)
I I I, theproperty,am exclusive) with licensed to
Plumbing}M.
as owner of contracting contractors con-""
Y 9
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
doesnot apply to an owner of property who builds or improves thereon, and who contracts for
S. M. 1.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
M 3, k'if '
1-1 I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date owner __
Infrastructure
WORKERS' COMPENSATJON D.ECLA;ION
i
I hereby affirm that I have a certificate of copse • to If•I,ps ray or a�cett�yficate of
Worker's Compensation Insurance, or a certified copy ereof so,.3B006LaboiCode.)
Policy No. Company
F) Copy is filed with the city. ❑ Cerlifi' d,c Py is heiebY furnished.
TOTAL
CERTIFICATE O EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(This section need not be completedfir,0 a 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
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
ZONE:
BY:
subject fo 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:
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 Setback from Property Line
Lender's Name
FINAL DATE
INSPECTOR
Lender's Address
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 certify that I have read this a plication and state=thaf�fhr;rve inforatfon is correct.
I agree to comply with city oupnty ordinancesEan at! aw orrg ating 10 building
Issued by:
Date Permit
�I
construction, and hereby au ze a resentat• e, i is t o enter the above•
mentioned for inspecf�o
property Grp es
Validated by:
Signature of aGPlicant Date
Mailing Address
Validation:
City, State, Zip
40
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201619-775-3500 1'y�
CERTIFICATE OF COMPLIANCE
Date 3/13/98
No. 16717
Owner NameWorld Development Inc.
No. 51-325 Street Calle Guatemala
City La Quinta
Tract # Lot #
Type of Development Jingle I,amlly Keslaence
Comments
APN # 769-111-005
Jurisdiction La Quinta
zip 92253
Permit #
Log #
Study Area
Square Footage 1300
No. of Units 1
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered
patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes.
It has been determined the above-named owner is exempt from paying school fees at this time due to the following
reason:
EXEMPTION NOT APPLICABLE r
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amouiit of
1.93 X 1,300 or $ 2,509.00 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
4 ,
Fees Paid By Check/Jim Snellenberger Telephone
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Rosita Jones Payment Received $2,509.00
Check No. 1217
Signature
40TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
rbove will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
nllect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
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Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 51-325 CALLE GUATEMALA
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9802-117
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC
Owner of Building: WORLD DEVELOPMENT INC
Building Official
Address: PO BOX 13287
City: LA QUINTA, CA., 92253
By: DANIEL P. CRAWFORD JR.
Date: 5/28/98
POST IN A CONSPICUOUS PLACE
r
AC PERFECTION ELECTRIC
74807 Gary Avenue Palm Desert, CA 92260
(760) 341-0012
License #384928 C-10
JOB NAME :
Single Family Residence for:
World Developement
Gvar� Plan
#2 1300 Sq. Ft.
ELECTRICAL LOAD CALCULATION:
H.V.A.C. Loads ( at 100% Load)
220 Volt - 2 circuits 30 amps each = 30 AMPS
Other loads
Lighting circuits 1300 square foot X 3 Watts per foot = 3900 WATTS
Small.appliance circuit 2 circuits at 1500 watts each = 3000 WATTS
Disposal 800
Dishwasher 1200
Laundry 1500
F.A.U. #1 1500
Garage door opener outlet 800
Total Loads = 13,.500 WATTS
Calculation: First 10 KW at 1000 = 10,000 WATTS
Remaining 3500 watts at 400 = 1,400 WATTS
Calculated Load: 11,400 WATTS
AMPS = 11,400 watts/230 volts = 50 AMPS
Total Demand Loads (AMPS)
with (1) 100% Total H.V.A.C. = 30 AMPS = 80 AMPS
Use 100 AMP service & meter per N.E.C. #8 Uffer water
& gas ground contineous to all.
A. C. PERFECTION ELECTRIC
2jpole
100 AMP
74807 GarvAve.
Palm Desert, CA 92260
Fax \Office (760041-0012
Iicensc #384928 C-10
100 AMP Bus 22,000 AIC
Distribution 124 circuits)
1114 6 Bare Copper Ground wire.
Uffer ground rod.
WATER- CAS & UFM CROUND CON INOUS
TO GROUND BUSS IN ELECTiCAL PANEL
CHARLES D. GARLAND, ARCHITECT
33-163 CATHEDRAL CYN DR.
CATHEDRAL CITY, CA 92.234
(760)324-7146 -
(760)770-7025 (fax)
19 February, 1998
City of La Quinta
Dept. of Building and Safety
78-495 Calle Tampico
La Quinta, CA 92253
To Whom it May Concern,
F
f
I have reviewed a copy of the truss calcs for this project, a 1300 model
for World Development, Inc., on Guatemala, in La Quinta, supplied to
me and prepared by Trussworks of Thousand Palms, CA. I found them
to be in substantial conformance with the design intent of the structural
calculations and plans.
Charles D. Garland,
Architect -
CHARLES D. GARLAND, ARCHITECT
33-163 CATHEDRAL CYN DR.
CATHEDRAL CITY, CA 92234.
(760) 324-7146
16 April 1998
City of La Quinta
Department of building and Safety
78-495 Calle tampico
La Quinta, CA 92253
Project: World Development Plan 1300
Re: Revision of structure
To Whom It May Concern,
I have been contacted by the subject projects developer to reveiw a revision to the plan.
4 Specifically, a fireplace has been added which demihishes the length of shear wall "A". The only
w� usable length of wall is now only 14f -011 at the rear of the.living/dining area. It's tributary V is now
`.. 3 850 lbs., the shear, v, per lineal foot is 275plf and the overturning is 2,048 lbs. As a result of all
of this the wall construction will have to be upgraded to a wall construction type "T which was
formally not used for this particular plan. This wall type Galles for edge nailing of 8d at 4" o.c. and
5/811 diameter x 10" anchor bolts at 32" o.c. All else is in conformance with the originalcalculations.
If you have any further questions regarding this or any other matter with regard to the subject
project, please feel free to contact me. '
Charles D. Garlan
Architect
c -IMI
�j No. C1119911 ))Ar)
� O XP DATGE
�1,
MAY -29-98 FRI 15:02 WESTERN INSULATION FAX NO 9096868786
WESTERN INSULATION, INC.
4211 Latham Street, Rtweralde, CaAfarnla 02501
(9091 ""'F60
(90916666 r" rax
P, 04
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE
CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24, STATE OF
CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT/ PHASE:
LOT#:
SITE ADDRESS:
3 CUSTOM HOUSES TRACT #:75265
51-325 GUATAMALA, LA QUINTA, CA
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 518 " R -VALUE: R-13
CEILINGS : BATTS clBLOW
MANUFACTURER: GREENSTONE IND. THICKNESS: 10.3 R -VALUE: R-38
-QENERAL CONTRACTOR: WORLD DEVELOPMENT
LICENSE NUMBER:
L_'a
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: Production Manager
DATE: 05/29/98
Building
Address
Owner
I:a1
a2 ��I
P.O. BOX 1504
ALLE
�LA QUINTACCAL FORN.pIA 92253
Address �%� X `Vffl - I
City JZip _ _ _ _ ITO,
Address,���
Zip I Tel.
Stateij � I City
& Classit. Lic. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm thalI am licensed un"*p o isfons of Cthapter 9 (commencing with Section
7000) of Divisi n 3 o t e Business and ro es Ions Code, and my license is in full force and
effect. Pi
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm 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, atter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to Ole a signed statement that he is licensed 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 nor more than five hundred dollars ($500).
17 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: 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,
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
of proving that he did not build or improve for the purpose of sale.)
I i 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.)
I 1 I 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. Company
(7 Copy is filed with the city. ❑ 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 Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
Lender's Address
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.
I certify that I have read this application and state that the above information is correct.
1 agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives sof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING DIVISION
APPLICATION ONLY
BUILDING: TYPE CONST.-OCC.
GRP.
A.P. Number
Legal Description
Description
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
Sq. Ft:� No.
Size Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑
Repair ❑
Demolition ❑
N
IVA/;I
Estimated Valuation
00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
31. 5,0
Mech.
5751,
Electrical
, Q
Plumbing
S.M.I.
I-)
Grading
210,
Driveway Enc.
Infrastructure
Z
TOTAL
REMARKS tt0,0 ei,,A, O`' bT�r fj
I41:)sn nn"
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. I ELECTR AL' FEES —vN0.
PLUMBING FEES
$
UNITS' ..,� ..- .
SLAB GRADE
ROUGH PLUMB.
1ST FL. SO. FT. ®
HEATING (ROUGH)
STORAGE TANK
FORMS
2ND FL. SO. FT, @
_
YARD SPKLR SYSTEM
ROCK STORAGE
POR. SO. FT. CP
MOBILEHOW SVC. ::.
BAR SINK
HEATING (FINAL)
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
TEMP. POLE
CAR P. SO. FT. ®
DRAINAGE PIPING
WATER HEATER
WALL SO. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
SO. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
FRAMING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
SPARK ARRESTOR
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
LATHING
COMPRESSOR HP
POLE,TEMlPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
INSULATIONISOUND
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. p c
WATER HEATER
FINAL INSPECTION
MAX. HEATER OUTPUT, B.T.U.
SO, FT. RESID ® 1V. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
INSPECTOR'S StGNATURESlINITIALS
GAS PIPING
GARDEN WALL FINAL
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE� PL.FE�
CONST. FEE
SMIFEE�i����
16 3,5o
b
STRUCTURE PLUMBING E EC;7, i,
TRICAL 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 APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
g —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 StGNATURESlINITIALS
GARDEN WALL FINAL
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated (619) 347-8631
Date 112/28/921 Type of Permit I La Quinta
No. 11918 1 Permit #
Owner Name Roger Snellenberger Log
No. 51330 Street Calle Guatemala
City La Quinta Zip 92253 Study Area 112
APN # Tract # Lot # 0 Square Footage 11218
Type of Development ISingle Family Residence No. of units 0
Comments
At the present time, the Desert Sands Unified School District does not collect fees on
garages/ carports, covered patios/ walkways, residential additions under 500 square feet,
detached accessory structures or replacement mobilehomes. It has been determined
the above-named owner is exempt from paying school fees at this time due to the
following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 1.58 x 1218. or $ 1,924.44 have been paid to D.S.U.S.D. for
the property listed above and that building permits and/or Certificates of Occupancy for
this square footage in this proposed project may now be issued.
Fees Paid By Roger Snellenberger & Associates Telephone 564-0793
Name on the check
By James F. Lively
Assistant Superintendent, Business Services
Fee collected /exempted by Vickie J. Durrett
Payment Received
Signature �C LR���.c/b iR-L Check No. 001921
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/ Receipt Copy - Accounting
2
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L r'= COUNTY OF RIVERSIDE HEALTH SERVICES AGENCYAssssors Parcel No.
q
7� — i 1*7;;,— ocn!,,
DEPARTMENT OF ENVIRONMENTAL HEALTH l
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 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.
LOG # VERIFY ITEMS IN SECTION A FROM A NON -FEE BUILDING & SAFETY (goldenrod) APPLICATION
Agent, NaCorLactt Person
Phone
Address City State Zip
��,(;J\��'�tJ
Owne
Phone
Address City State Zip
�.
crfa
,b 2
Job Prope Address
City
LA
Stat
Zip Legal Description Prop.,(PM, Trect Lott,l
rL I/ iJU �wtC
I —
1 NTS
C.
,,I+tiG
Lo s 4A
LotSize
Water Agency/Well
Use of Permit P/P, CU, etc. Other
DwellinDMHite Prep, etc.
t
Signature of Applicant
Date
CATEGORY REV CODE FEE
CATEGORY REV CODE FElk
❑ SUBSURFACE DISPOSAL (per system) 1238 $1.513 .00
[1 SITE EVALUATION UPON REQUEST 7349 $120.00
(NO PLOT PLAN)
❑ MULTIPLE PARCELS WITHIN SAME LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $ 58.00
a. 1st 4 Parcels (Each) 1238 $153.00
❑ PRELIMINARY ELECTIVE EVALUATION
b. Each Parcel after 4 7344 $ 55.00
(Attach DOH -SAN -53) 7352 $ 69.00
❑ REREVIEW (2nd review same parcel) 7344 $ 55.00
❑ HOLDING TANK 7351 $119.00
❑ SITE EVALUATION in Conjuction with Critical Area 7346 $197.00
❑ ALTERNATIVE EXPERIMENTAL SYSTEM 7345 $656.00
❑ GRADING PLAN REVIEW DETAILED 1238 $104.00
❑ SITE EVALUATION Lot Less than 10,000 Sq. Ft. 7347 $172.00
❑ GRADING PLAN REVIEW CURSORY 1238 $ 55.00
❑ SECOND FIELD VISIT (SITE EVALUATION) 7346 $ 85.00
❑ COPIES (LAND USE) 7786-81 * $ .50
INITIAL DATE
Holding Tank Agreements Completed ❑ Yes ❑ No
Certification of Existing S.D. System Required ❑ Yes ❑ No
WOCB Clearance Required ❑ Yes ❑ No
(Attach Form DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required ❑ Yes ❑ No
Special Feasibility Boring Report Required ❑ Yes ❑ No ?I
Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes ❑ No
Grading Handout Provided ❑ Yes ❑ No
Staff Specialist Lot Inspection Required ❑ Yes ❑ No
Maintenance Booklet Provided ❑ Yes ❑ No Lot Inspection Date Initials
C/42 / Soils Percolation Boring Report by Lic/Project # Date
Soils Map Page Soil Type Approved By Date
No. of Systems
Type of System(s)
No. Dwelling Units
(1) Septic Tank
Soil Rate
Grease/Sand
❑ Holding Tank ❑ Replacement
Bedrooms, Fixture Units
Grease lntop/UntTrap
[XNew ❑ Addition
❑ Existing
17- d rnnrn &
10Q Gal.
Gal.
Sq. Ft.
Total Linear
Sidewall Allowance
Leach Bed sq. ft.
Bottom Area
Ft.
tt rock/ sq, tt, per running ft.
Install Line(s) ft. long ft. wide with
of Bottom Area
Inlet Tested Depth ❑ NA
min. inches rock below drainlines or
Proposed Bottom Tested Depth
Leachlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
Seepage Pit Total Depth
(TD) 411 1
Other:
Inlet (BI)
Applicable
❑ 5 &6
'
Max. Depth
N/A Overburden Factor
�Al/lo'w!able
Y 1� 0,
Well Review Approved: Signature Date Well Drilling Permit #
Grading Plan Approved: Signature Date
REMARKS:
This application is APPROVED/RtN&_Qjor the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompanied plot plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the above -designed
sys�tem e
tr 1 Septic tank must be 100' minimum from any wells
lines must be 100' minimum from any wells, including expansion area
(Leach
,nftCw
(3) Seepage pits must be 150' minimum from any wells, including expansion area
Signature of Health Official . r� iif Q �/ ��..G �fe +. / /L]y /i� (� Date r
�-----� ❑ CASH N2HECK NO.' B S
RECEIPT NO. P7n l Issued By Date 1 % " d'
DISTRICT ❑ Riverside ❑ Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
DOH-SAN-122(Revt/92) 'DISTRIBUTION: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Plans/Records
Ivp
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CALVIN C. KAMINSKAS
Assistant Commissioner
(714) 275-3000
OFFICE OF
AGRICULTURAL COMMISSIONER
JAMES O. WALLACE, Commissioner
83-612 Avenue 45 Suite 7
Indio, CA 92201
(619) 342-8291
DAN RILEY
Sealer, Weights & Measures
(714) 275.3030
DATE I /�%%�— CASE NO. /20o7? -7
DEVELOPER'S NAME: %�O P✓ silt
ADDRESS: D,y9 O x l 7
TELEPHONE: (� :::;
5`_T -3 6 o ' s �. 4o 'cie j•� Qr�:
sl -33 0
Dear Developer:
After reviewing your landscaping plans, all plant material listed is not in
violation of quarantine laws governing the Coac eller Valley. If substitutions
do occur and they differ from plant material li ted, this office must be notified
immediately.
Thank you for protecting and preserving the Coachella Valley's pest -free environment.
,f r_-7
Agricultural Commis is Office
cct Indio and Riverside
4080 LEMON STREET, ROOM 14, RIVERSIDE, CALIFORNIA 92501 — FAX (714) 275-3012
C�