07519 (SFD)P.O. BOX 1504 N o . 07519
519
Building 78-105 CALLE ESTADO
j Address 5825 Guayms LA QUINTA, CALIFORNIA 92253
j Owner
Mailing
A & H Construction BUILDING: TYPE CONST. OCC: GRP.
Address - 7j69 -X75-006
A.P. Number
,r
City Zip ..Tel. - • _ _ _ .
m sa 7 Legal Description Lot 44
Contractor Project Description Single Family Aline
Sate '
Address
City Zip Tela
t
j. State Lic.- City
7
& Classif. ' 1 Lic. # 626 Sq. Ft. 2M No. No. Dw.
Size Stories Units
Arch., Engr.,-
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that ITBI
It
icensed.gnder provisions of Chapter 9 (commencing with Section
7000) of Divi'i " oftu iness and Pro �siofl Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation 9
I hereby affirm that I am exempt from the Contractor's License Law for the following `_���G21
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
p., 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 that. he is exempt therefrom, and the basis plan Chk. Dep. G��
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a
.00
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). Plan h Bad es�
❑ I, as owner of the property, or my employees with wages as their sole compensation, will J
Iq
1•',do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Con e t
Professions Code: The Contractor's License Law does not apply to an owner of property who _ 7
75-00
i, builds or improves thereon and who does such work himself or through his own employees, Mech.
provlded that such improvements are not intended or offered for sale. If, however, the building
or„jmprovement is sold within one year or completion, the owner -builder will have the burden Electrical -h
of proving that he did not build or Improve for the purpose of sale.) 1AAAA
A
0 I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
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.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec. - B. & P.C. for this reason
Driveway Enc.
Date owner Infrastructure
R
WORKERS' COMPENSATN DECLARATION Y
I hereby affirm that I have a certificate of cipsent to s jasure.aLA ertificate of
Worker's Compensation Insurance, or a certified py�there0 Sec. 3800, Labo,Odb.)
Policy No. Company f . .
O Copy is filed with the city. ❑ Certified c 9 py is hereby furnished.
TOTAL
1 '~ s •
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
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Dale 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
I
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
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 sVspended for 180 days.
I certify that I have read this plication and state .that the above information is correct. Issued by: Date ��90permit
I agree to comply with all city nd county orgmances and state laws relating to building
construction, and hereby auth rize representatives -of this city' to' enter" -•the above•.
mentioned property for inspect' n purposes. Validated by:
Signature of applicant' Date
Mailing Address Validation:
City, State, Zip.
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
'
2ND FL. SQ. FT.
r
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
SEWER OR SEPTIC ROUGH WIRING.
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
DRAINAGE PIPING
CAR P. I SQ. FT. ®
HEATING (FINAL)
OTHER APPJEQUIP.
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH E R(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP. (�
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROOFING . Ql/
LAUNDRYTRAY
AIR HANDLING UNIT CFM
REMARKS:
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.
SQ. FT. ®c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
HOUSE SEWER
MESH
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
r
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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. l ( -L /
ROOFING . Ql/
T vr� �4 / L 2 Q�0 (��
Ak A
�j /'/Q(, 0✓/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWAL �/b /✓I�y/
LATHING a.6
MESH
INSULATION/SOUND
FINISH GRADING / O go
FINAL INSPECTION (�
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
1
4 4v Qum&
4
P.O. BOX 1504 APPLICATION ONLY
Building LA QUINTA8-105 CCALIFORNIA 92253
Address "�/ _
Owner —7=n 77 _
Mailing
Address PC l� (D
City a Z
k2Zs3
Address
City _ ( W//I/.Rip ITel..
State Lic.City
& Classif. X9759 Lic. #
Arch., Engr.,
Designer
Address
Tel.
City ' Zip State
Lic. #
BUILDING: TYPE CONST.—OCC.
OCC. GRP.
A.P. Number 16f07-5—� 00 �O
'52;411032- Legal Description L O
Project, Description
LICENSED CON CTOR'S DECLARATION affirm that I am Ii nsed under provinnss of Chapter 9y commencing with Section
7 of Division 3 of the Bu n and Prof d m license is in full force and
effect.
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to /7i e a signed statement that hes licensed pursuant to
the provisions of the Contractor's License taw, 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 appGcant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (41500).
❑ 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
btdlds 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. 11, however, the building
or improvement is sold within one year of completion, the owner -builder wig have the burden
of proving that he did not build or knprove for the purpose of sale.)
❑ 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.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date Owner
WORKERS' COMP SATION DECLARA]kON
I hereby affirm that I have a certifi to of consent to self - in or a certificate of
Workers Compensation Insurance, or ace ifi py t re$aor385eo 3 0"0'Ca�or Code.)
Policy Nom
pany
CICopy is filed with the city. ❑ Certied copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed if the pearl is for one hundred dollars (41100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
N077CE TO APPLICANT: H, after making this Certificate of Firemption you should become
subject to the Workers' Compensation provisions of the tabor Code, you must forthwith
comply with such provisions or this permit shall be deemed remked.
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 Coda.)
Lenders 'Name
Lenders Address
This is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that 1 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
ateMailing Address
City, State, Zip
BUILDING DIVISION
I
r
Sq. Ft.?, J'� No. NoDw.
Size 3 v Stories Units
New Add ❑ Alter ❑ Repair ❑ Demolition ❑
stimated Valuation
Zr 7, Z 0
PERMIT
AMOUNT
Plan Chk. Dep.
Z -O. o O
Plan Chk. Bal.
r,
Const.
'z S—S—it Oc?
Mech.
Electrical
/ .. Sa
Plumbing
Q, ,-d
S.M.I.
/
Grading
o c==1
Driveway Enc.
Infrastructure
—7
TOTAL
2 7. a —0
REMARKS
005182 W 3191
04-03'-96 14
1U (.1,A3M 1 IUIAL
1 2_*(5.UU
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
i
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
GROUND PLUMBING
NO. ELECTRICAL FEES
NO. PLUMBING FEES
COLL. AREA
$ 'L�
UNITS
BONDING
HEATING (ROUGH)
1ST FL. v SQ. FT. ®
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
YARD SPKLR SYSTEM
2ND FL. Sp. FT. 0
REINF. STEEL
GAS (FINAL)
TEMP. POLE
3
MOBILEHOME SVC.
SERVICE
BAR SINK
POR. SQ. FT. ®
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
/ o
LUMBER GR.
POWER OUTLET
FINAL INSP.
ROOF DRAINS
GAR. v Sp, FT. ®
ROOFING
REMARKS:
VENTILATION
DRAINAGE PIPING
CAR P. I SQ. FT. ®
FIRE ZONE ROOFING
WALL Sp. FT. ®
7
DRINKING FOUNTAIN .
SPARK ARRESTOR
URINAL
SQ FT ®
LATHING
ESTIMATED CONSTRUCTION VALUATION -
$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINISH GRADING
FLOOR DRAIN
MECHANICAL FEES
FINAL INSPECTION
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
r
CERT. OCC.
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
INSPECTOR'S SIGNATURESIINITIALS
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GARDEN WALL FINAL 7d
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
lot
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/.c
/3
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 APPJEQUIP.
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
r
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL 7d
Desert Sands Unified School Disjrict �'' ' TM�r "Y4iP*'
CERTIFICATION PAYMENT
DLC41,CILITY FEES
t tp d f a�QI t o DATE: 0
Departme of Community Development
78-105 Calle Estado
La Quinta, CA 92253
A£ This is to c rtify t - '�� •
developer of 1whi h f'%�'IZ.
located at,; �, t �tI
92
this District, ^has paid sc ool facilt�
Y �V m ic�se � 'c n '"t the
aut or't ge erate4 by Governme t Code Sept*ost Y 089` 'ri 'E Mout- of
$ (�r f
covering a total of s0are
��.
( ) industrial/commercia development and .thatbud l *iii ,per }ta for 4*
this footage in this development may now be,iss:yed byY j,uri
sago � _ • .
,
3� for DESERT $A _S U. N FIEQ'- OISTRICT . `
White • Buil ing Department • Yellow— • Facilities PlanningPink - Accounting. 0 Gold - {: Develop9;
�D :-7003 3;55_ .- b 4-Q g, � T
i
IN
I
f -
f � i
a
5.
• 1 Y'' tf' f
ti.i
f
f
�
I
f -
/
DESERT SANDS UNIFIED SCHDDI DISTRICT
82-879 Highway 111
Indio, CA 92201
TO: �vti,�1 _ k ,AL
�ULCI'♦— � � ��
Date: 9
M
This is to certify,at
developer of - ., which is
to ted at
with thi school district, ,is required to 6hy school facility fees
pursuant to the authority generated by Government Code Section 5 080. The
amount of fees due for the/'above referenced pr 'ect i,ss $
covering total applicable /square footage of (d square feet,
which is subject to final verification.at time payment is presented.
Lo W
nP..+Q.. Pax 344
I+L .Quinta
..
SPACE ABOVE THIS UNE FOR RECORDER'S USE
GRANT DEED
,PiE UNDERSIGNED GRANTOR(S) DECLARE(S)
DOCUMENTARY TRANSFER TAX IS $
3C] computed on full value of property conveyed, or
O computed on full value less value of liens or encumbrances remaining at time of sale.
v 0 unincorporated -area -
XD city of La Quinta , AND
FORA_ VALUABLE CONSIDERATION, receipt of.which is hereby acknowledged,....-
,eo Howard, a married man as his sole and separate property
o _
hereby GRANT(s) to
&.M Construction, A California Partnership
the following described real property in the City of La Quinta
County of Riverside , State of California:
t8 33, 34, 35, 39, 42, 43,-'44,-45,..113, 115, 131, 135, 138 -of DESERT
UB •TRACT .UNIT •NO.5, as shown by -Map on file -in Book 21 Page$ 61 and 62
Mitps, Records of Riverside County, California.
} Leo Howard
S%4F OF CALIF1.ORNIA
COOMOF LOS
Otti#* day of J •4 a u , in the year 19 9_ Q- ,
beim me, the undersigned, a Notary Public in and for said State,
Personally appeared L<:o ,S1flcv,4,G1�
personally known to me
(or pmved to me on the basis of satisfactory evidence) to be the OFFICIAL SRAi.
RHOpFFICI
pelgoart whose nam 8 — is subscribed to the within `"°` A E FRANK
's kq rtaettent, and acknowledged to me that _ he-- executed it. w NOTARY PUBLIC - CALIFORNIA
LOS ANGELES 00UfM
NpTWSS my hand and official seal. My comm. expires AUG 28, 1"2
NOTARY PUBLIC IN AND FOR SAID STATE (Te am br official nmu ted)
I (REV 4/85) MAIL TAX STATEMENTS AS DIRECTED A8010E.
Ln
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8
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8
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N
COUNTY OF RIVERSIDE ENVIRONMENTAL Ase"Mm Parw No.
1769- a75 e66
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 speculations as indicated on the attached check Ilst
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.
vy+��u�►
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG #
r �
Agent, Contractor, n
C
Phone
Address 8 Firm /
km.
456yW37-
Owner /
C
Phone
Mailing Address r�U / 41- ( NTS
C.
City
Qom, �:,4-
to
�
Zi
Z53
Job Property Address
-G
Legal Descript Prop. (PM, T-11. Lot)
�- a S
o
Lot Sizeafar
Agency Jel11
Use of Permit P/P, CU, 4310 . 2�A / 44
Othe,D
Ce
�P7t G
J��
[ /
Dwelling, H Site Prop, eek.
y6
Signature of Applicant
Date
� CATEGORY: REV CODE FEE
[b, -SUBSURFACE DISPOSAL 1238 5, 0I
CATEGORY: REV CODE FEE
❑ SITE EVALUATION UPON REQUEST 7349 $ 43.00
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $ 17.00
a. 1 at 4 Parcels (Each) 1238 $ 57.00
(Less than 1 year) f
b. Each Parcel after 4 7344 $ 24.00
❑ PRELIMINARY ELECTIVE 7352 $ 23.00
❑ Rereview (2nd review same parcel) 7344 $ 24.00
EVALUATION (Attach DOH SCAN 53)
❑ She Evaluation in Conjunction with
❑ HOLDING TANK 7351 $ 47.00
Critical Area 7348 $111.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $222.00
❑ Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $ 87.00
jIN�IT/IAL} DATE
/•ft�(/� 3 ~ 36). 90
Holding Tank Agreements Completed ❑ Yes
-
Certification of Existing S.D. System Required ❑ Yes 211 N�o. i f
WOCB Clearance required. (Attach Form ❑ Yes O>•fJo
1 DOH SAN 007, Santa Ana Region Only)
Sills Percolation Report Required. ❑ Yes a '
��No'f
Special Feasibility Boring Report Required. ❑ Yes ,H7"�No., -
Detailed Contour Plot Plans Required (1 to 5 ft interval) ❑ Yes eN�r
Other ❑ Yes CP
Staff Specialist Lot Inspection Required ❑ Yes -
Lot Inspection Date
Silas boring report by Date
�PPrr`oject
Soils Map Page ! 1/ "•< / Sol; Type Approved by Date -3- 3v- %v
No. of systema • .
Type of Syste ms) •
p
No. Dwelling Units t 1
(1) Septic Tank
Soil Rats
Greae9/Send
�Orease
❑ Folding Tank ❑ Existing
l sFlew ❑ Replacement
Bedrooms, F7xtar"n is
Intcp
(f Qrf
^��
T ,6^%h4
2,L) Leech Line Sq. Ft.
-Bottom
Sidewall allowance
�
Install Line(s) ft long M wide with
Leach Bed sq. fL
,R
trench area
ft. rock/ sq• fL
min.below dnlnl'rnes or.
per running ft
Leachlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below,
Seepage Pit Total Depth
(TD)
ath
Applicable/I
/6
Inleh(Brp
f
U4
N/A u� Overburden factor
1�5� Of
i /O
Max. Allowable Depth
No. 2 SystemA//.4
REMARKS: ¢ / ,
,�.--fes
/i�t�/—� / //%�AASJ'�„G�.�/!%%! �.� ,!°I'�e�' C�'Y• i` �r+^4S►
This application is APPROVED - ENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompanied plot `pl5n, 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.
Septic tank and sewer lines must be 50' minimum from any wells /V -C�. '/- � V( 2t -
(2)' Leach lines must be 100' minimum from any wells, including expansion area /
Seepage be y
(3) pits must 150' minimum from any wells, including expansion area V/ 9 arc
1, a,- 6w
Signature of. Health Officia. I I / Date^ /1*0
RECEIPT NO. r Iced B.y I / f _ Date U ��
DISTRICT: ❑ Riverside, Lt 4ndie ❑ Hemet Q Perris ❑ R ,eho' alif. ❑ Blythe
DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
Desert Sands Unified School District
• CERTIFICATION OFrPAYMENT
FACILITY FEES
. ��,� ������ V
Tp�yci f L,aQin t a DATE
Departmen ,of Community Development
78-105 Calle Estado
La Qjuinntta, CA 92253
This is to c rtify t w
developer f_
located at
this%Distr;ict-has-pa id`sc ool
aut or.t generatp4 by Governme
$ 3 cLUM 1-41
covering a total of
( ) industrial/commercial devel
this footage in this development
M
5�'9p
1 OT-
_wh-i chi s
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facility fees imposed pursuant -the f`
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pment and that building permits for
may now be issued by your jurisdiction.
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for DESERT SAt46S UNIFIED SCHOOL DISTRICT
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,Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
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o �' e"�`•,. OFFICE OF
AGRICULTURAL COMMISSIONER
AND
WEIGHTS & MEASURES
�� CALVIN C. KAMINSKAS
JAMES O. WALLACE 4080 LEMON STREET. ROOM 19 Asslslanl Commissioner
,ftleulluralCommissloner RIVERSIDE, CALIFORNIA 92501 CLEMENT BENVENISTE
grecla of Welphh d Measures (714) 787.2561 Seater
" 49613 Highway 86, Suite B12
Coachella, Ca. 92236 Q /�
-1i��� (619) 342-CASE1No. PC�-G 0g637�
DATE r,,,
DMWPER' S NAME: A d Uri,
ADDRESS _P.����
TELEPI ZONE se (& I)
Dear Developer:
After reviewing your landscaping plans, all plant material listed is not in
violation of quarantine laws governing the -Coachella Valley. If substitutions
do occur and they differ fran plant material listed; this office must be notified
immediately.
Thank you for protecting and preserving the Coachella Valley's pest -free environment.
,.4