06015 (SFD)t
A
Building
Address 51-960ITerrers
Hichac2 C. Read
T4V1 4 4 a"
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Address 43576 Washington Sr.
City Bermuda Dunes Zip 92201 1 Tel.
owner/buil.dor
City lZip
State Lic.
& Classif. b#448018
I City
Lic. #
Arch., Engr.,
Designer
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70pp) of Division 3 of the Business and Professions Code, and my license is, in full force and
effect. i / y
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, ager, kmrove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile 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 app#=t to a civil penaltyof not more than five hundred dollars ($500).
❑ 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, 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.)
O 1 am exempt under Sec B. & 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 ✓
O 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 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: n, 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 shalt 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.)
Lenders 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 of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant -Date-
Mailing
ateMailing Address
City, State, zip
No. 06015
BUILDING: TYPE CONST. OCC. GRP.-
A.P. Number 773-173-811
Legal Description
'Project Description 15, 1).
Sq. Ft. No. No. Dw.
Size 1393 Stories 1 Units 1
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
1
Estimated Valuation 76.317.50
PERMIT
AMOUNT
Pian Chk. Dep.
' O0
Plan Chk. Bal.
Const.
3
Mech.
'
Electrical
•��
Plumbing
172.3
S.M.I.
'"y
Grading
Z0.03
Driveway Enc.
' 00
Infrastructure
Y
TOTAL
REMARKS <..:�. a .R , x< , , „.•. �- .r„ :.ts. ,n
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
6-113-89
Issued by: Date Permit
Validated
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING F€ES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
&1 SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CARP. SO. FT. ®
GAS (FINAL)
TEMP. POLE
WALL SO. FT.
DRINKING FOUNTAIN.
SQ FT ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP. f//
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
(/!/
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11.4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
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 171
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
gv—SETBACK --/�_
GROUND 4U IN f^
UNDERGROUND
A.C. UNIT
COLL. AREA
&1 SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR S
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. f//
WOOFING.
(/!/
I I9V
As
I0
(�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING /� 5/�l7
MESH
0 ULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL:d
1
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
SCHOOL FACILITY FEES
NOTICE: THIS DOCUMENT CANNOT
T0: City ofLaQu $ROCATED,
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
DATE:
This is to ertify tha 14 ,
developer of which is
located at WhA PA A within
this District, has paid school facility fees imposed pursuant to the
au orit}t, generate vernment Code ectio 530DO in the amou t ofd) p�'l�UZ7
55 , //
covering a o al of G% square feet of (Y) resi ential or
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
ILA L)
for DESERT SAN S•UNIFIED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37
i
RECEIPT NO. 15r3/ Issued By Date _57- o;;7 3 —00,F
DISTRICT: ❑ Riverside, Q, ndio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
MA
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH AssafO1° Parcel NO'
ENVIRONMENTAL HEALTH SERVICES
PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM
y
Applicant: Submit this form with four copies of a scaled plot pian (1-20 scale) drawn to County speci�lafr 'is indicated on the attached check list.
G
A non-refundable filing fee (see below) is required when the application Is submitted. Check must be made payable to the Cbunty of
Riverside. Approval of this application shall remain valid for a period not to exceed'one year from date of approval.
a
Q
ZI
.t
VERIFY ITEMS IN SECTION A FROM BUILDING Q SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'tx
A
O
Agent, Contractor, Contarson
Phone
Address 8 Phone
���
Phone �
Mani �Addresa r ��...
city
State
Zip
Job Property Address
escripf Prop. (PM, Tract, Lot)
�
c� r
c.',�
27� 1
/ , 1� 1
Lot Size
ter A nc 1
Use of Permit P/P, CU, etc. a
Other
/
� X/
a
�
I .elliiig, IH c. ( SET
V"1 ' sig <Applicant -
Date
CATEGORY: REV CODE
CATEGORY: REV CODE FEE
110 SUBSURFACE DISPOSAL 1238 $45.00
❑ SITE EVALUATION UPON REOUEST 7349 $42.00
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
m
Z
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
O
a. 1 st 4 Parcels (Each) 1238 $45.00
(Less than 1 year)
f` b. Each Parcel after 4 7344 $16.00
❑ PRELIMINARY ELECTIVE 7352 $45.00
LU
❑' Rereview (2nd review same parcel) 7344 $16.00
EVALUATION (Attach DOH SAN 53)
U)
is O� Site Evaluation In Conjunction with t
❑ HOLDING TANK 7351 $45.00
Critical Area 7346 $86.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $13200
❑ Site Evaluation Lot Less than
SYSTEM
101000 Sq. Ft. 7347 $86.00
NITIA DATE
Holding Tank Agreements Completed ❑ Yes BgN2- 3 —
Certification of Existing S.D. System Required ❑ Yes 0 No
WQCB Clearanoe required. (Attach Form ❑ Yes 1744o
DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required. ❑ Yes G) No
Special Feasibility Boring Report Required. ❑ Yes
Detailed Contour Plot Plans Required (1 to 5 ft, Interval) ❑ Yes
� I
Other ❑Yes
Staff Specialist Lot Inspection Required 11 Yes fYNo
Lot]LDate
Sills boring report by
l� Data
�--
Soils Map Page r I Soil Type Approved by ''C.C/�.-- Data 3
r r
U
No. of System
�{
Tyle of Systeme)
❑�I Olding Tenk ❑Existing
No. Dwelling Units
BedroomstmertlnNs
(1) Septic Tank
Soil RateGresse/Send
(f �/p old)
Inicp
O
f
J_
m
J New O Reptaoeer►t
1341hQ�'y
�
�Gaf
Gal
U
12) Leach Line Sq. Ft
Sidewall allowance
Install une(s) R long _fit wide with
Leach Bed sq. It.
trench arm
ft rook/ sq. It.
min. Diib>rod{4bebw drafnlines or
ofbal area
per running iL
NA
—�
Leachlinea/bed special design for slope:
(3) Pit Diameter
No. Pita
PR Below
Seepage Pit TC0 Depth
Otfrer.
Q<a
Apple
/
L�7 6
Inlet (BI)/
N a
Max. Allow le�Depth
N/A te�_ O.burn factor
NO.2 System A114 D ��p�•
REMARKS:
This application ' PPROVE ENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompariied p 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 area.
WLeach
Septic tank and sewer lines must be 50' minimum from any wells L1 f O i (P,, 1,,,_a,,,, e�
lines must be 100' minimum from any wells, including expansion 16a eo 4 1 e.J_t,
� t,
Seepage pits must�/be 150' minimum from any wells,,, including expansion area � to ,(¢ /�.k,_ ' V
•� uL � �. e
p i_
MVV � r
Si nature of Health Offician; "''• L L /f'J 0 KC ,6, 4 Date
RECEIPT NO. 15r3/ Issued By Date _57- o;;7 3 —00,F
DISTRICT: ❑ Riverside, Q, ndio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
MA
Buena Engineers, Inc. -
~� 79-811 Country Club Drive, Suite 4
Bermuda Dunes, CA 92201 • (619) 345-1588 / 328-9131
Client Name
Client
Client Phone
DATE
AUG . t4 $9
JOB NO.
6-7 � (62G 1
PROJECT
s1 A
LOCATION
/
CONTRACTOR
tA • 4 -FAT::)
OWNER
WEATHER
C-�r—AIiZ7–
TEMP.
oat AM
0 a PM
PRESENT AT SITE
OPTIMUM
MOISTURE
CONTENT
%
N2� i ST I
�'3
TEST
NUMBER
TEST LOCATION
'
LOT
NO.
ELEVATION
FIELD TESTING
REFERENCE CURVE
MOISTURE
CONTENT
%
DRY
DENSITY
lbs./Cu. ft.
MAXIMUM
DRY
DENSITY
%
MAXIMUM
DRY
DENSITY
lbs./cu. ft.
OPTIMUM
MOISTURE
CONTENT
%
N2� i ST I
�'3
10-L1
(0-7.
PF-
I t . <
(C8
r
REMARKS: MT=- A -et -A .
AS.SUM 10 F c2� E U t UUS *TE Ran(
7"9-GTC�E-E i E S f -t- c Q U 1 t2C M i A -j TS
FIELD REPORT
TECHNICIANS SIGNATURE.
%n'.'�.v..ir Lc� xs�l3:t.:L.`.'x..x'�'k�i4_X-i'•.v.,..y�>w... �.:.+4r,±d.a �� ,.:..>,E+o;.�Y.��1- j {�.� R;#�u:�.r,�6:,
�-.y-�w��v ���^ r"� .- `� '�Y'�r�'.t.-rs'Y-.:.,i�,r°w,..:w,.�y.,.r.^-y1rY,.r.,.;rrv�-�o�v-�"`s�-�✓• ) .. r• •w -v-.- � %---t,. .,.
Buena Engineers, Inc.
~� 79-811 Country Club Drive, Suite 4
Bermuda Dunes, CA 92201 • (619) 345-1588 / 328-9131
Client
Client Address
Client Phone
DATE
3bL`( Z 1 ►.qct
JOB NO.
(- 1 �>R P
PROJECT
ELEVATION
LOCATION
LA 0-,,j
1 tv`r-A
CONTRACTOR
MICt4AEL
F+A1
OWNER
WEATHER
Cc : A IZ
OPTIMUM
MOISTURE
CONTENT
%
TEMP. o at AM
° at PM
PRESENT AT SITE
1 Z4
ani
ICS,3
TEST
NUMBER
TEST LOCATION
)
000 --SE- PAC)
LOT
NO.
ELEVATION
FIELD TESTING
REFERENCE CURVE
MOISTURE
CONTENT
%
DRY
DENSITY
lbs./Cu. ft.
MAXIMUM
DRY
DENSITY
%
MAXIMUM
DRY
DENSITY
Ibslcu.ft.
OPTIMUM
MOISTURE
CONTENT
%
1
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REMARKS: PE F-FC}� M E 3 �j ON) USF` PACS A -2E A, �jv F 1 LL. .
PO'3J A 2F-1 UArL HEST AA L F CT- LCJT W A 6E t fJ C -r WAT-E [Z�E D. TESTS
A SD z3 A'e1` LOCATT� C3J W'E�T �14CF . /ASS,U to (,\J & A M CT -F (20
F14%LE Tp M SET C> -r-:- NisIn 12E (2E tit E TEST
COC Aa -F7 0-tJ CAST N A L E� Ae 1, SOME C.J'! 447f— U iZ \ L (Z
AQ � FA lLt 7 E-T-
SOIL-
SUIL S A to P L E j'A V --E tJ P-crcz T -CE- s-" IV G .
6646 CLIENT REPRESENTATIVE SIGNATURE
FIELD REPORT
TECHNICIANS SIGNATURE