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07068 (SFD)Building 52-790 Ferrers P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 No. 07068 Owner _ Jw.k Nelsen Mailing BUILDING: TYPE CONST. - OCC: GRP. , Address A.P. Number, 773-32.5-002 City Zip Tel. Legal Description ,,Contractor Project Description 3? Address. £City Zip Tela State Lic. City & Classif. Lic. # Sq. Ft. No. No. Dw. Arch., Engr., Size 1650 Stories Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City (Zip (State Lic: # f LICENSED CONTRACTOR'S DECLARATION I hereby affirm that'l am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3�off thee;8usiness and.P.roffeesrsions Code, and my license is in full force and effects SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason:' 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 file a signed statement that he is ficensed 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 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 anproves 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 -boder win have the burden of proving that he did not build or improve for the purpose of safe.) O I, as owner of the property, am exclusively contracting with licensed contractors to com. 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 contractors) licensed pursuant to the Contractor's License Law.) ❑ 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 . ❑ Copy is filed with the city. ❑ Certified copy is hereby fumished. 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.) 1 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: It. after making this Certiftate of Exemption you should become sub/ect 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 1 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 if work thereunder is suspended for 180 days. I certify that I 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 Address City,. State, Zip uation $89 PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL AMOUNT 196.85 596.50 53.50 132.00 145.50 6.30 20.0© 20.00 979.00 - REMARKS Aq-19;...4/1 f ij iv '.Kin A IV!#%. 3 aitw�i.c. 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 2/23/9® Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. ® $ UNITS r r BONDING HEATING (ROUGH) STORAGE TANK YARD SPKLR SYSTEM 2ND FL. SO. FT. @ ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. MOBILEHOME SVC. BAR SINK POR. SO. FT. ® REINF. STEEL 2✓ GAS (FINAL) GAR. SO. FT. ® POWER OUTLET ROOF DRAINS WATER HEATER SERVICE FINAL INSP. DRAINAGE PIPING CAR P. SO. FT. WATER SYSTEM GRADING FINAL INSP. CU. yd. $ -Plus-X$-=$ WALL SO. FT. LUMBER GR. DRINKING FOUNTAIN FRAMING FINAL INSP. URINAL SO FT ® REMARKS: ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER SPARK ARRESTOR GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GAR. FIREWALL LAUNDRY TRAY AIR HANDLING UNIT CFM LATHING T-0)VIV 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 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1 V. c SEWAGE DISPOSAL SO.FT.GAR ® Vic 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 IfVf UND PLUMBIN %��� UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE �3 l ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS /L SE IOC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL 2✓ GAS (FINAL) TEMP. POLE /V GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING FINAL INSP. CU. yd. $ -Plus-X$-=$ LUMBER GR. FRAMING FINAL INSP. ROOFING p 2 70 A-0- 0 V REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING T-0)VIV MESH INSULATIONISOUND ell FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESlINITIALS ' GARDEN WALL FINAL Building Address Owner AA Tit4t 4 4 Qum& P.O. BOX 1504 APPLICATION ONLY 78-105 CALLE ESTADO '/z 14 LA QUINTA, CALIFORNIA 92253 Mailing ITel BUILDING: TYPE CONST. OCC. GRP. A.P. Number -7 % 3 -z— Legal Description Z 0 7` Z �� Project Description Address City Zip Tel.. State Lica- City & Classif. Lic. # Sq. Ft. Size �(/ji �� No. No. Dw. Stories Units Arch., Engr., Designer �, New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. C► v G/lr/e / l! City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION •� ,1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 the Business Professions Code, license full force of and and my is in and effect - SIGNATURE, DATE OWNER -BUILDER DECLARATION • I' hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation reason: (Sec. 7031.5,6usiness and Professions Code: Any city or county which requires a permit to construct, after, reprove, demolish, or repair any structure, prior to its issuance also requires the applicant for such petmil4o Me a signed statement that he is licensed pursuant to the provisions of the Contractors 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 c"penally of nol more than rive hundred dollars ($500). subjects ❑ I, as owner of the property, or my employees with wages as their sole compensation, will PERMIT AMOUNT Plan Chk. Dep. -Z- Plan Chk. Bali Const. do the work, and the structure is not intended or offered for sale. (Sec. 7044, Suisness and Professions Code: The Contractor's License Law does not apply to an owner of property who Mech. i Q 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 o improve for the purpose of sale.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Electrical 'fil ,,o Plumbing y $ . 5 p 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. s Q 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 Grading _ Driveway Enc. Date owner Infrastructure IF7 P,00 WORKERS' COMPENSATION DECLARATION 9 O 8a I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) 2 7S�O0 Policy No Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation REMARKS AnR i A? it) 4 i 9A 01 -?4-90 in f .� I W CASH i TOTAL i. 2Y5.00 or less.) I certify that in the performance of thg work for which this permit Is issued, I shall not employ any ppeerson in any manner so as to become subject to the Workers' Compensation Laws of California Date Owner NOTICE TO APPLICANT: H, after making this Certificate of Exemption you should become ZONE: BY: subject to the workers' Conpensadon 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 1 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 Lenders Name FINAL DATE Issued by: Validated by: INSPECTOR Date Permit Lenders 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 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 Address Validation: City, State, Zip BUILDING DIVISION CONSTRUCTION ESTIMATE GROUND PLUMBING NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® O $ Q 2D UNITS BONDING r STORAGE TANK FORMS SEWER OR SEPTIC TANK C DUCT WORK YARD SPKLR al.STEM FOUND. REINF. 2ND FL. SQ. FT. @ METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE MOBILEHOME SVC. GROUT BAR SINK SERVICE POR. SQ. FT. ® BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ GAR. SO. FT. ® �{D POWER OUTLET FINAL INSP. ROOF DRAINS FINAL INSP. ROOFING DRAINAGE PIPING REMARKS: CAR P. SQ. FT. VENTILATION WALL SQ. FT. Q 2019 Ifa 0 FIREPLACE DRINKING FOUNTAIN SPARK ARRESTOR URINAL GAR. FIREWALL SO. FT. ® - LATHING -ESTIMATED CONSTRUCTION VALUATION - $ MESH WATER PIPING ng NOTE: Not to be used as property tax valuation FINISH GRADING FLOOR DRAIN MECHANICAL FEES CERT. OCC. WATER SOFTENER VENT SYSTEM I FAN EVAP.COOL HOOD Q SIGN INSPECTOR'S SIGNATURESIINITIALS WASHER(AUTO)(DISH) 2 QQ APPLIANCE DRYER GARDEN WALL FINAL GARBAGE DISPOSAL 0 FURNACE UNIT WALL FLOOR SUSPENDED 090 LAUNDRYTRAY AIR HANDLING UNIT CFM IKITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC I ( WATER CLOSET 1001 COMPRESSOR HP Ah 30 POLE, TEMIPERM 157 DD U1 LAVATORY 1 VDI HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ® c Q BATH TUB 12 06 SQ. FT. ® c WATER HEATER 7S MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac 00 HOUSE SEWER GAS PIPING PERMIT FEE Q PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE r3, So CC- 6 r 3 !� /J'-�.70 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 APPJEOUIP. 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 INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL COUNTY OF RIVERSIDE ENVIRONMENTAL Assesem ParoN No. 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 IIsi 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. VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG # Agent Cooglaictor, Contact PersonPhone 6�0 - A dress Fi m f 5t / <n/- C 4 ss 32- Ownert Phone Mailing Address / A • 41V' ' city '�-*jy'T.001404-C-9 Zip Job Property Add Legal Desefiption Prop. (PM, Tract, Lot le Lot Sizeter Agency Use of Permit P/P, CU, etc. % Other i • _ s,� /j �O eDDwelling `tt, X l , H Site Prep, etc. �T z� X90 Date Signature of Applicant CATEGORY: REV CODE CATEGORY: REV CODE FEE SUBSURFACE DISPOSAL 1238 $ 57.00 ❑ SITE EVALUATION UPON REQUEST 7349 $ 43.00 ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348 $ 17.00 a. 1 st 4 Parcels (Each) 1238 $ 57.00 (Lew than 1 yam) b. Each Parcel after 4 7344 $ 24.00 ❑ PRELIMINARY ELECTIVE 7352 $ 23.00 ❑ Rereview (2nd review same parcel) 7344 $ 24.00 EVALUATION (Attach DOH SAN 53) ❑ Site Evaluation in Conjunction with ❑ HOLDING TANK 7351 $ 47.00 Critical Area 7346 $111.00 ❑ ALTERNATIVE/EXPERIMENTAL 7345 $222.00 ❑ Site Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $ 87.00 5-�' ---lNhTIAL DATE Holding Tank Agreements Completed ❑ Yes '� - 00 Certification of Existing S.D. System Required ❑ YesNoo WQCB Clearance required. (Attach Form ❑Yes 8 N' o DOH SAN 007, Santa Ana Region Only) < Soils Percolation Report Required. ❑ Yes Special Feasibility Boring Report Required. ❑ Yes No Detailed Contour Plot Plans Required (1 to 5 R interval) ❑ Yes No - OC1er ❑ Yes r Staff Specialist Lot Inspection Required ❑ Yes No Lot Inspection Date Soils boring report by PrVedS Date 1 Soils Map Page Soil Type � � Approved by Date (� � Y _�AC1'4- No. of Sy -tem- TA of System(-) No. Dwelling Units fr) (1) Septi; Tank Soil Rate Grease/Send prJt�MFTewtiling Tank ❑ RepFecertbnt Bedrooms. d- u G 1G Cat Line Sq. FL Sidewall allowance IV Install Lines) fl. long ft wide with sq. tL h area _ ft rock/ sq. ft. min. inches c lines or of bottom arae per running ft ❑�� Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Seepage it T�gI th (TD) �Ij Applicable___.� / / Inlet (BI) (,ds N/A Overburden 18CtOr y( r Max. AI le f�epth No. 2 System REMARKS: J This appliclta i PPROVED ENtE^B for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompan' o pan, 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(d (2) Leach lines must be 100' minimum from any wells, including expansion t ea Seepage pits must be 50' minimum m�any%cells, including ex'ynsiio`onnareawi�� /fro l� 4;;1K Signature of Health Official /i (/y �C R!` �- /V J Date V RECEIPT NO. ! ' /F/ 36 / Issued By Date (— 190 DISTRICT: ❑ Riverside, Indio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE . Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records (44I E J Desert Sands Unified School District CERTIFICATION OF PAYMENT OF %ZQ SCHOOL FACI4 ES CAV% TO: Ci�t�y, f IAJ Qudn-taa 'i�t�� DATE: "Q ep s me bfauttnmd ity Development 78-105 CaR Estado La Quinta, CA 92253 tt --__ f j � This is to certifv thatnJr) �i'I � V IM'�-� 'J&/ , developer of V Iwhich is located at — r , within this District, has paid school facility fees imposed pursuant to the $u o,�i y �gedb by MGernment Co ectio t 53080 in t e amou t ofd covering a total of 1' square feet of ( ) residential or (—,,/ / ( ) industrial/commercial development and that building permits for (� this footage in this development may now be issued by your jurisdiction. CD U:7� Iq—) /3 Q � " n' &� /100 for DESERT SAJS UNIFIED SCHOOL DISTRICT White - Building Department 0 Yellow - Facilities Planning • Pink - Accounting • Gold - Developer (10)-37 ♦11. T'-`�"'T'7 V.'fIYTl1T�T'� +....f•jT•xu R'iA'7►�^i+"�i-Y����,+ 1 tmtion: A t. -.I -Ya Author: r` — !Field Techs.: IRC�I Contrector:-41-0Q s�-f t Day: �r''Z 11 ` ` Hours: i Foreman: 4 7-► k i A Weather:C• superintendent: Field Supervisor: 15oil Engines yf Geologist: Equipnant Working: 0 rvation/Testi of c- �- c Today's Yardage: summaoto r tions: _ � t'de to Date: �`� J 7-v � `n � �Y'•.. � � � � 7 59 ► t ��rUr ,�. `� �.., c� r� -�-NC:1 S �"" a n ,�► L ,� o C,t) i E1 �� N �-A C c C:, uv C -t a -t" I Qs ;RE's 1 o T -.j 20—�� O ?° v ^ i -= m Q-7-0/1 i P - t •�1.Y,Y . f DAILY FIELD REPORT P., o jest No. ` C) t � j -CA—�.--? j L � Q 1. T Report No 3910 799 Whit* - fib Copy Y@1low - Cunt. Copy - C%mt1Amey Copy � f Gold - Field Copy