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05616 (SFD)4 P.O. BOX 1504 No. 05616 Building Address 53795 S� LA QUINTA CALIFORNIA 92253 Coachella Valley Land BUILDING: TYPE CONST. A.P. Number Legal Description Project Description OCC. GRP. '074-163-015 Lot 3 Blk 237 Unit 22 SFD Mailing Address 247 E. Tah ;*+itz Way #2 City Palm Spiriaga Zip 92262 Tel. 619/322.1020 Contractor Starr Construction' Address 98�@ City Zip Tela State Lic. City & Classif. 387934 Lic. # 895 Sq. Ft. 11409 Size No. 1 No. Dw. Stories Units Arch., Engr., Designer New Add O Alter 0 Repair ❑ Demolition O Address Tel. 480 square foot jzaraf','e City Zip State Lic. # 174 fact. 6 -foot wood fence LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm under that I am licensed uer provisions of Chapter 9 (commencing with Section 7000) of ivision 3 of the Business and Professions Code, and my license is in full force and effect SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,8rsiress 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 Me a signed statement that he is 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 applicant for a permit sulVects the applicant to a civil penally 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 worl4 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 builds or improves thereon and who does such work himself or through his own employees, provided that such irproverrm;nts are not intended or offered for sate. If, however, the building orimprovement 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.) Estimated Valuation $76,360.00 PERMIT AMOUNT Plan Chk. Dep. la • plan Chk. Bal. • Const. t7 • Mech. 5 •� Electrical i •Z Plumbing IJI• Ju 0 1, as owner of the properly, am exclusively contracting with licensed contractors to con- struct the project (Sec. 7044• Business and Professions Code: The Contractor's License Law does not appy 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.) 0 1 am exempt under Ser R, & P.C. for this reason S.M.I. J.39 Grading • tf Driveway Enc. 20414V Date owner Infrastructure •b •o 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.) Polic No Company Q Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REMARKS enc. •Yl .n Y i 1:f4r 4 _wi )._fX*+ s 1 14 (This section need not be completed it the permit is for one hundred dollars ($100) valuation or less-) certify that in the performance of thg 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 NOTICE TO APPLICANT: i, after maUv liss Certificate of Exemption you should become subject to the Wohkers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this perms shalt be deemed revoked. ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 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 INSPECTOR 4/6/89 Lender's 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. 1 cerlity 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 Issued by: Validated by: Date Permit Signature of applicant Date Mailing) Ares¢ Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS COLL. AREA SLAB GRADE ROUGH PLUMB.// YARD SPKLR SYSTEM 2ND FL. SO. FT. 0 HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR. SO. FT. ® DUCT WORK ROCKSTORAGE GAR. SO. FT. ® POWER OUTLET ROOF DRAINS METER LOOP HEATING (FINAL) DRAINAGE PIPING CAR P. I SO. FT. ® GAS (FINAL) WALL SO. FT. ® DRINKING FOUNTAIN 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. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED I v I�✓ LAUNDRY TRAY 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. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 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 GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB.// BONDING HEATING (ROUGH) STORAGE TANK FORMS ER OR SEF6C/-,0 ROUGH WIRING DUCT WORK ROCKSTORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE S�a GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING I v I�✓ REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL�J LATHING MESH INSULATIONISOUN FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL Tiht 4 4 Qum& P.O. BOX 1504 APPLICATION ONLY Building 53717� 7&105 CALLE ESTADO Address f1/E!2!�'�RA LA QUINTA, CALIFORNIA 92253 Owner Mailing Address Z y 7 724//9Fe.4 i7' L WA City Zip Tel. �Pwl f 9 Z z G z, 3 Z 2 —/.0 z. a Contractor 11 e .tom e,,7e,00 City IZip ITel.. State Lic. City & Classif. X87 3 Lic. # Arch., Engr., Designer Address Tel. CityI Zip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirrrm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Divis' n 3 of the Businessd/P�fessions Code, �"d my license is in full force and effect. //� SIGm7A hnFZ n_ATF_ 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, after. irwrove, demolish, or repair any structure, pdor to its issuance also requires the appfcant for such permit to file 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 sutyects the appfcant to a c" penalty of not more than two 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 Contractors 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 buid 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 bha7dc or improves thereon, and who contracts for such projects with a contractor(s) fcensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec a. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATI N con I hereby affirm that I have a certificate of sent to s nn re, or a certificate of Worker's Compensation Insurance, or a certified co y1 at c. 800, Labor Code.) Policy No Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (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 Cali oroia. Date Owner NOTICE TO APPLICANT: N, aftar making this Certificate of Exemption you should become sL#ect to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed rewked. 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 property 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 Addr City, State, Zip BUILDING DIVISION BUILDING: TYPE CONST OCC. GRP A.P. Number 77y --/G3 -- of S' Legal Description .Cor -3 44e 23 7 4/A/ -,T L Z Description Sq. Ft. No. Size / 44a 5F5F Stories New,K Add ❑ Alter ❑ Plan Chk. Bal. Z , Const. No. Dw. Units Repair ❑ Demolition ❑ a ;timated Valuation PERMIT AMOUNT Plan Chk. Dep. 2 5r0 • o J Plan Chk. Bal. Z , Const. Mech. Q Electrical 10, `ie Plumbing -7 S.M.I. Grading b Driveway Enc. eo to Infrastructure 7 TOTAL REMARKS AAg f. Q "` n. 4 i T QT L i w _ 275.00 ZONE: BY: Minimum Setback Distances: I Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line r Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validati CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SO. FT. ® GROUT WATER HEATER WALL SQ. FT. ® FINAL INSP. DRINKING FOUNTAIN BOND BEAM WATER SYSTEM URINAL SO. FT. ® =$ LUMBER GR. ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING 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 VENTILATION GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIRE ZONE ROOFING LAUNDRYTRAY AIR HANDLING UNIT CFM FIREPLACE 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 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1+/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac 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 INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL s Desert Sands Unified School District � t CERTIFICATION OF PAYMENT OF ���l�� 7'N6 Doe SCHOOL FACILITY FEES r�u BE DUPLICATED, MANN®Y u�u TO: City of La Quinta DATE: Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 This is to certif that 1JL <--Vy�IL(/� , developer of % S�whi h 9 ilocated at II J this District, has paid school facil ty fees ii6posed pursuant to the aur ori,t,J Hera ,d y G ernment C de,Sec ion 5 080 i the amount of � � $ �, (SIO covering a total o square feet of( ) res' ential or ( ) industrial/commercial development and that buil ing permits for this footage in this development may now be issued by your jurisdiction. 1409 tfor DESERT SANDS UNIFIED SCHOOL DISTRICT 0U9 White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer (10)-37 v t m 2 O H U W N U Z 0 U COUNTY OF RIVERSIDE Parcel No.ERSIDE DEPARTMENT OF HEALTH -7 7'/'- � � 3 _ -0 �J' ENVIRONMENTAL HEALTH SERVICES 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. VERIFY ITEMS IN SECTION A FROM BUILDING d SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'* Agent, Contractor, Contact Person Phone Address 8 Phone S 0-O Kl 5 rag d 0-77-,' Q 3 Z 2 "/O z Owner Phone Mailing Address 2*7 !_' TitNauirz✓ WAY 16,Z City State Zip Job Property Address Legal Description Prop. (PM, Tract, Lot) PALM SPk'/c1GS 12 op f22.62- 53`795'N��Q��� 4pr3 d3��23 Clair 2Z Lot Size Is geklc %1Ahs11 Use of Parmit P/P, CU, etc. ry G { c +� Y Other!�e -5-0 K !ad •�/S T �G •1� wellin , MH Site P Drep, etc. /�. 3/29/�9 / Signature of Applicant Date CATEGORY: REV CODE FEE.,,. CATEGORY: REV CODE FEE 01 SUBSURFACE DISPOSAL 1238 $45.0 ❑ SITE EVALUATION UPON REQUEST 7349 $42.00 ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348 $11.00 a. 1 at 4 Parcels (Each) 1238 $45.00 (Less than 1 year) b. Each Parcel after 4 7344 $16.00 ❑ PRELIMINARY ELECTIVE 7352 $45.00 ❑ 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 $13200 ❑ Site Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $86.00 INITIAL DATE Holding Tank Agreements Completed ❑ Yes ❑ No l�L�� t -d 3 3,o-,99 Certification of Existing S.D. System Required ❑ Yes ❑ No i WOCB Clearance required. (Attach Forth ❑ Yes ❑ No DOH SAN 007, Santa Ana Region Only) Solis Percolation Report Required. ❑ Yes' ❑ No Special Feasibility Boring Report Required. ❑ Yes ❑ No Detailed Contour Plot Plans Required (1 to 5 R interval) ❑ Yes ❑ No a Other ❑ Yes ❑ No Staff Specialist Lot Inspection Required ❑ Yes ❑ No Lot Inspection Date Solis boring report by # Date /project Soils Map Page �/ 6 1� Sop Type 0,0,/ Approved by /�fL4 /d,- Dale 3 61 No. of Systems Type of Systems) No. Dwelling Unita(/ ) (1) Septk: Tank Soil Rate Grease/Sand ` O Holding Tank ❑ Existing New ❑ Replacement Bedroome, RixtumUnks Intcp AJ A— , M4y/ MJF 4- i_ O 1 Gal Leach Line Sq. Ft Sidewall allowance I Lines) R long ft wide with Leach Bed sq. R Bottom h '`�.`".. R run sq. R per running R min. below dmfnlines ori � Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Seepage Pit Total 9epth O Applicable -,Inlet(BI) 0: 5 / / [� / Max. Mloowablp Depth N/A b� Overburden factor J No. 2 System/V/14 REMARKS: �Iv_ This application is PPROVED TED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompanied 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. _. Septic tank and sewer lines must be 50' minimum from any wells 0 f `'�-� (2 Leach lines must be too' minimum from any wells, including expansi arga /^ 3) Seepage pits must be 11%50'' from/zany wells, including expansion area _/�� ,��� y►-a.�.-,� S V mini/mum / )1! P 3 30 �� Signature of Health Official ' � W. .CR�� y+ `,(J S � !/ f -_� RECEIPT NO. `- o `ff 5 Issued By Date DISTRICT: ❑ Riverside, 0-s1 olio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe .ry DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD Plans/Records c M