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
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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