06047 (SFD)Building"
Address 5�—€?15
Jack. Clark Jr.
T4ht °F:W Q"
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address P.O. Box 1371
City Zip Tel
;.a Oui-ata 92253
mi► ar/builder
Address
State Ljc. B 506667 I Lia # 11 is
Ci
&Classif.
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 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,Busi7ess 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 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 vkNation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a ewi penally of Trot more than rive 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 inprovements 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 inprove 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) kcensed 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
0 Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be conv*ted 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 California.
Date Owner
NOTICE TO APPLICANT: If, after malting 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 shall 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.)
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
No. 06047
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number 774-213•-013
Legal Description Lot 1
Project Description S.F.D.
Sq. Ft. 16030
Size
No.
Stories
No. Dw.
Units
.New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
90,291.00
PERMIT
AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal.
259.42
Const.
599.00
Mech.
53.50
Electrical
113.56
Plumbing
157.50
S.M.I.
6.37
Grading
20-00
Driveway Enc.
20.00
Infrastructure
2004.79
Precise Putti
25.030
TOTAL
REMARKS
ZONE: BY:
-L11411- r- ITri fir ^ .i
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
Issued by: Date6-29-89 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SETBACK
ROUND PLUMBINTROUGH
UNDERGROUND
YARD SPKLR SYSTEM
2ND FL SO. FT. @
SLAB GRAD � � 1
ROUGH PLUMB.
BONDING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
SEWER OR SEPTI
WIRING
DUCT WORK
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
DRAINAGE PIPING
CAR P. SO. Ff.
WALL SO. FT.
WATER HEATER
DRINKING FOUNTAIN
FINAL INSP.
URINAL
SO FT ®
FINAL INSP.3 /9 7, 0
GRADING
cu. yd.
$ plus x$
ESTIMATED CONSTRUCTION VALUATION $
LUMBER GR.
WATER PIPING
NOTE Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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. Fr. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1Vi c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Y.c
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
ROUND PLUMBINTROUGH
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRAD � � 1
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTI
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
FINAL INSP.3 /9 7, 0
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
RAMINGC:/ —
FINAL INSP.
1�ROOFING C/�
0� TO ("I � /j � �� �
,n 4,j 12— _ /2—
�{
v
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING - .6
MESH
INSULATION/SOUND 10 6
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
t
RECEIPT NO. 2Y 3 Issued By Date
DISTRICT: ❑ Riverside, ❑ Indio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
IN
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH ' I Attseseore Parcel No.
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 IisL
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.
Q
VERIFY ITEMS IN SECTION A FROM BUILDING 3 SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'*
Z
O
Agent, Contractor, Contact Person
CZA►211,. -
Phone
e
Address a Phone
-JAcll. -JP
W
to
Owner
_.SA M t:
Phone
..5A M E
Mailing Address
QA M t=
City
LA 611,< IN t r- A
State
LA
Zip
Job Property Address
ave,� 4wg
Legal Descriptbn Prop. (PM, Tract, Lot)
96t
Lot Size
Wat t -Age pv/Well
Use of Permit P/P, CU, etc.
Other S Vt t o l 3 i i Is1 D Ley
JI✓ it
.ea
515tFi�
410-1- �cLl ,
1irg'nrreUpec. b
•�
7C /I
Signature of Applicant
Date
CATEGORY: REV CODE FEE
CATEGORY: REV CODE FEE
O SUBSURFACE DISPOSAL 1238 *-;_O:�_,
❑ SITE EVALUATION UPON REQUEST 7349 $42.00 --
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
m
Z
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
p
a. 1 at 4 Parcels (Each) 1238 $45.00
(Less than 1 year)
H
b. Each Parcel after 4 7344 $16.00
13 PRELIMINARY ELECTIVE 7352 $45.00
W
❑ Rereview (2nd review same parcel) 7344 $16.00
EVALUATION (Attach DOH SAN 53)
U)
❑ Site Evaluation in Conjunction with
❑ HOLDING TANK . 7351 $45.00
Critical Area 7346 $86.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $13200
❑ Site Evaluabort Lot Leas than
SYSTEM
10,000 Sq. Ft. 7347 $86.00
IrN,IT-IAL!/ DATE
Holding Tank Agreements Completed ❑ Yes
,,rte !
-No
Certification of ExistingS.D. S 1
System Required ❑Yes A
WQCB Ciearanoe required. (Attach Form ❑ Yes �� o
DOH SAN 007, Santa Ana Region Only) `
Solis Percolation Report Required. ❑ Yes - Nom r
Special Feasibility Boring Report Required. ❑ Yes 0 ,
Detailed Contour Plot Plans Required (1 to 5 ft interval) ❑ Yes o i
RN,
Other .. _ - ❑ Yes - -
Staff Specialist Lot Inspection Required ❑Yes f
Lot Inspection Date
Solis boring report by Project,* Date
j
Soils Map Page t Soil T l �Cr /t/✓..Date
1 Type Approved by
I �
U
No. of systems
Type of Systems)
HoldTank ❑ Existing
No. Dwelling Unita' I %
s,ing
BedroomfWwe lJnits
(1) Septic Tank
Soil Rate
Grease/Sand
Inicp
O1h
9rlVew ❑ Replacement3a/t�"Gal
n
,y�
I—
U
-
LLI
(2) Leech Line Sq. Ft
6�ttom trench
Sidewall allowance
Irrsta� Lme(s) R long it wide with
� 0p�c„
leach Bed sq. ft
R rock/ �• fl-
per running ft.
min. it ,rodk below dralnl'mes or
of bottom area
•"`"'��....
Leachlines/)ed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
Seepage�•P7it Tb�J Depth
Other
Applicable
N/A !'Overburden factor
Inlet (BI)
I
�'� rX 0
—
Max. AJIVIe Depth
No. -.2 System / //f i
REMARKS:
.f,�..'"n7G'
: .
%.t ,+� �l-o- ..�'` •%� i�/+/��_ .�� �-.i-.C.O...� ley"' ('+%� .tJ.A .i �r1 r�
/3C-.t//i js,?,./I/,f,
1 �i/'/e//n/•.//X.-�...!..-f}},1n .: M
(I/�)
i�f n � � 'G .�- - � �....._O �./ .II�t' F� 4' .v . '_..X ✓ /'� �'L- 1!'' � / -d
1
This application �AFPPPROVEiD0-HED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompnusing the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
a Zabove-designed
system. No construction is permitted in the required reserved 100% expansion area.
1
(1) ,Septic tank and sewer lines must be 50' minimum from any wells of
�)` Leach lines must be too' minimum from including 'area
}U s
I
any wells, expansion
(LLI 3/ Seepage pits must be 150' minimum from any wells, including expansion areap �' �. i�����F��_�E�� %L*/.t✓` tri. c� •,,.r
e/,
Signature of Health Dateddd/
RECEIPT NO. 2Y 3 Issued By Date
DISTRICT: ❑ Riverside, ❑ Indio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
IN
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF CA
• SCHOOL FACILITY FEES
DUP
T0: City of La Quint LIGATED` ~��0 DATE: C �� 0
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
This is to c rtify that " , UlJli(�4/' `-' ,
developer of HAKWAiM, which is
located at - 1-11 within
this District, has paid school facility fees imposed pursuant to the
authority enga rnment CI)dp Sec ion 53080 in -the amount of
covering a total o square feet of �('n) res dential orindustrial/commercial development and that builig permits for
this footage in this development may now be issued by your jurisdiction.
I 'WhiteOQuiId ng Department
-D , (?u& /-�j xt
. k7vAp I � j/t,/ for W§ERT SAND UNIFIED CHOOL DISTRICT
0 Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37