05723 (SFD)Building
Address
P.O. BOX 1504
54--400 BZS 78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
TMCO DEV?.(iI' t M WC.
Mailing
Address P.O. BOX 4694
- J
C%LM DES= Zip 92251 Tel.
e6i91360-1464
Contractor » .
SAME -
Address .
Tela
State Lic. I City
& Classif. Lic. # 1245
Arch., Engr.,
Designer
Address Tel.
City IZip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter (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 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, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to We 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 applicant to a civil penally of not 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 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.)
❑ 1, 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 hnproves thereon, and who contracts for
such projects with a contractor(s) rlcensed pursuant to the Contractor's License Law.)
❑ 1 am exempt undo 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. O 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 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 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, C4v77 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. 05723
11LDING: TYPE CONST.% OCC: GRP.
P. Number 774-253`406
;gal Description LOT 18 BLK 300
oject Description SFD
ZONE:
BY:
Minimum Setback
Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Sq. Ft.
Size 1360
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ 'Demolition ❑
5/11/89Permit
Issued by:
Date
Validated by:
Validation:
Estimated Valuation
$77,328.00
PERMIT
AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal.
215.88
Const.
5 0.50
Mech.
53,502
Electrical
106.70
Plumbing
157.50
S.M.I.
5 46
Grading
• t3
Driveway Enc.•
Infrastructure
3 •��
TOTAL
04t; I.VJS), 14.3 14
REMARKS
r V ti«r,,,:,
. F
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
5/11/89Permit
Issued by:
Date
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
A.C. UNIT
COLL AREA
YARD SPKLR SYSTEM
2ND FL. SO. FT.
BONDING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
FORMS
SEWER OR SEPTIC TANK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
DUCT WORK
ROCKSTORAGE
DRAINAGE PIPING
CAR P. I SO. Fi,
WALL SO. FT.
DRINKING FOUNTAIN.
SD FT ®
REINF. STEEL
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(ALITOXDISH)
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, TEWPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
REMARKS:
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. Fr. RESID ® I V4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
FIREPLACE
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 �- -
A
[[[[[[
GROUND PLUMBI
/`-klr
UNDERGROUND
A.C. UNIT
COLL AREA
t
SLAB GRADE �"/l/ V
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCKSTORAGE
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
FINAL INSP.
RAMING 9'-1� — f�
/
FINAL INSP.
ROOFING
®� 7-O
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
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
SCHOOL FACILITY FEES
TO: City of La Quinta
Department of Community Development
78-105 Calle Estado NOTICE:
La Quinta, CA 92253 0v
DATE:
TJgg
THIS DOCUMENT CANNON'
BE DUPLICATED%
This is to certify that LU i ilet
,
developer of which is
located at 'S a / within
this District, has paid school facility fees imposed pursuant to the
authority generated by Government ode Section 53080 in the amount of
$��L
covering a total of square feet of (x) r sidential or
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
14 r /(/jam c& 2{�/
for DESERT SANDS -UNIFIED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37
• ... � _. . ' � . t' . � � ..rte'
i
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RECEIPT NO./ f Issued By Date ' �a
DISTRICT: ❑ Riverside, G-, qndio ❑ Hemet Q Perris ❑ Rancho Calif. ❑ Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records
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COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Anamm Parcel No.
I
—
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.
Q
VERIFY ITEMS IN SECTION A FROM BUILDING A SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'*
Z
O
Agent, Contractor, Contact Person
Phone
Address a Phone
v
HMCo NUFLUPfAATI , or
3G0 -I` Y
Fo. ux a4
W
Owner, t
Phone
Mailing Address
-
city
state
Zip
J,e� Property Address
Legal Description Prop. (PM, Tract, Lot)
ALTA b(SEK
f} .
`12zGr
i
or $ RLe ?0 air.,
Lot Size'
Water Agency • �,,',rn
"(n'"['/(��/
� of Permit P/P, GU, etc. Q
Other v
-501)(100,
/
D Iling, !i Prop, etc.
511,1 6tF FAm it If
tM all_
5-2 j f
Signature ofApplic ant
l Date
CATEGORY: REV CODECATEGORY:
�
REV CODE FEE
C3"' SUBSURFACE DISPOSAL 1238
❑ SITE EVALUATION UPON REQUEST 7349 $42.00
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
m
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
Z
O
a. 1 at 4 Parcels (Each) 1238 $45.00
(Less than 1 year)
F-
b. Each Parcel after 4 7344 $16.00
❑ PRELIMINARY ELECTIVE 7352 $45.00
W
❑ 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 586.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $13200
❑ Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $86.00
INITIA DATE
Tank Agreements Completed ❑ Yes
Holding
Certification of Existing S.D. System Required ❑ Yes o /
WQCB Clearance required. (Attach Form ❑ Yes QoNo
DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required. ❑ Yes ZrNo
Special Feasibility Boring Report Required. ❑ Yes
Detailed Contour Plot Plans Required (1 to 5 ft interval) ❑ Yes
011ier ❑ Yes No,
Staff Specialist Loi Inspection Required ❑ Yes �No
T Lot Inspection Date
Soils boring report by Project Date
,f
Soils Map Page I Soil Type ��` C_ Approved by��k_ Data
U
No. of Systeme
Type jpf System(.)
No. Dwelling Units
(1) Septic Tank
Soil Rate
Grease/Sand
Ing Tank O
Replacement
BedraoomQs,/
Incp0
�(�Gal
C mil '
/a
Gal
U
�
(..each Una Sq. Ft
Sidewall allowance
Instal ft wide with
L�e(81 R9
!Leach Bed sq. ft.
trench area
ff• rock/ sq. It
min. rock below dralnlines or
of -_
per running It.
Leachlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
Seepage Pit Tptal Depth
Other:
Applicable T-
y / r
1
Inlet (BI)
�/
Max. Depth
N/A Overburden factor
�J�'
/ (�
I
Niow�ble
Tn
No. 2 System 14
REMARKS�%�,�.s� kj lL-. /?tea ,r ,,, zn
This application is1A PROVED �1)71ED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
0
on the accompan p o pan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
' O
above -designed system. No construction is permitted in the required reserved 100% expansion area.
((1 Septic tank and sewer lines must be 50' minimum from any wellsd/!% gyp°/ -�
Leach lines must be 00' minimum from any wells, including expansio ar i OG�
3 Seepage pits must b)150' minimum from any wells, including expansion area C4/0
��t/j)Zi
Signature of Health Officia if Dal.
I / I
RECEIPT NO./ f Issued By Date ' �a
DISTRICT: ❑ Riverside, G-, qndio ❑ Hemet Q Perris ❑ Rancho Calif. ❑ Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records
Z;u
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
Received From.
Address:
C.
Account No. — • (s) --�
.*# .T 28 1 50
Date:
Service Address — - �' ""G.A. Code
O Meter(s) $
❑ Service(s)
❑ Backflow(s)
❑ House Lateral(s) y
• ,' ❑ DetectorCheck(s)
❑ Meter Surcharge .s►
�• �YSanitationCapacltyCharge��5 / 5 411,Q "
O.. WS.B.F.C.
J�
❑ Temporary Construction Meter
O Tum on Charge
<< ❑ Uncollected Account - Name s '
❑ Inspection Fee - Tract -
+ Fee -
s7
❑ Plan Check Fees Water I Sewer -�
} ` Tract - I ?
F t+' O Bond Payment - A.D. - Bond s
{ O CustomerDeposlt
r ❑ Other
E�41>.
' 1 ' TOTAL S �J�> /�
Remarks: J`}
;. w -
• i .j 11
OCopy to: F.
i r Cashvu�, }' ` r `ft ' WaterServlce
r Check a `
r L'
Money y x• ""f Cashier {;
Orderx•' CVW0-438 (11/89)
10
a its t tr 1r,
a1,/ 1.��•; :�5 1' 4`\.1. 'ai� .•r V' f �N. r�G y.' :yl!
J' .d.
Merv, .t•q
W 111,E or
AGI(IC;UL I URAL CU;MMISSIUNER
AND
M:1611 US b. HLASURES
49-613 Ilwy 116, 0111te 11-12
'CU1101e11n, CA 9ZZ36
619-342-0291
E. LEvr+ SPAUGY
co•a�n�;w�.ln
JAMES o WAUACE
CLEMENI af.%VENIS1E
sr urn
VNFE: M 2z cnsc 1u. P,(, os'ya
DEVELOPER'S 1WISs ��.� l 1tit.os s
AUL) LESS i
l� Ar
,rE Lu,i tutac t (61 j 1 3 o — / '-E to t/
War Developers
AEter zeviewissg your landscal biq pla11s, till pit1nt material listed is slot i.n
violation of yuarantitle laws yuvettting the Coachella Valley. If subsLitutions
do occur and they dlEEer Exon pleat material listed, this office must be notified
iuus>'diately.
'1'hmik you Lor ptolectLtg and preserving the Coachella Valley's pest -free envirorllerst.
/1gr ltutal Canitiss�ivner s UG[ice
CCI Indio raid Riverside Uf[ice