04961 (SFD)T a
i4 4 ea "
P.O. BOX 1504 No ) 9A?�t�I
Building 78-105 CALLE ESTADO ilADEQUATI )'!- � !' `�� i41°�ER
Address 80-085 Vista Grande LAQUINTA,CALIFOFIN IA92253 `-REQUREG(ATHE JOB„5I3a=DURING
Owner W All;
Address 79-81I Country Club ..
City Zip Tel.
XXXORM 1 92201 1 _345--65225
Aaaress .
79p-811 Country Club Drive
City Zip Tel.: ,R„
Indio 92201
-
State Lic. City
& Classif. 476007 Lic. #
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR] - DECLARATION
I hereby affirm that I am licensed under provisi ns�f Chapter 9 (commencing with Section
000) of Division 3 of,the Business and'Professions(Code, and my license isfln full force and
1 hereby affirm that I am exempt,fiom,ihe Contractors License Law f -r the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county •ch requires a
permit to construct, atter, improve, demolish, or repair any structure, prior to its suance also
requires the applicant for such permit to file a signed statement that he is licensed4pursuant 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 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 safe.)
❑ 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 contractors) licensed pursuant to the Contractor's License Law.)
13 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 completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg 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- d, 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, Civil Code.)
Lender's Name
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 certity that I have read this application and state that the above information 'is correct.
1 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,
ALL PHA11-NU JF UuNa1nut, rlJt
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 617`163-002
Legal Description
Project Description S.F.D.
Sq. Ft. No. No. Dw.
Size`Stories 2 Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
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
12/s/ IRS
Estimated Valuation
$iA9,9I6
Validated by:
PERMIT
AMOUNT
Plan Chk. Dep.r1
Plan Chk. Bal.
Const.
AIAS
Mech.
1A .ryn
Electrical
01 57
Plumbing
120.00.
S.M.I.
7.04.
Grading
20.00
Driveway Enc.
Infrastructure
2.473.11
A► — To R A
T. i r .
TOTAL
$3,700.63
REMARKS
0051.1,424£3 r iii
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
12/s/ IRS
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION EST. MATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
v
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCKSTORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF'DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT.
GAS (FINAL)
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
G NG
cu. yd.
plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
ROOFING
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAATY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ®c
I WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ic
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
TNST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
BACK �� --�
ND PLUMBING—
UNDERGROUND
A.C. UNIT
COLL AREA
SLAB GRADE
ROUGH PLUMB,
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEW" A
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
G NG
cu. yd.
plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.$
ROOFING
VENTILATION
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING j410 /L2
MESH
INSULATIONISOUND
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
City Q� n,eY' �, �'� J� ,?,!O ATE:
TO: Cit of La Uinta d
Department of.Community"Deve'lopment
78-105 Calle Estado,
La Quinta, CA 92253
This is to certify that YlJ
developer of which is /
located at within
this District, has paid school facility fees imposed pursuant to the
authorltv generated by Government Cod Section 53080 in the amount of
covering a total of ,j are feet of ( residentia or
( ) industrial/comme cial development and that bui ding permits for.
this footage in this development may now/be issued by your jurisdiction.
ERT SANDS•UNIFIED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37
0
-777'
77
9ECEIPT. N.O._L__L 'Issued By ZZ' Date'. -
iveiii ide[3— Indio �.D. Heftiet 'Per Ran
T�ICT: '0, 'R , :
cKo Calif. 0, Blythe'
SAN .122 (Rev 5/88)., DISTRIBUTION : WHITE -'.Office file ,. YELLOW- A6piicjiAt'7--1 PINK Bldg Dept��, -"GOLDENROD Plan_s/Records:,�
COUNTY OFA RIVERSIDE DEPARTMENT OF HEALTH Assessors 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 list.
Anon -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 oneyear from date of approval.
<
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG*
Z
'0
'A .6prit r Contact Person
Phone
40dress & Phorign /yam -7;R
0
Cu,
.Phone
Mailing Address
—e
state 11
"4
"Zip
9z
1100 Property ddress
Legal Description Prop. (PM, Tract, Lot)
Lot Size
ter'Agency 0' —
Use of'Kermit P ) etc . 61 Lt
C ./
Other
,
Dwelling, MH S1 a Prep, etc.
Ail
Signature of Applklqt .Date
CATEGORY:4 E
REV CODFEE
CATEGORY: REV CODE FEE
U
SUBSURFACE DISPOSA"V .12381 $45. L)
o SITE EVALUATION UPON REQUEST 7349 $42.00
0 MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
ZZLANDDIVISION
0 SEWER/SEPTIC VERIFICATION 7348 $11.00
0
a. -1st4Parcels JEach)' 1238 $45.00
(Less than 1. year) -
b. Each Pikel after 4. - 7344 $16.00
0 PRELIMINARY ELECTIVE 7352 $45.00
Uj
0 Rereview (2nd review same parcel) 7344 $16.00
EVALUATION (Attach DOH SAN 53)
.13 Site Evaluation In Cor juncilon with t
0 HOLDING TANK 7351 $45.00
Critical Area 7346 $86.00
0 ALTERNATIVE/EXPERIMENTAL 7345 '$13200
0 Site Evaluation Lot Less than
SYSTEM.
10,000Sq._R. 7347 $86.00
I MIAL DATE
Holding Tank Agreements
Completed 13 yes 0:
Certification of Existing S.D. System Required 0 Yes 10314 to
WQCB Clearance required., (Attach Form 0 Yes Pilo
DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required. 0 Yes N 0
Special Feasibility Boring Report Required. 13 Yes
Detailed Contour Plot Plans Required (1 to 5,fL interval) 0 Yes �;N
Other0 yes
Staff Specialist Lot Inspection Required
No
0 Yes No
Loi Inspection Dide-
Soils boring report by, project# Date
sod Type 0%
Soils Map PageApproved by Date
70
0
No. of. Systems
No-DvvelllngUnj�! (/)
(1) Septic Tank
Soil Raft
1r9rease/Sand
Z
0
0 Existing
0 Replacement
Bedrooms, Rourem,*
3
AOM
Grease Intop,
Get
UJI
(2) Leach Une Sq. Ft
Sidewall allowanoe-
install Und& 467ft. long —=3--i wide with
h
c Bed sq. rt
Bottom trench area
it. rock/— sq.:k
min. _A_--,1'lnd4 rock below drainlinew-of
Vf9b _m
X00 D AA
Ier
per running It.
Leachlines/bed 61:6cial design for slope: _\4
A
Applicable
(3) Pit Diameter
r"' L" '"'
,,No. Pits,
Z
Pit Below
N let (81)
see Pit Total Depth
��Z_
O`�
_� I.- I
4_��
0 5.
Zo�"-D.pth
N/A — Overburden factor I
No. 2 System
REMARKS:
0
0 �
This *app!jcati r the ca ego . ticked in AVabovt.�=La, i he u We cis m as IV
EN c' =42�i in �e �dq n
to XV do ca
es Lrf;c1e �d�sifllt�te fierlao'clAr
Vni, ris? t"
"!/ —,
on the. -'.plbt� pi to ro
a6c6m� Ing re
the q6ireriiimfs� set. .forth n CTION bull
a us i6ring! necessa r1jhe installation of the
'� rr, r �tt
Z�
construction . A
on is perm in the: r
No!oon i 6i reserved '100% expansion area.'
'Al Spp!x'tank :and sewer ines mustbe*5 minimum. from -anY,
` _aj
Leach lines'Qst m any wells, including ex�aTgi
must 1� exp'
u _g expansion ar
(3),� Seepage pits" `b6 60,.�rrii�irrium from any wells, ncl din t
_Q
nature 0.1-leafth'. Official /fi' .. �� ti �1f ; Dat
Sig of
0
-777'
77
9ECEIPT. N.O._L__L 'Issued By ZZ' Date'. -
iveiii ide[3— Indio �.D. Heftiet 'Per Ran
T�ICT: '0, 'R , :
cKo Calif. 0, Blythe'
SAN .122 (Rev 5/88)., DISTRIBUTION : WHITE -'.Office file ,. YELLOW- A6piicjiAt'7--1 PINK Bldg Dept��, -"GOLDENROD Plan_s/Records:,�