04999 (SFD)y -
Building
Address illi• -I
isul M_
sox,5oa N0.
LLE ESTADO "AN ADEQUATE?° �17_ED DER i VAIER
ALIFORNIA 92253 , iS REQUIRED 0?1 THE JOB -SITE DURING.
A! I PHASES QE OONSTRUOTiONII.
BUILDING: TYPE CONST. OCC: GRP.-
A.P. Number�7--i"
P.O.
71}105 CA
LA QUINTA, C
Tlxasti $nrassrt, +
Mailing
Address 79-811 Country Club
City Zip Tel.
Bernti8a tau -nes 9220 345-2362
Contractor
Address
State Lia City
& Classif. 466007 Lic. # 564
Arch., Engr.,
Designer
Address _-- , Tel.
I hereby affirm that I am licensed under provision"f Chapier 9 (commencing with Section
7000) of Division 3-of:the,Busiss and Professjons Code, and my license is in full force and
effect ��i': l// 1" �a4'—e" f',1Z_`�"i t
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
Permit to construct, atter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such perm to rite a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of -
Divislon 3 or 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 or not more than five hundred dollars ($500).
O 1, 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, Butsness and
Professions Code: The Contractor's License Law does not apply to an owner or property who
builds or improves thereon and who does such work himself or through his own empkiyees,
Provided that such improvements are not intended or offered for sale. lf, however, the building
or improvement is sold wither one year of completion, the owner -binder wig have the burden
of proving that he did not build or improve for the purpose of sale.)
O 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 or property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
O 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 fess.)
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: - ff, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
compty 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.)
Lenders 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
Legal Description
Project Description
. .
Sq. Ft. Z
Size
No.
Stories
No. Dw.
Units
New O Add ❑
Alter ❑
Repair ❑
-Demolition ❑
Estimated Valuation
**
Q tt
PERMIT
AMOUNT
Plan Chk. Dep.
R-Arl
Plan Chk. Bal.
Const.
I&AR
Mech.
1
Electrical
Plumbing
v)n nn
S.M.I.
Grading
n nn
Driveway Enc.
-
O
Infrastructure
:y
F ng --2 nab T
-
?a l4 nst
TOTAL
REMARKS
W,02 10 WS 12-2,9-881 to
io CASH" b TOTAL i A R�— 3
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear ISetback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
42/15/88
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
A.C. UNIT
COLL. AREA
SLAB GRADE
1ST FL. SQ. FT. ® $
UNITS
HEATING (ROUGH)
STORAGE TANK
FORMS
YARD SPKLR SYSTEM
2ND FL. Sp. FT.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
OTHER APPJEQUIP.
REINF. STEEL '.
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GROUT
DRAINAGE PIPING
CAR P. S0. FT. ®
FINAL INSP.
WALL Sp. FT. Q
WATER SYSTEM
DRINKING FOUNTAIN.
GRADING
cu. yd.
$ -Plus-x$-=$
URINAL
SO FT ®
FRAMING 1'
rJ
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
/
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOHDISH)
APPLIANCE DRYER
FIREPLACE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
IKITCHEN 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 ® 3Vec
HOUSE SEWER
CERT. OCC.
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
n STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
BACK ✓
OD PLUMBING iz UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPT C TA 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. A�
FRAMING 1'
rJ
FINAL INSP.
ROOFING S' /
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING d (� ��Oq
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
1
t
Desert Sands Unified School District
`-' UCER�T+I IF CA 'ION POFD! AY'KENT
Gi-JIFILINCOAT
SCHOOL FACILITY FEES
TO: City of La Quinta DATE:
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
(U
029 �'S
This is to certify that
developer of w ich is
located at 90-Z/V Icy i t h i n
this District, has paid school facility fees imposed pursuant the
authority genera ed by overnment Co e Sectio5t 5308 the amount'o
sem, )9L ,
covering a total of re feet of ( esidential or
( ) industrial/comme cial development.and that building permits for-
this footage 'in this development maynombe is�ued by your jurisdiction.
7 �
or pESERT SANDS UNIFIED SCHOOL DISTRICT
White - Buildin Department • Yellow - Facilities Pla Hing • Pink - Accounting 0 Gol - Developer
(10)-37
Mii
r. -c ;�? _ c?' mac... ;t'7 � -Da -�'_ _'e - . � +,'Ys.Lj:• sa' 1�J-`�%,".
t
RECEIPT NO -` p
_1409 Issued By A f Date
,DISTRICTS ❑ Riverside, ❑ifndio ❑ Hemet ❑ Perris ❑ Rancho Calif. �'`❑ Blythe
DOH SAN 122 (Rev,5/88) DISTRIBUTION WHfTE Office file YELLOW�rApplicent ` PINK Bldg- Dept GOLDENROD Plans/Retxirds
`
l
..... ._.._ _._.,.r..,s ._. _.'C_ .._..�- �.-,. ......_ ..-,....:ri:...73.�c,. +±�3t'".-^. .. .a ..sa_.. 4i ..._.a 6-...;-'"'-"�• - _-....�-c.,.. s L._ :s v-�.?'.?; . �>.-:. .. .. _- ..-�-.. _. _
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No.
ENVIRONMENTAL HEALTH SERVICES
PERMIT APPLICATION FOR ' SUBSURFACE SEWAGE DISPOSAL SYSTEM
Applicant: -Submit this form with fourcopies of a scaled plot plan (1-20 scale) drawn to County speculations as indicated on the attached checklist
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.
j •, ;
p
Q
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'*
Z
Q
reLK r, Person
UI
Phone
Mailing Address
Zi L ob Pro rty ddress
Legal Desp9tion Prop. (PM, Tnsct Lot)
Lot Size a
IN
er"A b
O G
use of Perm• P CU, etc.
Other
Dwelling, MH Site Prep, etc.
Date
Signature of Appl ,;s
CATEGORY: REV COD E S
CATEGORY: REV CODE FEE
®� SUBSURFACE DISPOSAL 1236 $45 00 a
SITE EVALUATION UPON REQUEST 7349 $42.00
❑ MULTIPLE PARCELS WITHIN SAME - ; . '- '
A0 (NO PLOT PLAN)
f. 0
LAND DIVISION ; i
' 'Y
`❑ ; SEWER/SEPTIC VERIFICATION 7348. $11.00
than 1.
,A
a. 1st 4. Ps (Each), ;1238 $45.00 - '
(Less year)
U.
b. Each-
ach Parcel after 4 r 17344 _ x,.$16.00 ' 1
❑ PRELIMINARY ELECTIVE 7352: $45.00
W
❑ Rereview (2nd review same parcel) 734,4 ^tz1,6.00
EVALUATION (Attach DOH SAN 53)
❑ . Site'Evaluation in Conjunction with c. ' {
❑ HOLDING TANK 7351 $45.00
y
Critical Area - 7346 $86.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $132,00
❑ Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. y 7347 $86,00 ;
K"v
• ,.f
S iT
Wilding Tank Agreements Completed
Oy
❑Yes N
it
Certification of Existing S.D. System Required ' ❑ Yes N .
W6CB Clearance required. (Attach Form :; ❑ Yes
DOH SAN 007, Santa Ana Region Only) r
;,Noe/,,////
Soils Percolation Report Required: /° ❑Yes .
Special Feasibility Boring Report Required. 13 Yes Y
Detailed Contour Plot Plans Required (1 to 5 R interval) ❑ Yes
Other ❑Yes No
t
Staff Specialist Lot Inspection Required., ❑ Yes E7 No
Lot Inspection Date
Sills boring report by' Date
Soils Map Page Soil Type Approved by Date
U
Z
No. of Systema
T of (s)
Ing Tank
No. Dwelling Units /
(1) Septic Tank
Soil Rate
rease/Sand
Q
'1
❑ Existing
New ❑ Replacement
Bedrooms, FlRfr`e,5V is
G p
(2) Leach Line Sq. Ft
Sidewall allowance.
Install Liire(s R kxig k wide With
Leach Bed sq. it
Bottom trench area
ft rock/ sq. R
min. rock below drainlineg(W
area
/
per running RNA
`Pit
V 1V
Leachlines/bed special design o slope:
3) Pit Diameter
No. Pita
Below
page Pit Total Depth
Othe�
Applicable`
/
(BI)
'
+J
N/A Overbu factor
❑ 5
Max. Allowable Depth
No. 2 System` VIA
y'
a
N
REMARKS:
t/
V6%�
This 8ri ' " Pf? ED 4VIE�fiut a ca egory cher eS l0 B abov rar mg. a esi of a subsurface disposal system mdigtedthmpani�
-pot plan,' using the.,requirements set, in SECTION_ above A buildmg Eiermit is necessary for she installation. of, the
Z''._.
Q
above designed -"system. construction is permitted in thqulred,"reserved 10096: expa siori, area :
Septx tank arid`sewer lines must be 50 -minimum from ariy;welis' 'J '
_
(2�J: Leach.lines must be 100.' mwmum from any wells; including expansion
Seepage 'must inimum
2=
u$' (3) pits be'/. 50 from an wells including expansi ar
s-
Signature"of ..HeaRh:Official. ii/L2e�Al.,I�O.Dat '
t
RECEIPT NO -` p
_1409 Issued By A f Date
,DISTRICTS ❑ Riverside, ❑ifndio ❑ Hemet ❑ Perris ❑ Rancho Calif. �'`❑ Blythe
DOH SAN 122 (Rev,5/88) DISTRIBUTION WHfTE Office file YELLOW�rApplicent ` PINK Bldg- Dept GOLDENROD Plans/Retxirds
`
l
..... ._.._ _._.,.r..,s ._. _.'C_ .._..�- �.-,. ......_ ..-,....:ri:...73.�c,. +±�3t'".-^. .. .a ..sa_.. 4i ..._.a 6-...;-'"'-"�• - _-....�-c.,.. s L._ :s v-�.?'.?; . �>.-:. .. .. _- ..-�-.. _. _