04989 (SFD)Building
Address
Owner
• ”
P.O. BOX 1504
1de.
LA QUINOTACCAL FORNIA 92253 IIA! ADE
. . .. ' IS REM';
Mailing
Address 79-811 Country Club,
Cityip Tel.
Bermuda;U0XZ
922€31 ,345-6225
Contractor
Cherokee Hates
Address
Zip I Tel:
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address I Tel.
City _ ( s
Zip (Stater' I
—7 Lic. #s
LICENSED CONTRACTO�W$ DECLARATION ,
I am licensed underr provtaiOns of Chapter V(commencing with Section
therBusiness and_Profesisions Co,ft, and my license is in full force and
OWNEWBUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any crty�oi county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permft 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
subjects the applicant to a civil penalty of not more than live hundred dollars ($500).
O 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. ff, 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.)
O 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) licensed 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 1 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 -
O 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 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: ff, 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
1 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 certity 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 lawsrelating 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. Q4989
QUATELY SIZED DEBRIS CONTAINER,
RED ON THE JOG -SITE DARING
IONtt
11LDING: TYPE. COW&Pmbn OI
P.Number - 617-1.83-004
,Legal Description
Project Description
S • F • •
Sq�'Ft. 2417
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑ 'Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
S i1! t O
Plan Chk. Bal.
S 1 lip -1 rA
Const.
455.50
Mech.
int 0
Electrical
on, 1,21
Plumbing
5 0140
S.M.I.
7.6A
Grading
f 0A
Driveway Enc.
t no
Infrastructure
S*—TA^A
T 4s •
I `e
TOTAL4
A 3 _ i T+..c./.�'�r_
1;%1-0
REMARKS
�,�„t i��A•C?.. `-"1�f �„�f #'rt tt'•_1�Y _'�atT �'.R , s
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
Issued by: r Date 1-2/1-3 %Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. • PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEOUIP.
DRAINAGE PIPING
CARP. SQ. FT.
P. POLE
WALL SQ. FT.
GROUT
DRINKING FOUNTAIN.
SQ FT ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
ROOFINGv 17
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
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, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
_ SEWAGE DISPOSAL
�SQ.FT.GAR ® V4c
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
ACK
OUND PLUMBIN
UNDERGROUND
A.C. UNIT
COLL AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEW TA
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (R GH) G�/2
y L
OP
G-
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINA
P. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP.
GRADING
cu. yd.
-plus-x$-=$
LUMBER GR.
F MING 6 �fG6 /
INC- weeozz
ROOFINGv 17
!�
REMARKS:
VENTILATION(,
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING &p
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
irSF."iiO NI FACILITY FEESHit
f
H
BE DUPLICATED` % 9,
TO: City of La Quinta DATE:
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
This is to certify that Ixe,"
developer of hich is
located at — within
this District, has paid school facility .fees impo d pursuan to the'
aut_hority generated by Government od Section 53080 in the amou Z o
��---
co/vering a total of 0 s,uare feet of ( resi ential or
( ) industrial/com ercial development and that building permits for
this footage in this development may now be issued,by your jurisdiction.
C019D,
f
ERT'SANDS UNJ'IED SCHOOL DISTR
,n,,W,h,,ite Building D partment • Yellow - Facilities Planning 0 Pink - Accounti g i Gnld - De a per
V 76
i
?'i'Assessors Parcel No.
COUNTY -OF RIVERSIDE DEPARTMENT OF HEALTH
ENVIRONMENTAL HEALTH br-MVILor-b vilf
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 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.
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'
�4
Age9tpContractor, Coqtact Person . I Ph.. Address & Phone
Phone . 1. Mailing Address
City State zip Job Property Address Legal Description Prop. (PM; TrEict, Lot)
Lot Size
terAgeI Use of Permit P/P, CU, etc. .4-4 IQ (41�144 Other'
qyPM
�Wellin6,81te Prep, etc.
Holding Tank Agreements Completed
Certification of Exisfing-S.D. System Required
W0CB Clearance required. (Attach Form
DOH SAN 007, Santa Ana Region Only)
Solis Percolation Report Required
Special Feasibility Boring Report Required.
Detailed Contour Plot Plans Required (11 to 5 ft. interval)
Other
Staff Specialist Lot inspection Required
• Yes
• yes
• yes
• Yes
• Yes
• Yes
• Yes
• Yes
f
Signature �
Of Applicant
Lot Inspection Date
Date
project Date
CATEGORY:.
REV CODE
FEE
No..of Systems
-CATEGORY:
REV CODE
FEE
(1) Septic Tank
U/SLIBSURFACE DISPOSAL
1 -
1�-00
SITE EVALUATION UPON REQUEST
7349
$42.00
0 MULTIPLE PARCELS WITHIN SAME
J,
.'D
(NO PLOT PLAN)
Sidewall allowance
Z
LAND DIVISION
0
SEWER/SEPTIC VERIFICATION
7348
—
$11.00
0
a:-1. it 4 Parcels (Each)
1238
$45.00
(Less than 1 year)
Pit
Pit Diameter
No. Pits
Pit Below
b. Each P6oel after 4
7344
$16.00
0
PRELIMINARY ELECTIVE
$45.00
W
0 Rer;avI6w (2nd review same parcel)
7344
$16.00
EVALUATION -(Attach DOH SAN 53)
.735.2
0. Site Evaluation in Conjunction with
Max. A
0
HOLDING
ING TANK
7351
$45.00
Critical Area
7346
$86.00
0
ALTERNATIVE/EXPERIMENTAL
730
$132.00
0 Site Evaluation Lot Less than
SYSTEM 'I
10,000 Sq. Ft. -
7347
$66.00
k
Holding Tank Agreements Completed
Certification of Exisfing-S.D. System Required
W0CB Clearance required. (Attach Form
DOH SAN 007, Santa Ana Region Only)
Solis Percolation Report Required
Special Feasibility Boring Report Required.
Detailed Contour Plot Plans Required (11 to 5 ft. interval)
Other
Staff Specialist Lot inspection Required
• Yes
• yes
• yes
• Yes
• Yes
• Yes
• Yes
• Yes
f
REMARKS:
L
PROVED I for the -d a
I P! I P. 0ac6Zrs$,L*ydgrKas indii4ted
I;N�Wov% regard
n erTiprits'-setiJorth' 'SECTION. C ab6w
p
This IAO;ryr�c�h�Cdl� rYlTII a '4-s'
g
o ""the,"'
p an, using 01 t 'S permit (/A building: is necessary _r Ahe. installation'of the
".accomparil the -req ir r
'Z,
711
designedabove system_ construction. is pe'rn1i1iid:ln' h'
No It e'required rese expansion; , area
0 _0o C 00%.
7�;
-So be
(1 tic'6hk. and sewer .lines must' 50-- minimum I any
lines must"be,100' minimum! rom an
f 2 Leach.1i y:weo:4c1ud1n9`q n, ti
LiJ�)x is
pits must be; 1 ,any'.wellsJincI_uding . expans n', rea,
('..':(3)• Seepage 561 from
minimum
.4� J7, 1 — i " `_5
I
_Sl4nature '.of'.HeaI... /CA Dat
B 'RECEIPT NO -:Isgued Ey
ASTRICT: .0Rversi'ile, '.`Ob Hen
b
mp
.0 Ranch.dCalif `'a' Blythe
)OH SAN 422 (Rey..6/88) '!-:DISTRIBUTION I. WHITE - Office file, -:YELLOW - Applibant.t
.,PINK Bldg. Depf, - 661-DENk06'!Dlan
s/Reoords,
Lot Inspection Date
Solis boring report by. . .
project Date
Soils Map Page A I W Type
Approved by Date
No..of Systems
TY64 of System(s)
DZIng Tank
13 Existing.
0 Replacement
No. Dwelling Units
Bed --Mi
(1) Septic Tank
Soil Rate
L
Grease/Sand
38,#,ZZ_Zy
J,
(2) LeacSq. Ft
Bottom trench area
Sidewall allowance
Instal 3
I LlnW_,6,7_ ft. wide with
%,,�h Bed sq! ft.
, 1. ..
R sq.A
min. rock below dralnIirwvor*_
of'- m area
per running It. ❑
LeachlinesIbb/ZA1,1 design for slope:
Pit
Pit Diameter
No. Pits
Pit Below
page Pit Total Depth
'Other.
ApplicaNe
3 5
BI)
N/Allowdft""�
01.b.rden factor
Max. A
No. 2 System
�9
REMARKS:
L
PROVED I for the -d a
I P! I P. 0ac6Zrs$,L*ydgrKas indii4ted
I;N�Wov% regard
n erTiprits'-setiJorth' 'SECTION. C ab6w
p
This IAO;ryr�c�h�Cdl� rYlTII a '4-s'
g
o ""the,"'
p an, using 01 t 'S permit (/A building: is necessary _r Ahe. installation'of the
".accomparil the -req ir r
'Z,
711
designedabove system_ construction. is pe'rn1i1iid:ln' h'
No It e'required rese expansion; , area
0 _0o C 00%.
7�;
-So be
(1 tic'6hk. and sewer .lines must' 50-- minimum I any
lines must"be,100' minimum! rom an
f 2 Leach.1i y:weo:4c1ud1n9`q n, ti
LiJ�)x is
pits must be; 1 ,any'.wellsJincI_uding . expans n', rea,
('..':(3)• Seepage 561 from
minimum
.4� J7, 1 — i " `_5
I
_Sl4nature '.of'.HeaI... /CA Dat
B 'RECEIPT NO -:Isgued Ey
ASTRICT: .0Rversi'ile, '.`Ob Hen
b
mp
.0 Ranch.dCalif `'a' Blythe
)OH SAN 422 (Rey..6/88) '!-:DISTRIBUTION I. WHITE - Office file, -:YELLOW - Applibant.t
.,PINK Bldg. Depf, - 661-DENk06'!Dlan
s/Reoords,