Loading...
SFD (003769)4 P.O. BOX 1504 No. 003769 Building78-105 CALLE ESTADO Address 52-770 'Hava�4; LA QUINTA, CALIFORNIA 92253 M Owner BUILDING: TYPE CONST. OCC. GRP. Mailing Address 79-940 Horseshoe A.P. Number 773-33S--001 City Zip Tel. IA € uinta 922.53 342--3170 Legal Description Contractor Project Description �.�.�. E31ar� 1�x- Ftt1� i. ]. s31? Address City Zip Tela State Lic. City & Classif. 4187351 Lic. # Sq. Ft. '6236 No. No. Dw. Arch'., Engr:, Size. Stories. Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address TeL City Zip State Lic. # - LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I 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 Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following .$72,589 reason: (Sec. 7031.5,Business and -Professions Code: Any city or county which requires' a permit to construct, alter, 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 - PERMIT AMOUNT the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or - 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 Plan. Chk. Dep. C -, n subjects the applicant to'a civil penalty of not more than rive hundred dollars ($500). - O. I, as owner of the property, or my employees with wages as their sole compensation, will Plan. Chk. Bal. I;A Q(% do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 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, Mech. provided that such improvements are not intended or offered for sale. If, however, the, building _ f� or improvement is sold within one year of completion, the owner -builder will have the burden Electrical - of proving that he did not build or Improve for the.purpose of sale.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 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 S.M.I. - such projects with a contractors) licensed pursuant to the Contractor's License Law.) - Grading M nA ❑ I am exempt under Sec. B. 8 P.C. for this reason ^1 Driveway Enc. app A Date owner zs+� i✓ `�`a} "^'' �✓�'" Infrastructure 40'` 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. ❑ Certified copy is hereby furnished. TOTAL $2,400.16 CERTIFICATE OF EXEMPTION FROM REMARKS 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 thispermitis issued, I shall -not .x Gtf�k3 C • ''�}� 4r:f...:?�.� . i - 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 making this Certificate or 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 HARD COPY 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: Date 4/41$8 Permit Validated by: Validation: ' CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES` 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. ® POR. SQ. FT. ® GAR. SQ, FT. ® CAR P. SQ. FT. WALL SO. FT. ® SQ, FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation ROUGH PLUMB. FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GAS (ROUGH) LAUNDRY TRAY AIR HANDLING UNIT CFM HEATING (FINAL) 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 BOND BEAM SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL LUMBER GR. FINAL INSC/ -12- SQ.FT.GAR ® 3/ac HOUSE SEWER Q !�G!/�LA� 5�� 7 r,�• REMARKS: 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 PLUMBINGj - ELECTRICAL HEATING & AIR COND. SOLAR ETBACK Ll— 1�_1S O VS GROUNDPLMZ46 r UNDERGROUND A.C. UNIT COLL, AREA p(SLAB GRADE L,/�- t' �� ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR E I ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. L/-10� ��� GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REINF. STEELt C,AS (FINAL)// TEMP. POLEL1`a/� GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM $ GRADING cu. yd. —plus—x$ _$ LUMBER GR. FINAL INSC/ -12- FRAMING INAL INSP. ROOFING VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING Y C9 MESH INSULATIONISOUND FINISH GRADING FI AL INSPECTION Pf �! CERT. OCC. FENCE FINAL Q !�G!/�LA� 5�� 7 r,�• REMARKS: inar�� � vn a a�unh� uncaim � iNw, GARDEN WALL FINAL Desert Sands Unified School District CERTIFICATION OF PAYMENT OF SCHOOL FACILITY FEES TO: City of La Quinta DATE: Department of Community Development 78-105 Calle Estado TWIM��` " H-1 S DOCU ENT CANNOT La Quinta, CA 9225 �U4 GN This is to certify tha developer of / which is located at S - Q , within this District, has paid school facility fees imposed pursuant to the authority penerato b Go ernment Cod Se ti 53080 in the amj5unt of $ a� of r c vering a total of /1? 3,6 quare feet of r s- ential or ( ) industrial/commercial development and that building per its for this footage in this development may now be issued by your jurisdiction. for DESERT SANDS UNIFIE6 SCHOOL DISTRICT White - Building Department • Yellow - Facilities Planning• i k - Accounting 0 Gold - Developer �z /// (10)-37 G, J Q Z O U W 0 W Z O U W rn rn `1 Ac[: Q W CE AW Z O I— U W U) COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION 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 specifications required on the attached check list. A non-refundable filing fee of $40 is required when the application is submitted. Check must be made payable to the County of Riverside. Building Department Application Log # Name (Owner. Agent. Contractor. Etc.) Mailing Address I City /} State Zip Code l J Telephone 'Job Propeny Address 'City or. Community 'Legal Description of Property. (Lot. PM, TR) ' /y r 'Assessor's P -J/ elZNo7, V /� 0 / Water Agency or Well usePermit Planning Case M Lot Size J � of +, SFO MH Site Preparation Etc. Signalure of Applicant Date The above information must be verified from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE Initial Date Certification of Existing S.D. System required. ❑ Yes No n WOCB Clearance required. ❑ Yes L No Soils feasibility report required. ❑ Yes � No Special feasibility boring report required. ❑ Yes No + Detailed contour plot plans required. ❑ Yes No Staff Specialist approval required. ❑ Yes No Lot Inspection Date I Soils/boring report by Project # Date Soils Map Page Soil Type S.'^ 14 Approved by Date Type of System: No. of Bedrooms (1) Septic Tank Soil Rate Required ❑ Existing V ew ❑ Additional ❑ Replacement -3 /-1-X /auO Gals. -2 � //''. (2) Leach line sq. ft. Sidewall allowance Install Line(s) • Ft. Long, Leach bed Sq. (Bottom trench area) ft. rock/ Sq. Ft. Ft. wide with min. inches Ft. of bottom per running ft. [B'N/A rock below drain lines area Leach lines/bed-special design for slope: (3) Pit Diameter , No. Pits Pit BI Seepage Pit total depth Applicable❑ N/Ai� Overburden factor 5' IJ 6' 6 "�Q / `1' Max. allowable depth r Z This application is appy d/denied for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements ,set forth in Section Baabove. A building permit is necessary for the installation of the above -designed system. 1)a Septic tank and sewer lines must be 50' from any wells (2) Leach lines must be 100' min. fromTany wells including expansion area C(3)-, Seepage pits must be 150' min. fromTany wells including expansion area 4 /1 Signature of Heahh Official - Date RECEIPT NO. -,) C/o3 Issued by -C;lf Dated District: ❑ Riverside NY Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File DOH SAN 122 (Rev 8187)