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04719 (SFD)y` Building n. Address Owner Mailing `ter. Address ClBdrmuay, d Contractor Sate t4.4 + - i k1Ff !tr ` e 78-105 0CA � E ESTADO "AN ADEQUATELY WIED DEBRfS % i�TA�t�EI .?" ' 46-260 RoadrE1D"311^aer "''LA OUINTA, CALIFORNIA92253IS REQj�IRE6 O�� ?HE'J►�Q- SlTE �;he rokee Roues . -. n .....,. _ EktL Pri IMS' QQ ISTRUCTit�1" IA .�w BUILDING: TYPE CONST. JCC. GRP.Country iZlub •r r `s A P' N b Address r City Zip State Lic. & Classif. 476047' Arch.; Engr., Designer Address um er Tel. «„ �.- .,.. �-�'� '" �k �• � •= 922Qa�.�,6 Legal Description ~'F Project Description' `• ' " r ` ` L,lty Lic. # w Sq. Ft..� 2 r 000 No. ,T Size Stories City JZip State . Lic. # I hereby affirm that I am+licensed under provisions of Chapter 9 (commejtcing with Section 7000) of Division 3 of the Blusiness anAd Prrofesalon"s_Co%,and my license,is in full force and effect. �`li`c.,�'.r.. i SLGNATURE "" 1 DATE OWNER -BUILDER DECLARATION Ihereby affirm that I am exempt from the Contractor's License Law for following reason: (Sec. 7031 . 5,Susiness 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 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 (5500). ❑ 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 or 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.) ❑ 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. 8 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 O Copy is filed with the city. 0 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: If, 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 ievoked. - t 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.) ' r 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 stale 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 • WHITE FINANCE, PINK - APPLICANT; GREEN - BUILDII No. Dw.� 1 Units F• New ❑ Add O Alter ❑ Repair ❑ Demolition ❑ Electrical ;`T 9€x.42 Plumbing Q ! s S.M.I. i :s . mss_. 7.46 Grading - 20 04 Driveway Enc. -420.00 Infrastructure a . -• q h1; i. ag a;; '+ti af5ou x#1 zara Estimated Valuation, REMARKS PERMIT ,} { 1IN-il lit ;ski f4#1?r"�f't�� : ; "'AMOUNT Plan Chk. Dep. $25040 ZONE: BY: Plan Chk. Bal. ' Front Setback frim Center Line Const. `;:.. 450,50 Mech. ,i` 36 s 00 Electrical ;`T 9€x.42 Plumbing Q ! s S.M.I. i :s . mss_. 7.46 Grading - 20 04 Driveway Enc. -420.00 Infrastructure a . -• q h1; i. ag a;; '+ti af5ou x#1 zara TOTAL REMARKS ,} { 1IN-il lit ;ski f4#1?r"�f't�� ZONE: BY: Minimum Setback Distances: ' Front Setback frim Center Line Rear Setback frcm Rear Prop. Line 'Side Street Setback from Center Line Side Setback from Property Line - FINAL DATE INSPECTOR�g Issued by: Date-Permit- atePermitValidated Validatedby: Validation: `- IG, - ASSESSOR'S OFFICE, HARD COPY - FILE'` r -GOLDENROD CONSTRUCTION ESTIMATL NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SO Fl Ip $ 2ND FL SO FT. POR SO FT. at GAR SO. FT, O CARP. 50 FT. a WALL SO. FT. (a SO. 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 BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTOHDISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APP.IEOUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ®c IBATH TUB FINAL INSP. SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID g I4. c SEWAGE DISPOSAL SO.FT.GAR r 3/4c HOUSE SEWER VENTILATION GAS PIPING PERMIT FEE FIRE ZONE ROOFING 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 8 AIR COND. SOLAR ET CK D PLUMBINGI� UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK FORMS SE 4#OR T ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plu5 xE = $ LUMBER GR. FINAL INSP. 7 �f ING S -� Yf FINAL INSP. / Z „ //, I � l{� �ii��N/� LD N i V •S 0 � � REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING, M SH TIONISOUND5 %a S- 113 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 NOTICE:THISDOCUMENT CANNOT (c na TO: City o E DQ!JuP'-taCATE10, DATE: Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 This is to certify that Jn? QJ developer of which is located at within this District, has paid school facility fees imposed pursuait to the authority generatedby Government Cpd Sec 53080 'n the am t of t,QiuoC� i covering a total ofs uare feet of ) ret- dential or ( ) industrial/commercial development and that building permits for this footage in this development may now a issued by your jurisdiction. CO r SERT SANDS -UNIFIED SCHOOL DISTRICT White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer (10)-37 04 Z O H 0 W CO M Z O r~ 0 W U) Z O W U) �Q Z t COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No. ENVIRONMENTAL HEALTH SERVICES �l%—/�• — r��% PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM r 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 # Agent, Contractor, Contact Person Phone Address & Phone , vOw n f p Phone Mailing Address C . State Zip Job roperty,Add ess Legal Description Prop. (PM, Tract, Lot) elv Lott Size ater Agenc ell Use of Pe�rrm�i P/P, 0 Q etc^ ZLl la% jTq Other `� Dwelling, MH ite Prep, etc. Signature of Applicant Date CATEGORY: REV CODE FEE CATEGORY: REV CODE FEE O SUBSURFACE DISPOSAL 1238$45.00 ❑ SITE EVALUATION UPON REQUEST 7349 $42.00 ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348 $11.00 a. 1 st 4 Parcels (Each) 1238 $45.00 (Less than 1 year) b. Each Parcel after 4 7344 $16.00 ❑ PRELIMINARY ELECTIVE 7352 $45.00 ❑ 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 $86.00 ❑ ALTERNATIVE/EXPERIMENTAL 7345 $132.00 ❑ Site Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $86.00 INITIAL DATE Holding Tank NoCertification Agreements Completed ❑ Yes i1a of Existing S.D. System Required ❑ Yes "QWQCB Clearance required. (Attach Form ❑ Yes 'N0 DOH SAN 007, Santa Ana Region Only) Soils Percolation Report Required. ❑ Yes No I Special Feasibility Boring Report Required. ❑ Yes Z Poq Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes No Other ❑ Yes No Staff Specialist Lot Inspection Required ❑ Yes X] No Lot Inspection Date Soils boring report by Project # Date o' Soils Map Page Soil Type t' Approved by A Date No. of Systems Type of System(s) No. Dwelling Units r (1) Septic Tank Soil Rate Grease/Sand iP Holding Tank ❑ Existing ❑ New ❑ Replacement Bedrooms, Fixture Units / A,,,�,,, j Grease Intcp 3,0 Dt.� - /v pv Ull G, (2) Leach Line Sq. Ft. Sidewall allowance �,/�7�.1 r Install —/— Line(#) � It. long �ft.wide with Leach Bed sq. ft. Bottom trench area It. rock/sq. it min. inches rock below drainlines or of bottom area per running ft. IRNA Leachlines/bed special design for slope: (3)^Pit Diameter No. Pits Pit Below Seepage Pit Total Depth Other, Applicable ❑ 5 8 \ �lol,� I) Max, Allowable N/A � Overburden factor Depth No. 2 System REMARKS:` _'f liG� �+- ©� r✓t�y r %1 7'� �d(JIu.cYt� -+gra- �G-c C� til •A +L�c, c� �.0-st[ � /y_ a�f ZC�C�►^.ts'� �CZ�f'� � s"y`1^ This applicat ais.APP ROVE9%DfRMEU or the ca ory checked SECT ON B a ovi4 regardi the design of a ssL ace disposal sy�m as indicated-" on the accompanied plot plan, using the requirements set forth ir�SECTION C above. A building permit is�e,essary for the installation of the aaaatttbove designed system. No construction is permitted in the required reserved 100% expansion area. � C Septic tank and sewer lines must be 50' minimum from any wells � ���fy� r \ 2) Leach lines must be 100' minimum from any wells, including expansion .area �G {, - 3) Seepage pits must be 50;x' minimum from wells, including e/xpansi - n area f� %any h'0 Signature of Health Official ^�'�/* l/V.G(�,,,[ Q Dat RECEIPT NO. ` to Issued By / Date- 7 - DISTRICT: ❑ Riverside, ❑ Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW -Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records