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No Permit No (SFD)Building TAddress '-1 - /q�AV�9. �•'��G�{) QLp V /V OWne'M,o �! �iV►rf�l%/� Mailing AdvW2� Addre�j city - Address P.O. BOX 1504 APPLICATION ONLY 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 p Tel.. State Lic. City &'Classif. Lic. # Arch., er T4YW .61 9� y'�� -4 - Z A Address Designer q ,,, �t ** 2 -/ Aep �oF Y� vL%z Tel.14�-� X1221 Cite`�// ) A � 2i State /) �� �/ �/ �f/✓ �!% �Lic. # C. LICENSED CONTRACTOR'S DECLARATION 1 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 OWNEWBUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, after, krmrove, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to rile 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 ProfessFDns 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 civilpenalty of not more than rive 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 Contractors License Lew does not apply to an owner of property who builds or kWmves thereon and who does such work himself or through his own employees, provided that such knprovements are not intended or offered for sale. If, however, the building or kriarovement is said within one year of completion, the owner-buflder will have the burden of proving that he did not bui d or knprove 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 contractors) 6cen ad pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec�B. & P.C. for 's reas Date Owner WORKERS' COMPENSATION DECLARATION 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 ❑ 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 lhQ work for which this permit is issued, I shall not employ any ppeerson in any manner so as to become subject to the Workers' Compensation Laws of Calnf0 k Date Owner NOTICE TO APPLICANT: ti, after making this Certificate of Exemption you should become subject to the Nbrkers' Convensabon 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. 1 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 bovementioned property for inspection purposes. Signature of applicant -Date- Mailing ateMailing Address City, State, Zip BUILDING DIVISION 11LDING: TYPE CONST. /• ' OCC. GRP. P. Number [ / -3/ 3 V / // (�, —7 Description Description M10 t� S40-) < n AAAA 0s• -()'?--q() 5 4 ib_ CASH i TOTAL i 250.00 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 Permit Validated by: Validati Sq.No. Size Stories No. Dw. Units New Add ❑ Alter ❑ Repair ❑ Demolition ❑ -:�2`7s' 0 i 4 "IJ Estimated Valuation / PERMIT AMOUNT Plan Chk. Dep. '?� d Plan Chk. Bal. 3 , Const. 7S sa Mech. Q Electrical / Plumbing S.M.I. Grading Driveway Enc. Infrastructure ye? r a TOTAL REMARKS t� S40-) < n AAAA 0s• -()'?--q() 5 4 ib_ CASH i TOTAL i 250.00 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 Permit Validated by: Validati CONSTRUCTION ESTIMATE GROUND PLUMBING NO. ELECTRICAL FEES. PLUMBING FEES 1ST Fj=.2-SO. FT. ® _$I SLAB GRADE UNITS BONDING HEATING (ROUGH) r FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK YARD SPKLR SYSTEM FOUND. REINF. 2ND FL. SQ. FT. 0 METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE �d 3 MOBILEHOME SVC. GROUT BAR SINK SERVICE POR. SQ. FT. ® BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ GAR. SQ. FT. ® 10,POWER OUTLET FINAL INSP. ROOF DRAINS FINAL INSP. ROOFING DRAINAGE PIPING REMARKS: CAR P. SQ. FT. ® VENTILATION WALL SQ. FT. ® % FIREPLACE DRINKING FOUNTAIN SQ. FT. @ SPARK ARRESTOR URINAL GAR. FIREWALL ESTIMATED CONSTRUCTION VALUATION W,I LATHING WATER PIPING NOTE: Not to be used as property tax valuation MESH FLOOR DRAIN MECHANICAL FEES FINISH GRADING WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD /� SIGN CERT. OCC. WASH ER(AUTO)(DISH) APPLIANCE DRYER INSPECTOR'S SIGNATURESIINITIALS GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GARDEN WALL FINAL LAUNDRY TRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM. - B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR Hp 3 POLE, TEM/PERM '� 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 ® 11/4 c SEWAGE DISPOSAL �s SQ.FT.GAR ® 3/ac /a Q HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE I COST.FEE ELECT. FEE SMI F F, PLUMB. FEE 7 T -nom ��y� ��ff- ewi'5- so STRUCTURE PLUMBING ELEC'TRI10 ( HEATING R AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. 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. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL Desert Sands Unified School District CERTIFICATION OF PAYMENT OF (UAJ N® SCHOOL FACILITY FEES �iCZ' ]'all/1 c� T0: City ofLI)`Q�,��Ff��T' c DATE: a� Department of CJr7t� Ati A' yjpeve pmur 78-105 Calle Estado La Quinta, CA 92253 This is to cert'f that, ,V v developer of hich is located at — a within this District, has paid school facility fees imposed pursuant to the autho ity generated,by Gove me t Code Se tion 5308Q in the am u t of $ no covering a total of square feet of ) resid ( ) industrial/commercial development and that building permits for s this footage in this development may now be issued by your jurisdiction. --) 14 C� Jrv)(2�0L&46d - ( A&W for DESERT SANDV UNIFIED SCHOOL DISTRICT White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer (10)-37 m U Z O_ 15 W U) COUNTY OF RIVERSIDE ENVIRONMENTAL`�Of_�NO' 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 speculations as indicated on the attached check last 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 # azm f-��ract DCorittoperson y Phone dress& Firmo Owner .�. PhonAddress e C�laili fAWAf &4 /T % City State Zip Job - Description Prop. (PM Track, Lot)14q/ /^LO Legalp?,V4I 147 I,l 1.4 C� Sri e , r ter Agency I Use of Permit P/P, CU, etc. )0,4 �I1 Other �! � /Lot / Dwelling, , H Silo P etc. 77, i /-11; Signature oMpNiDint Data CATEGORY: REV CODE E CATEGORY: REV CODE FEE ❑" SUBSURFACE DISPOSAL 12 $ 57.00 ❑ SfTE EVALUATION UPON REQUEST 7349 $ 43.00 ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348 $ 17.00 a. 1 at 4 Parcels (Each) 1238 $ 57.00 (Less than 1 year) b. Each Parcel after 4 7344 $ 24.00 ❑ PRELIMINARY ELECTIVE 7352 $ 23.00 ❑ Rereview (2nd review same parcel) 7344 $ 24.00 EVALUATION (Attach DOH SAN 53) ❑ Site Evaluation in Conjunction with ❑ HOLDING TANK 7351 $ 47.00 Critical Area 7346 $111.00 ❑ ALTERNATIVE/EXPERIMENTAL 7345 $222.00 ❑ Site Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $ 87.00 I I IAL DATE Holding Tank Agreements Completed ❑ yes r 2 7 (Y Certification of Existing S.D. System Required ❑ Yes Gd Ne0ol" WOCB Clearance required. (Attach Form ❑ Yes �o DOH SAN 007, Santa Ana Region Only) Silas Percolation Report Required. ❑ Yes No�_ Special Feasibility Boring Report Required. ❑ Yes Detailed Contour Plot Plans Required (1 to 5 R interval) ❑ Yes Other ❑ Yes ff'No Staff Specialist Lot Inspection Required ❑ Yes Lot Inspection Date Solis boring report by Project S Date C� Soils Map PageSoil Type Approved by Date No. of Systems Tfe of Systeme) No. Dwelling Unfta(I' (1) Septic Tank Soil Rata /Sand F�ng Tank ❑❑ Existingm Replacenwd Bedroos,F,)dure,k/t 0 Irrlcp 310A77iI a_Ga, ",! /° c3el (2)•leech Line Sq. FL Sidewall allowance Install,,,.Line(s) It long k wide with Leach Bed sq. k Botta' iu harea R rock/ sq. fl min. irxfierogc slow dralnlines a tea. d'n Brea `►� per running ft Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Bekaa Seepage Pit JW Depth Apple In1e6fBl) / (TD) N/A Overburden factor T - ` V0 Max. Allowabb Depth No. 2 System 4//,4 REMARKS: �'�Q i,�►-, f �U G/�1� 4 This application ' APPROVED ^ EW b for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompan p p n, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the above -designed system. No construction is permitted in the required reserved 100% expansion area. Q1. Septic tank and sewer lines must be 50' minimum from any wells /(? 7 Leach lines must be 100' minimum from any wells, including expansion rea 3) Seepage pis must be 150' m�inim�um—,afro/m any/wells, including ex�pans/fnnaar zw", /` ��P/ Signature Health Official / //k,• 444, / of Date RECEIPT NO. J 3 Q Issued By Or 141JIt Date Aa DISTRICT: ❑ Riverside, Into- ❑ Hemet q Perris ❑ Rancho Calif.' ❑ Blythe DOH -SAN -122 (Rev. 7189) DISTRIBUTION: WHITE - Office file YELLOW - Appticanl PINK - Bldg. Dept. GOLDENROD - Plans/Records 1 :-- l N i I Nl/65T/; ATrao✓ mr N�TGH�D j GP"l2•4"L� RA- F7'�:XS �e F 7 /—";k 44po4/� Al 0 TOY-1,ov 7Y4 57 a