No Permit No (SFD)Building
Address J
Owner
To Q C• c
Mailing I
Address J
City Zip
Qu; y
Contractor .
U r
Address
City Zip
State Lic:
& Classif.
Arch., Engr.,
Designer
Address
City lZip
C64 if
P.O. sox 1504 ; APPLICATION ONLY
78-105 CALLE ESTADO
LA OUINTA, CALIFORNIA &253
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number/ 61-7 lO l — 0 lo
Legal Description
Project Description s" /7
Lic. # Sq. Ft. No. No. Dw.
Size . Stories Units.
IState
Lic. #
LICENSED CONTRACTOR'S'DECLARATION
I hereby affirm that I am licensed under provisions of Chapter tI (commencing with Section
7000) of Division 3.of the BpsUless and Professions Code, and my1icense Is iwfull fo ceand
effect.
SIGNATURE DAZE
OWNER•BUILDER DECLARATION
Lhereby affirm that I am exemptfrom the Contnactora.License Law for the following
reason: (Sac. 7031.5;�tresa and Professlona Glide: Any dty :oI caunty which requires a
permit to construct; after, brwrove, demolish; or repair any structure,. prior :to Its Issuance .also
requires the appti 1 forsuchpermit to -go a signed statement that he Is licensed pursuant to
'the piowalorrs oI the.
Contractor's license Law, Chapter 9 (commencing with, Section 7000) of
Division 3 of the Mess and Plofessians Cade, or that. he ts' exempt therehom, and the basis
for the afted exemption: Any rloldrten of Section =7031:5 by any applicant for a pemW
suWcf U16 applicant to a dvB penalty o/not more: than the hundred dollars ($500).
O 1; asownerof the property, or.myemployees with wages as. their sole compensation, will.
-- do the work, and the structure is not intended or offered for sale. (Sec. 7011, 1361wess and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or hhproves thereon _and ,who., does such work himself or through his own employees,
P
rovided tihat such br0ororeirrenls arertmot.hdoaled or offered for safe. M, however. the Wrkdolp
or tmrhprovemarht is sold within one year of completion, the owner -builder will have the burden
of prorhng that he did nat.butld er knpmve fa the p!>Ep " of sale.) -
❑ I, as owner of the propeRy am exclusively contracting with licensed contractors to con
-
p;
project (Sec..70i ; f�6ress And Prplesslans Code:_ The Contractor's License Lew
does not apply -to an owner of property who builds or improves -thereon, aril who contracts for
such projects w#b:a cwdractor(s) 5cwmW pwmmd to,do Contractorrs License Law.)
❑ 1 am exempt:underSec- B. & P.C. for thisI-reason
Date Owner
m r
WORKERS' COMPENSATION DECLARATION
1 -hereby affirm: that 1 have a certificate -of consent to.self-insure, or a certificate of
Worker s Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.)
P011cy N0.' Company
❑ Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' OOMPENSATiON INSURANCE
`(i'fds section need not be completed it Ole permit Is for one. hundred dollars ($100) valuation
a fess.)
I %,* that -in the performance of the work -for which this permit is Issued, I shall•not
wnP1oY any pion in any manner so.as to become subject to the Workers' Compensation
Laws'of California
NOTX:E TO APPLICANT.• 9, alter mabV this CerWicate of Exemption you shouts became
subject to the Mbrkers' Compensation provigons of the tabor Code,. you must forMw#h
Comply w9h such provlaforrs or tide permit sha8 be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hetabv affinnAhat there is a construction, lending agency for the performance of the
work for which this Permitis Issued. (See. 3097, CNB Code.)
Lenders 'Name_
Lenders Address—
This is a building permit when properly filled out, signed and validated, and is. subject to
expiretion, it work thereunder Is suspended for 180 days:
I certify that 1 haft read this application and state that the above Infomlation is correct
I agree to comply with all city -and county ordinances and state laws relating to building
construction, and hereby authorize rapreseritatiyss -of this city to enter the above,
mentioned.property for inspection purpcsea
Signature of applicant Date
Mailing Address
City, slate, 23
BUILDING
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
#,r L
PERMIT I I AMOUNT
Plan Chk. Bal. Gra``i
Const.
Mech. 3 t
Electrical / r -
Plumbing / r
.
S.M.L 7,040
Grading Z_ rid
Driveway Enc.
Infrastructure -Z 7"4 L4.0
Al A
Cit. O
TOTAL f C) J
REMARKS 005182 10 6691 05-10-89 14
ZONE:BY"vAr1$"r-za-6rt�� �$' {
Minimum Setback Distancegr0 CASH i TFAL 1 250, 00
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:
Validation:
',CONSTRUCTION ESTIMATE
GROUND PLUMBING
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. •.
SLAB GRADE
-UNITS
BONDING
HEATING,(ROUGH)'
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
YARD SPKLR SYSTEM
2ND FL. SO: FT: ® --_
FOUND. REINF:
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER.APPJEQUIP:
REINF: STEEL
MOBILEHOME SVC.
TEMP. POLE
BAR SINK
POR:GZX; SQ. FT.. ® -
GROUT
WATER HEATER
SERVICE
FINAL INSP.
GAR. SQ. FT. ®`
r..
POWER OUTLET
ROOF DRAINS
_
LUMBER GR:
-
FiNAL INSP.
DRAINAGE PIPING
CAR P. SQ. FT. ®
ROOFING'
-
WALL - - SO.`Fr. ®' • -
REMARKS:
_ .
VENTILATION
DRINKING, FOUNTAIN._ -
FIRE ZONE ROOFING
URINAL
SQ. ®
FIREPLACE
ESTIMATED CONSTRUCTION VALUATION $
"'
WATER PIPING
NOTE: NoE.to'be used as: property, I" Valuation
LATHING
FLOOR DRAIN_ _
MECHANICAL FEES
MESH
WATERSOFTENER'
VENT SYSTEM FAN EVAP.000LHOOD
SIGN
FINISH^GRADING
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSPECTION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR. 18USPENDEDLAUNDRY
CERT. OCC.
TRAY
AIR HANDLING UNIT CFM
INSPECTOR'S SIGNATURESIINITIALS
KITCHEN SINK
ABSORPTION SYSTEM.' g.T.U.'
GARDEN WALL FINAL
TEMP USE PERMIT SVG
WATER CLOSET
COMPRESSOR HP
POLE, TEMIPERM
/
LAVATORY
HEATING SYSTEM" 'FORCED GRAVITY
AMPERES'SERV ENT
SHOWER-
HOWERBOILER-
BOILER.B.T.U..
SO. FT. @ c,
BATH TUB
SO. FT.,® c
WATER HEATER
MAX. HEAT,ER:OUTPUT, B.T.U.
SO. FT. RESID ®.1 Vi c
O
SEWAGE DISPOSAL
SQ.FT:GAR ®. 44c
( S
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE .
( �,
PERMIT.'F,EE,
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
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.APPJEQUIP:
REINF: STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
_
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
R�
UI I II,E of
AGRI :UL I URAL CUMNIISSiU"Llt
nyu
WI:IGI I IS b. MEASURES
49-613 Ilay 116, 001te 11-12
'COnehelln9 CA 922J6
619-342-0291
E. LE014 SPAU6Y
w.rRsictr ll
JAMES o WALIAO
„%5151 1 1*.01"IMISSR)AN
CUMENI tlF.%VEhI51E
$L -%un
UK
cnsc ilv. � �9 0: -5-7
7c
DEVEWPER's MISS Z:7
• AU1)hEss
y� 3 � � 11 1 i Hary kar Qu,.,g
�1'EL,L•"1'1IUIJES t /yi 3 y 2- 3 S 2/ sf - -
7q-SSl COI -fez
[)ear Wvelupera
listed Is llot 111
After teviewlaly your lanctscolalnq Illallal, Ii11CIuoultellalit, 110terial Valley- If subsUtutlolls
violatlon of yuaralltine lows tiuveinilly ll
do or acid they ditter [mall 111allt IIFSterltal listed, Mals oEEice uNs
occur ' be Ilotifled
ialtllediately.
teservlliy the Coachella Valley's pest -free envirolnl�nt.
'1'llank you Eor prvtectLly alld l►
11gr;cultua a C.al. oler, s iii
cci 111d10 and Riverside uttice
O
8
W
M
Z
0
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Asenam Parcel PAM
ENVIRONMENTAL HEALTH SERVICES
PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM
Applicant: Submit this form with four copies of a,scaled plot plan (1 -20 scale) drawnlo County speculations as Indicated ori the attached check fist.
A non-refundable filing fee (see below) Is required when the application Is,submittedl. Check must be made payable to the County of
Riverside. Approval of this application shall remain valid fora period not to exceed owyear from date of approval.
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'*
Agent contractor, contact Person
Phone
Address & Phone
Phope
W-
Address
&�e
City S"
Qun
Zip
lob
M
1 —1 Description Prop. TK Track Lot)
>7
-CnF Jai
Lot Size
I
use of PerP ato
C.)
�ME7P,,'
Other
,r4: r -F
fC V. a/4
�Ulng
0
110Signature
. C',
velling, MH rep, sto.
2?z��
of iCerrC
Ode
CATEGORY: REV CODE FFE
1211"iUBSURFACE DISPOSAL 1238
CATEGORY: REV CODE FEE
13 SITE EVALUATION UPON REGUEST 7349 $42.00
0 MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
LAND DIVISION
13 SEWER/SEPTIC VERIFICATION 7348 $11.00
a Ist4Parcels (Each) 1238 .$45.00
Masi than I yeed
b. Each Pafod after 4 7344 $11100
13 PRELIMINARY ELECTIVE 7352 $4500
• Rerewlew (2nd review same parcel) 7344. $11100
EVALUATION (Aftech DOH SAN 53)
• Site Evaluation In Conjunction with
13 HOLDING TANK 7351 $4540
CdticW Area 7346 $86.00
13 ALTERNATIVE/EXPEMMENTAL 7345 $132.OD
13 Sfte Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft 7347 $86-00
DATE
Holding Tank Agreements Completed 13 Yes
Certification of Existing &D. System Required 13 Yes,
WOW Clearance required (/Ricoh Form CO3 Yes
DOH SAN 007, Santa Aria Region Only)
Soft Percolation Report Required 13 Yes
Spode- Fiessibilfilly.Borlino Report R 0 Yes
Qds11ed,CcntWr Plot-Pisns Required, (I_tD 511. bltwvW)_ 0 Yes
9NO
Otlier 13 Yes
Staff'Specialist Lot Inspection Required 0 Yea
Lot Inspecilloin Data
Salle boring report by — Pildled# Date
Soils map Page Sol Type 19 _ �t--
_�pproved by J-4�Data I
Na of Syslem
�.e Of Systemle)
6=lng
N4 Dwelling Units
(1) Septic Tank
Sod Rate
G1,1116111111811nd
11ink 13 Existing
Reploosment
Jao-,—O.
ye-4j1W,!1
Gal
4), -Leach Lkie.Sq. Ft
trench area
Sldwwall WkwAince
ft rock/
—W—aqft
InOWL,,. Lk*e) - t brg a wide with-4.each
min. W911110je below dralrillnes orarea
Bed sq. It.
, �*
per ruming It
Leachlinewbed special design for dope:
(3) PR Diameter
No. Pita
Pit Below
seepage PHT O� Depth
Applicable
InIat
Allawal;ile Depth
WA Overburden (actoi
Max.
No. 2 System
REMARKS -
V
This application D the category chocked in SECTION B above, regarding ft design of a 94baurtaoe disposal system as Indicated
�:)V
using
on the aoco= t pan, 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.
(9 Septic tank and sewer lines must be W minimum from any, well /0
Leach lines must be 100' minimum from any wells, Including e on area
6) Seepage pits must be50' min from /9y wells Including expansion area -
050 minimum za,2,�- a 4- P-
re
natuof Health Official —
9
3
RECEIPT NO. Issued By 75 le - Date
-
DISTRICT: 0 Riverside, 00 Indio 0 Hemet 17 Perris 0 Rancho Calif. 0 Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK -Bldg. Dept GOLDENROD - Planaffl000rds
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
OL FACILITY FEES
NOTICE; THIS ROCU
BE DUPLICATED,
TO: City of La Quinta DATE:
Department of Community Development
78-10:5 Calle Estado
La Quinta, CA 92253
U4
RA
This is to certify that
developer of Ohich is
located at within
this District, has paid school fa '..ity fees imposed pursuant to the
au5h0ittyl g grit b Go ernment C de' Se ioli 530 n he adto91404 fil uq 4f
coverinlLg.��(ap tonal of square feet of ) e i eniial0or
( ) industrial/commercI al development and that building permits for
this footage in this development may now be issued by your jurisdiction.
Ck-- o I (V % � P-11 0 � bA M&
for DESERT SAWS UNIFIED SCHOOL DISTRICT
White Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37