04808 (SFD)T,df 4 4 Q"
P.O. BOX 1504
Building �,..._... 78-105 CALLE ESTADO
Aririrpcc i ` -` 7 - " ' ��' t LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address
City Zip Tel.
Contractor
Address
State Lic. City
& Classif. 1 3'�P Lic. #
Arch., Engr.,
Designer
Address Tel.
City I
Zip State —
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000I of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
S IC-, r4 a T LJ P.Q DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I 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, 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 ($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, Bussness 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. 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 confractor(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 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.
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 Ing 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, alter 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
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 permil when properly filled out, signed and validated, and is subject to
explrafion if work thereunder is suspended for 180 days.
I certify that I have read this application and slate that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to bultding
construction, and hereby authorize representatives -of this city to enter the above•
mantloned property for inspection purposes.
Signature of applicant Date
Mailing Address _
City, State, Zip
BUILDING: TYPE CONST. OCC. GRP
A.P. Number
Legal Description
Project Description
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
17
Estimated Valuation
n
PERMIT
AMOUNT
Plan Chk. Dep.
`'•r'� `1 •'%`-'
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
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 Lints
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Val i dated by:�C'J�-
d
Validation:'
WHITE - FINANCE, PINK - APPLICANT, GREEN - SUILOING, GOLOEIAINOO • A15E55OR'S OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
ISI FL SO FT rp S
UNITS
UNDERGROUND
A.C. UNIT
COLL. AREA
YARD SPKLR SYSTEM
2ND FL SO FT, V
ROUGH PLUMB
POR SO FT. or
MOBILEHOME SVC.
BAR SINK
GAR SO. FT. la
POWER OUTLET
ROOF DRAINS
S ER OR
DRAINAGE PIPING
CAR P. SO FT. (U
DUCT WORK
ROCK STORAGE
WALL SO FT. (d
DRINKING FOUNTAIN
SO. FT. Id
URINAL
ESTIMATED CONSTRUCTION VALUATION S
OTHER APP.IEOUIP.
WATER PIPING
NOTE: Not to be used as property tax valuation
GAS (FINAL)
FLOOR DRAIN
MECHANICAL FEES
TEMP. POLE
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTOXDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
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.
SO. FT. ® c
BATH TUB
SO. FT. g c
WATER HEATER -
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID a t V. c
SEWAGE DISPOSAL
SO.FT.GAR @ 1i.c
HOUSE SEWER
VENTILATION
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 8 AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB
ONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
S ER OR
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.
S -Plus-x$
-S
LUMBER GR.
FINAL INSP.
F AMING �/d -�
ri
/ FINAL INSP.
/- /2 _
OOFING (J5
s
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
(INSULATIONISOUNO
FINISH GRADING
INAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS ,
GARDEN WALL FINAL
2
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COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION
d a'
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 $57 is required when the application is submitted. Check must be made payable to the County of Riverside.
'* N Building Department Application Log #
Name (Owner, Agent, Contractor, Etc.)
Mailing Address
2-117 ,E 7;4 A Qu, /T L
City
pAL/�r S ,e ,vim
State
C�,4
Zip Code
y'Z z Z
Telephone
lG��i) 3 z Z -/a Ze
Job Property Address
`�ybr oommuniy,
Legal Description of Property. (Lot, PM, TR) 64,
.5 1 9 7S &,q,4 19,9 A.) X R
Ct, GAJ 7'a
LoT /z �L Ott /Sri 6L,c�✓�1,T
'Assessor's Parcel No.
VaM6AgA0;AorWell
Cy W,47-&_ 4Q,
�]
Use of Permit !�'a'Y' n,_ing Case #
Lot Size
sa
773-3 Z
(§F—DMH Site Preparation Etc.
j1 /U O
Signature of Applicant Date
'The above information must be verified from Building Application
STAFF USE — DO NOT WRITE BELOW THIS LINE ;I
Initial Date
Certification of Existing S.D. System required. ❑ Yes �*
WQCB Clearance required. El Yes L No/
Soils feasibility report required. El Yes E�X
Detailed boring report required. ❑ Yes Ld'
Detailed contour plot plans required. ❑Yes No
Z Date
Staff Specialist approval required. ❑ Yes No Lot Ins t once I
Soils/boring report by Project # Date
Soils Map Page Soil Type Approved by—' --,-'&A---" Datel 3
Type of System: U
No. of Bedrooms
(1) Septic Tank
Soil Rate Required
❑ Existing aNew ❑ Additional ❑ Replacement
16'VV Gals.
(2) Leach line sq. ft.
Sidewall allowance
Install Lines) Ft. Long,
Leach bed Sq.
(BOttO ench area)
ft. rock/ Sq. Ft.
D19/A
Ft. wl min. inches
Ft. of bo
per running ft.
rock below drain lines
area
Leach lines/bed-special design for slope:
(3) Pit Diameter
No. Pits
Pit BI
Seepage Pit total depth
Applicable.1/
N/A—,, -overburden factor
6'
/lT
Max. allowable depth
� / .�i!O/' _ !,f'�r. i�i_„_ /1�1`'7J�7�--- �/f/// d �G.//�?ir-1•Lrt i�
r
This application islzo.: ed/d -for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements
set forth in Section B above. A building permit is necessary for the installation,of the above -designed system.
(1 `7
Septic tank and sewer lines must be 50' from any wells / 0
2J�-+each lines must be 100' min. from any wells including expa sion area
(3) eepage pits/must be 150' min. from any wells including expansion area 1/0
,,-f�•�P- �f ,j
Signature of Health Official
RECEIPT NO. Issued byT
District: ❑ Riverside Q-1fidlo ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File
DOH -SAN -122 (Rev. 6/86)
A !<-
PHONE: (714) 568-1322
ERNEST GUSTAV SILVERTON
ATTORNEY AT LAW
74045 FAIRWAY DRIVE
PALM DESERT, CA 92260
March 5th, 1980
Mr Leo Rojo
Department of Building and Safety.
9th Floor
4.080 Lemon Street
Riverside, CA
Dear Mr Rojo: Re: Building Permit No. 369000
We commenced building a three bedroom residence in
La Quinta, California in November 1979. The cement
foundation has been completed. Unfortunately I had
to be hospitalized in December and again in January
and was unable to continue with the construction to
comply with the regulations regarding the next
inspection within the required time.
We interviewed the -head inspector at the Indio office
to -day and he kindly gave us an extension of thirty
days but because I must again be hospitalized this
-month and also because of the very unpredictable
weather in the desert at the present time it will be
impossible for me to have the framing completed for
approximately three months.
Because of these extenuating circumstances and on the
suggestion of your Indio office, we are writing to you
for your advice and instructions.
You will note that the permit is issued in the name of
Shelley Nielsen, who is our daughter and who has been
unexpectedly sent on a work assignment with the World
Health Organization in Geneva, Swi.tzerland.^
Respectfllyyk your
ERNEST V SIELVERTON
Y
Desert Sands Unified School District
THIS p�q CERTIFICATION OF PAYMENT
WAv���; THIS DOCUMENT r�HdONt.N�'OC�LITY FEES
BE DUPLICATED.
TO: City of La Quinta
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
This is to certify tht
developer of
located at Lj
this District, has paid school aci it
authority generateA by G yernment o
covering a total of s
( ) industrial/commercial development
this footage in this development may n
DATE:
9 a� LW 60
w •w�v w � ti� r
which is
within
fees imposed pursuant to the
Se t'o 53080 'n he amount of
uare feet of ( ) e,s dential or
and that building permits for
tV-pe issued by your jurisdiction.
U
&Omla v4G'9, f r ESERT SANDS-(JNIFIFP SCHOOL DISTRICT
V �g 90
Wh,i�t/lel - Building Depart 7ent•Yellow - Facilities Planning
• Pink-�(Acccouunting • Gold - eveloper
r�16-3 7 �� -= / 09,3 Tom" � (10)-37
9, 1
Off ICE OF
AGRICULTURAL COMMISSIONER
AND
WEIGHTS & MEASURES
49-613 Ilwy 86, Suite d-12
'Coachella, CA 92236
619-342-8291
E. LEON SPAUGY
CO�ritIS:IO`ER
JAMES 0 WALLACE
ASStS;A%t CI)MMISSIONEP.
CLEMENT UE`VENIS1E
SEALER
DATE ,(Jrt �, I�� G CASE N0. �� O cl /T
DEVELOPER'S NAME: L i, IJ � 7,e 42, G' Tl o
ADDRESS t ,2 � �= 7-4 ��� a / T z l/��� � .4f �
r L, ; s C// 9 2 2 7�
TELEPHONES (/o/g) G? z i o z v
Dear Developers
After reviewing your landscaping plans, all plant material listed is not in
violation of quarantine laws governing the Coachella Valley. If substitutions
do occur and they differ [run plaint material listed, this office must be notified
immediately.
Thank you for protecting and preserving the Coachella Valley's pest -free environment.
Zor /L 13L�/..�'�
E'�Z
Agric tural CoEnnissioner's Office
cc: Indio and Riverside Office
s,2 ? 7.3- C'A E; �e A,o z,9
pis 4uiv rq