04795 (SFD)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 53-105 Hart lien py. LA QUINTA, CALIFORNIA 92253
Owner
Coo beiia Vai ,ev a a
O BUILDING: TYPE CONST. OCC. GRP.
Mailing
Address 247 9. Tahquitz Way #2 A.P.•Number 774--061-017
City Zip Tel.
Palm Springa 322.62 322--1020 Legal Description
Y 'C onstrttrrtion,
Address I
City
State Lic.
& Classif.
Arch., Engr.,
Designer
Address
ME
s.,.
Project Description
387334 ICit
Lic.# I Sq. Ft. 1440 No.
Size Stories
CityI Zip I State
Lic. #
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 an'd,Professions Code, and my license is in full force and
effect. ,.r2SG'f'+ /y!- +.r 4, ` dry
SIGNATURE t 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 penally 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, Buisness 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 com
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 v
I hereby affirm that I have a certificate of consent to, self -unsure, or a certificate of
Worker's Compensation Insurance, or a certified copy.-theredf.`(Sec. 3800, Labor Code.)
Policy No. Company _.-1, /
❑ 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 thg 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 revoked.
04795
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑
Demolition ❑
428' Garage
198' 6' wood
fence
Side Setback from Property Line'
Lender's Name -
-
-
Lender's Address
FINAL DATE
INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
S
11/15/w
Estimated Valuation
PERMIT
Issued by:
AMOUNT
Plan Chk. Dep.
$250.00
Plan Chk. Bal.
64,05
Const.
Validated by:
364.00
Mech.
36.00
Electrical
Validation:
74.17
Plumbing
105,0.0
S.M.I.
5.36
Grading
20.00
Driveway Enc.
20.00
Infrastructure
e
D 7 • 5
TOTAL
$2,6118.43
REMARKS
. _ w gib_ A ..
.:
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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.)
Side Setback from Property Line'
Lender's Name -
-
-
Lender's Address
FINAL DATE
INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
11/15/w
expiration it work thereunder is suspended for 180 days.
1 certify that I have read this application and state that the above information is correct.
Issued by:
Date Permit
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.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT (q $
UNITS
COLL. AREA
SLAB GRADE
YARD SP?:LR SYSTEM
2ND FL SO FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR SO FT. a
DUCT WORK
ROCK STORAGE
FOUND. REINF.
POWER OUTLET
ROOF DRAINS
GAR SO. FT. (pc
HEATING (FINAL)
OTHER APP./EOUIP.
REINF. STEEL
DRAINAGE PIPING
CAR P. SO FT. 9
GROUT
DRINKING FOUNTAIN
WALL SO. FT. @
FINAL INSP.
BOND BEAM
URINAL
SO. FT. M
GRADING
cu. ytl.
$ plus x$
=$
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTONDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ I'A c
SEWAGE DISPOSAL
SO.FT.GAR er >i c
HOUSE SEWER
FINISH GRADING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE L.CK.FEE
7ST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR
SETBACK
GROUND PLUMBIN , `G
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
WER OR SEPTIC T
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. ytl.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
WROOFINGk
'
r
PLI
REMARKS:
VENTILATION
FIRE ZONE ROOFING
'
FIREPLACE
SPARK ARRESTOR-
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
&& NAL INSPECTION
y CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS ,
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
CC O F
® B Go THIS ® 00 .F C , LIT FEES
i..
RE DUPLICATED, w
QKD
TO: City of La Quinta --ATE:
Department of Community Development '
78-105 Calle Estado
La Quinta, CA 92253
This is to certif that J-rOAA
' ,
developer of which is
located at — / within
this District, has paid school facilit fees imposed pursuant to the
authority gen ra d by Government Code Section 53080 in the amount of
$ -
covering a total ofquare feet of ( ) residential r
( ) industrial/commercial development and that buil ing permits for
this footage in this development may now be issued by your jurisdiction.
&!4A,'tt
Q 1L1 for DESERT ANDS UNIFIED SCHOOL DISTRICT
White - Building Department 9 Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37
711
x.'y,- ..1.i7W'ir-}+...r ,.-_.:s ... e'�w+': is't3"�.r�=wT--n-.�•ira.,'-".�...y.Cy+«,:�-.-.�r� -. �.ty:.S,,,s�-,--w�.•-yyt•-. .•.•...-_�
t
-
'COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No.
ENVIRONMENTAL HEALTH SERVICES 17774— d6 —1917
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 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.
Q
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG' #
Z
O
Agent, Contractor, Contact Person \
Phone
Address & Phone
LU
Owner
Phone
Mailing Address
i
Z y7 7-14F/62V .Tg W.4 Y
City
1--1741,W f7�/CGS
State
0
Zip
9t 2(-
.lob Property Address �J ��p
&_3/oS/19A
Legal Description Prop. (PM, Tract, Lot)
GorX 13A.4 -J 208LL,uir zo
Lot Size
--T�
ater A eiicy,LWb1l'
Use of Permit P/P, CU, etc. A 4.it/� 1.
Other
Q'Aaa
�i 7'A& /C__1 -r_
Dwelling H de Prep, etc.
Signature of Applicant
/// Diite
CATEGORY: REV CODE FEE .
CATEGORY: REV CODE FEE
b�UBSURFACE DISPOSAL 1238 $45.
❑ SITE EVALUATION UPON REQUEST 7349 $42.00
m
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
Z
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
p
a. 1 at 4 Parcels (Each) 1238 $45.00
(Less than 1 year)
H .
b. Each Parcel after 4 7344 $16.00
❑ PRELIMINARY ELECTIVE 7352 $45.00
W
❑ Rereview (2nd review same parcel) 7344 $16.00
EVALUATION (Attach DOH SAN 53)
U
❑ 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
4
INITIAL DATE
Holding Tank Agreements Completed ❑ Yes
Q No
Certification of Existing S.D. System Required ❑ YesND' o
WQCB Clearance required. (Attach Form ❑ Yes No 1'
,
DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required. ❑ Yes No x
Special Feasibility Boring Report Required. ❑ Yes 11
Detailed Contour Plot Plans Required (1 to 5 ft interval) ❑ Yes NN i
Other ❑ Yes
Staff Specialist Lot Inspection Required ❑ Yes NO
Lot Inspection Date
Soils boring report by Date
f/
Soils Map Page Sod Type �v` /_,{,
Approved by Date
U
No. of Systems
%. of Systema)
❑ UdkTank Existing
No. Dwelling Unita f I i
ooms,
(1) Septic Tank
Soil Rate
11.2rease/Sand
Grease
�dNew aRt
Gal
U
N`(2)4L,,each
Line Sq. Ft
Sidewall allowance
v r
Install '�,� Une(s) R long ft wide with
Leach Bed sq. R
Botto�tnh nch area
ft rock/ sq. R
min. 'hires• below drafnlines or
sof' a►ea
per running It
O/NA
4 �
I-eachlines/bed special design for slope:
(3�it Diameter
No. Pits
Pit Below
See �P',,Tofal Depth
%jjjj
Applicable
/
)
!
Inlet (BI)
/
;
N/A Overburden factor
--
�y-
Max All I' Depth
No. 2 SystemR'
REMARKS:
v
This application` AP` A E�_?Mb:E NMED`for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
0
on the accompanied plot plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
Z
above -designed system. No construction is permitted in the required reserved 100% expansion area.
10) Septic tank
and sewer lines must be 50' minimum from any wells`//
V�
� Mach lines must be 100' minimum from any wells, including expansi� area
(3) Seepage pits must bei 1/j50' Aminimum from any wells,, including expansion a��
N
1�F-CRF./i (/V
:�
y
nature -of Health Official �a "O Dae � -
RECEIPT NO.07 Issued By SX Date ��'%'
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
OI 1 u:E OF
AGRICUL l URAL COMMISSIONLIt
AN
wi:IGI I S b.. MEASURES
49-613 Ilwy 116, Sulte 11-12
-Cuiicltelln, CA 92236
619-342-OZ91
VN
pEVEWPER' S I•U11.1E (
ADD LESS (
TELL1'I TUNE (
Gear Developers
E. LEON SPAUGY
Co•.t•n au .En
JAMES o WALLACE
A`SISIrO Y,').•1'•LSStU tt!
r-UNIEyt t5E`wE! ISIE
SL.«tn
J
22/026
i% lot
After reviewLlg your lalldsct [J"(1 plans, ell p1a1lt material lis JE substitutions
violation of yuarat)tine laws cwveL111119 elle Culchella Valley.
do occur and trey differ [rcln plant n4ilerial listed, this office must be notified
iunl diately.
'llkwic you for prutectbly and pLeserviny the Coachella Valley's pest -free enviro"lelit-
Al[
curai ice
cc: lrldio and Itiverside Uf f ice