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06227 (SFD)i Building Address 53-645 Martinez Owner c&ty/ 4 4 Q" P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Address P. Q. Bax 59 City Zip Tel. 7A tui3nta 92253 1 564-1486 ress General Contract Zip State Lic. City & Classif. 524325 1 Lic. # 1235 Arch., Engr., Designer Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I 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 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 sued 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 rive 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 of property who builds or inproves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. It, 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 kni rove for the purpose of sate.) ❑ 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 a- & 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, ora 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 ff 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: ff, 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 lids 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 abuilding permit when properly filled out, signed and validated, and is subject to expiration it 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 state 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 ateMailing Address City, State, Zip BUILDING: TYPE CONST No. OCC: GRP. P. Number 774-131-019 Legal Description Project Description S.F.D. 06227 Sq. Ft. 1633 Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $89,943 PERMIT AMOUNT Plan Chk. Dep. $250.00 Plan Chk. Bal. $ 256.70 Const. 594.50 Mech. 53.50 Electrical 115.53 Plumbing 157.50 S.M.I. 6.30 Grading 20.00 Driveway Enc. 20.00 Infrastructure 1,985.47 TOTAL $3.459.50 r) J, T6 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 Line FINAL DATE INSPECTOR 3/23(89 Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES ' IST FL. SQ. FT. ® $ UNITS COLL AREA LAB GRADE �� • f -� f� ROUGH PLUMB. YARD SPKLR SYSTEM 2ND FL. SQ. FT. HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR. SO. FT. ® DUCT WORK ROCK STORAGE FOUND. REINF. POWER OUTLET ROOF DRAINS GAR. SQ. FT. ® HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) O DRAINAGE PIPING CAR P. SQ. FT. @ GROUT WATER HEATER DRINKING FOUNTAIN WALL SQ. FT. ® FINAL INSP. BOND BEAM WATER SYSTEM URINAL SQ. FT. a GRADING CU. yd. plus xE =$ ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. 3 0 WATER PIPING NOTE: Not to be used as property tax valuation ROOFING J� ���/C '"'YYYY FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTOXDISH) 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. SQ. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/. c SEWAGE DISPOSAL SQ.FT.GAR ® V4c HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE FL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR BACK /0 • OUND PLUMB UNDERGROUND A.C. UNIT COLL AREA LAB GRADE �� • f -� f� ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS _EWER OR SE �fd ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) 2112137,P METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) O TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM $ GRADING CU. yd. plus xE =$ LUMBER GR. FINAL INSP. 3 0 FRAMING FINAL INSP. ROOFING J� ���/C '"'YYYY p/� / �l'P'• IJ1C �/;(L� IJ�gOU� ,/ `✓`4-,y //� ✓// VV [✓ i,J ,' L V q' ��" ��� C'� /"`` U / � L4 r R REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING40` A/ //#/f/ MESH INSULATIONISOUNDi' b� FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESJINITIALS GARDEN WALL FINAL 1 Desert Sands Unified School District CERTIFICATION OF PAYMENT N0I-Ic"OF. T n SCHOOL FACILITY FEES On TO : City �E �Qh0CLIf�•�' DATE: Department of Com main�if�r'y�Dev�e� op en �. 78-105 Calle Estado ` La Quinta, CA 92253 This is tQ icertify th t developer of hic is located at, within this District, has paid choo f cility fees impos pursuant to the a tf� rit g n rat d by Gov nm n Cod ecti ti 530$0 in t e moun $ ( Y/00 covering a al o square feet of ( e de tial or ( ) industrial/commerciAl—detvdlopment and that building permits for this footage ��inthis development may now be issued by your jurisdiction. (^[ 1 5 00a M t Ay'� '11 fo DESERT S DS UNIFIED SCHOOL DISTRICT 1. P Wfii - Wing Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer C')L�* �-i 19- (10)-37 Je . 1.4' RECEIPT NO. / s Issued By Date DISTRICT: ❑ Riverside, ❑e Indio ❑ Hemet, ❑ Perris ❑ Rancho Calif. ❑ Blythe ' DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE -.Office file YELLOW . Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records 29 toot. 4 COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No. ENVIRONMENTAL HEALTH SERVICES 7q 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 19, VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG Z O Agent; Contractor, Contact Person , Phone Address & Phone �,�v� Co.✓►re �i-+T Gc�p�6C �. 5 — t!�+Cv.r�.�.-r U W Owner Phone Mailing Address City Zip Job Property Address Legal Description Prop. (PM, Tract, Lot) �,� %_*1, V r LState - . 177�ieennc Lot Size x Use of Permit P/P, CU, etc. Other X!Pwelling H Site Prep, etc. l Signature of Applicant Date CATEGORY: REV CODE FE ,�j CATEGORY: REV CODE FEE �,� ❑0 SUBSURFACE DISPOSAL 1238 S 7 A - ❑ SITE EVALUATION UPON REQUEST 7349 $42.00 ❑ MULTIPLE PARCELS WITHIN SAME _ (NO PLOT PLAN) M Z LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348 $11.00 Q a. 1 st 4 Parcels (Each) 1238 $45.00 (Less than 1 year) U b. Each Parcel after 4 7344 $16.00 ❑ PRELIMINARY ELECTIVE 7,352 $45.00 UJ ❑ 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 fQ1TIAL, DA Holding Tank Agreements Completed 11 Yes o �/ / O Certification of Existing S.D. System Required ❑ Yes , 1 WQCB Clearance required. (Attach Form ❑ Yes -'No DOH SAN 007, Santa Ana Region Only) Soils Percolation Report Required. ❑ Yes Special Feasibility Boring Report Required. ❑ Yes eo- Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes Other❑ Yes o; ! Staff Specialist Lot Inspection Required ❑ Yes No 4 Lot Inspection Date Soils boring report by Project # Date Soils Map Page + { l Soil Type f/ Approved by Date U No. of Systems Ty b f System(s) No. Dwelling Units + (L) Septic Tank Soil Rate Grease/Sand Z Q ❑ Holding Tank ❑ Existing @!dew ❑Replacement Bedrooms, FiMMUMITIRP G ase Intcp J9/)A­- 414/AM—Gal f 1 Gal U LV (i leach Line Sq. Ft. Sidewall allowance Install Line(s) ft. long ft wide with Leach Bed sq. ft. Bo trench area ft. rocW sq• ft min. me e - kbe w drainlines or oT bottbm°are.a_,' per running ft. ®oIJA- Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Seepage it TptaI Depth Other: Applicablel '"6 Inlet (BI� Max. AI)ow�blq N/A Overburden factor Depth No. 2 System N14 REMARI(S: (.U4'-?' 1/Ir Gt.� . Cf c.� �C L ;� /O This applicatiortri APPROVED-NIED'for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompah e p an, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the Z CSS above designed system. No construction is permitted in the required reserved 100% expansion area. (1) }Septic tank and sewer lines must be 50' minimum from any wells/U 7 Leach lines must be 100' minimum from any wells, including expansion rea G�•�/�"` (3) Seepage pits mustbje 150' minimum wells, including expansio are f /)from y/a�y / i nature of. Health OfficiaV�`�"� �C. GcAir Date RECEIPT NO. / s Issued By Date DISTRICT: ❑ Riverside, ❑e Indio ❑ Hemet, ❑ Perris ❑ Rancho Calif. ❑ Blythe ' DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE -.Office file YELLOW . Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records 29 toot. 4