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04827 (SFD)P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 53-155 'obr000n LA QUINTA, CALIFORNIA 92253 _..... Coachella Valley Lana � Mailing Address 247 E. '1"ahquit2 Way #3 City Zip Tel. 92262 Contractor City jZip I Tel. State Lic. City & Classif. 387634 Lic. # 895 ._. _..., ......I Designer Address Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm'that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Diviisio�n 3 of the Business and Professions Code, and my license is in full force and effect..• � �1 _r� re �.�.� *,t7}P,Ir�' a 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, after, 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 wgrk, and the"structure is not intended or offered for sale. (Sec. 7044, Buisness and Professforis.Cddeg,.the`:Contractor's License Law does not apply to an owner of property who builds br, improves':thereon and who does such work himself or through his own employees, provided-that=sucli'iinprovements are not intended or offered for sale. If, however, the building or.imprdvemen(_is`sold within one year of completion, the owner -builder will have the burden of proving the.t,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 contractor(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-insur , r a certificate of Worker's Compensation Insurance, or a certified cop�ereoe�900, Labor Code.) Policy No. Company ems^ ❑ Copy Is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (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. 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 permit when properly filled out, signed and validated, and Is subject to expiration if 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 Address UILDING: TYPE CONST. OCC. GRP. .P. Number 774-044-020 egal Description roject Description S r F • ri s Sq. Ft. 1410 No. Size Stories , A 7 No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ 430' 170 X IEstimated Valuation $76005 PERMIT AMOUNT Plan Chk. Dep. $250;.00 Plan Chk. Bal. 64,03 Const. 364.00 Mech. 36.00 Electrical 74.17 Plumbing 105.60 S.M.I. 5.36 Grading 2 0 .66 Driveway Enc. 20.00 Infrastructure Validation: TOTAL $2 bis. 4: c;:A. 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 11/ 1.510 3 Issued by: Date Permit Validated by: 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 F1 (p $ UNITS ' ROUGH PLUMB BONDING YARD SPKLR SYSTEM 2ND FL SO FT. C FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR SO FT. a GAS (ROUGH) METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR SO. FT. to TEMP. POLE GROUT DRAINAGE PIPING CAR P. SO FT. fir FINAL INSP. WALL SO. FT. a WATER SYSTEM DRINKING FOUNTAIN GRADING cu. y0. $ plus x$ -$ URINAL SO. FT. (p FINAL INSP. FRAMING ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as properly tax valuation REMARKS: FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTOWISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM SPARK ARRESTOR 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 INSULATION/SOUND SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID a 1'A C SEWAGE DISPOSAL SO.FT.GAR (& VAc HOUSE SEWER 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 ROUND PLUMBIN �G 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.IEOUIF. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. y0. $ plus x$ -$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING 7CJ lI CA, 1""1 ^� ( �( 4.� REMARKS: VENTILATION FIRE ZONE ROOFINGi2�/w_"' FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS , GARDEN WALL FINAL rA" L _,..-ya .�--`LP.- ,3�:. �. "ix w-r,^� .d'f���`t�C", "` 'jy'i'�j�,c- �..i''y.=-��••,"i^S�' .",���n�"gni►.►?-`�'�}y^.i:.c_ .cY.,�'u�•- s' ��..,.�.�.rr=�.a�<{�': i:,Y_�iyy:,,c�;�,-s--�-.;d,�,,:._Fr.�r COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH`- Assessors Parcel No. ENVIRONMENTAL HEALTH SERVICES 7?� 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 list: A non-refundable filing fee (see below) is required when the application is submitted. Check must=tie 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. - b Q: VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION -LOG'* Z 0 Agent, Contractor, Contact Person 11 Phone Address & Phone W Owner Phone Mailing Address a 32s -lo=o 4 74,V lit./`TZ Wl -Z& f' City State Zip Job Property Addresslegal Description Prop. (PM, Tract Lot) q� f )1� SPi 1AJC.S c As- fZZGz �-is3�rs©B� <cr S� act as' C�..�. y Lot Size ter ge e " Use of Permft P/P, Cu, etc. 4 u!a//s} Other l/Q�ieCu�(Xw /3TiQ/dr J-�uing;,M H he Prep, etc. " Signature of Applicant ❑ ' CATEGORY: REV CODE FE SUBSURFACE DISPOSAL - 1236 $45. (Less than 1 year) ❑ MULTIPLE PARCELS WITHIN SAME PRELIMINARY ELECTIVE m LAND DIVISION ❑ Z ❑ ALTERNATIVE/EXPERIMENTAL 0 a 1 st 4 Parcels (Each) 1238 $45.00 U. b. Each Parcel after 4 7344 $16.00 W ❑ Rereview (2nd review same parcel) 7344 $16.00 " ❑ Site Evaluation in Conjunction with f Critical Area 7346 $86.00 ❑ Site Evaluation Lot Less_ than Leachlines/bed special design for slope: Applicable 10,000 Sq. Ft. 7347 $86.00 Pit Below Inlet (B Holding Tank Agreements Completed Seep PjtrTolS1 Depth Certification of Existing S.D. System Required ✓ WQCB Clearance required. (Attach Form �I DOH SAN 007, Santa Ana Region Only) _r- Max. Nt Deptfi Soils Percolation Report Required. -..' mss,_ Special Feasibility Boring Report Required. Detailed Contour Plot Plans Required (1 to 5 ft interval) Other -;. Staff Specialist Lot Inspection Required" ms's 7 0 r H U W C0 ate CATEGORY: REV CODE FEE -r ❑ SITE EVALUATION UPON REQUEST 7349 $42.00 ❑ Yes C30Rl�' ❑ Yes No ❑ Yes NNo`//_ ❑ Yes ❑' No' ❑ Yes 01N, ❑ Yes ❑ Yes ❑ Yes Lot Inspection. Date 7348 $11.00 7352 $45.00 7351 $45.00 7345 $13200. Soils boring report by jact # Date Sills Map Page (( l Soil Type Approved by Date _ No. of Systems �(s) No. Dwelling Units % (1) Septic Tank Soll Rate /Send. . / Ing Tank ❑ Existing, BedmQoma,Q ,!- ,, ' ID �j G Y .' New ❑Replacement 3 6,01ZOM-1M&/ l/l//// UG�//Mf7 _ (2) Leach Line Sq. Ft _� (NO PLOT PLAN) ❑ SEWER/SEPTIC VERIFICATION Line(s) (Less than 1 year) ❑ PRELIMINARY ELECTIVE EVALUATION (Attach DOH SAN 53) ❑ HOLDING TANK ❑ ALTERNATIVE/EXPERIMENTAL SYSTEM ❑ Yes C30Rl�' ❑ Yes No ❑ Yes NNo`//_ ❑ Yes ❑' No' ❑ Yes 01N, ❑ Yes ❑ Yes ❑ Yes Lot Inspection. Date 7348 $11.00 7352 $45.00 7351 $45.00 7345 $13200. Soils boring report by jact # Date Sills Map Page (( l Soil Type Approved by Date _ No. of Systems �(s) No. Dwelling Units % (1) Septic Tank Soll Rate /Send. . / Ing Tank ❑ Existing, BedmQoma,Q ,!- ,, ' ID �j G Y .' New ❑Replacement 3 6,01ZOM-1M&/ l/l//// UG�//Mf7 _ (2) Leach Line Sq. Ft _� Sidewali allowance Install Line(s) R long IR wide with Bed sq. It. om trench ares it rock/ sq• It min. inches rodi low drainlines �Leach per running ft*±.� NA Leachlines/bed special design for slope: Applicable (3) Pit Diameter No. Pits Pit Below Inlet (B Seep PjtrTolS1 Depth ✓ / �I _r- Max. Nt Deptfi N/A Overburden factor -..' mss,_ ftab)e (LO No. 2 System N/i+ (__:.REMARKS: GY Ga-��^ /LG`O?�^ • ��104i�LQ�o�-moi .� M This application i ENtE or the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompanied plot plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the Z- a . ve-designed system. No construction is permitted in the required reserved 10" expansion area. Septic, tank and sewer lines must be 50' minimum from any wells 0 Leach. lines must 100` minimum. from any wells, including expansio .ar .Seepage pds must . 50''minimum fro//m//any..wells; inclu ing expansion.a of:HeaRfi Official 3 fIssued By Date �( .7- 0:0 1 RiJers de,• �f Indio ❑' Hemet , ❑ - Perris < ❑+' 'Rancho Calif. ❑. Blythe '. 15/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant... PINK; Bldg. Dept GOLDENROD !Plans/Records . <, "'.�� "+.a.Y.... �.,i..�lY,-$'... �..] ,P. ._..+r't�..-�:.... : +. :.....: -. _....�'. �... _•.f'_ .- i ,..- ti:.. _. .. �:...c .1 .. .�M1�•. .1. ,___ ... _..?._1. __ -»>I.. r_ea. :].-. M3�... 1u4. i. R OV E LEON 50AUGv j �� s co iN115S;1ONL(Z iA.S16iO WALLACE 1.'ANU ` ASSSTd�tr7W�UcctU�EP. 0 ) CLE�IEV1 EtEhVEhISiE �S WLIGI I I S Fc N1Ei15UIZCS , i ; SMEA .. �•. 49 613. Hwy 869, Buit.e D'=12 . �Qe+� ..,•' UCoacl�e`lla ,.(.A 92236 eq 40-34;2 DATE ��" % %_$S /e�'n 5'.I`- / Z71 -- DEVELOPERS Nl1h1E: . T Ff y., R O.c/ s r -2u G ri a.1 ADDRESSs �•% T.d/Qc�:irz P A L1tit S f7+e 'I'EL.CP{ (ONE: 3<2 Dear Developer.i 7 7-41 -:7 p1. After reviewing -,,your Iauidscapii q plans, all plant iitiater�al listed=is not in violation: of tigoverning quaranne laws -, the Coact�el<la Valley: 'IF substitutions do occur :Slid they differ. frcn plait material listed=� tills -finis be notified is office.nru immediately: Thank you for protecting and preservvig `tlIe Coachella Valley's pest -free environment. r , Ag-' cultural Camti s oiier's Office cci Indio and -Riverside office y.. C