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12328 (SEWER)54925 Avenida Alvarado 1111111111111111148 IE Building- Alvarado Address Owner D. L. Fox T4tyl 4 4 Q" Mailing P O Box x1023 Address P.O. cii ancho Hirage zIpCA 92270 Tel. P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Contractor AVS Plumbing/R.V. Stevenson Address 74410 Velardo Drivete cxy'afim Desert, 1p 92250 T 41--9224 State Lic. City & Classif. C-35 602395 Lic. # Arch., Engr., Designer Address Tel. CityIZip t State I I f Lic. # I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Susiness 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 statgment 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). O 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.) O 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 -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 ROM WORKERS' COMPENSATION IN RANCE (This section need not be com Dleted_.i t innii ' for a hundre dollars ($100) valuation or less.) I certify that in the perfojm nc. f_1h or for w chi this mit is issugd, I shall not employ, any person i apy n) r 2 so a to'tS ' - J c4r .Wor rs om ensation aw's df Calf r a. ylj Date mower it NOTICE ApPLICANTv,Jf mer ma` ins this "Cert i ate o/ xe !on you o d become subject to the Workers' Compensation provisions o/ 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 ateMailing Address City, State, Zip No. WING: TYPE CONST. OCC. GRP P. Number 12328 ,Legal Description Project Description Sewer Connect Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ 7 -Wmated Valuation *,L;UUU.UU PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing • S.M.I. Grading Driveway Enc. Infrastructure TOTAL • 00 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 y FINAL DA' Issued by: Validated Validation X1111111111111111111111111 47 IE COUNTY OF RIVERSIDE, DEPARTMENT OF HEALTH PERMIT APPLICATION FOR A SUBSURFACE DISPOSAL SYSTEM Applicant: Submit this form with three copies of a scaled plot plan drawn to county specifications required on the attached check list. A non refundable filing fee of,$1,51s required when the application is submitted. Check must be made payable to County of Riverside. Name /- c,2 c. ✓ Gc 2 tt.. c.v_ Co Mailing Address I -e 3 - J'30 WA,7Ne 1.1 Q City State Zip Code Phone Z f,u 3 2 4— ~ U 'Property AddresS/V9 44C _y o–r C;ommunily _ 1 'Legal Description of Property (Lot, Parcel Map, Tract) SA Al, F - N g v ?PY c+ 4L nJi iY 4o7 /0-%/3 C- UNC 2 S 'Assessors Parcel No. Water Serving Property From Lot size Signature of Applicant Date j 'The above information must be verified from Building Application Staff Use — Do Not Write Below This Line Initial, Date WQCB Clearance required Yes ❑ No 4 Soils feasibility report required Yes ❑ No Detailed boring report required Yes ❑ No El ,Detailed contour plot required Yes ❑ Not] __Comments: m Z Soils or boring report by Date H U Approved by LU rn a ! za " > Soil Soils Map Page Type Tract File Nolf_ (O'ih e^i' Number of Bedrooms `11.., geptic Tank Size (gallons) Rate Required Type of System New Addition Replacement n- ' • ,l `- ` ©' ❑ ❑ Leach line sq. ft. of bottom area trench Leachrbed (sq. ft. of bottom -area bed) Seepage Pit Diameter ,59 6, - Number of Pits Seepage Pit Depth B.I. /Z-/ Total Depth of Pit Location of System Q Additional Requirements w / ^U^ , , /J✓ U A permit is>app, 'r ed/d:en•i.ed for the design of a subsurface disppal system as indicated on the accompanied plot plan Z 0designed using the requirements set forth in Section B above. A building permit is necessary for the installation of the above W system. (A e _ P Signature of Health Official % -Date Receipt No. 4 / dt f District: Riverside ❑ Indio,BHemet ❑ DISTRIBUTION: WHITE - Office File YELLOW - Applicant DOH SAN 122 (Rev 10/84) Issued By Date PINK - Building Dept. GOLDENROD - Pending File cry CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS COLL. AREA SLAB GRADE YARD SPKLR SYSTEM 2ND FL. SO. FT. HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® DUCT WORK ROCK STORAGE FOUND. REINF. POWER OUTLET ROOF DRAINS GAR. SO. FT. ® HEATING (FINAL) OTHER APP./EOUIP. REINF. STEEL DRAINAGE PIPING CAR P. I SO. FT. ® WALL SQ. FT. ® DRINKING FOUNTAIN SERVICE FINAL INSP. URINAL SQ. FT. ® WATER SYSTEM ESTIMATED CONSTRUCTION VALUATION $ GRADING cu. yd. $ plus x$ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) 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, TEM/PERM 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. SQ. FT. RESID ® 1+.6 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER INSULATIONISOUND 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 & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS 60SEWER 0f0,8ePTf17—rAW , OUGH WIRING -51 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. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING t REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL COACHELLA VALLEY WATER DISTRICT cecu or- ;!1pr nFfA11 Received F Address: Account N Seryice Ad ❑ Meter(s) 1 ❑ Service(s) 1 I ❑ Backflow(s) i ❑ House Lateral(s) I ❑ Detector Checks) ❑ Meter Surcharge Sanitation Capacity Charge t' C ❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - Fee - ❑ Plan Check Fees Water I Sewer - Tract - Bond Payment - A.D. - Bond Assmt. omer Deposit I ii t TOTAL $ / 2_2 S ) Water Service Cashier CVWD-438 (11/89) S AND G PUMPING SERVICE INVOICE # 1630 73-680 Hwy. 111 Suite 123 • Palm Desert, CA 92260 Cell (760) 766-5074 • (760) 404-6325 Dale: 4 _ 3 Q Bill To: Ph#: Address' City: Mechanic: i Helper. Job Name a 60 Description of Work: i I Amt. Pumped Gal Z11septic Tank ❑ Seepage Pit ❑Cesspool ❑ Grease Trap ❑ Other ❑ System is Failing ❑ System Passes Inspection ❑ Excessive Sludge ❑ Roots Quantity Description of Work or Material Used Price Amount , Pump & Dump Fee per 1000 gal (Grease Trap) Pump & Dump Fee per 1000 gal (Septic Tank) Locating & Opening Fee (per hour) High Pressure Water Jet (First Hour) High Pressure Water Jet (Additional Hour) Labor per hour Snake Line ❑Roof ❑After Hours ❑Sat. Charge ❑Sun. Charge Fuel Surcharge i IIIIIII VIII III VIII IIII' 42 IE Thank You Total a raw By. u%+nck'nrr &J u Dillto: v Signature Date Next Service Due ...p