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PLBG (0306-478) + SFD (04383)53805 Avenida Martinez 0306-478 04383 LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of. Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date Date Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( )_ 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, Business & Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). () I am exempt under Section B&P.C. for this reason ,Date to . .ri_ _ •Signature of OwneYe Yjt. / ;' F••-- A WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ( ) I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ( ) I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier Policy No. (This section need not be completed if the permit valuation is•for $100.00 or less). ( k II 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, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ate: rIV—r—Applicant r Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. `Sgnature (Owner/Agent) fln / ," A Date (A -1,4%"x'7 BUILDING PERMIT PERMIT ; y DATE VALUATION LOT TRACT JOB SITE ADDRESS 53-805 Alrg. M&M+.11 APN OWNER CONTRACTOR / DESIGNER / EN (NEER !i'r1"jl //'+ [ GARICA C? TER/F3t.T .,:ru Uk p y ( ] [ LA OiT.{3+1TA : CA 9'. 253 t CRL4 USE OF PERMIT SIPPT1C,AT4Al` D0Nl; 91rWWZR ZR NOOK k; VALUATION 1: i.8 'FISIM"ImD3 CONT 01r CONSPIM17C;"Z", ON , 5?rt3fJ P1s .il IT YET>. 913WIvIA '' PLUMBING RX -- SEWRR 101-000-419-000 La Q p EJU7 2003 CITY OF LA QUINTA FINANCE DEPT. X. SM-TOTK; C01 W. RU(MOV4 AIW PLAN C EC.Y, $30.00 PRE-•PAIDS RECEIPT DATE 1A BY DATE FINALED INSPECT INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ' ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL 96376 NO* Received From: Date: Address: '9 Account No. ' 01, Lot(s) C, ........... Tract Service Address ,4 G.A. Code • Meter(s) 0 Service(s) • Backflow(s) • House Lateral(s) • Detector Check(s) • Meter Surcharge S.anitation Capacity Charge 0 W.S.B.F.C. 0 Temporary Construction Meter 0 Turn onCharge 0 Uncollected Account -Nam 0 Inspection Fee-Tract- ee-Tract-Fee Fee- 0 Plan Check Fees Water I Sewer - Tract - 0 Bond Payment - A.D. --Bond Assmt. 0 Customer Deposit 0 Other TOTAL $ Remarks: 6 copy to: I V /0 Cash Water Service Check Money Cashier Order CVWD-438 (11189) 5 tt, sewer Se, rvicl4 :I.nc- JOB TICKET dba ECONO SEWER SERVICE P.O. Box 581029, North Palm Springs, CA. 92258 (760) 346-2793 (760) 328-7760 customer rder No. Date Ord d Fax (760) 251-3405 (! 3 5, t' 1' T— q-1`1 C 1 I - I FHUNE JOB N SERVICE PUMP SEPTIC TANK HAS SEPTIC TANK BEEN DUO UP? Yes [3No REQUESTED PUMP SEEPAGE PIT AT ITS RISER PMT. ON SITE PUMP GREASE TRAP OFFICE BILLING OTHER8 Yellow Oust. Q ANT. Yellow Office umping Fee per 1000 Gallons (or fraction) PRICIF AMOUNT Vaste Discharge Fee per 1000 Gallons Locating and Opening Fee (I hr. Min.) Out of Area Fee ..,.. : GREASETRAPS' RECOMMEND INLET/OUTLET/BAFFLE REPAIR. EXCESSIVE GREASE/FOOD/DEBRIS. EXCESSIVE ODOR. RECOMMEND MORE FREQUENT PUMPING. RECOMMEND LINE CLEANING, SEPTIC SYSTEMS ❑ THE LEACHING SYSTEM HAS FAILED. ❑ THERE 1S AN OBSTRUCTION "UPSTREAM" OF THE SEPTIC TANK. It will be necessary to contact a line cleaning company. ❑ WE RECOMMEND MAINTENANCE PUMPING OF THE SEPTIC TANK EVERY ❑ YEAR ❑ OTHER YEAR ❑ 2.3 YEARS To remove built up solids. This will increase the life of your leaching system. ❑ THIS PUMPING WILL PROVIDE ONLY TEMPORARY RELIEF AND NOT SOLVE CUSTOMERS SEPTIC PROBLEM BECAUSE OF THE ABOVE. ❑ CUSTOMER HAS BEEN GIVEN AN "EXPLAINAT(OM' PACKET. A SERVICE CHARGE OF $22 WH.L BE DUE ON ALL RETRUNED CHECKS. A FINANCE CHARGE OF 1 1/2% PER MONTH, 18% PER YEAR, WILL BE CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS IF PAYMENT IS BY CHECK DRIVERS LIC. SA -Tb, 1 hereby ae owledge t a wtlsfmo t pt lon of the above work: SIGNATU . otelc ' f OWNER/BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as ''Owner/ Builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the City or County. They are also required by law' to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the State and Federal Government as an employer,and you are subject to several obligations including State and Federal income tax withholding, federal social security taxes, worker's compensation insurance, disability insurance costs and unemployment compensation contributions. There maybe financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N. Street, Sacramento, California 95814. -1 Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, CITY OF LA QUINTA DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico La Quinta, CA 92253 (760) 777-7012 FAX:,( O) 77,7'7 11,,--1 OWNER'S SIGNATURE/DATE I I V5'; 'g0_1 2 N QlQA PROPERTY ADDRESS V - 050 • Y7 8 PERMIT NUMBER(s) 4 P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 53-805 Martinez LA QUINTA, CALIFORNIA 92253 Owner Coachella Valley ,and BUILDING: TYPE CONST. OCC. GRP. Mailing Address 247 B. Tahquitz Way 82 A.P. Number 774-171-015 City Zip Tel. Pala Springs 92252 322-1020 Legal Description Contractor 1project Description S • F • T) • Address V State Lic. City & Classif. 387934 1 Lic. # 095 Arch., Engr., Designer Address Tel. CityI Zip I State 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. <s.: i-,*- e' r" SIGNATURE 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, atter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to rile a signed statement that he is licensed pursuant to the provisions or 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 contractors) licensed pursuant to the Contractor's License Law.) O 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 th`ereof.,(Sec00, Labor Code.) Policy NO. Company C O Copy is filed with the city. O 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.) 1 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 City, State, Zip 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 Issued by: Date Permit Validated by: Validation: 1 WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE Sq. Ft. 1410 Size No. Stories No. Dw. Units New ❑ Add O Alter ❑ Repair ❑ Demolition O 4281 Garage 1701 61 ' toad Fence Estimated Valuation, 5 PERMIT AMOUNT Plan Chk. Dep. 600 Plan Chk. Bal. • 4 Const. 2+i Mech. UQ Electrical 11 Plumbing .f U5 U0 S.M.I. 5 .16 Grading 20 • VU Driveway Enc. 2O.UU . . Infrastructure s% •► TOTAL ' t 7 ,14 - REMARKS •t r n s a. 1 t r t „l ..r ..51 a, r1 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 Issued by: Date Permit Validated by: Validation: 1 WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE CONSTRUCTION ESTIMATL NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL ' SO FT y S UNITS COLL. AREA LAB GRADE ROUGH PLUMB YARD SPKLR SYSTEM 2ND FL SO FT. 6 HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR SO FTa ROCK STORAGE le OUND. REINF. _� — C(��-SR'EINF. GAS (ROUGH) POWER OUTLET ROOF DRAINS GAR SO. FT. Qx OTHER APP.IEOUIP. STEEL GAS (FINAL) DRAINAGE PIPING CAR P. SO FT. a GROUT WATER HEATER DRINKING FOUNTAIN WALL SO. FT. (d BOND BEAM WATER SYSTEM URINAL SO. FT. a - $ LUMBER GR. ESTIMATED CONSTRUCTION VALUATION S FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES ^� � „� WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTOXDISH) APPLIANCE DRYER VENTILATION GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIRE ZONE ROOFING LAUNDRYTRAY AIR HANDLING UNIT CFM FIREPLACE 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 (d I 1 c SEWAGE DISPOSAL SO.FT.GAR V4c 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 I SETBACK —�/� GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA LAB GRADE ROUGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE le OUND. REINF. _� — C(��-SR'EINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. S —plus—x$ - $ LUMBER GR. FINAL INSP. ,,,,,,rrr�ryryYYYY �RAMING lQ -2,1_ FINAL INSP. 4�OOFING 10-�7- Si� Q ^� � „� /��c REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR' GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION g— ' CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESlINITIALS GARDEN WALL FINAL \ ceit�t 4 P.O. BOX 1504 APPLICATION ONLY Building78-105 CALLE ESTADO Address J.3 ��: %W I—e7-;i,cJ!= Z. LA QUINTA, CALIFORNIA 92253 /FG Owner Mailing BUILDING: TYPE CONST. OCC. GRP. Mailing AddressA L/7 6�: VV 4 y --s'z A.P. Number 7 7 V _ /7 / —©/-"— City _ Zip Tel. f —-s— City S��/�G S � L Z. �Z 3 Z i - to Zo Legal Description LoT 3 . �9L,� .2 /7 401,L2,17- 2.3 Contractor Project Description �S��GG �AwfiC v .�4Jt IL�cJG' _57 Aq/eV_ Cf0A_-)S T 2 417 TANCJ u r Z �tJA �� City Zip Tel.. ,P,4Z S �j2.z4Z_ 32Z-/ozeo State Lic. City & Classif. 3 8 7 93 -,z Lic. # y� Arch., Engr., 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 Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Buslness 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, 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 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.) O 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 O 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 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: 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 City, State, Zip BUILDING DIVISION Sq. Ft. No. No. Dw. Size / `71/b Stories Units New;Q Add ❑ Alter ❑ Repair ❑ -Demolition ❑ -Z R, 10 Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure l�/IrIG 7 Si 7_ S- v -a TOTAL REMARKS 00518%, IQ 1134 V (-Z (-'tiffs J. •J 1 ANUU1'1 1 I tNI)LIitll c f j. vv 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 Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE 2ND FL. SO. FT. BONDING YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS FOUND. REINF. GAS (ROUGH) DRAINAGE PIPING CAR P. SO. FT. ® I REINF. STEEL WALL SO. FT. TEMP. POLE DRINKING FOUNTAIN SQ. FT. ® GROUT URINAL ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation WATER SYSTEM FLOOR DRAIN MECHANICAL FEES _$ 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 SPARK ARRESTOR SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/e c SEWAGE DISPOSAL LATHING SQ.FT.GAR ® 34c HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MEC-i.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR CON D. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK DOUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEQUIP. 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 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINIT4ALS, GARDEN WALL FINAL z 0 H H U w COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM pplicant: Submit this form with four copies of a scaled plot plan (1-20 scale) drawn to ounty specifications required on the attached check list. A non-refundable filing fee of �0•is required when the application is submitted. Check must be made payable to the ounty of Riverside j Building Department Application Log # Name (Owner, Agent, Contractor, Etc.) Mailing Address "Z 59':4.0.,tt. uSr.Pun rrn .Z5�% E T�i+Gu/Tz "dIA4V City StateZip Code Telephone A4 L�%!'1 S /a.t�/,cl G S C� A �r Z 2 L Z G i4 1 3 z 2- io z.o *Job Property Address *City�;,or-M6®mmun3ity *Legal Description of Prpty. (Lot, PM, TR) u� .5.3fTd 'W1NQT�� L Ld GA�LI/f/YiSI LG+T S AIL 4 14/7 Q.Nit Z_3 *Assessor's Parcel No. 9,WA encs Use of Permit `)r �..; u.l,.>+ . Lot Size 7741 -/7/ - D I -T 'Or'".Well' C !/ W AT..a- SFD, MH Site Prep Etc.' 4 Planning Case # P"(l h 0, Lf Signature of Applicant t Date *The above information must be verified from Building Application STAFF USE - DO NOT WRITE BELOW THIS LINE Initial Date Certification of Existing S.D. System reqd. Yes[ ] No[/7` WQCB Clearance reqd. Yes[ ] No C�] I 1 Soils feasibility report reqd. Yes[ ] No[ ] Detailed boring report regd. Yes[ ] Nor P Detailed contour plot plans reqd. Yes[ ] Nom ( _ 0 � H Staff Specialist approval reqd. Yes[ ] I-Tor3 Lot Inspection Date r U w - m Soils/boring report by Proj. # Date Soils Map Page I i Soil Type Approved by �. Date !A 1 Type of System: . No. of Bedroomsl (1) Septic Tank Soil Rate Reo_uired Existing New Addition Replacement /b�Vr Gals. (2)'Leach line sq. ft. Sidewall allowance Install Line(s) Leach bed (Bottom t� area) ft. rock/ Sq. Ft. Ft. tin ,_ Ft. wide Sq�'Ft-•.,of per running ft. with Min. man hes rock bottom N/A [ i-]'� below drain lines area Leach lines/bed-special design (3) Pit Diameter No. Pit Seepage Pit total depth for slop� Applicable 5,!-& OM1` 6' [v]� Pits BI N/A 70verburden factor 1! Max. allowable depth /i-4e.`9.:�'.—t+— / This application isLapprovedd/ enied for the design of a subsurface disposal s --stem as indicated on the accompanied plot plan using the requirements set forth in Section B above. U A building permit is necessary for the installation of the above -designed system. M �� Septic tank and sewer lines must be 50' from any wells, H (2) Leach lines must be 100' min. from any wells including expansion area wA (f 3) Seepage pits must be 150' min. from any wells including expansion area 1/ 0 ' 1 Signature of Health Official Date ✓s ua,,r �� �: RECEIPT NO. = n Issued by Date District: Riverside [ ] Indio CW Hemet [ ] Perris [ ] Rancho Calif. [ ] Blythe[ ] Distribution: WHITE -Office file YELLOW -Applicant PINK -Bldg. Dept. GOLDENROD -Pending File DOH SAN 122 (Rev. 2/86) JJ O 1 A\ � r s o I v �•_••_-7 \Z 9, 1 8% OFFICE OF AGRICULTURAL COMMISSIONER AND WEIGHTS & MEASURES 49-613 Ilwy 86, Suite B-12 'Coachella, CA 92236 619-342-8291 E. LEON SPAUGY Commmfo`ER LAMES O WALLACE- ASS;S;A\r COMMISSIONER CLENIE`IT BENVENISTE SEALER DATE CASE NO. 7 -- ESP, `d 7 2-1 DEVELOPER'S NPI -E: A C L . I \\ ADDRESS:. C� A �] 4 U. L 1- IJ 4L1,L S �... TEL.EPIIONE-: 2V - /0,2L� Dear Developer: 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 from plant material listed, this office must be notified immediately. Thank you for protecting and preserving the Coachella Valley's pest -free environment. Agricultural unissioner's Office cc: Indio and Riverside Office -7 7� / 7 - 06