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PLBG (12653) + BLCK (04138) + SFD (3721)
53980 Avenida Martinez 12653 04138 3721 Building Address Owner 53-984 Martinez Coachella Valley Land P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Mailing Address 78-150 Calle TampiCo 6232 CityZip Tel. La Quinta, CA 92253 5641-1155 °to 16tf ka,intenance Construction Address8-150 Calla Tampico #230 City Zip Te 92253 Quintan CA 92253 564-1373 State Lic.66423 City & Classif. Lic. # 2851 Arch., Engr., Designer Address Tel. CityI Zip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirmbthat I am licensed under provisions of Chapter 9 (commencing with Section A7000) of Division a fnthesgusiness and Professions Code, and my license is in f II force and. ieffect. '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, 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 Divi ston 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.) O 1, asowner 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 44py 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 No. 12653 BUILDING: TYPE CONST. OCC. GRP. A.P. Number Legal Description Project Description Sewer Connect .._ c. Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $1,500.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Line f de St etbac`i rom F er Line m vroperryl4.ine FINAL DAT Issued by: • u Date' _/__ U Iermit_ , By Validated fby: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS COLL. AREA 2ND FL. SQ. FT. YARD SPKLR SYSTEM POR. SQ. FT. ® MOBILEHOMESVC. BAR SINK GAR. SQ, FT. ® POWER OUTLET ROOF DRAINS CAR P. I SQ. FT. DUCT WORK DRAINAGE PIPING WALL SO. FT. ® DRINKING FOUNTAIN SQ. FT. ® HEATING (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION $ 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(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GRADING cu. yd. $ plus x$ LAUNDRYTRAY 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 VENTILATION SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL FIREPLACE SQ.FT.GAR ® 3/ac HOUSE SEWER SPARK ARRESTOR GAS PIPING PERMIT FEE GAR. FIREWALL 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 SEWER AfIK ROUGH 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 SIGNATURESIINITIALS GARDEN WALL FINAL 1 - COACHELLA VALLEY WATER DISTRICT l CASH RECEIPT DET -- — Received From: ( i l_G Date: Address:-- _ Account No. Lo s) Tract Service Address — Cp ; l G.A. Code ❑ Meter(s) $ O Service(s) - O Backflow(s) .❑ House Lateral(s) i O Detector Check(s) ❑ Meter Surcharge f Sanitation Capacity Charge O Temporary Construction Meter O Turn on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - Fee - O Plan Check Fees Water / Sewer - Tract - ❑ Bond Payment - A.D. - Bond Assmt. ❑ Customer Deposit O Other TOTAL Remarks: ❑Copy to: Cash Check Money Water Service 1 \ 1 J Order Cashier Nwe CVWD 38(11189) 1 - T-ihf 4 4 a" P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 53"980 Martinez LA QUINTA, CALIFORNIA 92253 Owner Mailing Address 247 E. Tahquitz Way 42 City Zip Tel. Palm Springs 92262 322 TA24 Contractor Starr Construction Address Sa= City lZip I Tel. State Lic.I City & Classif. 387934 Lic. # 895 Arcn., tngr., Designer Address—T—Tel CityI Zip I State I 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,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 penafty 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.) O 1, 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 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, 1 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 11LDING: TYPE CONST. OCC. GRP. P. Number 774-172-012 i l .,1} IF / r .,w Legal Description Project Description SO' of 4' retaining wall Sq. Ft. Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $915.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. $20.00 Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS n.t>~gte f if: r..n r r►*_ {,.stn 1Ei i Nt 3 WftiL s 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 6/21/08 Issued by: Date Permit Validated by: Validation: WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SO Fl (a $ UNITS SLAB GRADE ROUGH PLUMB BONDING YARD SPKLR SYSTEM 2ND FL SO FT. a FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR SO FTof GAS (ROUGH) METER LOOP GAR SO. FT. a POWER OUTLET ROOF DRAINS GAS (FINAL) DRAINAGE PIPING CAR P. SO FT. 6 GROUT WATER HEATER WALL SO. FT. @ FINAL INSP. DRINKING FOUNTAIN SO FT a WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ = $ WATER PIPING NOTE: Not to be used as propeny tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTOXDISH) APPLIANCE 'DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED VENTILATION LAUNDRYTRAY AIR HANDLING UNIT CFM FIRE ZONE ROOFING 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 LATHING SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID g 1 V: c SEWAGE DISPOSAL SO.FT.GAR (g 3i4c HOUSE SEWER FINISH GRADING 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 GROUND PLUMBING 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./EQUIP. 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 SIGNATURESlINITIALS GARDEN WALL FINAL T4tf Q94& 44 P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 53-980 mArtinez LA QUINTA, CALIFORNIA 92253 Owner Address 247 E. Tahquitz way #2 City Zip Tel. Palm.Springs 52262 322-1020 Contractor Starr Construction Co. Aaoress I Sam City lZip 'Tel. State Lic.I City & Classif. 387934 Lic. # 695 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 70 00) of Divisio/n.3 of the Busin>ass saand Professions Code, -and my license is in full force and effect. 1 - e✓ f , + .+! _! " ._ SIGNATURE r r - - 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, and, 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 (8500). 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.) . ❑ 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 a exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificatgo ,consent toeself-insure, or a certificate of Worker's Compensation Insurance, or a certiF1'C- c thereof -'{Sec. 3800, Labor Code.) Policy No. Company t+ ❑ Copy is filed with the city. ❑ Certijie' 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 (S100) 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 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 sof this city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip HARD COPY No. 003721 BUILDING: TYPE CONST. OCC. GRP. A.P. Number 7'74-172 '-012 Legal Description Project Description S.?.Do Sq. Ft. 1463 No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ 170* of 6' 1raod fence 475' Garage Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. $ 250.00 Plan Chk. Bal. 5}.a Const. 361.00 Mech. 33.00 Electrical 75.87 Plumbing 105.00 S.M.I. 5.29 Grading 20.00 Driveway Enc. 20.00 Infrastructure 11719.91-4 TOTAL S-2-0,649.97 REMARKS " f 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 3/X7!8 Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ 2ND FL. SO. FT. POR. SQ. FT. ® GAR. SO. FT. ® CAR P. SO. FT. WALL SO. FT. ® SO. FT, ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APP.IEOUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE 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 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL r SO.FT.GAR ® 3/ac HOUSE SEWER REMARKS: VENTILATION GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE JELECT.FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBIUG ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND JAI—' G UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE L 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.IEOUIP. 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 S f/ AL INSP. ROOFING r REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING 41 /al/ MESH INSULATION/SOUN FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS• GARDEN WALL FINAL Desert Sands Unified School District CERTIFICATION OF PAYMENT OF SCHOOL FACILITY FEES NOTICE: THIS DOCUME T CANNOT DE DUPLICATED. TO': City of La Quinta DATE: O n Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 This is to certify that developer of which is located at " ,3- within this District, has paid school Cffa-cility fees imposed pursuant to the authority generat d by G vernment Code Section 53080 i amount,of $ so ( ' covering a total of square feet of (>, ') res, 6 ntial or ( ) industrial/commerc`ial development and that building permits for this footage in this development may now be issued by your jurisdiction. 0 A # 4,,9 IJ,5 I - V2 4f,062D SMERT D SCHOOL DISTRICT White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer 0 007 Q Z O iZ U LU U) U) Y Cr Q w tr Q w U) COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION -7 7 7 y - 3 — 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 specifications required on the attached check list. A non-refundable filing fee of $40 is required when the application is submitted. Check must be made payable to the County of Riverside. Building Department Application Log # Name (Owner. Agent. Contractor. Etc.) .S7"',9 2 2 S 7 -Ad`& Y/o .J C: 6 . Mailing Address b2 y7 ,5 7.4 AlQa t rz v/A V ,Z City State c Zip Code ' 2 a 4 z Telephone 3 Z- 'Job Properly Address 4 . orGonnrnuruly, 'Legal Description of Property. (Lot. PM. TR)'z" Z' '!` • y -C o r Il R i2 7-1A) E L Ul.d T A LD T 13 BL K 2 u A.).17- 2 3 'Assessor's Parcel No Water A enC -*:Well g f / lj s~'• (/RCJ+; r 7 r• K2* Planning Case # Use of Permit A Lot Size r a (SFD MH Site Preparation Etc. S4 / {I( Sig n re of Applicant Date 'The above information must be verified from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE Initial) Date Certification Existing S.D. System ❑ Yes No _ of required. ,,© WOCB Clearance required. ❑ Yes 10'No Soils feasibility report required. ElYes ❑ N 1 t Special feasibility boring report required. El Yes ❑N.,f / Detailed contour plot plans required. ❑ Yes P'No Staff Specialist approval required. Eli Yes ©'NO Lot Inspection Date Soils/boring report by ► j Project # Date Soils Map Page ' 6" I Soil Types L Approved by Date ' / 17 > __9/ . Type of System: U No. of Bedrooms (1) SepticTankSoil Rate Required (''NEl❑ Existing ew Additional ❑ Replacement -3 h" Gals. (2) Leach line sq. ft. Sidewall allowance Install Line(s) Ft. Long, Leach bed Sq. (Sotto enchrea) ft. rock/ Sq. Ft. ft. LU.N7A Ft. wi t min. inches FNf botto=t m per running rock below drain lines area Leach lines/bed-special design for slope: (3) Pit Diameter No. Pits Pit BI If Seepage Pit total depth Applicable factor' Max. allowable depth N/A Overburden This application is approved ed.for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements set forth in Section a ove. A building permit'is necessary for the installation of the above designed system. (') Septic tank and sewer lines must be 50' from any wells rpa G► ► `.. t. ra ' 6c ,, _?,,, Leach lines must be 100' min. from any wells including exp nsion area / ' 2 ; ', _,c.,-+ r (3 Seepage pits must be 150' min. from any wells including expansion area,. >', /xI r 1 i ti. /,X. f . Signature of Health Official RECEIPT NO. 33 T 6 Issued by 5-4 Date__ District: ❑ Riverside GJ -Indite o ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File DOH SAN 122 (Rev 8,87) t F OF A Of FILE OF E. LEON SPAUGY 'P AGRICULTURAL WiNi iISSIONER COMMISilO`ER OJ I 1 o U r, JAMES 0 WALLACE AN ASS;STANT OH'•t 55tU ER WEIGH TS £. MEASURES CLEMENT BENVENISTE y;T t1• SEALER , — 49-613 Ilwy 86, Suite B-12 ,y_.•' Coachella, CA 92236 qYp req 619-342-8291 DATE 3 — /S - / 9 88 CASE NO. $ 8 IZ 5 4 3 1-- A DEVELOPER'S NAME: - - - - - ADDRESS: TELEPHONE: ( L /f) 3 22 - /O 2 G 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 frau plantFnaterial listed, this office must be notified imm-diately. Thank you for protecting and preserving the Coachella Valley's pest -free environment. W gricult al Cot i.oner's Office cc: Indio and Riverside Office