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SFD (003714)Building Address Owner Mailing Address City Contractor same Address 4 P.O. BOX 1504 51-725 Mendoza LA QUINTA CALIFORNIA 92253 Snnrose C v,,.anv State Lic. & Classif. 517085 Arch., Engr., .Designer Zip Tel. Zip Tela City Lic. # 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_R-rofessions'Code; and my license is in full force and .effect �/, y✓ 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 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): ❑ 1, 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.) ❑ 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 contractors) 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,gf-_ Worker's Compensation Insurance, ora certified copy thereof. (Sec:'3800° ei65rCode.) Policy No. Company 0 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 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 -of this city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, Stale, Zip HARD COPY No. 003714 JILDING: TYPE CONST: OCC. GRP.' P. Number 773-142-027. !gal Description oject Description T)wPilinex ZONE: BY: Minimum Setback Distances: Sq. Ft. 1385 Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR 3/15/88 Issued by: Estimated Valuation $78295 PERMIT AMOUNT Plan Chk. Dep. $250.00 Plan Chk. Bal. 611.23 Const. 370. Ull) Mech. 36.00 Electrical 73.74 Plumbing 105.00 S.M.I. 5.50 Grading 20.00 Driveway Enc. 20.00 Infrastructure 1, 674.44 TOTAL $2.622.91 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 3/15/88 Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ 2ND FL. SQ. FT. POR. SQ. FT. ® GAR. SO. FT, ® CAR P. SQ. FT. WALL SQ. FT. ® SQ. 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 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, 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. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac 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 & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA (,SLAB GRADE ROUGH PLUMB G BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK'dFROUGH WIRING DUCT WORK ROCK STORAGE CI&OUND. REINF. —/ GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL)- TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING LUMBER GR. FINAL INSP. cu. yd. FRAMING �:� -_ FINAL INSP. $ plus x$ =$ ROOFt G -` i„ ••-��/ ©� T/C (v �Ja� i/% of U �iC /�L REMARKS: ,//�� VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL %&THING //MESH YV �VNSU LATI ONISOUN D/O'",// FINISH GRADING k4wAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL 0- z Z O U W Cf) Z O P: U W rn rn Y Q W COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION SEWAGE DISPOSAL SYSTEM 7 �3 -I�- - O 7 PERMIT APPLICATION FOR A SUBSURFACE 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) k, 40 0 e Marking Address 17,;L _?' 5"110 �r C i staattee Zip Code ep 13 Telephone T'JJ; Propelly Address f j�+ `Cn oc C/_ i19 I 'Legal Description of Property . (Lot. PM. TR) Unit r -5 / I7 /I�! ' l l" 4m 4,1,, 1 'Assessor's Parcel No -Water Agenc WdlU /y '^� y/�. Lot Sa j%'i.F-:, �� rN Use of Permil-7A?e 4'%�c Og,. "`planning Case N SFD. MH Site Preparation Etc =7 / �pX /� S: 1 re of Xfopfidanf Date 'The above information must be verified from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE jnitial Date Certification Existing S.D. System El Yes E No////'/ of required. WQCB Clearance required. ❑ Yes ®-N 1 Soils feasibility report required. ❑ Yes LI Nm Special feasibility boring report required. E]Yes 2"_N,1_" f Detailed contour plot plans required. ❑ Yes ❑�No Staff Specialist approval required. ❑ Yes Lel No Lot Inspection Date Soils/boring report,,by i ' r Project # Date Soils Map Page � rrSoil Type y` Approved by �' ' Date d ` I Type of System: V No. of Bedrooms (1), Septic Tank Soil Rate Required / ❑ Existing N'NJew ❑ Additional ❑ Replacement J A— /07727 Gals. (2) Le c� h line sq. ft. Sidewall allowance ft. Sq. Ft. Instal Lines) Ft. Long. Leach bed Sq. (Sotto ench area) rock/ per running ft. UTl/A +d with min. inches rock below drain lines Ft. of bo m.�y area Leach lines/bed-special design for slope: ApplicablJ�burden (3) Pit Diameter No. Pits Pit BI J Seepage Pit total depth factor OverD ^" ,/ /- Max. allowable depth N/A TV This application is proved ied,for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements set forth in Section B above. A building permit is necessary for the installation of the above -designed system. 1) Septic tank and sewer lines must be r0 from any wells (,l /Uri( vc//j 2 Leach lines must be 100' min. from any wells including expapston area` � Seepage pits must be 150;. -min. from any wells including expansion area-/ /c, -+ � k F°. (c?� '� �•y. ��_ �., . v _ a,F"�'� � ��.+-��P..r� (.✓ r�rc�-�->,. .�. ,d 3 - k - .�� �.. cczz..�Ln c�:.<....�, Signature ofoHealth Official Date RECEIPT NO. Issued by !�-. Date District: ❑ Riverside Q]And ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File DOH SAN 122 (Rev 8187) A M Dear Developer/Landscaper: OFFICE OF AGRICULTURAL COMMISSIONER AND WEIGHTS & MEASURES 4080 LEMON STREET, ROOM 19 RIVERSIDE, CALIFORNIA 92501 (714) 787.2561 E. LEON SPAUGY COMMISSIONER JAMES O. WALLACE ASSISTANT COMMISSIONER CLEMENT BENVENISTE SEALER Prior to delivery to the Coachella Valley, the following plants/ landscaping material should be "free from" the insects/diseases listed. Plants, landscaping material, appliances, insects and diseases, other than those listed, are also applicable to quar- antine laws and regulations. Citrus Nursery Stock/Citrus Plants; free frau Red, Yellow, and Purple Scale, Tristeza Complex, Woolly Whitefly , and Canstock Mealybug. Euonymus species; free from Red, Yellow, and Purple Scale and Comstock Mealybug. Grape (Vinifera); insects and diseases. Olive trees; Olive knot and Red, Yellow, and Purple Scale. Palm trees, genus Phoenix; Prohibited. Please contact Agricultural Commissioner's Office. Psidium (Guava); Woolly Whitefly. Soil, plants and landscaping material with roots contaminated with Ozonium Root Rot; Prohibited. Please contact Agricultural Commissioner's Office. Hydrilla, viable forms and appliances associated with; Prohibited. Please contact Agricultural Cammissioner's Office. Certain plants/landscaping material frau Tulare County and portions of Kern County; Pro- hibited. Please contact Agricultural Commissioner's Office. Your cooperation is greatly appreciated. If you have any questions on laws and regulations governing the Coachella Valley, please do not hesitate to call our office. The telephone number for our district office in the Coachella Valley is (619) 342-8291. Yours truly, E n Spaugy Agricultural Commissioner ELS/jh 7/15/87