PLBG (06-2239)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
06-00002239
Property Address:
51965 AVENIDA MENDOZA
APN:
773-181-023-11 -000000-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL
Application valuation:
2000
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
------------- - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
UC SED CONTRACTOR'S ECLARATION
I hereby affirm under penalty of perjury that am icensed under prov' ions of Chapter 9 (commencing with
Section 7000) of Division 3 of theBusines d'Prof ionals Cod and my License is in full force and effect.
License qas : C36' en No.: 994
Date: D Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she 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 0500).:
(_) 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 and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
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 or she did not build or
improve for the purpose of sale:).
1 _ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued ISec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERA11T
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/01/06
Owner:
NEW CENTURY TILTLE
27290 MADISON AVE
TEMECULA, CA 92590 S
Contractor: / !I �oQ�
SCOTT COMPANY
P.O. BOX 2146 r'\
INDIO, CA 92202 O
(760) 779-5935 �fC GIy�
Lic. No.: 589994
�/
--------------=--------------------------------
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 require y ection 3700 of the Labor
Code, for the performance of th rk for which this permit is i ue My workers' compensation
insurance carrier and policy nu bar re:
Carrier EXEMPT P icy Number EXEMPT
1 c rtify that, in the performan of a work for which this pe is issued, I shall not employ any
person in any manner so a o ecome subject to the wor 'compensation laws of California,
and that,
that, if I sh a meEbt•worker compensatonprovisions of Section
3 ZO of the Labor { with ose provisions.
Date: �/p Applicant:
WARM G FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJEC N EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (5100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under orpursuant to permit issued as a result of this application,
the owner, and the applicant, each agrees to, and sha 'defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for ny act or omissi/not
the work b ng
performed under or following issuance of this per t.
2. Any permit issued as a result of this application co s null and voiot co enced
win 180 days from date of issuance of such er t, or cessation 80 ys will subject
pe it to cancellation. -I certify th t I ave read this application and state tha ve infor oto comply with all
city and un ordinances and state laws relatin o buil g con and hize representatives
of thi nt to terupon the above-mentioned prop r insp pur
Date D Signature (Applicant or Agent
Application Number
Permit
Additional desc .
Permit Fee . . . .
Issue Date . . . .
Expiration Date .
. . . . 06-00002239
PLUMBING SEWER
30.00 Plan Check Fee .
Valuation
11/28/06
.00
2000
Qty Unit Charge Per Extension
BASE FEE 30.00
----------------------------------------------------------------------------
Special Notes and Comments
SEWER CONNECT/SEPTIC DISCONNECT
Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total 30.00 .00 .00 30.00
Plan Check Total 00 .00 .00 .00
Grand Total 30.00 .00 .00 30.00
LQPERMIT
COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL NcOw. 11451
Received From: V 4'
Address: k,
CI
- ----------- —
Tract
Account No. C)
Lot(s)
Service Address 17 Nlx G.A. Code
• Meter(s)
• Service(s)
• Backflow(s)
• House. Late-ral(s)
• Detector Check(s)
• Meter Surcharge
,M`S,nitaticn Capacity Charge
0 W.S.B.F.C.
• S.I.W.S.C.
• Temporary Construction Mete
11 Turn on Charge
• Uncollected Account - Name
• Inspection Fee - Tract -
Fee -
0 Plan Check Fees Water Sewer -
Tract -
• Bond Payment -A.D. - Bond— Assmt
• Customer Deposit
• Other
7.
TOTAL
Remarks:
• Copy to:
Cash Water Servil
Check
Money Cashier
orderr
(1/05)
Or
06/01/2006 14:36 7602513405 A 1 CESSPOOL PAGE 01
M-1 %oesspooi service, inc.
P.D. 110: 680188, North Palen SP3ings, CA 92258 .JOBNVQ CE
`Since 1959' /////G1' /�
(760) 329-6875 Fax (760) 251-3405 w ( i
State Lie. #265214 'ssswmerOrderNo. to
www.alcesspool.com
GILL To , rr'
fit
CITY
L.
zr=nv $SEPTIC TANK HAS SEPTIC TANK WN DUO UP7
REQUESTED �PUMPSEEPAGEFITATITSRISSR
os [� No . ON SITE
O'FICPDILLtMC
4UANT.
DESCOFIrl
outer15,376
Pumping Fee pea 1000 Gnllans (or ficection)
Waste Discharge Fee per
j
L.
1000 Gallons
Locating and Opening Fee (I hr. Mn)
Out of Area Fee
13 TuE LSAmNa SY89' muAs F .SD.
THERE IS AN 0$MUCn0N-%AMREAWQFTHE SeMC. T
tt e+iR be ntxvury tq ee0taa a rtlt0 deening oomDam.
11 WE RECOMMEND MAYMNANCP, PUMPING OP THF8MFC gy
13 YM o wHSRYE 2-3 YEARS
To retnovo Fent up %dt4. 116 Gfe ofyt>nr ' ¢ systmt.
❑ TffM PUMPING WILL PROVI LY RSL F AND NOT v
SOLWCUSTOMERS SPFnr LSM USt 4vu,
�] cumoMER HAS 0GCN arvr>Tf TR L TT ACKE .
ASEMCCCOAIt 33E �)
ON ALL RKTR IE �r
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CF3AxGEA AST MMME ACC S n AA
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Bin #
City of La Quinta
Building a Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:'
77 9i+
Owner's Name:
A. P. Number:
Address: ? p2�� ��,✓ 3vD
Legal Description:
Contractor: ci0
City, ST, Zip: IC fL--tI j—
Telephone:
Address: D
Project Description:
City, ST, Zip:
Telephone70-77�
clz� ylj
State Lic. # : ffllq ! Lf
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: �--
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING .
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading, plan
2" Review, ready for corrections/issue
Electrical
Subcontactor. List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'`" Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
T4ht 4 4 Q"
Building
51-965 Hwdoza
Address
Owner
Sq. Ft. 1482
Size '
Frank J. GireCA
Mailing
New ❑ Add ❑
Address
79-380 Port Rio
City
Zip
Ra>wirttdA Tfvmnsa 92
Contractor
S�
Address
State Lic- I City
& Classif. 203493 Lic. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
P.O- BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
LICENSED CONTRACTOR'S DECLARATION
1 I�ereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
ton 3 of the Business and Professions Code, and my license is in full force and
effecL
SIGHADAW DATE
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the following
rasa[ (Sac. 7031.5,8usiress and Professions Code: Any city or county which requires a
permit to construct, after, irprove, demolish, or repair any structure, prior to its issuance also
spies the applicant for such permit to rde a signed statement that he is licensed pursuant to
the provshm of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
DNb n 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exempla". Any violation of Section 7031.5 by any applicant for a permit
sullowts the ppicam to a mW penalty of not more than rive hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will
do the wort, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
tiofessio s Code: The Contractors License Law does not apply to an owner of property who
hiss 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 rrprovement is sold within one year of completion, the owner -builder will have the burden
of provkg that he did riot 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) icensed pursuant to the Contractor's License Law.)
Cl I am exempt under Sec B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 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
(nos section need not be carpleted If the permit is for one hundred dollars ($100) valuation
of less.)
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.
Data Owner
M07ICE TO APPLICANT: ff, after making this Certificate of Exemption you should become
S~ to the Walkers' Compensation provisions of the Labor Code, you must forthwith
conpry wfth surh provisions d Otis permR shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of the
work for which Mis permit is issued. (Sec. 3097, Civil Code.)
Lenders Name
Lenders Address
This is abuilding 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.
1
agreeply 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.
LDING: TYPE CONST. OCC. GRP.
P. Number 773-•181-0"
Legal Description
Project Description
06563
REMARKS fY c 4 i5 l 46% ijrir;.A 1 rt-. i ? _ f'+, V Y t
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
10/17/89
Issued by: Date Permit
Validated by:
Validation:
Sq. Ft. 1482
Size '
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$8g tt
.? 9 V35
PERMIT
AMOUNT
Plan Chk. Dep.
$253.00
Plan Chk. Bal.
236.65
Const.
367.50
Mech.
53.50
Electrical
109.52
Plumbing
160.50
S. M.I.
5.88
Grading
20.00
Driveway Enc.
20.00
Infrastructure
1,843.53
TOTAL
53.267.123
REMARKS fY c 4 i5 l 46% ijrir;.A 1 rt-. i ? _ f'+, V Y t
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
10/17/89
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
DUCT WORK
ROCK STORAGE
FOUND. REINF.
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
REINF. STEEL
GAS (FINAL)TEMP. POLE
7/
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
WATER HEATER SERVICE
FINAL INSP.
DRAINAGE PIPING
CAR P. I SO. FT. ®
WATER SYSTEM
FINAL INSP.
FINAL INSP.
GRADING
cu. yd.
$ Plus -x$-=$
WALL SO. FT.
LUMBER GR.
DRINKING FOUNTAIN.
SO FT. ®
1 1110
(/ )(� 7
/� /01
5
El
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
VENTILATION
FLOOR DRAIN
MECHANICAL FEES
FIRE ZONE ROOFING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL 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.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.Ff.GAR @ VVic
HOUSE SEWER
FENCE FINAL
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 ad��l
((((
ROUND PLUMBING/�/s UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEPTIC TA ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) 211.31f0^,METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)TEMP. POLE
7/
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP.
GRADING
cu. yd.
$ Plus -x$-=$
LUMBER GR.
FRAMING
ROOFINGifth, of
1 1110
(/ )(� 7
/� /01
5
El
'�/a
1
0
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 'rDWj1
MESH
INSULATION/SOUND
7
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
N®1f% OF
Nj'SSCHOOL FACILITY FEES
Olip OCUIEA
T0: City of La Quin alecAT I 7.CA)V%� DATE:
Department of Community ev, lopmenf•® r
78-105 Calle Estado
La Quinta, CA .92253
This is to certify that r
developer of. r which is
located at 51 — / — , within
this District, has paid school facility fees im osed purfivanC to the
$Co� ' ty er��ted-by Go rnment Co ecti n 5308 in the amount of
►� - 4 /
covering a total of square feet of ( ) residential or
( ) industrial/commercial deve opment and that building'permits for
this footage in this development may now be issued by your jurisdict:ioh.-
1 @ 449
495, for DESERT SAN -UNIFIED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
3U (10)-37
rru
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
JAMES L. MONTGOMERY, Trustee of James L. Montgomery Trust, dated
March 18, 1980
hereby GRANT(S) to
FRANK J. GRECO and NANCY C. GRECO,
Husband and Wife as Joint Tenants
the following described real property in the city of La Quinta
county of Riverside , state'of California:
Lot 12 of Block 118 of Santa Carmelita at Vale La Quinta, Unit No. 12
as per Map recorded in Book'' -18 pages"7�ana o aps to e o icer
of the County Recorder of said County `.
Dated September 8, 1988
gn,'
mes L. Montgomery, rustee
STATE OF CAWYORNI.A j
COUNTY OF 'bticc(�GG!((-- } _SS. �. r�.. _ , _ . _, , -•..�
On _before me, the under.
signed, a Notary Public in and for said County and State, personally
appeared—.__--
FOR NOTARY SEAL OR STAMP
---- --- known to me
to he the person__ whose name subscribed to the within
w•. OFFICIAL. SEAL
instrument Ad acknowledjed thatexecuted the same. ( JA ,
' Signature of otiry
Name (Typed or Printed) of Notary
Title Order No.
Escrow No.
MAIL TAX STATEMENTS AS 01PECTED ABOVE
JANIE HARDING
NOTARY PUBLIC - CALIFORNIA
PRINCIPAL OFFICE IN
RIVERSIDE COUNTY
My Commission Exp. Sept 7, 1991
RECORDING REQUESTED BY
ONANGE COAS' TITLE CO.
°C •
V
tttr
W n:
CO)
(�
Q c3
N IMcc
®
LL
Ra'm
AND WHEN RECORDED MAIL TO
00•-a CL
Lis
Ljj
)
NAME
Frank J. Greco, etux
n�>' »
79380 Port Royal
ccS 16
CITY 6
sTAT`LBermuda
Dunes, CA 92201
Wa..
J Q
SPACE ABOVE THIS LINE FOR RECORDER'S USE
MAIL TAE eTAT=MENTe TO
F.
' '
Documentary transfer tax8.11-55 ..............................
NAME
SAME AS ABOVE
® Computed on full value of property conveyed, or
AoonEae
C] Computed on full value less liens 8 encumbrance,
CITY &
STATE
I
L..
re aining thereon at timof ,ale.
�J .......L.X_.9.Li.1.......14.:��.lL"-L.LL.�4................
Signature of declarant or agent determining; tax - firm name
Unincorporated area City of .... Za..Btx.zn.ta........
Grant Deed PARCEL NO 773-181-024- f
This form furnished by Orange Coast Title Company
rru
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
JAMES L. MONTGOMERY, Trustee of James L. Montgomery Trust, dated
March 18, 1980
hereby GRANT(S) to
FRANK J. GRECO and NANCY C. GRECO,
Husband and Wife as Joint Tenants
the following described real property in the city of La Quinta
county of Riverside , state'of California:
Lot 12 of Block 118 of Santa Carmelita at Vale La Quinta, Unit No. 12
as per Map recorded in Book'' -18 pages"7�ana o aps to e o icer
of the County Recorder of said County `.
Dated September 8, 1988
gn,'
mes L. Montgomery, rustee
STATE OF CAWYORNI.A j
COUNTY OF 'bticc(�GG!((-- } _SS. �. r�.. _ , _ . _, , -•..�
On _before me, the under.
signed, a Notary Public in and for said County and State, personally
appeared—.__--
FOR NOTARY SEAL OR STAMP
---- --- known to me
to he the person__ whose name subscribed to the within
w•. OFFICIAL. SEAL
instrument Ad acknowledjed thatexecuted the same. ( JA ,
' Signature of otiry
Name (Typed or Printed) of Notary
Title Order No.
Escrow No.
MAIL TAX STATEMENTS AS 01PECTED ABOVE
JANIE HARDING
NOTARY PUBLIC - CALIFORNIA
PRINCIPAL OFFICE IN
RIVERSIDE COUNTY
My Commission Exp. Sept 7, 1991
RECEIPT NO. S'7 Issued By -Date / O
DISTRICT: ❑ Riverside, Indio ❑ Hemet ❑ Perris ❑ • Rancho Calif. ❑ Blythe.
DOH SAN 122 (Rev. 5/88) DISTRIBUTION`. WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records
-14
=w�
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No.
" ENVIRONMENTAL HEALTH SERVICES
t
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 checklist.
A non-refundable filing fee (see below) is required when the application is submitted. Check must be 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.
Q
Z
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG #
O
Agent, Contractor, Contact Person
F �✓
P one
Address & Phone
Feb
W
Owner
Phone
M 'lin Addres
- a., T, y.�L AACE ,
City
$ER) -1 bd bt�iVLS_ --,d
Stat
�,
Zip
9�
Job Property Address
f�r1� % 2
Legal escription Prop. (PM, Tract, Lot)
��f/.&4E', %/8 q4pr'!^q,
Lot Size
NVater Age�njc a I'
Use of Permit P/P, CU, etc.__%Z1r
Other
Dwe11im;M Site Prep, etc. IF
ignature of Applicant
Date
CATEGORY: REV CODE FEEC-I-7
CATEGORY: REV CODE FEE
)
e"" SUBSURFACE DISPOSAL 1238 S •-BOE
70 ❑ SITE EVALUATION UPON REQUEST 7349 $42.00
m
❑ MULTIPLE PARCELS WITHIN; SAME
(NO PLOT PLAN)
Z
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
Q
a. 1 st 4 Parcels (Each) 1238 $45.00
(Less than 1 year)
U
b. Each Parcel after 4 7344 $16.00
❑ PRELIMINARY ELECTIVE 7352 $45.00
W
❑ Rereview (2nd review same parcel) 7344 $16.00
EVALUATION (Attach DOH SAN 53)
U)
❑ Site Evaluation in Conjunction with
❑ HOLDING TANK 7351 $45.00
Critical Area 7346 $86.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $132.00
❑ Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $86.00
l TIAL
Holding Tank Agreements Completed ❑ Yes ONo
Certification of Existing S.D. System Required ❑ Yes No
WQCB Clearance required. (Attach Form ❑ Yes 12160,///
DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required. ❑ Yes
Special Feasibility Boring Report Required. ❑ Yes
VNI-
Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes
Other❑ Yes 6
Staff Specialist Lot Inspection Required ❑ Yes ❑ No
Lot Inspection Date
Soils boring report by Project Date
/ t#�/J p
Q
Soils Map Page s Soil Type Approved by Date
U
O❑�:New
No. of Systems
TypJof System(s)
161'ding Tank 0 Existing
No. Dwelling Units
B ed rooms-Fmtvm-Vnft--G
(1) Septic Tank
Soil Rate
ease/ and
nG�
0 Replacement
U
W
(2)� each Line Sq. Ft.
Botto trench area
Sidewall allowance
Install Line(s) ft. long ft wide with
ch Bed sq. ft
ft rock/ sq. ft
min. inches , low drainlines or
of bofto Fea,,_
per running ft.
Leachlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
Seepage Pit otal epth
Other:
Applicable/
'
Inlet (BI)
N/A Overburden factor
-
fQ
IH
Max. Allowable Pepth
No. 2 System
REMARKS:
�
This application iCs A�P�PR�OVEO Ev for 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
above -designed system. No construction is permitted in the required reserved 100% expansion area.
(1 Septic tank and sewer lines must be 50' minimum from any wells
2�) Leach lines must be 100' minimum from any wells, including expansion rea
(3 Seepage pits must be 150' minimum from any webs, including expansion a a'{ /Q f�
-
Signature of Health Official Date
RECEIPT NO. S'7 Issued By -Date / O
DISTRICT: ❑ Riverside, Indio ❑ Hemet ❑ Perris ❑ • Rancho Calif. ❑ Blythe.
DOH SAN 122 (Rev. 5/88) DISTRIBUTION`. WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records
-14
=w�
r o ` ~c�••aOFFICE OF
AGRICULTURAL COMMISSIONER
V
` AND
•:�;1;: WEIGHTS & MEASURES
CALVIN C. KAMINSKAS
JAMES O. WALLACE 4080 LEMON STREET, ROOM 19 Assistant Commissioner
Agricultural Commissioner RIVERSIDE, CALIFORNIA 92501 CLEMENT BENVENISTE
Director of Weights & Measures Sealer
(714) 787.2561 -
49613 Highway 86, Suite B12
Coachella, Ca. 92236
DATE - �' —�% (619) 342-8291
DATE 8 9 ISS O S' 2 -
DEVELOPER'S
DEVELOPER'S NAME:
ADDRESS: 72 - 3 Y0. off-
TELEPHONE : 3 Y
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.
h/
Agricultural Commissioner' 0 fice
cc: Indio and Riverside Office
- Certificate of Compliance: Residential
' vie i�/ZEt O
. ProjeetTttk -
y ProjectAddren
1 JOHN H. HACKER 327-4565
Documentation Author Tdepbooe
POINT SYSTEM
(Page I of 2) CF -1R
Budding Permit
Checked By /Date
Bd arc rnew As eaey Use Cub
GENERAL INFORMATION
Total Conditioned Floor Area: ¢,7 Zft2
Building Type: Single Family Hotel/Motcl
(check one or more) Multi Family (less than 4 stories) Addition
Multi -Family (4 or more stories) Existing -Plus -Addition
Front Entry Orientation: North South / West / All Orientations (circle ate or more)
Number of Dwelling Units: _
Floor Construction Type: lab Raised Floor (circle one or both) -
infiltration Control: 4tand• ight (circle ate)
BUILDING SHELL INSULATION
Component Insulation Location/Comments
Type R -Value (attic, to garage, typical, etc.)
Wall .............. R- FRAME WALLS
Wall ..............
Roof ............. R-38 TYPICAL
L. -r- Roof .............
rlaor.............
Floor .............
Slab Edge..... O TYPICAL
1614
3-31•
�IECF CA1.�F���
GLAZING
Shading Devices
-
blazing Area
Glass Type
Interior Exterior
Ovcri;Wtig
: Framing Type
Orientation (sf)
(single, double)
(roller blind, etc.) (shadescreen, etc.)
{yeslno)
`in;_td/wood)
�
Front.... (—A) 5b-
DOUBLE
VERTICAL BLINDS NONE
YES
WOOD
Front
Front.... ( )
W11 TE
: Left,,,,,, (S) -j7;?7
DOUBLE
VERT I CAL BL I NDS NONE
YES
WOOD
Left...... ( )
_..
WHITE
-
-
Rear.....
DOUBLE
-VERTICAL BLINDS NONE
YES
WOOD '..
Rear..... (:)
WHITE
Right.... (14 =
DOUBLE
VERTICAL BLINDS NOPE
YES
WOOD
Right.... ( )
WHITE
- Skylight....... _�
DOUBLE
NONE
_ ND
Skylight.......
THERMAL MASS -
:.
Type/Covering
- Area Thickness
(slab/exposed, tile, etc.)
(sf)
(inches) Location/Description (kitchen, bath, etc.)
SLAB/EXPOSED
3 1/2" KITCHEN/BATH/ENTRY
i
Certificate of Compliance: Residential
PT
HVAC SYSTEMS
(Page 2 of;)... -CF-IR
Maximum Furnace Heating Output: . Btuh
HOT WATER SYSTEMS Tank Manufacturer/Model #
System Type (storage'gas. etc.) Capacity (or approved equal) Special Feature(s)
STD GAS 50 GAL OR LESS APPROVED MODEL
SPECIAL FEATURES/REMARKS (Add extra sheets if necessary)
COMPLIANCE STATEMENT
This certificate of compliance lists the building features and performance specifications needed to comply with
Title 24, Chapter 2-53 and Title 20, Chapter 2, Subchapter 4, Article 1 of the California Administrative code. This
certificate has been signed by the individual with overall design responsibility and the building owner, who shall
retain a copy of it and transmit the certificate to any subsequent purchaser of the building. When this certificate of
compliance is submitted for a single building plan to be built in multiple orientations, all building conservation
features which vary are indicated in the Special FeatureslRemarks section.
Designer
Name:
Title/Firm:
Address:
Telephone:
Lic. N:
(Apatum) (date)
Documentation Author
Name: JDM H. HACKER
Tide/Firm: JOHN H. HACKER AND ASSOCIATES
Address: 4501 E. SUNNY DUNES, SUITE D
PAL14 SPRINGS. CA 92264
Telepho r ) 327-4565
0.
ei ) (date)
Form Rrvisa Mrd. 19L,
Building Owner
Name:
Title/ am:
Address:
Telephone:
(siSnature) (doe)
Enforcement Agency
.Name:
Agency:
Telephone:
(tier atom or tUIV)
Minimum
Duct
Type Ownace.sk
Efficiency
Location
Duct - Output
Manufacturer/Model*
conditioner. Deu pump)
(sE. sEER.HsPF)
(attic. dc)
R -Value (Btuh)
(or approved equal)
FURNACE
7 =/
ATTIC
2.5
w jj1-0 OqA,)
AIR—COND.
ATTIC
2.5
.3 Z %ON
Maximum Furnace Heating Output: . Btuh
HOT WATER SYSTEMS Tank Manufacturer/Model #
System Type (storage'gas. etc.) Capacity (or approved equal) Special Feature(s)
STD GAS 50 GAL OR LESS APPROVED MODEL
SPECIAL FEATURES/REMARKS (Add extra sheets if necessary)
COMPLIANCE STATEMENT
This certificate of compliance lists the building features and performance specifications needed to comply with
Title 24, Chapter 2-53 and Title 20, Chapter 2, Subchapter 4, Article 1 of the California Administrative code. This
certificate has been signed by the individual with overall design responsibility and the building owner, who shall
retain a copy of it and transmit the certificate to any subsequent purchaser of the building. When this certificate of
compliance is submitted for a single building plan to be built in multiple orientations, all building conservation
features which vary are indicated in the Special FeatureslRemarks section.
Designer
Name:
Title/Firm:
Address:
Telephone:
Lic. N:
(Apatum) (date)
Documentation Author
Name: JDM H. HACKER
Tide/Firm: JOHN H. HACKER AND ASSOCIATES
Address: 4501 E. SUNNY DUNES, SUITE D
PAL14 SPRINGS. CA 92264
Telepho r ) 327-4565
0.
ei ) (date)
Form Rrvisa Mrd. 19L,
Building Owner
Name:
Title/ am:
Address:
Telephone:
(siSnature) (doe)
Enforcement Agency
.Name:
Agency:
Telephone:
(tier atom or tUIV)
Mandatory Measures Checklist: Residential MF -1R
NOTEi Lowrise residential buildings abject to the Sundards must contain these tine&%= regardless ohbe'
approach usod. Runs marked with an aswisk Cj may be supersedod by more strueat compliance requu ements listod
on the Certificate of Compliance. When this checklist is inc�arporated into the perm!c doctunants. the featxmes tooted shall
be considered by aU panics as binding minimum eomponent�eefocmanoe spoaficathoos for the mandatory measures
whether tbey arc tlhown elsewhere io the documents or on thhs cbocklist only.
DESCitEMON I DESIGNER I ViFORCEME;r I
Building Envelope Measum
•
12-5352(a): Minimum ceiling insulation R-19 weiSb ed average.
12-5352(b): Loose fill insulation manufacturer's labeled R Value.
• g2 -5352(c): Minimum wall insulation in framed walls R-11 weighted avenge (does not apply to
exterior mass walls).
12-535*): Slab edge insulation - water absorption we no greater than 03%. water vapor
transmission rate no greater than 2A permAnch.
12-5311: Insulation specified or installed meets California Energy Commission (CEC) quality
standards. Indicate type and form.
62-5352(f): Vapor barriers mandatoryinClimate Zones 14 and 16 only.
12-5317: Infiltration/Eufiltration Controls
a Doors and windows between conditioned and unconditioned spaces designed to limit air
leakage.
b. Doors and windows certified.
c. Doors and windows weatherstripped; all joints and penetrations caulked and sealed.
12-5352(e): Special infiltration barrier installed to comply with 12-5351 meets CEC gpUty
standards.
12-5352(d): Installation of Firepplaces
1. Masonry and factory -built fireplaces have:
IL Tight fitting, closeable metal or glass door
b. Outside air intake with damper and control
l c. Flue damper and control
\ 2. No continuous burning gas pilots allowed
HVAC and Plumbing System Measures
12-5352(8) and 2-5303: Space conditioning equipment sizing: attach calculations.
J2 -5352(h) and 2-5315: Setback thermostat on all applicable beating systems.
• 12-5316(a): Ducts constructed, installed and insulated per Chapter 10, 1976 UMC.
12-5316(b): Exhaust systems have damper controls.
12-5314(c): Gas-fired space beating equipment has intermittent ignition devices.
IN/AI I
§2-5314: HVAC equipment, water heaters, showerheads and faucets certified by the CEC. t/
12-5352(1): Water heater insulation blanket (R-12 or greater) or combined interior/exterior
insulation (R-16 or greater); fust 5 feet of pipes closest to tank insulated 00 or greater).
12-5312(Exception 1): Pipe insulation on steam and steam condensate return tit recirculating .
pipiping.I" /A
62-5318(d): Swimming Pool Heating
1. System has:
t On/off switch on heater.
b. W instruction plate on beater.
c. Plumbed to allow for solar.
2.75 percent thermal efficiency.
3. Pool cover.
4. Time clock.
5. Directional water inlet.
Lighting and Appliance Measures
12-5352U7: Lighting - 25 lumens/wau or greater for Seneral lighting in kitchens and bathrooms.
12-5314(c): Gas fired appliances equipped wtth intermittent ignition devices.
$2-5314(x): Refrigerawrs, refrigerator -freezers, boerers hind fluorescent lamp ballasts catiSed
by the CEC. Indicate make and model number.
Form Rrwed Dw=ba 1997
� MA
POINT SYSTEM SUMMARY:CLIMATE ZONE 15 P -2R
PROJECT TITLE=FRANK GRECO DATE=8-29-89
' "JOB SITE=LOT 12 BLK. 118 SANTA CARMELITA NO.12
. BUILDING DATA
`
CONDITIONED FLOOR AREA= 1492 NUMBER OF STORIES= 1
SLAB/RAISED FLOOR SLAB
TOTAL GLASS AREA 148 SQ.FT %GLASS 9.919571
CHECK ALL APPLICABLE UNIT TYPE CONDITION(S)
(X) SINGLE FAMILY DETACHED (SFD) ( ) ADDITION ALONE
( ) SINGLE FAMILY ATTACHED (SFA) ( ) EXISTING BUILDING
( ) MULTI -FAMILY (MF) ( ) EXISTING -PLUS -ADDITION
SCORE CARD
MEASURES
POINT SCORES
1.CEILINb INSU. 38
0
2.WALL INSU. 11
-8
3.RAISED FLOOR INSU 0
0
4.SLAB EDGE INSU 0
0
5.INFILTRATION STANDARD
0
6.GLASS HEAT LOSS DOUBLE PANE U=.65
7
SUM 1-6= (-1 )
7.SHADING (SHADE OPEN)
GLASS AREA
SC= .6776
A. NORTH
0
40
B. EAST
-1
58
D. SOUTH
0
34
E. WEST
0
16
H. SKYLIGHT
0
0
8. SHADING (SHADE CLOSED) % GLASS
SC= .2552
A, NORTH 0 2.680965
B. EAST1 3.887399
C. SOUTH 4 2.278821
D. WEST 5 1.072386
E. SKYLIGHT SC= 0.77 0 0
9. INTERIOR THERMAL MASS 2.714477 1
10.EXTERIOR WALL MASS 0 0
SUM 7-10 =( 10 )
11.HEATING SYSTEM 72 S.E. 0
12.COOLING SYSTEM 9.5 SEER 0
13 WATER HEATING S.G. 0
TOTAL POINTS 9
NAME ----A --- FRANK GRECO
~R^SS ---- LOT 12 BLK. 118 SANTA CARMELITA NO.12
.-DATE'------- 8-29-89
MANU'L J FOR HEATING AND COOLING LOSSES
AREA BLDG 1492 SQ. FT.
PERIMETER 165.7778 SQ. FT.
INSULATION R VALUES .FLOOR 0 ..CEILING 38- ..WALL 1.1
AREA NORTH WINDOWS 40 SQ.FT. PERCENT OF AREA 2.680965
AREA EAST WINDOWS'58 SQ -FT. PERCENT OF AREA 3.887399
AREA SOUTH WINDOWS 34 SQ.FT. PERCENT OF AREA 2.278821
AREA WEST WINDOWS 16 SQ.FT. PERCENT OF AREA 1.072386
AREA SKYLIGHTS 0 SQ.FT. PERCENT OF AREA 0
TOTAL WINDOW AREA 148 SQ.FT. PERCENT OF AREA 9.919571
THE U VALUE OF THE WINDOWS IS .65 DUAL PANE
THIS BLDG USES DRAPES & FLAT SHADING DEVICES* ON WINDOWS
(*mini -blinds, rollar shades, venetian blinds or vertical blinds)
THE TOTAL S.C. OF THE WINDOWS IS 0.30
SOUTH OVERHANG LENGTH 2
INTERIOR THERMAL MASS AREA = 405 SQ FT.
INFILTRATION (STD 0.018, MED 0.014, TIGHT 0.012) = .018
HEATING LOSSES
FOOTING LOSSES... 5755.804 BTU
CEILING LOSSES... 1170.937 BTU
WINDOW LOSSES.. 2982.2 BTU
WALL LOSSES.... 2921.991 BTU
INFILTRATION LOSSES... 6660.288 BTU
TOTAL HEAT LOSSES BTU/HR.. 19491.22
GAS FURNANCE SIZE 40258.59 BTU OR 45,000 BTU
COOLING LOSSES
FOOTING LOSSES... 2475.615 BTU
CEILING LOSSES... 1510.886 BTU
WINDOW LOSSES... 10530 BTU
WALL LOSSES.... 3763.911 BTU
INFILTRATION LOSSES... 2864.64 BTU
NO. OF PEOPLE... 5 COOLING LOSSES... 2000
KITCHEN... 1500 BTU
DUCT LOSSES INCLUDED IN TOTAL
TOTAL COOLING LOSSES 30374.33 BTU