SFD (09041)4
P.O. BOX 1504 No. 09041
Building 78-105 CALLE ESTADO
Address 53-900 Ave. Mendoza LA QUINTA, CALIFORNIA 92253
Owner
Landrace Corn. BUILDING: TYPE CONST__�_OCC. GRP. -
Mailing
Address 73-625 Mry 111 #G A.P.Number—
City Zip Tel.
Pa 1M Deqp.rt I 922fin 773-3125 Legal Description Toot 17, Block 249
Contractor Project Description ISM
Address
P.O. Box 2982
City Zip Tel.
Palm Desert 92260 340-6807
State Lic. City
& Classif. . 4110121 Lic. # IS26 Sq. Ft. 1450 No. No. Dw.
Arch., Engr., Size Stories Units
Designer New 0 Add 0 Alter 0 Repair El Demolition 0
Address Tel.
City Zip State
I Lic. #
LICENSED CONTRACTOR'S DECLARATION
I he re by 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 affi�m that I am exempt from the Contractor's License Law for the following
reason: (Sec. 703 1.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, Impro ve, 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).
01 ner of the property, or my employees with wages as their sole compensation, will
do ih.qo'rk, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: Th a 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
ofproving that he did not build or improve for the purpose of sale.)
0 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 contractorls) licensed pursuant to the Contractor's License Law.)
0 1 am exempt under Sec. -B. & P.C. for this reason
Date Owner
77
T
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
0 Copy is filed with the city. 0 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 (S100) valuation
or less.)
I certify that in the performance of thp 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. 309 7, 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 cer tify 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, Zi
tzstimatea valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Eric.
Infrastructure
TOTAL
REMARKS
AMOUNT
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:
Validated by:
Validation:
Date—Permit
14
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FIEE&
1ST FL. SO. FT. @ $
2ND FL. -SO. FT. @
POR. SO. FT. @
GAR. SO. FT. @
CAR P. I SO. FT. @
WALL SO. FT. @
I SO. FT. @
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WAIER PIPING
NOTE: Not to be used as property tax valuation
ROUGH I B
= X. -P 'f
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS(ROUGH)
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BONDBEAM
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR @ 3/4c
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE I
DBIL
L_
TOTAL FEES
I
MICRO FEE
MECHfl.FEE PL.CK.FEE
E
CONST. FEE ELECT.FEE
I
SMIFEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK 46x1f1 1,44
GROUND PLUMBING
O&UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 31,2"Oel Aw—
ROUGH I B
= X. -P 'f
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
.vf -f
SEWER
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS(ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL ;12, (Ifl
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BONDBEAM
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
LATHIN-1
TOWN
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
RECEIPT NO. Iss Lied By -Date
DISTRICT: 0 Riverside, 0 Indio 0 Hemet 0 Perris 0 Rancho,Parf. 0 Blythe
Ygwffitu'd'a IAL*t�
DOH -SAN -122 (Rev. 3/90) DISTRIBUTION: WHITE - Office file YELLOW - Applicarit PINK - Bldg. Dept. GOLDENROD - Plans/Reoords
?I -
AssessM P 11110.
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH
ENVIRONMENTAL SERVICES DIVISION
PERMIT APPUCATION 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 check IWL
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.
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG #
z
5
Agent Contractor, Contact Person
Phone
Address & Firm
J') C; Co in S7 12 oC-r I o At
3 C/O� r
19
<16 - 3 f-/ e
U.1
Owner
L J W, C c- cot,
Phone
Mailing Address
U)
'0 'q 0 -
9 72 -.3/ *IS-,
91 -
Pc "k
_Z�)
date
I
Zip
Job Property Address
Legaf Description Prop. (PM, Tract Lot)
L_ , 'e S e- Vol-
C�
il";�q 60
�o -r / 9 -riahey '2 9!�
Lot Size
Water Agency/Well
-6
Use of Permh P/P, CU, etc.
Other Llot;4 ".;Z _T
6 " ep'a A G L
00
V L4j
(=1:,ng)MH Site Prep, etc.
Signature of Applicant
Date
CATEGORY: REV CODE FEE
CATEGORY: REV CODE FEE
0 SUBSURFACE DISPOSAL 1238 $ 57.00
0 SITE EVALUATION UPON REQUEST 7349 $ 43.00
00
0 MULTIPLE PARCELS WITHIN SAME
(NCO PLOT PLAN)
z
LAND DIVISION
A(SEWEA /SEP:RC VERIFICATION 7348
-ItWthan oEgt�
0
a. 1 at 4 Parcels (Each) 1238 $ 57.00
1 year)
b. Each Parcel after 4 7344 $ 24.00
0 PRELIMINARY ELECTIVE 7352 $ 23.00
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0 RerevIew (2nd review same parcel) 7344 $ 24.00
EVALUATION (Attach DOH SAN 53)
0 Site Evaluation in Conjunction with
0 HOLDING TANK 7351 $ 47.00
Critical Area 7346 $111.00
0 ALTERNATIVE/EXPERIMENTAL 7345 $222.00
0 Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $ 87.00
INITIAL D
Holding Tank Agreements Completed 0 Yes No //7TE
Certification of Existing S.D. System Required 0 yes No
WOCB C4earance required. (Attach Form 0 yes No
DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required. 0 Yes No
Special Feasibility Boring Report Required. 0 Yes No
Detailed Contour Pilot Plans Required (11 to 5 ft. interval) 0 Yes I I No
Other 0 Yes I I No
Staff Specialist Lot Inspection Required 0 Yes I I No
Lot Inspection Dais
Soils boring report by Project
0
Soils Map Page Sol Type Approved by Dade
z
No. of Systems
T;� Not St
- No. Dwelling Units
a
k
Soll Rate
Gresee/Sand
0
ng:ts)
ank 11 Existing
Bedrooms, Fixture Units
�1) �*_
Grosse Intop
El No 0 Replacernwvt
LU
Cl)
(2)1 Line Sq. Ft
—11 allowarice
�-i
Install a) — It. long wide with
Bed sq. ft
Bottom trench area
rock/-----:--- sq. ft.
min. rock below drainlines or
of bottom area
per runn rig
\
0 NA
Leschlines/bed special design for slope:
(3) Ph lameter
No. Pits
Pit Below
Seepage Pit Total Depth
Other.
Applicable —
Inlet (BI)
(TD)
Max. Allowable Depth
N/A — Overburden factor
0 5>0
No. 2 System
REMARKS:
This application is CPR��D/DENIED for the category in SECTION B
ch�Xd 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
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above -designed system. No construction is permitted in the required reserved 100% expansion area
0
(1) Septic tank and sewer lines must be 50' minimum from any wells
tj
(2) Leach lines must be too' minimum from any wells, including expansion area
W
(3) Seepage pits must be 150' minimum from any wells, including expansion area
Signature of Health Official Z4 1 1�
RECEIPT NO. Iss Lied By -Date
DISTRICT: 0 Riverside, 0 Indio 0 Hemet 0 Perris 0 Rancho,Parf. 0 Blythe
Ygwffitu'd'a IAL*t�
DOH -SAN -122 (Rev. 3/90) DISTRIBUTION: WHITE - Office file YELLOW - Applicarit PINK - Bldg. Dept. GOLDENROD - Plans/Reoords
?I -
Of
.44" -.1.
1, A , 0 1
JAMES 0. WALLACE
Agricultural Commissioner
Director of Weights & Measures
OFFICE OF
AGRICULTURAL COMMISSIONER
. AND .
WEIGHTS & MEASURES CALVIN C. KAMINSKAS
4080 LEMON STREET, ROOM 19 Asshlant Commlssloner
RIVERSIDE. CALIFORNIA 92501 CLEMENT BENVENISTE
(744) 787-2561 Sealer
49613 Highway 86, Suite.B12
Coachella, Ca. 92236
r -In '3An OnOl
DATE Cyj qqc) CASE NO.
DEVELOPER'S NAME:
( PAA.&�__
ADDRESS: 3 --(o �. 6 - 4 LA -"A L t
CA
TELEPHONE.:
A JA,
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 miaterial listed, this office must be notified
impediately.
Thank you for protecting and preserving the Coachella Valley's pest -free environment.
__)D
Agriculfiiral Ccmnission-ees Office
cct Indio and Riverside Office
OFFICE OF
0 AGRICULTURAL COMMISSIONER
AND
& MEASURES
WEIGHTS CALVIN C. KAMINSKAS
JAMES 0. WALLACE 4080 LEMON STREET, ROOM `19 Asshlant Commisslorint
Agilculluial Commisiloner RIVERSIDE, CALIFORNIA 92501 CLEMENT BENVENISTE
Dbeclor of Welghli & Measures (714) 787-2561 Sealer
49613 Highway 86, Suite.B12
Coachella, Ca. 92236
(619-) 342-8291
DATE qo
CASE NO. PC C12V
DEVELOPER'S NiMi V-4 V3 IQ
ADDRESSt
CA
TELEPHONE:
"g-!?" ko
z�A JA P, A, aL,�Z f -A,/
Dear Developer -
dans, all plant material listed is not in
After reviewing your landscaping p
violation of quarantine laws governing the Coachella Valley. If substitutions
do occur and they differ frorn plant material listed, this office must be notified
immediately.
Thank you for protecting and preserving the Coachella Valley's pest -free environment.
A�iJA
AgriculAY—a-ij:Comnissiorier's Office
V
cct Indio and Riverside office
4 P OFFICE OF
a AGRICULTURAL COMMISSIONER
0
AND
41" WEIGHTS & MEASURES CALVIN C. KAMINSKAS
JAMES 0. WALLACE 4080 LEMON STREET, PO . OM 119 Asshlant Commlsslonor
Agricultural Commissioner RIVERSIDE. CALIFORNIA 92501 CLEMENT BENVENISTE
Director of Weights & Measures (7`14) 787-2561 Sealer
49613 Highway 86, Suite.B12
Coachella, Ca. 92236
qL) (619) 342-8291
DATE 7 CASE NO. PCX!112�
DEVELOPER'S NAME:. 4cy�, i�:W i-LAt PA V-4 0 It -,S E -
ADDRESS:
TELEPHONE: -7 _)-3
L,L g-:� kL3 Z,
P, 1,A, C)�L�.P-AA
Dear Developer:
After reviewing your landscaping plans, all plant material liste ' d is not in
violation of quarantine laws governing the Coachella Valley. If substitutions
do occur and they differ froin plant material listed, this office must be notified
imnediately.
Thank you for 'protecting and preserving the Coachella Valley's pest -free environtrent.
1p� "Izvt 0 4(�iA - -
Agrilculfftiral-Comnissioder's office
C7-
cci Indio and Riverside Office