05168 (SFD)T a 0
lihf 4 4 a"
Building 770
Address 51—M4 Carrant
Owner
Address
City Zip Tel.
Address
Tela
State Lic.I City
& Classif. 317390 Lic. #
Arcn., tngr.,
Designer
Address
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
City I
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
J OWNER -BUILDER DECLARATION
1 hereby affion that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8rrsi ess and Professions Code: Any city or cowry which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the aPAocant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractors 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).
0 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, 8uisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon arch 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 whdm one year of completion, the owner -builder will have the burden
of proving that he did not Ladd or iiprove 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 Contractors License Law
does not apply to an owner of property who buikds or inproves thereon, and who contracts for
such projects with a contractor(s) icensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec_ R, & 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
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy 7N Company r '
❑ Copy is filed with the city. 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed it 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
aliforniaDateOwner
NOTICE TO APPLICANT' ff. after mnakvW 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 On Penn 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.)
Lenders Name
Lenders 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 certity 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 properly for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
No. 06168
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
,Legal Description
Project Description
77�-1h5—f}1
Sq. Ft. 1500
Size
No. No. Dw.
Stories Units
New ❑ Add O
Alter O Repair ❑
Demolition 0
r—
Estimated Valuation
$84,078
PERMIT
AMOUNT
Plan Chk. Dep.
a f30
Plan Chk. Bal
4
A-1 _7 A
Const.
Mech.
Electrical
74 in
Plumbing
S.M.I.
5, p
Grading
IPA An
Driveway Enc.
A
Infrastructure
TOTAL
AA
REMARKS`ilt7�1
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 12/29/8Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL SO. FT. ® $
UNITS
COLL. AREA
CSLAB GRADE ��
YARD SPKLR SYSTEM
2ND FL SO. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR, SO. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SO. FT.
GAS (FINAL)
WALL SO. FT.
DRINKING FOUNTAIN
SO FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/.c
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 P
OUND PLUMBING - .
UNDERGROUND
A.C. UNIT
COLL. AREA
CSLAB GRADE ��
ROUGH PLUMF4j
III
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
.�
--UGH WIRING��
DUCT WORK
ROCK STORAGE
FOUND. REINF,
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP.POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GFL
FINAL INSP.
MING J C` liel
FINAL INSP.
COOPING _I—L — ,AYYYY
O v(/
'
O
(F
/j '
'
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
'
GARDEN WALL FINAL
)
OF R --,
�A °~ � a; J"\ OIrICE OF E. LEON SPAUGY
41
PCO�t�nS i+0'.ER
P AGRICULi ti1
URAL COMISSIONEIZ
� ,�� /1� � � ^ 1' 1nN1Es 0 WALLACEr`
O I V U ASS STA`I r0>I>15cIONEP.
,�L j, r j WEIGHTS & MEASURES CLEMENT BENVENISTE
�}�``�} SEALER
,,— 49-613 Ilwy 86, Suite 11-12
~�,,, Coachella, CA 92236
Mq Y 9 1q� 619-342-8291
DATE
DEVELOPER'S NAME:
CASE NO. egg r?S 1-2.2. %, — 7
ADDRESS:
TELEPHONE: ZONE: (6 /1) 3 YS-_ q2- 3 �
— . 5-/— -77O av
Dear Developer:
Q-�--� / cq
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 frun plauTt material listed, this office must be notified
imediately.
Thank you for protecting and preserving the Coachella Valley's pest -free environrmnt.
uenwl_/�Z&444a
Agricultural Ca►miss'o er's Office
cc: Indio and Riverside Office
J
'�•yra,.1, ;}�{!r`�'" J csd •,ys". � l,r+`�y: �4i�t',k-`�ky'T ,�,-rY _ fi''Fk ,�t�w � "� rs jr'` _ ..��+r,ri�-:: `"'`w,,,. i?
L� (1_ _ r
CD
Z
O
U
W
U)
X
Z
0
U
W
Z
0
U
W
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No.
ENVIRONMENTAL HEALTH SERVICES
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.
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'*
Agent, Contractor, Contact Person
Phone
Address & Phone
Owner
`JE/L� Z_a&0
Phone
Mailing Address
rty`
State
Zip
Job Property Address Qv.
Legal Description Prop. (PM, Tract, Lot)
• Ocl., rS
CA
92•zo l
5 7740 C'A/12124V2
Lot Size
Water Agency/Well
Use of Permit P/P, CU, etc.
Other
so "00 f
C
Dwelling, MH Site Prep, etc.
I
Date
% Signature of Wplicant
CATEGORY: REV CODE FEE
CATEGORY: REV CODE FEE
,IKSUBSURFACE DISPOSAL 1238
❑ SITE EVALUATION UPON REQUEST 7349 $42.00
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
a. 1 at 4 Parcels (Each) 1238 $45.00
(Less than 1 year)
b. Each Parcel after 4 7344 $16.00
❑ PRELIMINARY ELECTIVE 7352 $45.00
❑ Rereview (2nd review same parcel) 7344 $16.00
EVALUATION (Attach DOH SAN 53)
❑ 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
NITIArL�DATE /J ce
Holding Tank Agreements Completed ❑ Yes No
Certification of Existing S.D. System Required ❑ Yes No
WQCB Clearance required. (Attach Form ❑ Yes No
DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required. ❑ Yes ❑ No
Special Feasibility Boring Report Required. ❑ Yes ❑ No
Detailed Contour Plot Plans Required (1 to 5 it. interval) ❑ Yes ❑ No
Other ❑ Yes ❑ No
Staff Specialist Lot Inspection Required ❑ Yes ❑ No
Lot Inspection Date
Soils boring report by' Project # Date
Soils Map Page Soll Type Approved by Date
No. of Systems
Type of System(s)
No. Dwelling Units
(1) Septic Tank
Soi ate
Grease d
1
❑ Holding Tank ❑ Existing
❑NNew ❑ Replacement
Bedrooms, Fixture Units
'AACi
3
Gress 1cp
`�A KU XI
b 0
-
Gal
(2) Leach Line Sq. t
Sidewall allowance
Install Line(s) R long R wide with
Leach Bed . R
Bottom trench i}((eeaa
ft rock/ R
min. inches rods below drainlines or
of bottom area
/
per running fL
❑ NA
Leachlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
Seepage Pt Total Depth
Other
ApplicableOverburden
5 0 6
(
Inlet (BI)
K
Max. Allowable Depth
N/A❑
N/A -:factor
214'
No. 2 System
REMARKS: �,U CI r G Ut I U0 C Xfit S tt v( 0'4 C( ,
This application is 4O ED/DENIED 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
a e -designed system. No construction is permitted in the required reserved 100% expansion area.
11 Septic tank and sewer lines must be 50' minimum from any wells
(2) Leach lines must be 100' minimum from any wells, including expansion area k
t (^
(�3 Seepage pits must be i im m from any wells, including expansion area
'
Signature of HeaRhOfficial `c Date
RECEIPT NO. C4 , Issued By v11 Date
DISTRICT: ❑ Riverside, Andio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE -Office file YELLOW -Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records
1.1
OT/!CE OF
AGRICULI URAL COMMISSIONER
AND
WEIGHTS & MEASURES
49-613 Ilwy 86, Suite 8-12
'Coacltelln, CA 92236.
619-342-8291
E. LEON SPAUCY .
CO�t�uSaO`EA
)AMES 0 WALLACE
�SS:S � a� Y rq�tw5510�ER
CLEMENT BE`VEM.STE
SLALER
DATE ��-2S'-�� :CASE NO.
DEVEWPER' S .NAME:
ADDRESS:
_...,., 4 ? i 2 o
TELEP[IONE: ( 612 3 N z 7 6
�/- 770 ate.
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 frun plant material listed, this office must be notified
iirz►�diately.
Thank you for protectii:g and.preserving the Coachella Valley's pest -free enviromient.
Agricultural Cotimiss'o er's Office
cc: Indio and Riverside Office
0