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04212 (SFD)•--- 4 4 Qum& 04212 • P.O. BOX 1504 Builder 51 x,820 Cwarranza LA QUINTACCALIFORNIA 92253 ' Address _ .. OwnerMai Jahn Ro $ll�iX`nev BUILDING: -TYPE CONST. OCC. GRP. i1�3,G9� Highway Ill 43 Address 773-X166. 004 A.P. Number City Zip Tel. FLEE<1C�iG9 '�i�X'8Q3 $2 ii? . Legal Description Contractor Pacific Habitat, Inc. Project Description Single Family Dwelling Address SHS® City Zip Tel. State Lic. City & Classif. Lic. # , , Sq. Ft. 1369 No. , No' Dw. Size Stories Units Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ 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 Professions code, and my license is in,foll`lorce and effect. SIGNATURE X DATE OWNER -BUILDER DECLARATION f J I herby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation 4704798 � �n reason: (Sec.. 7031.5.Susiness and Professions Code: Any city or county which requires a p 7 permit to construct, aker,.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 PERMIT ►a AMOUNT 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 plan Chk. De $250.,00 2y qq ApA/� for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permitp L V „ 5! it 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 Plan Chk. Bal. +� • .. do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. d ft • U 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, Mech. ,j� • 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 Electrical • 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- Plumbing • r 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 S.M.I. •b such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. 8 P.C. for this reason Grading • Driveway Enc. •V Date Owner Infrastructure 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'copyl thereof. (Sec. 3800, Labor Code.) Policy NO. Company "--...,_ e:_-✓''� . _..^'1...-"�+.L,tw ,fit - ❑ Copy is filed with the city. O Certified copy is hereby furnished. , - - �J TOTAL 7 t1r t� r ii ti r, -I • '`* r. CERTIFICATE OF EXEMPTION FROM REMARKS t 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. . Owner NOTICE TO. APPLICANT., If, after making this Certificate of Exemption you should become ZONE: BY. 4io4 subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 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.) Side Setback from Property Line Lender's Name Lender's Address FINAL DATE IN PECTOR. 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. 1 certify that 1 have read this application and state that the above Information Is correct. Issued by: Date Permit 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. Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip i r WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SO FT rp $ UNITS ' A.C. UNIT COLL. AREA YARD SPKLR SYSTEM 2ND FL SO F7. a BONDING MOBILEHOME SVC. BAR SINK POR SO FTat FORMS :J IVIIA,1116PTI dot 14r POWER OUTLET ROOF DRAINS GAR SO. FT. 01 DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) DRAINAGE PIPING CAR P. SO FT. id WALL SO FT. (d OTHER APP.IEOUIP. DRINKING FOUNTAIN GAS (FINAL) URINAL SO. FT. tp ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation SERVICE FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED _ $ LAUNDRY TRAY AIR HANDLING UNIT CFM FINAL INSP. 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. SO. FT. RESID (aI' C SEWAGE DISPOSAL SO.FT.GAR rg Vic HOUSE SEWER SPARK ARRESTOR 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 RO GH P MB BONDING HEATING (ROUGH) STORAGE TANK FORMS :J IVIIA,1116PTI dot 14r 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$ _ $ GR. FINAL INSP. %%L'�UMBER i(_F_RAMING , �- (( _ROOFING FINAL INSP. , `` ` - / U Q L -- �y/G�_ REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH SULATIONISOUND -/J'�Q FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL Building S�O o 0 AddressZ Owner P.O. BOX 1504, 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Mailing Address 9 71.-301 Hwy 111 #3 City RANCHO MIRAGE .112270 Zip Tel. Contractor PACIFIC HABITAT INC. Address 71-301 HIGHWAY 111 #3 City RANCHO MIRAGE. Zi �J2270 T I 340-0801 State sic. +85366 & Classif. � City Lic. # Arch., Engr., Designer PAUL RING DRAFTING 33622 AVE. T' 714/755-4300 City Vt .^ A . r% A Zip 07700 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 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors 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 applicanUtbr such permit to lila 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). ❑ 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.) 0 1 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 (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 expirationif 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 BUILDING DIVISION 6J APPLICATION ONLY BUILDING: TYPE CONST. OCC. GRP. A.P. Number 773-165-004 Legal Description LOT 21, $LK 58 SANTA 'GARMELITA Project Description Sq. Ft. Size v New Zi No.No. Dw. 1369. Stories 1 Units Add ❑ Alter ❑ Repair ❑ Demolition ❑ ILstimateo valuation —76 74?o lp PERMIT Plan Chk. Dep. 2 SU Plan Chk. Bal. AMOUNT Const. Mech. Electrical . $ Plumbing /0 as S.M.I. S . Grading 2-0,00 Driveway Enc. 6Z Infrastructure 7 ZS of ' VVI tl;'' 1 Uc55 'TO6-15-88 i; TOTAL 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 Issued by: Date Permit Validated by: Validation:_ CONSTRUCTION ESTIMATE GROUND PLUMBING O. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL.136?SO. FT. ® <<iO $ Z a UNITS BONDING HEATING (ROUGH) 2ND FL. SO. FT. ® FORMS SEWER OR SEPTIC TANK ROUGH WIRING YARD SPKLR SYSTEM c— L MOBILEHOME SVC. METER LOOP BAR SINK POR. SO. FT. ® • V GAS (FINAL) TEMP. POLE GAR. SO. FT. ® 70 7 POWER OUTLET SERVICE ROOF DRAINS CARP. SO. FT. ® BOND BEAM WATER SYSTEM DRAINAGE PIPING �yf WALL SO. FT. ® • `V1700 LUMBER GR. FINAL INSP. DRINKING FOUNTAIN SO. FT. ROOFING URINAL ESTIMATED CONSTRUCTION VALUATION $ REMARKS: VENTILATION WATER PIPING NOTE: Not to be used as property tax valuation FIRE ZONE ROOFING FLOOR DRAIN MECHANICAL FEES FIREPLACE WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER LATHING GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM FINISH GRADING KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC FINAL INSPECTION WATER CLOSET' COMPRESSOR HP CERT. OCC. POLE, TEM/PERM D LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT '�/ SHOWER BOILER B.T.U. GARDEN WALL FINAL SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c 7 SEWAGE DISPOSAL SO.FT.GAR ® 3/ac J 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. 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 INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS. GARDEN WALL FINAL Z O F -- U W W CID Z O F_ U w U) cn `1 Q W W U) µpe-,�.�r�.�.«e�+'fiv�ri,w:r'.lr�i,:r►i'd.;t;•::�'v"'�ti irv':YJ'Yiv rs-=�"rJ�'�.;�q''�5""1o.Yti`$R'��'sar'�'�,re+. �ti+ti;'�''''"�'=-�'`"4{ '".•,:rr-w�`'��.,:a�ar.. •+r..�--- w•.w ,:'Nw� COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION 773 —16r— Oay FOR SEWAGE DISPOSAL SYSTEM PERMIT APPLICATION 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. E .) ` ,PA,� T y,�,� Mailing Address , .goy Cay State Zip Code 17,2 2 Tel phone oyl NCAO 101,rV1 /�, a U/ -Job Property AddressI VA. C 'Cf- r-com- tuagy LA 'Legal Description of Properly. (Lot. PM. TR),f`` Cee y 6k& �e. 6), 1V z 'Assessor's Parcel No Water Agency or Well UseolPermitDtPCase#L[J Lo<t Sae 77 toos5�{„ SF . MH site Preparation Etc. Signatu. py of Apt Date The above information must be verified from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE t• Initial Date Certification of Existing S.D. System required. 1:1 Yes ZNWO�l-�� Uh WQCB Clearance required. ❑ Yes WIN o i 1 Soils feasibility report required. ❑ Yes ®O Special feasibility boring report required. ❑ Yes 0 No Detailed contour plot plans required. ❑ Yes f7 No" 1 Staff Specialist approval required. ❑ Yes ©NO Lot Inspection Date Soils/boring report by— Project # Date -d. / , Soils Map Page Soil Type Approved by Date (� " J~ Type of System: {i No. of Bedrooms (1) Septic Tank Soil Rate Required , ElExisting L`New ❑Additional ❑Replacement ,° u�Gals. (21'teach line sq. ft. (Bo) ttom ch area Sidewall allowance ft . rock/ Sq. Ft. Install Lines) Ft. Long, Ft. wlct th min. inches Leach bed Sq. Ft. of bottom �' ©"N/A per running ft. rock below drain lines area Leach lines/bed-special design for slope: A licable (3) Pit Diameter No. Pits Pit BI / ^^��(( Seepage Pit total depth "' � 9 � ' N/A Overburden factor = ® 6' p� i Max. allowable depth �D t /L-� liLr�c/•- • ,t? ,� � ' 9....., /_2.�...�^��.G'�ls" r �i�F� • j'/'7° r� � t� r� �'-w�� �2.v'i� ,O l.(/�-�t This application is a prove enied for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements set forth in Section 8 a ove. A building permit isnecessaryfor the installation pf the above -designed system. (1 � Septic tank and sewer lines must be 50'•from any wellst f /0, (2 Leach lines must be 100' min. from any wells including expaysli"ion area �4�'"'" (3 Seepage pits must be 150' min. from any wells including expansion area ,i'!t �.. -�.., ✓�,tr�,{�� , ,_ G.v. y� , it 1� .0 r ij s /f �Y/ /1 L GAJ �J A -e-A-1 .!J • it^f✓ Signature of Health Official �• / n / " //� Date g ( Q :,,i• i'Y.2.!� b �N r."sem--4P•.o. -� 4'.�E-1-..... ,.fl..s RECEIPT NO._�! d District: ❑ Riverside EDInd ❑ Hemet Distribution: WHITE—Office file YELLOW—App DOH SAN 122 (Rev 8187) Issued by- /% Date !/ -/5- eff ❑ Perris ❑ Rancho Calif. ❑ Blythe znt PINK—Bldg. Dept. GOLDENROD—Pending File I {o 41. OFR \ A �" • V OFFICE OF E. LEON SPAUGY CO�INISiIO`EA s AGRICULTURAL CONIMISSIONER ,(I JAMES 0 WALLACE 0 p t� AN v ASS:S;A',t COMMISSIONER V - . ^'CLEMENT .-� WEIGHTS Ec MEASURES BENVENISTE SEALER 49-613 Ilwy 86, Suite B-12 J�,,,••'� s9 'Coachella, CA 92236 q r 9, 619-342-8.291 DATE l S� 9 CASE NO. 1? d s Off' ge c Miu, DEVELOPER'S NAME: PIOXC4 _L;� ADDRESS: 7/. wy- Y'1�:11 � �► 9 227a TELEPHONE:. (6 t j )• 3 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 fran plant material listed, this office must be notified immediately. Thank you for protecting and preserving the Coachella Valley's pest -free environment. Agricultural Cannissioner s Office cc: Indio and Riverside Office