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05382 (SFD)Building Owner TUC=_SE4i' LEy T4`�p 4 4 Qum& P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Address 41-625 'HECTIC ST, G-1 CityZip JTel. - Contractor , ress Tel: State Lic. City & Classif. D-1 248823 1 Lic. # 856 Arch., Engr., Designer Address Tel. City( Zip ( State I Lic. # LICENSED CONTRACTOR'S DECLARATION 1 herebyaffirm that I am licensed under provisions of Chapter 9 (commencing with Section 7of Division 3 of the Business and P tessionst��yCode, and my license is in full force and effect. .. s. A 1_1 I E. , If. to 1 i 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, after, 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 (co mmenchig 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 lire hundred dollars ($500). O 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 safe. II, however, the building or improvement is sold within one year of completion, the owner -builder wig have the burden of proving that he did not build or improve for the purpose of safe.) ❑ 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.) ❑ I 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 of Worker's Compensation Insurance, or a certified copyithereof. (Sec. 3800, Labor Code.) Policy No.Company - ,N it Copy is filed with the city. ❑ Certified copyehereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (E100) 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: lf, 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 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 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 No. 05382 BUILDING: TYPE CONST. OCC: GRP. A.P. Number i7—i�2--`3tifi Legal Description lnt 21 MR 157 jtA rritialitA 719 Project Description Sq. Ft. No. No. Dw. Size 1420 Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 221,63 Const. 540,.50 Mech., 53.50 Electrical 108.28 Plumbing 166.00 S.M.I. 5,53 Grading 20.00 Driveway Enc. 20.00 Infrastructure 1,720.00 TOTAL REMARKS te�t'• ��{ �,,}}y] }f5 y 4 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 2/22/la9 Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL SQ. FT. ® 2ND FL. SQ. FT. @ POR. SQ. FT. ® GAR. SQ. FT. ® CAR P. SO. FT. ® WALL SQ. FT. SQ FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS YARD SPKLR SYSTEM MOBILEHOME SVC. BAR SINK IPOWER OUTLET 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.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 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/4c I HOUSE SEWER I GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE EPL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK ND PLUMBINJd'0 UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE 9 ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS / SEWER OR SE PQ E� ROUGH WIRING DUCT WORK ROCKSTORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPIEQUIP. REINF. STEEL GAS (FINAL) %/HEMP. POLE—� GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM $ GRADING cu. yd. plus x$ =$ LUMBER GR. FINAL INSP FRAMING 5 G FINAL INSP. ROOFING p� — f L `�� / r REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING V1 &INAL INSPECTION� CERT. OCC. FENCE FINAL INSPECTOR'S SIGNA7URE5lINlTIALS GARDEN WALL FINAL of)Buena Engineers, Inc. M81 Courcy ClubD&e. Suko 4 Bermuda Dunes, CA 92201 •(Big) 345-15881328-9131 Gent Name C,Wnt Adit-- Gent Phone DATE 3-;2+-�l ao6 NO. wr NO. rRoaECT 52- Xbo $2 - 95O 1,.yNrt]A 0ilw i LOCATION J U�. DRY DENSITY WDLL 2 MAXNAIM MA>OIAJM DRY DRY DENSITY 'DENS" CONTRACM -rar S f OWWR . VWAYWR TEMP. C'rfAR oe¢ eat AM PM SFNT AT SITE 1� Z `t% ,y. tl lot, 2 TEST NUMBER TEST LOCATION 11 +� wr NO. ELEVATION FIELD TESTING REFERENCE CURVE MD1SiW comes % DRY DENSITY WDLL 2 MAXNAIM MA>OIAJM DRY DRY DENSITY 'DENS" OPT/aim MOISTURE CONIENT Z `t% ,y. tl lot, 2 3 b�QS� /2.6 Jud• � .:` �% q .3.0 o5•�i 52-9G5 S2-fr95 52-83$ _ :F EwstiA�j EXisridy Exisii�j . • v .. D Y A✓imlbA C'rteAq R sz-ho a 5Z-uo 524+10 O Ul p O REMARKS: d ' .W++ 1W, 7f 12 o p 24V- h If C G AC s rs1,JfeC s'6(,&fr FIELD REPORT CUENT REPRESENTATIVE SIGNATURE TECHNICIANS SIGNATURE 485 UEVEIAE'Elt'5 tJN•fEi Ut I Ir,E ar AGRICUL I URAL CONNISSIONLIt AND WI:IGI I I'S b.. 1ALASURES 49-613 Ilwy 116, Sulte I1-12 'Cuncl,elln, CA 92236 G 19-342-11'19 L E. LEOM SPAUGY co•.�•n�au�.[n ZANIES o WALOCE �SStS1A�1 � •).'•1•d,ttll)`f.P. CLEMEYI CEWENISIE st. an >\UUItESS [ a4/: �/��� -i- e -A TELL•"N IUIJE e ( &/M `_� - 3� Dear Developers After reviewing your 71.1 plant material listed is trot 3.tt violation of quarantine laws tjoveEnlltg the Cuacltella Valley. if substitutions do occur and they differ frcm plant iwiterial listed, tills office must be notified itlsl>ediately • . 'Pltaltic you Cor protectitty and pl;eserviny the Coachella Valley's pest -free enviroletcnt. 11�j--Uj-tUj7j rcaC n ssioner s Ul[ice ccs Indio autd Riverside U[ [ ice -,a l—sem (f:CL t ? 1['�1"►;-:, .#�t — _.syr^tir•rk�ejti j7"'Y� ull! j c' r RECEIPT NO. UJ l Issued By U `(I Date— DISTRICT: ate DISTRICT: ❑ Riverside, C Indio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK- Bldg. Dept GOLDENROD - Plans/Records 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 check list. 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 VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG # Z Q Agent, Contractor, Contact Person �^ � � �+ Phone Address & Phone H WOwner 70C - <�i r^, /e Phone Mailing Address -) . /State Zip Job Property Address Legal Description Prop. (PM, Tract, Lot) Lot Size Water Agency/Well Use of Permit P/P, CU, etc. Other �Px100 0 Dwelling, MH Site Prep, etc. I C_ a -� Signature oLApplicant Date ( CATEGORY: REV CODE FEES CATEGORY: REV CODE FEE BSURFACE DISPOSAL 1238 X007' ❑ SITE EVALUATION UPON REQUEST 7349 $42.00 O MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) m LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348 $11.00 Z Q a. 1 at 4 Parcels (Each) 1238 $45.00 (Less than 1 year) H 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) 0) ❑ Site Evaluation in Conjunction with ❑ HOLDING TANK 7351 $45.00 Critical Area 7346 $86.00 ❑ ALTERNATIVE/EXPERIMENTAL 7345 $13200 ❑ Site Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $86.00 \IN-fi-IAL DATE S Holding Tank Agreements Completed ❑ Yes ❑ No y es Certification of Existing S.D. System Required ❑ Yes I I No ` WQCB Clearance required. (Attach Form ❑ Yes I I No DOH SAN 007, Santa Ana Region Only) I Soils Percolation Report Required. ❑ Yes 13 No Special Feasibility Boring Report Required. ❑ Yes ID No I Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes No 1 Other ❑ Yes NO 1 Staff Specialist Lot Inspection Required ❑ Yes No y Lot Inspection Date Soils boring report by O VN y� `� Project # Date Soils Map Page Sol Type Approved by Data U No. of Systems Type of Systems) No. Dwelling Unita (1) Septic Tank Soil Rate Grease/Sand 21 ❑ Holding Tank ❑ Existing Bedrooms, Fixture Units I AGreases kcp Q 9'�New Replacement 1�< MCN I CY-0 c 4 r ' /Gal Gal U LLI (2) Leach Line Sq. Ft Boft"ng Sidewall allowance /sq. Install Lines) ft. long ft wide with Leach Bed sq. ft/ �am R PRer�wi min. inches ro drelnl'rnss or of bottom ❑ :NA Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Seepage Pit Total Depth Other. Applicable Inlet (BI� \ y Max. Allowable Depth N/A Overburden factorz__ ❑ 5 X6 (� No. 2 System REMARKS: ��Gi.q kClS-n (00 4 t P6 V\ 5 Vn G>•�p This application is(AP O D/DENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated 0 on the accompanied plot plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the ZO 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 U (2) Leach lines must be 100' minimum from any wells, including expansion area OW (! 3),) Seepage pits must 50' r6nimum from 07ny wells, including expansion area WA%% ,, t �c-� wG v('�c." 1 `�C• fh Signature of Heartofficial L' Date 2 r i ✓ c' r RECEIPT NO. UJ l Issued By U `(I Date— DISTRICT: ate DISTRICT: ❑ Riverside, C Indio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK- Bldg. Dept GOLDENROD - Plans/Records 4 r KEN , - ,`a ! / . -✓` +; t t -; j�,� i C RECEIPT NO. I -A-7 Issued By rr Date— DISTRICT: ate DISTRICT: ❑ Riverside, 11�1/ Indio ❑ Hemet q Perris • ❑ Rancho Calif. ❑ Blythe DOH SAN 122 (Rev. 5/88) DISTRIBUTION:' WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records •t Asasswrs Pan* No. COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH _ / ENVIRONMENTAL HEALTH SERVICES PERM 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 check list 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 VERIFY ITEMS IN SECTION A FROM BUILDING b SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG' 4t Z O Agent, Contractor, Contact Person Phone Address & Phone H W • ,U)(veIC&k_ ` Owner - � T-7 !eY Phone 3���1z �1 Mailing Address -? 4 —05-0 /144n,aD Ct.t e-(9-. " City State Zip Job Property Address Legal Description Prop. (PM, Tract, Lot) v Lot Size Water Agency/Well Use of Permit P/P, CU, etc. Other Dwelling, MH She Prep, etc. t 'Signature ofy plic:ant Date CATEGORY: REVCODE FEE SdLRFACE CATEGORY: REV CODE FEE DISPOSAL 1238 x$45.00~' ❑ SITE EVALUATION UPON REQUEST 7349 $42.00 ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) LAND DIVISION 11SEWER/SEPTIC VERIFICATION 7348 $11.00 Z Z O a. 1 at 4 Parcels (Each) 1238 $45.00 (Less than 1 year) H 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) CO ❑ Site Evaluation in Conjunction with ❑ HOLDING TANK 7351 $45.00 Critical Area 7346 $86.00 ❑ ALTERNATIVE/EXPERIMENTAL 7345 $13200 ❑ Site Evaluatkm Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $86.00 INITIAL DATE ( ` Holding Tank Agreements Completed ❑ Yes Ij No `� / '` ? Z-0 Certification of Existing S.D. System Required ❑ Yes © No WQCB Clearance required. (Attach Form ❑ Yes No 1El DOH SAN 007, Santa Ana Region Only) l Soils Percolatlon Report Required. ❑ Yes ID No j Special Feasibility Boring Report Required. ❑ Yes O No +S Detailed Contour Plot Plans Required (1 to 5 R interval) ❑ Yes No 1 O Other ❑ Yes 0 NO 1 Staff Specialist Lot Inspection Required ❑ Yes 13 No LotlnspecUon Date Soils boring report by fa i, h �- Project # v Data Soils Map Page SON Type Approved by Date U No. of Systems Type of System(s) No. Dwelling Units (1) Septic Tank Soil Rate Grease/Sand Z Holding Tank ❑ Existing Bedrooms, Fixture Units Grease% I"ntop ��New ❑R gplaceme ►t t�.��il ►�1!\' 1tX_ia U �W (2) Leach Utne Sq. Ft Bottom Sidewall allowance - Install Lk*s) /R long ft wide with Leach Bed sq. ft. j� roc sq. ft min. inches nock dminlines or of bottom area running per ng JJ1/ ❑ ,NA — Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Seepage PR Total Depth Other. Applicable Inlet (BI) v Max. Allowable Depth N/A Overburden facto ❑ 5 0/6 ` ( 9 No. 2 System REMARKS: I l 3ti`� r r�. tiA 1 r -, �" C, This application is,APPRbVED/DENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated 0 on the accompaniedpotl plan, usingthe requirements set forth in SECTION C above. A building g permit is necessary for the installation of the Oabove -designed system. No construction is permitted in the required reserved 100% expansion area. C(1) H Septic tank and sewer lines must be 50' minimum from any wells U�(2) Mach lines must be 100' minimum from any wells, including expansion area L(3)j Seepage pits must m_-inimum from any wells, including expansion area e {{{tbe 150' Signature of Health Official Date ✓ c� C RECEIPT NO. I -A-7 Issued By rr Date— DISTRICT: ate DISTRICT: ❑ Riverside, 11�1/ Indio ❑ Hemet q Perris • ❑ Rancho Calif. ❑ Blythe DOH SAN 122 (Rev. 5/88) DISTRIBUTION:' WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records •t