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04334 (SFD)T4ht 4 4 Q" Og334 P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 52T983 Car- anza LA QUINTA, CALIFORNIA 92253 Owner Mailing gac1').e la Valley 'Land C:C?i3Yany BUILDING: TYPE CONST. OCC. GRP. Address 247 Be Tahf,,,,Uitz 'Way '�2? A.P. Number City zip Tel. Palo ;:,?Xi.r>�r� 97262 ?�� 2 1020 Legal Description Contractor St:*:rx Coa 8 l.�xtsctzon e_,! a Project Description n Address S a i-1 City Zip Tel. State Lic. City �3 ra y� & Classif. Lic. # Sq. Ft. # No. No. Dw. Arch., E=ngr., :r 2 Size 1, Stories Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. ) f C3:r 'f:C3 ai zalit,: City Zip State f �� Jt',�azLjrr Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (cnmmencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in lull force and effect. DATE OWNER -BUILDER DECLARATION Eslirnated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following � 7 2 5 3' 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 Us issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT 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 for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit Plan Chk. Dep. subjects the applicant to a civil penally of not more than five hundred dollars ($500) ❑ 1, 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, Bussness and Const. 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. 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 17 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- Plumbing 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, • _ such projects with a contraclor(s) licensed pursuant to the Contractor's License Law.) Grading ,_ - ❑ I am exempt under Sec. B. & P.C. for this reason Driveway Enc. 2 , Date owner Infrastructure U + -'► WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a Certificate of consent to self -insure, or a certificate of Worker's Cam pen sation Insurance, or a certified copy thereof. rSac 3800, Labor Code.) Policy No. Cbmpany ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS 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 ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances: 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 P art 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 t have read this application and state thal 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 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 !p S UNITS COLL. AREA 2ND FL SO FT. C OUGH PLUMB&L YARD SPKLR SYSTEM BONDING MOBILEHOME SVC. BAR SINK POR SO FT. a SEWER OR SEPTIC TANK OUGH WIRING`j a n rN Z O H U W U) W. Z O U LU rn Z1 W U) P COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION 179,- J.21- Ido J 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 specifications required on the attached check list. A non-refundable filing fee of $[/37 is required when the application is submitted. Check must be made payable to the County of Riverside. *Ti Building Department Application Log # Name (Owner, Agent, Contractor, Etc.) Mailing Address vt/ A y -ft 2 ,M/9 2 , 01 Sr a r,� ,� r r t3 A) o? S/7 A& 7.4� Q u r ~r z City State Zip Code Telephone Job Property Address :C111y�or•Cpmrennity,— Legal Description of Property. (Lot, PM, TR)��L�c�« �. AJ Z A © �4JT �4 o T 3 BLK /SG Ll.d .> / Assessor's Parcel No. 'Water Agency Well ��}} ✓ �' Use of Permit(lMt�D�./��/ "` Pl 4AIng Case # Lot Size t — t 3 7 I— pJ � SCS s`a yr /0 �` lrw fa =,,, SFD, MH Site Preparation Etc. Signature of Applicant Date *The above information must be verified from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE Initial ° abate r Certification of Existing S.D. System required. ❑ Yes 2�'�Nce WQCB Clearance required. ❑Yes Soils feasibility report required. ❑ Yes [21 N Detailed boring report required. E) Yes ❑�rNb Detailed contour plot plans required. ❑ Yes .I�'J No Staff Specialist approval required. ❑ Yes -nNo Lot Inspection Date Soils/boring report by Project # Date Soils Map Pager Soil Type / /- Approved by /< f All L Date Type of System: Y No. of Bedrooms (1) Septic Tank Soil Rate Required ❑ Existing ®`New El Additional ❑Replacement 3 i'Y- Gals. (2)'Leach line sq. ft. Sidewall allowance Install Line(s)-Ft. Long, v Leach e'd Sq. (Bono-trenc_ h area) ft. rock/ Sq. Ft. F_t wd6-with,min. inches Ft. of bottoM per running ft. ❑+ ,N/A rock below drain lines i'' area Leach lines/bed-special design for slope: Applicable - (3) Pit Diameter No. Pits Pit BI J Seepage Pit total depth �cp N/A�-� Overburden factor- actor^1 r l Max. allowable depth 4^1-/ J .-IVY - w.. A _ 7i -0 e �/7.L! ���(� �i� / /....�4-....- r.�Pt �Gf�.r..�C�u Gin-��A_ '�.,.+-✓ /ai1�G�C/ ✓.//�-lGGt.4. This application iQpprodgpied for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements set forth in Section B above. A building permit inecessary for the installation of the above -designed system. I (1� Septic tank and sewer lines must be 50' from any wells (2) Leach lines must be 100' min. from any wells including expansion`ar'ea-I 4�- L(3-1 ud• in�g expansion area eepagepsmusemn.romanywesncv„e., y �' ` :z.l� k' " 3,�'�f-c-e k •�� , s�- Signature of Health Official ate_ RECEIPT RECEIPT NO. -3,K3 6 Issued by 1� Iaz- Date District: ❑ Riverside Rr.Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe Distribution: WHITE -Office file YELLOW -Applicant PINK -Bldg. Dept. GOLDENROD -Pending File DOH -SAN -122 (Rev. 6/86) «, !:J DNIE CASE [K). DEVELOPER'S MtE: 5 *,4 1rw A)&4t-LA_ c4 -&j ADDRESS e �-� % % ~f} �q i T L WAN 2 TELEPIIONSE ((o►( j ,Z2 -- IaQL'� 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 frm plant material listed, this office must be notified humdiately. Thank you for protecting and preserving the Coachella Valley's pest -free environment. Agr ultural Ccamt ssioner's Office cci Indio and Riverside Office ()I 11r,E. OF E. LEON SPAUGY :1 AGRICULTURAL COMMISSIONER 1 AND 1n�lE.S 0 WALLACE O -. ,�. M ASSISIAN► r:$yM%11SSI0\(R " ; ' ti ►-) I, AGI I I S & MEASURES CLEMENT I3E`VEhISIE SEATER 49-613 IlwY 86, Sulte I1-12 Mq Corchelln' CA 92236 619-342-8291 DNIE CASE [K). DEVELOPER'S MtE: 5 *,4 1rw A)&4t-LA_ c4 -&j ADDRESS e �-� % % ~f} �q i T L WAN 2 TELEPIIONSE ((o►( j ,Z2 -- IaQL'� 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 frm plant material listed, this office must be notified humdiately. Thank you for protecting and preserving the Coachella Valley's pest -free environment. Agr ultural Ccamt ssioner's Office cci Indio and Riverside Office