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08757 (BLCK)4P. O. BOX 1504 N o . Building 78-105 CALLE ESTADO Address 53-810 Ca ranza LA QUINTA, CALIFORNIA 92253 Owner Address P.O. ilk -1v x City lZip Tel.. factor P.O. Box 1124 p I Tela .PRI-x7n State Lic. City & Classif. 13 '127235 Lic. # Arch., Engr.; Designer Address I Tel. 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 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, alter, 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 (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 rot 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.) O 1, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professicns 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.) ❑ 1 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 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 1 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. i 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. �• //, oif� t� Signature of applicant + r- !'ter j .A'f/ :.a Date i� f''✓/Y _Mailing Address City, State, Zip r• d JILDING: TYPE CONST.' OCC: GRP. P. Number .774-161-0051 88757 Legal Description Project Description Sq. Ft. Size 1578 No. Stories 1) No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ rmit inc3udAp 170't of fnncA PArtslrit fines not ine,l"da bloc t wails or 1=xao 1 l . Estimated Valuation PERMIT..AMOUNT Plan Chk. Dep. 250..00 Plan Chk. Bal.2Ar%QA Const. Mech. 42,00 Electrical 1260 Plumbing 1391 AA S.M.I. 0 Grading 0 Driveway Enc. 0 Infrastructure q k 2-A=4 r TOTAL3364 f REMARKS ►ext Y -Y ,M Y YS Y Y'tii.. i\ a9 a wl' y w 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 NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS A.C. UNIT COLL. AREA SLAB GRADE / �.f YARD SPKLR SYSTEM 2ND FL. SO. FT. BONDING HEATING (ROUGH) MOBILEHOME SVC. BAR SINK POR. SO. FT. ® SEWER OR SEPTIC TANK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS FOUND. REINF. DRAINAGE PIPING CAR P. I SO. FT. METER LOOP HEATING (FINAL) WALL SO. FT. REINF. STEEL DRINKING FOUNTAIN SO. FT. ® URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation WATER HEATER FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LUMBER GR. LAUNDRY TRAY AIR HANDLING UNIT CFM FINAL INSP. 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 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SPARK ARRESTOR SO.FT.GAR ® 3/.c HOUSE SEWER GAR. FIREWALL 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 / 3 �; GROUND PLUMBIN&//�Wl UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE / �.f Ak 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 APPJEGUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP. GRADING cu. yd. $ Plus -X$-=$ LUMBER GR. FRAMING FINAL INSP. ROOFING VENTILATION / O/ /i/j�/ REMARKS: FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL '��� /�� P.O. BOX 1504 APPLICATION ONLY Building �� ^ � / � �f^U� ZA 78 105 CALLE CALIFORNIAESTAD9 Address , LA QUINTA, ORNIA 92253 Owner — I, , . Mailing~' Address /^ a / / iZ 17-1g Tel. State LiC. ity & Classif. 2 2 - �' Fic.# Arch., Engr.,�% Designer / , Address / Tel. '.. + c r City ^ Zip State Alter ❑ n Lic. # LIG N ED CONTTOR'S DECLARATION I hereby of i at I a}I ed under p sionspf Chapter 9 (commencing with Section 7000) of ivisj n of oft i j • ess aniPro1i�s�Code, and my license is in full force and I hereby affirm that I am exempt frdm th6,gontractyrs License Law for the. following reason: (Sec. 7031.5,Buslness and Professions Oode�l"ny 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 (commencing with Section 7000) of .Division 3 of the Business and Professions Code, or thathe 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 or 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.) ❑ 1 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 copy thereof. (Sec. 3800, Labor Code.) Policy No. Company ❑ Copy is filed with the city. 0 Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (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 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 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 Ihereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, C/O 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. I agree to comply with all c fy 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 BUILDING: TYPE /CONST. /' OCC. GRP. A.P. Number T-COa , /(c .� Legal Description Project Description ZONE: BY: ell Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Sq. Ft. Size No. Stories Q 11 i NoDw. / Units � A New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ �2P/Uh2t d12(•�•U �� 7,9 .1 Estimated Valuation i� PERMIT - AMOUNT Plan Chk. Dep. J S'O. 00 Plan Chk. Bal. Const. Mech. , av Electrical 02 6 • D Plumbing 3r7. 6D S.M.I. . o Grading �p ---- Driveway Enc. Infrastructure .QE t ne �,2 S o A C 40-.) i_ -;AS? ' 0 TOTAL tS H i MAL i 20.UU '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 r FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE GROUND PLUMBING NO. ELECTRICAL FEES NO. PLUMBING FEES $ ^7 �f 0 06 HEATING (ROUGH) UNITS 3 SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK IST FL.5777V SQ. FT. ® / 7D GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) 2ND FL. SQ. FT. GROUT WATER HEATER SERVICE YARD SPKLR SYSTEM �+ POR. SQ. FT. ® WATER SYSTEM MOBILEHOME SVC. _$ LUMBER GR. BAR SINK FINAL INSP. GAR. SQ. FT. ® O�AQ POWER OUTLET ROOF DRAINS REMARKS: CAR P. SQ. FT. VENTILATION DRAINAGE PIPING WALL SQ. FT. FIREPLACE SPARK ARRESTOR DRINKING FOUNTAIN SQ FT ® GAR. FIREWALL LATHING URINAL MESH ESTIMATED CONSTRUCTION VALUATION $ INSULATIONISOUND WATER PIPING FINISH GRADING NOTE: Not to be used as property tax valuation FINAL INSPECTION FLOOR DRAIN CERT. OCC. MECHANICAL FEES FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD GARDEN WALL FINAL SIGN 7i WASH ER(AUTO)(DISH) APPLIANCE DRYER / GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM Z KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC '7- WATER CLOSET 2 COMPRESSOR HP Ab POLE,TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER 2 BOILER B.T.U. SQ. FT. ® c BATH TUB 2 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c 3 SEWAGE DISPOSAL SQ.FT.GAR ® 3/ic HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE � PE�LECT.FEE PERMIT FEE r� DBL TOTAL FEES MICRO FEE MECH.FEE PL. (.FE CONST. FEE SMIFEE PLUMB. FEE da ,58/,�0o p y STRUCTURE PLUMBING 0 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.IEOUIP. 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 SIGNATURES/INITIALS GARDEN WALL FINAL ■ Q Z O W to co .Z O _b W CA)' U Z b W U) Z O t W Cr COUNTY OF RIVERSIDE ENVIRONMENTAL HEALTH SERVICES DIVISION r -. _; ��00 PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM Applicant: Submit this form with four copies of a scOed plot plan (1-20 scale) drawn to County spaculations as Indiep' a on the ate .tihed chwJm lit+t. A non-refundable filing fee (see below) is required when the application Is submitted. Chock must be 1, sde payable ?o the County of Riverside. Approval of this application shall remair, valid for a period not to exceed one y" Iron. doto of approval. VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG # q lvGl� Agent C or, Contact Penson Phone + Addrs & Firmaip Owner �- Mailing Address R o c x. 772 / l../� 0A �� A, 972 City I State Zip P cAdd Legal Description Prop. (PM, ) it c 7i Lot Sizefor A n I Use of Permit P/P, CU, etc. Other '7 ' moo Q.V. W tY 9r5 "Dwelling, Srfe Prep, e SVTf6 of Applicani Deft CATEGORY: REV CODE,,, --FEE--., CATEGORY: REV CODE FM 64 SUBSURFACE DISPOSAL 123d $ 57.00 J ) ❑ SITE EVALUATION UPON REQUEST 7349 $ 43.00 ❑ MULTIPLE PARCELS WITHIN SAME �* "" ' (NO PLOT PLAN) LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348 $ 17.00 a. 1 at 4 Parcels (Each) 1238 $ 57.00 (Less than 1 year) b. Each Parcel after 4 7344 $ 24.00 ❑ PRELIMINARY ELECTIVE 7352 $ 23.00 ❑ Rereview (2nd review same parcel) 7344 $ 24.00 EVALUATION (Attach DOH SAN 53) ❑ Site Evaluation in Conjunction with ❑ HOLDING TANK 7351 $ 47.00 Critical Area 7348 $111.00 O ALTERNATIVE/EXPERIMENTAL 7345 $222.00 ❑ Site Evaluatbn Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $ 87.00 J 1N,1/1 L DATE Holding Tank Agreements Completed ❑Yes N0 .. Certification of Existing S.D. System Required ❑ Yes No_ WQCB Clearance required. (Attach Form ❑ Yes 0 DOH SAN 007, Santa Ana Region Only) ' Soils Percolation Report Required. ❑ Yes — Special Feasibility Boring Report Required. ❑ Yes Detailed Contour Plot Plans Required (1. to 5 ft. interval) ❑ Yes— (DOW ❑ Yes Slaff Specialist Lot Inspection Required ❑ Yes No Lot Ins0ection Date Sella boring report by Project 0 _-- Date _ Soils Map Page _ Sol Type __ Approved by Date . : . cF Syebme Type S;SEerrr(ej No. Dwelling Units l 1 / (1) Septic Tank SO Ram _ reeee/Sersd ❑ yW Ing Tank ❑ Existing Bedroo n i, ahl%lMcp J— P'Fiew ❑ RepksoerwntQpn�r.lrcFx. 0c1 /�'�°`��,'^. Leech Line Sq. FL Skw"Il allowance ImQt Lx*s) It long ft wide with Leach Bed sq. K trench area R rock/ sq. IL per running tL min..�m��iscbrock below drelnlines or N pg�lom area Leachiines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Seepage Ph T [moth (TD) ,?7) " C� Applicable %�� .moi UIo6 + Inlet (Bq / ( Max. Nlowaab Depth N/A �_ Overburden factor / T No. 2 System 1111A REMARKS: � -a,4444 Cocke ba -&a Z 17 64 This application i9•JCPPR6VE6Wgor the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated nrk the accompa.NAIWTen, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the above -designed system. No construction is permitted in the required reserved 100% expansion area. �+N Septic tank and sewer lines must be 50' minimum from any wells qi/ 0 ?, Leach lines must be 100' minimum from any wells, including expans' res wells, including expn area` /0 ,• /-4. - /L /� VC4^14-41- k-0 ,_ , Seepage pits must !: ?50' minimum from anyaro . �� , � � �f ( �7f C/ �V - `C) l Signature of Health Officially -'w Vt/ i J Qatr� ✓ 7 r � RECEIPT NO. 6 -3O / Issued By �- Dated DISTRICT: ❑ Riverside, Iffs''Ind-io ❑ Hemet 17 Perris ❑ Rancho Calif. ❑ Blythe DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records bl Z