04712 (SFD)- ----------
4 0471.2
P.O. BOX 1504
Buildingt, 78-105 CALLE ESTADO
Address _ 54-$8Q Carranza LA QUINTA, CALIFORNIA 92253
Owner r
Alto" DevelopmItit COM, BUILDING: TYPE CONST. OCC. GRP.
Mailing
Address � $9; 730 Highway 111, #118 A.P. Number 774-275-004
City , Zip Tel.
Raubbp H#aga 1 92270 3281= Legal Description
Contractor Project Description s`ni'p`
�L+t11;8
Address
s
City Zip Tel.
State Lic. �i79✓� City 1Q4 114
& Classif. Lic. # Sq. Ft. No. No. Dw:
Arch., Engr., Size Stories Units
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 full force and
effect..-, -- e I ",
SIGNATURE - DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm.thal.l am exempt from the Contractor's License taw for the following $01,294
reason: (Sec: 7031.5,Buslness 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 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 thathe 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. $2.30.00
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. $ 75.46
do the work, and the structure is not intended or offered `or sale. (Sec. 7044, Buisness and Const. 379 00
Professions Code: The Contractor's License Law does not apply to an owner of property who MAO
s
builds or improves thereon and who does such work himself or through his own employees. Meeh. AO
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 86a19S
of proving that he did not build or improve for the purpose of sale ) tui
O I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing x,05.00
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law 5.71
� y Y
does not apply, to an owner of property who builds or improves thereon, and who contracts for S.M.I. 5 • 1
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) g 20 0 00 .
Gradin is W
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc. 20400
Date Owner Infrastructure 7 s795►6U'
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
D Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL iZr<
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit Is for one hundred dollars ($100) valuation ; � �r t;vr� f Q'7 M1 -V 1 -4?fJ 14 , 1 r 1 k'
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, alter making this Certificate of Exemption you should become ZONE: BY:
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 INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to INSPECTOR
expiration if work thereunder is suspended for 180 days.
188
I certify that I 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
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING F[FS
IST FL SO FT rp $
UNITS
a
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL $O FT. g
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FTa
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GARSO. FT.
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO FT. ra
FINAL INSP.
WALL SO. FT. @
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
cu. yd.
$ plus x$
_$
URINAL
SO. FT. rat
FINAL INSP.
���FRAMING /Y' �
(
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
J
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOKDISHI
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
LAUNDRYTRAY
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID g t'A c
SEWAGE DISPOSAL
SO.FT.GAR'rg H c
HOUSE SEWER
/ /A
L_/_INAL INSPECTION` 4101vl
111
GAS PIPING
PERMIT FEE
PERMIT FEE
[PL.GK.;:EE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR
ffll��
A/C.FOUND PLUMBIN 3�i�
UNDERGROUND
A.C. UNIT
COLL. AREA
//SETBACK/z`
&14 LAB GRADE - aj
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 /Y' �
(
FINAL INSP.
ROOFING /—
f
J
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
SULATIONISOUND / 30 -
FINISH GRADING
/ /A
L_/_INAL INSPECTION` 4101vl
111
.CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
'
L7
,F:r..,+r-+.r„rcc. p ,'.`.� y' '•iaK^iK 'Two eyi� r'`r f i "'r . C`erwf-af �."Y`�4.-•3 t `ht y 7� t ���. -� r' w .ter,- . *a; :•'S ,
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 #
8 ,r
Agent, Contractor, Contact Person
ALLO UW)Fmo,7 CoW
Phone
WIM(f
Address & Phone
6.9-130 f \A IIB
Owner Ca
Phone
Mailing Address
Crtn
ti to
Zip
�j
Job Property Address �
A Legal Description Prop. (PM, Tract, Lot) 5< v,-ICAQ4
4C!
A
a7D
��' S�Sv/i,c
Lot Size
ater Agenc X11
Use of Permit P/P, CU, etc. A 0 ui /V7,1
Other
f
, o Dwelling„QMH
So X
Site Prep, etc.
Sign�'APPlicant
Date
CATEGORY: REV CODE FEE
CATEGORY: CATEGORY: REV CODE FEE
O” SUBSURFACE DISPOSAL 1238 5_q,D
❑ SITE EVALUATION UPON REQUEST 7349 $42.00
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
a. 1st 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
INITIAL DATE(
A,
Holding Tank Agreements Completed ,❑ Yes
Certification of Existing S.D. System Required ❑ Yes 12 No - i
/No
WQCB Clearance required. (Attach Form ❑ Yes
DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required. ❑ Yes 16No
Special Feasibility Boring Report Required. ❑ Yes o/
- Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes
Other ❑ Yes O/No .' '
" Staff Specialist Lot Inspection Required ❑ Yes 0 No +
Lot Inspection Date
Soils boring report by' Project # Date
Soils Map Page iq. 1 LL Date
Soil Type Approved by Date
'
No. of Systems
Type of System(s)
No. Dwelling Unitst1sf
(1) Septic Tank
Soil Rate
Grease/Sand
O Holding Tank ❑ Existing
❑Replacement
Bedrooms, Fixture Wntts*
/*4w
R
!7Intcp
eG_2
UJGal
al
�
r
(2) Leach Line Sq. Ft.
bottom trench area
Sidewall allowance
ft. ft.
Install; Lines) ft. long ft wide with
Leach Bed sq. ft.
& ttom
rock/ sq.
per running ft.
min. inch rock_ below drainlines or
area
Leachlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
Inlet (BI)
Seepage Pitotal Depth
`� �.?5I
Other.
Applicable %
/
I5W5_ C V" 6 s
�•
IIJ./
Max. Allowable Depth
N/AOver��bu//rden factor
No. 2 System /t/IA
REMARKS: Yi—tt�, �. �G� L . /"fir �(f ✓j +j :yam *,� �� t��.i
/AY.+%r i:l%••%/1 �.%� %%% i�%.F'! .I'C �C�(.•(... .i!✓!F /.*..•1•"./"��..f r.`G�7..1J ��Ir .. /,/'R.r.�...It•�J'
/
� � s
This application is �A: P�R�OVED -NIED-for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accomparne--Ippusing 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. ?
�.
1) Septic tank and sewer lines must be 50' minimum from any wells ! J
Is `/
(2) Leach lines must be 100' minimum from any wells, including expan
(2)
(3) Seepage pits must t�150' minimum m any wells, inc�uding expansion area!/�, ��� -1 !� fj't sr cz..,•a� s'<
1`
���t'Gl�.� ( 3 '�iT �' ✓%vu� f J..rs�r 6r.t
Si;_vl
nature of Health Official:C/!�(( >/G'� Dat
RECEIPT NO. W6 7 Issued By ` Date l0
DISTRICT: ❑ Riverside, C4/Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records
A4
0 111Ix" '
011 WE OF
AGRICUL I URAL CUNIMISSIONLIt
AND
MAGI I fS b MEASURES
49-613 Ilwy 06, Sulte 11-12 .
Conchel.ln, CA 92236
619-342-0291
IM /Q - s - CASE W. ' 9 -
DEVELOPER'S IWIEs
ADDRESSs
TELUN IONE s
Dear Developers;
6.9- 34 w rrr
E. LEON S11AUGY
co•a.n�;ur..cn
WMES 0 WALLACF
ASStStA�t /;•).••1••Oaclq�C�
CLEMEy1. CF`VENISIE
S[.ACCn
S
After reviewing your landscaping plans, all plant waterial listed is not
violation of quarantine 1OWS gvveiming the Coachella Valley. if substitutions .
do occur and they differ frun plant 11%.terial listed, tills office must be notified
ilnlndiately.
Th.mik you for prvtectialg 011d I)Leservil)g the Coachella Valley's fest-free ellvirotment.
Agricultural Canlu s i
is ULE ice
ccs Indio and Itiverside office
y