04714 (SFD)-- --------------------------
4
04 714
P.O. BOX 1504
Building $4-840 CI'iPitll> X4 78 105 CALLE
Address LA QUINTA, CALIFOORNIARNIA 9 92253
Owner
.- Alco Dovelopwint " BUILDING: TYPE CONST.—OCC. GRP.
Mailing -
Address 69_730 RjfhV49 111 0118 A.P. Number 774-295-005
City.r Zip Tel.
. .. o.
Contractor
;tiiRta
Address',
- lZip I Tel.
State Lic. City
& Classif. 387296 Lic. # 1034
Arch., Engr.,
Designer
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 BusiAess;and Professions Code, and my license is in full force and
effect. b,,, t,{ .- 1'; f • 1 `
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 rile 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 Cade, 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
in
or offered for sale. If, however, the building
or improvement: is. sold within one year of completion, the owner -builder will have the burden
or provingdhathe:did not build or improve for the purpose or sale.)
❑ 1,," dwner:oPthe 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 projecfs with a contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 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 z"w
❑ 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, alter making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions or 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.
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
Legal Descrlpion
Project Description.i?
Sq. Ft. 1514 No. _ No. Dw.,
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$$1 i294
PERMIT
AMOUNT
Plan Chk. Dep.
0250.00
Plan Chk. Bal.
0 75.45
Const.
379,00
Mech.
36.00 ,
Electrical
76.95
Plumbing
105,00
S.M.I.
5.91
Grading
20.00
Driveway Enc.
20.00
Infrastructure
TOTAL
02,764.72
REMARKS
00'.11t i3 4' 'rjCxit l �!'x~rtRfi.A.7�1t:
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 DATEINSPECTOR
10J21/a8
Issued by: Date Permit
Validated by:
Validation:
• 1
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO F1 y S
UNITS
A.C. UNIT
COLL. AREARADE
ESE
- -
YARD SPKLR SYSTEM
2ND FL SO FT. a
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR SO FT
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
POWER OUTLET
ROOF DRAINS
GAR SO. FT. fix
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO FT. 6
GAS (FINAL)
WALL SO. FT. a
TEMP. POLE
DRINKING FOUNTAIN
GROUT
URINAL
SO. FT. a
SERVICE
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTONDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LUMBER GR.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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 @ I'A c
SEWAGE DISPOSAL
SO.FT.GAR ar 3/4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
FIRE ZONE ROOFING
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 .
CK - GG
OUND PLUMBI
,fr—/-�
UNDERGROUND
A.C. UNIT
COLL. AREARADE
ESE
- -
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
LUMBER GR.
FINAL INSP.
cu. yd.
AeFRAMING
FINAL INSP.
plus x$
_ $
ROOFING
�
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
'
LATHING
MESH
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
GARDEN WALL FINAL
Q
Z
O
U
W
U)
to
Z
O
U
W
W
T
Z
0
U
W
V)
ifR
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 #
Agent, Contractor, Contact Person
1t 7 I)NL1- mcm-k oow?
Phone
$ $�(`6l,
Address & Phone
1- 3v"p l�t,/l 111 531'E ttg
Owner
Phone
Mailing Address
City
State
Zip 1t
Job Property
+{Address A17n�Legal
A,<
Description Prop. (PM, TractLot) !`
��`0
s
��10 i A
Lot Size�Ae
I
Use of Permit P/P, CU, etc, I- A A/ JA
Other
i .x 11r�
Dwel gl nini� vIH Site Prep, tc.1-17 • r'
Signature of Applicant
Date
CATEGORY: REV CODE FEE
r CATEGORY: REV CODE FEE
l6 SUBSURFACE DISPOSAL 1238 $45.00
❑ SITE EVALUATION UPON REQUEST 7349 $42.00
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
a. 1 st 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 $86.00
INITIAL DATE
,/111"
Holding Tank Agreements Completed ❑ Yes 1 /•/f
Q'No'
Certification of Existing S.D. System Required ❑ Yes 04-
WQCB Clearance required. (Attach Form ❑ Yes E No
DOH SAN 007, Santa Ana Region Only) �*
Soils Percolation Report Required. ❑ Yes
Special Feasibility Boring Report Required. ❑ Yes ❑ NN
Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes 21
Other ❑ Yes EYNo
Staff Specialist Lot Inspection Required ❑ Yes O No
Lot Inspection Date
Soils boring report by Project # Date
�^�
Soils Map Page G Sal Type ( Approved by!'�- Date A;J -
No. of Systems
Type of System(s)
No. Dwelling Units(r)
(1) Septic Tank
Soil Rate
Grease/Sand
❑ Holding Tank ❑ Existing
3`New ❑Replacement
Bedrooms, Fixture-Idaits—
Qy
se Intcp
3
��/
G
(2) Leach Line Sq. Ft.
Sidewall allowance
—"—Gal-�
Install Line(s) ft. long ft wide with
Leach Bed sq. fL
,$otto� h area
ft rock/ sq. ft.
per running ft.
min. !!7! below drainlines or
o om area
Gi-NA
Leachlines/bed special design for slope:
Applicable/
(3) Pit Diameter
No. Pits
Pit Below
Inlet (BI)
Seepage Pit Total Depth
her.
Max. All IQ Depth
r
j f
N/A ✓ Overburden factors
6
!
gwb
Y
No. 2 System A11A
REMARKS: / i- Y-='/ C? _= t��? .� ".'�>G't ��c/l'�u Gn/jr� r Diel-
d
•'�aJ.t h: i /li. a�f �n '1-�Gl_.(CI'- si r"T �.ri� X./P'f' �%.�! if'/1 :.t i.f.! 1--.f�Y�C cilr_r./.l.uC�ii1A"
This application' APAPPROVE tED+for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompantea plan, 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.
Septic tank and sewer lines must be 50' minimum from any wells t ,,(p'U Yt�LrLeach
lines must be 100' minimum from any wells, including expansion rea /S
E(3)
Seepage pits must be 150' minimum from any wells, including expansion area',/,),t
)
f
�U- 'CSLt I /r�
Signature of Health Officials/(""'�`+� !�
RECEIPT NO. 416.7 Issued By 4 Date m
DISTRICT: ❑ Riverside, C3Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records
NA�,q
— 295F'05
DEVELOPER'S IWIEt
of I Ir E OF
AGRICUL I URAL CUNIHISSIONUI
AN
MAGI I I'S b MEASURES
49-613 Ilwy 06, Sulte 11-12
Conchel.ln, CA 92236
619-342-0291
E. LEON SPAUGY
CO'.t��tS?u)'.Etl
)ANIES O WALLACE
ASStStA.St 1: "I"115ctu"Ett
CLENIEv1 BENVENIS1E
SLAUn
CASE 11J.
TELL' N ZONE s , (61?) Z 8 ` 9fF IFG
S y -8'60 GL+,
bear Developer:
After reviewing your landscaping plans, all plant material listed is not 3.I1
violation of yuara)ttine Brous yc)verni.ng the Coachella Valley. if subsMutions
do occur and they differ [roil plant mAerial listed, tills office must be notified
itnitediately.
,Ili .mik you Lor protecUllg and ltceservillg the Coachella Valley's lest -free envirolnlient.
l�gricultural
cc: Indio and Riverside Office
Ir