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05614 (SFD)4 P.O. BOX 1504 N o . 05614. Building 53195 RUBIO78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner Coachella ValleyLandMailing BUILDING: TYPE CONST. OCC: GRP. Address 247 H. iehquiitz tq� 2 7y�i-�i3 -023 A.P: Number City Zip ]Te -l. Lot 11 Blk 177 unit 1$ Fortis S. rings 82262 61�%3Z 2-W20 Legal Description Contractor Starr Constmctiou •� Project Description SFD Address SElt'ie City Zip Tel.' State Lic. City & Classif. 387934 Lic. # 895 sq. Ft. 1410 No. I No. Dw. Arch., Engr., Size Stories Units Designer New EN Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. 428 sq>`i8'ce fogs garage City Zip State 170 feet 6 -foot wood fence Lic. # LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section eT000) of Division 3 of the Business and Professions Code, and my license is in full force and SIGNATURE DATE OWNER -BUILDER DECLARATION Estimated Valuation 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 00 permit to construct, after, improve, demolish, or repair any structure, pnor to its issuance also requires the applicant for such pemu7 to file a signed statement that he is licensed pursuant to PERMIT AMOUNT the provsions of the Contractors license Law. Chapter 9 (commencing with Section 7000) of D v don 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. 250.00 subjects the applicant to a civil penalty o1 not more than five hundred dollars (S500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 212.59 do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 55E.-00 Professions Code: The Contractors License Law does not apply to an owner of property who Cn bludds or improves thereon and who does such work himself or through his own employees, Mech. 53.50 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 li1�i�:S.1 of proving that he did not build or improve for the purpose of sale.) ` ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 157..50 struct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law �A does not apply to an owner of property who buftds or improves thereon, and who contracts for S.M.I. 5.39 such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) " Grading 20._00 ❑ 1 am exempt under Sec B. & P.C. for this reason Driveway Enc. 201" Date Owner Infrastructure 1,679.85 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. TOTAL r CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (Alis section need not be completed d the permit is for one hundred dollars (5100) valuation , ' �` � •' `� or less.) 1 certify that in the performance of the work for which this permit is issued, I shall not employ anyperson in any manner so as to become subject to the Workers' Compensation Laws of California Date Owner N017CE TO APPLICANT: n, after malmg this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Compensatim provisions of the Labor Code, you must forthwith oonwy 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, CivifCode.) Side Setback from Property Line Lender's Name Lenders Address This is a building permit when property filled out, signed and validated, and is subject to FINAL DATE INSPECTOR expiration if work thereunder is suspended for 180 days. 4/6/89 1 certify that I have read this application and state that the above information is correct. Issued by: Date Permit 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 Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES UNDERGROUND A.C. UNIT COLL. AREA IST FL. SO. FT. ® $ UNITS PLUMB.7/f, 6 BONDING HEATING (ROUGH) YARD SPKLR SYSTEM 2ND FL. SO. FT. ER OR SE8k� ROUGH WIRING 7 MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) METER LOOP POWER OUTLET ROOF DRAINS GAR. SO. FT. ® GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SQ. FT. ® WATER HEATER SERVICE FINAL INSP. DRINKING FOUNTAIN. WALL SQ. FT. WATER SYSTEM FINAL INSP. GRADING cu. yd. $ -Plus-X$-=$ URINAL SQFT ® FRAMING �% ESTIMATED CONSTRUCTION VALUATION $ R0:OFING<J `` 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, 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. SQ. FT. RESID ® 1+/a c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER FINAL INSPECTION 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 GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE PLUMB.7/f, 6 BONDING HEATING (ROUGH) STORAGE TANK FORMS ER OR SE8k� ROUGH WIRING 7 DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. 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. R0:OFING<J `` �'� 1 JL✓ 1 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH AVUMLATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESJINITIALS GARDEN WALL FINAL Q Z 0 W :` _1 A 11111L. 1'4 t COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH -f Assessor Parcel No. �7� a , ENVIRONMENTAL HEALTH SERVICES �° • yy_ Q7` — Q'�t 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. VERIFY ITEMS IN SECTION A FROM BUILDING 8 SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'* Agent Contractor, Contact Person CL��4Cerf., .�t_c SI. . Q,rJ� Phone 3z.3 Address 8 Phone ` y 7 t. 7'�l��r�.rz vc�.4 Owner. , _ _. , �. ,. - Phone Mailing Address City State Zip Job Property Address � Legal Description Prop. (PM, Tract Lot)x Lot Size Water Agenc,�Wll- Use of Permit P/P, CU, etc. A r t i;a/iyi Other "f etc. ���1 �} ,�.. i{• / ' `> %Signature Of Applicant y� `Date CATEGORY: REV CODE FEE CATEGORY: REV CODE -'FEE'. 111/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 Crttk:al Area .l 7346 $86.00 ❑ ALTERNATIVE/EXPERIMENTAL 7345 $13200 ❑ Site Evaluatidn Lot Less than SYSTEM 10,000 Sg44Ft. 7347 $86.00 INITIALDATE Holding Tank Agreements Completed ❑ Yes p -No! ..` Certification of Existing S.D. System Required ❑ Yes No 1 WQCB�jClearanoe required. (Attach Form ❑ Yes © No 1 DOHtSAN 007, Santa Ana Region Only) Soils, Percolation Report Required. O Yea Special Feasibility -Boring Report Required.Yes 0'f�d Detailed Contour Plot Plans Required (1 to 5 ft interval) 11 Yes 0 No'''/ Other ❑ Yes 0,/�Nd Staff Specialist Lot Inspection Required ❑ Yes ❑ No Lot Inspection Date Solis boring report by Project # Date Map Page f / k � Soll Type Approved by ,•- Data 0 Soils .: No. of Systems 6 q Type of System(s) (❑ Holding Tank ❑ Existing O'frew ❑.Replaoertrent Na Dwelling Units /) Bedrooms, Fixture-Mritts (1) Septic Tank Soil Rate Grease/Sand "Grease j Gals l ,,e) leach Line Sq. Ft Sidewali allowance Insopt Lines) R long ft wide with Leach Bed sq. It. Bottom` trench area a ft rocW ' sq. R min. below dralnlines or +•• of•bottorn area per running it , ©!NA Leachiines/bed special design for slope: Applicable"� (3) Pit Diameter No. Pita Pit Below' Inlet (Bq. Seepage Pit Total Depth �✓%: Other. "ti,,� N/A L/ Overburden factor /' O ' IiI 6 //!�� / ' Max. Allowable Depth No. 2 System �/ r i REMARKS: C/�/% /'tri/.c,acc/;�� .'7.G'7J�•`�j��/) i(%v"�%d/GI�-y.� t'G -t.L.. C•, This application is9A0R6VE'DENIEDfor the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accomp ie- - , -t=. l 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. A (t Septic tank and sewer lines must be 50' minimum from any wellsq/ %U f''t� /`'�'��; up., � "-" ' s� f (2� Leach lines must be 100' minimum from any wells, including expanstoy area' ,.a Y, - _ .�. t{l Seepage pits must bd, 150' minimum from any wells, including expansion area / ;; l/j y ; , L2 S = . If! DateA.4d Si nature of Health OfficiaAmy ••, : y , .,t ,l "Cr(ll Date RECEIPT NO. x "3 Issued By DISTRICT: ❑ Riverside, O'rindio ❑ Hemet Q Perris ❑ Rancho Calif. ❑ Blythe DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW --Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records 1/1 01