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04690 (SFD)•f444 046S0 P.O. BOX 1504 Building 52- 665 PamireZ 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner Coachella Valley Land BUILDING: TYPE CONST. OCC. GRP. Mailing Address247 $• Tahquitz waty #2 A.P. Number 778-2PI-020 City Zip Tel. Palm Springy �22�2 j22-1020 Legal Description Contractor Project Description * • • Starr Construction Address Ate?? + City Zip Tel. - State Lic. City & Classif. 3$7934 Lic. # ,$95 Sq. Ft. 1410 No. No. Dw. Arch., Engr., Size Stories Units ' Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. 4280 Garage City Zip State 1701 61 wood f@ITl e 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 Prdfessions Code, and my license is in full force and effect. ..�.. i, a.., .i 1'+'r C)//i14,S' _SIGNATURE Y / DATE OWNER -BUILDER DECLARATION Estimated Valuation 1 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 - 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 plan Chk. De �++� for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit Plan Y subjects the applicant to a civil penalty of not more than five hundred dollars ($500). Plan Chk. BBI. ❑ I, as owner of the properly, 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 ti Professions Code: The Contractor's License Law does not apply to an owner of property who Const. 4U builds or improves thereon and who does such work himself or through his own employees, Mech. ". 1414 provided that such improvements are not intended or offered for sale. If, however, the building �y ^� or improvement is sold within one year of completion, the owner -builder will have the burden • w, of proving that he did not build or improve for the purpose of sale.) Electrical I 1. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 105 A 00 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. 1. i [36 such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - Grading asM • V id ❑ 1 am exempt under Sec. B. & P.C. for this reason Driveway Enc. .}# Date Owner Infrastructure ►. 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 3800, Labor Code.) Policy No. Company ❑ Copy is filed with the city. 0 Certified copy is hereby furnished. TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE y. (This section need not be completed if the permit Is for one'hundred dollars ($100) valuation 0 11tylkx �S� ` 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 Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. Front Setback from Center Line Rear Setback frons 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 OR This is a building permit when properly filled out, signed and validated, and is subject to 1 t10FINAL DATE INSPECTOR J expiration if work thereunder is suspended for 180 days. d I f I 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 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 W $ 2ND FL SO FT. R POR SO FT. a GARSO. FT. fp CARP. SO FT. ff1 WALL SO. FT. SO. FT. rpt ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE Not to be used as property tax valuation SLAB GRADE FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTOXDISH) APPLIANCE DRYER AA65WER OR SEP I1' GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED DUCT WORK LAUNDRYTRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. ITEMP 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 @- I' c SEWAGE DISPOSAL BOND BEAM SO.FT.GAR (g JV;c HOUSE SEWER GRADING cu. yd. $ plus x$ 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 8 AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK FORMS AA65WER OR SEP I1' 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 /T r r U (/( ,�jG�� e A` p REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR- GAR. FIREWALLW(OT RING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES11NITIALS GARDEN WALL FINAL Ic M 100 Z O 1— U w U) Y Q W Cr • COUNTY OF RIVERSIDE, DEPARTMENT OF HEALTH p ENVIRONMENTAL HEALTH SERVICES DIVISION 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 specifications squired on the attached check list. A non-refundable filing fee of is, required when the application is submitted. Check must be made payable to the County of Riverside. Building Department Applicallon Log # Name (Owner. Agent. Contractor. Etc.) Mailing Address --"17 L-' Tr���Q�:.ir'z w 009 •{ jf" � City t�A.0 of Soe%.�c s State Cf',4 Zip Code �! Z Z G v Telephone 3 z Z —/ o� _ 'Job Property Address N 4.4 "City or` .:mmpnrt 'Legal Description of Property (Lot. PM. TR), -A5 i%� .f "�2 G G a/>y► AAs ay.,I%rA iCaT �. .(�L .�/.5 •c% Ldv� > lc 'Assessor's Parcel No 12�vT.,�+!eUa C V W Use of Permit / t ?SCt-/-+P18nrnng Cax M • Lot Size i 77.3- a V - Z o / S r -a .d- T SFD. MH Site Preparation Etc 5F/) ✓ X /00 Signature of Applicant Date 'The above information must be verified from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE �,In�iti�al Date Certification of Existing S.D. System required. ❑ Yes WQCB Clearance required. ❑ Yes t Soils feasibility report required. ❑Yes N Special feasibility boring report required. ❑ Yes ufl� V Detailed contour plot plans required. ❑ Yes�lO� Specialist El Yes f No Lot lias4ection Date Staff approval required. Soils/boring report by / Project # Date Soils Map Page -2 / oil Type Approved by 1��� Date r) Ap /i Type of System: V No. of Bedrooms (1) Septic Tank Soil Rate Required ❑ Existing ©<New ❑ Additional ❑ Replacement 3 h- a/ -Gas. `� � /C>�a,, (2) Leach line sq. ft. Sidewall allowance ft. Sq. Ft. InstallLine(s) Ft. Long, Ft. n. inches L�abed Sq. Ft. of bo�oma (Botto 4enc�) rock/ ft. ❑SNA wi�tta. rock below drain lines ............ R area per running Leach lines/bed-special design for slope: (3) Pit Diameter No. Pits Pit BI Seepage Pit total depth ti/ter Applicable N/A l.�P Overburden factor NMI- E61641"'� /LLQ T Max. allowable depth�i3 ' This application is proved/' nred�for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements Seth in Section a ova. A building permit is necessary for the installation of the above designed system. (1)� Septic tank and sewer lines must be 50' from any wells (2) Leach lines must be 100' min. from any wells inclu"8l expajsto ata �, x �>; c L Zz"� CC -2 / s 1 ) Seepage be 150' from including pits /mustmien. any wells n area 711 !ee!x)Sansio /,4 T • 1._ of Health Off cial t! De SignatureOfficial RECEIPT NO. ! I Issued by— Date / ;=7 District: ❑ Riverside ❑ Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File DOH -SAN -122 (Rev. 4/88) L !ti , -6, jA Of R� { « , V o1FIf.E OF E..L`:ON SPAUGY � o. f �.�trigSilO`Eq AGRICULTURAL 1'COti1MISSIO.NCIZ DAMES O WALLACE AND U.. ASSIST NI rhW.nccIUIEP. {� { WLIGI'I I S & MEASURES CLE�IEr1 6E`VE!vISTE VG SEALER , 49-613 Ilwy 86, Suite 8-12 -ft �.,q� 'Coachella, CA 92236 r v, a 619-342-8291 DATECASE NO. IL��y rt Q DEVELOPER'S NAM i STA R R e,toAJ aT'lea GT/ -,c, AJ ADDRESS: —.. 4! J r.��-IQct r z vL�A y 2 PALM 5912 i,U4�2,� TELEPHONE t Ca/ `; I 3 2 21 " %, 2, Q Dear Developer: After reviewing your landscapuig plans, all plant niaterial. listed- isnot in violation of quarantine laws governing the Coachella Valley. 'If substitutions do, occur and they differ frun plant noterial listed, this office alust be notified immediately. Thank you for protecting and preserving the Coachella Valley's pert -free environment. Lk Agr' ultural Camnissioner's office cct Indio and Riverside Office 'n