06214 (SFD)Building
Address 53-060 RaMIX09
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
i Chariac Tme.
Mailing
Address Fs �� BOX 59
City Zip Tel.
!La -Quiuta 97253 56471486
Contractor
General Contract Hana.nez$ant
Address
State Lic. City
& Classif. 524325 Lic. # 1235
Arch., Engr.,
Designer
Address I Tel.
City( Zip ( State I
Lic. #
_ r r
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
700 of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
_SIGNATURE DATE
OWNER -BUILDER DECLARATION
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, after, improve, demolish, or repair any structure, pdor 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 (commenclmg 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 dagars (S500).
❑ 1, 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 intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -budder wig have the burden
of proving that he did not build or knprove 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.)
O 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 i1 the permit is for one hundred dollars (5100) 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
aliforniaDateOwner
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
expiration if work thereunder is suspended for 180 days.
I car ity 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
No. 05214
JILDING: TYPE CONST. .P.11.- OCC: GRP.
P. Number 774-052--003
Legal Description
Project.Description
�•'�••
Sq. Ft. 1485
Size
No.
Stories -
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$81,952
PERMIT
AMOUNT
Plan Chk. Dep.
�2
Plan Chk. Bal.
S 230.24
Const.
�
g5j ,50A
Mech.
60.00
Electrical
109.12
Plumbing
154.5G
S.M.I.
5.74
Grading
20.00
Driveway Enc.
20.00
Infrastructure
1,805.67
17
TOTAL
$3,.213.77
--��� r �9` +fes
REMARKS R,r, .x an ti 44 •i n b e -112—nr� d +i
1 11,1 f AL 1 zyitfi ,7 . r f
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
024/89
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. I SQ. FT.
WALL SQ. FT.
FT ®
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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
rl(REINF. MP. POLE !0 CIS -
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
FINAL INSP. 12---Plus—x$—=$
SQ. FT. ®c
IWATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
HOUSE SEWER
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 — ��
ROUND PLUMBIf/
UNDERGROUND
A.C. UNIT
COLL. AREA
V SLAB GRADE —�
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP/0—A0
HEATING (FINAL)
OTHER APPJEQUIP.
STEEL
GAS (FINAL)
rl(REINF. MP. POLE !0 CIS -
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP. 12---Plus—x$—=$
FRAMING /2& Q
FINAL INSP.
ROOFING&4 _ /l
ry � 7
(vry,11"
5'
U fj
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
L /)y,
LATHING 'I DW4 I /'o
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL
)
q.w n t S�i"%i 'L` • T S.!
i 7' c�. F' w' 9l!^�:?Yip�i' y„eT �ap, p .
d^ �WI� 5..� _
, . - . � ..
A non-refundable filing fee (see below) is required when the application is submitted. Check must be made payable to the County of
, � .. • F
VERIFY .ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG '#
Agent, Contractor, Con ct Person
Phone
Address & Phone
Owner ' 'I
COUNTY OF RIVERSIDE DEPARTMENT OF.HEALTH Assessors Parcel No.
ENVIRONMENTAL HEALTH SERVICES 7711 xv
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 indicatk 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, Con ct Person
Phone
Address & Phone
Owner ' 'I
Phop
Mailing Address
City V
S to
Zip
Job Property Address ,
Legal Description Flop. (PM, Tract, Lot)
Rr
!,
Lot Size;'
Agency/Well
Use of Permit P/P, CU, etc.
Other
-,f//
JWa'ter
` "Jo
Dwelling, MH Site Prep, etc.
Signature of Applicant Y
Date
CATEGORY: REV CODE FEE r v
CATEGORY: REV CODE FEE
�1 .SUBSURFACE DISPOSAL f 1238 445.o6",, -i "'
�❑• SITE EVALUATION UPON REQUEST 7349 $42.00
<3 . MULTIPLE PARCELS WITHIN SAME f
(NO PLOT PLAN)
LAND DIVISION 1
❑ 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
'GI Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $86.00
r
INITI L v ATE
'
Holding Tank Agreements Completed _ "" ❑ Yes No�: '
Certification of Existing S.D. System Required ❑Yes No
WQCB Clearance required. (Attach Form ❑ Yes No
DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required. ❑ Yes No
Special Feasibility Boring Report Required. ❑ Yes C No
„Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes C No
\
Other ❑ Yes I No
StaffSpecialist Lot Inspection Required ❑ Yes I No
�.. Lot Inspection Date
by-��'
Soils boring repo y Project # Date
'`
Soils Map Page Soil Type Approved by Date
No. of Systems
Type of Systems)
No. Dwelling Units
(1) Septic Tank
Sal Rate
Grease Sand
❑ Holding Tank,, ❑ Existing
`-❑
Bedrooms, Fixture Units
G W60,,
/
New Replacement.
�A rttfi n,ak
c,
Gal
Gal
4t
(2) Leach Line . Ft.`-�
Bottom trench rea
Sidewall allowance .. --
1•` ft rocW� sq. ft:– ,,
Install Line(s) long ft wide with
min. inches rock below drainlines or
Leach Bed sq. ft1
of bottom area
Kiingf
❑ NA
/
�
Leachlines/bed special desig/for slope:
Pit Diameter
No. Pits
Pit Below
Seepage Pit Total Depth
Other.
Applicable
"b
'N'%16
Inlet (BI)
t
❑ 5
` '
I
Max. Allowable. Depth
N/A Overburden factor
No. 2 System
REMARKS: V\n0.+H�G
This application i`APP� ED/DENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompanied plot 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.
(Ll))
Septic tank and sewer lines must be 50' l minimum from any wells
(2) Mach lines must be 100' minimum from any wells, including expansion area
� F1 � 1,., ZZs. `amu,, _AA J
. n.d•.
(3 Seepage pits must be 1`50'' minimum from any well •including expansion area S
(,
T C4ku std'
U
Signature of Health Officiate-- G Date
RECEIPT NO. �' 2 Issued By C Date—
DISTRICT:
ate DISTRICT: ❑ Riverside, IX Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
{ DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records
Al
A eaarrar, <<�
1 11 u;E t)t E. EEW SPnt;r,Y
co .rn�ao .tn
nGlKUL I URAL COMMISSIWt" )AMES 1) V1M.UACF
AN 0 CIEMEN 1 F.14VEN151E
WI.1611 I'S b. MEASURES suattn
49-613 Iluy 06, Suite 11-12
M,I Y v. 1'eq� G 19-342-5'l91
c CASS 10-
DUE
IU.Ul1l'
bEVELOPER' S I'IN E Gia-Po�aL
ADDRESSt Q r
53-060 Aoe,
L)ear Vevelopers
lifter reviewing your 1a11c SC0111.1KI 1110113; tali 1110"1 11HtValle lis Jed substitutliolls.
violation of yuaralltine MWS klOvel-11111y th'e Coachella Y
do occur 011c1 they cliE[er [resn 1110111 1
1>:lterial listed, 11113 o[[ice must be ilotiEied
isnlp-diately. ,
ilc you for prvtectilly and 1lteservilly the Coachella Valley's fest-[ree eilvirotellent.
Thal y
n cultural Cuxultl a61erjs UL E ice
ccs 111dio Euld Riverside U[[ice