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003525 (SFD)Building 53-630 tiro z . Address Mailing Address City Contractor -Pecs Address - Same ' City State Lic. & Classif. Arch., Engr., Designer Address LA IZIp .a P.O. BOX 1504 No. 00352.5 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Zip Tela City 328410 Lic. # 680 Tel. BUILDING: TYPE CONST. OCC: GRP. A.P. Number Legal Description 6e IMffI,. Ta AM-41c> f -Witt nr- Sq. Description d m� `�4_ y Sq. Ft. 1453No. No. Dw. Size - Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ 44nt 1 City Zip State 20-39 .1 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 ^.•- !., Front Setback from Center Line .. .. ... SIGNATURE-�. Ne DATE 'OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the followin972.700 reason: (Sec. 7031.5,Business and Professions Code: Any city or county ,which requires a EStlmated Valuation ' • ��� - PERMIT AMOUNT perm: to construct, alter, improve, demolish, or repair any structure, prior to,its issuance also requires. the applicant for such permitto file a signed statement that he is licensed pursuant 4o• • the provisions of the Contractor's License Law, Chapter 9. (commencing .with Section 7000) of ' Division 3 of the Business and Professions Code, or.fhat.he is exempt therefrom, and the basis' for, the alleged exemption. Any violation or Section 7031.5: by any applicant for. the applicant We civil penalty,of not more than rive hundred dollars ($500). ' ❑ I, as owner of the property, or my employees with wages as their sole compensation, will Validated by: . ' plan Chk. Dep. p S2,50.00subjects Plan Chk. Bal. r► 4 G. a 4 4 e 81 Const. ��.� - • - do :fie 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 ; Mech. - '��` 0. builds or improves thereon and who does such workhimself or through his own employees, provided that such improvements are not Intended or offered for.sale. If, however, the, building Electrical - '6.27' or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did. not build or improve for the purpose of sale.) Plumbing _ 105 • 010 ` ❑ 1, 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 or 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 l am exempt under Sec. B: 8 P.C. for this reason S. M.1;,:" ':, 5.50 Grading 20 „ Driveway Enc. 0 . DO _ Date Owner Infrastructure 1,7320.00— r 732.50 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 • 6]0 a (r CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE REMARKS 6 01i I r i ; a �:.:� r' fa !- - � 3._ 1-.• (This section need not be completed if the permit is for one hundred dollars ($100) valuation or lel 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. �• f f'YI,'�±f ` I(' P jsjc 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. ZONE: BY: Minimum Setback Distances: ' 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, Civ&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 HARD COPY 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 Issued by: Date 1? 16 Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ 2ND FL. SQ. FT. POR. SQ. FT. ® GAR. SQ. FT. ® CAR P. I SQ. FT. WALL SO. FT. ® SQ 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 ROUGH PLUMB. FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GAS (ROUGH) LAUNDRY TRAY AIR HANDLING UNIT CFM HEATING (FINAL) 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. SQ. FT. ®c BATH TUB BOND BEAM SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL LUMBER GR. SQ.FT.GAR ® 3/ac HOUSE SEWER FRAMING FINAL INSP. 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 10210ROUND PLUMBING — UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADEN ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. t, GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. 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 y f/ REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING , o �I MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTIONer CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS. GARDEN WALL FINAL 0 Z O P U W Cn Z O U W r� Y W Q W cr U Z O 1= U W U) COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION t� PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM 'M- r - 1,--,d - j o `% (�t y Applicant: Submit this form with four copies of a scaled plot plan (1.20 scale) drawn to County specifications required on the attached check list. A non-refundable filing fee of $40 is required when the application is submitted. Check must be made payable to the County of Riverside. Building Department Application Log # Name (Owner. Agent. Contractor, Etc.) Mailing Address Cdy State 7 Zrp Code Telephone 'Job Property Address r ity ' Legal Description of Properly(((Lol PM TR) "Wey}�,E/LF .Assessor's Parcel No Water Agency orrlwNl' •G�P ,f' Use of Permit �., Planning Case Of Lot Size t p G �4�- �"_ A tc. SFO. MH Site Preparation Etc.— Sfgnature-of 'Applicant Date ' Signature-of -The above information must be verified from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE Initial Date Certification of Existing S.D. System required. El Yes ®Nom WOCB Clearance required. ❑ Yes ® o+� 1 Soils feasibility report required. ❑ Yes © No E� Special feasibility boring report required. ❑ Yes Z Nee 1 Detailed contour plot plans required. ❑ Yes 21 Nor' Staff Specialist approval required. ElL"J Yes No Lot Inspection Date Project # Date Soils/boring report by Project !� Soils Map Page 4P f Soil Type( �'r C Approved by =��'.` Date '�— Type of System: V No. of Bedrooms (1) Septic Tank Soil Rate Required ❑ Existing O New ❑ Additional ❑ Replacement + b G+s i / Gals. (2) Leach line sq. ft. Sidewall allowance co Install.,—Line(s) Ft. Long, Leach bed Sq. (Bottom trench area) ft. rock/ - Sq. Ft. _Ft wliie, with min. inches Ft. ofbottom per running ft. O N A rock below drain line area Leach lines/bed-special design for slope: (3) Pit Diameter No. Pits Pit BI Seepage Pit total depth " Applicable—'5' O & / Max. allowable depth N/A Overburden factor r This application is,-:ppp_iDvedAtiecl4or the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements set forth in Section B above. A building permit is necessary for the installation of the above -designed system. l�( 3 Septic tank and sewer lines must be,50' from any wells ­r (2) Leach lines must be 100' min. from any wells including expadslontarea �t3)� Seepage pits must be 150' min. from any wells including expansion area GUSignature te-1 of Health Off c al a Dae -A f RECEIPT NO. 2"A District: ❑ Riverside If Indio Distribution: WHITE—Office file DOH SAN 122 (Rev 8187) Issued by Date/ I 7 -,IE ) r ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe YELLOW—Applicant INK=Bldg. Dept. GOLDENROD—Pending File L ry � O' F.R f , OFFirE OF t E. LEON SPAUGY ti ... s n r x Q +k Com"IS10`ER AGRICULTUFZAL,C0;�1M15510NE1� :. „ s P PIES 0 'WAILACE AS SPAM COMN!SSIONER V ... , '�j r" `_ WEIGHTS L'C�NIEASI'JREs ' ` 'IlCdE`-IE;NT'BE•WtNISTE ' k SEALER r 49-613 Hwy y86, Suite ;B-1.2 �`,�`��•�..,,t�•� r' Coac1►ella,=.CAf X922:3,6 r� q'r<9 aQ y . 6.19-14.2- 82.91 DATE / 2 - 'L., I <= 8 7 t CASE -'NO. .z DEVELDPER' S'' AME ADDRESS. SS 3 r _l_75-ce�� J. , TELEPHONE:`(;6 /,C/)' ss 6:y'-, Do Y6, S/3 - 6 9.01' -Dear Developer* Aftereviewing your landscap ng}pI' r all plant material,listed is not in violation: of quarantine>laws governing the Coachella Valley 4If- subs fitut „ do occur,;'and they d Aler`.frc' plant material listed, this; office must .be, notified immdi.ately. "i �, "• ' Thank •you for protecting and.presery ng e Coachella Valley spelt -free environment: t Agricultural CoEmus 016nek's Office . cc: Indio and Riverside Office ' jet.• ..~ lav' ;� . - y F" i4.. ,. a _,..st -.. a.9-+,,.: 'ea. :?' 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