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06402 (SFD)4 P.O. BOX 1504 Building 53-785 Pari ez7&105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner Cowhella ®alley Land Address 247 E. Tahquit2 Way #2 City Zip Tel. . Palo sprines 92262 1 3221020 State Lic. City & Classif. 387934 Lic- # 895 Arch., Engr., Designer Address Tel. City I Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70pp) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE PATE OWNEWBUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Buskress and Professions Code: Any city or county which requires a permit to construct, after, improve, demmafsh, or repair any structure, prior to its tssuance also requires the applicant for such permit to we a signed statement that he is licensed pursuant to the provisions or the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Protessions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any vkdation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a cW penaGy of not more than rive hundred dollars ($500). O 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, Suisness and Professions Code: The Contractors 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-bulider will have the burden of proving that he did not build orrnprove 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 briproves thereon, and who contracts for such projects with a contractors) 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 canpleted ff the permit is for one hundred dollars ($100) valuation or less.) I 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. Date (honer NOTICE TO APPLICANT: It, after making this Certi6xWe of Exemption you should become subject to the Workers' Compensation provisions of the tabor 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 property 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' No. 11LDING: TYPE CONST. OCC: GRP. P. Number 774-161-416 Description Project Description SFD 06402 FINAL DATE INSP CTOR 9/26 89 Issued by: Date Permit Validated by: Validation: Sq. Ft. 1410 Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ 428 square feet gara¢e 170' 6' goad fence Estimated Valuation $76,36) PERMIT AMOUNT Plan Chk. Dep. $250.00 Plan Chk. Bal. r Z 1 2. 9 Const. 536.133 Mech. 53.50 Electrical 06.41 Plumbing 157.50 S.M.I. .5.39 Grading 23.00 Driveway Enc. 20.00 Infrastructure 1,679.85 TOTAL V-3,041.24 REMARKS Atq�rl�'.'fi jftr3''.'•i' 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 INSP CTOR 9/26 89 Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS SOLAR SETBACK1 YARD SPKLR SYSTEM 2ND FL SQ. FT. UNDERGROUND A.C. UNIT COLL. AREA MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® ROUGH PLUMB. BONDING HEATING (ROUGH) POWER OUTLET ROOF DRAINS GAR. SQ. FT. ® t ffi SEPTIC TA ROUGH WIRING. DUCT WORK DRAINAGE PIPING CAR P. SQ. FT. ® GAS (ROUGH) METER LOOP DRINKING FOUNTAIN. WALL SQ. FT. URINAL SQ. FT. REINF. STEEL ESTIMATED CONSTRUCTION VALUATION $ 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 BOND BEAM GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED WATER SYSTEM LAUNDRY TRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP 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 SQ. FT. ® c WATER HEATER MAX HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1% c SEWAGE DISPOSAL $ -plus-x$-=$ SQ.FT.GAR ® V4c 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 R AIR COND. SOLAR SETBACK1 UND PLUMBI UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS t ffi SEPTIC TA ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING LUMBER GR. FINAL INSP. �7 T% cu. yd. FRAMING / FINAL INSP. $ -plus-x$-=$ ROOFING e/, / REMARKS: VENTILATION FIRE ZONE ROOFING: FIREPLACE SPARK ARRESTOR 1 GAR. FIREWALL LATHING i w/V ' 9 MESH U INSULATIONISOUND / /b \ FINISH GRADING b � 1 FINAL INSPECTION 1 CERT. OCC. FENCE FINAL [NSPFCTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL w COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No. ENVIRONMENTAL HEALTH SERVICES'. �7y " — Q l *o 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. & SAFETY APPLICATION• -BUILDING DEPARTMENT APPLICATION LOG # ,f Agent, Contractor, Contact Person- J' Phone Address & Phone �r,9/Zg­ r,0 x-) -s-r-;-- we., -/o Owner Phone 3 Z 2 /o zo Mailing Address ZY / ' ?'. �✓ cQ v rT z t llA- Y� L City State Zip Job Property Address Legal Description Prop. (PM, Tract, Lot) T --,o Siie/'J� s. L�+a SPto2.�a» ws 378S 'RiYIi� L . Loi V l-q[.A� z3s'dAfl-;-Z'2. Lot Size . Water Agency/Well Use of Perm ft P/P, CU, etc." '' Other S"'p x / ®o C L/ 1A), a" TJ5 A-0 % y -r Az r� i'' Dwelling, MH Site Prep, etc. C-.�a.�q® x✓ SAII /moi . Signature of Applicant Date CATEGORY: REV CODE FEE/ 6- CATEGORY: REV'CODE FEE 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 Holding Tank Agreements Completed ❑ Yes No Certification of Existing S.D. System Required ❑' Yes No f 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 E No Detailed Contour Plot Plans Required (1 to.5 ft. interval). - O Yes E No Other ❑ Yes No Staff Specialist Lot Inspection Required ❑ Yes C No Lot Inspection Date r� Soils boring report by Project # Date Soils Map Page. Soil Type Approved by Date . No. of Systems Type of System(s) No`Dwelling Units (1) Septic Tank. Soil Rate Grease/Sand ❑ Hogjding Tank ❑ Existing 1:3 -New ❑ Replacement \(Bedrooms Units �/ /va t C, Grease Intcp .Fixture {� 7 Gal Gal (2) Leach Line Sq. Ft. Sidewall allowance Install Line(s) ft long ft wide with Leach Bed sq. ft.' " Bottom trench -area / ft rock/ sq. ft. per running e-- ❑ NA min. inches rock below drainlines or of bottom area Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below' Seepage Pit Total Depth -Other:_ a Applicable N/A Overburden factor 5 ❑ - v� h �l Max. Allowable Depth '2 0 No. 2 System REMARKS: ` y� This application is APPROVED/D IED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompanied` plot pan, 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 (2) Leach lines must be 100' minimum from any wells, •including expansion area 3)" Seepage pits must. be 150' minimum from any wells, including..expansion area: " Si nature of Health ,Official—' �"`^�` - ! - Date y "