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04830 (SFD)a 4 P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 53-545 Raitl. VeZ LA QUINTA, CALIFORNIA 92253 Owner Mailing OaChell a V9118Y !And BUILDING: TYPE CONST. OCC. GRP. Address 24 VE. Tah1 {' Z WAV 02 A.P. Number 774--161-023 City Zip Tel. knJ��YC� � �cri 92262 322 �32Q Legal Description Contractor Starr Construction Project Description A.V.D. .. . Address ` Sam City Zip Tel. State Lic. 387934 City 895 WX410.. No. No. Dw. Arch., Engr., Size Stories Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. 4.281 Garage City Zip State 170 X G o wood ;Qpnce Lic. # _ LICENSED CONTRACTOR'S DECLARATION I h&eby affirm that) am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division, 33 of=the Business and Professions Code, and my license is in full force and effect. tis�.LfC.sz'd' SIGNATURE [ DATE OWNER -BUILDER DECLARATION Estimated Valuation ry�s I hereby affirm that I am exempt from the Contractor's License Law for the following JW I HcS 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 AMOUNT requires the applicant for such permit to lila a signed statement that he is licensed pursuant to PERMIT the provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis $230000 for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit Plan Chk. Dep. $230 0 00 t� subjects the applicant to a civil penalty of not more than live hundred dollars ($500). Plan Chk. BBI. . v ❑ I, -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 Const. 31)34 .0C Professions Code: The Contractor's License Law does not apply to an owner or property who t t� builds or improves thereon and who does such work himself or through his own employees. Mach. e7 ani provided that such improvements are not intended or offered for sale. Il, however, the building or Improvement is sold within one year of completion, the owner -builder will have the burden Electrical 74.17 - of proving that he did not build or improve for the purpose o/ sale.) y ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 10 51 4 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,j, 5136 such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading ❑ I am exempt under Sec. B. 8 P.C. for this reason 20.04) Driveway Enc. 20000 Date Owner Infrastructure�I% 5 r WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to'r+self•insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof, 3800, Labor Code.) Policy No. Company ✓ % .C+A ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL � � p �i � . �.� � -5, ill--" el 'Pj CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE trr� e4i2;' { (This section need not be completed i/ the permit Is for one hundred dollars ($100) valuation '�lgdl�7i�+�di,ii r ,c + iTx10 or less.) b w vc..r .. I certify that in the performance of thg work for which this permit is issued, I shall not employ any parson 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 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, Civil Code.) Side Setback from Property Line Lender's Name Lender's Address FINAL DATE INSPECTOR This is a building permit when properly filled out, signed and validated, and is subject to �/ 1r expiration if work thereunder is suspended for 180 days. A I certify that I have read this application and state that the above information Is correct. Issued by: Date Permit 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. 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 F1 y S UNITS A.C. UNIT COLL. AREA ASLAB GRADE YARD SPKLR SYSTEM 2ND FL SO FT. a BONDING HEATING (ROUGH) MOBILEHOME SVC. BAR SINK POR SO FT. a SEWER OR SEPTIC TANK ROUGH WIRING POWER OUTLET I ROOF DRAINS GAR SO. FT. or GAS (ROUGH) METER LOOP DRAINAGE PIPING CARP. SO FT. 6 REINF. STEEL GAS (FINAL) DRINKING FOUNTAIN WALL SO. FT. a GROUT WATER HEATER URINAL SO. FT. • (d FINAL INSP. ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES LUMBER GR. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTOXDISHI APPLIANCE DRYER ROOFING GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED c / - y� 1 _ LAUNDRYTRAY 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 SPARK ARRESTOR SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 11A c SEWAGE DISPOSAL SO.FT.GAR (g 3/,c HOUSE SEWER MESH GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CKYEE CONST. FEE ELECT. FEE SMI FEE PLUMB FEE STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR SETBACK _� . GROUND PLUMBIN UNDERGROUND A.C. UNIT COLL. AREA ASLAB GRADE ROUGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK 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 J c / - y� 1 _ REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL THING MESH INSULATIONISOUND FINISH GRADING FI AL INSPECTION —/( CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL 7d RECEIPT NO. JV 7 Issued By /W Date�. �- � / i DISTRICT: ❑ Riverside; •❑ ,rn`dio ❑ Hemet'- c ❑ Perris ❑ Rancho Calif. ❑: Blythe_ DOH SAN 122 (Rev. 5/88) DISTRIBUTION:' WHITE - Office file YELLOW - Applicant PINK - Bldg: Dept GOLDENROD - Plans/Records ......Q. COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No. 7 7K ' ENVIRONMENTAL HEALTH SERVICES Ael — ® 2,3 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 checklist A non-refundable filing fee (see below) is required when the application is.submitted. Check must be made payabld to the County of Riverside. Approval of this application shall remain valid for a period not to exceed one year from date of approval. Q VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'tt Z Q U Agent, Contractor, Contact Person ) -Sil'�zl GAO 6]r-AZZI /DLJ Phone 32-z 2o Address & Phone W Owner, Phone Mailing Address 2 V7 r rOWOQ,/r'Ti WW City i� /Lj SlW/.c�G S State a-iq _ Zip y a'Z t, 'L Job Property Address 1S3 9 4 fWl 2 Legal Description Prop. (PM, Tract, Lot) , Ae 2 Lot Sizer ee SgQcy/Welt- Use of Permit P/P, CU, etc. t- 4 Llr n/7A Other /C. 1/au S'aY-40 ca Gj U 0a r4e/Z /ST12/QiT wet Pig H Site Pref, etc.u�f Signature o,(Applicant Date - CATEGORY: REV CODE FEE`_ :> CATEGORY:. REV CODE FEE ©' SUBSURFACE DISPOSAL 1238 5;O ❑ SITE EVALUATION UPON REQUEST 7349 $42.00 ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) Z LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348 $11.00 Q a 1 at 4 Parcels (Each) 1238 $45.00 (Less than 1 year) H , b. Each Parcel after 4 7344 $16.00 ❑ PRELIMINARY ELECTIVE 7352 $45.00 W ❑ Rereview (2nd review same parcel) 7344 $16.00 EVALUATION (Attach DOH SAN 53) W' ❑ Site Evaluation In Conjunction with ❑ HOLDING TANK 7351 $45.00 Cirttk:al.Area. „ 7346 $86.00 ❑ ALTERNATIVE/EXPERIMENTAL 7345 $132.00 ❑ Site Evaluation Lot Less than ' SYSTEM 10,000 Sq. -Ft. 7347 $86.00 INITIAL- b'°"(I DATE . Holding Tank Agreements Completed ❑ Yes BYNo.r Certification of Existing S.D. System Required ❑ Yes f7N WQCB Gearanoe required. (Attach Form ❑ Yes ❑' No ' DOH SAN 007, Santa Ana Region Only) Solis Percolation. Report Required. ❑ Yes ❑`No/ Special Feasibility Boring Report Required. ❑ Yes El No k �tt Detailed Contour Plot Plans Required (1 to 5 R interval) ❑ Yes Other ❑ Yes Staff Specialist Lot Inspection Required ❑ Yes No Lotlinspeclion Date ,e Soils boring report by' Project # Date Soils Map Page% r �` i 11- 1 % -06 Soil Type / , • Approved by /� Date !f U Z Q No. of Systems Type of Systems) t]�liolding Tank ❑Existing 21 New ❑ Replacement No. Dwelling Units 1 i Bedrooms Fbctare•UnMs 3 � D 2 iN �yA� V (1) Septic Tank q�� Id Soil Rate //�/ Grease/Sand Intcp • �fir! Get 2) Leach Line Sq. Ft Sidewall allowance Install �Line(s"'�) ft kxrg ft wide—with MactuBed sq. ft om trench area ft rock/ sq. R min. inch�es�ro k'b"bw' inlines or of bottom area per running It. NA �� l Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below SeepagePit Total D9pth / Other. Applicable r Inlet (Bq / N/A Overburden factor [�,/ 6 /!{ Max. Allowable 9epth VV No. 2 System n REMARKS:'i This application isROVFD EIJIEB-for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated 0 on the accompanied plot plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of }he O above -designed system. No construction is permitted in the required reserved 10.0% expansiont _ area. ` f 1) Septic tank and sewer lines must be 50' minimum .from any welIS4 I bof Leach lines must be too' minimum from any wells, including expansion. a S . rW lea , � (' Seepage pits must be 1,1550 minimum/from aan`yfwells,iincluding eexpansion re c�r'� 1 Gv�.Cvt7 Com. YY�c yrric ..�C Gi .vif� �. sC. f ^f��i�` (�JZ1� Signature of Health Official �. , , >>7 Date r RECEIPT NO. JV 7 Issued By /W Date�. �- � / i DISTRICT: ❑ Riverside; •❑ ,rn`dio ❑ Hemet'- c ❑ Perris ❑ Rancho Calif. ❑: Blythe_ DOH SAN 122 (Rev. 5/88) DISTRIBUTION:' WHITE - Office file YELLOW - Applicant PINK - Bldg: Dept GOLDENROD - Plans/Records ......Q. 1{ o�� r Ol llrE OF: :.u) E, LEON SPnUGY An nc�sicu.� I ulznt co�tMisstoNIz ,� s �1 �• • 1n�1E5 O NlnllACE r" AN U�SS�S:A�t r,�W•ucSiu�ER WEAGI ILS b.. MEASURES CLE�IEvT pE`vE!vlstE S[alErt 4'9=61-3 '11'w.yr'86, Oui'te._ D-1.2 ``•M u1",', - Mq.r °� -`6 cheCA"', 2236 619 3.42-8291 o • r , ��'�7 `�� .pG CASE DATE DEVELOPER' S' NAME l'rA' -7_7 1,DwESs t ft 7 J, Ie�Cc I T z vL'Ay '� Z J AJ TELEP1[ONE : (G/ `l 37 2 i� 2; c0 - Dear Developer: 7 >.� /� i' - e, 'Z 3 After reviewing your; lanlscapbiq plans, all: Slant, mater al listed is not in `' substitutions violation of ,quarantine 'Maws goveri 'b` ig fie :Coachella Valley. If do occur and theydlffer,>;fri�m`pla�rt n>rater. al listed, this- office must be notified immediately. . Thank you for pro tecting.ai d preservij-ig the.co6c1 elia Valley's pest-f•ree enviroirmnt. Agricultural. Gal u ssioler's .VEEce. cc: Indio and Riverside,Office; • B NO. py 79-811 Country Club Drive, Suite 4 -.. g'f"-z PROJECT Bermuda Dunes, CA 92201 - (619) 345-1588 328-9131 C/ LOCATION Z-1 OWNER Client Name. ... .... CONTRACTOR WEATHER TEMP. 0 at AIM Client Address a0 at PM PRESENT.AT SITE 5 Client Phone FIELD REPORT Ile, CLIENT REPRESENTATIVE SIGNATURE TECHNICIANS '3712 FIELD TESTING REFERENCE CURVE MOISTURE DRY MAXIMUM, MAXIMUM OPTIMUM, TEST TEST LOCATION LOT NUMBER No. ELEVATION CONTENT DENSITY DRY DRY MOISTURE % lbsiCu. ft. DENSITY % DENSITY Ibsjcb. ft.... CONTENT % Per%,hcl 112-7-3 -7" F 9. /30,0 REMARKsp--'--- o� /* - (A 16 1 P4 4a P, C'A kw$4- L 4 (A PH V7- —I -qve (� VT r Z �, si 9 /�-VT _� 90,C09 /14 /;,V;r!nom l Good FIELD REPORT Ile, CLIENT REPRESENTATIVE SIGNATURE TECHNICIANS '3712