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14540 (PLBG)P.O. BOX 1504 Building 52-661 Ave. Bermudas 78-495 CALLE TAMPICO Address LA OUINTA, CALIFORNIA 92253 Owner Pedro Zamora mailing Address Same City Zip Tel. " S.a .Quanta, Cit 92253. Contractor Valley P1umbing''C©. Address. 46-•780 Clinton St. Y14io, CA Zip *2201 Tei 47-.3629 State Lic. city & Classif. 2730188 - Lic. # 101 Arch., Engr.; Designer Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 000) of Division 3 of the Business and Professions Code, and my license is in full force and a fact. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors 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 rile a signed statement that he is licensed pursuant to the provisions of 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 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 rive hundred dollars ($500). . O 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 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 -builder will have the burden of provi that he did not build or 'reprove for the purpose of sale.) 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) frcensed pursuant to the Contractor's License Law.) O'I am exempt un/Iderl1Sec- ^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.) i Policy N - Company Copy is filed with the city. O Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed it 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 ' Owner NOTICE TO APPLICANT: It, 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. • WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE .HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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 JILDING: TYPE CONST P. Number gal Description Project Description No. 14540 OCC. GRP.: Gas Line, new water heater Sq. Ft. No. No. Dw. Size -Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation .$950.00 PERMIT AMOUNT Plan Chk. Dep,,,. > _ Plan Chk. Bal. -w - Const. Mech. Electrical ' Plumbing 24.00 S.M.I. Grading Driveway Enc. Infrastructure TOTAL 24.00 REMARKS 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 Issued by:_ Validated It Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINU FEES IST FL. SO. FT. @ $ UNITS A.C. UNIT 2ND FL. SO. FT. SLAB GRADE YARD SPKLR SYSTEM POR. SO. FT. @ MOBILEHOME SVC. BAR SINK GAR. SO. FT. @ POWER OUTLET ROOF DRAINS CAR P. I SO. FT. DRAINAGE PIPING WALL SO. FT. @ ROCK STORAGE DRINKING FOUNTAIN SO. FT. a URINAL ESTIMATED CONSTRUCTION VALUATION $ HEATING (FINAL) WATER PIPING NOTE: Not to be used as property lax valuation GAS (FINAL) / FLOOR DRAIN MECHANICAL FEES TEMP. POLE WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY 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 SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 11/4 c SEWAGE DISPOSAL VENTILATION SO.FT.GAR @ 3/4c HOUSE SEWER FIRE ZONE ROOFING 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 GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH)1/ METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) / J 9� 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 / REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIONATURESIINITIALS GARDEN WALL FINAL Buena Engineers, Inc. AN EARTH SYSTEMS. INC. COMPANY 17314 WALTER STREET March 18, 1987 _ Starr Construction 655 N. Palm Canyon Palm Springs, CA 92262 VENTURA, CALIFORNIA 93003 RECEIVED APR (805) 642-6727 B -17052-P1 87-3-757 Project: 53-755 & 53-775 Avenida Alverado, 52-641 & 5.2-661 AVenid� Bermudas,_54-025 & 54-045 Avenida Carranza, 54-225 & 54-245 Avenida Herrera, 54-365 & 54-765 Avenida Ramirez La Guinta, CA Subject: Report of Field Densities House Pads Between January 12 through January 23, 1987, a representative of our firm performed density tests on the various residential building pads on the above referenced project. Tests were performed at random locations in accordance with ASTM D 2922-81 and ASTM D 3017-78 Nuclear Density Test Procedure. Tests were performed as per authorization of Starr Construction. The estimated locations of the tests are presented on the attached plan with their results being summarized on the attached test report sheet. A total of twenty-one (21) density tests were performed. Tests results indicate that a minimum of ninety percent (900) relative compaction has been obtained within the areas tested, with the exception of test No. 17. The maximum density -optimum moisture were determined in the laboratory in accordance with ASTM D 1557-78, Method A or C. Test. results are as follows: Soil Descriotion Tan f ine to medium sand Light brown fine to coarse sand with gravel Light brown fine to coarse sand with gravel and stones VENTURA (805) 642-6727 L) am Maximum Density -Optimum Moisture SM 110.4 pcf 12.60 SP/SM 123.3 pcf SP/SM 10.11070 128.7 pcf 11.0% LANCASTER (805) 948-7538 BAKERSFlELD SANTA BARBARA PALM SPRINGS SAN LUIS OBISPO (805)327-5150 (805)966-9912 (619)328-9131 (805)544-6187 4 19 March 18, 1987 -2- B-17052-P1 87-s-757 1. The house pads are located at various locations in the City of La Quinta, CA. 2. Prior to our arrival at the sites, they were brought to grade and compacted. :5. The contractor was informed by the City of La Quinta that the building pad at 54-225 Avenida Herrera was not required to have compaction test. 4. On January 27, 1987 this information was passed onto Buena Engineers, Inc. therefore we did not retest No.17 (54-225 Avenida Herrera). 5. The purpose of testing was to observe compliance with the minimum requirements of the City of La Quinta, CA. The test results summarized in this report present the moisture and ;ipnsitonly at. the l ;ra+.inn=, and depths tested on the specified dates. The. surrrrnavized field and laboratory tests were performed in accordance with engineering principles generally accepted at this time and location. No opinion is expressed as to the uniformity of the material, compaction, nor adequacy of the material to perform its intended function. No guarantee or warranty of the contractor's work is made or implied. If there are any questions, please do not hesitate to contact this office Respectfully submitted, BUENA ENGINEERS, INC. Brett L. Anderson BLA/JRV/th Copies: 2 - Starr Construction 2 - City of La Quinta 2- PS File 2 - VTA File Reviewed and Appr o J`t2. l% ; seph R. Venuti Civil Engineer BUENA ENGINEERS, INC. oQ Of ESS/pNgl _y G -• O No. C 041210 Exp. 3-31-11 =' s C1v11• �Q r9TF OF CAO��� RUEnuEngineers,im, REPORT OF RELATIVE COMPACTIONS Q Q Job No. B -17052-P 1 CONTRACTOR: DATE: March 18, 1987 Report No. 87-3-757 ADDRESS: - - JOB & LOCATION: I A Oidnta f A TEST NO. DATE TESTED DESCRIPTION % MOISTURE IN PLACE DRY DENSITY IN PLACE RELATIVE COMPACTION MAXIMUM DENSITY 52-641 & 52�6T61 A�en.i.da Be.rm"das� 1 1-12-87 Per Plan 1.0 BFG 16.8 105.9 96 110.4 2 1-12-87 Per Plan FG 12.5 102.0 92 110.4 3 1-12-87 Per Plan 0.5 BFG 7.0 103.3 95 110.4 4 1-12-87 Per Plan FG 17.3 107.9 98 110.4 53-755 & 53-775 Avenida Alverado 5 1-13-87 Per Plan 0.5 BFG 11.9 100.1 91 110.4 6 1-13-87 Per Plan 1.0 BFG 12.4 100.3 95 1 10.4 7 1-13-87 Per Plan 0.5 BFG 5.5 108.0 98 110.4 8 1-13-87 Per Plan 1.0 BFG 11.1 102.3 93 1 10.4 54-025 & 54-045 Avenida Carranza 9 1-14-87 Per Plan FG 17.6 100.8 91 1 10.4 10 1-14-87 Per- Plan 0.5 BFG 12.8 101.7 92 110.4 1 1 1-14-87 Per Plan FG 16.5 100.6 91 110.4 12 1-14-87 Per Plan 0.5 BFG 17.9 101.5 92 1 10.4 54-765 Avenida Ramirez 13 1-21-87 Per Plan 0.5 BFG 4.9 125.1 97 128.7 14 1-21-87 Per Plan FG 6.0 126.1 98 128.7 54-365 Avenida Ramirez 15 1-21-87 Per Plan FG 16.1 100.5 91 110.4 16 1-21-87 Per Plan 0.5 BFG 13.8 105.6 96 110.4 WE CERTIFY THAT THESE TESTS WERE PERFORMED IN CONFORMANCE WITH COPIES: BUENA ENGINEERS, INC. 1,4-Z5OCI 9 '0" 3113 L8 • °j l-£ '31ya '3NI 'SN33NION3 VN3nG sqn IH]bi-14o►cv�nb-1��? Sro�ya�o� 1s�1 - ❑ A m Z Q co jo � Ig9Z5 b m v 0 N a ` 4 4 " P.O. BOX 1504 APPLICATION ONLY Building / / L�C2LJp`aS78-105CALLEESTADO Address �� ^ �c0/ AoE'A1/Oq LA QUINTA, CALIFORNIA 92253 Owner Mailing Address City Zip - Tel. Starr ConstructioA Company, Address ', City Zip Tel.. Palm Springs, Ca. 1 92262 322-1020 State Lic. City & Classif. n — 1R7q 1d Lic. # Designer Address Tel. City( Zip I State 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. ' SIGNATURE DATE OWNER -BUILDER DECLARATION I 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 rile a signed statement that he is licensed pursuant to the provisions of 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 for the aleged 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 dollars ($500). ❑ 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 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 -builder will have the burden of proving that he did not build or Improve 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.) ❑ 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 If the permit is for one hundred dollars ($100) 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 NOTICE TO APPLICANT: If, alter 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 Ihereby 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 it 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 ateMailing Address City, State, Zip BUILDING DIVISION BUILDING: TYPE CONST. WD RARE OCC. GRP. A.P. Number 773-305-019 Legal Description T n1- A 13.1 nr•lr 1 an TTn; t 1 5 Project Description �Sinale Family Residence CSii'2 w (7' ig� �l �C/ fi Minimum Setback Distances: Sq. Ft. Size 1410 No. No. Dw. Stories 1 Units 1 New,'® Add ❑ Alter ❑ Repair ❑ Demolition ❑ Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: A 6 9 0 4 12 12 275,00 R Estimated Valuation —7 �9 PERMIT v v AMOUNT Plan Chk. Dep. CJ Plan Chk. Bal. y v Const. 3503, ©p Mech. z CPO Electrical . yr Plumbing 7 O S.M.I. eZ Z Grading Driveway Enc. , d O Infrastructureri V L/` r TOTAL REMARKS LQ 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 Issued by: Date Permit Validated by: Validation: A 6 9 0 4 12 12 275,00 R CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ UNITS SLAB GRADE 2ND FL. SQ. FT. BONDING YARD SPKLR SYSTEM STORAGE TANK MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® DUCT WORK ROCK STORAGE GAR. SQ, FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) OTHER APP.IEOUIP. DRAINAGE PIPING CAR P. SQ. FT. TEMP. POLE WALL SQ. FT. @ GROUT DRINKING FOUNTAIN SO. FT. ® FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM WATER PIPING NOTE: Not to be used as property tax valuation _$ FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED 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. SQ. FT. ® c BATH TUB GAR. FIREWALL SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL MESH SO.FT.GAR ® 3/ac HOUSE SEWER INSULATION/SOUND GAS PIPING PERMIT FEE FINISH GRADING 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 GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB 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 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS. GARDEN WALL FINAL Jx%fIE0 S O G _ = —0 H BERMUDA DUNES r RANCHO MIRAGE INDIAN WELLS H PALM DESERT a %P LA OUINTA ''gyp INDIO y� J Desert Sands Unified School District 82-879 HIGHWAY 111 • INDIO, CALIFORNIA 92201-5678 • (619) 347-8631 December 12, 1986 * City of La Quinta Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 Re: Lot 6, Block 140, Unit 15, La Quinta, CA - 1 unit Gentlemen: The developer of the above referenced project has mitigated its impacts on our overcrowded schools by payment of the amount of $628 per unit. This amount is to'be applied to the cost of additional district educational facilities made necessary by such new development. Sincerely, John D. Brooks Assistant S rintendent Business a es By: Richard M. Beck Facilities Planner JDB/vmm * This certification of payment of developer fees is valid for issuance of building permits only up to and including December 31, 1986. 0'F 0 OFFICE OF AGRICULTURAL COMMISSIONER 4080 LEMON STREET, ROOM 19 RIVERSIDE. CALIFORNIA 92501 (7 14) 787-2561 46-209 Oasis Street, Room 14 Indio, CA .92201 (619) 342-8291 ' Dear Developer/Landscaper: E. LEON SPAUGY COMMISSIONER JAMES O. WALLACE ASSISTANT COM.NiSSIONFR Thank you for inquiring with the Agricultural Commissioner's Office regarding local quarantine laws. Any diseases or insects associated with the plants/landscaping material presented on your landscaping plans do not pose a threat to the Coachella Valley Citrus, Date, Grape, Vegetable, or Field Crop industry. We therefore approve your landscaping plans, If however, any substitutions of plants/landscaping materials within your plans occurs between now and the actual planting date, you must contact this office within 48 hours before delivery into the Coachella Valley. Also, the substituted plants/landscaping material must be held for inspection upon arrival. Any sub- stituted landscaping material found infected/infested with quarantine pests will be immediately treated or shipped out of the Coachella Valley at the discretion of the Agricultural Commissioner's Office. Under penalty of perjury, I.the undersigned will comply with the above. Authorized Agent:., I atue �UCLL Date /Z—/� -7 6"G Signature Permit Number..(s)t s Developer za ; ,1,,��,1,s,, _ Address 6 S`.5 - �^ fool AGRICULTURAL COI iMISSIONER' S APPROVAL L✓ Date ) 2 Authority cited: Agricultural Code; Sections 6301, 6461A,",400-`;�+`;vf��5. , 6521- 6524 APPROVED cc: 2 Plan Check, Indio Office, Riverside Office BY:.._. DATE--17-65- Form ATE:/2- 5 -Form A - 10/84 HAL Ca 0- Z Z O H U w U) M Z O F_ U UL! U) C0 Y Cr Q W Ir AW Z O U W -t COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM �% %3 — 30s-- 0/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 $37 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 ehsr , Al.#1 � �a � p City State Zip Code Telephone Job Property Address Cit nit Legal Description of Property. (Lot, PM,y�iv t 'Assessor's Parcel No. 7 Water Agency eANbll ��E � �� �� � � Use of Perm' � '�"T��Ftning Case X SfD, MH Site Preparation Etc. Lot Size Me S' azure of Applicant Date 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. ❑ Yes Id'NJ/ -0- - WOCB Clearance required. ❑ Yes ❑`N Soils feasibility report required. ❑ Yes, Detailed boring report required. ❑ Yes N Detailed contour plot plans required. ❑ Yes No, Staff Specialist approval required. ❑ Yes IQ NO Lot Inspection Date Soils/boring report by Project # Date Soils Map Page Soil Type Approved byl�(,t// Dad L ' Ztftll Type of System: V No. of Bedrooms (1) Septic Tank Soil Rate Required ❑ Existing ew ❑ Additional ❑ Replacement 107V Gals. (2) achline sq. ft. (Botto nch area) Sidewall allowance ft. rock/ Sq. Ft. Install�Line(s) Ft. Long, Ft. with min. inches Leach bed Sq. Ft. of'bo om per running ft. (0 -NA rock below drain lines area Leach lines/bed-special design for slope: Applicable N//�verburden factor (3) Pit Diameter 6' No. Pits 1 Pit BI / �% Seepage Pit total depth "V 8 Max. allowable depth �(J IBCA G 1 This application is a p ed ed -for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements set forth in Section B a ove. A building permit is necessary for the installation of the above -designed system. (1 %S/titX.PiJ cy ,fy / eptic tank and sewer lines must AM' from any wells410 Leach lines must be 100' min. from any wells including expansion reaSeepage pits must be 150' min. from any wells including expansion area /0 6(3 Signature of Health Official -ti Date RECEIPT NO. W 00A V District: ❑ Riverside CSI dio ❑ Hemet Issued by 111V(A ❑ Perris ❑ Rancho Calif. ❑ Blythe Date f'� b? I �C Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File DOH -SAN -122 (Rev. 6/86) r, +�� � [ _ }.. � • .. - - ; r. . -.� ,,yam � • .. .�. `. "_ - -.Ky p� + +!r_'� p RECEIPT NO. l7� U Issued by V (t Date 1? �'7 �•`t• '' District: ❑ Riverside O'1ndio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg., Dept. GOLDENROD—Pending File 1 DOH -SAN -122 (Rev. 6/86) r a;; �tAl* I i ---COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION —-PERMIT �% — 30s — 0l APPLICATION FORA SUBSURFACE SEWAGE DISPOSAL SYSTEM k Applicant: Submit this form with four coVies of a scaled plot plan (1.20 scale) drawn to County specifications required on the attached check list. A non-refundable filing fee of $37 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.) 5-,O(;9,Qt2 rP.cl m Gr • Mailing Address 4�6"6` ,4/, �/7 .✓�cs.�/ .�.Z City Stale y Zip Coodde^f Telephone / Job Property Address �.rv�-n�.a1� y C unity_ Ltici' 'Legal Description of Property. (Lot, PM, TRY• !�'�"r� f.��� /f/� �"�`' /'� �,,�•""4 ."`�ru�� �1�� ,old -'Assessor's Parcel No. Water Agency`orWelP- r Use of Permit'_t ,,A �`"`Planning Case # Lot Size �E*dd Ks / �r� • _ 5 0 AAA t� SFD, MH Site Preparation Etc. Si atur��t Date 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. ❑ Yes 21No, A.t�2 WQCB Clearance required. ❑ Yes Q'No, 1 ❑ ©Nom Soils feasibility report required. Yes 1111 , Detailed boring report required. El Yes ❑ 11 No, Detailed contour plot plans required. ❑ Yes OO No � i Staff Specialist approval required. El Yes O No Lot Inspection Date Soils/boring report by l , Project # Date Soils Map Page I + 1 0/Soil Type t 'Approved byff ( 4J11 J Date Z r > I: Type of System: V No. of Bedrooms (1) Septic Tank Soil Rate Required ElExisting Q -New E3Additional ❑ Replacement i /� '/Gals. (2)% , ach line sq. ft..• Sidewall allowance Ft. Install .� Line(s)- Ft. Long, Ft: Leach bed Sq. Ft. (Sotto ench area) ft. rock/ Sq. 9,N%A wide with min. inches f,bottom per running ft. rock below drain line area Leach lines/bed-special design for slope: (3) Pit Diameter No. Pits Pit BI Seepage Pit total depth Applicable N��/A factor ` ®�r [(j f ( I Max. allowable depth �V ��!!n-Overburden n !/K�f !i .. Q fi>��, �✓?/ r %flys% is �-� .rt'+ / v i This application isaps' p_ coed/denied for the design ofa subsurface disposal system as indicated on the accompanied plot plan using the requirements set forthinSection B above. A building permit is necessary for the installation of the above -designed system. ,A (1)/Septic tank and sewer lines must e50' from any wells`004y (2) Leach lines must be 100' min. from any wells including expansion a67rrea [✓ (3)} Seepage pits must be 150' min. from any wells including expansion area f /,)"/`�Yl.? r/ U� Signature of Health Official of Health Otticial C�, Date / C>< ','CK lid RECEIPT NO. l7� U Issued by V (t Date 1? �'7 �•`t• '' District: ❑ Riverside O'1ndio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg., Dept. GOLDENROD—Pending File 1 DOH -SAN -122 (Rev. 6/86) r a;; �tAl* I i