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001742 (PLBG)Building Address Owner T4.hf " P.O. BOX 1504 78-105 CALLE ESTADO 52»731, JWesli$ EIREMILUI&LA QUINTA, CALIFORNIA 92253 No. • 001742 ' Mailing BUILDING: TYPE CONST.• OCC. GRP. Address fl_0. r1rX 49R A.P. Number 773=3n"2.4-3 Legal.Description rift 3.i. Project Description City La Quinta Zip 92253 Tel. % Contractor c " reni t x= ww'seeutic Frit. Address _ aboVe City Zip Tela " �r1w�+e State Lic. City & Classif. Lic. # Sq. Ft. No. No. Dw. Size- Stories Units Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State Lic. # - LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70)0) 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 file 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 penally of not more than five hundred dollars (5500). 0. I, as owner of the eproppot of 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- Estimated Valuation " - - PERMIT AMOUNT Plan.Chk. Dep. Plan Cllr(• Bal. Const. Mech. ' Electrical - - Plumbing 25.00 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.I. • 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 j Grading Driveway Enc. Date Owner t' ^�-' ` + " Infrastructure ISTk�tallr% "- S s Vii ur If WORKERS' COMPENSATION DECLARAT.N 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. . O Certified copy is hereby furnished. TOTAL 40.00 REMARKS CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ' (This section need not be completed if the permit is for one hundred dollars (S100) 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, after making this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must 'forthwith comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances: 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 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.f 7 Signature of applicant�l �-! f°ia{ Date r MailingAddress �� C�l/L" r" {t C_• Ixt} f ✓w City, State, Zip ` `✓ FINAL DATE. INSPECTOR Issued by: Date Permit Validated by: Validation: AZ80Z lU 7 4x00 Ck_ T f HARD COPY f CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ UNITS SLAB GRADE 2ND FL. SO. FT. ® BONDING YARD SPKLR SYSTEM POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS CAR P. I SQ. FT. GAS (ROUGH) DRAINAGE PIPING WALL SQ. FT. OTHER APP./EQUIP. DRINKING FOUNTAIN SQ. FT. @ TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. 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. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL GAR. FIREWALL SQ.FT.GAR ® 3/ac HOUSE SEWER LATHING GAS PIPING PERMIT FEE MESH PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE UPL.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 ROCKSTORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. 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 / L INSP. J �j 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 24 t. U Z 0 W N Receipt No. 4 75"17/ District: Riverside ❑ Indio El Hemet ❑ DISTRIBUTION: WHITE - Office File YELLOW - Applicant DOH SAN 122 (Rev 10/84) Issued By /6/L/�Z Date It, -'/" ff, PINK - Building Dept. GOLDENROD - Pending File °J/Y" i r� COUNTY OF RIVERSIDE, DEPARTMENT OF HEALTH ' PERMIT APPLICATION FOR A SUBSURFACE DISPOSAL SYSTEM Applicant: Submit this form with three copies of a scaled plot plan drawn to county specifications required on the attached check list. A non refundable filing fee of $15 is required when the application is submitted. Check must be made,payable to County of Riverside. y 71171 7, Name / �- Mailing Address rte. City State Zip Code Ph//one 'Property Address t1F Ptity orlOommuni.y, !� *Legal Description arcel Mapti, Taract) r kof Property (Lot, Parcel IC4 1 �' i/yZ �()1 1 ✓4( ( 11 14 # 1 'Assessors Parcel No. Water Serving Property From Lot size _ Signature of�A pplicant / _ _ Date 'The above information must be verified from Building Application Staff Use — Do Not Write Below This Line Initial Date WQCB Clearance required Yes ❑ No Soils feasibility report required Yes ❑ No © i ❑ [I Detailed boring report required Yes No Detailed contour plot required Yes ❑ No ❑ Comments: Soils or boring report by Date Approved by Date � ,y �� Ot Soils Map Page Soil Type Tract File No._ her Number of Bedrooms �jClST'•c� 8Q/2/h "�>n Septic Tank Size (gallons) 7�Q Rate Required, „/�D F Type of System New Addition Replace P �c� / Leach line sq. ft. of bottom area trench LeacF/bed (sq. fl-Iroybottom area bed) Gs. 1 Seepage Pit Diameter Number of`Pits Seepage Pit Depth B.I. Total Depth of Pit Location of System '�. /�� "y`y�'y[t Q,Js, y/` �7 /��/f�''7y/��/-1 /�� '�}`��''�/ `� /1 �,/j��1//J�, � 1 /j,, ,r) •'�•,s.//G'� Z��/"� [t.v,n/.���" !(�Grf�%C/.C.� F/ fic�'i',GJ •G'i'C�I , /�f:i�;,i�';(%�/� 6!!/�/ .CivM.l�i f.r���+C�, c.sci..� ".Qr'wt.!{�..� /7,11J - r Additional Requirements', '(//}��,(jnv"e"J Cf t" 4L.a • .i+'` ,�.r.- r.y�*- ,r.� f����r�+G GG"E'L�..t�r ✓ /O �• j�'r. G.J yL6. /+•.Ct o.- � -, fu -''C! tv t �% `' w:� . .k .G 4 X.�-. —. t:c e/til 1'^ �° 4./ . i! C _ . A permit is�provT ed/d.enred forthe design of a subsurface disposal system as�lndlcated 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. W. A�� " /e/ Signature of Health Official / Date Receipt No. 4 75"17/ District: Riverside ❑ Indio El Hemet ❑ DISTRIBUTION: WHITE - Office File YELLOW - Applicant DOH SAN 122 (Rev 10/84) Issued By /6/L/�Z Date It, -'/" ff, PINK - Building Dept. GOLDENROD - Pending File °J/Y" i `s ter• xmioIUt Cuum14 VtrAKTMtNI Ut rUlsui.� ncALln DIVISION OF ENVIRONMENTAL HEALTH Food Establishment 9 Disposal L Sewa a Di osal Trailer Park , rGxal. Septic Tank MotelApt., Hotel tqrf Leach Lin Seepage Pit (6L✓Dwelling E(/f,,c.9 Commercial Building - Connection to Sewer Swimming Pool No on-site regenerating water softening devices may be discharged into the individual sewage disposal system herewith approved without clearance from the Water Quality Control Board:.; ITWater supply se ry �''thh'' in Ilation must be from an approved source. All sewage dispo; PI i�RO if 15 must conform with requirements of current Uniform Plumbing Code. Any cutting, gradin), or filliri0 in excess bt four`(4)-feet will nullify sewage disposal approval. Approval has been obtained from the Regiori�l Water QLrality Control Board for installation of -the sew- age disposal system. This is to certify that the Riverside County Department of Public Health approves forte, constnsct6 or'installation the item(s) checked above. id oL. vim,`' • Q GAJ ` 4<� THIS APPROVAL GRATED BY THE n DEPARTMENT OF PUBLIC HEALTH 'Approval of these plana by the Department of Yuaua�oxa�� IS VALID FOR ONE (1)' YEAR Health of Riverside County does not relieve the 1&1&. ear or Architect of the responsibility for the Engineer• FROM DATE OF APPROVAL,- lne or Architectural desion," ` I ie r a.' .:. i�...: :;. ..i- r .. i ♦i•?i rr. nnu rte.. ..v .�:�A1%• '=S�'�.,'� .. .. ... � r -j6" KIVtt411ue CUUN 1 1 UtPAKI MM 1. UP rt.bL-t%: ncraa.I h DIVISION OF ENVIRONMENTAL HEALTH Food Establishment Sewage Disposal Trailer Park ZtZ Gal. Septic Tank Motel, Apt., Hotel p Sq. t 9f Leach Line n- ,, �, Dwelling E(/fr, vV��/1/t(,%1 r� x Seepage Pit �6>:✓��y�'l Commercial Building - Connection to Sewer Swimming Pool Ix No on-site regenerating water softening devices may be discharged into the individual sewage disposal system herewith approved without clearance from the Water Quality Control Board. Water supply sere' 2�,, �thh'�' in,�jallation must be from an approved source. All sewage disposal i "iffa � if �'li must conform with requirements of current Uniform Plumbing Code. Any cutting, gradin, or filling in excess"of four (4) feet will nullify sewage disposal approval. Approval has been obtained from the RegioiW Water Quality Control Board for installation of -the sew- age disposal system. T.'iis is to certify. that the Riverside County Department of Public Health approves for -eclopaway,-construction or installation the item(s) checked above. �•� ry� ,�-ryt.�,,, . /.moo - � �ti�� o/ THIS APPROVAL GNATED BY THE DEPARTMENT OF PUBLIC HEALTH 'Approval of these ptans by the Daparanent at l-uau. IS VALID FOR ONE (1) YEAR Health of Riverside County. does not relieve the Ebgin- FROM DATE OF APPROVAL...,. ear or Architect of the responsibility for the BnffW9er• tuff or Architectural desiffa." a