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04705 (SFD)4 0470 1 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,Susiness 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 penalty of not more than five hundred dollars ($500). 0 I, as owner of the properly, 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 for this reason Date /! 7� { Y Owner r 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 O 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 thip 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: ff, 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. 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 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 P.O. BOX 1504 Building r��,, (�3r 1i8ar't17Gdas78-105 PERMIT CALLE ESTADO Address $250.00 -LA QUINTA, CALIFORNIA 92253 Owner Const. 3tA.UU Willint J. COX Electrical 7A. 43 Plumbing BUILDING: TYPE CONST. OCC. GRP. Mailing 10. 36 Grading Address p, 0. Box 967 Driveway Enc. _ .. - A.P. Number e773--335-016 City Zip Tel. palzimener 92261 Legal Description _ Contractor Project Description••ae _ Sold TOTALt�.31 Address City Zip Tel. 10 CASH # TOTAL 1 .1.171. 3" 1 - State Lic. & Classif. 163957 City Lic. # t .. , .... .., ���� Sq. Ft.. No. 4i, 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 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,Susiness 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 penalty of not more than five hundred dollars ($500). 0 I, as owner of the properly, 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 for this reason Date /! 7� { Y Owner r 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 O 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 thip 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: ff, 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. 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 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 1 WHITE - FINANCE, PINK - APPLICANT, tG.REEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE }..... ..r.. t ... _. ... ��.... .... .... .. .-, .. ..,.,+.-. .tea., tl:...ie.,a �'� . as:> tr.... .+, .-;"?.i..-+43•:_ ',?Ss�tt. ....- ...:. :timated Valuation��v2� PERMIT AMOUNT Plan Chk. Dep. $250.00 Plan Chk. Bal. 64.1 Const. 3tA.UU Mech.�•� Electrical 7A. 43 Plumbing 105.W S.M.I. 10. 36 Grading 2.0-.() U Driveway Enc. 20.UO Infrastructure r+� TOTALt�.31 REMARKS 10 CASH # TOTAL 1 .1.171. 3" 1 - 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: 1 WHITE - FINANCE, PINK - APPLICANT, tG.REEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE }..... ..r.. t ... _. ... ��.... .... .... .. .-, .. ..,.,+.-. .tea., tl:...ie.,a �'� . as:> tr.... .+, .-;"?.i..-+43•:_ ',?Ss�tt. ....- ...:. CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES tST FL SO FT rp S UNITS COLL. AREA SLAB GRADE ROUGH PLUMB YARD SPKLR SYSTEM 2ND FL SO FT. @ HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR SO FT. Or DUCT WORK ROCK STORAGE GARSO. FT. * POWER OUTLET ROOF DRAINS HEATING (FINAL) DRAINAGE PIPING CAR P. SO FT. 6 GAS (FINAL) TEMP. POLE WALL SO. FT. !� DRINKING FOUNTAIN . SO. FT. Id WATER HEATER URINAL ESTIMATED CONSTRUCTION VALUATION S FINAL INSP. WATER PIPING NOTE' Not to be used as property tax valuation - FLOOR DRAIN MECHANICAL FEES GRADING Cu. yd. $-Plus-X$- WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTOWISHI APPLIANCE DRYER / �% -//� WSOOFING � / 1 GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED 'V - ��, LAUNDRYTRAY AIR HANDLING UNIT CFM VENTILATION 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. a c BATH TUB SO. FT. c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID g t'A c SEWAGE DISPOSAL SO.FT.GAR rg 3/ic HOUSE SEWER MESH GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE70-� ELECT. FEE SMI FEE PLUMB FEE STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK FORMS R OR SEPTIC T > ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. AGAS (ROUGH) L _G/ 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.3 Z FRAMING FINAL INSP. � y / �% -//� WSOOFING � / 1 YV 1, J A (- - U 25 'V - ��, REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING �- bcl MESH INSULATIONISOUND FINISH GRADING. FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESlINITIALS GARDEN WALL FINAL 4 P.O. BOX 1504 APPLICATION ONLY Building5`2 rz 7&105 CALLE ESTADO Address i 2 — kO !,C(21 --TAS LA QUINTA, CALIFORNIA 92253 Owner C / BUILDING: TYPE CONST. OCCIGRP. Mailing _ // Address /�v� A.P. Number �� — 33 0/b City Zip Tel. Z-0 T 3 G/. (�� Legal Description Con a for_ Project Description S IC I Cwt Zi Tel 4&, J),�r p ��2 _/ 3 State Lic. City & Classif. /iL z /� [r/7 / _/�, Lic. # 'Arch., Engr., I Designer Address Tel. City IZip I State I 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 effecI. _SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that 1 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 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 or 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 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.) O 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.) O 1 am exempt under Sec. B. 6 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 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: 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. 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.) Lenders Name Lenders 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 BUILDING DIVISION 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: Sq. Ft. /�� Size ,,. Stories Stories No. Unitss New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. S (� , p a Plan Chk. Bal. Const. Mech. Clp Electrical -4 ' Plumbing S.M.I. !�® Grading Driveway Enc. Infrastructure TOTAL D REMARKS 005182.0 22'5.4._14-1i-88___ _ _1s IV urt rt Y IUIf9t_ 1 crJ.Vv 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: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES A.C. UNIT COLL. AREA SLAB GRADE 1ST FL. SO. FT. ® $ UNITS HEATING (ROUGH) 2ND FL. SO. FT. ® FORMS YARD SPKLR SYSTEM I ROUGH WIRING DUCT WORK a FOUND. REINF. MOBILEHOMESVC. BAR SINK POR. SO. FT. ® OTHER APPJEOUIP. REINF. STEEL GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. SO. FT. GROUT DRAINAGE PIPING WALL SO. FT. FINAL INSP. DRINKING FOUNTAIN SO FT ® WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED VENTILATION LAUNDRY TRAY AIR HANDLING UNIT CFM FIRE ZONE ROOFING 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 LATHING SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/a c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER FINISH GRADING 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 GOND. 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 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 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS, GARDEN WALL FINAL 71 T .^ .mak 'F-�'.'-'4-` • � y�tr�,if •7:..y:r r. ••Y� N � COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No. ENVIRONMENTAL HEALTH SERVICES 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. t 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' # �) A ant, Contractor, Contact Pe on Phone Addr ss & Phone A A0�as _ Owner _ Phone Mailing Address City State Zip Job Property Address Legal Description Prop. (PM, Tract, Lot)A�AM Z4 Qf f;Nr,-r �1.9- / / Zkl,"udAf iV4 v T 1 Lot Size l Water Agency e I , (,u"p Zip,Z Use of Permit P/P, CU, etc. :���� Other I ellen H SitrS„Prep, etc. Sign re of Ap iceW Date CATEGORY:REV CODE FEE SUBSURFACE DISPOSAL 1238`$45.00 CATEGORY: REV CODE FEE ❑ SITE EVALUATION UPON REQUEST 7349 $42.00 ❑ MULTIPLE PARCELS WITHIN SAME -Ev (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 thane SYSTEM 10,000 Sq. Ft. 7347 $86.00 DATE Holding Tank Agreements Completed ❑ Yes "0 Igo Certification of Existing S.D. System Required ❑ Yes 004o- ► `w WQCB Clearance required. (Attach Form ❑ Yes Q o DOH SAN 007, Santa Ana Region Only) Soils Percolation Report Required. ❑ Yes _ ,N�o Special Feasibility Boring Report Required. ❑ Yes �N� Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes Other ❑ YesFNo� Staff Specialist Lot Inspection Required ❑ Yes Lot Inspection Date t Soils boring report by//II P ject # Date Q Soils Map Page Soil Type ����rr Approved by Dates "7�a No. of Systems Type&f System(s) ❑�olding Tank ❑ Existing No. Dwelling Units Bedrooms, Fi#WGe_<aFlite> (1) Septic Tank Soil Rate * Grease/Sand Grease Intcp J ew ❑Replacement ?; t/1,_ 41 ?4U, jM � � W 2) Leach Line Sq. Ft om trench area Be Sidewall allowance install —Is fL long ft wide with Leach Bed sq. ft. ft rock/sq. ft per running ft. min. irk k below drainlines or of arE ea j` Leachlines/bed design for Pit Diameter No. Pits Pit special slope: (3) Below (BIl Seepage Pit /Tgta4Depth / Other. ApplicableInlet N/A a" Overburden factor EtliI LT' 6 / r Max. Allowable Depth (% ty r No. 2 System l" REMARKS /fes ny,,� ��d Gu261 n This application i PPROVED (1id39.for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompame -- - an, 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 reserved100% expansion area. (1 Septic tank and sewer lines must be 50' minimum from any -Wells �� Leach lines must be 100' minimum from any wells, including expanse are Seepage pits must be 150' minimum from ny wells, including expar cion area 'Signature of Health Official Dae c' ` RECEIPT NO. % / (/Issued By Date /a - r% DISTRICT: ❑ Riverside, Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe r DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records -ted' i