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06246, 9640 (SFD)I .• r .y Building Address 51~1145 Quito 4 P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 No. 9640 Sieve Farhadi BUILDING: TYPE CONST. OCC: GRP. Mailing Address 26002 Margret Pkwy #435 A.P. Number 769-134~007 City Zip Tel. MSM Viejo 92692 Legal Description Project Description SFD Contractor Owner/Builder Address City Zip Tel.: State Lic. City & Classif. Lic. # Sq. Ft. 2 Q No. No. Dw. Size Stories Units Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. Supplemental permit; replaces permit #06246 City Zip State Lic. # /'� •� Gene --al Contractor no longer involved UCENSEDCONTRACTOR'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. 7031.5,13usfness and Professions Code: Any city or county which requires a permit to construct, after, #Wrove, 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) o1 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 civilpenalty 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, Bufsness and 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 Bnprovements are not intended or offered for sale. If, however, the building orimprovement 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.)' q I, as owner of the property, am exclusively contracting with licensed contractors to coo -Plumbing st ct 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 contractors) licensed pursuant to the Contractor's License Law.) ❑ I am exempt under Sec B. & P.C. for this reason " Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. ' Plan Chk. Bal. Const. Mech. Electrical S.M.I: _ Grading Driveway Enc. Date y/- �> s)a a Owner �I�� t'• �'<f- .r yr Infrastructure WORKERS' COMPENSATION DECLARATION 1 hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company tpy is filed with the city. ❑ Certified copy is hereby furnished. I TOTAL —0— ij^^CERTIFICATE CERTIFICATEOF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE _ �- REMARKS (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- aliforniaDateowner Date-owner NOTICE TO APPLICANT. N, 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. ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line 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.) Side Street Setback from Center Line Side Setback fro Tl Property Line Lender's Name FINAL DATE INSPECTOR 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 certity 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. Issued by: Date Permit Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip 0 CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES • 1ST FL. SQ. FT. $ 2ND FL. SO. FT. ® POR. SQ. FT. ® GAR. SQ. FT. CAR P. Q. FT. WALL SQ. FT. ® SQ, FT. ® ESTIMATED CONSTRUCTION VALUATION $ . UNITS MOBILEHOME SVC. POWER OUTLET `� YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM. FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEQUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE 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. SQ. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11% c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER REMARKS: GAS PIPING PERMIT FEE PERMIT FEE:d . 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 APPJEQUIP. 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 ��d May 28, 1991 Steve Farhadi 26-002 Margret Parkway #415 Mission Viejo, CA 92692 RE: 51-145 Calle Quinto Dear Mr. Farhadi: .This letter serves as -notification that Mr. Dennis Rickenberg and, Mr.. Mike McWhirter have withdrawn.as contractors on the above referenced building address. Please provide this office with °a complete list of sub -contractors and contractors used and to.be used on this house for completion. We must have their state license number, city License number and a 'copy of their workman's compensation certificate in this office before we can continue -with inspections. Also, you,need to come into our office and pull a supplemental permit, at no charge, showing the change in contractor information. If you have any questions, please do not hesitate to contact me. Sincerely, BUILDING AND SAFETY DEPARTMENT Tom Hartung Director of Building and Safety Lonnie' Day Building Inspector I LD/lc cc: Dennis Rickenberg Mike McWhirter P.O. box 1504 76105 CALLE ESTADO LA OUINTA. CALIFORNIA 9225 , Contractor Owner ca -1,A, a Address Job ]address 11q&a LkX�� La Quinta City License No.: Expires: Bldg. Permit No.: This form shall be posted on the,.job with the Building Inspection Card and it. shall be the duty of the General Contractor or. if Owner -Builder Permit, the owner to see that all sub -contractors sign this card, giving his City of La Quinta Business License Number,, Contractors License Number and a current certificate of Workman's Compensation Insurance Certificate when he starts the job. Failure to comply. may cause Building Inspectors, to. stop work, or complaints to be filed, against such contractors or owners. ' CITY CONT.,. SUB -CONTRACTORS NAME LIC. NO. EXPIRES LIC. NO. EXPIRES 1• Grade s Excavate ' 2'• Pipelines 3• Cement -Foundations 2 4. Cement walks i Drives I �faldd o `zp Q .• 5. Asphalt Paving 6. Framing. 7• Steel Structural - 8. Masonry" - 9 • Plumbing Al `l0. Lathing �2i✓ .�ctLw,--, Lq� . ll. Drywall �wbtsz sav�.t,Q e r i nq ~ . ` * _ �<1.+�v�,�- _ s 4-,a- � . l 3 . HVAC , • ctrical 15.. Roofing 0 n t►2�c7� Y C% 16. Sheet.Metal ` 17• Floors -All Types 18. Glass - Glazing * 19. Insulation/weatherstrip- ` 20• Sewage Disposal- 1 21• Painting/Decorating 22. Tile 23• Cabinets -Installations 24- Ornamental Metal. 25.• Fences/Blockwalls 26• Landscaping = 27., Others t 28. DO NOT RFJCVE ,THIS CARD Before Final Building Inspection Will Be Made'; This Form. Must Be Completed and Filed With Title 24,Calcs and Plans T ZZ7 4, —AC=' .9 Az .4 & 'iso r & AT hitt fe ill irN ion This Certificate issued .,pursuant Jo,'th Oxequireme'-n'ts--of Section 306 of the Uniform. Bulking { i 4, Code certifying that at ffie-! tiM6-i6f. issi'bance this structure was in compliance with the various ordinances of the 'construction or use. For the followirioa'. 4 Calle-Qtinto i 1 51 8U1LD1NG''ADDRttS'-_,',%- 5 '7 FD Bldg. Perenit No. Use Classification 9640 5 MA Group R3 Use Zone a Zone V Owner of Building !_L�6002 Margret # 4 15 dd4s I Mission S S i6ri vi�l. c �N-q; R! i 2 City ByLonnie Day . 9/25/91 k" -Date. 700" Building Official -in cb�$"cuo T "ice ack Building , 51-145 Quito Address Owner Mailing Address City Zip Tel. La Quinti, 92253 Contractor �# i Peakillso 42.t405a1Wa9hLnnon= 8>o—z P.O. BOX 1504 No. 06246 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 City-VatlwDeSert Z WO 4x*7 State Lic. City & Classif.Lic. #�. Arch., Engr., Designer Address Tel. CityI 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 constrict, after, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to Tile a signed statement that he is licensed pursuant to the provisions of the Contractors 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 app8rant to a c&H penally of not more than five hundred dollars (5500). P%_ 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. It, however, the building or brproyement is sold within one year of completion, the owner-bugder wig have the burden of proving that he did not buBd or improve for the purpose or sale.) 'O 1, 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 Thereby 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. e 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 BUILDING: TYPE CONST. OCC: GRP. A.P. Number W 769-134--007 Legal Description Project Description'��� Sq. Ft. f. 7�'7 No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ 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 Estimated Valuation $188.537 Issued by: PERMIT Validated by: AMOUNT Plan Chk. Dep. $250.00 Plan Chk. Bal. 513.11 Const. $81.00 Mech. 98.50 Electrical 188.33 Plumbing 246.00 S.M.I. 11,83 Grading 20.00 Driveway Enc. 20.00 Infrastructure 3,663.69 TOTAL $5,€392.26 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 9/1/89 Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL SQ. FT. ® $ 2ND FL SQ. FT. POR. SO. FT. ® GAR. SQ. FT. ® CAR P. SQ. FT. WALL SQ. FT. ® SQ FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE Not to be used as property tax valuation ROUGH PLUMB. BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEQUIP. I LAUNDRY TRAY AIR HANDLING UNIT CFM GAS (FINAL) TEMP. POLE 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 FINAL INSP. [/ SO. FT. ® c WATER HEATER MAX HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ic HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PLCK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING S AIR COND. SOLAR &141 -4 r SETBACK GROUND PLUMBING Q UNDERGROUND A.C. UNIT COLL. AREA SLAB GRAD ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK/'i ROUGH WIRING �6 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 cu. yd. $ plus x$ _$ LUMBER GR FINAL INSP. [/ FRAMING Q /� FINAL INSP. a �/ l ROOFING 4L( 8 �O (� 10-57L � :i�% Pei REMARKS: VENTILATION�< FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL JLA HING 1 — � � /—P MESH INSULATIONISOUND 121Z W MU FINISH GRADING FINAL INSPECnO l CERT. OCC_ FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS ' GARDEN WALL FINAL I Desert Sands Unified School District CERTIFICATION OF PAYMENT OF SCHOOL FAC,, L -}I TY FEES TO: C i ty� .q*al c a���®, DATE: ® 0-TIJ pe�parr -4,r f�,kAmulnity Development �i`� 78-10X5Calle Estado La Quinta, CA 92253 . Etta! a CON This is to certify ha /W � / ! , developer of which is located at within this District, has paid school facility ees imposed pu^fsuant to the aut ority generat by Gov r ment Code Se ti n 3080 in the amo"rt- 7 S Q covering a total of squar f t f ( )Ires_dential or ( ) industrial/commercial evelopment and that buil i pernits for this footage in this development may now be issued by your jurisdiction. 100 for DESERT SAND •UNIFIED SCHOOL DISTRICT White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer (10)-37 RECORDING REOUESTSU By WON UND InU COMPANY ANO WNEN AfCOAOE� MAIL THIS NEED AND UNLESS OTHERWISE SHOWN `BELOW. MAIL TAIL STAfEMEN TO: Name . Manouchehr Farhadimoayyed Street AndreaS. Farhadi Address P.O. B o X 604 City& La Qui nta, CA . 92253 State MAIL TAX STATEMENT Name I Street. same as above Aadreea . City ✓! State %_A t I r-% I N I Li C C U THE UNDERSIGNED GRANTORS) DECLARE(S) DOCUMENTARY TRANSFER TAX is $ 41 .25 t )a computed on full value of property conveyed, or ❑ Computed on full value less value of liens or encumbrances remaining at time of Sale. ❑ .unincorporated area ❑ city of AND FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, ,DONALD C. PARKER AND JULIE PARKER, husband and wife as joint tenants hereby GRANT($) to MAN0UrH17HR FAR'HADIMAYYFO AN1) A c. F?! ?;!,A!lT , i�i;Sha;nri i' i wi fa as joint 'Lerriants the following described real proOerty in the County of R i v e r s i d e State of California: Lot 112; of Unit #5, of Desert Club Tract, as per Map recorded in Book 21, Pages 61 through 62 of Maps, records of Riverside: County, California, • - j' LniriV STATE OF CALIFORNIA COUNTY OF _._zos-— .. .__. SS. ---•-- On this 104 day Of_ `� �--• in theyear before me, the undersigned, a Notary Public in and for said Mate, personally appearod personally known to me'. (or. proved to me on the basis of satistaetory evidence) to be the persons whose name..____LOA��_ subscribed to the within instrument. and acknowledged to me that..__ he–.... executed it. WITNESS my hand and official seal, Signature/rJ/1�d•yt'� NOTARY PU80C IN AND FOR SAID STATE OFFICIAL SEAT. RHODORA E PRANK j NOTARY PUBLIC - CALIFORNIA LOS ANGELES COUNTY V My comm. exEires A'JG 28, 1992 (This area (or ollizial no(efial Beall ►� V 6 w iig %_A t I r-% I N I Li C C U THE UNDERSIGNED GRANTORS) DECLARE(S) DOCUMENTARY TRANSFER TAX is $ 41 .25 t )a computed on full value of property conveyed, or ❑ Computed on full value less value of liens or encumbrances remaining at time of Sale. ❑ .unincorporated area ❑ city of AND FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, ,DONALD C. PARKER AND JULIE PARKER, husband and wife as joint tenants hereby GRANT($) to MAN0UrH17HR FAR'HADIMAYYFO AN1) A c. F?! ?;!,A!lT , i�i;Sha;nri i' i wi fa as joint 'Lerriants the following described real proOerty in the County of R i v e r s i d e State of California: Lot 112; of Unit #5, of Desert Club Tract, as per Map recorded in Book 21, Pages 61 through 62 of Maps, records of Riverside: County, California, • - j' LniriV STATE OF CALIFORNIA COUNTY OF _._zos-— .. .__. SS. ---•-- On this 104 day Of_ `� �--• in theyear before me, the undersigned, a Notary Public in and for said Mate, personally appearod personally known to me'. (or. proved to me on the basis of satistaetory evidence) to be the persons whose name..____LOA��_ subscribed to the within instrument. and acknowledged to me that..__ he–.... executed it. WITNESS my hand and official seal, Signature/rJ/1�d•yt'� NOTARY PU80C IN AND FOR SAID STATE OFFICIAL SEAT. RHODORA E PRANK j NOTARY PUBLIC - CALIFORNIA LOS ANGELES COUNTY V My comm. exEires A'JG 28, 1992 (This area (or ollizial no(efial Beall ,a • - 1�'j ,Fa u* 4 MINZER �........ ......... ......._._........ . May 16,1991 City of La Quinta A 78105 Calle Estado La Quanta, CA 92253 City of La Quinta, This letter is to notify you that Micheal B. MCWhirter'i.s no longer working with or for Stevens Enterprises. Any representation by him to Stevens Enterprises•.w.ili be under r falseY of retenses, We want to make sure the Cit La p Qv.l'nta is aware of this fact. If any judgements are made against Mike McWbi.rter it will-be his sole responsibility no:, th.a,t of Stevens Enterprises. This is effective immedietly. •If• -' there are any questions please notify me at 714-472-LOTS,`' I will ap-pr.eciare. your full cooperation on this matter. a .,•• ��' i Farhadi stvc M.. DEVELOP ENTS.FQR'THE FUTUREr ­'NOW� � z (619).'564=0217, - 73-091 COUNT! Y,CLUB' DRI'VE, SUITE�A5•47 PALMDESERT, CALIEQRNIA 92260-' r 'il��.J i'i•`r�'4.rdy�1�`r��.`= V' r� u.L, �, �i T" �.. iy�J•.j 'sy1-{�'ti' ,� w 'Y ,�, �,ii�2�����1i-","/i,'' �. �.'.. -�}' "� Al I� snj S i .Va p RECEIPT NO. / to Issued By 514- Date -7- -Z 7 ^ er V / r;. DISTRICT: d Riverside, GSf of dio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe DOH,SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD-'�lans/Records 1 COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No. f,�m ENVIRONMENTAL HEALTH SERVICES tvr t VQ I 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 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. Q VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY; APPLICATION BUILDING DEPARTMENT APPLICATION LOG # Z .7 Agent, Contractor Co tact Person Phone Address & Phone JJ Owner � Phone Mailing Address City " � Sate 5- Zip J P Property Address Legal Description Prop. (PM, Tract, Lot) �G L -A1 1u , t.c Q !!V -Tv Lot Size r Agency IA_ Use of Permit P/P CU etc. Age 7 ��G .Other ]��+�E� - Cl 6 /k&r tate Dwelling, Site Prep, eta?� Signature of Applicant Date CATEGORY: e� REV CODE FEE J9'I CATEGORY: REV CODE FEE 19 SUBSURFACE DISPOSAL 1238 $45'0 ❑ SITE EVALUATION UPON REQUEST 7349 $42.00 m ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) Z LAND DIVISION ❑ `SEWER/SEPTIC VERIFICATION 7348 $11.00 ` 0 a. 1 st 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) ❑ 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. Ftt ' I 7347 $86.00 k " INITIAL DATE Holding Tank Agreements Completed ❑ Yes No l '7 - -Certification-of Certification -ofExisting S.D. System Required ❑ Yes O�>s,N�o-9" A �/ WQCB Clearance required. (Attach Form ❑ Yes 1 14o DOH SAN 007, Santa Ana Region Only) Soils Percolation Report Required. ❑Yes 01,90 ,r E Special Feasibility Boring Report Required. ❑ Yes N,;. Detailed Contour Plot Plans Required (1 to 5 ft. interval) '` ❑ Yes ❑ NNoI ! Other CI Yes lloe_" 1 Staff Specialist Lot Inspection Required IM Yes 04No r rT7 Lot Inspection Dat? Soils boring report by Gate /Project '# Soils Map Page r / Soil Type i Approved �if�[s�z--- 2' - r by Date7 ,F U No. of Systems Type oSystem(s) No. Dwelling Units (f/ (1) Septic Tank Soil Rate 'o rereal�e/$and' Z 0 ❑Holding Tank ❑Existing 0111 ew ❑ Replacement Bedrooms, FrxtrmeUpits [LA IC q� " �1 04 Greese Ititcp T `d ✓� Gal f. P s� '��f � ^e •fi Gal LLI Leach Line Sq. Ft. Bottom trench area Sidewall allowance Instal Line(s) ft long _ fff widb with ` ��• each Bed sq- ft/ w,r ft rock/sq. ft. per running ft. ©SNA min. iricch s sock below drainlines or oPbotto area Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Belows Seepage Pit Tota: Depth Otwfte Applicable I p d- 6 J Inlet:(6b)- I Max. Allowable Depth ;? L.+LLA N/A s,F'" Overburden factor � a ' No. 2 System REMARKS: � (Cifs4�w/t t/}� t^-r,/ICF -ar /Z,& -,.son s�,.t..,in/,,�aj..r .,,.. �� . .z�..� t�aY esr ..Jf ' .X /...1✓st.�'�.�,Q•!."1 ..1.,. //' .,iY�P...�i;�/tfa..�..� �V This application is PPRONIEp„for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on? the accompanied plot plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the Z" above -designed system. No construction is permitted in the required reserved 100% expansion area. (t) Septic tank and sewer lines must be 50' minimum from any wells /0 (2j Leach lines must be 100' minimum from any wells, including expansion rea�rf7g_2�� IUB 3) Seepage pits must be 150' minimum from any wells, including expansioc> area i _ Si nature of Health Official /_/,r�!/. % /> /t'�i�v�ir (�� �C.a.�f�.c-4 / iWJ Date �%- X 5 ..f� I� snj S i .Va p RECEIPT NO. / to Issued By 514- Date -7- -Z 7 ^ er V / r;. DISTRICT: d Riverside, GSf of dio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe DOH,SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD-'�lans/Records 1 OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No. .COUNTY ENVIRONMENTAL HEALTH SERVICES PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM Apipkant:- Submit this form with four copies of a scaled plot plan (1 -20 scale) drawn to County speculations as indicated on the attached checklist. J 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 Agent Contractor, C4*tact PersonPhone Address 8 Phone U) Owner, I . !�> FA\Zt0,,D I 1 1. Phone Mailing Address --- cl :�UC4_5_ - I 12B��l C' s 1, - S ate Zip/ Property Address Label Description Prop. (PM, Tract 7- Lot) "lAlit--L Q0NTv4 Lot Size > , a er Agency g�ncy ��r UseofPermRP/P,CU,etc. C-6 ca 9 Other -2 tc T�� r x-,- X tv Sit rep, eto7 Signature of Applicant Date CATEGORY: - REV CODE FEE -SUBSURFACE CATEGORY: REV CODE FEE MI DISPOSAL 1238 5 0o 0 SITE EVALUATION UPON REQUEST 7349 $42.00 co 0 MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) Z - LAND DIVISION 0 'SEWER/SEPTIC VERIFICATION 7348 $11.00 0 a 1 st 4 Parcels (Each) 1238 $45.00 (Less than 1 year) F-' L) b. Each Parcel after 4 7344 $16.00 0 PRELIMINARY ELECTIVE 7352 $45.00 W 0 Rgreview (2nd review same parcel) 7344 $16.00 EVALUATION (Attach DOH SAN 53) - 0 Site Evaluation in Conjunction with 0 HOLDING TANK "7351 $45.00 Critical Area 7346 $86.00 0 ALTERNATIVE/EXPERIMENTAL 7345 $132.00 0 Site Evaluatio n-, Lot Less than SYSTEM 10,000 Sq. Ff.. 7347 $86.00 IJ4,ITIAL DATE 1- Holdilig Tank Agreements Completed 0 Yes WN /L Certification of Existing S.D. System Required 0 Yes WQCB Clearance required. (Attach Form 0 Yes No DOH SAN 007, Santa Ana Region Only) Soils Percolation Report Required. 0 Yes Special Feasibility Boring Report Required. 0 Yes Detaik Contobr Plot Plans Required (1 to 5 ft. interval) 0 Yes 'N Otherl :01 Yes N Staff Specialist Lot Inspection Required .7 0 Yes R/No Lot Inspection Date Soils boring report by Project Date Soils !Ma7 Pa Page S Soil T p goype Approved by A�a, - .- -7-- i --- Date Z No. of. Systems Type C#System(s) 13 Hpldllng Tank 0 Existing No. Dwelling Units (1) Bedrooms (1) Septic Tank Soil Rate -rease p 0 EAew 0 Repladement :•0 G I 0 LU U) I Leach Line Ft Sidewall allowance Instak Line(s) ft. long wide with Leach Bed sq ft. trench 1gtrench area. ftrock/- sq• ft. per running H. min. inc; w drainlines or Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below- Seepage Pit Total Depth ON, Applicable " 60-56 1/6 1 Max. Allowable Depth ..S N/A Overburden factor' No. 2 S,ystem. IV14 REMARKS: 44 This application is category "agor the categochecked in SECTION B above, regarding the design of a subsurface disposal system as Indicated Z0 ' on the accompanied pop a. using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the above4designed system. No construction is permitted in the required reserved 100% expansion area. C/ OSeptic tank and sewer lines must be 50' minimum from any wells 0 All— Leach lines must be 100' minimum from any wells, including n n expansion rea Seepage pits must be 150' minimum from any wells, Including expansirare. I r J, I f, i ­y Avi, gzc nature of Health Official. I0 Dat 7- _�2 7- PTI;NO.- RECEI Issued By Date 2 DISTRICT: 0 Riverside, Indio 0 Hemet 0 Perris 0 Rancho Calif. 0 Blythe DOH SAN 1122 (Rev. 5/88). DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records 11r*__4_, Agricultural Ceruuis I let's ULE ice cc, 1(rdio and Riverside UEfice IN s ul AGI(ICUL I URAL COMMISSIONER E. LEON SPAUGY MMESO Y;ALLA(:F ,rte; 1� ) ny U �rssra�r rnrrassn�.ta WEIGI IIS b MEASURES CLENIENI DENVEMSIE scAttn • } �- 49-613 Ilay 06, 8ulte II-12 -Cvrrchelln, CA 92216. 619-342-0291 CASE I IJ. (�0.✓ ✓ C �i �: 1 1 i� s DEVELOPER'S IME r ADDRESSr _ �. 3 a.� la LK-- • R'aK c AV- TELL• N U461 ( I J CaY Qw�-� A A-;#% /a :Co QV4.'- Dear Developer: Alter reviewing your landscapi.nq plops, 111 plant material Valley. listed is not IE substitutio(Is violation of yvaralltine 10-45gcwetniny the Cvacllella do occur and they differ Ercall plant material listed, tills office drn�st be notified il(uediately. '1'limik you for prutectbly and pteserviny tine Coachella Valley's pest-Eree� envirolnnent. Agricultural Ceruuis I let's ULE ice cc, 1(rdio and Riverside UEfice IN