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04718 (SFD)P.O. BOX 1504 Building 78.105 CALLE ESTADO AricirAca 46-280 Roadrunner LA OUINTA, CALIFORNIA 92,253 Owner Cherokee Homes Mailing Address 79--811 Country City Zip BrJtmuda Dwn IS 92201 Contractor Homers Address City lZip BUILDING: TYPE CONST. OCC. GRP. ,Ixb A.P. Number 617-112-010 Tel. 345-6225 Legal Description Project Description••• W &IaS's if. 476007 I Lic. # Arch., Engr., Designer Address Tel. CityI Zip I State I i 4 Lic. # = LICENSED CONTRACTOR'S DECLARATION I hereby affirm 'that1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division'3 of the -Business and Professions Codef'and my license is in full force and effect.' ,i` 7�f►- SIGNATURE ' 1 .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 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. 8 P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARx ATION I hereby affirm that I have a certificate of,consent,to self -insure, or a certificate of Worker's Compensation Insurance, or a certified'co_py theieof `(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 peon in any manner so as to become subject to the Workers' Compensation Laws of Cal ifornirsa. 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.) 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 1.0 4 T18 ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Sq. Ft. 15180 Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Side Setback from Property Line FINAL DATEINSyPECTrOR 101se Issued by: Date Permit Validated by: Validation: Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. *25 • 00 Plan Chk. Bal. �' • .�— Const. • 7 Mech. • Electrical Plumbing % •33 S.M.I. Grading 20 • ou N Driveway Enc. 20.00 Infrastructure I i UU7 a b7 Tlzuru L44 9 -44 mow'#/aJ�t+V:�i sl TOTAL REMARKS r 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 DATEINSyPECTrOR 101se Issued by: Date Permit Validated by: Validation: WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE CONSTRUCTION ESTIMATE NO.., ELECTRICAL FEES NO. PLUMBING FEES IST FL SO FT rp $ 2ND FL SO FT. /@ POR SO FT. at GAR SO. FT. 0 CAR P. SO FT. 4V WALL SO. FT. (d SO. FT. 43 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 WASHERIAUTONDISHI APPLIANCE DRYER UGHii 2 C— GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APP.IEOUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM I IKITCHEN 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 INSP. SO. FT. c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID g 1li. c SEWAGE DISPOSAL REMARKS: SO.FT.GAR 3/,c HOUSE SEWER VENTILATION GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.F:EE CONST. FEE ELECT. FEE SMI FEE PLUMB FEE STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR �-� �y GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA //ETBACK ($LAB GRADE — —�/ ROUGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK FORMS / MER OR SEPTIC TIS ROUGH WIRING DUCT WORK ROCK STORAGE ✓Jji FOUND. REINF.// �—XG l ( UGHii 2 C— METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL AL) JEMP. POLE`GROUT HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus X$ =$ LUMBER GR. INSP. �7FINAL MING—t—bFINAL INSP. O/��—Qj}j �FIRE au5� IA90 f �Ylf / �cALN L��uL ' REMARKS: VENTILATION ZONE ROOFING FIREPLACE SPARK ARRESTOR vFING G G I A 1-6922 LNG d— MESH ULATIONISOUND F SH GRADING INSPECTION l[ CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL Desert Sands Unified School District CERTIFICATION OF PAYMENT OF i �J hue% NOICE: TH1 SCHOOL FACILITY FEES ,S DOCUA i( CA TO: City of Le 0# t#JCA 'Ep 111401 DATE: Department of Community DUelopment 78-105 Calle Estado La Quinta, CA 92253 This is to certify that i a L.0 , developer of whish is located at -a within this District, has paid -school facility fees imposed pursuant to the autbLorit enerat d by Governmen Code Se tio5t 30 0 'n he oust b $ / ( 1/71 02 co/ve'ring a total of f square feet of ( ) residential or ( ) industrial/commercial development and that building permits for this footage in this development may now be issued by your jurisdiction. ou for DESERT ANDS UNIFIED SCHOOL DISTRICT White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - (Developer 0007 111 1��^aayyt-�-s•�,`�[1..��r�@�:'�.�•i�i��"'�.����"'`r��_�_�r. a,,._;- +.}�wxa�r...T.•3+v''�`�yr...+y� Q Z O H U W U) M Z O U W V) i` Z 0 W to D Z Q yywW__ COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No. ENVIRONMENTAL HEALTH SERVICES 12 % —%� 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 -trade 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, Contact Person Phone �2Z Address & Phone O�v Phone Mailing Address JCity M`t� G�✓�r- State Zip Job. roperty Address Legal Description Prop. (PM, Tract, Lot) �G/�� i/v ,D1/ Lot Size r �ate� AA enc g y/YVell f d's+n w. ltirr< d Use of P�er�m7 it /P, CSU/,etc. A L,r;Y A Other i ��,� ��, �D erring, MH Site Prep, etc. O Signature of ApplicAt Date CATEGORY: RMCODE FEE CATEGORY: REV CODE FEE q SUBSURFACE DISPOSAL 1238 $45.00. .� ❑ SITE EVALUATION UPON REQUEST 7349 $42.00 ❑ MULTIPLE PARCELS WITHIN SAME (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 SANI53) ` ❑ 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. Ft. 7347 $86.00 JJANITIAL DATE Holding Tank Agreements Completed ❑ Yes Y Nor Certification of Existing S.D. System Required ❑ Yes ��)ez rri t WQCB Clearance required. (Attach Form a ❑ Yes �M No t ! DOH SAN 007, Santa Ana Region Only) Soils Percolation Report Required. ❑ Yes !0" No, Special Feasibility Boring Report Required. ❑ Yes ed N, ` Detailed Contour Plot Pians Required (1 to 5 ft. interval) ❑ Yes No" F Other ❑ Yes No Staff Specialist Lot Inspection Required ❑ Yes 21 No Lot Inspection Eate Soils boring report by' Project # Date c Soils Map Page f % Soil Type 1114y) Approved by P�i2- Date" - o No. of Systems Type of System(s) No. Dwelling Unitsilj) (1) Septic Tank Soil Rate Grease/Sand ❑ Holding Tank ❑Existing []'New ❑Replacement Bedrooms, Fixture Units=:' �G Grease a lntcp G� /(�11 �a�' - Gai•� (2) Leach Line Sq. Ft Sidewall allowance - ` Install —/— Lini"6 7 ft long _Rftwide with each Bed sq. ft. Bottom trench area ft rock/sq. ft min. /1-11 inches rock below drainlines or of om area 0 0 r0 per running ft. IRNA Leachlines/bed design for special slope: (3) Pit Diameter No. Pits , Pit Below Seepage Pit btal Depth \I Other. Applicable Inlet (BI) N/AOverburden factor ❑ 5 �, M AiloWable Depth No. 2 System A11,J 4 REMARKS:h "!t✓tr (�. Q _r....,..Z , ,_ : L.l'� a, ,.t %rIGU vti. c�-s�G/ /`" .C.D � r%,sem r- i1 � v /�� (mss-� Gr :.•*-G� e� L%�%i?/�° �,,,1/�:v-•GPS f.�i / J'?/<�.a.�,.���%-/�[.�,.�.� �j��7 G��/y� ^{/J�.b�7f.u- " i Jr/�Ei (fzrFr �� � Gam^ � ./1,/��'C..S.��T//JGy✓r//! L:/wI/� �GpJ�� •7�/�t�6'1/�Arr 3. �SKB� /—'" •' /�- 1'�9'"•�J .iia - U ,'�' This aplflicatior�s APPROGE /RENIE� D oth�l� tegory cha`�ckn SECTION B, rega •d ng the designui s rf d si posatter� s indicated on the accomparne t0 plan, using the equirements set forth in SECTION C abo . A building permit is necessary for the installation of the above -designed system. No construction is permitted in the required reserved 100% expansion area. �) a2(1 Septic tank and sewer lines must be 50' minimum from any well -41 s f�1 Leach lines must be 100' minimum from any wells, including expansion akea _ (3) Seepage must be/.150'from including pits ,minimuum any wells, expansion/p area=late 'Signature of Health Official1l W. GynY"�/ %3 • =-c g2. [ , i - 7 RECEIPT NO. / ( Issued By l Date DISTRICT: ❑ Riverside, O" Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe „ DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office fife YELLOW -Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records 7-2 rw�1