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15573 (CONR)1 44 P.O. BOX 1504 No. 15573 Building 56� 13� PGA ��Vd�. 78-495 CALLE TAMPICO Address LA QUINTA, CALIFORNIA 92253 Owner KSL. Recreation Corp. Mailing BUILDING: TYPE CONST. OCC. GRP. Address 56d-140 PGS Blvd, A.P. Number City Zip Tel. La. Quinta,. CA 92253 Legal Description ContractorProject Description Nal fav house on the Stadium Rancho CP3s'tga>zcaCorp. elf Course Address 79-687 Country Club Dr. City pA 92201 Tel. �e�lYt: 345--7755 �lt3a Dunes, State Lic.Cit & Classif. S 597975 Lic. 1969 Arch., Engr., Designer Conrad Santiago Address Trel 554-7430 Cit Zi State Lay iinta, CA p 92253 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 OWNEWBUILDER 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 rite 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 havethe 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) #caned 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 A 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: d, 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 property 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. ateMailing. Address City, State, Zip Sq. Ft. 361 No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ L :stimated Valuation $2611209.00 I PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 250 . 16 Const. 265.00 Mech. 42.50 Electrical 60.72 Plumbing ' 139.50 S.M.I. .5 e.50 Grading 20.00 Driveway Enc. 00 Infrastructure 589.7W Arts in PubLic Places 131.05 TOTAL 1.504.1.3 :. REMARKS ZONE:' BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop..Line', Side Street Setback from CentevLine, ' Side Setback from Propeity-L ne FINAL DATE INSPECTOR %'• \ �� �ti v e Issued Validat Validat w CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINU FEES IST FL. SO. FT. ® $ 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. ® DUCT WORK ROCK STORAGE GAR. SO. FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) DRAINAGE PIPING CAR P. SO. FT. GAS (FINAL) TEMP. POLE WALL SO. FT. DRINKING FOUNTAIN. SO. FT. ® WATER' HEATER URINAL ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation WATER SYSTEM FLOOR DRAIN MECHANICAL FEES GRADING Cu. yd. $ plus x$OV& WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER WNAL INSP'- GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED ILAUNDRYTRAY 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 ® 1+/e c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER. 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 OUNO PLUMBING ', UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS ER O SEPTI A ROUGH WIRING DUCT WORK ROCK STORAGE OUND. REINF. 5 GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPIEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER' HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING Cu. yd. $ plus x$OV& c$ LUMBER GR. INAL INSP. C� �� FRAMING 1 WNAL INSP'- tr�- OOFING JGr4; REMARKS: VENTILATION/(/_ FIRE ZONE ROOFING ' FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH NSULATIONISOUND 95 FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIONATURESIINITIALS GARDEN WALL FINAL �. ..r a sins 1VAJEd 1' yr Mill V 11(V1,I1VMN I_Al; � i k;A ;111. FOOD FACILITY INSPECTION REPORT Based on an inspection this-day,.the items. identified below -are violations in structural or operational requirements which must be corrected by the inspection next routine or such shorter period of time as may be specified in writing. Failure to comply with any: time limits for corrections specified in this notice may result in cessation of our fopd facility operation. The Department of Health appreciates your cooperation.' Public health protection is everyone s responsibility. E TABLISHMENT NAME / PHONED AT TIME IN LOCATION DISTRICT 17 RLI 3 PEC/TION SATE OWNER ACTIVITY & SERVICE CODE OR EMEN ; OF F,1 R - D Y TIME OUT MAILING ADDRESS PERMIT R�LE N0. NEXP: T DESCRIPTION OF ITEM VALUE REMARKS Lose 1. FOOD: Approved source 4. No spoilage/contamination 4; Not reused Properly stored 2; Properly protected 4; _ f<, R' Use of sulfites I- Properly.labeted 1; Si>�:':' e' 2. TEMPERATURE- CONTROL: Poten— tially hazardous food below 45' For above 1400 F 2; Refer thermometer P� Probe thermometer 2; Food properlyel 3 - thawed 4; Frozen food maintained "<;Y•z�:ga: frozen or not refrozen 3. PERSONNEL; Foodhandler cards 4; Personal hygiene S; Clean clothes 2; Food handling 2; Hair restraint 2; No smoking' 3; Clothing storage 1. 4. WATER & SEWAGE: Hot and cold potable water under pressure j; Liquid waste disposal 3; Plumbing In good „> ;tj<; / /� /�% repair 3; No cross connections 2.:�.rks';< /0,�� ^J✓ -'�. S. EQUIPMENT: Maintained In clean ""'''' condition 16; Maintained In good repair 10; PTOPeril P t protected 4; Approved 3. 6. UTENSILS: Proper washing N Proper .. sanitizing 7; Clean 3; No damage 2; Properly stored X, Testing material provided j. 7. FLOORS: Clean 2; Good repair 2. WALLS & CEILING/WINDOWS & SCREENS: Clean 2; 'repair Good Light color 1.`' a. TOILET/DRESSING ROOM & HAND c„ SINKS: Good repair 3; Clean 3; Salt -closing doors 1'; Hand cleanser 4; Towels ,4 Proper dispensers 2; Toilet ..'.4 tissue 2; Hand wash signs 1�Properly vented Adequate j, ''f >... ::..9. .: LIGHTVENTILATIO : Adequate 3; Exhaust filters 2; Functioning 2; Fixtures protected 1. 10. PEST CONTROL: No Insects No rodents g; No animals of birds g; Outer openings protected 2; Self-closing outside doors 1. 11. REFUSE: Properly stored ,1; Containers covered 1; Adequate & Clean;; Surrounding: clean 1. 12. OPERATION: Toxics labeled and k^a{rry} separated4 ; Living& slee In sleeping quarters separated 1; Signs posted 1; Cleaniog n equipment storage 1; Proper linen `' storage 1; Spoils area maintained 2. POINTS POSSIBLE 200- POINTS LOST -:.2 = TOTAL SCORE This facility is required by local. Ordinance to display a grade card in a conspicuous place. selected by the Enforcement Officer. The gr not be concealed and can only be removed by the Epnforcement Officer. GRADES REPRESENT THE FOLLOWING SCORE RANGES: A = 100-90, B =.89-80 and C = 79-0. RIVERSIDE HEMET PERRIS BANNING PALM SPRINGS' INDIO BLYTHE 358-5172 766-2478 657-07'38 849-8794 778-2235. 34.2-8287 922-8158 ooH-sAN°zap:1EvtFA Orig.— Office 1st CopyOwner 2nd Copy —Office Page _of 3 i .� __ - . _ ,_ , ...... ... _ ... „... _ �.,�z .-3;. r�- :•vtw� r ..r.+c,..ar^ �:• .y _ w,. ;._w. ,r.r - �-nn n • ASSESSOR'S PARCEL NUMBER COUNTY OF: RIVERSIDE HEALTH SERVICES AGENCY DEPARTMENT OF, ENVIRONMENTAL HEALTH 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 specifications as indicated on the attached check list. A non-refundable filing fee is required when the application is submitted. Check must be made payable to the County of Riverside. Approval of this applica- tion shall remain valid for a period not to exceed one year from date of payment. LOG # 6 rY ©F 14 QU A/ r/a Agent, 'Contractor, Contact Person Address City State Zip Telephones /9 J Owner Address /� City State Zip _6-00'0 &/1 31 d0, AQw„/,74 (14. 9ad33 Telephone ( / 9,J S6.11-/Uff Z Job Property Address S6 ='•p0� PCA A v 4 , City n 14 0o,v i Zip U Lot Size &Vater Agency .ei Use of Permit, P/P, SUP, PUP, etc. Legal Description %��i��FC % P�/1�Ft /LIAR �Q fa � U� O,oLU tslE<Cn vIA1 ,'L,/ruoo FI TA L Sfl An/ WA 7-4, 917-,21 �Dwellinov,H"tsAe�ep�etc.I(f7,8.A.:IvC� GJEf7 SiAOia,++l�U✓/ir�f%lclWA/TitluSEy Signature of }lppli ant / / Date 491 CHECK BOX IF.REO tRE • +ki ❑ Holding Tank Agreements'Completed ❑ Detailed Contour Plot Plans Required (1 to 5 foot interval) ❑ Certification of Existing S.D. System Required t ❑ Grading Handout Provided m ❑�WQCB Clearance Required ❑ Staff Specialist Lot Inspection Required Z 0 (Attach For DOH -SAN -007, Santa Ana Region Only ❑ Lot Inspection U❑ Soils Percolation Report Required W❑ Date Lot Inspection Completed: Initials U ❑ Special Feasibility Boring Report Required (� ('4(x'4 �c.p,9 "Ot41i/O!La J Remarks: ❑ Maintenance Booklet Provided 4 Initials Date /J� ❑ Final Inspection by Department of Environmental Health is required. G1,42_11 Soils Percolation Boring Report by FILA SY STEat f (nnl.ra r 7-AA1i J =- Project# .7 J J!' "0/ Date � ' c2 Soils Map Page Soil Type Approved By / `✓�d�! cc ��z Date No of Systems Type of Systems) ; EMP0Q4/Ty YI79w' No. rDw.elling Units iT (1) Septic Tank Soil Rate Grease/Sand ' Cl folding Tank ❑ Replacement 131-N- ew 0 Addition B'edrooms, Fixture Units SEdT.dG: iva✓r �u /S-00GaL / �.�9 �k/ Grease Intcp/Wnt Trap A/on/F_ /FCvui/c�j O Existing 6' �� !!T T.-i,r T. Gal. r, „✓ rw.n � nx1 y. ' , Sq. Ft. Bo om Area Total Linear Ft.e Sidewall Allowance rock/ '�sq. ft. running ft. _ Install �"'Une(s) —ft. long ft. wide with Leach Bed sq. ft. of Botto Area Inlet Tested Depth ^^” 0INA min. inches rock 'eb lo. drainlinas or U Proposed Bottom Tested Depth .. W_ Z Leach lines/bed special design for slope: (3) Pit Diameter No. Pits ` 'Pit Below Inlet (BI) Seepage Pit Maximum Other: Or Applicable � I ? Total Depth Allowable Depth 0-0IS712/B✓7io W N/A 41"' Overburden Factor 'A'S= 6' U T# �Q . ' TD -62 _3' _ U Well Review Approved: Date: Well Drilling Permit If _d SIGNATURE .. -Grading Plan Approved: Date: SIGNATURE Sewer Verification Approve d: Date: / REMARKS: �►XJ�. it ` d U�/L�r[ �a �LG(�i/ y� Ile .CL.I:•LG`% nt^ /L�s �if1'�•./ � � f?.C''� � ��Gr � •. �� . This application is PPROVED ' ENIED�orltbeaeategoryxchecked.4%SECTLON,-Q_, v FOR OFFICE USE ONLY - - .- -above' regarding the eslgn of a subsurface disposal system as Indicated on the acompanied plot plan, using the requirements set forth In SECTION C above. A build- ing is for the installation the No Revenue �- 00 permit necessary of above -designed system. construc- tion is permitted in the required reserved 100% expansion area. code a7.3d 7'a �} Fee $ 1.2(16.1.2(16. -r�T Lei* * ' ' $ 8 1) Septic Tank must be 100' minimum from any wells.c(/(3/j• /tom 7_•gag. / Check # If 5a/n1 (2) Leach lines must be 100' minimum from any wells, including expansion area. Date I Co-) 1 Q .J Initial jjee_ (3) Sewer lines must be 50' minimum from any wells. Z _O 4) Seepage pits must be 150' minimum from any wells, Including expansion area. W U Signature of Health Official Date DOH -SAN 122 (Rev 9/93) UISirjouvon: YYril I t—UTTICe elle; T tLLUW—Appllcam; t-IIVR—mpg. uepi.; UULULNHUL—Flans/HecordS in