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05585 (SFD)Building 52-525 JUAPXZ Address c&ty/ 4 P.O. BOX 1504 No, 05585 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Coachella 'Valley Lancs Address 247 E. Tahquitz Way 42 , City Zip Tel. Palm �prisesl 32252 419/32271020 Contractor I Starr construction Address Satre Zip State Lic. City i£ Classif., 387334 Lic. # 995,,- Arch., 95,Arch., Engr., Designer 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 effect. Division:3 of the Business and Professions Code, and my license is in full force and effect. - -c. • r .0 f:� c arm^. !ez �s _SIGNATURE I I DATE OWNER -BUILDER DECLARATION I hereby affiryn that I am exempt from the Contractors License Law for the following reason:. (Sec. 7031.5,liisbess and Professions Code: Any city or county which requires a permit to construct, after, improve, demolish• or repair any structure, prior to its issuance also requires the aAPHcanl for such pemiif to Me a signed statement that hes 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 Wofition of Section 7031.5 by -'any applicant for a permit subjects the applicant to a chd penalty of rot more than rive 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 Contractors 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' suchrrprovements are not intended or offered for sale. d, however, the building or improvement is sold wdhiu one year of completion, the owner -budder will have the burden of proving that he did not buil or li prove for the purpose or safe.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project (Sec. 7044, less 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 conhactor(s) licensed pursuant to the Contractor's License Law.) ❑ lam 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 sett lnwre,. r a certificate of worker's Compensation Insurance, ora certified copy thereof Sec,/53800' ,Labor Code.) Policy No. Company �✓} ._ +B ❑"Copy is filed with the city. ❑ Certified copy is hereby fumished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the pemrit 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 anyppeerson in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT. Ll, after maliig 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 oris pertml 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 Lenders Address 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 1 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 774-244-013 Legal Description Lot 4 Blk 167 Unit 17 Project Description SFID Sq. Ft. 1409 No. 1 No. Dw. Size Stories Units New ?s 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 Issued by: 3/33/39 Date Permit Validated by: Validation: 430 square feet garage 170 feet 6 -foot wood. fence Estimated Valuation $76,36.0.00 PERMIT AMOUNT Plan Chk. Dep. • a Plan Chk. Bala • Const. . >J Mech. 33.50 Electrical 10b.41 Plumbing "i •.5 S.M.I. 5.39 Grading Q Driveway Enc. 'Fi. 0 Infrastructure s _ TOTAL REMARKS r r �',''�•"'^efYY�i'i° A`�Yl`-:i:ia'..r.�`'-'." 't.:1Y, .ic;" 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 DATE INSPECTOR Issued by: 3/33/39 Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ UNITS SLAB GRADE GH PLUMB? FSREWERORSE&4 BONDING YARD SPKLR SYSTEM 2ND FL SQ. FT. FORMS Kr. ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) METER LOOP GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CARP. SQ. FT. ® GROUT WATER HEATER WALL SQ. FT. FINAL INSP. DRINKING FOUNTAIN SO FT ® WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation p FRAMING 3 l FLOOR DRAIN MECHANICAL FEES %/)/` f� WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTOXDISH) APPLIANCE DRYER 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, TEM/PERM 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. SO. FT. RESID ® 1% c SEWAGE DISPOSAL INSULATION/SOUND FINISH GRADING SQ.FT.GAR ® 3/ic 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 UND PLUMBIN(��� UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE GH PLUMB? FSREWERORSE&4 BONDING HEATING (ROUGH) STORAGE TANK FORMS Kr. 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. p FRAMING 3 l FINAL INSP. ROOFING—' V %/)/` f� / '^`v GQ� �l J (( �,nJ'1 / P Q c_ REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING -7�b� MESH INSULATION/SOUND FINISH GRADING F NAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITUILS GARDEN WALL FINAL . ��' x ��"I�O�` K''�r�'k�°�<'^'�"'�''tX�.:� �^^�sj�.� + '� � - .'� v� +•+ ti�;.gL�p�s�w� o t REfEIPT NO. Issued By 5k Date s ( _ DISTRICT: ❑ Riverside, Indio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg, Dept GOLDENROD - Plans/Records IN W COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Asenwrs Parcel No. r ENVIRONMENTAL HEALTH SERVICES i APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM jPERMIT Applicant: Submit this form with four copies of a scaled plot plan (1-20 scale) drawn to County speculations as indicated on the attached check list 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 d+ SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'* 2 0 Agent, Contractor, Contact Person Phone Address & Phone U i2 s a 32 -i so + LU Owner Phone. Mailing Address 0 City State Zip Job Property Addresg2C4, �, -&t Legal Description Prop. (PM, Tract, Lot) ?A 1, A9 6 P 4dr4/b 7 i Lot Size Water Agent WI* Use of Permit P/P, CU, etc. XV,, a -L�;- 4 Other Site Prep, elling julH etc. ) L Signhture of Applicant Ddie CATEGORY: REV CODE FEE / $45. � CATEGORY: REV CODE FEE 0,SUBSURFACE DISPOSAL 1238 ❑ SITE EVALUATION UPON REQUEST 7349 $42.00 ❑ MULTIPLE PARCELS WITHIN SAME (NO; PLOT PLAN) m Z LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348 $11.00 0 a. 1 st 4 Parcels (Each) 1238 $45.00 (Less than 1 year) U 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 $13200 ❑ Site Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $86.00 r 1 c INITIAL DATE Holding Tank Agreements Completed ❑Yes ❑SNo / /� r Certification of Existing S.D. System Required ❑ Yes 1344 0 WOCB Clearance required. (Attach Form ❑ Yes ©-' o DOH SAN 007, Santa Ana Region Only) 4 Sills Percolation Report Required. ❑ Yes ,J s- Special Feasibility Boring Report Required. ❑ Yes O"' _ Detailed- Contour, Plot,Plans Required (1.to 5 ft interval). ❑_Yesq N. ._ _. Other O Yes Staff Specialist Lot Inspection Required ❑ Yes ❑ No Lot Inspection Date Sills boring report by Project # Date Soils Map Page % Ei9 / Soil Type ( Approved by - — Date' U Z No. of Systems Typo Systems) ❑` Holding Tank ❑ Existing Na Dwelling Units Bedrooms, FAntw"a fs (1) Septic Tank Soil Rate Gresse/Send �`'Gr6ase o � � ❑ Replacement Intcp . U W (�2)1_sach Line Sq. Ft. Bott french area Sidewall allowance Install._`� Lines) It long t► wide with Leach Bed sq. tt It rock/sq. R per running it min. ricf below drainiines or -,a bottom area m --NA Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Seepage Pit Total Depth Applicable "I N/A ' lf!fo Overburden factor / � � Inlet (BI) /()(f Max. Alloyvabo Depth No. 2 System r; REMARKS:)'Yu^--,Z,-1' 1 •{u c .� '' >ti..- , �07f J fL-,•:s-r rti G(,�.�G. fi`t, •4 This application i PPRO 151I159 -for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated 0 on the accompanied plot plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the c -Q above -designed system. No construction is permitted in the required reserved 100% expansion area. f� Septic tank �- 0 w (1 and sewer lines must be 50' minimum from any wells�iQ , ff Leach lines must be 100' minimum from any wells, including expans'io area r ��, . `- •,...�c.�.�t ;cam, ,D3. Seepage. pits must be 150' minimum from any wells, including expansion a/ Signature of Health Official`C.�T w• ILF3pat REfEIPT NO. Issued By 5k Date s ( _ DISTRICT: ❑ Riverside, Indio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg, Dept GOLDENROD - Plans/Records IN W