003426 (SFD)Building
Address 54-245 Juarez
Owner
4
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address I A1 v tpa,1106e1*1 4 wr t47>+•>?
City
Zip -7
BY:
Palm Springs
9226.2
IT91.
322-342€
Contractor
Starr Con6truction
Address
S=e
City lZip
Side Setback from Property Line
Tel.'
State Lic. I City
& Classif. . 387934 Lic. # _895
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
7000).of Division 3 of the Business and Professions Code, and my license is in full force and
effect. + a ski _ ,:,, _ li' .:r'P� _f_r}f .rw!-. �.•(i' i
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 o/ the Contractor's License Law, Chapter 9 .(commencing twith 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
Prolessions Code: The Contractor's License Law does not apply to an ownerofproperty 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
o/ proving that he did not build or improve lor,the purpose o/ sale.) -
❑ l,.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.)
❑ Lam exempt under Sec. B. & P.C. for this reason
No. 00426
BUILDING: TYPE CONST. • .'OCC,. GRP
A.P. Number 9IA-1 Q'}—>Fi 7
Legal Description `
Project Description Plan a Sinale Family i wo.
Sq. Ft. 3 463 No. No. Dw.
Size -. Stories • Units
New ❑ Add ❑ Alter ❑
A75` Garage
3541 Fence
itimated Valuation .
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech. .
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Date Owner Infrastructure
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 i/ the permit is for one hundred dollars ($700) valuation
or less.) - --
I certify that in the performance of thg 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
Ihereby 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
HARD COPY
TOTAL
. Repair ❑ Demolition ❑
$75,565
t�
AMOUNT -
$25Q.a4
$ 59.89
361 � B0
X33.00
7
i5.til
09.00
5.63
24.00
20.40
�.���.�•4rJ
REMARKS 11,y
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 1016%87Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. Sp, FT, ®
CARP. SQ. FT.
WALL SO. FT. ®
Sp 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.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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.
SQ. FT. ® c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
HOUSE SEWER
ROOFING f7/ 8c^
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING r�
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
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
GROUND PLUMBIN
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SE I
TAROUGH
WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. �� Gy1 D
GAS (ROUGH)
LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
`METER
/ TEMP. POLE///� •��
r—SERVICE /
GROUT
WATER HEATER
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING FINAL INSP.
ROOFING f7/ 8c^
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING r�
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
y
/
REMARKS:
IUR'b swnAIUntbliNniALs.
GARDEN WALL FINAL
P.O. BOX 1504 APPLICATION ONLY
Building-�- 7&105 CALLE ESTADO
Address y-2ys �1/ {�,' QED LA QUINTA, CALIFORNIA 92253
Owner
/i'Q ./ 42
C, Zip Tel.
Contractor
Address I
1247
State Lic. - City
& Classif. A _ 3f7 93� Lic. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisib4s of Chapter (commencing with Section
7000) of Dlvlslonlp of the Business apppd Professions Code, rf 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 construct, alter, Improve, 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) 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 or 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 propertywhobuilds 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
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 thg 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 Callfornia.
Date Owner
NOTICE TO APPLICANT: If, alter 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
ateMailing Address
City, State, Zip
BUILDING DIVISION
WING: TYPE CONST. OCC. GRP.
A.P. Number "774- 66- b2y
Legal Description L
Project Description FLA A) ;F�
Sq. Ft.
Size �/�p
No. No. Dw.
Stories ( Units
NewA_ Add ❑
Alter ❑ Repair ❑ 'Demolition ❑
7 � G4
-1z-
/L50
5 -0` %45AtcAF
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Z S o. o c�
Plan Chk. Bal.
S9. 8
Const.
Mech.
r7 O
Electrical
R.-7
Plumbing
00
S.M.I.
Z
Grading
0 A o u
Driveway Enc.
2 O 00
Infrastructure
TOTAL
o t1
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
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP./EOUIP.
DRINKING FOUNTAIN
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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
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 APP./EOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRAD?NG
-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 SIGNATURES/INITIALS
GARDEN WALL FINAL
0
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W
Z
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RECEIPT NO. 6 —9 Issued by. 51 Date lo
District: ❑ Riverside L l Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe o
Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File
DOH -SAN -122 (Rev. 6/86)
11
COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION
PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM Y,
t
Applicant: Submit this form with four copies of a scaled plot plan (1-20 scale) drawn to County specifications required on the attached check list.
A non-refundable filing fee of•;$37i's required when the application is submitted. Check must be made payable to the County of Riverside.
Aye
Building Department Application Log #
Name (Owner, Agent, Contractor, Etc.)
- LLF �r�
Mailing Address
2 X. V s c�Ju 2
City
l.�IM j' l4L,
State
Zip Code
Te ephone
32V
Job Property Address /
5"�Si1�C`Z
City ommuraity
7 t i.�l ia�
Legal Description of Property. (Lot, PM, TR) <12.
Lf.�T/2 �Ld -2.S'
'Assessor's Parcel No.
titer Agency Well°
� -n �)� �"'
Use of Permi,blAgX2A) . �C4-fr,'
�Pianning Case N
Lot Size
.�7�/
7 ��� D 2 s
SFD, MH Site Preparation Etc.
Signatule-&Applicant
//' 'The above information must be verified from Building Application
STAFF USE — DO NOT WRITE BELOW THIS LINE
Initial Date
Certification of Existing S.D. System required. ❑ Yes
WQCB Clearance required. ❑ Yes LJo a
Soils feasibility report required. ❑ Yes N
Detailed boring report required. ❑ Yes �LI�N0
Detailed contour plot plans required. ❑ Yes ❑ No'
T
Staff Specialist approval required. E] Yes 2No Lot Inspection Date
Soils/boring report by / Project # Date
Soils Map Page ► �M ( Soil Type C-11- Approved by /r (A -1J/ L Date—&--
Type of System:
❑ Existing OlNew ❑ Additional ❑ Replacement
No. of Bedrooms
(1) Septic Tank
Soil Rate Required
Gals.��
(2) Leach line sq. ft.
trench
Sidewall allowance
ft.
InstallLines) Ft. Long,Leach
bed Sq.
�F oftbottom
(Bottom area)
rock/ Sq. Ft.
ft. 9�N/A
Ft'dwide with min. inches
per running
rock below drain lines
area
Leach lines/bed-special design for slope:
(3) Pit Diameter
No. Pits
Pit total depth_ � ljApplicable
�
urden factor
��N/A
I 7,Seepage
x. allowable depth V t
n / o
This application J, app d ;denied for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements
set forth in Section B above. A building permit is necessary for the installation of the above -designed system.
(1) Septic tank and sewer lines must b X50' from any wells;IIO'e, tC/r �jW k,.- MA.
.,�
(2 Leach lines must be 100' min. from any wells including exptanslon area 7 e�' s, <
(3). Seepage pits must be 1:50' min. from any wel�ls including expansion area .�.•,��.,�6vi-•t,.+.o,
sT� /J
Signature of Health Official -" Date
RECEIPT NO. 6 —9 Issued by. 51 Date lo
District: ❑ Riverside L l Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe o
Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File
DOH -SAN -122 (Rev. 6/86)
11